LEW 48 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year I960 E. H. R. Smithard, MBE, MD, DPH London: e. g. Berryman & Sons, Ltd., Blackheath Road, s.e.10 METROPOLITAN BOROUGH OF LEWISHAM Report OF THE Medical Officer of Health for the Year 1960 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 33 Housing 39 Inspection and Supervision of Food 44 Infectious Diseases 51 Appendix A — Statutory Instruments 61 „ B — Legal Proceedings 63 „ C — Special Reports to Health Committee 64 "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 31/12/60 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Public Health Inspector Deputy Senior Public Health Inspector A. J. Phillips (a) (b) J. R. Craven (a) (b) Group Public Health Inspectors A. G. Thomas (a) (b) (Food) R. C. Brittain (a) (b) (Housing) Assistant Group Housing Inspector *R. Mahoney (a) (b) (District) J. W. Bevan (a) (b) (c) 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) (b) *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) A. J. Thrussell (a) *K. R. Wagener (a) (b) *T. E. R. Ware (a) (b) (a) Public Health Inspector's certificate. (ft) Meat and Other Foods certificate. (c) Smoke Inspector's certificate. *With responsibility for certain food work. Women Health Officers Mrs. A. Carins, srn, rfn Mrs. L. Champness, srn, rfn Mrs. M. M. Coulson, srn, qn Principal Clerk E. W. Cheesman Clerical Staff Student public health inspectors S. Burridge, (senior clerk) A. Lakeland C. R. Coleman J. T. Smith Mrs. D. J. Handford G. Matthews Miss D. Cashman Miss M. E. Hinchcliff Mrs. M. G. James Mrs. H. I. Barnes 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 Mayer, Aldermen and Councillors of the Metropolitan Borough of Lewisham Mr. Mayor, Ladies and Gentlemen, I submit my report for the health department for the year 1960. Vital statistics The Registrar General's estimate of the population in midyear 1960, on which the rates in this report are based, was 221,300, an increase of 300 on the previous year's estimate. The preliminary report of the census of 1961 is already to hand and this shows that the population at the census was 221,590—a very close agreement with the Registrar General's estimate. The crude birth rate for 1960 at 16.2 again shows an increase (it was 15.7 in the previous year). The adjusted birth rate brings this down slightly to 15.4. The crude death rate at 11.3 is slightly lower than the 11.8 of the previous year, while the adjusted death rate (allowing for age and sex distribution of the population) is the same. The infant mortality rate at 18.9 is fractionally higher than the 18.4 of 1959 but could still be regarded as satisfactory. 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). These rates were respectively 10.9, 2.2 and 5.8. The stillbirth rate at 17.3 was slightly lower. Although the total male births remains higher than that of the females (by 53) the greater liability of males to succumb in the first year of life is very apparent. For the infant mortality rate as a whole the male rate was 25 as against 12, for the neonatal rate it was 18 as against 9 and for the early neonatal rate it was 15 as against 6. The various comparative figures of general statistics since the beginning of the century are shown in table 11. Infectious disease other than tuberculosis The total number of notifications received (including 134 for tuberculosis) was 1452 which is considerably less than half the number for the previous year which in itself was just about double that of 1958. This again reflects the two year periodicity of measles, cases of which came down from 2,631 to 262. Dysentery cases increased from 233 to 367 and these were mainly from school outbreaks. They were of a mild type. Food poisoning cases were, at 31, a little below the average, although it is likely that many such cases are not reported. There were only 33 notifications of pneumonia, which is the lowest figure for many years past, indicating perhaps the mild weather and the absence of an influenza outbreak. There were only two cases of poliomyelitis and it seems reasonably certain that vaccination has been a considerable factor here. It is essential that all children and young adults should for their own wellbeing and for the peace of mind of their relatives be protected against poliomyelitis. The three or perhaps four injections tend to put some people off, but injection procedure is still regarded as the correct one. A vaccine which can be taken by mouth is available but on the advice of the Ministry this would only be used in an emergency when there is a relatively severe and localised outbreak. Consideration is being given to the best method by which a large number of the population, perhaps up to a hundred thousand, can be given the oral vaccination in emergency within a matter of days. 4 Tuberculosis The number of new notifications again decreased, though this year slightly compared with the major drop of the previous year. The total was 134 giving a notification rate of 61 per 100,000 population, a low record. The death rate from pulmonary tuberculosis remained at the same low figure of 5 per 100,000 population, compared with 7 for the County of London as a whole. Clean air Considerable progress was made in the establishment of smoke control areas whether through survey or by the making of Orders or in the administrative and technical work necessary for the payment of grant. More details are given in section B of the report, together with a reference to the proposed telescoping of the smoke control programme. It is now hoped that it may be possible to make the last Order affecting the borough in 1965 instead of in 1968 as previously programmed. Old people Three additional clubs applied for grant aid and altogether 17 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 number of old people on the club registers of the grant-aided clubs was much the same as during the previous year and although new clubs get started and build up a reasonably good membership other clubs tend to lose their membership and even upon occasion a club ceases to exist. This is disappointing and even a little surprising in a residential area such as this where the estimated number of old people goes up substantially year by year. The lack of men members is an obvious feature of some of the clubs. That there should be less men members is understandable since there are many less men of retirement age than there are women, but the low proportion of male members is altogether beyond this and it seems that some new approach is necessary to get men interested in club life at (or preferably in a mild way even before) retirement. The special King Edward Hospital Fund committee mentioned in my last report continued during the year, but it will not be until the end of 1961 that the detailed survey of a considerable portion of the borough will be available. Home Safety The Public Health committee have regular reports on home safety matters, and the quarterly home safety bulletin which is got out by the department continues to be issued. The ability of London boroughs to do some home safety work has now been increased (in 1961) by the Home Safety Act 1961 so that all parts of the country have been given the specific power to contribute to voluntary organisations doing home safety work in their areas. s Staff Mr. E. Walker resigned as Senior Public Health Inspector on November 7 after 40 years' service in local government, all of which were spent in this borough. He received the warm thanks of the Council for the good work he had done, and the best wishes of the Council and his colleagues for a long and happy retirement. The following subsequent changes occurred in the staff: Mr. Phillips, the deputy senior inspector, was appointed senior public health inspector; Mr. Craven, the group housing inspector, was appointed deputy senior public health inspector; and Mr. Brittain, the assistant group housing inspector, was appointed group housing inspector. The establishment of public health inspectors was reduced by one to a total of twenty by the omission of a specialist smoke inspector; Mr. Bevan, who had previously filled this position, being appointed as assistant group housing inspector. The year also gave us the first returns from the pupil public health inspectors' scheme which was established a few years ago. Three pupils qualified as public health inspectors; one of them was retained to fill the only vacancy on the establishment while the other two immediately found appointments in neighbouring boroughs. There is still however a little difficulty in recruitment due to the desirability of candidates having passed the necessary preliminary examination, and of course from competing interests in other professions and industry. Other successes (with the help of the Council's post-entry training scheme) included Mr. Cleverly, public health inspector, who obtained the Meat and Other Foods certificate, and Mr. Coleman, clerical officer (III), who passed the intermediate examination of the Diploma of Municipal Administration. 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 for the heavy additional work they have got through under the Clean Air programme, and for the difficulties they have surmounted in this 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 M. R. Butler, 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, Mrs. 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 1961 (preliminary report) 221,590 The Registrar-General's estimate of the home population at midyear 1960 was 221,330. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1960 £3,184,562 Estimated net product of a penny rate 1960/61 £12,675 Estimated number of separately assessed dwellings at April 1, 1960 64,630 Births (adjusted for inward and outward transfers) Livebirths 3,583 Males Females Total Legitimate 1,702 1,646 3,348 Illegitimate 116 119 235 Totals 1,818 1,765 3,583 Crude birth rate per 1,000 of the estimated population 16.2 Adjusted birth rate for comparative purposes (Area comparability factor = 0.95) 15.4 Birth rate for England and Wales 17.1 Adjusted birth rate for London Administrative County 16.0 Stillbirths The stillbirths allocated to the borough during the year were 63, (38 males and 25 females) which represents a stillbirth rate per thousand live and still births of 20.4 in the case of males, 14.0 in the case of females, and 17.3 for all stillbirths. Deaths The deaths belonging to the borough registered during the year were 2,510, consisting of 1,375 males and 1,135 females, giving a crude death rate per thousand of the estimated population of 11.3. The area comparability factor for deaths is 1.0 therefore the adjusted rate is the same at 11.3 which compares with rates of 11.5 for England and Wales and 11.2 for the Administrative County of London. Infant mortality Infant deaths (all deaths of liveborn children under one year) 68 Males Females Total Legitimate 41 19 60 Illegitimate 5 3 8 Total 46 22 68 7 Rates: 1. All infants per thousand livebirths 18.9 2. Legitimate infants per thousand legitimate livebirths 17.9 3. Illegitimate infants per thousand illegitimate livebirths 34.0 4. Male infants per thousand male livebirths 25.3 5. Female infants per thousand female livebirths 12.5 Neonatal deaths (under 4 weeks of age) 48 Neonatal death rates:— Males, per 1,000 male livebirths 17.6 Females, per 1,000 female livebirths 9.1 All infants, per 1,000 livebirths 13.1 Early neonatal deaths (under 1 week of age) 39 Males, per thousand male livebirths 15.4 Females, per thousand female livebirths 6.2 All infants per thousand livebirths 10.9 Perinatal mortality (deaths under 1 week plus stillbirths) 102 Males, per thousand live and still male births 35.6 Females, per thousand live and still female births 20.1 All infants, per thousand live and stillbirths 28.0 Reproductive wastage—(Stillbirths plus all infant deaths) 131 Males, per 1,000 live and still male births 45.2 Females, per 1,000 live and still female births 26.2 All infants, per 1,000 live and still births 35.9 Maternal deaths Maternal deaths Nil Other special causes of death Measles - Whooping-cough — Gastroenteritis (infants) — Tuberculosis (all forms) 11 Motor Vehicle Accidents 28 Suicide 33 Respiratory Diseases (other than tuberculosis) (Code Nos. 22-25) 294 Cancer (Code Nos. 10-15) 539 Heart and circulation diseases (Code Nos. 17-21) 1,156 Comparative statistics for the year 1960 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 15.4 17.3 11.3 18.9 England and Wales 17.1 19.7 11.5 21.7 London Administrative County 16.0 17.9 11.2 21.6 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 46 5 8 18 54 353 368 523 2510 1 Tuberculosis, respiratory 7 - - - - 1 3 2 1 10 2 Tuberculosis, other forms - - - - - - - - - 1 3 Syphilitic diseases — - — — — - — 3 1 5 4 Diphtheria — - — — — — — — 1 - 5 Whooping cough — - — — — — — — — - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - 8 Measles — - — — — - - - — - 9 Other infective and parasitic diseases 3 - - - - - 2 1 - 4 10 Malignant neoplasms, stomach 34 - - - - - 9 12 13 31 11 Malignant neoplasms, lung and bronchus 145 - - - - 3 67 46 29 162 12 Malignant neoplasms, breast - - — — — — — — — 49 13 Malignant neoplasms, uterus - - - - - - - - - 21 14 Other malignant and lymphatic neoplasms 131 - - 1 1 5 47 39 38 260 15 Leukaemia, aleukaemia 5 - 1 2 — - 1 1 — 16 16 Diabetes 9 - — — - 1 1 3 4 20 17 Vascular lesions of nervous system 183 - - - - 1 35 48 99 356 18 Coronary disease, angina 297 - — — — 12 83 90 112 364 19 Hypertension with heart disease 19 - - - - - 4 7 8 46 20 Other heart disease 105 - — 1 1 3 14 22 64 277 21 Other circulatory disease 47 - — — — 1 10 14 22 113 22 Influenza 2 - 1 — — - - 1 — 3 23 Pneumonia 71 12 - — - 1 9 7 42 134 24 Bronchitis 99 1 — — — - 25 35 38 141 25 Other diseases of respiratory system 13 - - 1 1 1 3 3 4 16 26 Ulcers of stomach and duodenum 30 - - - - - 10 10 10 37 27 Gastritis, enteritis and diarrhœa 5 - - - - - 3 1 1 12 28 Nephritis and nephrosis 8 — — 2 — 2 3 — 1 15 29 Hyperplasia of prostate 13 - - - - - 1 5 7 13 30 Pregnancy, childbirth, abortion - - - - - - - - - - 31 Congenital malformations 14 9 1 — — 2 1 1 — 30 32 Other defined and ill defined causes 79 24 2 - 1 8 12 15 17 162 33 Motor vehicle accidents 15 — — — 6 2 2 1 4 28 34 All other accidents 9 — — 1 1 3 — — 4 20 35 Suicides 27 — — — 6 8 8 1 4 33 36 Homicide and operations of war 1 — — — 1 — — — - 1 9 of life during the year 1960 ages at death during the calendar year 1960:— Code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough FEMALES Total persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals all causes 1135 22 6 4 8 33 164 262 636 2510 1 Tuberculosis, respiratory 3 - — - - 1 1 1 - 10 2 Tuberculosis, other forms 1 - - - - - - 1 - 1 3 Syphilitic diseases 1 - — — - - - - 1 5 4 Diphtheria - - — - - - - - - - 5 Whooping cough — - — — - — - - - - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis — - — — - — - - - - 8 Measles - - - - - - - - - - 9 Other infective and parasitic diseases 1 - - - - - - 1 - 4 10 Malignant neoplasms, stomach 27 - - - - 1 4 11 11 31 11 Malignant neoplasms, lung and bronchus 17 - - - - 3 5 5 4 162 12 Malignant neoplasms, breast 49 - — — - 6 21 8 14 49 13 Malignant neoplasms, uterus 21 - - - - - 11 5 5 21 14 Other malignant and lymphatic neoplasms 129 - - 2 1 7 37 37 45 260 15 Leukaemia, aleukaemia 11 - — - 1 2 2 2 4 16 16 Diabetes 11 - — - - - 1 5 5 20 17 Vascular lesions of nervous system 173 - 1 - - 4 16 44 108 356 18 Coronary disease, angina 167 - — - - - 19 54 94 364 19 Hypertension with heart disease 27 - - - - - 1 4 22 46 20 Other heart disease 172 - — - - 2 12 18 140 277 21 Other circulatory disease 66 - — - - 2 6 19 39 113 22 Influenza 1 - - - - - - - 1 3 23 Pneumonia 63 2 - - - - 3 6 52 134 24 Bronchitis 42 1 - - - - 5 10 26 141 25 Other diseases of respiratory system 3 - - - - - - 1 2 16 26 Ulcer of stomach and duodenum 7 - - - - - 1 - 6 37 27 Gastritis, enteritis and diarrhœa 7 - - - - - - 3 4 12 28 Nephritis and nephrosis 7 - 1 — 1 - 1 1 3 15 29 Hyperplasia of prostate - - - - - - - - - 13 30 Pregnancy, childbirth, abortion - - - - - - - - - - 31 Congenital malformations 16 9 3 - - - 4 - - 30 32 Other defined and ill defined causes 83 10 1 1 3 1 8 19 40 162 34 Motor vehicle accidents 13 - — 1 1 1 2 2 6 28 34 All other accidents 11 — — - 1 1 2 3 4 20 35 Suicides 6 - - - - 2 2 2 - 33 36 Homicide and operations of war - — — — — - - - — 1 10 Deaths under 1 year of age Table 3 Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths. Total under 1 yr. Inflammatory diseases of central nervous system M - - 1 - - 1 - 1 - - 1 2 F - - - - - - - - - - - - Diseases of ear and mastoid process M - - - - - - - - - - - - F - - - - - - 1 - - - 1 1 Pneumonia M 2 1 1 - - 4 5 3 - - 8 12 F - - - - - - 1 1 - - 2 2 Bronchitis M - - - - - - - - 1 - 1 1 F - - - - - - 1 - - - 1 1 Spina-bifida and meningocele M - - - - - - 1 - - - 1 1 F - - 1 - - 1 - - - - - 1 Congenital malformations of heart M - 2 1 - - 3 - - - - - 3 F - - - 1 - 1 - 1 - 1 2 Congenital malformations of genito-urinary system M 2 1 - - - 3 - - - - - 3 F - - - - - - - - - - - - Other congenital malformations M - - - - - - - 1 - 1 2 2 F 1 1 3 - - 5 1 - - - 1 6 Injury at birth M 3 1 - - - 4 - - - - - 4 F 1 - - - - 1 - - - - - 1 Post-natal asphyxia and atelectasis M 3 3 - - - 6 - - - - - 6 F - - - - - - - - - - - - Haemolytic disease of newborn M - - - - - - - - - - - - F 1 1 - - - 2 - - - - - 2 Immaturity M 4 2 1 - - 7 - - - - - 7 F 6 - - - - 6 - - - - - 6 All other causes M 3 1 - - - 4 - - 1 - 1 5 F - - - - - - - - - - - - TOTALS M 17 11 4 - - 32 6 5 2 1 14 46 F 9 2 4 1 - 16 4 2 - - 6 22 GRAND TOTAL 26 13 8 1 - 48 10 7 2 1 20 68 There were no deaths in the following groups: tuberculosis (all forms), syphilis, diphtheria, whooping cough, meningococcal infections, acute poliomyelitis, measles, haemorrhagic conditions, pink disease, gastritis and duodenitis, gastro-enteritis, diseases of skin and subcutaneous tissue, congenital hydrocephalus, pemphigus and sepsis of newborn, convulsions, accidents, and lack or care of newborn. 20 infants (14 male and 6 female) thus died between the age of one month and one year compared with 18 in the previous year and 19 the year before that. 12 of the 20 were from pneumonia and bronchitis, 11 4 were from congenital malformations and there was one each in 3 other causes, with one being undefined. There was an increase of 2 in the number of deaths under 4 weeks of age, the greatest incidence being in immaturity with 13 deaths which was however one less than the previous year. Local sickness Through the courtesy of the Regional Medical Officer of the Ministry of National Insurance, I am sent weekly a return indicating for the various areas of London the first certificates of sickness benefit received in the local offices. The areas served by these local offices are in the main coterminous with postal districts of London and do not coincide with borough boundaries. Lewisham is served by four offices, "Lewisham," "Downham," "Eltham," and "Norwood," but as only a very small portion of the borough comes within the purview of the last two, it is felt that a better representation of the trend of sickness within the borough is given by quoting only the figures for "Lewisham," and "Downham." Table 4 Morbidity shown in insurance certificates Weekly average for period ending "Lewisham" "Downham" January 26 725 158 February 23 693 163 March 22 629 138 April 19 477 112 May 17 463 102 June 14 388 78 July 12 357 82 August 9 329 74 September 6 380 95 October 4 465 105 November 1 619 139 November 29 583 131 December 27 578 129 Average for period 5 April to 29 November 1960 435 104 Weekly average for the year 1960 515 118 „ „ 1959 545 131 „ „ 1958 497 117 „ „ 1957 602 150 „ „ 1956 469 124 „ „1955 480 129 „ „ 1954 424 115 „ „ 1953 471 133 The year cannot be regarded as abnormal. Social class in relation to cause of death Of the 2,510 deaths analysed by us the social categories were as follow:— Table 5 Social class I II III IV V Total No information Males 41 244 741 205 124 1355 20 Females 34 208 624 140 71 1077 58 Total 75 452 1365 345 195 2432 78 Percentage 3 19 56 14 8 100 — 12 In detail, the social class, related to cause of death, was as follows:— Table 6 Code No. Cause of death Male Female I II Ill IV V Total I II Ill IV V Total 1 Tuberculosis, respiratory - - 6 - 2 8 - - 1 - 1 2 2 Tuberculosis, other forms - - - - - - - - - 1 — 1 3 Syphilitic disease - — 2 — — 2 - 1 — — — 1 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - — — — — - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases - - 1 - - 1 - - 1 - - 1 10 Malignant neoplasm, stomach 1 5 16 9 3 34 - 4 18 1 2 25 11 Malignant neoplasm, lung, bronchus 2 28 75 22 12 139 - 5 9 2 - 16 12 Malignant neoplasm, breast - — — — — — 4 5 30 7 3 49 13 Malignant neoplasm, uterus - - - - - - - 4 13 2 1 20 14 Other malignant and lymphatic neoplasms 4 29 75 17 12 137 4 30 64 22 7 127 15 Leukaemia, aleukaemia - 2 5 1 — 8 1 2 8 — — 11 16 Diabetes - 2 2 2 1 7 - 2 6 2 — 10 17 Vascular lesions of nervous system 7 39 78 25 17 166 6 38 103 14 6 187 18 Coronary disease, angina 10 56 162 34 18 280 2 32 74 19 7 134 19 Hypertension with heart disease 1 9 27 6 3 46 3 8 29 7 3 50 20 Other heart disease 2 19 47 25 14 107 6 30 107 26 13 182 21 Other circulatory disease 2 6 38 13 3 62 1 9 25 10 5 50 22 Influenza - — — — — — - 2 — — — 2 23 Pneumonia 2 10 45 11 8 76 3 15 34 10 5 67 24 Bronchitis 3 10 57 15 12 97 1 5 24 8 8 46 25 Other diseases of respiratory system 2 2 8 - 3 15 - - 4 - 1 5 26 Ulcer of stomach and duodenum - 6 12 3 4 25 - — 4 — 4 27 Gastritis, enteritis and diarrhœa - — — — — — - — 1 — — 1 28 Nephritis and nephrosis 1 4 9 1 1 16 1 6 7 1 2 17 29 Hyperplasia of prostate - 3 5 3 — 11 - — — — — — 30 Pregnancy, childbirth, abortion - — — — — — - — — - — — 31 Congenital malformations - 1 11 1 4 17 - 2 9 1 — 12 32 Other defined and ill defined diseases 2 6 43 10 2 63 1 7 33 5 5 51 33 Motor vehicle accidents 1 1 7 1 3 13 1 - 7 — 1 9 34 All other accidents - 2 5 3 1 11 - - 9 2 1 12 35 Suicides 1 4 14 3 1 23 - 1 4 — — 5 36 Homicide and operations of war - - 1 - - 1 — - - - - - No social class assessed - — — — — 20 - — — — - 58 There are various discrepancies between the above table and table 2, owing to different methods of assessment, and for comparative purposes therefore it is safer to group the causes of death which are linked together. Thus code numbers 10 to 15 may be regarded as all different kinds of cancer, while numbers 17 to 21 are all diseases of the heart and circulation. Similarly 22 to 25 are best grouped together. 13 Certain statistics have thus been extracted from the last table and grouped in this way. They are shown in the following table which also includes the percentage of each social class for each disease or group of diseases. The percentages should be compared with those in table 5 for all deaths, but for certain groups it will be realised that the numbers are too small for comparison year by year. Table 7 Grouped deaths in social class Code Nos. Group Male Female I II III IV V Total I II III IV V Total 10-15 Cancers No. 7 64 172 49 27 319 9 50 142 34 13 248 % 2 20 55 15 8 100 4 20 5/ 14 5 100 17-21 Heart and circulation No. 22 129 352 103 55 661 18 117 338 76 34 583 % 3 20 53 16 8 100 3 20 58 13 6 100 22-25 Lung, not TB or cancer No. 7 22 110 76 23 188 4 22 62 18 14 120 % 4 12 58 14 12 100 3 18 52 15 12 100 33, 34 Accidents No. 1 3 12 4 4 24 1 - 16 2 2 21 % 4 12 50 17 17 100 5 - 75 10 10 100 35 Suicides No. 1 4 14 3 1 23 — 1 4 - - 5 % 4 17 62 13 4 100 - 20 80 - — 100 Social class in relation to infant statistics The following table shows the social classification in relation to registered births, registered infant deaths, notified stillbirths and notified premature births, an extra line being added to each group to indicate the percentage. Apart from the registered births the figures are too small to be significant; the percentages in the category of registered births can be compared with those for the registered deaths shown in table 5 Table 8 Social classification Total Not classifiable I II III IV V Registered births No. 122 630 2083 429 225 3489 94 % 3 18 61 12 6 100 Registered stillbirths No. — 2 32 10 6 50 13 % — 4 64 20 12 100 Registered infant deaths No. 2 4 52 3 4 65 3 % 3 6 80 5 6 100 Notified premature births No. 5 27 136 28 19 215 33 % 2 13 63 13 9 100 14 Coronary disease Active research continues, 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 regime on a likely possibility rather than a scientific probability, advice which could be given at this stage would amount to this: eat sparingly, cut down fats particularly, look askance at foodstuffs with a high cholesterol content— brains, egg yolk, kidneys, butter— prefer vegetable and fish oil to animal fat, and take regular exercise. This is simple advice, easy to follow, and unlikely to do any harm; and it is advice which quite possibly might do a lot of good. There are, almost inevitably, "savings" and "provisos" even to these simple rules but the only one of note here is in relation to vegetable fat: coconut oil is under some suspicion, while peanut oil is probably advantageous. For cooking and frying purposes there are now excellent vegetable oils on the market, and there are also evaporated milks where the butter fat has been replaced by vegetable fat. 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) (e) (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 1951 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 4 70 360 118 948 161 110 2617 36 6.2 4.2 1960 364 321 113 798 149 102 2510 32 5.9 4.1 ? means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. IS An interesting development was the making of the Skimmed Milk with Non-Milk Fat Regulations 1960, which come into force in September, 1961. These, amongst other things, require any label which carries a claim in relation to coronary disease to bear also a statement of the kind and amount of fat used. Various brands are mentioned by name. The draft regulations caused the usual furore amongst the dyed-in-thewool cows' milk fans, but fortunately they were unsuccessful in getting them annulled. Lung cancer The upward trend still continues— for men at least— and for all age groups over 45. 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 1960 315 145 46 254 17 7 The consumption of cigarettes is no less, and according to The Times over £6½ million was spent by tobacco firms on advertising (£3½ million on TV). 16 General statistics from 1901 Table 11 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate ‡ Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12)-(10) ** Infant mortality rate ** Reproductive wastage rate (9) +(12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate†† Death rate†† % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1901 127,495 13.0 - 74 26 - 3.9 - - - 128 - - 93 - 1902 132,432 13.7 — 74 26 - 4.3 - - - 122 - - 106 - 1903 136,405 11.1 — 72 26 - 2.5 - - - 92 - - 78 - 1904 140,401 12.0 — 70 26 - 3.6 - - - 122 - - 84 - 1905 144,420 11.7 — 67 25 - 28 - 30 63 93 - - 87 - 1906 148,463 12.0 — 72 23 - 2.0 - 30 83 113 - - 80 - 1907 152,532 11.5 — 67 24 - 2.5 - 34 56 90 - - 90 - 1908 156,627 11.0 — 68 23 - 1.4 - 30 57 87 - - 85 - 1909 160,749 10.4 — 63 22 - 2.0 - 35 40 75 - - 78 - 1910 164,899 9.7 — 65 21 — 2.6 — 29 50 79 — — 55 — 1911 161,677 11.4 46 68 21 - 2.3 - 31 73 104 - - 64 - 1912 165,249 10.5 39 63 20 - 2.8 - 30 39 69 - 208 68 11 1913 168,822 10.7 43 65 20 - 2.6 - 28 48 76 - 188 73 25 1914 169,211 10.9 40 62 19 - 3.3 - 27 46 73 - 138 77 18 1915 164,438 12.9 36 61 19 - 4.0 - 30 49 79 - 154 90 26 1916 — 11.9 — — 18 - - - - - 75 - - 102 - 1917 — 11.8 — — 15 - - - - - 87 - - 112 - 1918 — 13.2 — — 14 - - - - - 66 - - 106 - 1919 174,750 11.4 35 59 17 - 3.1 - 28 32 60 - 179 86 22 1920 174,698 10.8 38 59 23 - 3.8 — 32 30 62 — 160 73 22 1921 175,800 10.5 34 58 19 - 2.6 - 23 31 54 - 135 81 18 1922 176,600 11.1 31 57 18 - 2.5 - 26 28 54 - 154 74 16 1923 182,400 10.1 31 56 18 - 3.6 - 20 23 43 - 154 76 17 1924 184,900 10.5 29 56 16 - 3.6 - 23 24 47 - 149 68 22 1925 185,600 10.3 30 56 16 - 1.6 - 23 32 55 - 142 63 15 1926 187,800 10.0 29 54 15 - 2.1 - 18 22 40 - 158 71 17 1927 188,600 11.0 28 53 15 - 2.1 - 35 21 46 - 157 92 12 1928 199,300 10.0 29 54 15 - 2.3 - 22 30 52 - 168 77 15 1929 207,900 11.5 27 52 16 - 5.3 - - - 44 - 142 74 13 1930 207,900 9.7 28 53 15 - 0.9 37 — — 42 79 154 76 12 17 Table 11— continued Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate ‡ Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12) . (10) ** Infant mortality rate ** Reproductive wastage rate (9)+(12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate†† Death rate†† % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1931 220,800 10.2 26 52 14 - 4.9 31 25 24 49 80 132 69 14 1932 221,500 10.2 26 49 13 - 3.4 32 31 23 54 86 123 59 11 1933 221,100 10.2 22 50 12 - 2.6 31 21 18 39 70 125 68 9 1934 222,180 10.1 23 50 12 - 1.5 36 21 22 43 79 129 58 14 1935 223,000 10.0 23 47 12 - 4.3 35 24 19 43 78 126 58 13 1936 224,000 10.9 23 48 13 - 2.0 37 23 32 55 92 131 62 12 1937 226,000 10.9 20 47 13 - 1.3 39 18 29 47 86 156 59 12 1938 229,000 10.5 23 49 14 - 2.1 26 - - 47 73 116 61 12 1939 220,300 10.8 — — 14 - 2.9 34 - - 42 76 111 64 12 1940 192,540 15.8 22 50 15 — 1.0 24 — — 45 69 111 67 11 1941 148,150 14.3 22 48 14 - 1.9 29 - - 34 63 176 93 10 1942 161,800 12.0 18 44 17 - 3.2 37 - - 37 74 175 73 15 1943 168,530 13.9 20 45 19 - 3.1 25 - - 42 67 194 76 14 1944 163,320 14.8 21 49 19 - 10 22 - - 40 62 196 79 11 1945 171,280 12.1 20 43 18 - 1.9 18 - - 34 52 179 71 13 1946 207,410 10 6 17 43 22 - 1.1 21 - - 33 54 193 53 15 1947 221,170 11.9 17 42 22 - 1.0 21 - - 33 54 166 55 12 1948 226,100 9.9 16 41 19 - 0.5 15 15 13 28 43 198 43 16 1949 227,700 10.2 11 35 17 - 0.3 16 13 6 19 35 146 40 12 1950 228,300 10.6 11 35 15 - 0.6 15 19 7 26 40 158 29 13 1951 227,200 112 10 34 15 67 0.3 16 17 8 25 41 117 26 15 1952 227,100 11.4 9 32 14 86 0.3 18 16 6 22 40 117 15 8 1953 225,800 11.1 9 29 14 75 0.3 23 16 6 22 45 136 19 14 1954 224,200 10.0 8 31 14 60 0.0 14 13 8 21 35 102 16 10 1955 223,400 10.8 7 28 14 69 0.9 18 11 6 17 35 114 10 5 1956 222,100 11.3 6 27 14 59 0.0 19 16 3 19 38 88 13 11 1957 220,900 11.0 8 32 15 65 0.6 18 12 4 16 33 100 14 10 1958 221,000 11.0 8 29 15 78 0.0 18 19 5 24 42 98 8 11 1959 221,000 11.8 7 28 16 75 0.8 18 13 5 18 36 56 5 8 1960 221,300 11.3 8 28 16 69 0.0 17 13 6 19 36 54 5 10 *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 B — GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows:— Disinfecting Station Table 12 West North South Total Disinfection Premises visited 75 68 67 210 Rooms disinfected 151 152 137 440 Articles disinfected 1632 1458 798 3888 Disinfestation Premises visited 55 44 18 117 Rooms disinfested 166 162 69 397 Articles disinfested 121 68 70 259 Articles treated Beds 37 28 25 90 Mattresses 125 109 89 323 Bolsters 29 19 21 69 Pillows 251 127 117 495 Cushions 26 17 7 50 Quilts 45 26 42 113 Blankets 347 120 166 633 Sheets 126 165 63 354 Household articles 400 443 243 1086 Wearing apparel 367 472 95 934 Total articles 1753 1526 868 4147 Articles received from the cleansing station - 862 - 862 Articles received from the Coroner's court — 1096 — 1096 Public library books treated after infection 154 186 151 489 Private library books treated after infection 2 - 7 9 Articles treated under the Public Health (London) Act s.122 12582 16478 15753 44813 Treatments for verminous conditions and for scabies were as follow: — Verminous conditions Table 13 1st Cleansing 2nd Cleansing 3rd Cleansing 4th Cleansing Children under 5 12 - - - School children 79 32 7 4 Adults 41 1 — — TOTALS 132 33 7 4 19 Scabies Table 13 — continued Cases Contacts Treatments Children under 5 8 - 11 School children 26 - 40 Adults 17 2 31 TOTALS 51 2 82 London County Council (General Powers) Act, 1953 Section 43 of the above Act states that, on receipt of a report from the medical officer of health or a sanitary inspector that any aged person within their district is verminous or is for any other reason in need of cleansing in order to prevent injury or the danger of injury and is so enfeebled that he is unable to avail himself of any facilities for cleansing himself provided by the authority or to cleanse himself properly, the sanitary authority may on application or with the consent of that person (but not otherwise) cause him to be cleansed free of charge at the place where he resides or at any other suitable place. The authority is enabled to make such arrangements and provide any apparatus required to exercise these powers. 4 persons received treatment during the year. Anti-fly and anti-mosquito campaign The campaign was held from May 2 to September 30 and Mr. Phillips, the present senior health inspector who was in charge of anti-pest work reports:— "348 sites, grass verges and rear garage ways were visited on 4 occasions each and necessary treatment carried out by spraying or the use of powder. The material collected or destroyed on the sites consisted of 56 mattresses and a large quantity of miscellaneous articles such as carpets, linoleum, furniture and clothing. Most of this rubbish was taken direct to the wharf at Greenwich because of the difficulty of destroying it on the site when wet. On a few occasions, however, when the material was reasonably dry it was destroyed by burning." The co-operation of the Borough Engineer's department was once again available for the treatment of dustbins with a powder supplied by the health department. The powder contained gammexane and was applied to dustbins at the time of refuse collection. Altogether some 4 tons of powder containing 0.5 per cent. gamma benzene hexachloride was used. 5 stables or piggeries, and one plot of land known to be particularly bad as a rubbish tip were treated as special sites and visited on 15 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. 5 visits were also paid to both 20 this Council's and the London County Council's blocks of flats where dustchutes are used. 244 dustchutes with 974 openings were sprayed. One private block containing 9 chutes and 27 openings was also included in this treatment The caretakers of this Council's flats were also provided with sprayers, 22 gallons insecticide and 130 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 storage of kitchen waste. In addition treatment by spraying was carried out in 16 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. 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. The quarterly Bulletin on home safety continued to be distributed to some 500 organisations in the borough. In the course of the year eight lectures or talks were delivered by Health Department staff, four of these to Boy Scout groups, two to older schoolgirls, one to members of a political organisation and one to a group of old age pensioners. 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. Statistics are as under:— Table 14 Month Bodies received from Institutions Others Post-mortem examinations Inquests held (Lewisham or Southwark) Lewisham residents Others January 30 35 37 28 3 February 42 34 55 21 5 March 26 29 35 20 5 April 31 32 45 18 9 May 48 22 41 29 15 June 46 21 30 37 16 July 35 22 31 26 7 August 11 24 20 15 4 September 31 24 39 16 7 October 31 29 41 19 6 November 34 21 27 28 12 December 30 35 37 28 11 TOTALS 395 328 438 285 100 21 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 1960, Mr. Phillips, the senior public health inspector, states: "The rivers still appear to be one of the main sources of infestation and extensive baiting of the banks and the gassing of holes has undoubtedly helped to keep the rat population at a reasonable level. The infestation in many houses was found to be due to defective drains and as soon as the drains were repaired the infestation was quickly cleared. The laying up of rats under garden sheds is another problem which has to be carefully watched. A great deal of the blame for rat infestation must still be placed upon the general public for throwing out bread and other scraps of food for birds, particularly late in the day, when it is taken by rats and stored under nearby garden sheds. Other infestations were dealt with by the use of warfarin and other poisons. The use of sodium fluoracetate in sewers seems to be proving very effective and it is hoped that this may lead to a decrease of surface infestations in due course." The undermentioned table gives a summary of the work on the rivers and ditches, prebait being laid on 3/4 days: Table 15 Location Base points Poison bait taken (ozs.) (Estimated) River Ravensbourne 228 264 River Quaggy 160 244 River Pool 110 104 Ditches 21 24 Special liaison is made with the Borough Engineer's Department for the treatment of sewers. In consultation with the Ministry of Agriculture, Fisheries and Food, and the Borough Engineer, a scheme was worked out (which commenced in April 1960) for continuous baiting of the sewer manholes in place of the usual twice yearly treatment. The poison used is sodium fluoracetate (1080). The use of this highly toxic substance is mainly confined at the present time to the baiting of sewers. The Ministry have trained a number of the Council's sewermen in the technique of sewer baiting and the correct handling and use of this particular posion. Continuous baiting of 3040 sewer manholes, each dosed with sodium fluoracetate, was carried out three times during the year. Prebait checks over the same number of manholes showed approximately 290 takes, which is a great reduction from the original figure of around 700 takes under the old twice annual treatment. 22 Prevention of Damage by Pests Act, 1949 A copy of the report covering the calendar year 1960 submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended: Table 16 Type of property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Properties in borough 137 65,330 10,633 76,100 Properties inspected as a result of:- (a) notification 10 1,116 137 1,263 (b) survey 1 1,283 33 1,317 (c) otherwise 31 31 Total inspections (including reinspections) 11 2,456 170 2,637 Properties inspected which were found to be infested by: (a) Rats major minor 6 719 81 806 (b) Micemajor minor 6 270 55 331 Infested properties treated 12 974 129 1,115 - Total treatments (including retreatments) 23 1,962 348 2,333 "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 1960: Table 17 Specimens Number Remarks Faeces 1,099 Negative 260 Shigella sonnei 8 Salmonella typhimurium 6 Salmonella give 2 CI. welchii 1 Bact. coli, type 0.125 1 Staph, aureus Urine 81 Routine Swabs, from nose, throat etc. 163 Negative Sputum 21 Film and organisms Negative 1 Positive for tubercle bacilli Cough plate (for H. pertussis) 1 Negative Food 5 Total specimens 1,657 23 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 vear. Table 18 Bath Tests Variation of chlorine (p.p.m.) Chlorine Bact. Ladywell (1 & 2) 8 - 0.701.75 Forest Hill North 10 0.854.50 Forest Hill South 10 0.754.30 Downham 8 1.002.25 Bellingham (openair) 4 - 0.651.40 The water used for these baths is supplied by the Metropolitan Water Board and is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metaphosphate being used to control acidity aind 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. an l 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 4 persons, at a net cost to the Council of ,£19. National Assistance Act, 1948section 47 Several possible cases were investigated during the year and in one case it was necessary to apply to the court for an order for compulsory removal. This was granted. 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 144 plans were submitted to the public health inspectors for examination and approval. Water supply I am indebted to the Director of Water Examination of the Metropolitan Water Board for the information on which the following report on Lewisham's water supply is based. Tables 19 and 20 show the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board: 24 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1960 milligrams per litre (unless otherwise stated) (a) CHEMICAL Table 19 Description of the sample Ammonia nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as CI. Oxygen abs. from permanganate (4 hrs. at 27°C) Hardness (total) Hardness (noncarbonate) pH value Electrical Conductivity (gemmhos) Thames-derived filtered water 038 080 4.0 28 1.26 254 68 7.8 525 Deptford 012 034 7.8 36 0.16 368 130 7.1 725 Shortlands 016 026 5.3 18 0.04 282 64 7.2 525 Darenth 011 022 5.5 17 0.06 268 40 7.2 500 Wilmington 012 028 7.8 21 0.10 284 54 7.1 550 (b) BACTERIOLOGICAL Table 20 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. 37o C. (20-24 hrs.) 22° C. (3 days) 37o C. (20-24 hrs.) 22° C. (3 days) Coliform E. Coli Coliform E. Coli Thames derived filtered water - - - - 8.6 - 99.57 100.0 Darenth well 0.1 4 86.21 93.10 0.1 151 100.00 100.0 Deptford 5.0 215 97.57 98.38 0.3 51 100.00 100.0 Shortlands No. 1 0.1 1 100.0 100.00 Shortlands No. 2 1 99.5 100.00 0.1 19 100.00 100.0 Shortlands No. 3 1.0 25 99.1 100.00 Wilmington No 2. Well 0.1 45 94.38 99.20 - 11 99.61 100.0 25 Atmospheric pollution Clean Air Act During 1960 two more areas were made the subject of amok Control Orders and particulars with regard to these are as follows: Nome No. 6 (Lewisham Park) No. 7 (Sandhurst) Acreage 320 200 Open space 30 No. of industrial premises 12 4 No. of commercial premises 294 44 No. of dwellings 3,730 2,187 No. of other premises 19 5 Present annual tonnage of bituminous coal etc., to be replaced 4,080 2,500 Likely additional fuel required annually (a) Electricity (BTUs) 450,000 250,000 (b) Gas (therms) 85,000 50,000 (c) Oil, etc, Nil Nil (d) Solid smokeless fuel (tons) 2,900 2,000 Existing appliances requiring replacement or adaptation (a) Open fires 5,666 3,606 (b) Open fires with boilers 108 184 (c) Combination grates without boilers 113 18 (d) Combination grates with boilers 19 4 (e) Washboilers 3 3 (f) Domestic boilers 151 337 (g) Other appliances (freestanding stoves etc.) 153 92 Total estimated cost of works £83,983 £42,046 Date: Order made 27.7.60 9.6.60 Order confirmed 9.11.60 9.11.60 Order operative 1.8.61 1.8.61 The progressive total (when these Orders are operative) will be 1,970 acres covering 16,722 dwellings. Programme As a result of the experience gained in the first few areas of the borough it has been decided to bring forward the target dates for the remaining proposed Smoke Control Orders. The programme is now shortened from 1968 to 1965. This will be a difficult task, but the advantages of smoke control, and its potential saving of money on such things as clothes, curtains, paint and the fabric of buildings, to say nothing of the unassessable though considerable benefit to individual and communal health, make the attempt to shorten the time schedule well worth while. At the end of December 1960, the position in relation to areas still the subject of smoke control action was as follows: (continued on p. 28) 26 27 Table 21 gives a record of the principal results from six stations and also give are not specific to the borough, having been obtained from a publication of the meteor Atmospheric Conditions in Tab some indication of the sunshine, rainfall, etc., during the year. Some of these latter data ological office, and relate to the nearest station which records the particular item concerned. 1960 21 January February March April May June July August September October November December Average or actual (as applic.) Temperatu re Mean maximum1 °F 44.4 45.8 49.8 56.7 6.4 70.7 66.9 67.6 64.0 56.9 51.4 44.6 56.9 Mean minimum1 °F 38.1 37.1 41 -0 42.9 49.5 54.7 55.4 54 3 51.4 48.0 43.3 38.1 46.1 Mean1 °F 41.3 41.5 45-4 49.8 56.9 62.7 61.1 60.9 57.7 52.5 47.3 41.3 51.5 Diff. from average1 °F + 0.7 + 0.6 + 1-3 + 1.1 + 2.4 +12.4 2.9 -2.2 1.1 + 0.8 + 2.4 + 0.2 + 0.5 Highest maximum2 °F 54 62 62 66 79 87 79 77 75 66 62 55 87 (Jun. 20) Lowest minimum2 °F 26 27 33 35 42 51 50 49 46 35 34 32 26 (Jan. II) Rainfall Total2 in. 1.42 1.46 1 -81 0.42 1.65 0.93 2.96 2.39 4.04 5.15 3.14 2.27 27.64 Percent of average1 79 108 109 29 91 70 138 81 172 240 144 96 114 Sunshine1 Daily mean hrs. 1.45 2.80 2-34 5.76 6.10 8.55 5.26 5.68 4.86 2.82 2.39 1.59 4.1 Percent of average 105 130 64 116 97 122 82 94 104 91 139 123 105 Wind1 NE/E/SE % 21 31 81 23 31 29 6 13 30 46 9 18 29 S/SW/W % 53 55 13 40 41 51 86 69 38 29 79 55 51 NW/N/Calm % 26 14 6 37 21 20 8 18 32 25 12 27 20 Atmospheric pollution West Division3: Water insol. matter tpm 8.55 7.19 8.62 7.76 11.04 11.30 8.72 6.50 6.96 6.56 9.28 13.92 8.87 Water sol. matter tpm 5.20 5.53 7.52 3.38 6.36 5.20 4.38 3.88 6.69 6.53 4.71 6.20 5.46 Sulphur † 2.77 2.47 2.29 1.47 1.14 9.73 0.83 0.38 1.44 1.43 1-82 1.53 Smoke, daily average * 19.0 16.0 13.0 7.0 4.0 2.0 1.6 2.0 5.0 9.0 13.0 24.0 9.62 ,, maximum * 55.0 30.0 27.0 11.0 7.0 4.0 3.0 5.0 10.0 14.0 52.0 52.0 55.0 (date) (6.8) (6-9) (31-1) (6-8) (7-9) (23-24) (1-4) (18-19) (24-26) (29-31) (8-9) (8-9) (Jan. 6-8) ,, minimum * 9.0 5.0 2.0 2.0 1.0 1.0 1.0 1.0 2.0 5.0 4.0 3.0 1.0 (date) (30.1) (27-29) (29-2) (8-11) (24-27) (8-10) (5-6) (20-22) (31-2) (6-7) (24-26) (1-2) (Various) North Division4 : Water insol. matter tpm 7.79 10.34 13.8 3 8.89 12.95 9.12 8.33 4.35 7.38 8.56 5.17 10.57 8.94 Water sol. matter tpm 7.95 6.82 10.44 4.18 8.30 5.04 4.91 4.64 6.36 8.17 5.00 7.64 6.62 Sulphur † 4.25 3.32 3.00 2.44 1.97 1.50 0.84 0.92 0.51 2.08 2.58 3.99 2.28 Smoke, daily average * 18.0 14.0 9.0 9.0 4.0 3.0 1.7 2.0 4.0 8.0 13.0 16.0 9.06 ,, maximum * 55.0 23.0 19.0 13.0 7.0 4.0 3.0 5.0 7.0 13.0 40.0 34.0 55.0 (date) (6-) (6-9) (31-1) (6-8) (7-9) (4-7) (1-4) (18-19) (24-26) (13-14) (8-9) (7) (Jan. 6-8) „ minimum * 9.0 5.0 4.0 4.0 2.0 1.0 1.0 1.0 2.0 4.0 4.0 4.0 1.0 (date) (30-) (27-29) (29-2) (8.11) (24-11) (8-10) (5-6) (20-22) (31-2) (6-7) (26) (1) (Various) South Division5: Water insol. matter tpm 7.74 11.2 8.42 10.24 8.81 9.77 9.30 7.42 6.18 4.50 5.77 9.67 8.32 Water sol. matter tpm 5.67 6.8 7.28 3-92 5.44 4.93 3.59 8.45 5.17 8.97 4.43 3.25 5.61 Sulphur † 1.75 1.4 1.30 0.85 0.83 0.62 2.0 0.21 0.26 0.46 0.70 0.55 1.30 0.85 Smoke, daily average * 17.0 13. 8.0 6.0 4.0 5.0 1.4 2.0 3.0 6.0 8.0 13.0 6.95 ,, maximum * 51.0 22. 11.0 11.0 7.0 5.0 3.0 4.0 6.0 12.0 38.0 34.0 51.0 (date) (6-8) (6-9) (31-1) (6-8) (17-18) 2.0 (23-24) 1-n (1-4) (18-19) (24-26) (13-14) (8-9) (8) (Jan. 6-8) „ minimum * 7.0 4. 1.0 2.0 2.0 1.0 1.0 1.0 1.0 3.0 1.0 1.0 1.0 (date) (30.1) (27-29) (29-2) (8.11) (24-30) (8-10) (5-6) (20-22) (3-5) (1-3) (26) (1) (Various) Weather summary Mild, fairly dry Mild and sunny Mild but dull Mild, dry and sunny Warm, fairly dry Warm, dry, sunny Cool, wet dry and windy Cool rather dull Cool and wet Dull; exceptionally wet Mild and fairly sunny Changeable Notes : 'Kew; 2Lewisham; 3Valentine Court for smoke, Pool allotments for others; 'para gon place for smoke, Wearside Road for others; 5Downham Depot for smoke, Verdant Lane for others tpm: tons per square mile per month; †as trioxide in mg per 100 sq. cms. per day mg per 100 cub. metres. 28 (continued from p. 25) Area No. and name No. of dwellings Date of operation Remarks 1 Ladywell 1,409 1.9.59 2 Southend 2,827 1.11.59 3 Brookdale 1,155 1.9.60 4 Penerley 3,367 1.10.60 5 Glenbow 2,059 1.9.60 6 Lewisham Park 3,716 1.8.61 7 Sandhurst 2,187 1.8.61 8 Hazelbank 3,154 Submitted to Minister (for 1.7.62) 9 Northover 3,225 Submitted to Minister (for 1.9.62) 10 Blythe Hill 2,680* Under survey 11 Algernon 2,000† Under survey *approximate †approximate and including Loampit Vale Area The above deals with approximately 28,000 dwellings out of an estimated total of 71,000. 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 for 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. In 1961 the Home Safety Act was passed which repeals and re-enacts the above powers, and allows contributions to be made to voluntary committees and organisations carrying out home safety work. 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 people's 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. Furthermore a quarterly bulletin is issued to local clubs, organisations, doctors and dentists, so that it can be available to club members, those attending surgeries, and so on. Some 500 copies of each issue are distributed. 29 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. In my last report I gave details of the figures for Lewisham cases reported from the Sydenham Children's Hospital. For some administrative reason which is a little difficult to appreciate the supply of this helpful information has ceased. The special statistics which the LCC collected from the hospitals of London have not yet been analysed and issued, but some general statistics, based on ambulance removals, are shown as follows: Table 22 Accidents Quarter of year Total 1st 2nd 3rd 4th 1960 1959 Total for London 1908 1883 1927 2229 7947 7814 Total for Div. 7 (Lewisham and Camberwell) 263 239 223 225 980 973 Rate per 10,000 population London 6.0 5.9 6.0 7.0 24.9 24.4 Div. 7 6.6 6.0 5.6 6.4 24.7 24.5 Falls total 1475 1440 1472 1753 6140 5937 on stairs 302 272 295 352 1221 1175 tripping 318 192 162 216 888 1004 in garden 50 95 75 31 251 305 Knifelike wounds 60 102 85 74 321 327 Gassing 44 27 23 43 137 188 Burns and scalds 128 81 87 135 431 442 Poisoning (including foreign objects) 70 74 101 73 318 255 It will be seen that there are no separate figures for Lewisham, but based on the first four lines the approximate numbers for Lewisham, (below the horizontal line in the table) would be about one-sixteenth of those shown. It must be emphasised that these are only accidents sufficiently serious to require removal to hospital by ambulance. Old people General comments on the problems connected with the care of old people are made in the introduction of this report. The Council continued to make grants to organisations in the borough which are carrying out work for old people, whether by recreational facilities or by the provision of meals. A sum of £7,380 was eventually included in the annual estimates for the year 1960-61 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 follows:— 30 £ Lewisham Old People's Welfare Association 5,400 Lewisham Darby and Joan Club 420 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 40 Lee Branch of the National Federation of Old Age Pensions Associations 40 Good Companions Club 18 St. Hilda's Seniors' Club 65 Blackheath Branch of the National Federation of Old Age Pensions Associations 22 September Club 26 Happy Old Folks'Club (St. Barnabas) 18 St. John's Over 60's Club 30 This left a sum of money available for new clubs which might qualify for grant, and three such clubs, the Spring Hill Social Club, Darby and Joan Section (£10), St. Barnabas Darby and Joan Club for the Deaf and Dumb (£25), and the Friendship Circle Over 60's Club (£12 10s.), were given the grants indicated for part of the year. Additional grants were paid to nearly all the clubs as a help towards fares an:d to the purchase of nutrients. It is hoped that such old people's organisations as can will not only provide the usual afternoon's recreation with a little tea, but will also make arrangements to provide lunch either on the day the club meets or another day. To this end the Lewisham Old People's Welfare Association is prepared to cooperate by conveying the meals in bulk from the central kitchen, where they are obtained, to the luncheon club. 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 in some ways a preferable alternative to the so-called "workshops for the elderly" which have been set up particularly in a few 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 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. 31 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 to certain clubs, and during the year ended 31st March 1961, 33,634 meals were delivered. In addition the WVS delivered 4,205 in one area of the borough. The Saville The committee has for some time past been anxious to acquire premises which could be adapted for various services for old people, and even provide a comprehensive centre for such services. The search for premises however failed, until the autumn of 1960 when a dance hall in Lewisham High Street, known as The Saville, came on the market. After inspection by officers and consideration by the committee the Council decided to purchase, and agreed terms were eventually reached. The premises comprise a large main hall with small stage, three other rooms on the ground floor and three rooms (including a bathroom) upstairs. There is a commodious cellar. It is planned to have kitchen facilities there (to help the meals-on-wheels), afternoon clubs, handicraft classes, and lunch clubs, and also to develop the premises in other ways. They are expected to open in the autumn of 1961. 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 23 W N S Total First Visits 39 221 141 401 Futile visits 23 165 116 304 Revisits 190 1262 235 1687 Total 252 1648 492 2392 Facilities for the aged, generally The King Edward Hospital Fund committee set up 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, continued to meet during the year. Lewisham was chosen for two main reasons: first because although the services were in some respects (for example, a geriatric unit) less than in many other boroughs it was maintained by the hospital and 32 other authorities that 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. Besides representatives of the Fund, the committee includes representatives of the hospital management committee, the London County Council, local practitioners and LOPW.A, and I represent the borough council. The committee has decided to carry out a partial house-to house survey of the borough through an official agency. After a pilot survey, in which the health department officers gave great help, the main survey was carried out in the late spring of 1961. Tabulated results will not be available to the committee until the end of 1961. 33 SECTION C —SANITARY CIRCUMSTANCES OF THE AREA I he following table gives a summary of the inspections, etc., carried out by the public health inspectors during the year:— Table 24 Reason for inspection West North South Total On complaint 895 749 347 1991 House to house 142 92 234 Improvement grants 147 143 88 378 Houses let in lodgings 2 1 — 3 Rent Acts 54 51 19 124 Other Housing Act visits 724 550 233 1507 Notice from builder 337 171 122 630 Infectious diseases 9 9 7 25 Infestation 101 95 75 271 Factories, mechanical 22 10 25 57 Factories, non-mechanical 9 9 11 29 Outworkers 160 58 109 327 National Assistance Act, S47 4 15 2 21 Smoke observations 9 39 65 113 Clean air inspections — 3353 9023 12376 Keeping of animals 14 42 7 63 Water certificates 98 19 5 122 Fireguards 44 44 Crash helmets 3 2 1 6 Hairdressers 50 6 5 61 Pharmacy and poisons 66 46 26 138 Milkshops 36 27 39 102 Icecream premises 132 75 76 283 Restaurants and eating houses 119 119 205 443 Bakehouses 22 23 9 54 Other food shops 342 238 598 1178 Othe rshops 21 44 21 86 Food inspections 132 392 180 704 Sampling 223 271 127 621 Markets and stalls 2 427 69 498 Slaughterhouses — 79 — 79 Futile visits 3542 2358 5735 11635 All other matters 1635 1067 539 3241 Revisits 6015 8548 3747 18310 Total — all inspectors 15111 19128 21515 55754 Smoke abatement Observations 113 Intimations served — Complaints received 10 Statutory notices served — Legal proceedings — Convictions — 34 Summary of notices served Table 25 West North South Total Intimation notices:— Public Health (London) Act, 1936 261 158 89 508 Factories Act, 1937 6 7 2 15 Informal intimations under Housing Act, 1957 7 3 3 13 Total intimations 274 168 94 536 Statutory notices :— Public Health (London) Act, 1936 136 92 43 271 Factories Act, 1937 — — — — Clean Air Act 1956* — 195 881 1076 Housing Act, 1957 6 1 — 7 Byelaws 35 7 29 71 Total statutory notices 177 295 953 1425 *The vast majority of these were for late applications (those received later than a month before the Orders became operative) and were served to safeguard Ministry and Borough Council grant. Nuisances remedied Table 26 Nuisance West North South Total Wall and ceiling plaster repaired 165 76 34 275 Roofs repaired 55 42 8 105 Dampness remedied 143 108 51 302 Brickwork repaired 21 31 8 60 Chimneys repaired 4 3 3 10 Drains cleared 18 9 7 34 Drains repaired 6 8 10 24 Drinking water cisterns repaired — — — — Dustbins supplied 3 7 1 11 Doors and door frames repaired or renewed 10 33 6 49 Flushing cisterns repaired, renewed or cleansed 10 11 6 27 Flush pipes repaired or renewed 1 — 1 2 Firegrates, etc., repaired or renewed 9 21 5 35 Flooring repaired or renewed 59 50 13 122 Dry rot remedied 21 10 3 34 Gullies renewed, repaired or cleansed 3 7 3 13 Gutters repaired 42 28 14 84 Refuse cleared — 1 — 1 Rainwater pipes repaired 24 10 2 36 Soil pipes repaired, ventilated or renewed 11 4 3 18 Sinks provided 5 9 2 16 Sashcords renewed 65 39 17 121 Water closets repaired or renewed 24 23 19 66 Walls and ceilings cleansed 2 1 — 3 Windows and frames repaired or renewed 15 28 5 48 Water service pipes repaired or renewed, water supply restored 7 6 - 13 Yards and areas paved 8 5 — 13 Other nuisances remedied 50 54 8 112 TOTALS 781 624 229 1634 35 Heating Appliances (Fireguards) Act, 1952 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. 44 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 150 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 19 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. 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 182 premises and 8 blocks of flats certifying that under the provisions of the Public Health (London) Act, 1936, a proper and sufficient supply of water had been provided. Factories Section 7 of the Factories Act, 1937, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the council in all factories, whether mechanical power is used in the factory or not. The provisions of sections, 1, 2, 3, 4 and 6 relating to cleanliness, overcrowding, the maintenance of a reasonable temperature, the securing of dequate ventilation of workrooms and the furnishing of adequate 36 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 27 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 62 29 - — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 486 57 15 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 29 29 - - TOTAL 577 115 15 — 37 Cases in which defects were found Table 28 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 2 — 2 (b) unsuitable or defective 27 — 28 (c) not separate for sexes — — — Other offences against the Act (not including offences relating to outwork) 1 1 1 TOTAL 1 33 1 33 — 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. The following is a list of trades concerned, extracted from the August, 1960 lists received:— Trade Outworkers employed Clothing 182 Lampshades 4 Box making 9 Carding 2 Paper bags 2 Surgical appliances 1 Firework cases 8 Brushmaking 3 Artificial jewellery 7 218 38 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 being temporary exceptions. The inspectors made 327 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. Five premises are registered for the use of filling materials for upholstery purposes, one of these being also registered for storage. Samples of these materials proved satisfactory on examination. Destruction of pigeons Several visits were paid to railway bridges during the year and young birds and eggs destroyed. Other complaints were received and dealt with. The public, which still seems divided on whether pigeons should be destroyed or encouraged, provided bread and other food for the birds in different parts of the borough. The pigeons came to feed regularly during the day but their roosting places were not always easy to locate. More of the complaints than in previous years referred to woodpigeons and damage to crops in gardens and allotments was reported. It is hoped that in the current year arrangements will be made for a more effective control of the pigeon nuisance. Exhumations It is the practice for a public health inspector to be in attendance at an exhumation, but no such attendance was made in 1960. Sanitary work generally Mr. Phillips, the senior public health inspector, reports: "The number of complaints received during the year was slightly higher than last year, and this together with an increase in house-tohouse inspections resulted in more notices being served under the Public Health (London) Act. There continues to be a steady decline in the applications for certificates under the Rent Act, 1957. The higher figures under the heading of "Other Housing Act" visits are principally due to surveys of houses to be purchased by means of loans from the Council under the Housing (Financial Provisions) Act 1958. Although more visits were paid to outworkers this is still very seasonal work, many of the people working only for short periods in the year. More smoke observations have been carried out in those areas which have already been dealt with under the Clean Air Act, but it has been found that the public is responding very well to the requirements of that Act." 39 SECTION D —HOUSING Building The following 372 new dwellings were completed by the Council during the year: — Boone Street 21 Fermor Road 13 Greystead Road 7 Knapdale Close 4 Legge Street 16 Leybridge Court 172 Sandstone Road 103 Westbourne Drive 24 Wynell Road 12 Families rehoused for first time During the year the following families were rehoused:— 1. By the Lewisham Borough Council:— (a) in permanent properties 332 (b) in temporary bungalows 9 341 2. By the London County Council (figures supplied by district offices) 44 385 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 295 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 10 informal and 4 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 1960, together with the present position of cases originating in previous years which had not been complied with at the end of 1959:— 40 Table 29 Properties Dwellings involved Present position 2 Rennell Street 1 Works completed 69 St. Germans Road 1 Offer of works accepted 4 Elthruda Road 1 Closing order on whole house 4 Railway Terrace 1 Closing order on whole house 3 Railway Terrace 1 Closing order on whole house 2 Railway Terrace 1 Closing order on whole house 8 Molesworth Street 1 Demolition order made 8 Elthruda Road 1 Closing order on whole house 51 Mount Pleasant Road 1 Notices served 6 Drysdale Road 1 Notices served 25 Handen Road 1 Closing order on whole house determined Closing Orders in respect of part of house Table 30 Properties Part of house Present position 71 Courthill Road Two rooms in semibasement Order made and determined 25 Mount Pleasant Two rooms, scullery and w.c. in semi-basement Order made 14 Dacre Houses Two rooms, ground floor Order made 24 Dacre Houses Three rooms, top floor Order made 345 Baring Road Two basement rooms Order made 89 Burnt Ash Hill Two rooms, scullery and w.c. in semi-basement Order made 59 Summerfield Street Two rooms, scullery and w.c., ground floor Notices served 154 Lewisham Road Two rooms and scullery in basement Notices served 7 Mayow Road Two rooms, scullery and w.c., basement Notices served 20 Elthruda Road Three rooms, scullery and w.c., ground floor flat Notices served 267 Lee High Road Basement flat Varied to allow use of flat of four rooms (from original two rooms at rear) for human habitation. Front room to continue in use as office 23a Silverdale Basement flat Works completed Order determined 58 Knowles Hill Crescent Front and middle room ground floor Order determined 53a Honor Oak Road Basement flat Works completed 15 Eastdown Park Basement flat Order determined Order determined 41 Table 31 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE A —HOUSES DEMOLISHED Clearance areas (Housing Act, 1957) Houses Displaced Persons Families Houses unfit for human habitation — 73 18 Houses included by reason of bad arrangement — 3 1 Houses or land acquired under s. 43 — 12 3 Not in clearance areas Formal or informal procedure under s. 17 (1) 6 13 3 Local authority houses certified unfit by medical officer of health — — — B —UNFIT HOUSES CLOSED (Housing Act, 1957) ss 16, 17 and 35 5 10 4 ss 17(3) and 26 — — — Parts of buildings closed under s.18 6 17 4 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 11 After formal notice under Public Health Acts — — After formal notice under Housing Act, 1957 12 1 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 7 19 42 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 1960, and for the whole period. Table 32 1960 1957-60 Applications for certificates 54 1057 Decisions not to issue certificates — 20 Decisions to issue certificates (a) in respect of some but not all the defects 12 631 (b) in respect of all defects 35 374 Undertakings given by landlords to repair 28 479 Undertakings refused for special reasons — — Certificates of disrepair issued 23 499 Applications by landlords for cancellation of certificates 41 308 Objections by tenants to cancellation 11 105 Decisions to cancel in spite of tenants' objection 1 20 Certificates cancelled 28 213 House Purchase Loans Approximately 774 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 Provisions) 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 57 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 97 applications were investigated and reported on. On housing work generally, Mr. Brittain, the group housing inspector states: 43 The increasing interest in improving grants noted in 1959 continued during 1960 and the number of applications showed a gain of almost 50% by the end of the year. This was mainly due to a larger request for Standard Grants, the total of which more than doubled. An advantage of this form of improvement grant is that it enables the owner of a house which ha3 some of the necessary amenities to obtain assistance in providing the remainder, however small the cost, whereas the discretionary grant stipulates that the work shall cost at least £100. Unfortunately the standard is lower than could be desired, in that an external water closet is accepted provided it is contiguous to the house, but it is to be hoped that this will be rectified in the future. Both forms of grant require that any repairs that are necessary to make the house fit shall be carried out, the requirements being more stringent in the case of discretionary grants, and therefore, as the number of applications increases so will the general standard of housing in the borough improve. The last group of houses in the Council's clearance area programme for 1956/60 had been represented at the end of 1959. An additional group of three houses was represented during 1960 and confirmation of the Clearance Orders made in each case was received from the Ministry of Housing and Local Government. Consideration was given during the year to the clearance programme for 196l/65 and a large number of houses which were thought to be of a suitable type were inspected. From these a combined programme part of which will be dealt with by the London County Council was evolved. It is becoming increasingly difficult, in this borough, to find the type of house which is obviously worn out and beyond repair as was the case about ten years or more ago. One can visualise that, as the general standard improves so will sights be set higher and houses which get by as borderline now will be considered to be well below standard. The year saw the resumption on a small scale of house-to-house inspection. This operation is of value in maintaining a reasonable standard of repair in the houses concerned and brings to notice defects which might not otherwise be brought to the attention of the health department. 44 SECTION E— INSPECTION AND SUPERVISION OF FOOD MILK The Milk and Dairies (General) Regulations, 1959 These Regulations re-enacted with amendments the Milk and Dairies Regulations, 1949 to 1954. At the end of the year there were 117 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, to remain in operation from January 1 to December 31, were issued during the year as follows:— Table 33 Dealer's Supplementary Total Licences issued for :— sale of pasteurised milk 82 18 100 sale of tuberculin tested milk 72 17 89 sale of sterilised milk 99 19 118 TOTALS 253 54 307 Examination of heat-treated milk 119 samples of pasteurised milk and 20 samples of tuberculin tested (pasteurised) milk were submitted for examination during the year and all were found to be satisfactory. Analysis of milk During the year under review, 46 samples of milk were submitted for examination to the public analyst by the Council's inspectors ; all were found to be genuine. The average composition of the samples is set out in the following table:— Table 34 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 19 3.27 8.7 3 88.00 Second quarter 13 3.22 8.77 88.01 Third quarter 9 3.40 8.72 87.88 Fourth quarter 5 3.63 8.85 87.52 TOTALS 46 3.32 8.75 87.93 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 45 ICECREAM Food Standards (Icecream) Regulations 1959, Labelling of Food (Amendment) Regulations 1959 The composition and labelling of icecream was altered from April 1959, new regulations under the above headings coming into operation then. A summary of the changes was set out in last year's report. The 44 samples submitted to the public analyst were found to have the composition shown in the appended table:— Table 35 [##]Period Samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter 8 11.0 11.4 14.5 63.1 Second quarter 14 10.2 11.8 15.2 62.8 Third quarter 14 10.3 11.4 15.2 63.1 Fourth quarter 8 11.2 11.2 15.9 61.7 TOTALS 44 10.6 11.5 15.2 62.7 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 163 samples of icecream were submitted for bacteriological examination with the following results:— Table 36 Grading Samples submitted % Grade I 114 70.0 Grade II 38 23.3 Grade III 8 4.9 Grade IV 3 1.8 TOTAL 163 100.0 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. 46 FOOD GENERALLY Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 572; of these, 40 were formal and 532 informal. After examination the public analyst reported that 4 of the formal samples and 10 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 10.0 in the formal samples, 1.9 in the informal samples, and to 2.4 of all the samples submitted, compared with 3.4 in the previous year. Samples Table 37 Articles Examined Adulterated Formal Informal Total Formal Informal Total Baking powder, cereals and flour 6 25 31 2 - 2 Biscuits — 1 1 — — — Bread and butter 3 — 3 — — — Butter 3 6 9 — — — Cheese — 8 8 — — — Coffee, cocoa, chocolate — 21 21 — — — Confectionery, sugar — 27 27 — — — Cream — 7 7 - 1 1 Drinks, soft 2 14 16 — — — Dripping, lard and suet 2 9 11 1 — 1 Drugs 1 67 68 — — — Fish — 17 17 — — — Fish cakes, etc 1 — 1 — — — Flavourers and condiments — 107 107 — 3 3 Fruit, dried and canned 1 23 24 — 1 1 Icecream 2 42 44 — — — Jellies and custards 1 8 9 — 1 1 Jams, marmalades and preserves - 11 11 - 1 1 Margarine — 4 4 - — — Meat products 4 5 9 - 1 1 Milk 3 43 46 - — — Milk, Channel Islands — 2 2 - — — Milk, condensed — 9 9 - — — Milk, hot 3 — 3 1 — 1 Paste, fish and meat — 16 16 - — — Pie filling, pudding mixtures etc. 1 11 12 - - - Pies, meat 1 2 3 - — — Sausages 3 20 23 - 2 2 Soups — 12 12 - — — Vegetables 1 7 8 - — — Spirits — 8 8 - — — Sugar 2 - 2 - - - TOTALS 40 532 572 4 10 14 47 Non-genuine samples Table 38 Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Dates Informal Bought as "stoneless dates" but contained date-stones No stock remaining Ground cinnamon Informal Lacked full aroma and was almost devoid of flavour Retailers immediately withdrew remaining stocks from sale Hot milk Formal 17.3% deficient in milk fat and at least 7.7% deficient in MSNF Warning letter sent Blancmange powder Informal Label misleading. Sample contained insufficient glucose to warrant description "with added glucose" Manufacturer stated the glucose was only added to make a smoother blancmange Preserved pork sausages Informal Contained insufficient meat Formal sample to be taken Preserved pork sausages Informal Contained insufficient meat. Formal sample to be taken. Cream Informal Contained insufficient milk fat All stocks sold Cream slices Formal These samples contained artificial cream Legal proceedings instituted, but summonses dismissed on a technicality Cream horns Formal Seasoning Informal No statement of ingredients on labels as required by Labelling of Food Order, 1953 Formal samples taken, but further procedure rendered void by death of public analyst Seasoning Informal Shredded beef suet Formal Slightly deficient in beef fat Letter to manufacturers Pork luncheon meat Informal Sample considered to be deficient in meat Manufacturers comments invited Lemon curd Informal Sample mouldy. Manufacture of this lemon curd discontinued. 48 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:— Porage oats Fish and chips Cooking fat Coloured sugar balls Bread (2) Milk bottle Lamb chop Lemon juice Butter Plum jam Sliced bread Meat pie (2) Jelly tablet Luncheon meat Loin of pork Soup powders (4) Sausages (2) Sponge cake Hamburger Registration of food premises During the year the following were registered, the total (including previous registrations) being shown in the last column. Type 1960 Total Sale and storage of icecream 16 328 Manufacture of icecream — 4 Fish frying 3 32 Fish curing 3 20 Preparation or manufacture of sausages 4 75 Preparation or manufacture of potted, pressed, pickled or preserved food 11 139 Unsound food Approximately 6½ 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 2 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. Details were set out in the last annual report. No exemption certificates were issued during the year. Food Hygiene Regulations, 1960 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. 49 Pharmacy and Poisons The names of 11 persons were entered on the Council's list of persons entitled to sell poisons in Part II of the poisons list and the names of 175 persons previously registered were retained on the register. 138 visits were paid by the food inspectors in connection with the granting and renewal of these licences. Slaughterhouses and slaughtermen There is one private slaughterhouse in the borough in respect of which the licence was renewed during the year, with the proviso that only pigs could be slaughtered. The premises were visited periodically by the food inspector. 105 pigs were slaughtered and the carcases inspected. 1 pig was condemned for fevered condition following broken back and hind legs, and 2 whole carcases were condemned for generalised tuberculosis. The weight of these 3 carcases was 555 lbs. In addition 168 lbs. of parts and 95 lbs. offal were condemned. The premises in which this slaughterhouse is situated are being taken over by the Council as an open space and it is anticipated that the slaughterhouse will cease to operate early in 1962. 4 slaughtermen's licences were issued during the year. Offensive trades There are no offensive trades carried on in the borough. Continental Goods Depot, Hither Green A very large British Railways Depot for dealing with continental goods traffic has been built at Hither Green and was opened in October. The major part of the material passing through it is similar to that previously handled at Southwark. We are concerned insofar as unfit food may be present, in which case we have to ensure that it is either destroyed or not used for human consumption. It may be necessary to contact wholesalers and various local authorities if it is intended for distribution elsewhere. Although the proportion of unfit food is small (there was none in the first three months) the large amount of material handled through the depot throws considerable extra work on the food inspectors concerned. Totals for the portion of the year in which the depot was working are shown in the table:— Table 39 Country of origin Tonnage imported Amount unfit, and remarks Spain 39,920 - Italy 6,859 — France 5,734 - Belgium 212 - Israel 58 - Algeria 4,918 - Australia 84 - Yugoslavia 86 - 50 Food hygiene The Food Hygiene Regulations 1955, which at the time marked a considerable advance in the control of the manufacture and sale of food products, were consolidated and amended by the Food Hygiene (General) Regulations 1960 which extended them to food businesses carried on from home-going ships and moored vessels. Other principal changes brought about were:— (a) the extension of the definition of the handling of food to include the cleaning of food utensils and equipment; (b) the relaxation in certain respects of regulation 25 of the 1955 Regulations, which deals with the temperature at which foods are to be kept on catering premises; (c) the modification of regulation 29 of the 1955 Regulations to permit the transport of certain types of offal without being put in special containers ; (d) the person carrying on the food business is principally responsible for securing compliance with the regulations, but a manager or foreman is also required to take all reasonable steps to secure compliance by the food handlers under his control. In general the regulations lay down requirements in respect of:— (i) the cleanliness of premises, ships, stalls, vehicles, etc., used for the purposes of the food business and of apparatus and equipment used for those purposes; (ii) the hygienic handling of food; (iii) the cleanliness of persons engaged in the handling of food and of their clothing, and the action to be taken where they suffer from or are the carriers of certain infections liable to cause food poisoning; (iv) the construction of premises and ships used for the purposes of a food business and the repair and maintenance of such premises and ships and of stalls, vehicles, etc.; (v) sanitary conveniences and the provision of a water supply and washing facilities; (vi) the temperatures at which certain foods which are particularly liable to transmit disease are to be kept on catering premises. 51 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 1960 with comparative figures for the previous six years. Table 40 Diseases Cases notified 1960 1959 1958 1957 1956 1955 1954 Diphtheria - - - - - 1 - Dysentery 367 233 214 129 579 92 394 Encephalitis (acute) — — 1 2 2 — — Enteric or typhoid fever — 6 4 2 3 1 1 Erysipelas 20 16 13 15 20 26 24 Food poisoning 31 49 27 42 46 48 110 Malaria 2 — — — — 1 3 Measles 262 2613 835 2728 206 3905 521 Meningococcal infection 8 3 3 4 9 4 6 Ophthalmia neonatorum 1 1 1 2 2 4 2 Pneumonia 33 108 61 96 89 121 77 Poliomyelitis (acute) 2 6 2 15 26 63 16 Puerperal pyrexia 78 48 59 93 57 92 59 Scabies 9 9 9 18 29 18 14 Scarlet fever 172 303 210 143 188 158 331 Tuberculosis 134 143 236 247 212 271 256 Whooping cough 333 229 154 225 241 412 449 TOTALS 1452 3767 1829 3761 1709 5217 2263 52 Notifications of infectious diseases in 1960 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 9 5 41 26 28 22 46 49 21 21 6 14 15 37 9 13 1 4 176 191 Erysipelas — — — — — — — — 1 — — — 1 1 9 5 — 3 11 9 Food poisoning 1 1 2 1 2 1 1 — 2 2 2 5 1 5 1 3 — 1 12 19 Malaria - - — - - - - - — — — — — — 1 1 — — 1 1 Measles 3 3 27 33 31 22 65 76 — 1 — — — 1 — — — — 126 136 Meningococcal infection - 1 2 - - 1 1 - - - - - 2 - - 1 - - 5 3 Ophthalmia neonatorum - 1 - - - - - - - - - - - - - - - - - 1 Pneumonia — — 2 1 — — 8 3 — 1 — — 3 2 6 5 2 — 21 12 Poliomyelitis (paralytic) - - 1 - - 1 - - - - - - - - - - - - 1 1 Puerperal pyrexia - - - - - - - - - - - 42 - 36 - - - - - 78 Scabies — — — — — — — 1 — 1 2 1 2 1 — 1 — — 4 5 Scarlet fever — 1 4 9 19 18 53 43 10 9 — 3 1 2 — — — — 87 85 Tuberculosis (respiratory) - - 3 - 1 - 1 1 4 - 12 9 22 16 24 11 11 4 78 41 Tuberculosis (non-respratory) - - 1 - - - - 1 1 - 1 3 3 2 - 1 - 2 6 9 Whooping cough 14 14 38 42 30 26 66 67 10 17 1 2 2 1 1 2 - - 162 171 Totals 27 26 121 112 111 91 241 241 49 52 24 79 52 104 51 43 14 14 690 762 53 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 6 21 26 41 14 7 18 8 - 141 N 4 32 12 24 5 8 12 5 1 103 S 4 14 12 30 23 5 22 9 4 123 Total 14 67 50 95 42 20 52 22 5 367 Measles W 2 39 38 110 - - 1 - - 190 N 2 15 14 29 - - - - — 60 S 2 6 1 2 1 - - - - 12 Total 6 60 53 141 1 - 1 - - 262 Pneumonia W _ 1 5 1 3 4 - 14 N - 1 - 3 - - 1 1 1 7 S - 1 - 3 - - 1 6 1 12 Total - 3 - 11 1 - 5 11 2 33 Poliomyelitis W - - - - - - - - - - N - 1 - - - - - - - 1 S - - 1 - - - - - - 1 Total - 1 1 - - - - - - 2 Scarlet fever W - 5 10 37 8 1 2 - - 63 N 1 1 10 16 5 1 1 - - 35 S - 7 17 43 6 1 - - - 74 Total 1 13 37 96 19 3 3 - - 172 Tuberculosis (respiratory) W - 2 - 1 - 6 11 15 5 40 N - - - - 1 7 13 13 7 41 S - 1 1 1 3 8 14 7 3 38 Total - 3 1 2 4 21 38 35 15 119 Whooping cough W 9 26 18 54 10 - 2 2 - 121 N 11 24 23 42 9 1 1 1 - 112 S 8 30 15 37 8 2 - - 100 Total 28 80 56 133 27 3 3 3 - 333 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. 54 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 24:— Table 43 W N S Total First visits 353 307 454 1114 Futile visits 555 189 297 1041 Revisits 247 212 158 617 Total 1155 708 909 2772 Poliomyelitis In 1960 two cases of poliomyelitis were confirmed, one of them in the North division and the other in the South. They were both between one and five years of age. Dysentery The number of cases increased, being about half as many again as in the previous year. The focus for local outbreaks is often the schools and the mildness of the type of dysentery conduces to 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 1960 was an "off-peak" year there being only 262 cases, less than one-tenth of the number of the previous year. They were of mild degree. Pneumonia The number of cases dropped from 108 to 33—the lowest number for many years past. The mild winter and spring and the absence of any influenza outbreak was probably responsible for this although it is likely that many cases of pneumonia are not formally notified. Scarlet fever There was a decreased number of cases in 1960, the total being only a little more than half the previous year. They were scattered throughout the borough. 55 Whooping cough Cases again increased and although no major outbreak occurred the total was the highest since 1955. This calls attention to the desirability of young children being protected by immunisation, as whooping cough is in general the more serious the younger the child is. Whooping cough immunisation can be combined with diphtheria immunisation, thus reducing the number of injections the young child requires. Tuberculosis After the dramatic fall shown in the previous year the number of cases in 1960 dropped only a little further—from 143 to 134. 119 of these were pulmonary and were scattered evenly through the three divisions of the borough. The biggest number occurred in the age group 25-45 followed closely by the age group 45-65. As in previous years there were many more cases in males than in females as far as respiratory tuberculosis was concerned, there being 78 males (an increase of 5) and 41 females (a decrease of 10). 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- 3 - 1 - 4 - - - - - - - 2- 1 - _ - 1 - - - - - - - 5- 1 1 - 1 1 2 - - — — — - 10- 4 - 1 - 5 - - - - - — - 15- 3 3 1 1 4 4 - - - - - - 20- 9 6 - 2 9 8 - - - - - - 25- 9 11 2 2 11 13 1 1 - - 1 1 35- 13 5 1 - 14 5 45- 13 7 - - 13 7 3 1 - - 3 1 55- 11 4 - 1 11 5 65- 6 2 — 1 6 3 2 1 - 1 2 2 75+ 5 2 - 1 5 3 1 - - - 1 - 78 41 6 9 84 50 7 3 - 1 7 4 56 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 - 2 - 1 - - 2 4 4 6 2 1 3 25 F - - - - - 1 3 2 1 5 2 - 1 15 Non-respiratory M - - - - - - - 1 1 - - - - 2 F - - - - - - 2 1 - - - 1 - 4 North Respiratory M - - - - 1 - 5 1 5 4 6 5 - 27 F - - - - - 1 1 6 1 1 2 1 1 14 Non-respiratory M - 1 - - 1 - - 1 - - - - - 3 F - - - - - 1 - 1 - - - - - 2 South Respiratory M - 1 1 - 3 3 2 4 4 3 3 - 2 26 F - - - 1 - 1 2 3 3 1 - 1 - 12 Non-respiratory M - - - - - 1 - - - - - - - 1 F - - - 1 - - - - - - 1 - 1 3 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 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 1960 221,300 134 61 11 10 5 7 57 Tuberculosis — environmental conditions Case papers showing the environmental condition of patients attending the Lewisham Chest Clinic in 1960 have been analysed in 223 cases with the following results:— Table 47 Cases %* Males 135 61 Females 88 39 Social classification:— Class I 4 2 Class II 22 12 Class III 121 68 Class IV 22 12 Class V 11 6 Not classifiable 43 — Rooms occupied:— 2 or more rooms per person 41 20 1—2 rooms per person 118 56 Less than 1 room per person 50 24 No information 14 — Accommodation:— Separate bed 62 28 Separate bedroom 43 19 Condition of premises occupied:— Good 185 90 Fair 17 8 Poor 5 2 No information 16 — *Excluding cases not classified Food poisoning The cases last year formally notified decreased from 49 to 31. 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. One episode, though not contributing to the above total caused some anxiety as it was concerned with a restaurant which serves a considerable number of meals a day and caters for association and club dinners in the evening. Two largish groups of mild food poisoning cases occurred before the department was informed of the trouble on the third occasion, but after a considerable amount of investigation the conclusion was come to that the cause was probably one member of the kitchen staff who, it seems, might well have been a chronic carrier of the organism likely to have caused the outbreaks. Since steps were taken to eliminate this cause no further trouble has been reported. Most of the cases were of residents from outside the borough. 58 (1) Food poisoning cases Table 48 Notifications (corrected) Cases otherwise ascertained Symptomless excreters Fatal cases 1st quarter 6 3 — — 2nd quarter 5 3 — — 3rd quarter 9 4 — — 4th quarter. 11 152 — — Year 31 162 — — (2) Particulars of outbreaks Table 49 Outbreaks Cases Total cases Family outbreaks Other outbreaks Notified Otherwise ascertained Agent identified:— CI. Welchii — 4 — 150 150 Agent not identified 1 — 2 — 2 (3) Single cases Table 50 Notified Otherwise ascertained Total cases Agent identified:— Salmonella typhimurium 12 3 15 „ Bareilly — 1 1 „ Heidelberg 1 — 1 „ group C 1 — 1 „ group B 2 — 2 „ group D 1 — 1 Agent not identified 12 8 20 (4) Salmonella infections, not food-borne Nil 59 Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1960 on which the following table is based. The Unit during the course of the year was stationed at 9 different locations in the borough, and also visited firms in two areas of the borough, the time spent at each varying from 1 day to 2 weeks. Table 51 Patients Men Women Total General analysis X-rayed 6,806 6,781 13,587 Previously x-rayed 4,511 3,780 8,291 Reviewed 373 213 586 Abnormal after review 233 131 364 Analysis of abnormal large films:— Cases considered tuberculous:— (a) no further action required — — — (b) occasional supervision only... 9 2 11 (c) requiring treatment 13 5 18 (d) still under investigation — — — (e) refused further investigation — — — Previously known tuberculous cases 9 4 13 Non-tuberculous cases:— (a) investigated 43 15 58 (b) still under investigation 1 — 1 Cardio-vascular lesions 13 25 38 No action required 145 80 225 Commenting on the year's work, Dr. J. M. Morgan, director of the South East London mass x-ray service, states:— "The numerical response to public Mass X-Ray Service in Lewisham was not very satisfactory during the year 1960, only 13,500 persons being examined, but a total of 18 cases of active tuberculosis were detected giving an apparent incidence of about 1.3 per thousand. The true figure, however, is somewhat higher than this as a proportion of the examined are men over forty-five who are taking part in a special survey in relation to carcinoma of the bronchus and are being examined at six monthly intervals. Tuberculosis, therefore, continues to be a problem, and it is interesting to note that the four cases diagnosed in firms at Lower Sydenham were all under thirty years of age. At our next visit to these firms an even greater effort will be made to examine those who persistently fail to volunteer, and it seems that the public may still need to appreciate that a pool of carriers continues to exist, and that the possibility of infection of healthy persons remains a major problem." 60 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, 1960 Under 1 1 2 3 4 5-9 10-14 Total under 15 Born in year I960 1959 1958 1957 1956 1951-55 1946-50 (i) Diphtheria (including combined and triple):— immunised during year 1237 2047 146 77 75 193 35 3810 Immunised at end of year 1237 4116 2744 2332 2515 13,644 13,688 40,276 Estimated mid-year population 16,100 31,800 47,900 (ii) Whooping cough (including combined and triple):— Immunised during year 1230 2009 135 71 61 83 21 3,610 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 1,870 240 73 102 2,285 Revaccination - 10 48 192 250 (iv) Poliomyelitis Inoculated against poliomyelitis (at clinics and schools in Lewisham) 1st injection 2nd Injection 3rd injection 8,429 7,718 18,778 Council Offices, E. H. R. SMITHARD Canadian Avenue, Medical Officer of Health S.E.6. October, 1961. 61 APPENDIX A Acts of Parliament, Statutory Instruments and Circulars issued by Government Departments with regard to the public health services, during the year 1960:— Statutes London County Council (General Powers) Act 1959 Offices Act, 1960 Public Health Laboratory Service Act 1960 Oil Burners (Standards) Act 1960 Noise Abatement Act 1960 Caravan Sites and Control of Development Act 1960 Statutory Instruments Civil Defence (Disease) Regulations 1960 The Poisons List Order, 1960 The Poisons Rules, 1960 The Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day—No. 1) Order 1960 The Slaughterhouses (Hygiene) Regulations (Appointed Day—No. 1) Order, 1960 The Factories Act, 1959 (Commencement No. 2) Order 1960 The Meat (Staining and Sterilisation) Regulations 1960 The Authorised Officers (Meat Inspection) Regulations 1960 The Town and Country Planning (General) (Amendment) Regulations 1960 The Caravan Sites (Licence Applications) Order 1960 The Town and Country Planning General Development (Amendment No. 2) Order 1960 The Milk (Special Designations) Regulations 1960 The Food Hygiene (Docks, Carriers, etc.) Regulations 1960 The Food Hygiene (General) Regulations 1960 The National Insurance (Non-participation-Certificates) Regulations, 1959 The National Insurance (Non-participation-Appeals and References) Regulations, 1959 The Public Health (Infectious Diseases) (Amendment) Regulations 1960 The Arsenic in Food (Amendment) Regulations 1960 Skimmed Milk with non-milk fat Regulations 1960 Ministry of Health Circulars No. 1 Annual Reports of Medical Officers of Health for 1959 2 Outworking in the Shrimp and Pickled Onion Industries. Review of the Food Hygiene (Amendment) Regulations 1957 6 Civil Defence (Disease) Regulations 1960 20 The Food Hygiene (Docks, Carriers, etc.) Regulations, 1960 19 The Food Hygiene (General) Regulations, 1960 21 Food Hygiene Codes of Practice. The Hygienic Transport and ling of Fish. Hygiene in the Retail Fish Trade. 24 Anthrax. 62 Ministry of Housing and Local Government Circulars No. 2 Slum Clearance 30 Local Employment Act, 1960. Rehabilitation of derelict, neglected or unsightly land. Water and Sewerage schemes. 33 Heating of public buildings 28 Clean Air Act 1956. (i) Use of sticks and paper in smoke control areas (ii) Smoke Control Areas : Model question and answer booklet (iii) Clean Air Advisory Service 38 Clean Air Act 1956—smoke control areas 42 Caravan sites and control of development Act 1960 43 Clean Rivers (Estuaries and Tidal Waters) Act 1960 47 More flatlets for old people 53 Local Government Superannuation. National Insurance Act 1959 58 Noise Abatement Act, 1960 Model Standards Caravan Sites and Control of Development Act Ministry of Agriculture, Fisheries and Food Circular No. FSH 1 The Slaughterhouses Reports (Appointed Day) Order 1959 The Slaughterhouses (Reports) Direction, 1959 2 The Slaughterhouses (Meat Inspection Grant) Regulations 1958 3 Milk and Dairies (General) Regulations, 1959 4 Slaughter of Animals Act—Calf Slaughter 5 The Meat (Staining and Sterilisation) Regulations, 1960 7 The Milk (Special Designation) Regulations 1960 8 The Authorised Officers (Meat Inspection) Regulations 1960 9 Milk and Dairies (General) Regulations 1959 Approved Chemical Agents 12 The Arsenic in Food (Amendment) Regulations 1960 13 Skimmed milk with non-milk fat Regulations 1960 PDP 3 Fluoracetamide for the control of rats in sewers General Register Office Circular No. MOH 3 Annual Reports of Medical Officers of Health 1959—Vital Statistics 63 APPENDIX B Legal Proceedings, 1960 The following are details of legal proceedings during the year:— Nature of summons No. Total fines Total costs Remarks Public Health (London) Act 1936 Non-compltance with nuisance notices £ s. d. £ s. d. 9 Abatement Orders were made; 3 summonses were withdrawn (work completed); 3 summonses were adjourned sine die 15 — 13 11 0 Section 105 3 5 0 0 2 2 0 2 summonses were adjourned sine die Section 109 1 5 0 0 - Non-compliance with Byelaw notice (waste water preventer) 1 5 0 0 1 1 0 Non-compliance with Nuisance Orders 3 15 0 0 3 3 0 1 summons adjourned sine die Non-compliance with notice after conviction 2 20 0 0 2 2 0 London County Council (General Powers) Acts Want of dustbin 2 1 0 0 - 1 summons withdrawn (bin supplied) Food and Drugs Acts, 1955 Section 2 13 79 0 0 18 18 0 3 summonses were withdrawn; 1 conditional discharge and 1 absolute discharge were granted Section 8 3 20 0 0 4 4 0 Food Hygiene (General) Regulations, 1960 Regulations 6(1) 3 6 0 0 - 2 summonses dismissed 8 3 10 0 0 - 23 1 2 0 0 2 2 0 Public Health (London) Act LCC (General Powers) Acts Dustbins—appeals by owners 2 - - One appeal was not proceeded with, a bin having been supplied. The other appeal was dismissed. 64 APPENDIX C List of special reports submitted to the Health Committee by the medical officer of health during 1960:— February 2 Special committee of King Edward Hospital Fund March 29 Old people—geriatric unit Sewage contamination of bathing beaches May 31 Conference on the care of the elderly Royal Society of Health Congress Bell Green gasworks—alteration in fuel Local hospital services July 5 Inquests at Lewisham Free washing facilities at public conveniences November 29 Investigation of atmospheric pollution 65 INDEX SUBJECT PAGE Acts, regulations and orders 61 Area of borough 6 Atmospheric conditions 26 Births and birth rate 6 Cancer 15 Clean Air Act 25 Clearance areas 41 Continental Goods Depot 49 Coronary disease 14 Deaths and death rate 6 Deaths, cause of 8 Discretionary grants and standard grants 42 Disinfection and personal cleansing 18 Dog nuisances 23 Drainage work 23 Dysentery 54 Exhumations 38 Factories 35 Flies and mosquitos 19 Food, adulteration of 46 Food inspection and supervision 44 Food poisoning 57 Food Hygiene Regulations, 1960 48 Food Standards Regulations 45 General statistics from 1901 16 Hairdressers 35 Health education 20 Health Services, general provision of 18 Heating appliances 35 Heattreated milk 44 Home Safety 28 House purchase loans 42 Housing:— Building 39 Families rehoused 39 Housing Act, 1957 39 Icecream composition 45 Icecream grading 45 Immunisation 60 Infant mortality 6 Infant mortality statistics 10 Infectious diseases 51 Infectious disease visiting 53 Laboratory facilities 22 SUBJECT PAGB Legal proceedings 63 LCC (General Powers) Act, 1953, section 43 19 Mass miniature radiography 59 Maternal deaths 7 Measles 54 Milk, analysis of 44 Milk and Dairies Regulations 44 Mortuary and Coroner's Court 20 National Assistance Act, 1948 s. 50 23 s. 47 23 Nuisances remedied 34 Offensive trades 49 Old people 29 Outworkers 37 Pet Animals Act, 1951 35 Pharmacy and Poisons Act, 1953 49 Pigeons 38 Pneumonia 54 Poliomyelitis 54 Population 6 Prevention of Damage by Pests Act, 1949 22 Rag Flock and Other Filling Materials Act, 1951 38 Rateable value 6 Rent Act, 1957 42 Rodent control 21 Sampling 46 Sanitary circumstances of the area 33 Scarlet fever 54 Shops Act, 1950 48 Sickness, local 11 Slaughterhouses 49 Smoke nuisances 33 Social medicine statistics 11 Staff 2 Stillbirths 6 Swimming baths 23 Tuberculosis 55 Unsound food 48 Vaccination 60 Vital statistics 6 Water certificates 35 Water supply 23 Whooping cough 55 66 TABLES TABLE SUBJECT PAGE TABLE SUBJECT PACE NO. Section A NO. Section D 1 Comparative statistics 7 29 Demolition orders 40 2 Causes of death by age 30 Closing orders 40 groups 8 31 Clearance areas 41 3 Deaths under one year 10 32 Rent Act ,957 42 4 Local sickness 11 5 Deaths by social class 11 6 Causes of death by social class 12 Section E 7 Grouped causes of death by social class 13 Milk licenses 44 8 Births, infant deaths, etc., Analysis of milk 44 by social class 13 35 Icecream composition 45 9 Heart and circulation 36 Icecream grading 45 mortality 14 37 Samples analysed 46 10 Lung cancer 15 38 Adulterated samples 47 11 General Statistics from 1901 16 39 Continental Goods Depot 49 Section B 12 Disinfecting station 18 13 Verminous conditions, etc. 18 14 Public mortuary 20 Section F 15 Rodent control—treatment 40 Notified cases of infectious of rivers 21 diseases 51 16 Prevention of Damage by 41 Notifications of infectious Pests Act 22 diseases by age and sex 52 17 Laboratory facilities 22 42 Analysis of certain diseases 18 Swimming Baths 23 into divisional 53 43 Infectious disease visiting 54 19 Water, chemical samples 24 20 Water, Bacteriological 44 Tuberculosis notifications samples 24 and deaths 55 45 Analysis of new cases of 21 Atmospheric conditions 26 tuberculosis into 22 Accidents 29 sional areas 56 23 Old People's visits 32 46 Tuberculosis statistics 56 . 47 Tuberculosis — Section C mental conditions 57 24 Sanitary inspection 33 48 Food poisoning cases 58 25 Summary of notices 34 49 Food poisoning outbreaks 58 26 Nuisances remedied 34 50 Food poisoning agents 58 27 Factory inspections 36 51 Mass Radiography 59 28 Factory defects 37 52 Immunisation against infectious disease 60