AC 4514 Library 7.10.63 LEW 50 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1962 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 1962 E. H. R. Smithard, MBE, MD, DPH CONTENTS Page Staff 2 Introduction 3 Vital Statistics 6 General Provision of Health Services 20 The Care of the Elderly 32 Sanitary Circumstances of the Area 42 Housing 49 Inspection and Supervision of Food 54 Infectious Diseases 61 Appendix A — Statutory Instruments 70 „ B — Legal Proceedings 72 „ C — Special Reports to Health Committee 72 „ D — The 1961 Census 73 "The chief function of the Medical Officer of Health is to safeguard the health of the area for which he acts by such means as are at his disposal . . ." "He should endeavour to acquire an accurate knowledge of the influences, social, environmental and industrial, which may operate prejudicially to health in the area. "While he has special duties for the prevention of infectious diseases, all morbid conditions contributing to a high sickness rate or mortality in the area from these or other causes should be studied with a view to their prevention or control." —from the Ministry of Health Memorandum on the duties of MOHs 2 STAFF as at 31/12/62 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Deputy Senior Public Health Inspector J. R. Craven (a) (6) Assistant Group Housing Inspector J. W. Bevan (a) (b) (c) Divisional Food Inspector H. W. Ellery (a) (b) Senior Public Health Inspector A. J. Phillips (a) (b) Group Public Health Inspectors H. Tolson (a) (b) (Food) R. C. Brittain (a) (b) (Housing) *R. Mahoney (a) (b) (District) District Inspectors *G. L. Belshaw (a) (b) *K. G. C. Burt (a) (b) (c) *L. J. Cleverly (a) (b) *C. L. Connor (a) (b) *R. L. Davis (a) (b) *G. E. Fallows (a) (b) *E. A. Howard (a) (b) A. Lakeland (a) *D. G. Oliver (a) (b) (c) *W. J. Wilcox (a) (6) G. P. Gibaut (a) Two vacancies (a) Public Health Inspector's certificate. (b) Meat and Other Foods certificate. (c) Smoke Inspector's certificate. * With responsibility for certain food work. Women Health Officers Mrs. A. Carins, srn, rfn Mrs. L. Champness, srn, rfn Mrs. M. M. Coulson, srn, qn Principal Clerk E. W. Cheesman Clerical Staff S. Burridge, (senior clerk) C. R. Coleman Mrs. D. J. Handford Miss D. Cashman Miss M. E. Hinchcliff Mrs. M. G. James Mrs. H. I. Barnes Miss F. E. Smith Miss A. Keys Coroner's Court and Mortuary W. C. Spear, officer-in-charge Disinfecting Station, Pest Control, etc. J. G. Beale, superintendent Foreman Disinfector Disinfectors 9 Bathing attendants 2 Domiciliary Bathing Attendant 1 Wardens Mrs. M. L. Shorten, sean Mrs. M. C. Aspinall, srn Student public health inspectors J. T. Smith G. Matthews M. Chapman D. Boon R. A. Sharman, foreman rodent operative Rodent operatives 4 Rodent/fly operatives 2 Drain tester 1 Public Analyst J. H. Shelton, fric Bacteriologists E. H. Bailey, mrcs, lrcp, and A. J. H. Tomlinson, mb, BChir, of the Public Health Laboratory Service. 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham Mr. Mayor, Ladies and Gentlemen, I submit my report for the health department for the year 1962. Vital statistics The Registrar General's estimate of the population in midyear 1962 on which the rates in this report are based, was 222,170, an increase of 1260 on the previous year's estimate. The census of 1961 showed that the population at the census was 221,590. The crude birth rate for 1962 at 17.6 again shows an increase (it was 16.9 in the previous year) and was the highest since 1949. The adjusted birth rate brings this down slightly to 16.9. The crude death rate at 11.6 is slightly lower than the 11.7 of the previous year, while the adjusted death rate (allowing for age and sex distribution of the population) is 11.5. The infant mortality rate at 18.9 is lower than the 19.6 of 1961; it appears to be stuck around this figure. 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 11.8, 1.2 and 5.9. The stillbirth rate at 12.6 was substantially lower. The various comparative figures of this century are shown in table 10. Infectious disease other than tuberculosis The total number of notifications received (including 103 for tuberculosis) was 909 which is in all probability by far the lowest total figure lately recorded. Indeed only on three occasions in the last fifteen years has it dropped below two thousand, and the lowest previous figure in this series was 1,452 in 1960. A large part of this present drop no doubt is accounted for by the fact that it was not a "measles year", but over the period there have been many other reductions, more particularly in scarlet fever, tuberculosis and whooping cough. In 1962 dysentery cases increased, from 92 to 162, but they were again of a mild type, mainly based on school children and more of a nuisance than anything else. There were only 423 measles cases against 4,278 the previous year. For the second year running there were no poliomyelitis cases and it seems reasonably certain that vaccination was a considerable factor here. The development of an oral vaccine has still further increased the ease with which children can be immunised and there seems no excuse at all, apart from current illness, why parents should run the risk of not having their children protected. Tuberculosis The number of new notifications again decreased—for the sixth successive year. The total was 103, giving a notification rate of 46 per 100,000 population, again a low record. The death rate from pulmonary tuberculosis, however, once more increased, this time from 8 to 10 per 100,000 population. I do not think there is any special significance to be attached to this. The control of tuberculosis, apart from the treatment of cases, is resolving itself more and more into an active search for contacts so as to uncover hitherto unknown cases. This is done primarily by the chest clinic in each case which comes to their notice, and on a rather wider basis by the mass Xray radiography unit. 4 Clean air We have now reached the busiest point in our scheme for the establishment of smoke control areas and if the work goes according to plan the number of houses in which adaptations will be required will decrease slightly in 1964 and in 1965 (when it is hoped that the last Smoke Control Order will be made) and will cease some time in 1966 as the result of the 1965 Orders. The work has gone reasonably smoothly so far, and no local difficulties of a major nature are anticipated provided sufficient staff can be maintained. It is, however, slightly disquieting to hear (in 1963) that there may be an increasing shortage of solid smokeless fuel available. This is against all previous central government advice and is apparently due to the newer technological methods of obtaining gas. It may mean that there will be greater pressure brought to bear on the householder for the installation of gas or electric fittings, or oil fittings, rather than fireplaces which will burn solid smokeless fuel. Details of the work done in 1962 are shown in the body of the report. Old people For the first year there is a separate section devoted to the work of the Council in relation to the care of the elderly. This is because the work has grown so rapidly since the War that it is now one of the major factors in health department expenditure and administration. An incentive to this was an Act passed in 1962 which allowed local authorities to carry out directly many services for the elderly, instead of having to do this indirectly—mainly by means of grants. 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 was increased 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. Housing Act 1961 The Housing Act 1961 was welcomed when it became fully operative as an additional weapon with which to tackle substandard and unpleasantly crowded premises—premises which are usually in multioccupation, housing 2, 3, or several families. Certain work has been carried out under the Act, but in some cases the limitations of the Act have been shown up and although it remains a useful additional weapon it is apparent that it is not going to be the full answer to multioccupation, at any rate as far as London is concerned. In other cases householders have been encouraged to apply for improvement grants, whether discretionary or standard, but the number of such cases remains rather disappointingly low. 5 Staff At the end of the year we still had two vacancies for public health inspectors and this has a braking effect on the amount of work which can be done. The pupil public health inspectors' scheme continues and this, together with similar schemes elsewhere, is having a very gradual effect on diminishing the total number of vacancies. Unfortunately, as far as the London boroughs are concerned, the pupil, having qualified and naturally seeking for additional experience, tends to leave the borough for new fields at the end of the two years requisite service. With the help of the Council's post-entry training scheme Mr. Lakeland, a public health inspector who had been trained here, obtained the Meat and Other Foods certificate. 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 work they have got through under the Clean Air programme, and for the difficulties they continue to surmount 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) Councillor Mrs. D. Hurren, J.P. (The Mayor) Alderman C. S. E. Fox Councillors Mrs. H. D. Burch, Mrs. C. M. Costello, Mrs. D. I. Cox, J. E. Dale, J. Donovan, Mrs. D. E. Eagles, Mrs. D. K. Epps, M.B.E., P. E. J. Forward, R. J. Groves, Mrs. G. M. M. Land, Mrs. D. E. New, Miss B. G. Oldham and A. J. Pinnegar. 6 VITAL STATISTICS NOTE—The principal figures for the previous year are italicised in brackets. Area The area 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 1962 was 222,170. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1962 £3,199,540 Estimated net product of a penny rate 1962/3 £13,020 Estimated number of separately assessed dwellings at April 1, 1962 65,758 Births (adjusted for inward and outward transfers) Total Livebirths 3,910 Males Females Total Legitimate 1,829 1,668 3,497 (3,437) Illegitimate 197 216 413 (303) Totals 2,026 1,884 3,910 (3,740) Crude birth rate per 1,000 of the estimated population 17.6 (16.9) Adjusted birth rate for comparative purposes (Area comparability factor = 0.96) 16.9 (16.3) Birth rate for England and Wales 18.0 (17.4) Adjusted birth rate for London Administrative County 17.6 (16.8) Stillbirths Total (21 males and 29 females) 50 (72) Rate per 1,000 live and stillbirths) 12.6 (18.9) (males 10.3 (21.1): females 15.2 (16.6)) Deaths Total (1,365 males, 1,204 females) 2,569 (2,586) Crude death rate per 1,000 population 11.6 (11.7) Adjusted death rate 11.5 (11.2) (Area comparability factor = 0.99) Death rate for England and Wales 11.9 (12.0) „ ,, ,, London Administrative County 12-0 (11.4) Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 45 21 66 (65) Illegitimate 4 4 8 (9) Total 49 25 74 (74) 7 Rates : 1. All infants per thousand livebirths 18.9 (19.8) 2. Legitimate infants per thousand legitimate livebirths 18.9 (18.9) 3. Illegitimate infants per thousand illegitimate livebirths 19.4 (29.7) 4. Male infants per thousand male livebirths 24.2 (20.5) 5. Female infants per thousand female livebirths 13.3 (19.1) Neonatal deaths (under 4 weeks of age) 51 (51) Neonatal death rates:— Males, per 1,000 male livebirths 17.8 Females, per 1,000 female livebirths 8.0 All infants, per 1,000 livebirths 13.0 (13.6) Early neonatal deaths (under 1 week of age) 46 (44) Males, per thousand male livebirths 16.3 Females, per thousand female livebirths 6.9 All infants per thousand livebirths 11.8 (11.8) Perinatal mortality (deaths under 1 week plus stillbirths) 96 (116) Males, per thousand live and still male births 26.4 Females, per thousand live and still female births 22.0 All infants, per thousand live and stillbirths 24.2 (30.4) Reproductive wastage—(Stillbirths plus all infant deaths) 124 (146) Males, per 1,000 live and still male births 34.2 Females, per 1,000 live and still female births 28.2 All infants, per 1,000 live and still births 31.3 (38.3) Maternal deaths Maternal deaths 2 (1) Maternal mortality rate per thousand live and still births 0.5 (0 3) Other special causes of death Measles (1) Whooping-cough — (—) Gastroenteritis (infants) — (—) Tuberculosis (all forms) 23 (19) Motor vehicle accidents 28 (29) Suicide 26 (31) Respiratory diseases (other than tuberculosis) (Code Nos. 22-25) 379 (379) Cancer (Code Nos. 10-15) 548 (481) Heart and circulation diseases (Code Nos. 17-21) 1,207 (1,311) Comparative statistics for the year 1962 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 16.9 12.6 11.5 18.9 England and Wales 18.0 18.1 11.9 20.7 London Administrative County 17.6 16.6 12.0 21.1 8 Causes of death at different periods of life during the year 1962 The following table shows the causes of and age at death during the calender year 1962:- 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 (b [Oil tin * Totals, all causes 1365 49 2 5 13 50 372 375 499 2569 1 Tuberculosis, respiratory 18 — — — — 3 7 6 2 22 2 Tuberculosis, other forms 1 — — — — — 1 — — 1 3 Syphilitic diseases 4 — — — — — 2 2 — 7 4 Diphtheria — — — — — — — — — - 5 Whooping cough — — — — — — — — — - 6 Meningococcal infections 1 1 — — — — — — — 1 7 Acute poliomyelitis — — — — — — — — — - 8 Measles — — — — — — — — — - 9 Other infective and parasitic diseases 1 — — — — 1 — — 5 10 Malignant neoplasms, stomach 34 — — — — — 13 13 8 62 11 Malignant neoplasms, lung and bronchus 155 — — — — 1 82 55 17 174 12 Malignant neoplasms, breast — — — — — — — — — 54 13 Malignant neoplasms, uterus — — — — — — — — — 17 14 Other malignant and lymphatic neoplasms 127 — — 1 2 7 37 34 46 227 15 Leukaemia, aleukaemia 8 — 1 1 — — 4 — 2 14 16 Diabetes 5 — — — — — 1 1 3 23 17 Vascular lesions of nervous system 106 — — — — 2 19 33 52 288 18 Coronary disease, angina 290 — — — — 7 96 96 91 494 19 Hypertension with heart disease 22 — — — — — 5 7 10 52 20 Other heart disease 103 — — — — 3 11 18 71 262 21 Other circulatory disease 62 — — — — 3 20 12 21 111 22 Influenza 4 — — — — — — 2 1 7 23 Pneumonia 62 4 — — — 1 8 8 41 136 24 Bronchitis 147 1 — — — 2 31 52 61 210 25 Other diseases of respiratory system 12 — — — 1 2 3 6 26 26 Ulcers of stomach and duodenum 12 — — — — 1 1 7 3 20 27 Gastritis, enteritis and diarrhoea 1 — — — — — — 1 — 9 28 Nephritis and nephrosis 9 — — — — 2 2 1 4 21 29 Hyperplasia of prostate 10 — — — — — 1 3 6 10 30 Pregnancy, childbirth, abortion — — — — — — — — — 2 31 Congenital malformations 15 12 — — — — 2 1 — 22 32 Other defined and ill defined 94 30 — — 4 6 10 13 31 189 33 Motor vehicle accidents 20 — — 2 5 6 4 — 3 28 34 All other accidents 26 1 1 1 — 3 6 2 12 47 35 Suicides 16 — — — 2 1 7 5 1 26 36 Homicide and operations of war — — — — — — — — — 2 9 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 1204 25 5 1 2 36 206 274 655 2569 1 Tuberculosis, respiratory 4 — — — — — 2 2 — 22 2 Tuberculosis, other forms — — — — — — — — — 1 3 Syphilitic diseases 3 — — — — — — 1 2 7 4 Diphtheria — — — — — — — — — — 5 Whooping cough — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — 1 7 Acute poliomyelitis — — — — — — — — — — 8 Measles — — — — — — — — — — 9 Other infective and parasitic diseases 4 1 1 — — — 1 1 — 5 10 Malignant neoplasms, stomach 28 — — — — — 9 9 10 62 11 Malignant neoplasms, lung and bronchus 19 — — — — — 8 6 5 174 12 Malignant neoplasms, breast 54 — — — — 4 25 13 12 54 13 Malignant neoplasms, uterus 17 — — — — — 7 6 4 17 14 Other malignant and lymphatic neoplasms 100 — 1 — — 3 33 27 36 227 15 Leukaemia, aleukaemia 6 — — — — 3 1 2 14 16 Diabetes 18 — — — — 1 2 8 7 23 17 Vascular lesions of nervous system 182 — — — — 4 12 41 125 288 18 Coronary disease, angina 204 — — — — 1 37 70 96 494 19 Hypertension with heart disease 30 — — — — — 1 6 23 52 20 Other heart disease 159 — 1 — — 5 15 18 120 262 21 22 Other circulatory disease Influenza 49 3 — — — — 2 6 1 12 29 2 111 7 23 Pneumonia 74 7 1 — — — 7 7 52 136 24 Bronchitis 63 — — — — — 7 18 38 210 25 Other diseases of respiratory system 14 — — — — 2 — 2 10 26 26 Ulcer of stomach and duodenum 8 — — — — 1 3 1 3 20 27 Gastritis, enteritis and diarrhoea. 8 — — — — 1 2 — 5 9 28 Nephritis and nephrosis 12 — — — — 1 3 2 6 21 29 Hyperplasia of prostate 10 30 Pregnancy, childbirth, abortion 2 — — — 1 1 — — — 2 31 Congenital malformations 7 5 — 1 — — — 1 — 22 32 Other defined and ill defined causes 95 12 1 — — 4 12 18 48 189 33 Motor vehicle accidents 8 — — — 1 — 2 1 4 28 34 All other accidents 21 — — — — 1 3 2 15 47 35 Suicides 10 — — — — 7 5 2 1 26 36 Homicide and operations of war 2 — — — — — 2 — — 2 10 Deaths under 1 year of age Table 3 Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths. Total under 1 yr. Meningococcal infections M — — — — — —— 1 — — — 1 1 F — — — — — — — — — — — — Other infective and parasitic diseases M — — — — — — — — — — — — F — — — — — — — — — 1 1 1 Inflammatory diseases of central nervous system M — — — — — — — — — — — — F — — — — — — — — — 1 1 1 Pneumonia M — — — — — — 7 — 7 — 4 4 F 1 1 — — — 2 2 2 1 — 5 7 Bronchitis M — — — — — — — 1 — — 1 1 F — — — — — — — — — — — — Spina-bifida and meningocele M — — 1 — — 1 — — — — — 1 F — — — — — — 1 — — — 1 1 Congenital malformations of heart M 1 4 — — — 5 — 1 — — 1 6 F — — — 1 — 1 1 — — — 1 2 Other congenital malformations M 2 — 2 — — 4 — — 1 1 5 F — 1 — — 1 2 — — — — — 2 Injury at birth M 1 5 — — — 6 — — — — — 6 F 1 — — — — 1 — — — — — 1 Post-natal asphyxia and atelectasis M 3 5 — — — 8 — — — — — 8 F 2 1 — — — 3 — — — — — 3 Haemolytic disease of newborn M 1 1 — — — 2 — — — — — 2 F — — — — — — — — — — — — Immaturity M 5 3 — — — 8 — — — — — 8 F 3 2 — — — 5 — — — — — 5 Accidents M — — — — — — — — — 1 1 1 F — — — — — — — — — — — — All other causes M 1 1 — — 2 2 2 — — 4 6 F 1 — — — — 1 — — 1 — 1 2 TOTALS M 14 19 3 — — 36 5 4 3 1 13 49 F 8 5 — 1 1 15 4 2 2 2 10 25 GRAND TOTAL 22 24 3 1 1 51 9 6 5 3 23 74 23 infants (13 male and 10 female) thus died between the age of one month and one year, the same number as in the previous year, and compared with 20 the year before that. 10 of the 23 deaths were from pneumonia and bronchitis, 2 were from congenital malformations, and there was one each through 6 other causes, with 5 being undefined. The number of deaths under 4 weeks of age was also the same as the previous year, the greatest incidences being in immaturity with 13 deaths (1 less than last year), and post-natal asphyxia and atelectasis with 11 deaths (1 more than last year). 11 The social class, related to cause of death, was as follows :— Table 4 Code No. Cause of death Male Female 1 11 Ill IV V Total 1 11 III IV V Total 1 Tuberculosis, respiratory — 15 1 5 21 — 1 1 2 4 2 Tuberculosis, other forms — — 1 — 1 — — — — — — 3 Syphilitic disease — — — 4 — 4 — — — 3 — 3 4 Diphtheria — — — — — — — 5 Whooping cough — — — — — — — — — — — — 6 Meningococcal infections — — — — — — — 7 Acute poliomyelitis — — — — — — — — — — — 8 Measles — — — — — — — — — — — — 9 Other infective and parasitic diseases — — 1 — — 1 — — 2 — — 2 10 Malignant neoplasm, stomach — 5 18 10 1 34 — 5 12 5 4 26 11 Malignant neoplasm, lung, bronchus 5 27 80 32 11 155 1 4 8 4 2 19 12 Malignant neoplasm, breast — — — — — — 1 14 31 6 1 53 13 Malignant neoplasm, uterus — — — — — — — 2 11 3 1 17 14 Other malignant and lymphatic neoplasms 8 20 66 25 5 124 3 29 47 15 7 101 15 Leukaemia, aleukaemia — 4 7 1 1 13 — 4 2 6 16 Diabetes — 1 1 2 4 1 3 10 2 2 18 17 Vascular lesions of nervous system 6 19 65 13 8 111 5 32 94 21 8 160 18 Coronary disease, angina 5 48 142 28 16 239 4 32 82 24 10 152 19 Hypertension with heart disease 2 10 23 4 3 42 2 15 26 7 2 52 20 Other heart disease 5 26 72 17 13 133 6 39 97 20 15 177 21 Other circulatory disease 2 15 26 9 4 56 2 8 33 4 3 50 22 Influenza — 2 — 2 — 2 1 1 4 23 Pneumonia 3 13 30 20 5 71 — 13 37 15 8 73 24 Bronchitis 3 24 79 22 17 145 15 30 10 7 62 25 Other diseases of respiratory system — — 7 — 1 8 — — 8 1 1 10 26 Ulcer of stomach and duodenum — 5 3 3 2 13 — 2 4 2 1 9 27 Gastritis, enteritis and diarrhoea — 1 1 — 4 2 6 28 Nephritis and nephrosis — 1 10 5 1 17 1 5 10 1 17 29 Hyperplasia of prostate — 4 3 1 8 30 Pregnancy, childbirth, abortion — — 1 1 2 31 Congenital malformations — 2 12 1 1 16 — — 4 1 — 5 32 Other defined and ill defined diseases 4 10 46 15 3 78 3 22 44 10 4 83 33 Motor vehicle accidents — 2 12 2 2 18 — 1 5 3 — 9 34 All other accidents — 5 10 2 2 19 - 5 9 — 2 16 35 Suicides 1 4 10 2 17 1 1 3 6 11 36 Homicide and operations of war — — — — — 1 1 — — 2 Totals 44 247 739 216 105 1351 30 252 614 169 84 1149 Percentage 3 18 55 16 8 100 3 22 53 15 7 100 No social class assessed — — — — — 14 — — — — — 55 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. 12 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 4 for all deaths, but for certain groups it will be realised that the numbers are too small for comparison year by year. Table 5 Grouped deaths in social class Code Nos. Group Male Female I 11 III IV V Total I 11 III IV V Total 10-15 Cancers No. 13 56 171 68 18 326 5 58 111 33 15 222 % 4 17 52 21 6 100 2 26 50 IS 7 100 17-21 Heart and circulation No. 20 118 328 71 44 581 19 126 332 76 38 591 % 3 20 57 12 8 100 3 21 56 13 7 100 22-25 Lung, not TB or cancer No. 6 39 116 42 23 226 28 77 27 17 149 % J 1/ 5/ 19 10 100 — 19 52 18 11 100 33-34 Accidents No. 7 22 4 4 37 — 6 14 3 1 25 % — 19 59 11 11 100 — 24 56 12 8 100 35 Suicides No. 1 4 10 2 17 1 1 3 6 11 % 6 23 59 — 12 100 9 9 27 55 — 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 4. Table 6 Social classification Total Not classifiable I 11 III IV V Registered births No. 139 698 2224 473 261 3795 115 % 4 18 59 12 7 100 Registered stillbirths No. - 2 29 8 5 44 6 % — 5 66 18 11 100 Registered infant deaths No. - 6 57 9 2 74 - % — 8 77 12 3 100 Notified premature births No. 5 29 146 38 25 243 44 % 2 12 60 16 10 100 13 Local sickness The Regional Medical Officer of the Ministry of National Insurance sends a weekly return indicating 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 mainly by two offices, "Lewisham," and "Downham," and a fair representation of the trend of sickness within the borough can be given by quoting the combined figures for these two. Table 7 Morbidity shown in insurance certificates Weekly average for period ending "Lewisham & Downham" Weekly average for period ending "Lewisham & Downham" January 30 1499 August 14 434 February 27 957 September 14 463 March 27 939 October 12 651 April 24 788 November 6 720 May 22 725 December 4 769 June 19 518 January 1 1085 July 17 465 Weekly average for the year 1962 760 „ 1961 699 FIRST APPLICATIONS FOR SICKNESS BENEFIT Dotted lines—Maximum and Minimum 1951—61 Continuous line—1962 14 The year cannot be regarded as abnormal. A peak occurred however at the beginning of the year, and during the middle part the graph line ran at or slightly over the maximum for the previous eleven years. Though remaining steady towards the end of the year it was considerably below past peaks of that period, except for the 50th week when it reached a high point. Coronary disease The dietary factor seems to loom ever larger as more is understood about coronary disease, and advice on this has been given in the last three annual reports. It can be summarised as follows : 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. The table below shows an increase of over 50 per cent in coronary mortality in the age group 45-65 in only ten years ; in the age group 25-45 for males it is even more. Table 8 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 diseasesi Total Coronary diseases (e) of (h) (f) of (h) (g) of (h) (o) (b) (c) (d) (e) (f) (g) (h) (i) (J) (k) 1928 357 97 454 115 — 1993 23 5.8 1 1933 516 117 633 162 — 2271 28 7.1 1 1938 659 139 798 178 - 2403 33 7.4 1 1943 583 64 647 129 - 2359 27 5.5 1 1948 696 63 759 155 — 2253 34 6.9 1 1953 775 113 888 140 — 2502 35 5.6 3.4 1958 770 109 879 150 - 2433 36 6.2 4.1 1953 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 6.1 4.1 8 407 363 109 879 150 99 2433 36 6.1 4.1 9 470 360 118 948 161 110 2617 36 6.2 4.2 1960 364 321 113 798 149 102 2510 32 5.9 4.1 1 492 375 123 990 176 122 2586 38 6.8 4.7 2 494 314 111 919 191 133 2569 36 7.4 5.2 I means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. 15 Lung cancer Table 9 Year MALE FEMALE All cancer deaths Lung cancer deaths (c)as 0/ of(b) All cancer deaths Lung cancer deaths (f)as % of(e) (°) (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 3 4 226 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 1961 271 119 44 210 15 7 1962 324 155 48 224 19 8 The Tobacco Manufacturers' Standing Committee have done well to issue a third edition of their smoking statistics in the UK. These are extremely detailed but it appears from them that the total tobacco goods sold to the public in the UK in 1961 were 22% over those in 1951. For cigarettes this percentage increase was 27 (6 for plain and no less than 21 for tipped—which 10 years ago were only a very small part but are now about one-fifth of all cigarettes sold) ; for ordinary tobacco there was a decrease of 12 percent ; and for cigars an increase of 60 percent, though total sales of these are still very small. With regard to the sexes, during the same period of time there was an increase from 3610 to 4010 in the number of cigarettes consumed per adult male (11%) while for the adult female the number of cigarettes consumed increased from 1120 to 1680 (50%). The effect of recent propaganda against smoking appears to have been negligible, or even negative. Thus, up to age 25, for males, 61% were smokers in 1956 and 67% in 1961, and for females to the same age, 38% were smokers in 1956 while 49% were smokers in 1961. [This is a truly appalling result for the efforts made to guide the younger adults in the community]. Over the age of 25 the percentage of non-smokers in males between 1951 and 1961 increased from 19 to 27. From another table given it appears that the average adult man aged 47 had over the previous 20 years smoked 92,000 cigarettes, as against 33,000 for a woman of the same age—a ratio of nearly 3:1 ; at the age of 65 the ratio would be nearly 4:1 [this no doubt throws light on the difference in the lung cancer ratio between the sexes]. The tobacco manufacturers have given a large sum of money for research in the causation of lung cancer, and they must be congratulated on the clear and detailed layout of the statistical tables they have provided, on which the above comments are based. What to do ? From table 9 it will be seen that male deaths from lung cancer are more than double what they were only eight years previously. It appears that local propaganda to stop or cut down cigarette smoking may have failed, and it would seem that a sustained national effort, by advertisement and education, and directed to the teenagers particularly, is essential. 16 Because the matter is so important, and as far as teenagers are concerned, so urgent, I feel I should repeat extracts from the advice I gave last year after the publication of the report of the Royal College of Physicians : "For many years medical officers of health have underlined the association of cigarette smoking with lung cancer (in this borough advice on this has been given over at least the last 10 years), but unfortunately with no obvious effect on the amount of tobacco consumed, while at the same time the lung cancer rate has steadily increased. Advice to stop smoking, certainly of cigarettes, to lessen the risk from lung cancer, chronic bronchitis, and certain heart diseases, has now been given by such an influential body as the Royal College of Physicians, and so the gist of their advice is modestly repeated here: SAVE YOUR HEALTH, YOUR FAMILY, YOUR POCKET... by giving up smoking. That is what it really amounts to. If you are wavering on the brink of giving it up, do now take the plunge, but even if you have not the inclination or will-power for that, please get out of the unhealthy social habit of offering cigarettes on so many occasions to your friends. (Keep them, if you have to, for your enemies!) Remember that: lung cancer may not show itself for 20 years or more; it is almost invariably fatal; it attacks younger age-groups than most other cancers; 20,000 men died of it last year in this country; it appears to be one of the very few cancers which is mainly preventable; evidence of its connection with cigarette smoking is overwhelming. Also remember that cigarette smoking can cause, or make worse, chronic bronchitis, certain types of heart disease, some stomach ulcers. A word for the middle-aged smoker: Statistics show that your safety chances improve with every year you give up smoking. Long-term comfort : With all the research going on now there is a probability that sooner or later the disease-causing factors in smoking will be identified and eliminated. The younger person therefore if he gives up now because it is dangerous, can comfort himself with the thought that in one, five, perhaps ten years' time, he will be able to smoke without danger to himself, other than to his pocket." 17 The decline in child mortality Statistics about causes of deaths and the ages at which people die depress a lot of readers, especially as they get older. Sometimes, however such statistics have a highly encouraging content, particularly in relation to children. No harm is done, therefore, by occasionally drawing attention to them. In a booklet entitled A Study In Childhood Mortality, published at the end of 1962 by the Office of Health Economics (an offshoot of the Pharmaceutical Industry) figures are given of childhood deaths (aged 1 to 14) from specified causes, from which the following table is constructed. The figures are the annual death rates per million children living in this country. Cause 1931/35 1956/60 ALL CAUSES 3,017 523 Diphtheria, Measles, Whooping cough, Meningitis, Scarlet fever 824 17 Pneumonia, Bronchitis, Influenza 707 65 Tuberculosis 332 6 Gastro-enteritis 72 9 Non-traffic accidents 142 83 Road deaths 134 62 Neoplasms 64 85 In only one of the earlier main causes of childhood deaths, namely neoplasms (cancer), has there been an increase. This, though serious and calling for increased research, should not prevent a feeling of gratitude to the drug industry and to hygiene generally for the spectacular decrease during a mere 25 years of so many other killers. The saving of life and health (and thereby working capacity) has been phenomenal and can be calculated in terms of money; the saving of the feelings of parents and relatives is beyond calculation. The figures for road deaths, however, have a more sinister side. Although at first it seems surprising that they have decreased to less than half of what they were 25 years ago the total number of casualties, and also the number of fatal casualties, has steadily increased in the last 12 years, and the saving of life, in many cases offset by permanent crippling, has been due to improved surgical techniques and to drugs. These national figures can no doubt be applied almost exactly pro rata to this borough. 18 General statistics from 1901 Table 10 Year Population Death rate 0 % dying under age 45 % dying under age 65 Birth rate * Premature birth rate t Maternal death rate t Stillbirth rate t 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. roteff Death roteff % 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 — 2.8 — 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 S4 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 — 79 154 76 12 19 Table 10 —continued (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 1.0 22 — — 40 62 196 79 11 1945 171,230 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 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 11.2 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 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 Nil 14 13 8 21 3S 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 Nil 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 Nil 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 Nil 17 13 6 19 36 54 5 10 1961 220,910 11.7 7 28 17 72 0.3 19 14 6 20 39 51 8 9 1962 222,170 11.6 7 30 18 73 0.5 13 13 6 19 32 37 10 11 *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. — means figure not available. 20 GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows :— Disinfecting Station Table 11 West North South Total Disinfection Premises visited 24 31 42 97 Rooms disinfected 45 74 93 212 Articles disinfected 837 750 694 2281 Disinfestation Premises visited 21 22 9 52 Rooms disinfested 59 66 24 149 Articles disinfested 19 9 2 30 Articles treated Beds 18 7 18 43 Mattresses 69 40 70 179 Bolsters 20 14 17 51 Pillows 127 49 86 262 Cushions 7 5 19 31 Quilts 17 10 20 47 Blankets 187 76 93 356 Sheets 28 39 44 111 Household articles 222 194 205 621 Wearing apparel 161 325 124 610 Total articles 856 759 696 2311 Articles received from the cleansing station - 1221 - 1221 Articles received from the Coroner's court - 1123 — 1123 Public library books treated after infection 137 53 76 266 Private library books treated after infection - 6 1 7 Articles treated under the Public Health (London) Act s.122 20446 26320 12516 59282 Treatments for verminous conditions and for scabies were as follow: — Verminous conditions Table 12 1st Cleansing 2nd Cleansing 3rd Cleansing 4th Cleansing Children under 5 6 - - - School children 40 2 - - Adults 14 1 - — TOTALS 60 3 - — 21 Scabies Table 12—continued Cases Contacts Treatments Children under 5 15 - 28 School children 43 - 86 Adults 24 — 48 TOTALS 82 — 162 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 health 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. 8 such cases arose during the year. Anti-fly and anti-mosquito campaign During the period of this campaign, May to the end of September, 310 sites, grass verges and rear entrances were visited and treatment by spraying or the use of powder applied as necessary. Material collected or destroyed on the sites consisted of 50 mattresses, 27 chairs, items of bedding and a large quantity of miscellaneous articles such as carpets, lino, straw, paper and rags. Most of this rubbish was taken to the depot for removal with the household refuse. In a few instances, when the material was dry, it was destroyed by burning on the site. Mr. Craven, the deputy senior inspector, who is in charge of this anti-pest work reports that stables, piggeries and certain plots of land known to be particularly bad as rubbish dumps were treated as special sites and these were visited regularly, particular attention being paid to the manure receptacles at the stables and piggeries. Throughout the campaign frequent visits were made to Lewisham Hospital to spray the refuse containers and sites of the kitchen waste bins. Some attention was also given to the dustchutes and openings at both the Council's and the L.C.C.'s blocks of flats. The caretakers of the Council's flats were supplied with both liquid and powder insecticide for use in connection with the containers at the base of the chutes, particularly following emptying, and for the sites of any waste bins. The cooperation of the Borough Engineer's Department was again available for the treatment of dustbins with powder supplied by the Health Department. In addition treatment by spraying of houses was carried out by the staff of the disinfecting station following complaint by the householder concerned. In a number of cases a supply of insecticide was also left with the householders for use in their own sprayers. 22 Health education During the year the food inspectors during the course of their routine inspections of foodshops 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 recipients in the borough. In the course of the year four lectures or talks were delivered by the Health Department staff, two of these to members of a women's club, one to older schoolboys, and one to an old people's club. 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 13 Month Bodies received from Institutions Others Post-mortem examinations Inquests held Lewisham residents Others January 40 48 63 25 7 February 34 35 45 24 9 March 40 50 57 33 18 April 28 42 45 25 10 May 43 34 42 35 14 June 29 40 32 37 4 July 35 25 30 30 15 August 23 22 26 19 4 September 40 22 30 32 11 October 40 33 35 38 20 November 31 23 32 22 10 December 48 50 57 41 14 TOTALS 431 424 494 361 136 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 1962, Mr. Phillips, the senior public health inspector, states:—"Houses in multi-occupation still figure fairly high in the list of complaints of mouse infestation, and, again, reasonable control was obtained by the use of warfarin although in one or two food shops the baiting had to be extended over a considerable period before a complete clearance was effected. 23 The number of rat complaints showed a slight decrease, which may be due to two causes: firstly to a few years' baiting of the sewers with sodium fluoracetamide, and secondly to repair work being carried out to the river banks by the County Council. Again defective and disused drains were the cause of a number of the complaints and it was necessary to serve notices on the owners to carry out repairs or to seal off the connections to the sewers. Food, principally bread and kitchen scraps thrown out for the birds especially during the severe winter, was responsible for attracting rats in certain areas of the borough and people were reluctant to stop this practice. It should be impressed on the public that this feeding is best carried out first thing in the morning so that the birds have a chance of clearing it before dusk when rats are more active and in search of food." The undermentioned table gives a summary of the work on the rivers, prebait being laid on 3/4 days :— Table 14 Location Base points River Ravensbourne 158 River Quaggy 130 For the past three years continuous baiting of manholes has been undei taken by a permanent rodent control gang, and after some 4,000 manholes had been baited four times over a period slightly longer than a year a complete pre-baiting and poisoning control was exercised to ascertain the result. Under the old system of undertaking rodent control twice a year the position was becoming static and over one-quarter of poison takes were being recorded from the number of manholes baited. The prebait and poison check which was undertaken in 1962 showed quite encouraging results, recording a total of poison takes of considerably less than a quarter. Continuous baiting has once again been undertaken, but no further pre-baiting test has been carried out. Prevention of Damage by Pests Act, 1949 A copy of the report covering the calendar year 1962 submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended:— 24 Table 15 Type of property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Properties in borough 140 66,307 12,051 78,498 — Properties inspected as a result of:— (a) notification 4 1,338 164 1,506 - (b) survey 1 493 19 513 — (c) otherwise 1 12 4 17 — Total inspections (including reinspections) 7 2,004 188 2,199 _ Properties inspected which were found to be infested by:— (a) Rats — major - - - - (b) —minor 5 1,010 107 1,122 — (c) Mice—major — — — — — (d) —minor .. — 287 52 339 — Infested properties treated 5 1,185 151 1,341 Total treatments (including retreatments) 18 1,958 433 2,409 — "Block" control schemes carried outNil Laboratory facilities The following summary relates to the work carried out by the public health laboratory on behalf of the Council during 1962. The total number of specimens shows a considerable decrease on the previous year. Table 16 Specimens Number Remarks Faeces 359 Negative 42 Shigella sonnei 4 „ flexneri 18 Salmonella typhimurium 3 „ give 1 „ enteritidis 1 „ heidelberg 3 „ typhi 1 „ paratyphi B. Urine 16 Routine Swabs from nose, throat etc. 60 Negative 13 B-haem. strep. 1 E. coli 7 Staph. aureus Sputum 2 Negative Water (various) 5 Food 5 Blood (for Widal reactions) 7 Total specimens 527 25 Swimming baths There are 4 public swimming baths in the borough, in addition to a few club and school swimming baths. The public swimming baths are shown in the table, together with the laboratory tests taken during the year. Table 17 Bath Tests Variation of chlorine (p.p.m.) Chlorine 8 act. Ladywell West 8 0.2—1.6 Ladywell East 11 - 0.1—1.2 Forest Hill North 3 - 0.8—1.3 Forest Hill South 4 - 0.8—2.4 Downham 11 - 0.2—1.4 Bellingham (openair) 4 — 0.1-1.2 The water used for these baiths is supplied by the Metropolitan Water Board anid is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metaphosphate being used to control acidity 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. and 1 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 8 persons, at a net cost to the Council of £23. National Assistance Act, 1948—section 47 Possible cases were investigated during the year and in none of them was it necessary to apply for a compulsory order. (See also the section on the Care of the Elderly). Dog excreta nuisances No proceedings were taken during the year, although complaints were received of the condition of certain roads and paths. Where a complaint is received it is the practice to exhibit a byelaw notice at a convenient site nearby. Drainage work During the year 159 plans were submitted to the public health inspectors for examination and approval. Water supply The Director of Water Examination of the Metropolitan Water Board states that the water supply to the Borough is well water derived from the Darenth, Deptford, Bexley and Wilmington wells, together with River Thames derived filtered water. There were no new sources of supply instituted by the Board during 1962 nor were there any important extensions of trunk mains, but 1,193 yards of smaller mains were laid in the Borough for local supply purposes. Tables 18 and 19 give the average results of the chemical and bacteriological analyses of the various supplies for 1962. 26 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1962 milligrams per litre (unless otherwise stated) (a) CHEMICAL Table 18 Description of the sample Ammonia nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as CI. Oxygen abs. from permanganate (4 hrs. at 27°C) Hardness (total) Hardness (noncarbonate) pH value Electrical Conductivity (micromhos) Southern Group .042 .076 4.0 31 1.12 256 58 7.8 550 Deptford .009 .029 7.0 36 0.14 362 114 7.2 720 Bexley .011 .031 5.5 19 0.10 318 68 7.2 580 Darenth .010 .023 5.3 17 0.10 266 26 7.2 500 Wilmington .017 .033 9.3 23 0.14 292 48 7.2 550 (b) BACTERIOLOGICAL Table 19 BEFORE TREATMENT (RAW WATER) AFTER TREATMENT (WATER PASSING INTO SUPPLY) Plate counts (average per ml.) Colonies counted on agar 37°C. Coliform count Plate counts (average per ml.) Colonies counted on agar 37°C. Coliform count Percentage samples neg. 100 ml. Percentage samples neg. 100 ml. (20-24 hrs.) 22°C. (3 days) Coliform E. Coli (20-24 hrs.) 22°C. (3 days) Coliform E. Coli Southern Group - - - - 11.5 - 99.79 99.95 Darenth well 0.0 129 96.00 99.20 0.2 6 99.60 100.C0 Deptford 0.0 58 98.80 99.20 2.2 216 99.61 99.61 Wilmington No 2. Well 0.1 42 94.31 97.15 13.0 375 98.41 100.00 Bexley 0.1 44 98.41 98.80 0.0 10 100.00 100.00 27 Home safety As a result of pressure by the Metropolitan Boroughs' Standing Joint Committee a clause was included in the LC'C (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. The collection of home accident statistics is to some extent a longterm process and it is only by obtaining the knowledge and studying it an'd 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. It has been found impracticable to gather the necessary statistics, buit some of a limited nature, based on County Council ambulance removals for 1962, are as follows: Table 20 Accidents Quarter of year Total 1st 2nd 3rd 4th 1962 1961 Total for London 2170 2092 1977 2368 8607 8431 Total for Div. 7 (Lewisham and Camberwell) 294 266 285 281 1126 1028 Rate per 10,000 population London 6.8 6.6 6.2 7.4 27.1 26.5 Div. 7 7.4 6.7 7.2 7.1 28.5 26.0 Falls total 1670 1602 1522 1771 6565 6456 on stairs 256 233 253 256 998 1119 fipping 274 164 146 167 751 920 in the garden 58 67 59 35 219 227 Knifelike wounds 73 100 75 78 326 337 Gassing 49 46 30 67 192 165 Burns and scalds 145 117 101 190 553 497 Poisoning (including foreign objects) 73 74 95 98 340 338 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. 28 Atmospheric pollution Clean Air Act During 1962 two more areas were made the subject ot bmoke Control Orders and particulars with regard to these are as follows:— Name No. 12 (Brockley) No. 13 (Manor) Acreage 260 680 No. of industrial premises 5 78 No. of commercial premises 137 589 No. of dwellings 4,402 6,932 No. of other premises 8 50 Present annual tonnage of bituminous coal to be replaced 5,210 10,000 Likely additional fuel required annually:— (a) Electricity (BTUs) 585,000 1,000,000 (b) Gas (therms) 110,500 200,000 (c) Oil, etc. NIL NIL (d) Solid smokeless fuel (tons) 3,908 8,000 Total estimated cost of works £68,100 £80,200 Date:—Order made 25.7.62 25.7.62 Order confirmed 31.10.62 31.10.62 Order operative 1.7.63 1.10.63 The progressive total (when these Orders are operative) will be 3,850 acres covering 38,972 dwellings. Programme As a result of the experience gained in the first few areas of the borough it was 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 and1 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 ithe end of December 1962, the position in relation to areas which have been or still are the subject of smoke control action was as follows: — Table 21 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 3,123 1.7.62 9 Northover 3,226 1.9.62 10 Blythe Hill 2,586 1.10.62 11 Algernon 1,981 1.11.62 12 Brockley 4,402 1.7.63 13 Manor 6,932 1.10.63 14 Vancouver 2,200 — Programmed for survey 15 Baring 5,250 — do 16 HonorOak 2,400 — do 17 Blackheath 2,100 — do The above deals with approximately 51,000 dwellings out of an estimated total of 71,000. 29 Measurement of atmospheric pollution Table 22, on pages 30 and 31, gives a record of the principal results from the stations, and also gives some indication of the sunshine, rainfall etc. during the year. Some of these latter data are not specific to the borough, having been obtained from a publication of the Meteorological Office, and relate to the nearest station which records the particular item concerned. Later in the year an additional volumetric station was sited at the Town Hall, capable of giving hourly smoke readings. This enabled the variations in the December smog to be seen with exactitude (see chart), Although the smog had many things in common with the killer of 1952 its lethal effect was very small. There is a mild belief that the smoke control programme was a major factor here. 30 31 Atmospheric Condition in 1962 Table 22 January February March April May June July August September October November December Average or actual (as applic.) Temperature— Mean maximum1 °C 7.4 7.3 6.7 12.0 14.4 19.3 19.8 19.4 17.1 14.9 8.8 4.8 11.8 Mean minimum' °C 3.3 3.3 0.9 5.5 8.1 10.2 12.7 12.4 10.5 8.6 4.7 0.8 6.8 Mean1 °C 5.3 5.3 3.8 8.7 11.2 14.7 16.3 15.9 13.8 11.7 6.7 2.8 9.7 Diff. from average1 °C + 0.5 + 0.4 —2.9 —0.6 —1.3 -1.0 —1.5 —1.4 —1.1 —0.8 —0.5 —2.3 —1.0 Highest maximum2 °C 12.8 12.2 13.3 21.1 20.5 26.1 25.0 25.5 24.4 18.9 12.8 12.2 26.1 Lowest minimum2 °C —5.0 —2.2 —2.8 3.3 3.3 5.0 10.5 9.4 5.5 1.7 —1.1 —3.9 —5.0 Rainfall— Total2 in. 2.92 0.47 1.06 2.21 1.97 0.35 2.16 1.83 2.46 1.34 1.54 1.34 19.6 Percent of average1 ... 107 41 92 92 86 16 95 108 143 96 80 111 89 Sunshine1 Daily mean hrs. 2.13 2.43 3.64 4.69 5.43 8.73 4.30 5.57 5.07 3.77 1.22 2.20 4.07 Percent of average ... 154 113 100 94 81 124 67 92 109 121 71 171 108 Wind1 NE/E/SE % 10 26 32 31 18 29 23 10 13 33 32 33 24 S/SW/W % 73 44 28 43 52 44 46 74 60 38 28 35 47 NW/N/Calm % 17 30 40 26 30 27 31 16 27 29 40 32 29 Atmospheric pollution— West Division3: Water insol. matter tpm 12.31 5.58 11.22 9.89 12.75 9.56 9.71 12.22 9.55 7.40 8.38 4.87 9.45 Water sol. matter tpm 6.73 3.96 5.15 5.85 5.00 4.16 4.55 3.95 4.86 6.46 5.33 3.85 4.99 Sulphur † 2.17 1.99 1.53 2.83 1.02 0.58 0.64 0.59 0.56 1.11 1.42 2.28 1.39 Smoke, daily average * 114 97 112 49 41 23 25 16 36 110 113 191 77 „ maximum * 748 412 460 128 128 65 56 57 113 280 471 1868 — „ minimum * 4 28 16 4 9 7 5 5 4 14 46 16 — Sulphur, daily average * 147 165 222 127 83 75 75 42 69 194 233 384 151 „ maximum * 929 467 483 477 288 232 213 136 169 425 756 2394 — minimum * 23 62 48 57 18 13 13 13 13 28 60 73 — North Division4 : Smoke, daily average * 129 88 105 49 39 22 22 20 36 98 102 195 75 „ maximum * 688 296 344 108 108 68 54 64 95 259 391 1340 — „ minimum * 24 24 26 12 8 6 2 6 6 14 35 82 — Sulphur, daily average * 216 137 331 100 71 88 75 67 69 124 120 230 136 „ maximum * 861 288 239 183 153 271 157 123 127 284 290 1294 — „ minimum * 55 66 57 36 13 13 40 13 13 36 52 82 — South Division5 : Water insol. matter tpm 11.59 7.18 10.94 10.03 12.52 9.10 7.74 8.18 7.65 7.00 7.46 5.35 8.73 Water sol. matter tpm 7.84 5.22 6.61 6.53 6.28 4.16 5.98 4.24 4.87 7.96 6.25 4.17 2.03 Sulphur † 1.33 0.56 1.40 1.07 0.84 0.43 0.52 0.28 0.43 1.01 1.49 2.03 0.95 Smoke, daily average * 149 138 140 71 59 25 23 14 39 102 99 166 85 „ maximum * 884 496 464 136 148 52 77 68 120 279 391 1496 — „ minimum * 20 32 32 12 24 2 1 1 4 12 20 24 — Sulphur, daily average * 245 179 222 136 94 79 74 44 73 214 248 405 168 ,, maximum * 1246 535 542 518 303 222 226 160 181 505 692 2678 - „ minimum * 54 44 71 32 24 14 12 13 13 27 57 95 - Weather summary ... Changeable but sunny Dry, somewhat stormy Unusually cold Rather cold Coo and dull Sunny, but cool and dry Cool, very dull Cool, wet, dull Cool and wet Bright and quiet Dull, fairly dry Cold, fog, then sunny Notes : 1Kew; 2Lewisham; 3Valentine Court for smoke and sulphur, Pool allotments for others Paragon Place for smoke and sulphur; 5Pendragon school for smoke and sulphur, Verdant Lane for others tpm: tons per square mile per month; †as trioxide in mg per 100sq. cms. per day microgrammes per cubic metre. 32 CARE OF THE ELDERLY 1. General The work done by the Council on the care of the elderly has increased so much in recent years that it now justifies a separate section in this report. The "elderly" for administrative purposes are regarded as men over the age of 65 and women over the age of 60. In the 1951 census there were 9,508 men and 21,199 women in these age groups, making a total number of 30, 707 out of a total population of 227,576, being equivalent to 14 percent. In the 1961 census these figures were 10,177, 24,052, 34,229, 221,753 and 16 percent respectively, thus showing a 3,500 increase in the elderly. The number of old people resident in the borough is likely to go on increasing for some years, although recent forecasts by statistical experts has thrown a rather different light on the probable future proportion of old people in the population over the whole country. At one time it was thought that this would go on increasing until the end of the century but the unexpected increase in the birth rate over the last few years has indicated that in fact the proportion of the elderly, after rising slowly in the next decade, will probably drop. Nevertheless the problem remains a large one and the care of the elderly has thus become an increasing factor in the work of the Public Health Department. 2. Powers available Until 1962 the metropolitan boroughs had very limited powers with regard to carrying out this work, and apart from a few minor more or less indirect duties in connection with the elderly, their power was limited to making grants to those voluntary organisations which provided meals or recreation for old people. The Borough Council took full advantage of this, as will have been seen in my previous annual reports, and apart from that made to some twenty voluntary clubs of varying size and complexity, a very large grant, increasing each year, has been made to the Lewisham Old People's Welfare Association, which is the main coordinating organisation for old people in the borough. The power to make grants was contained in the National Assistance Act, 1948, but last year there was passed the National Assistance Act 1948 (Amendment) Act, 1962, which empowered local authorities, as an alternative to giving grants to voluntary organisations, to carry out similar work directly themselves. 3. Direct work The Council's direct work in the care of the elderly is commented on in the following paragraphs: (a) The Saville Details of the Saville premises in Lewisham High Street which were opened in October 1961 as a centre for various activities for old people, were set out in my last year's annual report. The Saville had been purchased and started under other powers then available to the Council, which powers could include certain things for the welfare of the elderly. Activities at the Saville increased during the year and at the end of the year the following was the timetable of activities as far as old people were concerned, this being in addition to the work at the 33 meals-on-wheels kitchen which is administered by the Lewisham Old People's Welfare Association and which during the year produced 20,338 meals, 9,820 of which were taken up by the luncheon club at the Saville itself. Morning Midday Afternoon Monday Dressmaking classes (upstairs) Morning coffee Dinner club Club Tuesday Handicraft classes (upstairs) Housebound club —do— Handicraft for housebound Wednesday Choir practice (downstairs) Morning coffee (upstairs) —do— Club Thursday Handicraft classes (upstairs) —do— Handicraft for housebound Friday Dressmaking classes (upstairs) Morning coffee —do— Club Additionally, when not required for old people, the Saville has been found very popular for hiring by outside individuals and organisations. It appears to be a favourite place for wedding receptions on a Saturday. It is also let in the evenings for the routine work of a division of the St. John Ambulance Brigade and for one or two other organisations' committee meetings. As will also be seen later in this report it is used experimentally for a Junior Pensioners club organised by LOPWA. (b) Burnt Ash In the spring of 1962, the County Council gave notice that they would not continue to use certain premises at the corner of Burnt Ash Hill and Marvels Lane (which belong to the Borough Council) and which they had been using as a school annexe for many years past. After much consideration it was decided that the buildings could be used for old persons' activities although in fact they are not well sited geographically, being on the edge of the borough in the south-east corner where there is an area of light residential development and several playing fields. The buildings comprise two large wooden/concrete structures, one of which is a large hall with cloakroom, small kitchen and office accommodation, while the other is made up of three classrooms together with similar cloakroom and office accommodation. Although the County Council was moving out its primary school, it had had for many years an arrangement with various youth organisations for the use of the premises in the evenings, and it was decided that in addition to the activities for the elderly the youth organisations should continue to use the premises. This of course has had a very limiting effect on the amount of adaptation which could be carried out and it has made for some difficulties in the upkeep and maintenance of the premises. After a small amount of adaptation the premises were 34 opened in October 1962 by the Mayor, and the activities for the elderly carried on there are as follows : (i) An afternoon club for the elderly This is held at present on a Thursday afternoon and additional sessions will be started if attendances warrant them. (ii) The rest room One of the classrooms has been brightly and comfortably furnished as a rest room where any elderly person in the locality can sit down, buy snacks, read journals or play cards, if he so desires. This has not so far caught on very well for casual visitors, but the room has been used by members of the club and those attending the workshop. (iii) Workshop for the elderly There has been a tendency up and down the country to establish what are called workshops for the elderly, in which light unskilled or semi-skilled work is carried out for what amounts to a nominal wage. The objective is to let an elderly person, particularly a lonely elderly person, realise that he or she can still be of use to the community. There has been no lack of persons wishing to do the work, a greater problem being the amount of suitable work available. The workroom at Burnt Ash started in one classroom with a mere handful of people in the autumn, but by the end of the year it had so increased that the second classroom was necessary and this increase (after a difficult period during the cold spring) shows signs of continuing. Altogether, apart from certain inherent and basic difficulties, this part of the Council's work appears to be met with increasing success. The workpeople are given pocket money at the rate of Is. 6d. an hour and sessions are held morning and afternoon for two hours each, five days a week. The workers attend for a varying number of sessions a week according to their capacity and the amount of work available, a guiding objective being to spread the work over as large a number of workers as is reasonably practicable. (c) Site of the Naborhood Cinema The general policy of the Council would appear to be moving in the direction of establishing various comprehensive or semicomprehensive centres for the elderly in different parts of the borough. The Saville is near the geographical centre of the borough. Burnt Ash is in the southeast segment, and in the southwest segment in Sydenham Road there is a site of an old cinema which belongs to the Borough Council, and it has now been decided that in addition to establishing shops or business premises on the ground floor (to fit in with the general development in the neighbourhood) a centre for old people will be built, partly on the ground floor but mainly on the first floor, to which there will be a lift. Plans are fairly far advanced and it is hoped that more specific development will occur during the current year. (d) Holidays and holiday home There has been an increasing tendency, certainly amongst metropolitan boroughs, to accept that there is a considerable physical and psychological advantage to many old people in getting away to the country or preferably the seaside for a short holiday. LOPWA has each year for the last few years increased the number of facilities for 35 holidays of this nature and in addition some of the individual old people's clubs have been sending groups of their members, perhaps by charabanc, for a week or ten days holiday, and this has proved popular. The Council decided early in 1962 to acquire a holiday home when suitable premises could be obtained. For various reasons the Sussex coast was regarded as the most suitable particularly the area of Brighton or Worthing. Many hotels were inspected by me and a few of these were inspected by a subcommittee of the Public Health committee. Unfortunately suitable premises have not so far been arranged and the seeking of suitable premises at a suitable cost is continuing. Meanwhile, as will be described in more detail in the next annual report, the Health Department took over from LOPWA in April 1963 the organisation of holidays for old people with the exception of the special requirements for handicapped old people. (e) Laundry As will be seen elsewhere in this report the Health Department again carried out a very large amount of work in dealing with the laundry of incontinent elderly people, a record number of 59,282 articles being dealt with in this way. This appears to be a service which is highly appreciated by the old person himself and sometimes even more so by the relatives. (f) Bathing attendant A further method of help for certain frail and usually bedridden old people was agreed to by the committee in October. This was the employment of a woman to help with domiciliary bathing and cleansing, to work primarily under the direction and supervision of the Ranyard Nurses although she can be used for cases originating through the Health Department office. The demands on such help are great and at the moment the helper is confining her activities to a relatively small area of the borough in the neighbourhood of Forest Hill. Some increase in the services available have taken place in 1963. (g) The handicapped A particularly deserving group of the elderly comprise those who are badly handicapped. Many of such have been housebound for years. Some of them are bedbound and for these there is little that the Borough Council can do, their care being mainly one for the welfare authority and the local health authority. With regard to those who are not bedbound but are housebound, the Borough Council has, as is indicated in the paragraph above on the Saville, established two sessions a week there and it is hoped that later similar sessions will be held at Burnt Ash (and also at the Naborhood). One of the biggest problems is to get the handicapped from their houses to the centre and we have availed ourselves of the help of the London County Council as welfare authority in this connection. The County Council supply specially adapted coaches which incorporate lifts for those who are severely handicapped. The amount of help the County Council can give however is limited but the Borough Council was so seized with the desirability of helping the handicapped that it was decided that the next Health Department van or coach to be obtained would incorporate a lift. The type of lift decided on was a Burtonwood tail-lift and the 13-seater coach concerned was delivered in the spring of 1963. 36 (h) Escorts The handicapped require escorts in travelling from their home to and from the centre, and although various volunteers have given generously of their services for this work it was found necessary to supplement such services by the use of a paid escort for two days a week. The final arrangements for this were made in early 1963. (i) S.47 S.47 of the National Assistance Act 1948 allows application to be made to a Magistrates' Court for an order for the compulsory removal of an old person from his home in certain circumstances. These circumstances are strictly limited and in general only apply to old persons in very poor health living in bad hygienic conditions. Every effort is made to prevent such cases occurring and this can usually be done if the Department gets to know about them at a reasonably early date. In such circumstances they are visited by the women health officers who can generally set in motion other aids, such as home helps, nursing care, medical care, meals, and so on and often can prevent further deterioration of the case. Alternatively the patient will be persuaded to enter a Part III home of the county council or in some cases to enter hospital. It is only the extreme case who refuses to have such help where application will have to be made to the Magistrates' Court. In 1962 although several cases were investigated none went as far as requiring court proceedings. (j) Visiting The women health officers are also infectious disease visitors. Infectious diseases vary considerably year by year and season by season, and during the slacker seasons of infections the women health officers are able to put in a greater amount of visiting of old people. This dual-purpose visiting, though not perhaps very logical, works well in practice, and the number of visits paid to the elderly is shown in the following table: Table 23 W N S Total First visits 163 267 201 628 Futile visits 153 220 143 516 Revisits 538 1274 443 2255 Total 851 1761 787 3399 (k) Housing Satisfactory housing can be a major requirement for continued health and wellbeing in the elderly. Eventually for most people a time will come when they cannot easily climb stairs and they cannot easily do the housework in a large or difficult house. The one-roomed flatlet on the ground floor or in a building with a lift then becomes almost essential. It has the added advantage that premises which are often underoccupied are consequently vacated and can be used for a larger family. There has been a tendency in recent years to increase the number of one-roomed flatlets or similar type of small premises available for old people, and the Lewisham Old People's Housing 37 Association were one of the first to do this in this borough. They now have three flatlet houses which between them house 32 elderly people, including 3 housemothers. A fourth house is being converted which will house 7 elderly people. Ideally a flatlet house or a flatlet block should be large enough to accommodate also a warden or supervisor. The Borough Council during the year made progress with the building of two blocks of small flats for the elderly at Normanton Street/Siddons Road which between them will house 31 old people with a warden, and during the year a start was made with designing a block of flats in Crofton Park Road which will house 24 people and a warden. It is known also that the Lewisham Darby and Joan Club in Stanstead Road have been considering the possibilities of building a block of flatlets for the elderly on their premises. (l) Concerts The individual clubs arrange entertainment on their own on some or many of the days their afternoon club meets, and in addition they often have a special concert or entertainment at Christmas. During the year the Public Health committee decided to run a series of concerts at the Town Hall for the elderly. The first one, which was regarded as experimental, was held in March 1963 and was attended by some 900 old people from the clubs. A service of charabancs was arranged to bring in members from some of the peripheral clubs and take them back again after the concert. The concert was regarded as highly successful and it is proposed to do a series of six monthly concerts (except December) in the winter of 1963/64. Some at any rate of these will be open to old people whether they attend clubs or not. (m) Grants It has been mentioned earlier in this section that the Public Health committee has for many years been giving maintenance grants to the voluntary clubs in the borough and also to two or three voluntary clubs just outside the borough boundary but which have a fairly considerable proportion of Lewisham residents amongst their members. Details for 1962 are shown in paragraph 5 below. Luncheon club9 have in the past also been in receipt of grant of about Is. for each meal supplied and the same grant has been available for recipients under the meals-on-wheels scheme. This grant has been paid by the borough council from money received for that purpose from the county council, but from April 1963 the borough council will provide this money without help from the county. (This is a decision which applies to all metropolitan boroughs.) 4. The Lewisham Old People's Welfare Association The Lewisham Old People's Welfare Association (LOPWA), so far as the Borough Council's work for old people's welfare is concerned, is the main body in the area and has affiliated to it the various other bodies to which the Borough Council makes grant. LOPWA during the year continued all its routine work, and expanded in all branches. Notes on its main activities during the year April 1962/63 (based on a report by the secretary) are as follows:— 38 Meals-on-wheels service 52,652 dinners were delivered to the housebound and to Darby and Joan clubs, 14,383 more than last year. (The deliveries to the dinner clubs totalled 18,045.) The dinners were drawn from three sources; Dartmouth restaurant, 31,270; Lewisham Town Hall canteen, 1,044; Saville kitchen, 20,338. All the increase was thus taken up by the Saville kitchen and most of the increased number of dinners delivered were accounted for by the dinners to club members at the Saville clubs. When the Town Hall basement canteen was closed and the new restaurant opened (in 1963) collection of dinners from the fifth floor was found to be difficult and the small number of 24 dinners per week which were being supplied by the Town Hall was taken over by the Saville. Deliveries to the housebound are still twice a week, though generally a meal for the next day is also left. Holidays and outings The number of holidays arranged and subsidised increased considerably. The total was 360 (193 in 1961/62). Of these, 56 were special holidays for frail and handicapped old people. Holidays for another 80 were arranged through the Women's Holiday Fund. 22 grants were made to old people who made their own holiday arrangements. A number of half-day outings for the infirm were organised, including a party at Stanstead Lodge. Marmite The sales of this useful nutrient for old people again increased. Boarding-out scheme Ten people in all accepted offers of accommodation during the period: of these 5 were men and 5 women. Of the ten: two were found unfurnished flats which were referred to LOPWA as the owners did not wish to advertise; two were found unfurnished accommodation sharing amenities with the existing tenants (all four were lonely people who have been helped by being brought together); five were found accommodation with board—of these two moved on to rest homes, one died, and two are still boarded out; one was found temporary accommodation while her landlady had a holiday. At the end of March, 6 of the 10 were still in private accommodation found by LOPWA. Others were found accommodation, but for one reason or another did not accept it. One was about to move to an address but had a relapse and had to stay in the nursing home she was in. Cases referred 1,377 new cases were referred to the office during the year—111 more than the previous year. 3,719 callers were dealt with at the office during the year. Other activities The usual annual exhibition of handwork was organised, and the annual Service at St. Mary's Church for old people and their friends was arranged. Distribution of Christmas parcels and dinners was organised as usual, and to an increased number—770—with the help of members of schools, youth groups, Rotary clubs and others. Several old people had their rooms redecorated by groups of volunteers. A Talent Show, in which all the artistes were members of Darby and Joan Clubs, was produced by Mr. Wybrew, the then public relations officer, in September. A start was made with a junior pensioners club (for recently retired pensioners) which meets once a month at the Saville. 39 Staff Three social workers (excluding Miss Ellis the secretary) were working for the Association throughout the year. 5. Other clubs Apart from LOPWA the Council continued to make grants to organisations in the borough which carry out work for old people, whether by recreational facilities or by the provision of meals. A sum of £12,000 (to include LOPWA) was eventually put in the annual estimates for the year 1962-63 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:— Lewisham Old People's Welfare Association 9,900 Lewisham Darby and Joan Club 420 St. Mark's Old Folks' Club 80 Hither Green Branch of the National Federation of Old Age Pensions Associations 68 St. Philip's Darby and Joan Club 30 The Over 60's Friendly Club 44 The Bellingham Community Association Darby and Joan Club 40 Lee Branch of the National Federation of Old Age Pensions Associations 52 Good Companions Club 18 St. Hilda's Seniors' Club 75 Blackheath Branch of the National Federation of Old Age Pensions Associations 24 September Club 40 Happy Old Folk's Club (St. Barnabas) 20 St. John's Over 60's Club 60 The Friendship Circle over 60's Club 50 Sydenham Hill Social Club, Darby and Joan Section 20 Companions Darby and Joan Club for Deaf and Dumb 36 Autumn Club 44 St. Cyprian's 61 Club 36 Saville Club 180 This left a sum of money available for new clubs which might qualify for grant, and three such clubs, the Sunset Club (£15), the Silver Lining Club (£30) and the Burnt Ash Club (£250), were given the grants indicated for the part year. Additional grants were paid to nearly all the clubs as a help towards fares and towards 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 modest tea, but will also make arrangements to provide lunch either on the day the club meets or on another day. To this end the Lewisham Old People's Welfare Association is prepared to cooperate by conveying the meals in bulk from the kitchens, where they are obtained, to the luncheon club. 40 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 suitable alternative to the socalled "workshops for the elderly" which have been set up in a few London boroughs and one of which is now open at Burnt Ash (see paragraph 3(b) (iii) above). There are difficulties with such workshops in an outer London dormitory borough such as this, but some of these difficulties would not apply to handicraft classes and if the work turned out at such classes were good enough it would have a saleable value of its own. Unfortunately most of the clubs found it impracticable to get sufficient of their members interested in the scheme to allow a qualified teacher to be obtained for them, but one or two clubs have succeeded. 6. Coordinating committee 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 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 LOPWA, and I represent the borough council. The committee decided to carry out a partial house-to-house survey of the borough through a government 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 were not available to the committee until the early part of 1962. Various discussions on these results were had during the year in an attempt to avoid a divergence of opinion, and later it was thought necessary to obtain additional statistics in relation to hospitals from the Ministry of Health. A considerable delay occurred in this and has resulted in a postponement of the issue of the report ; much work however has been done on the report and it is hoped that it will be issued during the current year. 7. Costs It is not easy to give a definite statement of the cost to the Borough Council of work for old people as some of the cost is by its very nature hidden in various estimates : for example, the salary of the women health officers is partly on infectious disease and partly on old people. Similarly there has often been a hidden subsidy to LOPWA in the rent charged to them for their office accommodation. 41 Bearing in mind, however, these provisos, it seems that in the financial year 1962/63 a sum of about £24,000 was spent by the Borough Council on the care of the elderly. To understand the growth of this service it is only necessary to mention that ten years ago, in the year 1952/3, the corresponding expenditure was £1,750 and for the current year 1963/4 the sum included in the estimates has been £39,957. These are gross figures, against which some income can be set (£3,275 for 1963/4) but they do not include any apportionment of salaries. 42 SANITARY CIRCUMSTANCES OF THE AREA The following table gives a summary of the inspections, etc., carried out by the public health inspectors during the year Table 24 Reason for inspection West North South Total On complaint 773 852 331 1,956 House to house 13 1 13 27 Improvement grants 89 95 70 254 Houses in multiple occupation 10 22 11 43 Rent Acts 23 13 11 47 Mortgage survey 443 380 203 1,026 Other Housing Act visits 134 143 28 305 Notice from builder 510 628 43 1,181 Infectious diseases 7 12 6 25 Infestation 64 118 65 247 Factories, mechanical 29 26 23 78 Factories, non-mechanical 3 6 9 Outworkers 53 58 33 144 Clean air inspections 4,365 6,228 1,099 11,692 Pet animals Act 27 18 8 53 Water certificates 67 69 22 158 Fireguards 13 13 26 Hairdressers 17 2 - 19 Pharmacy and poisons 60 62 35 157 Icecream premises 84 23 36 143 Restaurants, cafes, etc 146 56 76 278 Bakehouses 20 5 4 29 Food shops and stalls 341 286 291 918 Other shops and stalls 14 57 19 90 Food inspections 94 101 548 743 Sampling 144 123 203 470 Futile visits 3,967 3,851 2,387 10,205 All other matters 1,368 1,319 922 3,609 Revisits 3,794 5,498 4,813 14,105 Total — all inspectors 16,672 20,065 11,300 48,037 Smoke abatement Observations 10 Intimations served — Complaints 4 Statutory notices served — Legal proceedings - Convictions — 43 Summary of notices served Table 25 West North South Total Intimation notices:— Public Health (London) Act, 1936 142 182 61 385 Factories Act, 1937 - 4 1 5 Informal intimations .Housing Act, 1957 8 2 1 11 Ditto, Housing Act, 1961 - 6 3 9 Total intimations 150 194 66 410 Statutory notices:— Public Health (London) Act, 1936 95 142 27 264 Factories Act, 1937 - 1 - 1 Clean Air Act, 1956* 407 289 230 926 Housing Act, 1957 10 55 11 76 Byelaws 33 39 16 88 Housing Act, 1961 1 6 5 12 Total statutory notices 546 532 289 1367 "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. Repairs carried out Table 26 Repairs West North South Total Wall and ceiling plaster repaired 39 97 37 173 Roofs repaired 35 45 15 95 Dampness remedied 87 145 60 292 Brickwork repaired 1 19 - 20 Chimneys repaired 1 3 - 4 Drains cleared 13 29 12 54 Drains repaired 4 5 4 13 Drinking water cisterns repaired — — — — Dustbins supplied 5 13 — 18 Doors and door frames repaired or renewed 6 12 5 23 Flushing cisterns repaired, renewed or cleansed 4 10 14 Flush pipes repaired or renewed 2 3 — 5 Firegrates, etc., repaired or renewed 1 4 — 5 Flooring repaired or renewed 19 42 12 73 Dry rot remedied 2 14 — 16 Gullies renewed, repaired or cleansed 1 9 4 14 Gutters repaired 22 25 11 58 Refuse cleared 1 6 1 8 Rainwater pipes repaired 7 10 5 22 Soil pipes repaired, ventilated or renewed 9 8 3 20 Sinks provided 5 12 2 19 Sashcords renewed 13 27 21 61 Water closets repaired or renewed 14 22 7 43 Walls and ceilings cleansed - 4 — 4 Windows and frames repaired or renewed 7 19 3 29 Water service pipes repaired or renewed, water supply restored 4 3 7 Yards and areas paved 1 5 6 12 Glazing 2 7 — 9 Painting — 34 — 34 Other repairs 11 26 6 43 TOTALS 316 658 214 1188 44 Consumer Protection Act, 1961 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. 26 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 154 persons were registered. Byelaws governing the conduct of these establishments, designed to ensure cleanliness of the person, equipment and premises, came into force on December 1, 1955. The standard of hygiene in those visited up to the end of the year was good. Pet Animals Act, 1951 During the year 20 premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and coldwater fish. In general it has been found that pets are kept for sale under conditions which do not call for any particular comment and in no case has it been found necessary to attach special conditions to any licence which has been issued. A report by a veterinary surgeon was obtained in one case after complaints had been received. 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 236 premises and 5 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, 1961, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the council in all factories, whether mechanical power is used in the factory or not. The provisions of sections, 1, 2, 3, 4 and 6 relating to cleanliness, overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate 45 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 50 9 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 483 78 5 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 50 50 — — TOTAL 583 137 5 — 46 Cases in which defects were found Table 28 No. of defects Defects Found Remedied Referred Prosecutions instituted To HM Inspector By HM Inspector Want of cleanliness (S 1) — Overcrowding (S 2) — — — — - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) - - - - - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S7) : (a) insufficient - — - - - (b) unsuitable or defective 5 5 - 3 - (c) not separate for sexes — — - — - Other offences against the Act (not including offences relating to outwork) — - — - TOTAL 5 5 - 3 — Outworkers Under section 133 of the Factories Act, 1961 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 134 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 occupations concerned: Outworkers Trade employed Clothing 109 Leather goods 2 Stuffed toys 3 Bags 1 Soft furnishings 4 Boxes 2 Lampshades 4 Buttons 1 Jewellery 1 Millinery 4 47 Outworkers Trade employed Box making 2 Knitting 3 Ties 2 Wigs 1 Rosettes 1 Trimmings. 3 Cards 1 144 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 144 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 During 1962 the pigeon catcher was again employed on a parttime basis from March to September but was prevented from working during part of this time due to illness. A number of churches were visited as the pigeons find the towers suitable nesting places, and he also visited some of the many railway bridges in the borough. The regular feeding of the birds by the general public was responsible for pigeons collecting in large numbers in open spaces, but they were normally dealt with by tracing them back to their roosting places. The pigeon catcher altogether accounted for the destruction of 553 birds, 45 eggs and 44 nests. In addition 100 rabbits and 4 foxes were destroyed. Mechanical ventilation of internal water-closets I have previously (see especially my annual report for 1957) queried the desirability of relying on mechanical ventilation of bathrooms and water closets. The Council has accepted this view as far as it is able to impose conditions in this borough. I put forward a dozen or so good reasons against the system, but an additional one came to light from 48 another borough during the year, to the effect that, where such a system had already been installed, it frequently infringed the bye-laws in that it used air drawn in from the kitchen or passage and not "fresh" air (i.e. air from outside) as is required. Subsequently, having considered a joint report of the Borough Medical Officers of Health and the Association of Metropolitan Borough Engineers and Surveyors, a committee of the Metropolitan Boroughs Standing Joint Committee asked the London County Council to endeavour to arrange for full technical research into the problem of mechanical ventilation of internal water closets with a view to the production of a suitable code of practice designed to secure both a satisfactory standard of ventilation and uniformity of application throughout the metropolitan area. The London County Council replied stating that its technical officers had been consulted and that it had been agreed that research into this problem would be useful. The County Council had accordingly asked the Building Research Station at Garston to undertake the necessary investigations, following which a further communication would be sent to the Committee. Sanitary work generally Mr. Phillips, the senior public health inspector, reports that during 1962, many of the public health inspectors were engaged principally on inspection of premises under the Clean Air Act. 11,692 visits were necessary to carry out this work, which consisted of the survey of premises to be included in areas, advice on the types of grates and fuels, and approval of the conversion of grates to burn authorised fuels. 1,956 complaints were investigated compared with 1,284 the previous year but the number of intimation notices dropped by over a hundred, which was due principally to the temporary absence of house-to-house inspections which had to be curtailed because of shortage of staff and the pressure of work under the Clean Air Act. For the first time separate figures have been kept of mortgage surveys and it is interesting to note that over a thousand were carried out in the year, which shows how anxious people are to become owner-occupiers and avail themselves of the facilities offered by the Council. A considerable amount of development is being carried out by private concerns which entails the supervision of drainage and plumbing work. This is reflected in the considerable increase in the number of water certificates issued. Inspection of houses in multi-occupation has proceeded at a steady rate but it was felt that it was better to deal with this problem in an informal way as much as possible. A concentrated attack on these premises and the service of formal notices might very well lead to owners evicting tenants rather than carrying out a large number of improvements. There is no doubt that this type of property still presents difficult problems. 49 HOUSING Building The following 191 new dwellings were completed by the Council during the year:— Sites Dacre Park 12 Bargery Road/Sangley Road 24 Nelgarde Road/Silverdale/Engleheart Road 20 Engleheart Road/Sangley Road/Shorndean Street Elmer Road 64 Campshill Place 10 Stanstead Road 20 Corona Road 18 Longfield Crescent 15 St. German's Road 8 Families rehoused for first time During the year the following families were rehoused:— 1. By the Lewisham Borough Council:— (a) in permanent properties 269 (b) in temporary bungalows 4 273 2. By the London County Council (figures supplied by district offices) 21 294 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 208 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 11 informal and 2 formal notices were served. 5 properties were repaired by the owners after service of notices ; in no case was work done by the Council in default (section 10). 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 1962, together with the present position of cases originating in previous years which had not been complied with at the end of 1961:— 50 Table 29 Properties Dwellings involved Present position 60 Knowles Hill Crescent 1 Order made 1963 62 Knowles Hill Crescent 1 10 Conington Road 1 Order made—whole house 25 Horton Street 1 Consideration deferred pending decision of Works and Highways 26 Horton Street 1 Committee. 65, St. Germans Road 1 Undertaking to carry out works accepted 67, St. Germans Road 1 398, Bromley Road 1 Two rooms on right hand side of front entrance (one room on ground floor and one on first floor) made fit for habitation. 56, Summerfield Street 1 Works completed. Order determined 56, Molesworth Street 1 Works completed. Closing Orders in respect of part of house Table 30 Properties Part of house Present position 269 Stanstead Road Two rooms in basement Order made 85 Perry Vale Semi-basement rooms LCC to purchase property 31 Devonshire Road Two rooms and kitchen in basement Order made 46 St. Germans Road Semi-basement rooms, hall and larder Order made 49 Clarendon Rise Two semi-basement rooms Order determined 102 Westwood Hill Basement front kitchen Order made 59 Clarendon Rise Main back room in basement Works completed. Order determined 35 Devonshire Road Two rooms, scullery, WC, passage in semibasement. Order determined. Works completed. 32 Manor Park Three rooms, scullery, WC, in semi-basement. Works completed. Order determined. 37 Devonshire Road Two rooms, scullery, passage, WC, semibasement Works completed. Order determined. 13 Recreation Road Two rooms, scullery, bathroom, WC, semibasement Works completed. Order determined 43 Morley Road Two rooms, kitchen in basement Works completed. Order determined. 21a Mount Pleasant Road Two rooms and scullery in semi-basement. Works completed. 51 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 - 11 4 Houses included by reason of bad arrangement — 1 1 Houses or land acquired under s. 43 — — — Not in clearance areas Formal or informal procedure under s. 17 (1) 3 4 3 Local authority houses certified unfit by medical officer of health — — — B-UNFIT HOUSES CLOSED (Housing Act, 1957) ss 16, 17 and 35 1 2 1 ss 17(3) and 26 — — — Parts of buildings closed under s.18 4 10 2 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 5 - After formal notice under Public Health Acts - - After formal notice under Housing Act, 1957 15 - 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 - - 52 Rent Act 1957 The following table shows the applications for certificates of disrepair dealt with during the year 1962, and for the whole period. Table 32 1962 62 Applications for certificates 25 1116 Decisions not to issue certificates 4 25 Decisions to issue certificates (a) in respect of some but not all the defects — 655 (b) in respect of all defects 21 409 Undertakings given by landlords to repair 8 509 Undertakings refused for special reasons 1 1 Certificates of disrepair issued ... 10 530 Applications by landlords for cancellation of certificates 27 359 Objections by tenants :o cancellation ... 7 119 Decisions to cancel in spite of tenants' objection 1 22 Certificates cancelled 19 254 House purchase loans 933 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 70 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 53 applications were investigated and reported on. Moveable dwellings During the year the overall position in London as far as homeless families were concerned became even more acute and in an effort to ameliorate this, the County Council decided to set up prefabricated moveable dwellings on various vacant sites. These dwellings will be connected to the main services (water, electricity and drainage) and they, and their surroundings will have to conform to regulations unofficially agreed between the metropolitan boroughs. Two sites had been licensed in Lewisham by the end of the year, with room for 12 dwellings on one and two dwellings on the other. 53 On housing work generally, Mr. Brittain, the group housing inspector states: "A number of houses in multiple occupation were dealt with under the Housing Act 1961, mainly for the provision of required amenities and to control the total number of persons using the respective houses. In only one case was it necessary to take action under Section 12, which gives power to apply a code of management and is designed to deal with really squalid conditions. A start was made on that part of the 1961/65 slum clearance programme to be carried out by this Council and 6 small areas involving 16 houses were represented as unfit for habitation. It was necessary also to make a number of closing orders but, on the other hand, a greater number of dwellings already subject to such orders were repaired and brought back into use. Improvement grants showed a very small increase in total over the previous year and the scheme is progressing far too slowly. When visiting houses to give advice, it has been evident to me that some owners have realised only quite recently that these grants are available and it is probable that many others are still ignorant of the financial assistance which can be obtained. In August the Ministry of Housing and Local Government issued a Circular asking local authorities to make a systematic approach to the subject and tackle the problem by streets or areas. It was decided to deal with an area consisting of 186 houses, of which about 30 are known to have the necessary amenities and it is hoped that owners of the remainder will take advantage of the grant aid. The Circular contains a sting in the tail : it mentions the possibility of using compulsory powers where owners, whose houses are perfectly capable of being improved at reasonable cost, are unwilling to co-operate." 54 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 126 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 expire on December 31, 1965, were issued during the year as follows:—(the total numbers now current are shown in brackets) for sale of pasteurised milk 2 (107) „ sale of tuberculin tested milk 2 (86) „ sale of sterilised milk 3 (119) Examination of heat-treated milk 43 samples of pasteurised milk and 27 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, 57 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 33 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 12 3 55 8.75 87.70 Second quarter 17 3 62 8.68 87.70 Third quarter 24 3.52 8.93 87.55 Fourth quarter 4 3.81 8. 63 87.56 TOTALS 57 3.63 8.74 87.63 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 55 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. The 22 samples submitted to the public analyst were found to have the composition shown in the appended table:— Table 34 Period Samples Average percentage composition Fat Milk solidsnot fat Water First quarter 3 11.3 10.9 77. 8 Second quarter 5 7.2 9.8 83.0 Third quarter 14 9.3 10.2 80.5 Fourth quarter — — — — TOTALS 22 93 10.3 80.4 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 71 samples of icecream were submitted for bacteriological examination with the following results:— Table 35 Grading Samples submitted % Grade 1 50 71 Grade II 9 13 Grade III 6 8 Grade IV 6 8 TOTAL 71 100 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. 56 FOOD GENERALLY Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 675 ; of these, 8 were formal and 667 informal. After examination the public analyst reported that 5 of the formal samples and 22 of the informal samples were adulterated or below standard ; the percentage of adulteration amounted to 62.5 in the formal samples, 3.3 in the informal samples, and to 4.0 of all the samples submitted, compared with 3 • 5 in the previous year. Samples analysed Table 36 Articles Examined Adulterated Formal Informal Total Formal Informal Total Beverages 1 47 48 1 4 5 Bread, biscuits, cake flour — 37 37 — — Colouring matter — 6 6 — — — Drugs — 5 5 — 2 2 Fats, cheese — 9 9 - - — Fish - 15 15 - 3 3 Flavourings and condiments — 142 142 - 2 2 Fruit, nuts — 26 26 - - - Icecream - 28 28 - - - Jams, pastes, etc. — 54 54 — 3 3 Meats and preserved meats 1 35 36 — 4 4 Milk and cream 2 80 82 - - — Sausages 3 45 48 3 2 5 Sweet confectionery 1 45 46 1 1 2 Vegetables and cereals — 30 30 — — — Miscellaneous — 63 63 — 1 1 TOTALS 8 667 675 5 22 27 Non-genuine samples Table 37 Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Composition essence Informal Sample did not contain the declared amount of alcohol Formal sample required Rum and butter toffees Informal Sample contained insufficient butter fat Formal sample taken (see next item) Rum and butter toffees Formal Fat in sample contained not more than 2% butter Labels to be amended Minced chicken in jelly Informal Deficient in meat to the extent of 5.7% Formal sample required Hamburger sausage meat Informal Deficient in meat to the extent of 14.7% Manufacturer notified Hamburger sausage meat Formal Deficient in meat to the extent of 20% Manufacturer notified 57 Table 37—continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Hamburger sausage meat Formal Deficient in meat to the extent of 21 % Manufacturer notified Minced meat Informal Contained preservative contrary to the Preservative in Food Regulations, 1925. Manufacturers written to Lemonade powder Informal Did not bear a label specifying the name of the product, list of ingredients and name and address of packer or labeller. Product to be withdrawn from sale. Shrimp slices Informal Contained not more than 4% hydrated shrimps. The description was misleading Manufacturers in Hong Kong notified. Formula 120 Informal Tablets did not satisfy B.P. disintegration test. Formal sample required Minced turkey in jelly Informal Deficient in meat to the extent of 7 .1% Manufacturer notified Cumberland brandy butter Informal Insufficient proof spirit to justify the description Manufacturer notified Cumberland rum butter Informal Insufficient proof spirit to justify the description Manufacturer notified Orange drink Informal Deficient in orange juice to the extent of 60%. Manufacturer notified Tinned orange juice Informal Contained not more than 41% juice. Formal sample to be taken. (see below) Hamburger sausage meat Informal Deficient in meat to the extent of 15%. Formal sample to be taken. (see below) Menthol and eucalyptus Informal Product labelled incorrectly New labels produced Anchovy fillets Informal Contained excessive amount of lead. Formal sample to be taken. Hamburger sausage meat Formal Deficient in meat to the extent of 15% Warning letter sent. Tinned orange juice Formal Contained not more than 37% juice. Stocks withdrawn Meat paste, chicken Informal Deficient in meat to the extent of 3% Formal sample to be taken 58 Table 37—continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Diabetic marmalade Informal Lid of jar badly corroded. Sample most probably old stock. Stock withdrawn Ricory (instant coffee and chicory) Informal Contents of tin had solidified due to absorbtion of moisture Stock withdrawn Marmalade Informal Sample contained several small pieces of wood Manufacturer notified Chicken fillets Informal Incorrect labelling Manufacturer notified Dry fry Informal Label did not bear a declaration of the list of ingredients. Manufacturer notified 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:— Steak and kidney pie Sausage meat (10) Milk bottles (7) Tinned pineapple Roll and butter Creamed rice milk pudding Stewed steak Frozen peas Tongue sandwich Butter Bread (7) Lithographic ink Swiss doughnut Rice paper Milk Macaroon Sandwich spread Polony Hamburger Dessicated coconut Registration of food premises During the year the following were registered, the total (including previous registrations still existing) being shown in the last column. Type 1962 Total Sale and storage of icecream 20 350 Manufacture of icecream 1 5 Fish frying 1 30 Fish curing — 19 Preparation or manufacture of sausages 3 79 Preparation or manufacture of potted, pressed, pickled or preserved food 5 142 Unsound food Approximately 41 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. 59 Shops Act, 1950 — section 38 No certificates of exemption in respect of sanitary conveniences were issued during the year. Under s.38 of the Shops Act, 1950, we already had powers and duties with regard to ventilation, temperature and sanitary conveniences in shops. Under s.18 of the L.C.C. (General Powers) Act, 1958, additional powers and duties under s.38 came to us on 1 January 1959, and these were to do with lighting, with washing facilities and with facilities for the taking of meals. Details were set out in the 1959 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. Pharmacy and Poisons The names of 13 persons were entered on the Council's list of persons entitled to sell poisons in Part II of the poisons list and the names of 147 persons previously registered were retained on the register. 157 visits were paid by the food inspectors in connection with the granting and renewal of these licences. Slaughterhouses and slaughtermen There are no slaughterhouses in the Borough. 2 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 is at Hither Green and was opened in October, 1960. 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 (last year 0.02%) the large amount of material handled through the depot throws considerable extra work on the food inspectors concerned. 60 Totals for the year are shown in the table:— Table 38 Country of origin Tonnage imported Amount unfit and remarks (tons) Spain 72,765 1 ¼ tomatoes Italy 50,694 3 chestnuts ¾ plums France 21,559 - Belguim 1,089 - Algeria 8,787 - Yugoslavia 19,144 25 beef Israel 178 - Africa 32 - Switzerland 18 - Majorca 802 - Canary Islands 32 - Tunisia 3 - Morocco 16 - Total 175,119 30 Food hygiene The Food Hygiene Regulations 1955, which at the time they were made 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. One major change was that the person carrying on a 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:— 1 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 ; 2 the hygienic handling of food ; 3 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 ; 4 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.; 5 sanitary conveniences and the provision of a water supply and washing facilities ; 6 the temperatures at which certain foods which are particularly liable to transmit disease are to be kept on catering premises. 61 PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES Notifiable Diseases The undermentioned diseases are notifiable by medical practitioners to the Medical Officer of Health:— Anthrax Plague Cholera Pneumonia, acute influenzal Diphtheria Pneumonia, acute primary Dysentery (bacillary or amoebic) Poliomyelitis, acute Encephalitis, acute Puerperal pyrexia Enteric fever Relapsing fever Erysipelas Scabies Food poisoning Scarlet fever Malaria Smallpox Measles Tuberculosis, all forms Membranous croup Typhoid fever, including paratyphoii Meningococcal infection Typhus fever Ophthalmia neonatorum Whooping cough Number of Notified Cases (corrected for revised diagnosis) during the year 1962 with comparative figures for the previous six years. Table 39 Diseases Cases notified 1962 1961 1960 1959 1958 1957 1956 Diphtheria - - - - - - - Dysentery 162 96 367 233 214 129 579 Encephalitis (acute) — 1 — — 1 2 2 Enteric or typhoid fever 3 2 — 6 4 2 3 Erysipelas 1 14 20 16 13 15 20 Food poisoning 13 26 31 49 27 42 46 Malaria 2 — 2 - - - - Measles 423 4278 262 2613 835 2728 206 Meningococcal infection 4 5 8 3 3 4 9 Ophthalmia neonatorum 1 — 1 1 1 2 2 Pneumonia 23 62 33 108 61 96 89 Poliomyelitis (acute) — — 2 6 2 15 26 Puerperal pyrexia 71 46 78 48 59 93 57 Scabies 9 8 9 9 9 18 29 Scarlet fever 53 94 172 303 210 143 188 Tuberculosis 103 123 134 143 236 247 212 Whooping cough 41 65 333 229 154 225 241 TOTALS 909 4820 1452 3767 1829 3761 1709 62 Notifications of infectious diseases in 1962 showing sex and age groups Table 40 Diseases Under 1 1- 3- 5- 10- 15- 25- 45- 65 4- Total M F M F M F M F M F M F M F M F M F M F Dysentery 4 2 17 25 19 17 17 14 4 3 2 9 8 9 3 7 - 2 74 88 Erysipelas — — — — — — — — - - - - - - - 1 - - - 1 Food poisoning 1 — 2 1 2 — - 3 - 1 1 - - - - 1 - 1 6 7 Malaria - — — 1 — 1 - - - - - - - - - - - - - 2 Measles 5 8 63 43 62 45 84 83 10 11 3 5 - 1 -_ - - - 227 196 Meningococcal infection - - 1 - - - 1 - - - - 1 1 - - - - - 3 1 Ophthalmia Neonatorum — 1 - - - - - - - - - - - - - - - - - 1 Paratyphoid fever - - - - - - - - - - - - - - - - - - - 1 Pneumonia 1 - - - - - 1 — - 2 3 1 1 3 4 2 4 1 14 9 Puerperal pyrexia — — — — — —. — — - - - 30 - 40 - 1 - - - 71 Scabies — — 3 1 - — 2 - - - - - 1 - 2 - - - 8 1 Scarlet fever — — 3 1 3 5 11 15 5 3 3 3 1 - - - - 25 28 Tuberculosis (respiratory) - - 1 1 - 1 1 - - 4 5 7 17 9 18 9 9 1 51 32 Tuberculosis (non-respiratory) - 1 - - - - - - 1 1 1 1 4 7 3 1 - - 9 11 Typhoid - — — — — — — — - - - - - 1 - 1 - - - 2 Whooping cough 2 3 6 3 4 6 3 12 — 2 15 26 Totals 13 15 96 77 90 7S 120 127 20 27 18 57 32 71 30 23 13 5 432 477 63 Analysis of certain diseases in table 40 into divisional areas— Table 41 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65- Total W 1 10 9 15 3 2 5 2 1 48 N 2 24 22 2 - 6 3 - 1 60 Dysentery S 2 8 5 13 5 4 9 8 - 54 Total 5 42 36 30 8 12 17 10 2 162 W 5 14 17 20 3 - - - - 59 N 6 61 50 52 6 1 - - - 176 Measles S 2 31 40 95 12 7 1 - - 188 Total 13 106 107 167 21 8 1 - - 423 W - - - - - 2 1 1 2 6 N 1 - - - 1 1 - 2 2 7 Pneumonia S - - 1 1 1 3 3 1 10 Total 1 - - 1 2 4 4 6 5 23 W - 1 5 7 3 3 1 - - 20 N - 3 - 6 2 2 - - - 13 Scarlet fever S - 3 13 3 1 - - - 20 Total - 4 8 26 8 6 1 - - 53 Tuberculosis (respiratory) W _ 1 _ 1 1 6 8 13 2 32 N — 1 - 2 - 11 9 5 28 S - 1 - - 1 6 7 5 3 23 Total - 2 1 1 4 12 26 27 10 83 W 1 1 3 2 - - - - 7 N 3 6 4 7 1 — — - - 21 Whooping cough S 1 2 3 6 1 - - - - 13 Total 5 9 10 15 2 - - - - 41 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. 64 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 42 W N S Total First visits 125 130 262 517 Futile visits 252 84 174 510 Revisits 180 76 148 404 Total 557 290 584 1431 Poliomyelitis In 1962 no case of poliomyelitis was notified—the second year in succession. Dysentery The number of cases showed a large increase over the previous year, which was exceptionally low. 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 1962 was not an epidemic year, there being only 423 cases. They were of mild degree. Pneumonia The number of cases was 23, the lowest recorded for over 20 years. 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 again a decreased number of cases in 1962, the total, 53,being only a little more than half the previous year, which in itself was only a little over half those in 1960. 65 Whooping cough After the record low number of 65 in 1961 the cases in 1962 fell yet further, to 41 in all. Whooping cough is however a preventable disease, and attention is called 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 in 1959 the number of cases had continued to fall, and in 1962 they dropped still further—from 143 to 103. 83 of these were pulmonary and were scattered evenly through the three divisions of the borough. The biggest number for men occurred in the age group 45-55 but for women the biggest number occurred in the age group 20-25. As in previous years there were many more cases in males than in females as far as respiratory tuberculosis was concerned, there being 51 males and 32 females. With the drop in cases and the small increase in population the rate per 100,000 came down to 47, the lowest on record. The death rate, however, rose to 10 from 8. Table 43 Age periods New cases notified Deaths Respiratory NonRespiratory Totais Respiratory NonRespiratory Totals M F M F M F M F M F M f 0 - — - - 1 - 1 - - - - - - 1- - - - - - - - - - - - - 2- 1 2 - - 1 2 - - - - - - -5-- 1 - - - 1 - - - - _ _ _ 10- - 4 1 1 1 5 - - - - - - 15- 1 1 1 - 2 1 - - - - - - 20- 4 6 - 1 4 7 - - - - - - 25- 9 4 4 3 13 7 3 - - - - - 35- 8 5 4 8 9 — — ~ 3 — 45 13 5 2 1 15 6 7 - - - - - 55- 5 4 1 - 6 4 2 1 - 8 2 65- 7 1 - - 7 1 6 2 - - 6 2 75+ 2 - - - 2 " 2 - - - 2 51 32 9 11 60 43 18 4 1 - 19 4 66 Analysis of new cases of tuberculosis into divisional areas :— Table 44 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Tolol West Respiratory M - - 1 1 - - 2 3 2 2 1 - 18 F - - - - 1 1 3 2 1 3 2 1 - 14 Non-respiratory M - - - - 1 - - - 1 - - - 2 F 1 - - - - - 1 - 1 1 - - - 4 North Respiratory M 5 3 3 2 S - 18 F - - 1 - 2 - - 3 2 2 - - 10 Non-respiratory M - - - - - 1 - 2 - 1 - - - 4 F 4 1 - - - S South Respiratory M - - - - - 1 2 1 3 4 1 1 2 15 F - - 1 - 1 - 3 2 1 - - - - 8 Non-respiratory M - - - - - - - 1 - - 1 - - 2 F - - - - 1 - - - 1 1 - - - 3 Summary of statistics as to tuberculosis for the last ten years Table 45 Year Population New cases notified (all forms) (excluding inward transfers) Notif. rate per 100,000 pop. Deaths Death rate from resp. tuberculosis per 100,000 pop. All forms Respiratory Lewisham County of London 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 1961 220,910 123 56 19 18 8 9 1962 222,170 103 46 23 22 10 9 67 Tuberculosis — environmental conditions Case papers showing the environmental conditions of new patients attending the Lewisham Chest Clinic in 1962 have been analysed in 146 cases with the following results :— Table 46 Cases %* Males 88 60 Females 58 40 Social classification:— Class I 2 2 Class II 14 12 Class III 72 63 Class IV 15 13 Class V 11 10 Not classifiable 32 — Rooms occupied:— 2 or more rooms per person 20 14 1—2 rooms per person 82 59 Less than 1 room per person 37 27 No information 7 — Accommodation:— Separate bed 62 42 Separate bedroom 43 29 Condition of premises occupied:— Good 108 79 Fair 22 16 Poor 7 5 No information 9 — 'Excluding cases not classified Food poisoning The cases last year formally notified further decreased, from 26 to 13. Again I must point out that the number notified is probably incomplete as many cases are sufficiently mild as not to require the attendance of a doctor. The following tables are based on returns made to the Ministry of Health. (1) Food poisoning cases Table 47 Notifications (corrected) Cases otherwise ascertained Symptomless excreters Fatal cases 1st quarter 4 - - - 2nd quarter 6 - - - 3rd quarter 5 - - - 4th quarter 3 - - — Year 18 — — — 68 (2) Single cases Notified Otherwise ascertained Total cases Agent identified:— Salmonella group B 2 — 2 „ typhimurium 6 — 6 ,, give 1 — 1 Agent not identified 4 — 4 (3) Salmonella infections, not food-borne Nil Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1962 on which the following table is based. Table 48 Patients Men Women Total General analysis X-rayed 2,541 1,340 3,881 Previously x-rayed 1,981 611 2,592 Reviewed 136 50 186 Abnormal after review 90 23 113 Analysis of abnormal films:— Cases considered tuberculous :— (a) no further action required — — — (b) occasional supervision only 4 — 4 (c) requiring treatment 2 1 3 (d) still under investigation 1 — 1 (e) refused further investigation — — — Previously known tuberculous cases 3 2 5 Non-tuberculous cases:— (a) investigated 13 2 15 (b) still under investigation 2 1 3 Cardio-vascular lesions 5 4 9 No action required 60 13 73 Commenting on the year's work, Dr. J. M. Morgan, director of the south-east London mass x-ray, service, states:— "The total of 3,881 examinations included 1,712 X-rayed during visits to firms : 1,161 during brief visits to public centres, mainly for men over forty-five : 865 in homes and hospitals and 143 at a school. Of the three cases of significant tuberculosis discovered, one was found at a firm, one in a hospital and the third among the kitchen staff in a girl's school. After deducting 550 repeat examinations from the total of 3,881 X-rayed, the incidence of tuberculosis requiring close supervision or treatment was 0.9 per thousand." 69 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 49 Age at December 31, 1962 Under 1 2 3 4 5-9 10-14 Total under 15 In in year 1962 1961 I960 1959 1958 1953-57 1948-52 |i) Diphtheria (including combined and triple):— immunised during year immunised at end of 1316 1344 137 56 39 95 34 3021 year 1316 2823 3144 4478 3000 13,840 14,083 42,684 Estimated mid-year population 16,800 29,600 46,400 (ii) Whooping cough (including combined and triple):— Immunised during year 1311 1337 137 55 35 69 26 2,970 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 2,441 1,997 5,359 6,746 16,543 Revaccination — 572 5,196 14,576 20,344 (iv)Pollmyelitis Immunised 1st Injection 2nd Injection 3rd Injection 4th Injection against or dose or dose or dose or dose Poliomyelitis (booster) Sa|k vaccine 1,977 1,989 3,207 337 Sabin(oral)*vaccine 2,470 2,180 3,241 787 The use of oral vaccine commenced 1 April 1962. Council Offices, E. H. R. SMITHARD Canadian Avbnue, Medical Officer of Health S.E.6. 70 APPENDIX A Acts of Parliament, Statutory Instruments and Circulars issued by Government Departments with regard to the public health services, during the year 1962:— Statutes Licencing Act, 1961 London County Council (General Powers) Act, 1962 Landlord and Tenant Act, 1962 National Assistance Act, 1948 (Amendment) Act, 1962 Recorded Delivery Service Act, 1962 Town and Country Planning Act, 1962 Statutory Instruments The Food Hygiene (General) Regulations, 1962 The National Health Service (Designation of London Teaching Hospitals) Order, 1962 Milk and Dairies (Emulsifiers and Stabilisers) Regulations, 1962 The Emulsifiers and Stabilisers in Food Regulations, 1962 The Housing (Management of Houses in Multiple Occupation) Regulations, 1962 The Slaughter of Animals (Prevention of Cruelty) Regulations, (Appointed Day—No. 2) Order, 1962 The Food and Drugs (Legal Proceedings) Regulations, 1962 The Milk and Dairies (Legal Proceedings) Regulations, 1962 The Food Standards (Table Jellies) (Amendment and Revocation) Regulations, 1962 The Milk and Dairies (Preservatives) Regulations, 1962 The Preservatives in Food Regulations, 1962 The Slaughterhouses (Hygiene) Regulations (Appointed Day—No. 3) Order, 1962 The Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day—No. 3) Order, 1962 The Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed Day —No. 4) Order, 1962 The Slaughterhouses (Hygiene) Regulations (Appointed Day—No. 4) Order, 1962 The Poisons Rules, 1962 The Poisons List Order, 1962 Ministry of Health Circulars No. 6 Smoking and Health 7 Development of Local Authority Health and Welfare Services: Cooperation with Voluntary Organisations 12 National Assistance Act, 1948 (Amendment) Act, 1962 18 Co-operation with Voluntary Organisations 25 Removal of Ministry's Offices 28 Fluoridation of Water Supplies 71 Ministry of Housing and Local Government Circulars No. 2 Caravan Parks 3 Clean Air Act, 1956. Smoke Control Areas 6 Gypsies 13 "Homes for Today and Tomorrow" 16 Housing Act, 1961: Part II. Houses in Multiple Occupation. 26 Housing Act, 1961. Prescribed Forms 29 Improvement and Conversion Grants—Practice Notes 42 Improvement of Houses 49 The Town and Country Planning Appeals (Inquiries Procedure) Rules, 1962 (S.I. 1962/1425) 49 The Compulsory Purchase By Local Authorities (Inquiries Procedure) Rules, 1962 (S.I. 1962/1424) 50 Clean Air Act, 1956 53 Housing Design Bulletins 54 Rating of Owners 58 Civil Defence: Dispersal 59 Landlord and Tenant Act, 1962 62 Requirements for the Construction of Sewers Ministry of Agriculture, Fisheries and Food Circulars No. FSH 1 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents 3 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents 5 Emulsifiers and Stabilisers in Food Regulations, 1962. Milk and Dairies (Emulsifiers and Stabilisers) Regulations, 1962 6 The Slaughterhouses (Meat Inspection Grant) Regulations, 1958 7 The Food and Drugs (Legal Proceedings) Regulations, 1962 The Milk and Dairies (Legal Proceedings) Regulations, 1962 8 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents 9 The Food Standards (Table Jellies) (Amendment and Revocation) Regulations, 1962 10 Preservations in Food Regulations, 1962. Milk and Dairies servatives) Regulations, 1962 11 The Slaughterhouse Licences (Forms and Records) Regulations, 1959 12 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents General Register Office Circular No. MOH 3 Annual Reports of Medical Officers of Health, 1962—Vital Statistics 72 APPENDIX B Legal Proceedings, 1962 The following are details of legal proceedings during the year:— Nature of summons No. Total fines Total costs Remarks £ s. C s. Public Health (London) Act, 1936 Non-compliance with nuisance notices 22 41 0 14 11 5 summonses withdrawn (work completed) ; 8 abatement orders made Food and Drugs Act, 1955 4 adjourned sine die. sections:— 2 10 60 0 38 17 1 summons absolute discharge 8 3 110 0 3 3 Food Hygiene (General) Regulations, I960 Regulations 9(e) 3 3 0 6(1) 2 20 0 3 3 14(1) (a) 1 5 0 16(2) 1 5 0 16(3) 1 1 0 16(4) 1 1 0 19 (1) (c) 1 3 0 23(1) 2 2 0 Lonaon County Council (General Powers), Acts Caravans on unlicensed sites 4 10 0 2 summonses withdrawn Failure to supply dustbin 1 2 0 1 1 Housing Act, 1957 Section 85 (3) 1 Summons dismissed APPENDIX C List of special reports submitted to the Health Committee by the medical officer of health during 1962:— February 6 Acquisition of unfit property April 3 Temporary school, Burnt Ash Hill—Use for old people May 29 Royal Society of Health Congress at Scarborough Holiday Home Conference on "Housing and Welfare of Old People", "Employment and Workshops for the Elderly" July 3 Houses in multiple occupation Workroom for the Elderly Old People's Club At Burnt Ash Hill Other activities October 30 Circular 42/62—Improvement of Houses November 27 Slum Clearance The Saville—Hirinz and general report 73 APPENDIX D The 1961 Census A report on the County of London, compiled from the census which took place in April 1961, has been recently published by HM Stationery Office and the following data, in the main relating to Lewisham, have been extracted from it. To give added interest any figures given in italics in brackets show the corresponding statistic from the 1951 census. The total population in the City and County was 3,200,484 (3,347,982), a decline of 147,000 persons since the 1951 census. A decrease was common to all boroughs except Hampstead, Stoke Newington, Kensington and Wandsworth. Lewisham showed a decrease of 5,823 persons, the total population at the census being 221,753 (227,576). Ward populations varied from 7,668 (Culverley) to 17,657 (South Lee). The persons per acre in the wards varied from 22.7 (South Lee) to 48.0 (Grove Park). The persons per room varied from 0.60 (Culverley) to 0.87 (Bellingham) and the percentage of persons living more than 1½ per room varied from 2.0 (St. Andrew's) to 9-9 (Grove Park), the average for the whole borough being 5 •9 (8 . 3). Details follow: Ward Acreage Population Persons per acre Rooms occupied Persons per rooms % persons more than 1 ½ per room 1951 1961 Bellingham 442 11,767 10,816 24.5 12,518 0.87 8.5 Blackheath and 411 9,135 10,290 250 14,442 0.70 5.0 Church Lee Brockley 352 16,205 15,128 430 21,971 0.69 7.8 Culverley 253 8,339 7,668 30.3 12,815 0.60 2.8 forest Hill 498 16,097 15,928 320 24,224 0.66 4.8 Grove Park 199 11,360 9,543 480 11,239 0.85 9.9 Honor Oak Park 435 15,443 15,443 35-5 23,234 0.67 5.2 Ladywell 334 13,363 13,399 40.1 18,626 0.68 6.8 Lewisham Park 338 13,808 13,532 400 17,275 0.73 8.5 Lewisham Village 306 9,253 9,088 29.7 12,261 0.74 9.7 Manor(Lee) 221 9,858 9,327 42.2 14,350 0.65 5.2 Rushey Green 217 8,742 7,852 36.2 11,813 0.67 6.3 St. Andrews 315 12,495 11,773 37.4 19,178 0.62 20 South (Lee) 777 17,607 17,657 22.7 25,950 0.68 40 Southend 576 15,639 15,085 26.2 19,224 0.79 7.4 Sydenham E. 510 16,490 15,453 30-3 23,608 0.66 4.8 Sydenham W. 468 11,642 13,724 29.3 19,141 0.71 3.9 Whitefoot 364 10,333 10,047 27.6 13,643 0.74 4.2 BOROUGH 7,017 227,576 221,753 31 -6 315,512 0.70 5.9 It will be seen that only 4 wards have an increased population compared with 1951, the biggest increase being in Sydenham W, followed by Blackheath and Church Lee, Ladywell and South Lee (very few only in these last two). The largest decrease is in Grove Park. Ages and marital condition These statistics are grouped into five-year periods and are as overleaf: 74 Age last birthday Persons Male Female Total Single Married W'd'wed D'd Total Single Married W'd'wed D'v'd Total 221,753 104,978 44,264 57,403 2,808 503 116,775 44,786 58,112 12,866 1,011 W'd'wd 15,674 2,808 12,866 D'v'd 1,514 503 1,011 0-4 15,614 7,857 7,857 7,757 7,757 5-9 13,802 6,999 6,999 6,803 6,803 10-14 17,374 8,749 8,749 8,625 8,625 15-19 15,604 7,738 7,678 60 - - 7,866 7,343 523 - - 20-24 14,589 7,072 4,883 2,187 2 — 7,517 3,353 4,150 4 10 25-29 13,690 6,992 2,184 4,778 5 25 6,698 1,312 5,320 19 47 30-34 13,673 6,760 1,331 5,376 13 40 6,913 918 5,886 41 68 35-39 15,649 7,479 1,042 6,347 22 68 8,170 1,001 6,923 103 143 40-44 15,182 7,290 755 6,414 49 72 7,892 958 6,526 218 190 45-49 16,622 7,985 690 7,103 104 88 8,637 1,018 7,058 415 146 50-54 16,011 7,833 573 7,019 152 89 8,178 1,086 6,288 654 150 55-59 14,578 6,911 513 6,139 194 65 7,667 1,134 5,407 1,023 103 60-64 11,819 5,136 311 4,504 283 38 6,683 934 4.071 1,595 83 65-69 9,847 3,945 233 3,352 354 6 5,902 833 2,902 2,121 46 70-74 7,706 2,894 178 2,222 485 9 4,812 699 1,797 2,298 18 75-79 5,274 1,810 144 1,196 468 2 3,464 498 870 2,091 5 80-84 3,060 1,034 95 534 404 1 2,026 319 298 1,407 2 85-89 1,315 414 42 151 221 - 901 146 82 673 - 90-94 300 69 6 15 48 _ 231 40 9 182 - 95 and over 44 11 1 6 4 — 33 9 2 22 - It will be seen that the number of males exceeds the number of females as far as age 14, but from then onwards the number of females exceeds the number of males in an almost continually increasing ratio until in the age group 85 to 89 there are more than double the number of females to males—901 compared with 414. It will also be seen that there were 33 women over the age of 95 and 11 men of that age group (compared with 20 and 7 ten years previously). Taking 65 for men and 60 for women as the retiring age the number of "old people" in the borough was 10,177 men and 24,052 women making 34,229 persons in all (against 9,508, 21,199 and 30,707 respectively in 1951). Ages of juveniles With regard to persons under the age of 21, there were 32,678 (31,533) males and 32,466 (32,288) females in Lewisham. The distribution in the various ages was as follows: Age last birthday Males Females 0-20 32,678 32,466 0 1,768 1,702 1 1,573 1,610 2 1,558 1,530 3 1,531 1,469 4 1,427 1,446 75 Age last birthday Males Females 5 1,383 1,344 6 1,427 1,372 7 1,424 1,361 8 1,415 1,307 9 1,350 1,419 10 1,479 1,431 11 1,447 1,481 12 1,686 1,618 13 1,937 2,005 14 2,200 2,090 15 1,624 1,625 16 1,688 1,643 17 1,549 1,539 18 1,581 1,616 19 1,296 1,443 20 1,335 1,415 Dwellings, rooms and households In Lewisham there were 65,046 structurally separate dwellings occupied and 884 additional ones vacant making 65,930 (59,336) structurally separate dwellings in all, including three caravans. The 65,930 structurally separate dwellings housed 73,935 private households numbering 217, 625 persons in 315,512 rooms as follows : Households occupying the following rooms (1) Total private households therein (2) No. of households sharing dwelling (3) Col. 3 Households without exclusive use of both stove and sink (4) 1 room 1,840 1,368 835 2 rooms 5,774 2,982 793 3 16,329 6,310 613 4 17,583 3,457 241 5 19,273 1,135 84 6 8,634 384 34 7 2,711 134 16 8 or 9 „ 1,475 56 5 10 or more rooms 316 9 — All sizes 73,935 15,835 A private household was defined to the enumerator as follows: "A household comprises one person living alone or a group of persons living together, partaking of meals prepared together and benefiting from common housekeeping. A person or persons living but not boarding with a household in a house, flat, etc. should be treated as a separate household. But a person living with a household who usually has at least one main meal a day provided by that household while in residence is part of that household. (Breakfast counts as a meal for this purpose.) A household must have exclusive use of at least one room. If two people share one room and do not have exclusive use of at least one other room they should be treated as one house-hold." 76 Dwellings by tenure Of the total of 73,421 "household spaces" the distribution was as follows: Number Percentage Lew. All Lond. Owner-occupied 28,754 340 15 6 Held by virtue of employment 1,242 1.6 2.7 Rented together with business premises 468 0.6 0.7 Rented from a Local Authority 18,763 25.6 21.2 Rented unfurnished from a private person or company 21,889 31 -9 460 Rented furnished from a private person or company 2,305 6.2 13. 8 Lewisham thus has more than double the average of owneroccupiers, slightly more than the average of houses rented from local authorities, and less than half the average of houses rented furnished, compared with London as a whole. Private households in relation to size, rooms occupied and density of occupation Of the 72,922 occupying households (of the total 73,935 households) the distribution of private households by numbers of persons per room was as under : Persons per room Numbers Percentages Those sharing (numbers) Those sharing and not having exclusive use of both stove and sink (numbers) Over 1½ 2,315 3.2 564 405 1 to 1½ 6,699 9.2 1,096 214 1 13,965 19.2 2,981 1,108 ¾to1 10,032 13.8 1,154 85 ½to¾ 23,880 32.7 4,857 613 under ½ 16,031 22.0 2,240 296 Private households according to possession of certain household arrangements Of the 72,922 households 40 were entirely without a piped cold water supply, and 2,567 shared a piped cold water supply with other households. 15,270 households were entirely without a piped hot water supply and a further 3,337 shared a piped hot water supply with other households. 8,574 households were without a fixed bath (compared with 13,245 ten years previously) and 11,269 (compared with 14,966 ten years previously) shared a fixed bath with other households. 205* households were entirely without a water-closet (compared with 52 ten years previously) and 10,673 (compared with 14,807 ten years previously) shared a water-closet with other households. * The increase in this figure, compared with 10 years ago, seems almost confined to "households and single household dwellings" of which there were 16 in 1951 and 139 in 1961, thus accounting for 123 of the increase of 153. 77 Looking at it the other way 47,021 of the 72,922 households, or (.4-5 percent had all four arrangements (piped cold water, piped hot water, fixed bath, and water-closet). This percentage compares with 45 -2 for the whole of London and in fact Lewisham was only exceeded in this respect by the City (77-6), Chelsea (66-8), St. Marylebone (65-5) and Woolwich (70-1) Population in non-private households Of the 221,753 total population of Lewisham, 217,625 or 98-14% were in private households. Of the others 986 were in hotels, boarding houses etc., 476 were in educational establishments or children's homes, 1471 were in hospital or nursing homes, 29 were in mental institutions, 898 were in homes for permanently disabled or aged persons, 209 were in miscellaneous communal establishments, 39 (15) were in places of detention including Borstals and police stations, and there were 20 other persons who came under the heading of "campers, vagrants, etc." Birthplaces and nationalities of the population The following are a few interesting figures picked out from some very detailed statistics. Of the 221,753 population of the borough, 2,584 (2,869) were born in Wales, 2,951 (2,939) in Scotland, 925 (678) in Northern Ireland, 3,792 (2,370) in the Irish Republic, 194 ( 70) others in Ireland unspecified, 33 (32) in the Isle of Man and 152 (179) in the Channel Islands. 2,420 (1,433) of the population were born in Commonwealth countries, 3,387 (444) in colonies, protectorates, etc. and 3,384 (3,393) in foreign countries. A further analysis of the birthplaces of persons born outside the British Isles shows that of the total of 9,603 such persons, 246 (173) were South Africans, 258 (257) Canadians, 82 (32) from Ceylon, 1,060 (680) from India, 65 (40) from Pakistan, 234 (177) were Australians and 75 (68) New Zealanders. There were 2,703 (115) from the Caribbean area. Of those from foreign countries, 2,548 (2,008) were from European countries, including 129 (103) from Austria, 117 (108) from Belgium, 200 (199) from France, 584 (454) from Germany, 420 (152) from Italy, 84 (84) from the Netherlands, 541 (473) from Poland, 135 (146) from Russia and 77 (60) from Switzerland. Of the 261 (166) from foreign countries in Asia, 52 (40) came from China, and 76 from Burma. Of the 222 (219) from foreign countries in America, 131 (146) came from the US. Persons of pensionable age Persons of pensionable age who were in one- or two-person households can be divided up statistically as follows : Total of such households containing persons of pensionable age ... ... ... ... ... 15,717 One person households with a male 65 or over ... 839 „ „ a female 60 or over ... 5,230 78 Two person households (1) with a male and a female (a) both married (i) one pensionable 2,253 (ii) both pensionable 3,821 (b) not both married (i) one pensionable 1,362 (ii) both pensionable 266 (2) two males (i) one pensionable 94 (ii) both pensionable 15 (3) two females (i) one pensionable 1,246 (ii) both pensionable 591 Total persons of pensionable age in one- and two-person house- Total persons of pensionable age in one- or two-person households 20,410 of which one pensionable 11,024 both „ 9,386 79 INDEX SUBJECT PAGE Acts, regulations and orders 70 Area of borough 6 Atmospheric conditions 28 Births and birth rate 6 Cancer of lung 15 Census, 1961 73 Clean Air Act 28 Clearance areas 51 Consumer Protection Act 44 Continental Goods Depot 59 Coronary disease 14 Deaths and death rate 6 Deaths, cause of 8 Decline in child mortality 17 Discretionary grants and standard grants 52 Disinfection and personal cleansing 20 Dog nuisances 25 Drainage work 25 Dysentery 64 Factories 44 Flies and mosquitos 21 Food, adulteration of 56 Food inspection and supervision 54 Food poisoning 67 Food Hygiene Regulations, 59 General statistics from 1901 18 Hairdressers 44 Health education 22 Health Services, general provision of 20 Heattreated milk 54 Home safety 27 House purchase loans 52 Housing:— Building 49 Families rehoused 49 Housing Act, 1957 49 Housing Act, 1961 4 Icecream composition 55 Icecream grading 55 Immunisation 69 Infant mortality 6 Infant mortality analysis 10 Infectious diseases 61 Infectious disease visiting 63 Laboratory facilities 24 SUBJECT PAGE Legal proceedings 72 LCC (General Powers) Act, 1953, section43 21 Mass miniature radiography 68 Maternal deaths 7 Measles 64 Mechanical ventilation of internal W.C.'s 47 Milk, analysis of 54 Milk and Dairies Regulations 54 Mortuary and Coroner's Court 22 Moveable dwellings 52 National Assistance Act, 1948 s. 50 25 s. 47 25 Offensive trades 59 Old people 32 Outworkers 46 Pet animals 44 Pharmacy and Poisons 59 Pigeons 47 Pneumonia 64 Poliomyelitis 64 Population 6 Prevention of Damage by Pests 23 Rag flock etc 47 Rateable value 6 Rent Act 52 Repairs carried out 43 Rodent control 22 Sampling 56 Sanitary circumstances of the area 42 Scarlet fever 64 Shops Act 59 Sickness, local 13 Slaughterhouses 59 Smoke nuisances 42 Social medicine statistics 11 Staff 2 Stillbirths 6 Swimming baths 25 Tuberculosis 65 Unsound food 58 Vaccination 69 Vital statistics 6 Water certificates 44 Water supply 25 Whooping cough 65 80 TABLES TABLE SUBJECT PAGE TABLE SUBJECT PAGE NO. NO. 1 Comparative statistics 7 29 Demolition orders 50 2 Causes of death by age 30 Closing orders 50 groups 8 in 31 Clearance areas 51 3 Deaths under one year 10 4 Deaths by social class 11 32 Rent Act, 1957 52 5 Grouped causes of death 33 Analysis of milk 54 by social class 12 34 Icecream composition 55 6 Births, infants deaths, etc. by social class 12 35 Icecream grading 55 7 Morbidity 13 36 Samples analysed 56 8 Heart and circulation mort- 37 Adulterated samples 56 ality 14 15 38 Continental Goods Depot 60 9 Lung cancer 15 10 General Statistics 18 39 Notified cases of infectious diseases 61 11 Disinfecting station 20 40 Notifications of infectious 12 Verminous conditions e t c. diseases by age and sex 62 13 Public mortuary 2„ 41 Analysis of certain diseases 14 Rodent control—treatment into divisional areas 63 of rivers 23 42 Infectious disease visiting b4 15 Prevention of Damage by Pests Act 24 43 Tuberculosis notifications and deaths 65 16 Laboratory facilities 24 44 Analysis of new cases of 17 Swimming Baths 25 tuberculosis into divisional 18 Water, chemical samples 26 areas 66 19 Water, Bacteriological 45 Tuberculosis 10 year statistics 66 samples 26 45 Tuberculosis—environmental 20 Accidents 27 conditions 67 21 Smoke Control Areas 28 47 Food poisoning cases 67 22 Atmospheric conditions 30 48 Mass Radiography 68 23 Old People's visits 36 49 Immunisation against in_ 24 Sanitary inspection 42 fectious disease 69 25 Summary of notices 43 26 Repairs carried out 43 27 Factory inspections 45 28 Factory defects 46 CHARTS First applications for sickness benefit 1951 - 62 13 Measurement of atmospheric pollution 29