LEW 51 METROPOLITAN BOROUGH OF LEWISHAM Report OF THE Medical Officer of Health for the Year 1963 E. H. R. Smithard, MBE, MD, DPH CONTENTS Page Staff 2 Introduction 3 Vital Statistics 4 General Provision of Health Services 18 The Care of the Elderly 30 Sanitary Circumstances of the Area 37 Housing 44 Inspection and Supervision of Food 48 Infectious Diseases 56 Appendix A — Statutory Instruments 66 „ B—Legal Proceedings 68 „ C—Special Reports to Health Committee 68 "The chief function of the Medical Officer of Health is to safeguard the health of the area for which he acts by such means as are at his disposal" "He should endeavour to acquire an accurate knowledge of the influences, social, environmental and industrial, which may operate prejudicially to health in the area" "While he has special duties for the prevention of infectious diseases, all morbid conditions contributing to a high sickness rate or mortality in the area from these or other causes should be studied with a view to their prevention or control." —from the Ministry of Health Memorandum on the duties of MOHs 2 STAFF as at 31/12/63 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Public Health Inspector Deputy Senior Public Health Inspector A. J. Phillips (a) (b) J. R. Craven (a) (b) Group Public Health Inspectors H. Tolson (a) (b) (Food) R. C. Brittain (a) (b) (Housing) Assistant Group Housing Inspector *R. Mahoney (a) (b) (District) J. W. Bevan (a) (b) (c) District Inspectors Divisional Food Inspector *G. L. Belshaw (a) (b) H. W. Ellery (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) *F. W. Culver (a) (b) *D. G. Oliver (a) (b) (c) *W. J. Wilcox (a) (b) J. T. Smith (a) R. W. Bradstock (a) (b) B. Boyd (a) {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 Wardens Mrs. A. Carins, srn, rfn Mrs. E. Peevor, srmn., rmpa Mrs. L. Champness, srn, rfn Mrs. C. M. Heath, srn Mrs. M, M. Coulson, srn, qidn Principal Clerk E. W. Cheesman Clerical Staff Student public health inspectors S. Burridge, (senior clerk) G. Matthews C. R. Coleman M. Chapman Mrs. D. J. Handford D. Boon Miss M. E. Hinchcliff K. Richardson Mrs. M. G. James Mrs. H. I. Barnes Miss F. E. Smith Miss A. Keys Mrs. T. Dean Coroner's Court and Mortuary W. C. Spear, officer-in-charge Disinfecting Station, Pest Control, etc. J. G. Beale, superintendent R. A. Sharman, foreman rodent Foreman Disinfector operative Disinfectors 7 Rodent operatives 4 Bathing attendants 2 Rodent/fly operatives 2 Domiciliary Bathing Attendants 2 Drain tester 1 Handyman 1 Public Analyst J. H. Shelton, fric Bacteriologist E. H. Bailey, mrcs, lrcp, of the Public Health Laboratory Service. 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham Mr. Mayor, Ladies and Gentlemen, This report on the health and environmental circumstances of Lewisham for 1963 was prepared before the sad death of Dr. Smithard in March of this year and it is therefore my melancholy duty to provide a brief introductory statement. The work of the Health Department during the year which is under review and recorded in these pages, reflects the enthusiasms and the interests of the late Medical Officer of Health. The statistics and the tabulations together with the necessary explanatory statements bear the stamp of his lucid and exact mind. Dr. Smithard's interests lay in the welfare of people old and young alike and in the way they can react to their environment and respond to fellowship one with another. If he applied himself particularly to the problems of the aged it was because it was in that field that he could make, in his official capacity, the most direct impact; but his annual analyses of the factors which impinge directly or indirectly on the health of the community were always fresh and stimulating and were of great local social value. This report should be read not only for the intrinsic merit of a carefully documented account of the important work of the Health Department, but also because it was the last full year that Dr. Smithard was in charge of the Department. I am honoured to be associated with this report which is a credit to his memory. J. K. Brown, Acting Medical Officer of Health The Public Health Committee during the year was constituted as follows: Councillor A. A. Hawkins (Chairman) Councillor Mrs. D. I. Cox (Vice-Chairman) Councillor F. P. Page (The Mayor) Alderman C. S. E. Fox Councillors Mrs. H. D. Burch, Mrs. C. M. Costello, 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, A. J. Pinnegar and E. F. Inch. 4 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 221,753 The Registrar-General's estimate of the home population at midyear 1963 was 222,730. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1963 £8,854,026 Estimated net product of a penny rate 1963/4 £35,750 Estimated number of separately assessed dwellings at April 1, 1963 66,307 Births (adjusted for inward and outward transfers) Total Livebirths 3,996 Males Females Total Legitimate 1,852 1,726 3,578 (3,497) Illegitimate 207 211 418 (413) Totals 2,059 1,937 3,996 (3,910) Crude birth rate per 1,000 of the estimated population 17.9 (17.6) Adjusted birth rate for comparative purposes (Area comparability factor = 0.97) 17.4 (16.9) Birth rate for England and Wales 18.2 (18.0) Adjusted birth rate for London Administrative County 17.2 (17.6) Stillbirths Total (30 males and 24 females) 54 (50) Rate per 1,000 live and stillbirths) 13.3 (12.6) (males 14.3 (10.3): females 12.2 (15.2) Deaths Total (1,367 males, 1,272 females) 2,639 (2,569) Crude death rate per 1,000 population 11.8 (11.6) Adjusted death rate 11.4 (11.5) (Area comparability factor = 0.97) Death rate for England and Wales 12.2 (11.9) ,, „ „ London Administrative County 12.5 (11.4) Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 55 26 81 (66) Illegitimate 5 6 11 (8) Total 60 32 92 (74) 5 Rates: 1. All infants per thousand livebirths 23.0 (18.9) 2. Legitimate infants per thousand legitimate livebirths 22.6 (18.9) 3. Illegitimate infants per thousand illegitimate livebirths 26.3 (19.4) 4. Male infants per thousand male livebirths 29.1 (24.2) 5. Female infants per thousand female livebirths 16.5 (13.3) Neonatal deaths (under 4 weeks of age) 63 (51) Neonatal death rates:— Males, per 1,000 male livebirths 20.4 Females, per 1,000 female livebirths 10.8 All infants, per 1,000 livebirths 15.8 (13.0) Early neonatal deaths (under 1 week of age) 53 (46) Males, per thousand male livebirths 18.0 Females, per thousand female livebirths 8.3 All infants per thousand livebirths 13.3 (11.8) Perinatal mortality (deaths under 1 week plus stillbirths) 107 (96) Males, per thousand live and still male births 32.1 Females, per thousand live and still female births 20.4 All infants, per thousand live and stillbirths 26.4 (24.2) Reproductive wastage—(Stillbirths plus all infant deaths) 146 (124) Males, per 1,000 live and still male births 43.1 Females, per 1,000 live and still female births 28.6 All infants, per 1,000 live and still births 36.0 (31.3) Maternal deaths Maternal deaths 2 (2) Maternal mortality rate per thousand live and still births 0.5 (0.5) Other special causes of death Measles — (—) Whooping-cough — (—) Gastroenteritis (infants) — (—) Tuberculosis (all forms) 15 (23) Motor vehicle accidents 19 (28) Suicide 40 (26) Respiratory diseases (other than tuberculosis) (Code Nos. 22.-25) 401 (339) Cancer (Code Nos. 10-15) 490 (548) Heart and circulation diseases (Code Nos. 17-21) 1,325 (1,207) Comparative statistics for the year 1963 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 17.4 13.3 11.4 23.0 England and Wales 18.2 17.3 12.2 20.9 London Administrative County 17.2 15.7 12.5 21.8 6 Causes of death at different periods I he following table shows the causes ot and Tib Code No. Causes of death Nett deaths at the subjoined ages of " residents" whether occurring within or without the borough MALES Total person (i.e) incl. table opp. All ages Under 1 yr. 1 and under 5 5 and under IS 15 and under 25 2J and under 45 45 and under 65 65 anc under 75 75 and over Totals, all causes 1367 60 6 10 10 50 359 355 517 2639 1 Tuberculosis, respiratory 12 — — — — 1 4 2 5 15 2 Tuberculosis, other forms — — — — — — — — — — 3 Syphilitic diseases 6 — — — — — 2 2 2 7 4 Diphtheria — — — — — — — — — — 5 Whooping cough — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — 7 Acute poliomyelitis — — — — — — — — — — 8 Measles — — — — — — — — — — 9 Other infective and parasitic diseases 5 1 — 1 — — 1 1 1 5 10 Malignant neoplasms, stomach 38 — — — — 2 15 15 6 64 11 Malignant neoplasms, lung and bronchus 117 — — — — 4 51 45 17 139 12 Malignant neoplasms, breast — — — — — — — — — 53 13 Malignant neoplasms, uterus — — — — — — — — — 17 14 Other malignant and lymphatic neoplasms 103 — — — — 6 27 30 40 201 15 Leukaemia, aleukaemia 8 — — 2 — — 2 1 3 16 16 Diabetes 6 — — — — — 1 4 1 16 17 Vascular lesions of nervous system 138 — — — 1 3 26 31 77 346 18 Coronary disease, angina 330 — — — — 10 106 113 101 557 19 Hypertension with heart disease 18 — — — — 2 3 2 11 49 20 Other heart disease 100 — — — 1 3 19 24 53 260 21 Other circulatory disease 46 — — — — 2 11 10 23 113 22 Influenza 3 — — — — — 2 1 — 7 23 Pneumonia 92 4 2 — 1 — 15 16 54 182 24 Bronchitis 139 3 — — 1 1 39 32 63 190 25 Other diseases of respiratory system 9 1 — — — — 1 2 5 22 26 Ulcers of stomach and denum 8 — — — — — 2 3 3 15 27 Gastritis, enteritis and diarrhœa 7 2 1 — — 1 1 1 1 19 28 Nephritis and nephrosis 10 — — — 1 1 5 2 1 17 29 Hyperplasia of prostate 14 — — — — — — 3 11 14 30 Pregnancy, childbirth, abortion — — — — — — — — — 2 31 Congenital malformations 19 18 1 — — — — — — 35 32 Other defined and ill defined causes 91 30 2 1 1 4 13 8 32 182 33 Motor vehicle accidents 11 — — 3 2 2 2 — 2 19 34 All other accidents 15 — — 3 1 1 4 3 3 35 35 Suicides 20 — — — 1 6 7 4 2 40 36 Homicide and operations of war 2 1 — — — 1 — — — 2 7 of life during the year 1963 ages at death during the calendar year 1963:— 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 1272 32 4 4 4 35 203 297 693 2639 1 Tuberculosis, respiratory 3 — — — — 1 — 1 1 15 2 Tuberculosis, other forms — — — — — — — — — — 3 Syphilitic diseases 1 — — — — — — — 1 7 4 Diphtheria — — — — — — — — — — 5 Whooping cough — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — 7 Acute poliomyelitis — — — — — — — — — — 8 Measles — — — — — — — — — — 9 Other infective and parasitic diseases — — — — — — — — — 5 10 Malignant neoplasms, stomach 26 — — — — — 5 2 19 64 11 Malignant neoplasms, lung and bronchus 22 — — — — 1 6 11 4 139 12 Malignant neoplasms, breast 53 — — — — 7 22 14 10 53 13 Malignant neoplasms, uterus 17 — — — — 1 6 4 6 17 14 Other malignant and lymphatic neoplasms 98 — — 1 1 5 30 24 27 201 15 Leukaemia, aleukaemia 8 — — 1 — — 5 2 — 16 16 Diabetes 10 — — — — — 1 6 3 16 17 Vascular lesions of nervous system 208 — — — — 2 27 45 134 346 18 Coronary disease, angina 227 — — — — — 23 69 135 557 19 Hypertension with heart disease 31 — — — — 1 — 8 22 49 20 Other heart disease 160 — — — — 1 11 28 120 260 21 Other circulatory disease 67 — — — — — 7 15 45 113 22 Influenza 4 — — — — — — 2 2 7 23 Pneumonia 90 5 2 — — — 10 15 58 182 24 Bronchitis 51 — — — — — 7 12 32 190 25 Other diseases of respiratory system 13 2 — — — — 1 4 6 22 26 Ulcer of stomach and duodenum 7 — — — — — 1 2 4 15 27 Gastritis, enteritis and diarrhœa 12 — — — — 2 3 4 3 19 28 Nephritis and nephrosis 7 — — — 2 1 4 — — 17 29 Hyperplasia of prostate — — — — — — — — — 14 30 Pregnancy, childbirth, abortion 2 — — — — 2 — — — 2 31 Congenital malformations 16 10 — 1 — 1 1 1 2 35 32 Other defined and ill defined causes 91 14 1 1 — 2 22 19 32 182 33 Motor vehicle accidents 8 — — — 1 1 — 4 2 19 34 All other accidents 20 1 1 — — 1 2 3 12 35 35 Suicides 20 — — — — 6 9 2 3 40 36 Homicide and operations of war — — — — — — — — — 2 8 Deaths under 1 year of age Table 3 Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths Total under 1 yr. Other infective and parasitic diseases M 1 — — — — 1 — — — — — 1 F — — — — — — — — — — — — Haemorrhagic conditions M — — — — — — — — — — — — F — — 1 — — 1 — — — — — 1 Inflammatory diseases of central nervous system M — — — — — — — — — — — — F — — 1 — — 1 — — — — — 1 Pneumonia M — — — — — — 2 — 2 — 4 4 F — — — — — — 3 1 — — 4 4 Bronchitis M — — — 1 — 1 — 1 — 1 2 3 F — — — — — — — — — — — — Other respiratory diseases M 1 — — — — 1 — — — — — 1 F — — — — — — 1 1 — — 2 2 Gastro-enteritis M — — — — — — 2 — — — 2 2 F — — — — — — — — — — — — Spina bifida and meningocele M 1 — — — — 1 — — 1 — 1 2 F — — — — — — 1 — — — 1 1 Congenital hydrocephalus M — — — — — — — — — — — — F — 1 — — — 1 — — — — — 1 Congenital malformations of heart M — 2 2 — — 4 4 1 — — 5 9 F — 2 1 — — 3 — 1 — — 1 4 Congenital malformations of genito-urinary system M 1 — — — — 1 — — — — — 1 F — — — — — — — — — — — — Other congenital malformations M 1 1 — — 2 4 — 1 1 — 2 6 F 1 2 — — — 3 — 1 — — 1 4 Injury at birth M 3 3 — — — 6 — — — — — 6 F 3 — 1 — — 4 — — — — — 4 Postnatal asphyxia and atelectasis M 1 7 — — — 8 — — — — — 8 F 1 1 — — — 2 — — — — — 2 Pneumonia of newborn M — — — — — — — — — — — — F — —1 — — — 1 — — — — — 1 9 Table 3—continued Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths. Total under 1 yr. Pemphigus and sepsis of newborn M — — — — — — — — — — — — F — — 1 — — 1 — — — — — 1 Haemolytic disease of newborn M — 1 — — — 1 — — — — — 1 F — — — — — — — — — — — Immaturity M 7 5 — — — 12 — — — — — 12 F 4 — — — — 4 — — — — — 4 Accidental mechanical suffocation M — — — — — — — — — — — — F — — — — — — — — 1 — 1 1 All other causes M — 2 — — — 2 — 2 — — 2 4 F — — — — — — 1 — — — 1 1 TOTALS M 16 21 2 1 2 42 8 5 4 1 18 60 F 9 7 5 — — 21 6 4 1 — 11 32 GRAND TOTAL 25 28 7 1 2 63 14 9 5 1 29 92 29 infants (18 male and 11 female) thus died between the age of one month and one year, six more than in the previous year, and compared with 23 the year before that. 10 of the 29 deaths were from pneumonia and bronchitis, 9 were from congenital malformations, 2 were from gastro-enteritis, and there were 5 from other causes, with 3 being undefined. The number of deaths under 4 weeks of age was 63, twelve more than in the previous year, the greatest incidences being in immaturity with 16 deaths (3 more than last year), injury at birth with 10 deaths, and post-natal asphyxia and atelectasis with 10 deaths (1 less than last year). 10 The social class, related to cause of death, was as follows:— Table 4 Code No. Cause of death Male Female 1 II Ill IV V Total 1 II Ill IV V Totol 1 Tuberculosis, respiratory — 1 11 — — 12 — — 3 — — 3 2 Tuberculosis, other forms — — — — — — — — — — — — 3 Syphilitic disease — — — — — — — — — — — — 4 Diphtheria — — — — — — — — — — — — 5 Whooping cough — — — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — — — 7 Acute poliomyelitis — — — — — — — — — — — — 8 Measles — — — — — — — — — — — — 9 Other infective and parasitic diseases — — 3 2 — 5 — — — — — — 10 Malignant neoplasm, stomach — 6 19 7 5 37 — 4 18 4 2 28 11 Malignant neoplasm, lung, bronchus 1 22 67 24 7 121 — 2 17 — 1 20 12 Malignant neoplasm, breast — — — — — — 3 15 29 5 1 53 13 Malignant neoplasm, uterus — — — — — — — 1 9 2 1 13 14 Other malignant and lymphatic neoplasms 2 18 59 17 4 100 3 25 44 15 8 95 15 Leukaemia, aleukaemia 1 3 3 6 — 13 — 2 5 1 — 8 16 Diabetes 1 1 1 2 — 5 — 2 6 1 — 9 17 Vascular lesions of nervous system 4 29 87 18 13 151 9 35 90 27 14 175 18 Coronary disease, angina 12 41 163 33 22 271 5 27 92 27 9 160 19 Hypertension with heart disease — 6 18 4 — 28 1 9 28 15 4 57 20 Other heart disease 5 22 78 16 15 136 5 31 108 32 15 191 21 Other circulatory disease 2 6 29 7 — 44 — 6 25 7 2 40 22 Influenza — — 2 1 — 3 — — 2 1 1 4 23 Pneumonia 2 8 48 17 17 92 — 26 52 17 8 103 24 Bronchitis 1 25 73 21 19 139 1 7 29 7 7 51 25 Other diseases of respiratory system — — 5 2 1 8 — 3 3 — — 6 26 Ulcer of stomach and duodenum 1 — 3 1 3 8 — — 5 2 — 7 27 Gastritis, enteritis and diarrhœa — — 1 — — 1 — — — 1 — 1 28 Nephritis and nephrosis — 3 12 1 3 19 1 3 10 4 2 20 29 Hyperplasia of prostate — 2 11 — — 13 — — — — — — 30 Pregnancy, childbirth, abortion — — — — — — — — 2 — — 2 31 Congenital malformations 1 4 8 3 — 16 2 2 6 — 1 11 32 Other defined and ill defined diseases 5 9 44 11 1 70 4 16 39 10 2 71 33 Motor vehicle accidents 1 — 7 2 1 11 — 1 4 3 — 8 34 All other accidents — 3 10 2 1 16 — 5 10 — 2 17 35 Suicides — 3 12 1 4 20 2 5 9 2 1 19 36 Homicide and operations of war — — 1 — 1 2 — — — — — — Totals 39 212 775 198 117 1341 36 227 645 183 81 1172 Percentage 3 16 58 IS 8 100 3 19 55 16 7 100 No social class assessed — — — — — 26 — — — — — 100 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. 11 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 1 II III IV V Total 1 II III IV V Total 10-15 Cancers No. 4 49 148 54 16 271 6 49 122 27 13 217 % / 18 55 20 6 100 3 23 56 12 6 100 17-21 Heart and circulation No. 23 104 375 78 50 630 20 108 343 108 44 623 % 4 16 60 12 8 100 3 17 55 17 8 100 22-25 Lung, not TB or cancer No. 3 33 128 41 37 242 1 36 86 25 16 164 % 1 14 53 17 15 100 1 22 52 15 10 100 33,34 Accidents No. 1 3 17 4 2 27 — 6 14 3 2 25 % 4 11 63 15 7 100 — 24 56 12 8 100 35 Suicides No. — 3 12 1 4 20 2 5 9 2 1 19 % — 15 60 5 20 100 11 26 47 II 5 100 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 6 Morbidity shown in insurance certificates Weekly average for period ending "Lewisham & Downham" Weekly average for period ending "Lewisham & Downham" January 29 1368 August 13 455 February 26 1652 September 10 491 March 26 1051 October 8 649 April 23 630 November 5 762 May 21 608 December 3 749 June 18 497 December 31 703 July 16 501 Weekly average for the year 1963 765 „ ,, 1962 760 12 FIRST APPLICATIONS FOR SICKNESS BENEFIT Dotted lines—Maximum and Minimum 1951—62 Continuous line—1963 Heart disease Besides being responsible for a prodigious loss of man-working capacity in the United Kingdom amounting, it is estimated, to some 12 million week days per year, cardiovascular and atherosclerotic disease as a group are responsible for more deaths than any other single cause and, as such, constitute the greatest possible challenge to preventive medicine. The urgency of this problem becomes intensified when it is realised that deaths from arteriosclerotic and degenerative heart disease are mounting year by year. In animals where atherosclerosis has been artificially induced, occlusion is so rare that it would appear that the problem is not simply the thickening of arteries but of their blockage or occlusion and some research workers are confident that the cause is to be found in a disturbance of the fat and cholesterol metabolism and coagulability of the arterial blood. A glance at table 7 will be enough to show how the percentage of deaths from such maladies have risen over the past 35 years, and the high numbers occurring in the age groups 45-65, 13 The speed and strain of modern civilisation is thought to have a great bearing on these so-called "stress" diseases but stress, which is recognised as a predisposing factor in the increased incidence of cardiac disability is a somewhat vague term. However, some of the following circumstances undoubtedly give rise to "stress" as we understand it today. Living Standards.—As living standards rise, not unnaturally there is an increase in "high-living" which generally goes hand in hand with bigger meals and an increased intake of fatty foods. This in turn gives rise to over-weight and obesity. Single mindedness—The concentration on a narrow field or single motive constitutes a "stress". All classes are susceptible from the housewife or humble clerk to the managing director. Indolence.—Inactivity, perhaps largely enforced, by persons having to travel long distances to work, to conferences or to customers by car or train, results in muscles being unable to respond to a call for unusual effort and, with the heart, there is often no recovery. Smoking.—Over recent years there has been a substantial rise in tobacco consumption. Nicotine is known as a cardiac poison which in many instances blunts the desire for physical effort. Modern Living.—An environment of noise, petty irritations, current news, jobs with a time limit, results in an increase in adrenalin demand. Eventually the environment wins and there is a breakdown. Table 7 Heart and circulation mortality Deaths from Total heart and circulation (all ages) Age group 45-65 Total deaths in borough Percentage Year Coronary diseases Other heart diseases* Other circulatory diseases† Total Coronary diseases (e) of (h) (f) of (h) (g) of (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) 1928 357 97 454 115 — 1993 23 5.8 ? 1933 516 117 633 162 — 2271 28 7.1 ? 1938 659 139 798 178 — 2403 33 7.4 ? 1943 583 64 647 129 — 2359 27 5.5 ? 1948 696 63 759 155 — 2253 34 6.9 ? 1953 775 113 888 140 — 2502 35 5.6 3.4 1958 770 109 879 150 — 2433 36 6.2 4.1 1963 866 113 979 180 — 2639 37 6.8 4.9 1958 407 363 109 879 150 99 2433 36 6.2 4.1 9 470 360 118 948 161 110 2617 36 6.2 4.2 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 3 557 309 113 979 180 129 2639 37 6.8 4.9 means figure not available, *R,G, Code Nos, 19 and 20. †R.G. Code No. 21. 14 Lung cancer Table 8 Year (a) MALE FEMALE All cancer deaths (b) Lung cancer deaths (c) (c) as % of (b) (d) All cancer deaths (e) Lung cancer deaths (f) (f) as % °f (e) (g) 1952 246 77 31 238 9 4 1953 237 83 35 215 13 6 1954 238 76 32 192 13 7 1955 303 102 34 226 19 8 1956 259 96 37 226 12 5 1957 267 101 38 229 21 9 1958 271 114 42 201 21 10 1959 297 118 40 235 22 9 1960 315 145 46 254 17 7 1961 271 119 44 210 15 7 1962 324 155 48 224 19 8 1963 266 117 44 224 22 10 These figures although slightly less than last year's are nevertheless appalling, and no excuse is made for repeating the following extracts from last year's annual report. "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. "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. 15 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." There is, however, a small but increasing attitude among the public of the desirability of doing something about this problem as is evidenced by a growing disapproval of smoking in public places, a greater demand for non-smoking compartments in trains and a general awareness that smoking at least of cigarettes is a bad habit and not an aspect of manliness. It is to be hoped that this tendency will continue and the time will not be too far distant when it will have a major effect in reducing the amount of tobacco consumed. General statistics from 1901 Table 9 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate ‡ Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12)-(10) ** Infant mortality rate ** Reproductive wastage rate (9)+(12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate †† Death rate †† % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1901 127,495 13.0 — 74 26 — 3.9 — — — 128 — — 93 — 1902 132,432 13.7 — 74 26 — 4.3 — — — 122 — — 106 — 1903 136,405 1.1 — 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 54 15 — 2 3 — 22 30 52 — 168 77 15 1929 207,900 11.5 27 52 16 — 5.3 — — — 44 — 142 74 13 1930 207,900 9.7 28 53 15 — 0.9 37 — — 42 79 154 76 12 16 Table 9-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 II 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 II 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 48 16 1949 227,700 10.2 II 35 17 — 0.3 16 13 6 19 35 146 40 12 1950 228,300 10.6 II 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 8 1953 225,800 11.1 9 29 14 75 0.3 23 16 6 22 45 136 19 14 1954 224,200 10.0 8 31 14 60 Nil 14 13 8 21 35 102 16 10 1955 223,400 10.8 7 28 14 69 0.9 18 11 6 17 35 114 10 5 1956 222,100 11.3 6 27 14 59 Nil 19 16 3 19 38 88 13 II 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 II 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 II 1963 222,730 11.8 8 29 18 78 0.5 13 16 7 23 36 48 7 9 17 *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. 18 GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows:— Disinfecting Station Table 10 West North South Total Disinfection Premises visited 43 20 23 86 Rooms disinfected 103 45 70 218 Articles disinfected 1306 977 459 2742 Disinfestation Premises visited 26 17 13 56 Rooms disinfested 76 72 37 185 Articles disinfested 17 33 37 87 Articles treated Beds 22 13 10 45 Mattresses 61 29 31 121 Bolsters 15 11 15 41 Pillows 104 57 61 222 Cushions 25 16 8 49 Quilts 26 23 16 65 Blankets 143 86 64 293 Sheets 60 51 32 143 Household articles 422 485 128 1035 Wearing apparel 445 239 131 815 Total articles 1323 1010 496 2829 Articles received from the cleansing station — 845 — 845 Articles received from the Coroner's court — 1054 — 1054 Public library books treated after infection 84 73 102 259 Private library books treated after infection 126 18 — 144 Articles treated under the Public Health (London) Act s.122 18598 19016 14334 51948 Treatments for verminous conditions and for scabies were as follows: Verminous conditions Table 11 1st Cleansing 2nd Cleansing 3rd Cleansing 4th Cleansing Children under 5 6 — — — School children 28 2 — — Adults 15 — — — TOTALS 49 2 — — 19 Scabies Table 11—continued Cases Contacts Treatments Children under 5 2 — 4 School children 9 — 18 Adults 22 — 45 TOTALS 33 — 67 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. No such cases arose during the year. Anti-fly and anti-mosquito campaign This campaign, which for some years has operated from early May to the end of September, had this year to be considerably curtailed. The reason was mainly due to resignations and illness which occurred early in the period among the operatives normally seconded for this work and the difficulties in appointing new staff. However it was possible to deal with certain sites known to be particularly bad as rubbish dumps, and a number of these were visited and treated several times. Some of the rubbish found was burnt on the site, the remainder being removed to the Council's depot for disposal with the household refuse. Attention was also given to potential sources of flies, such as stables and piggeries. A few complaints from householders were also dealt with by the operatives. The co-operation of the Borough Engineer's department was again available for the treatment of dustbins with powder supplied by the health department. Generally it would seem that there has been a considerable reduction in fly infestations in recent years. This may be due to the control methods adopted, particularly with the modern insecticides, but probably weather conditions have also had some effect. 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 2,500 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 elder schoolgirls, and two to members of women's clubs. 20 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 12 Month Bodies received from Institutions Others Post-mortem examinations Inquests held Lewisham residents Others January 57 65 75 47 11 February 58 57 74 41 11 March 59 49 51 47 9 April 42 33 48 27 9 May 34 41 46 29 15 June 46 33 40 39 8 July 38 27 37 28 6 August 31 24 31 24 17 September 41 34 27 38 14 October 35 30 33 32 14 November 58 42 63 37 17 December 63 42 68 37 15 TOTALS 562 477 593 426 146 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 1963, Mr. Phillips, the senior public health inspector, states:—"The number of complaints of rat infestation showed a slight decrease in 1962 and this has been maintained during 1963 with a reduction from 1,122 to 961. This can be attributed to the effect of the regular baiting of the sewers and also to the improvement of the rivers where the number of base points laid was lower than in 1962 both in the river Ravensbourne and the river Quaggy. These rivers, however, still call for considerable attention due to a very great extent to the scraps of food and rubbish which are thrown into them. Most of the infestations were dealt with by the use of warfarin in oatmeal but in some of the cases it was necessary to use other bait. Although the number of visits made to deal with infestations of rats was less it was rather disturbing to note a further increase in mice complaints. In dwelling houses these were 392 compared with 339 in 1962 and in shops the numbers were 76 compared with 52. The figures for dwelling houses are disappointing in that after ensuring that a number of houses in multi-occupation were provided with proper food stores, this type of property was still the cause of many of the complaints." 21 Table 13 Location Base points River Ravensbourne 120 River Quaggy 67 For the past four years continuous baiting of manholes has been undertaken by a permanent rodent control gang, and after some 3,000 manholes had been baited three 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 1963 submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended:— Table 14 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 11 1,431 176 1,618 — (b) survey 7 1,073 41 1,121 — (c) otherwise — 34 4 38 — Total inspections (including reinspections) 18 2,661 222 2,901 — Properties inspected which were found to be infested by:— (a) Rats—major — — — — — (b) —minor 7 861 93 961 — (c) Mice—major — — — — — (d) —minor 5 311 76 392 — Infested properties treated 13 1,120 162 1,295 — Total treatments (including retreatments) 23 2,017 482 2,522 — "Block" control schemes carried out Nil 22 Laboratory facilities The following summary relates to the work carried out by the public health laboratory on behalf of the Council during 1963. Table 15 Specimens Number Remarks Faeces 985 Negative 289 Shigella sonnei 3 Salmonella typhimurium 1 „ anatum 39 „ paratyphi B. 1 B. coli, type 026 Urine 7 Routine Swabs from nose and throat etc. 51 Negative 6 B-haem. strep. 7 Staph. aureus 1 H. pertussis Cough plates 8 Negative Sputum 1 ,, Water (various) 4 Food 17 Total specimens 1,420 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 16 Bath Tests Variation of chlorine (p.p.m.) Chlorine Bad. Ladywell West 9 — 0.1—2.0 Ladywell East 9 — 0.1—1.4 Forest Hill North 3 — 1.1—3.1 Forest Hill South 4 — 0.4—3.3 Downham 7 — 0.1—1.7 Bellingham (openair) 2 — 0.05—0.1 The water used for these baths is supplied by the Metropolitan Water Board and is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metaphosphate being used to control acidity and to keep the pH above 7.2. Colorimetric tests for free chlorine and pH value are also made at the baths at 9 a.m., 1 p.m. and 6 p.m. on weekdays and at 9 a.m. 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 5 persons, at a net cost to the Council of £2 17s. 6d. 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, and no complaints were received. Where a complaint is received it is the practice to exhibit a byelaw notice at a convenient site nearby. Drainage work During the year 174 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 1963 nor were there any important extensions of trunk mains, but 1,868 yards of service mains were laid in the Borough for local supply purposes. Tables 17 and 18 give the average results of the chemical and bacteriological analyses of the various supplies for 1963. Table 17 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1963 milligrams per litre (unless otherwise stated) Description of the Sample No. of Samples Ammoni- acal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as CI. Oxygen abs. from KMn04 4 hrs. at27°C. Turbidity units Colour (burgess) scale Hardness (total) Hardness (noncarbo nate) PH value Phosphate as PO4 Silicate as SiO2 Sulphate S04 Magnesium as Mg. Natural Fluoride as F. Surface active material as Manoxol OT Sodium as Na. Potassium as K Electrical Conduc tivity (microm hos) Bexley well 9 0.007 0.018 4.3 19 0.10 Nil Nil 316 70 7.1 13.0 2.1 580 Darenth well 5 0.010 0.015 4.8 18 0.02 Nil Nil 266 32 7.1 11.0 1.9 480 Deptford well 4 0.005 0.020 6.0 40 0.08 Nil Nil 354 110 7.2 25 5.1 700 Wilmington Well 3 0.016 0.016 6.9 23 0.20 0.1 Nil 282 44 7.2 15 2.2 550 Thames-derived South of River 156 0.20 0.079 3.8 32 1.18 0.3 10 266 66 7.8 1.3 11 62 5 0.25 0.08 550 Table 18 Bacteriological Results—Yearly Averages, 1963 of water supplied to the Borough of Lewisham Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli. count 20-24 hours at 37°C 3 days at 22°C Per cent. samples negative in 100ml. Count per 100ml. Per cent samples negative in 100ml. Count per 100ml. 20-24 hours at 37°C 3 days at 22°C Per cent. samples negative in 100ml. Per cent. samples negative in 100ml. Bexley well 251 2.9 32 99.60 — 100.0 — 256 0.1 4 100.0 100.0 Darenth well 251 0.0 10 99.20 — 99.20 — 255 0.0 5 98.43 100.0 Deptford well 251 0.2 18 98.80 — 99.60 — 255 2.3 102 100.0 100.0 Wilmington well 197 0.2 51 97.97 — 99.49 — 198 0.0 45 99.48 100.0 Thames-derived South of River 1.873 12.5 — 99.41 99.47 24 25 Home safety The Home Safety Act, 1961 S.l (1) states that "A local authority may promote safety in the home by publishing or making arrangements for otherwise giving information or advice relating to the prevention of accidents in the home" and S.l. (2) states that "a local authority may make contributions to any organisation whose activities are carried on otherwise than for profit and consist of or include the promotion of safety in the home." 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 2,500 copies of each issue are distributed. In October the Council agreed that the activities of the Local Safety Organisation be extended to include publicity measures to be undertaken to reduce the incidence of accidents in the home; that the Lewisham Old People's Welfare Association and such other bodies are, considered appropriate be included in the list of bodies entitled to nominate a representative to the Local Safety Organisation. As remarked upon in previous annual reports it has been found impracticable to gather the necessary statistics regarding home accidents, but some of a limited nature, based on County Council ambulance removals for 1963, are as follows: Table 19 Accidents Quarter of year Total 1st 2nd 3rd 4th 1963 1962 Total for London 2678 2071 2213 2346 9308 8607 Total for Div. 7 (Lewisham and Camberwell) 366 240 266 276 1148 1126 Rate per 10,000 population London 8.4 6.5 6.9 7.4 29.2 27.1 Div. 7 9.2 6.1 6.7 7.0 29.0 28.5 Falls total 1941 1536 1675 1748 6900 6565 on stairs 239 242 244 236 961 998 tripping 209 178 171 308 866 751 in the garden 34 50 66 24 174 219 Knifelike wounds 63 95 86 75 319 326 Gassing 165 34 37 58 294 192 Burns and scalds 129 82 99 76 386 553 Poisoning (including foreign objects) 80 112 103 98 393 340 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. 26 Atmospheric pollution Clean Air Act During 1963 four more areas were made the subject of Smoke Control Orders and particulars with regard to these are as follows:— Name No. 14 (Vancouver) No. 15 (Baring) No. 16 (Honor Oak) No. 17 (Blackheath) Acreage 140 770 230 400 No. of industrial premises 3 4 3 12 No. of commercial premises 66 34 60 134 No. of dwellings 2,731 5,232 2,281 3,042 No. of other premises 10 10 7 18 Present annual tonnage of bituminous coal to be replaced 3,000 5,200 2,500 4,400 Likely additional fuel required annually:— (a) Electricity (BTUs) 350,000 585,000 275,000 400,000 (b) Gas (therms) 65,000 110,500 55,000 75,000 (c) Oil, etc. Nil Nil Nil Nil (d) Solid smokeless fuel (tons) 2,250 3,900 1,900 2,550 Total estimated cost of works £40,000 £47,254 £38,000 £40,000 Date:—Order made 24.7.63 24.7.63 24.7.63 24.7.63 Order confirmed 21.11.63 21.11.63 21.11.63 21.11.63 Order operative 1.6.64 1.7.64 1.8.64 1.9.64 The progressive total (when these Orders are operative) will be 5,390 acres covering 52,258 dwellings. Programme At the end of December 1963, the position in relation to areas which have been or still are the subject of smoke control action was as follows:— Table 20 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 2,731 1.6.64 15 Baring 5,232 1.7.64 16 Honor Oak 2,281 1.8.64 17 Blackheath 3,042 1.9.64 18 Sunderland 1,900 — Programmed for survey 19 Sydenham 3,800 — do 20 Mayow 2,000 — do The above deals with approximately 60,000 dwellings out of an estimated total of 71,000. 27 Measurement of atmospheric pollution Table 21, on pages 28 and 29, 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. 28 Atmospheric Condition Table January February March April May Temperature— Mean maximum1 °C 0.6 2.2 9.9 13.2 15.4 Mean minimum1 °C —2.7 —1.4 4.0 6.3 7.8 Mean1 °C —1.1 0.4 6.9 9.7 11.6 Diff. from average1 °C —5.3 —4.0 +0.3 +0.4 —0.9 Highest maximum2 °C 6.0 5.0 14.0 19.0 20.0 Lowest minimum2 °c —12.0 —5.0 —4.0 1.0 5.0 Rainfall— Total2 in. 1.46 0.59 2.01 1.93 1.65 Percent of average1 36 16 158 107 84 Sunshine1 Daily mean hrs. 1.59 2.53 3.35 4.53 6. 63 Percent of average 107 112 92 85 103 Wind1 NE/E/SE % 57 64 26 28 14 S/SW/W % 14 10 59 56 55 NW/N/Calm % 29 26 15 16 31 Atmospheric pollution— West Division3: Water insol. matter tpm 4.92 23.96 18.22 11.85 11.92 Water sol. matter tpm 10.75 16.62 5.42 6.45 3.92 Sulphur † 3.13 2.36 1.71 1.62 0.94 Smoke, daily average * 226 306 99 71 23 „ maximum * 848 628 456 208 79 „ minimum * 40 76 16 20 5 Sulphur, daily average * 386 326 129 163 84 „ maximum * 1018 640 471 366 194 minimum * 120 140 33 41 38 North Division4: Smoke, daily average * 186 230 94 56 28 „ maximum * 756 440 326 140 109 „ minimum * 16 64 26 14 9 Sulphur, daily average * 205 167 73 81 51 „ maximum * 470 421 353 284 96 „ minimum * 65 73 17 32 18 South Division5: Water insol. matter tpm 4.06 9.41 18.56 10.77 11.23 Water sol. matter tpm 15.93 7.77 7.29 8.16 4.45 Sulphur † 2.88 2.30 0.90 1.14 0.79 Smoke, daily average * 209 277 95 46 26 „ maximum * 724 508 428 136 81 minimum * 12 48 16 12 6 Sulphur, daily average * 381 313 124 159 94 „ maximum * 1034 611 349 529 229 „ minimum * 109 102 30 34 48 Weather summary Very cold but dry Very cold but dry Wet; otherwise average Dull; changeable changeable and cool Notes: 1Kew; 2Lewisham; 3Valentine Court for smoke and sulphur, Pool allotments for other tpm: tons per square mile per month; †as trioxide in mg per 100 sq. cms. Per day 29 1963 21 June July August September October November December Average or actual (as applic.) 20.0 20.6 19.2 17.5 14.2 11.7 5.4 12.5 11.9 12.3 12.2 10.8 9.2 7.1 1.8 6.6 15.9 16.5 15.7 14.1 11.7 9.4 3.6 9.5 Nil —1.-1 —1.5 —0.7 +0.9 +2.1 —1.6 —1.0 26.0 27.0 25.0 22.0 18.0 15.0 9.0 27.0 9.0 12.0 10.0 9.0 6.0 2.0 —6.0 —12.0 1. 38 1.42 1.97 2.01 1.46 2.76 0.47 19.11 112 52 103 113 67 180 33 88 6.72 6.58 4.64 4.23 2.92 2.07 1.39 3.93 95 103 76 89 93 II7 109 98 29 27 10 26 18 22 45 31 58 60 70 42 72 60 25 48 13 13 20 32 10 18 30 21 12.90 17.38 14.14 16.80 16.00 12.01 12.82 14.41 4.46 5.17 4.82 void 13.87 5.88 4.74 5.65 0.80 0.65 0.63 0.75 1.02 1.46 2.29 1.45 21 13 24 50 60 85 221 100 51 27 74 104 122 324 424 - 7 3 6 12 24 12 92 - 101 77 61 137 142 139 298 170 245 189 177 281 273 439 678 - 25 36 28 35 73 43 115 — 23 11 24 48 44 66 169 82 52 29 72 105 109 270 396 - 8 3 7 12 19 10 66 - 65 53 63 83 91 57 123 93 129 116 134 195 160 168 321 - 24 31 17 24 43 19 20 — 11.13 9.55 16.60 6.80 5.80 7.45 10.42 10.15 4.70 14.54 12.89 9.85 4.06 7.17 5.00 8.48 0.78 0.48 0.36 0.79 0.74 0.74 1.93 1.15 27 12 17 37 51 76 197 89 64 27 59 122 124 284 440 - 8 2 3 13 12 11 72 - 97 73 62 133 128 136 308 167 234 194 170 282 337 438 678 - 23 25 26 46 68 43 99 — Dry and cool Dull and cool Cool and moist Dry and mild Cool and moist Cold and dry smoke and sulphur ; sPendragon school for smoke and sulphur, Verdant Lane for others Slimes per cubic metre. 30 CARE OF THE ELDERLY 1. General The "Elderly" for administrative purposes are regarded as men over the age of 65 and women over the age of 60. In the 1961 census there were 10,177 men and 24,052 women in these age groups, making a total number of 34,229 out of a total population of 221,753, being equivalent to 16 per cent. One of the fundamental difficulties of the public health department is to find out who among the elderly require help or advice, and where they may be found. Nevertheless, it can be said that more and more of this population group are becoming aware of the services available and are taking advantage of them. This is borne out by the increasing numbers shown on the returns made to the department by the various sections dealing with old people. 2. Direct Work The Council's direct work in the care of the elderly is commented upon in the following paragraphs: (a) The Saville (i) General The Saville premises were opened in October 1961 as a centre for various activities for old people, and it has proved so highly successful that it has become very difficult to keep the club's memberships within reasonable limits. The whole available time for club activities is fully used, and 'apart from the very cold weather at the beginning of the year attendances were high. Apart from normal club activities a number of outings were organised by the Management Committee during the winter months including several visits to pantomimes, a visit to a Croydon bakery, and return visits to other old people's clubs in Southwark and Camberwell. Among a number of outings arranged during the summer months was a trip to Brighton and another of a tour of Kent. Two sales of handiwork were made during the year, both of which proved very profitable. Mrs. Shorten who was appointed warden at the start of activities at the Saville, and who helped to get the clubs and their activities well organised resigned in October, 1963, her place being taken by the present warden Mrs. Heath. (ii) Handicrafts Handicraft sessions are held Monday to Friday mornings (5 sessions) and on Tuesday and Thursday all day (2 sessions per day), with a normal total attendance of some 100 members. The handicrafts include basketwork, leatherwork, feltwork, dressmaking, embroidery, tatting and quilting, of which dressmaking and basketwork are the most popular. There are sessions of handicraft for the handicapped held on Tuesday and Thursday afternoons. (iii) Housebound or handicapped There are about 30 members to each club who attend on Tuesday and Thursday all day. These elderly people are picked up from their homes and returned by special transport which is provided with a lift for the chairborne, and which is accompanied by a paid escort. 31 (iv) Luncheons The Meals-on-Wheels kitchen which is administered by the Lewisham Old People's Welfare Association and which during the year produced 29,784 meals, of which 12,338 were taken up by the luncheon club at the Saville itself. (v) Hiring of the Saville When not required for old people the Saville has been found very popular for hiring by outside individuals and organisations. It is very popular for wedding receptions of which some 25 took place during the year mainly on Saturdays. 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. (b) Burnt Ash These premises were opened in October 1962 by the Mayor, and the activities for the elderly carried on there have increased steadily during 1963 as the following report will show: (i) Workshop for the elderly The number of elderly workers increased from 30 at the beginning of the year to 80 at the end. Many of these people attend 4 or 5 times a week, but with one exception the hours of work are restricted to 2 hours a day per person. The one exception being a lady who helps with the organisation of the workroom. The workpeople are given pocket money at the rate of 1s. 6d. an hour, and the sessions are held morning and afternoon for two hours each, five days a week, 40 attending each session. The problem of finding suitable work for the elderly was not as difficult as anticipated and work was available for all of the workpeople during the whole of the year, although there were fluctuations in the type of work available at various times. The types of work carried out included the following: Type of work carried out Cutting and coiling of cable Shutter assembly Bracket assembly Enlarger switches Breaking out and packing of edible golden crosses Stitching and carding of: pens erasers paint brushes protractors geometry sets Covering of coat hangers Remarks Variable supply, male workers have become skilled in cutting and paring the wire and fitting plugs. Variable supply; welcomed by male members. Variable supply; semi-skilled jobs and workers apply themselves well to them. Almost continuing supply. Several workers proficient at this work which needs getting used to. Well supplied; work colourful, easy and fairly quickly done and appeals strongly to the elderly. Supply continuous. 32 The last three occupations, covering of coathangers, packing of edible crosses, and stitching and carding is by far the most continuous work available. (ii) Afternoon clubs for the elderly By Spring the Rendezvous club had an attendance of some 60 members per week, and the numbers were rising so rapidly that by June the attendances were up to 110 per week. It was therefore decided to form a second club, "the Gaytime" and to restrict membership to a maximum of 100 for each club, no member being allowed to belong to both clubs. At the end of the year the Rendezvous (Thursday afternoon) and the Gaytime (Wednesday afternoon) clubs had a membership of about 90 each. A social club for the handicapped was started on October 1 with a small membership of 10, which had increased to 14 by the end of the year. The members are picked up by special transport and taken to the club each Tuesday at about 10 a.m. where they have lunch, play games, and are entertained and looked after by several members of the Rendezvous and Gaytime clubs until about 3 p.m. when they start to return home. It is hoped to start handicraft classes for these people when the membership has risen sufficiently to warrant the employment of a teacher for the handicapped. A number of outings and shows were organised by the clubs which proved highly successful, as was the sale of work which made a large profit. The club for the handicapped had their own party at the end of the year, and all thought that it was the best day they had had for many years. (iii) Meals for the elderly Meals are supplied to members of the club, and to members of the workshop daily at a cost of 1s. 1d. to the recipient. Most of the meals are prepared at the Saville and delivered each day except Fridays when all of the meals are prepared at Burnt Ash. At the beginning of the year the number of meals taken daily average 12 and by the end of the year the average had risen to 35 a day. On special occasions, for instance when an outing had been arranged, the number of meals supplied reached as many as 65. (iv) Change of Warden Mrs. Aspinall who was appointed at the start of activities at Burnt Ash Centre, and who saw the various sections well established resigned in May, her place being taken by the present warden Mrs. Peevor who commenced in July. (c) Holidays and holiday home As stated in the last report the Council had decided in early 1962 to acquire a holiday home when suitable premises could be obtained. Again it has to be reported that although a number of hotels were inspected, suitable premises have not so far been arranged, but the quest is continuing. In April 1963 the Health Department took over from the Lewisham Old People's Welfare Association the organisation of holidays for old people with the exception of the special requirements for handicapped old people. The number of holidays arranged was 470 of which 33 414 were taken. Holidays are confined to the off-peak season, usually the early part of May and the latter part of September. The majority of elderly persons went to boarding houses and guest houses, and stayed for two weeks. The seaside resorts to which the old people went were mainly those situated on the south-east and south coasts, from Broadstairs to Boscombe, but one party went to Dawlish on the Devonshire coast, and three people went to Clacton. The majority of holidays, however were taken at Cliftonville, Broadstairs and Boscombe, the resorts where it was easiest to find accommodation or the most people requested. The cost of a holiday to the elderly person is based upon a simple method of assessment of the person's net income after deducting the rent and insurances, and should the house be owned by the applicant an average sum of £1 for rates and repairs is also deducted. If the net weekly income is £3 or less per person, the charge made to a single person is £4 15s., and to a married couple £4 10s. each. This is for the total holiday, i.e. two weeks and fares. If the net income per person is more than £3, the minimum charged is increased by half the excess of the net income over £3 to a single person, or £6 for a married couple. A non-returnable booking fee is taken of 5s. These holidays were well received by the elderly people and many postcards and letters of thanks have been received in the department. (d) 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, 51,948 articles being dealt with in this way. (e) Bathing attendants A further method of help for certain frail and usually bedridden old people was started in December 1962 with the employment of a woman to help with domiciliary bathing and cleansing to work primarily under the direction and supervision of the Ranyard nurses. The demands for such help are great and in May a further bathing attendant was appointed, and the service extended to cover most of the borough. At the end of the year it was under discussion to extend the service still further, and to appoint a male bathing attendant. This was done early in 1964. The number of cleansings and bathings carried out during the year were West 322, North 432 and South 532 making a total of 1286. (f) 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 34 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 1963 although several cases were investigated none went as far as requiring court proceedings. (g) 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 22 N W S Total First visits 65 116 49 230 Futile visits 86 57 35 218 Revisits 310 907 303 1520 Total 461 1120 387 1963 (h) Concerts The first of a series of concerts run by the Public Health Committee at the Town Hall for the elderly was held in March and was attended by some 900 old people from the clubs. This experimental concert was regarded as highly successful, and it was therefore decided that in the future tickets would also be made available to old people in the borough other than members of old people's clubs. There were two further concerts during the year, one in October and the other in November. Apart from December, monthly concerts were planned for the rest of the winter season up to April. Perhaps the comment made in the local press following the October concert sums up the appreciation of the old folk attending the concerts when it remarked that "the enthusiasm of Beatle-fans had nothing on that shown by more than 1,000 local old folk who swarmed into the Town Hall on Wednesday for the first of a series of monthly Concert Hall nights—they even danced in the aisles." The concerts held since have been no less highly praised. 3. The Lewisham Old People's Welfare Association The Lewisham Old People's Welfare Association (LOPWA), during the year continued all its routine work, and notes on its main activities during the year April 1963/64 (based on a report by the secretary) are as follows:— Meals-on-wheels service 61,867 dinners were delivered to the housebound and to Darby and Joan clubs, 785 more than last year. (The deliveries to the dinner clubs totalled 24,276). The dinners were drawn from three sources; Dartmouth restaurant, 32,190; Lewisham Town Hall canteen 211; Saville kitchen 29,784. 35 The big increase in the number of dinners served to club members were accounted for by the meals served from the Saville kitchen to members of the Saville clubs. Holidays and outings The main arrangements for out-of-season holidays for old people were transferred to the public health department, and a report about them appears elsewhere. The number of special holidays for frail and handicapped old people was 62. Holidays were also arranged through the Women's Holiday Fund, and these numbered 100. Eleven grants were made to old people who made their own holiday arrangements. Six outings for the infirm were organised, including a party at Stanstead Lodge. Boarding-out scheme Offers of accommodation were accepted by 22 people during the period: of these 13 were found accommodation with board; one was found unfurnished accommodation; two were found partially furnished rooms; and six were found furnished rooms. Six of the twenty-two only required temporary accommodation. At the end of March thirteen were still in private accommodation. The remainder have been offered accommodation by the Borough Housing department, or have had to go into homes or hospitals. One married and went to Australia. Cases referred 1,266 new cases were referred to the office during the year—111 less than last year, but this did not include those referred for Christmas parcels only. 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—837—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, was again produced by Mr. Wybrew, two performances were given in the large concert hall at the Town Hall, to a full house on each occasion. Staff An additional part-time social worker joined the staff in the Autumn, thus four social workers (excluding Miss Ellis the secretary) are now working for the Association. 4. 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 £18,800 (to include LOPWA) was eventually put in the annual estimates for the year 1963-64 for such organisations as accepted the Council's conditions and to assist any 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:— 36 Lewisham Old People's Welfare Association 16,600 Lewisham Darby and Joan Club 500 St. Mark's Old Folks' Club 70 Hither Green Branch of the National Federation of Old Age Pensions Associations 68 St. Philip's Darby and Joan Club 34 The Over 60's Friendly Club 48 The Bellingham Community Association Darby and Joan Club 44 Lee Branch of the National Federation of Old Age Pensions Associations 54 Good Companions Club 20 St. Hilda's Seniors' Club 75 Blackheath Branch of the National Federation of Old Age Pensions Associations 24 September Club 60 St. John's Over 60's Club 64 The Friendship Circle over 60's Club 75 Sydenham Hill Social Club, Darby and Joan Section 20 Companions Darby and Joan Club for Deaf and Dumb 38 Autumn Club 46 St. Cyprian's 61 Club 38 Saville Club 220 Burnt Ash Club 160 Sunset Club 20 Primrose Club 35 Silver Lining Club 50 This left a sum of money available for new clubs which might qualify for grant, and one such club, the Welcome Club (£40) was given the grant indicated for the part year. Additional grants were paid to nearly all the clubs as a help towards fares. 5. 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. Bearing in mind, however, these provisos, it seems that in the financial year 1963/64 a sum of about £38,000 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 eleven years ago, in the year 1952/53, the corresponding expenditure was £1,750 and for the current year 1964/65 the sum included in the estimates has been £53,565. These are gross figures, against which some income can be set (£4,255 for 1964/5) but they do not include any apportionment of salaries. 37 SANITARY CIRCUMSTANCES OF THE AREA The following table gives a summary of the inspections, etc., carried out by the public health inspectors during the year:— Table 23 Reason for inspection West North South Total On complaint 1,160 941 412 2,513 House to house 2 16 11 29 Improvement grants 133 164 119 416 Houses in multiple occupation 63 48 7 118 Rent Acts 19 11 6 36 Mortgage survey 484 446 324 1,254 Other Housing Act visits 145 123 33 301 Notice from builder 608 601 101 1,310 Infectious diseases 28 156 8 192 Infestation 63 73 35 171 Factories, mechanical 9 2 44 55 Factories, non-mechanical 1 3 - 4 Outworkers 38 35 40 113 Clean air inspections 4,542 5,777 109 10,428 Pet animals Act 20 9 6 35 Water certificates 36 91 2 129 Fireguards 13 12 - 25 Hairdressers 22 19 2 43 Pharmacy and poisons 51 62 38 151 Icecream premises 101 15 23 139 Restaurants, cafes, etc. 166 50 93 309 Bakehouses 20 6 8 34 Food shops and stalls 401 198 335 934 Other shops and stalls 9 6 8 23 Food inspections 87 109 341 537 Sampling 137 63 138 338 Futile visits 3,501 4,107 1,918 9,526 All other matters 1,478 1,272 979 3,729 Revisits 4,515 5,143 4,342 14,000 Total—all inspections 17,852 19,558 9,482 46,892 Smoke abatement Observations 3 Intimations served — Complaints 1 Statutory notices served — Legal proceedings — Convictions — 38 Summary of notices served Table 24 West North South Total Intimation notices:— Public Health (London) Act, 1936 235 215 86 536 Factories Act, 1937 — — — — Informal intimations, Housing Act, 1957 18 4 — 22 Ditto, Housing Act, 1961 10 1 1 12 Total intimations 263 220 87 570 Statutory notices:— Public Health (London) Act, 1936 128 124 53 305 Factories Act, 1937 — — — — Clean Air Act, 1956* 437 552 30 1,019 Housing Act, 1957 — 3 — 3 Byelaws 61 25 68 154 Housing Act, 1961 13 8 3 24 Total statutory notices 639 712 154 1,505 *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 25 Repairs West North South Total Wall and ceiling plaster repaired 66 39 54 159 Roofs repaired 38 35 25 98 Dampness remedied 139 99 82 320 Brickwork repaired 3 6 2 11 Chimneys repaired 2 — — 2 Drains cleared 26 23 11 60 Drains repaired 6 2 5 13 Drinking water cisterns repaired — — — — Dustbins supplied 4 6 3 13 Doors and door frames repaired or renewed 4 3 7 14 Flushing cisterns repaired, renewed or cleansed 9 15 9 33 Flush pipes repaired or renewed 4 — 2 6 Firegrates, etc., repaired or renewed 7 2 3 12 Flooring repaired or renewed 23 17 29 69 Dry rot remedied 3 2 — 5 Gullies renewed, repaired or cleansed 6 10 12 28 Gutters repaired 50 32 30 112 Refuse cleared 2 9 1 12 Rainwater pipes repaired 14 10 14 38 Soil pipes repaired, ventilated or renewed 9 9 10 28 Sinks provided 15 14 19 48 Sashcords renewed 17 13 27 57 Water closets repaired or renewed 34 26 18 78 Walls and ceilings cleansed 1 6 2 9 Windows and frames repaired or renewed 13 17 13 43 Water service pipes repaired or renewed, water supply restored 25 11 5 41 Yards and areas paved 3 2 2 7 Glazing 4 5 1 10 Painting — 1 3 4 Other repairs 9 7 23 39 TOTALS 536 421 412 1,369 39 Consumer Protection Act, 1961 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. No inspections were made during the year. Registration of hairdressers 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 167 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 18 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 377 premises and 2 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 40 means for draining floors where wet processes are carried on, are enforced by the council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories with respect to which it is responsible for the enforcement of any of the provisions mentioned above. Close cooperation is maintained with HM Inspectors of Factories in that any defaults found by them during the course of their visits and for which it is the duty of the local authority to secure that remedial measures are taken, are notified to the health department. Similarly the public health inspectors notify HM Inspectors of any contraventions of the provisions of the Act which come within their jurisdiction. HM Inspectors also forward to the health department details relating to the establishment of new factories, the introduction of mechanical power and other information which may come to their notice and which appears to affect factories subject to the control of the local authority. Special attention is paid to factories which provide canteens. These factories are visited by the council's food inspectors and the opportunity is taken to discuss with the canteen staff the various requirements needed to maintain a good standard in food hygiene. The medical officer of health is required in his annual report to the local authority to report specifically on the administration of, and furnish prescribed particulars with respect to, the matters under part I (factories) and part VIII (outworkers) which are administered by the local authority. Details follow:— Inspections Table 26 Premises Number on register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 46 4 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 470 55 — — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 31 31 — — TOTAL 547 90 — — 41 Cases in which defects were found Table 27 Defects No. of defects Prosecutions instituted Found Remedied Referred 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 (S 7) (a) insufficient — — — — — (b) unsuitable or defective — — — — — (c) not separate for sexes 1 1 — 1 — Other offences against the Act (not including offences relating to outwork) — — — — — TOTAL 1 1 — 1 — 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: Trade Outworkers employed Clothing 94 Brushes 2 Boxmaking 4 Bags 2 Soft furnishings 6 Lampshades 2 Buttons 3 Jewellery 1 42 Trade Outworkers employed Millinery 1 Knitting 1 Ties 2 Rosettes 3 Trimmings 6 122 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 113 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 1963 the pigeon catcher was again employed on a parttime basis from March to December. 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 1,123 birds, 201 eggs and 94 nests. Sanitary work generally Mr. Phillips, the senior public health inspector, reports that during 1963 one of the main concerns of most of the public health inspectors was the inspection of premises under the Clean Air Act, 1956. Four additional areas were confirmed in November to come into force during the summer of 1964, and this will entail a very steady rate of inspections during the ensuing year. Surveys for advances by the Council under the Housing (Financial Provisions) Act, 1958 and the House Purchase and Housing Act, 1959 increased from 1026 to 1254 and this illustrates the 43 continued desire of the public to become owner-occupiers. It was noted that having purchased their homes a greater number were anxious to improve the condition of them. This is shown by a considerable increase in the number of improvement grants. It is hoped that the standard in all these cases may soon include the provision of a bathroom with a hot-water supply, an internal water closet and proper provision for the storage of food. The number of complaints investigated rose considerably and is reflected in the service of 536 intimation notices compared with 385 in 1962. An increase occurred in the issue of formal notices under the Housing Act, 1961, the Clean Air Act, 1956, as well as the Public Health (London) Act, 1936. The number of visits to outworkers continues to fall showing that this type of work in the Borough is gradually disappearing, being almost confined now to the making up of clothing. The registration of hairdressers showed a slight increase and it is pleasing to note that no adverse comments were made on the new applications, thus indicating the desire to provide good hygienic conditions. Finally, the steady increase of inspections of houses in multiple occupation was maintained, the number of formal notices being doubled. A great deal however, was achieved by informal action and conditions in this type of property were very much improved. 44 Building 278 new dwellings were completed by the Council during the year. Families rehoused for first time During the year the following families were rehoused:— 1. By the Lewisham Borough Council:— (a) in permanent properties 435 (b) in temporary bungalows 5 440 2. By the London County Council (figures supplied by district offices) 34 478 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 384 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 22 informal and 3 formal notices were served. 3 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 1953, together with the present position of cases originating in previous years which had not been complied with at the end of 1962:- Table 28 Properties Dwellings involved Present position 23, 24, 27 Horton Street 3 Notices served 4 Elthruda Road 1 Works completed. Order determined 42 Oakcroft Road 1 Order made 1963 60 Knowles Hill Crescent 1 Order made 1963 (time for pliance with orders extended in November, 1963) 62 Knowles Hill Crescent 1 25, 26 Horton Street 2 To be considered in conjunction with 23, 24, 27 Horton Street (Notices served) 45 Closing Orders in respect of part of house Table 29 Properties Part of house Present position 32 Panmure Road Two rooms and kitchen in basement Order made 23a Devonshire Road Two rooms in basement Represented 52a Horniman Drive Three rooms, kitchen and bathroom in semibasement Notices served 7 Peak Hill Avenue Front room, back room, hall, scullery and WC basement Works completed. Order determined. 85 Perry Vale Semi-basement rooms Order made Table 30 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 9 — — Houses included by reason of bad arrangement 4 — — Houses or land acquired under s. 43 2 — — Not in clearance areas Formal or informal procedure under s.17 (1) 10 15 4 Local authority houses certified unfit by medical officer of health — — — B —UNFIT HOUSES CLOSED (Housing Act, 1957) ss 16,17 and 35 — 1 1 ss 17(3) and 26 — — — Parts of buildings closed under s.18 2 7 2 C—UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 2 — After formal notice under Public Health Acts — — After formal notice under Housing Act, 1957 3 — Under s.24 Housing Act, 1957 — — 46 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 — — 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 31 1963 1957-63 Applications for certificates 21 1137 Decisions not to issue certificates 4 29 Decisions to issue certificates (a) in respect of some but not all the defects 8 663 (b) in respect of all defects 9 418 Undertakings given by landlords to repair 9 518 Undertakings refused for special reasons 1 2 Certificates of disrepair issued 8 538 Applications by landlords for cancellation of certificates 16 375 Objections by tenants to cancellation 11 130 Decisions to cancel in spite of tenants' objection 1 23 Certificates cancelled 7 261 House purchase loans 958 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 69 applications were investigated and reported on. 47 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 81 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 in 1962 to set up prefabricated moveable dwellings on various vacant sites. These dwellings are connected to the main services (water, electricity and drainage) and they, and their surroundings have to conform to regulations unofficially agreed between the metropolitan boroughs. Four sites had been licensed in Lewisham by the end of the year, with room for 52 dwellings. On housing work generally, Mr. Brittain, the group housing inspector states: "Following upon a circular issued by the Ministry of Housing and Local Government in 1962, an effort was made to speed up the use of improvement grants by concentrating on a large block of dwellings. The area chosen contained 186 houses of which 156 needed some or all of the amenities obtainable under the grant scheme. Explanatory booklets were sent to each address, together with an invitation to a public meeting, which was held in a local school during March presided over by the Chairman of the Public Health Committee (Councillor Hawkins), and at which officers were present to answer questions. The result was disappointing as the attendance was very poor and only five applications for improvement grants have been received from this area. Over the whole borough the interest shown was more encouraging with 81 discretionary grants and 69 standard grants giving an overall increase of nearly 22% on last year. Approximately 15% of the total were in respect of tenanted properties. Conversions of houses into two or more self-contained flats were carried out under ten of the discretionary grants, so providing additional units of accommodation, and a further two cases each provided six flatlets for old people together with a flat for a resident warden. There was an increase in the number of notices served under section 9 of the Housing Act, 1957, also, action for closure or demolition was taken in five cases and two properties which were subject to closing orders were repaired and made fit for habitation. Houses in multiple occupation were dealt with under the Housing Act, 1961, mainly for the provision of required amenities or to control the total number of persons per house. It has been necessary in two cases to use the power given by section 12 of the Act to apply a code of management where conditions are well below standard. In December an appeal against a section 15 notice, requiring additional amenities, was heard at Bromley County Court and was dismissed. During the year fourteen notices were served under this section." 48 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 127 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 11 (118) „ sale of tuberculin tested milk 5 (91) „ sale of sterilised milk 9 (128) Examination of heat-treated milk 39 samples of pasteurised milk and 32 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, 49 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 32 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Total Solids First quarter 19 3.63 8.6 7 12.30 Second quarter 15 3.40 8.70 12.10 Third quarter 4 3.47 8.65 12.12 Fourth quarter 11 3.76 8.93 12.69 TOTALS 49 3.58 8.74 12.30 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. (total solids 11.5%) 49 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 33 Period Samples Average percentage composition Fat Milk solidsnot fat Water First quarter 5 10.2 10.8 79.0 Second quarter 7 9.7 10.1 80.2 Third quarter 5 7.1 10.9 82.0 Fourth quarter 5 9.8 10.2 80.0 TOTALS 22 9.2 10.5 80.3 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 35 samples of icecream were submitted for bacteriological examination with the following results:— Table 34 Grading Samples submitted % Grade 1 12 34 Grade II 9 26 Grade III 7 20 Grade IV 7 20 TOTAL 35 100 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. 50 FOOD GENERALLY Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 695; of these, 9 were formal and 686 informal. After examination the public analyst reported that 4 of the formal samples and 39 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 44.4 in the formal samples, 5.7 in the informal samples, and to 6.2 of all the samples submitted, compared with 4.0 in the previous year. Samples analysed Table 35 Articles Examined Adulterated Formal Informal Total Formal Informal Total Beverages — 36 36 — 1 1 Bread, biscuits, cake flour — 9 9 — — — Colouring matter — 3 3 — — — Drugs 4 34 38 2 4 6 Fats, cheese 1 40 41 1 2 3 Fish — 8 8 — — — Flavourings and condiments — 134 134 — 11 11 Fruit, nuts — 64 64 — — — Icecream — 29 29 — — — Jams, pastes, etc. — 31 31 — 2 2 Meats and preserved meats 2 51 53 1 10 11 Milk and cream 2 65 67 — 2 2 Sausages — 26 26 — 2 2 Sweet confectionery — 34 34 — 4 4 Vegetables and cereals — 51 51 — — — Miscellaneous — 71 71 — 1 1 TOTALS 9 686 695 4 39 43 A disturbing feature of the above table is the number of samples (25 out of 43) which did not comply with the Labelling of Food Order, 1953. In the majority of cases where the manufacturers' or retailers' attention was drawn to the offences, it was possible to arrange for new labels to be used which would provide the purchaser with a clear indication of what the food contained, and in cases where co-operation was lacking formal samples were taken and legal proceedings authorised, but in no cases was it necessary to take proceedings. The above table includes 44 samples of fruit taken at the Continental Freight Depot, and in all cases the samples were found to be free from excessive amounts of pesticides. Non-genuine samples Table 36 Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Milk Informal Deficient in fat to the extent of 10.3% Second sample taken and found to be satisfactory 51 Table 36—continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Cooking butter Informal Sample rancid Remainder of stock destroyed Cooking butter Informal Sample rancid Remainder of stock destroyed Anise seed Informal Contained an excess of foreign organic matter. Further sample taken and found satisfactory Cake decorations Informal Contained a nonpermitted green colour Colour changed to a permitted one. Cake decorations Informal Contained a nonpermitted green colour Colour changed to a permitted one Orange syrup Informal Sample described as "true fruit flavour" although artificially flavoured New label printed Lemon/lime syrup Informal —do— —do— Lime syrup Informal Contained a nonpermitted green colour. Also described as "true fruit flavour" although artificially flavoured Colour changed to a permitted one. New labels printed. Instant coffee Informal Incorrectly labelled Manufacturer notified Cooking butter Formal Sample rancid New labels printed Pumpkin pie spice Informal Incorrectly labelled Manufacturer notified Cream Informal Contained 21% fat other than butter fat Formal sample taken and found to be genuine Garden mint in vinegar Informal Contained large amount of stalk Stock all sold Mushroom sauce Informal List of ingredients not in correct order Discontinued line (imported from France) Garden mint in vinegar Informal Contained a large amount of stalk Manufacturers state that an identical complaint was dismissed by magistrates in 1955 Compound Codeine tablets Informal Contained an excess of aspirin and phenacetin Formal sample found to be genuine Ammoniated Tincture of quinine Informal Deficient in ammonia Formal sample found to be genuine Chopped pork Informal Deficient in meat content Manufacturer notified 52 Table 36—continued Articale Formal or informal Adulteration or irregularity Action taken or result of proceedings Mushroom ketchup Informal Produce of poor flavour Manufacturers state that process of cooking in vinegar may affect flavour Pork sausages Informal Presence of preservatives not declared Manufacturer notified Chopped pork Informal Deficient in meat content Manufacturer notified Boneless chicken in chicken jelly Informal Deficient in meat content Stock all sold Hamburgers Informal Deficient in meat content Manufacture discontinued. Pork sausages Informal Presence of preservatives not declared Notice concerning preservatives displayed in shop Banana syrup Informal Incorrectly labelled MOH of area in which manufacturers are situated notified. Strawberry syrup Informal Incorrectly labelled MOH of area in which manufactuers are situated notified Hot pepper sauce Informal Contained excessive amount of lead MOH of area in which manufacturers are situated notified. Tinned tomatoes Informal Inside of tin corroded and contents contaminated with tin Stock returned to manufacturers Casserole steak Informal Deficient in meat content Manufacturers notified Chicken Informal Sample consisted of chicken in chicken sauce Manufacturers notified Brandy flavour dessert Informal Incorrect list of ingredients Labels changed Steaklets Informal Deficient in meat; incorrect label and also contained preservative Formal sample to be taken (see below) Hamburger Informal Deficient in meat content Manufacture discontinued Tartare sauce Informal Incorrect list of ingredients Labels changed 53 Table 36—continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Ammoniated tincture of quinine Informal Sample deficient in ammonia Formal sample to be taken (see below) Spirit of Sal Volatile B.P.C. Informal Sample deficient in free ammonia Formal sample to be taken (see below) Ammoniated tincture of quinine Formal Sample deficient in ammonia Stock withdrawn and disposed of Spirit of Sal Volatile B.P.C. Formal Sample deficient in free ammonia Stock withdrawn and disposed of Steaklets Formal Contained preserved meat Manufacturers have agreed to change label and to include statement as to meat content Chopped ham and pork Informal Deficient in meat content Formal sample to be taken Full strength chocolate liqueurs Informal Liquid centres only contained 16.2% proof spirit Proposed new labels satisfactory Full strength chocolate liqueurs Informal Liquid centres only contained 15.9% proof spirit Proposed new labels satisfactory 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:— Baby food Tea infusion Guinness Yoghurt Water (4) Biscuits Rice Vegetable soup (2) Strawberry jam (2) Baked beans Bread (8) Dates Sausages (7) Tinned meat Coffee Meat (for dogs) (5) Gherkins Dried egg (3) Milk (3) Desiccated coconut (2) Bacon 54 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 1963 Total Sale and storage of icecream 9 367 Manufacture of icecream — 7 Fish frying — 33 Fish curing — 20 Preparation or manufacture of sausages — 75 Preparation or manufacture of potted, pressed, pickled or preserved food 2 151 Unsound food Approximately 14 tons of food were surrendered as unfit for human consumption. This was dealt with by the Council's food inspectors and consisted of meat, fruit pulp, fish, vegetables etc. Shops Act, 1950 — section 38 No certificates of exemption in respect of sanitary conveniences were issued during the year. Under s.38 of the Shops Act, 1950, we already had powers and duties with regard to ventilation, temperature and sanitary conveniences in shops. Under s.18 of the L.C.C. (General Powers) Act, 1958, additional powers and duties under s.38 came to us on 1 January 1959, and these were to do with lighting, with washing facilities and with facilities for the taking of meals. 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 7 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 146 persons previously registered were retained on the register. 151 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 Imports of perishable food from the continent through the Continental Freight Depot continues, and a small amount of food, mostly meat, has been exported. We are concerned insofar as unfit food or meat without proper documents may be imported, 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 0.01%) the large amount of material handled through the depot throws considerable extra work on the food inspector concerned. 55 Totals for the year are shown in the table :— Table 37 Country of origin Tonnage imported Amount unit and remarks Spain 75,415 (tons) 3½ tomatoes Italy 32,544 5 Corn on the cob ½grapes France 27,049 Belgium 1,285 Israel 159 Yugoslavia 9,587 Algeria 4,271 Brazil 363 Total 150,673 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. Number of Notified Cases (corrected for revised diagnosis) during the year 1963 with comparative figures for the previous six years. Table 38 Diseases Cases notified 1963 1962 1961 1960 1959 1958 1957 Diphtheria Dysentery 341 162 96 367 233 214 129 Encephalitis (acute) — — 1 — — 1 2 Enteric or typhoid fever 12 3 2 — 6 4 2 Erysipelas 4 1 14 20 16 13 15 Food poisoning 10 13 26 31 49 27 42 Malaria — 2 — 2 — — — Measles 2408 423 4278 262 2613 835 2728 Meningococcal infection 1 4 5 8 3 3 4 Ophthalmia neonatorum 3 1 ■— 1 1 1 2 Pneumonia 42 23 62 33 108 61 96 Poliomyelitis (acute) — — — 2 6 2 15 Puerperal pyrexia 42 71 46 78 48 59 93 Scabies 9 9 8 9 9 9 18 Scarlet fever 76 53 94 172 303 210 143 Tuberculosis 122 103 123 134 143 236 247 Whooping cough 186 41 65 333 229 154 225 TOTALS 3256 909 4820 1452 3767 1829 3761 56 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 paratyphoid Meningococcal infection Typhus fever Ophthalmia neonatorum Whooping cough 57 Notifications of infectious diseases in 1963 showing sex and age groups Table 39 r Diseases Under 1 /- 3- 5- 10- 15- 25- 45- 65 + Total M F M F M F M F M F M F M F M F M F M F Dysentery 8 6 38 22 26 23 51 54 17 13 3 15 16 23 8 12 2 4 169 172 Erysipelas — — — — — — — — — — 1 — — 1 — — 2 1 3 Food poisoning — — — — — — 3 1 — — — 1 3 2 8 2 Measles 48 33 315 289 315 324 508 510 20 33 5 4 3 1 „ 1214 1194 Meningococcal infection 1 Ophthalmia Neonatorum 1 2 1 7 Paratyphoid fever... — — 1 — 1 1 1 2 4 1 1 10 2 Pneumonia — — — — — — — — 1 1 1 5 4 13 5 5 7 24 18 Puerperal pyrexia... — — — — — — — 22 20 42 Scabies — — 1 1 1 1 2 7 Scarlet fever 1 — 2 3 7 15 26 15 4 1 ? 41 35 Tuberculosis (respiratory) _ 2 1 2 3 2 18 8 16 15 77 3 11 78 30 Tuberculosis (non-respiratory) _ _ _ 1 1 5 2 4 1 3 11 Whooping cough ... 8 12 18 23 22 13 29 43 7 6 1 — — 1 1 2 — — 86 100 Totals 66 S3 378 338 373 376 618 626 S3 55 35 64 42 69 53 24 20 13 1638 1618 58 Analysis of certain diseases in table 39 into divisional areas— Table 40 Disease D/V. areas Under 1 /- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 8 14 18 57 16 7 12 5 4 141 N 4 37 17 21 5 6 11 9 - 110 S 2 9 14 27 9 5 16 6 2 90 Total 14 60 49 105 30 18 39 20 6 341 Measles W 36 311 338 544 21 1 1 1252 N 19 156 163 227 17 3 2 — — 587 S 26 137 138 247 15 5 1 — — 569 Total 81 604 639 1018 53 9 4 — — 2408 Pneumonia W 2 4 8 8 22 N 2 1 3 S — — — — 1 — 5 8 3 1/ Total — — — — 1 2 9 18 12 42 Scarlet fever W 1 12 22 2 1 - - - 38 N 3 2 8 — 1 - - - 14 S 1 1 8 11 2 1 - - - 24 Total 1 5 22 41 4 3 - - - 76 Tuberculosis (respiratory) W 2 1 2 16 14 15 5 55 N — — 1 — 2 4 9 8 1 25 S — — — 1 1 6 8 7 5 28 Total — 2 1 2 5 26 31 30 11 108 Whooping cough W 9 12 8 14 2 - - - - 45 N 7 14 14 19 3 - - - - 5/ S 4 15 13 39 8 1 1 3 - 84 Total 20 41 35 72 13 1 1 3 - 186 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. 59 The work of the infectious disease visitors as agents of the medical officer of health includes the investigation of home conditions, the giving of advice to patients and contacts, particularly where the patient is left at home, and in general the taking of such measures as may be necessary to combat the spread of infection. The following is a summary of the work in visiting infectious diseases carried out during the year which is in addition to the visits paid by the public health inspectors referred to in table 23 Table 41 W N S Total First visits 183 140 289 612 Futile visits 316 113 194 623 Revisits 206 106 204 516 Total 705 359 687 1751 Paratyphoid B. fever An outbreak of paratyphoid B fever occurred in April from which 12 cases were eventually notified. The cases were brought to notice at various intervals of time, and it was not until nearly two weeks after the first case had been notified, and the third case had just come to notice that a pattern began to emerge. These cases and subsequent cases all pointed to a bakery in the district as being the link between them. A detailed investigation of the bakery was made, and it was found at the time, something like 180 cream buns and cream doughnuts were made daily, together with other cakes also with cream inside them. The bakery had used Chinese egg certainly at the end of March and possibly during the first few days of April, since when it had been using New Zealand egg. Chinese egg has given rise to trouble of this nature for many years past, but for various reasons it has been found difficult to ban its importation or to insist in its adequate pasteurisation. Recent work has indicated that frozen Chinese egg can be pasteurised satisfactorily, and the situation up and down the country became so relatively serious that one riparian authority at least where this Chinese egg is handled, has now put a stop on its distribution until it has been adequately pasteurised. Sampling does not often reveal a paratyphoid infection and in fact, in the riparian authority referred to, of 250 samples taken only one was positive. In these circumstances there is in fact no firm legal basis for putting such a stop on the product but it has been done after discussion between the medical officer of health and a dozen or so main importers who, because of the circumstances, have readily agreed to arrange pasteurisation. A circular letter was sent to 26 bakery firms with addresses in the borough advising them to avoid using Chinese egg and to ensure that if in spite of the advice they continued to use it, they should well wash and sterilise all vessels, containers or implements used with it; furthermore that the fullest hygienic standard should be required from their employees. 60 Poliomyelitis In 1963 no cases of poliomyelitis was notified-the third year in succession. Dysentery The number of cases again showed a large increase over the previous year. The focus for local outbreaks is often the schools and the mildness of the type of dysentery conduces to spread as the child may go on attending school for the first day or two when likely to be most infective. The only real bar to the quick spread of the disease appears to be an extremely high hygienic standard from the very start in connection with all the apparatus of the water-closet and with hand washing; and with immediate exclusion from school. Measles 1963 was an endemic year, there being 2408 cases. They were of mild degree, and no deaths were recorded. Pneumonia The number of cases was 42. The absence of any influenza outbreak was probably responsible for this low number, although it is likely that many cases of pneumonia are not formally notified. Scarlet fever The number of cases was 76 in 1963, an increase of 23 over those of the previous year, the lowest recorded. Whooping cough After the record low number of 41 in 1962 the cases in 1963 rose dramatically to 186. Whooping cough is a preventable disease, and attention is once again 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 continued to fall until 1962 when they reached a record low of 103. In 1963 however, the number rose to 122, but was still slightly lower than that of 1961 (123). 108 of these were pulmonary. As in previous years there were many more cases in males than in females as far as respiratory tuberculosis was concerned, there being 78 males and 30 females. The number of females was in fact 2 less than in 1962, and the increase in total number of respiratory cases was therefore accounted for by the increase in the number of male cases from 51 in 1962 to 78 in 1963. The largest male increases over 1962 occurred in the age groups 15-20 (an increase of 10 cases) and in the age group 55-65 (an increase of 10 cases). 61 Table 42 Age periods New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- - - - - - - - - - - - - 1- 1 - — - 1 - - - - - - - 2- 2 - - - 2 - - - - - - - 5- - 2 - 1 - 3 - - - - - - 10- 3 2 - - 3 2 - - - - - - 15- 11 3 - 1 11 4 - - - - - - 20- 7 5 1 4 8 9 - - - - - - 25- 6 8 1 2 7 10 - 1 - - - - 35- 10 7 1 2 11 9 1 - - - - - 45- 12 1 - 1 12 2 2 - - - 2 - 55- 15 2 - - 15 2 2 - - - 2 - 65- 8 - - - 8 - 2 1 - - 2 1 75+ 3 - - - 3 - 5 1 - - 5 1 78 30 3 11 81 41 12 3 - - 12 3 Analysis of new cases of tuberculosis into divisional areas:— Table 43 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Respiratory M - 1 1 - 1 9 3 4 4 3 9 4 1 40 F - - - 1 1 2 2 3 3 1 2 - - 15 Non-respiratory M - - - - - - - - - - - - - - F - - - 1 - - 2 1 1 1 - - - 6 North Respiratory M - - 1 - 2 1 - 2 5 4 4 1 - 20 F - - - - - - 3 1 1 - - - - 5 Non-respiratory M - - - - - - - 1 1 - - - - 2 F - - - - - - 2 - - - - - - 2 South Respiratory M - - - - - 1 4 - 1 3 4 3 2 18 F - - - 1 1 1 - 4 3 - - - - 10 Non-respiratory M - - - - - - 1 - - - - - - 1 F - - - - - 1 - 1 1 - - - - 3 62 Summary of statistics as to tuberculosis for the last ten years Table 44 Year Population New cases notified (all forms) (excluding inward transfers) Notifrate per 100,000 pop. Deaths Death rate from resp. tuberculosis per 100,000 pop. All forms Respiratory Lewisham County of London 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 1963 222,730 122 55 15 15 7 7 Tuberculosis — environmental conditions Case papers showing the environmental conditions of new patients attending the Lewisham Chest Clinic in 1963 have been analysed in 164 cases with the following results :— Table 45 Cases 0/ * /o Males 101 62 Females 63 38 Social classification:— Class I — — Class II 10 6 Class III 91 56 Class IV 20 12 Class V 15 9 Not classifiable 28 - Rooms occupied:— 2 or more rooms per person 25 15 1—2 rooms per person 77 47 Less than 1 room per person 42 26 No information 20 — \ccommodation:— Separate bed 54 33 Separate bedroom 38 23 Condition of premises occupied:— Good 132 81 Fair 18 11 Poor 8 5 No information 6 — *Excluding cases not classified 63 Food poisoning The cases last year formally notified further decreased, from 13 to 12. 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 46 Notifications (corrected) Cases otherwise ascertained Symptomless excreters Fatal cases 1st quarter 1 — — - 2nd quarter 3 - - - 3rd quarter 6 - - - 4th quarter 6 - - 1 Year 16 — — 1 (2) Single cases Notified Otherwise ascertained Total cases Agent identified:- Salmonella group B 1 - 1 „ „ D 1 - 1 „ typhimurium 3 - 3 „ Newport 1 - 1 „ Blockley 1 - 1 Agent not identified 3 - 3 (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 1963 on which the following table is based. Table 47 Patients Men Women Total General analysis X-rayed 5,372 3,152 8,524 Previously x-rayed 2,741 1,253 3,994 Reviewed 251 105 356 Abnormal after review 162 71 233 Analysis of abnormal films:— Cases considered tuberculous:— (a) no further action required - - - (b) occasional supervision only 3 3 6 (c) requiring treatment... 9 6 15 (d) still under investigation — — — (e) refused further investigation — — - Previously known tuberculous cases 6 9 15 Non-tuberculous cases:— (a) investigated 37 19 56 (b) still under investigation 6 — 6 Cardio-vascular lesions 14 8 22 No action required 67 24 91 64 Commenting on the year's work, Dr. J. M. Morgan, director of the south-east London mass x-ray service, states:— "Of the fifteen cases requiring close supervision or treatment seven were discovered at public surveys, four men and three women, giving an incidence of 2.9 and 1.6 respectively, with an overall incidence of 2.2 per thousand. Not one of these cases found had been previously x-rayed, and the incidence in this sample of the un-x-rayed population is therefore 4.7 for men and 2.5 for women, with an overall incidence or 3.4. Seven cases requiring close supervision or treatment were found in firms, six men and one woman, giving an incidence of 5.1 and 1.1 per thousand respectively, with an overall incidence of 3.4. Of these seven cases, only one had been previously x-rayed, and the incidence in the un-x-rayed group is therefore very high at 12.3 per thousand for men, and 2.4 for women, giving an overall incidence of 8.4 per thousand. The other case was a schoolboy. These figures reveal once more the extent of tuberculosis in London, particularly among those who have not yet had chest x-ray examination, and provide reasonable grounds for urging all those concerned with the problem to make every effort to bring unexamined persons to mass x-ray units. 65 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 48 at December 31, 1963 1 Under 1 1 2 3 4 5-9 10-14 Total under 15 in year 1963 1962 1961 I960 19 59 1954-58 1949-53 Diphtheria (including combined and triple):— immunised during year 1359 1446 161 56 24 94 34 3174 immunised at end of year 1359 2762 2984 3200 4502 14,166 14,069 43,042 Estimated mid-year population 17,700 28,400 46,100 ) Whooping cough (including combined and triple):— Immunised during year 1352 1438 157 52 15 50 20 3084 (iii) Vaccination. Vaccinated during the year (age ot date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 315 253 70 112 750 Revaccination — 22 108 370 500 (iv) Poliomyelitis Immunised against Poliomyelitis 1st Injection dose 2nd Injection or dose 3rd Injection or dose 4th Injection or dose (booster) Salk vaccine 172 371 574 109 Sabin (oral) vaccine 2,530 2,230 3,377 771 Council Offices, E. H. R. SMITHARD Town Hall, Medical Officer of Health S.E.6. APPENDIX A Acts of Parliament, Statutory Instruments and Circulars issued by Government Departments with regard to the public health services, during the year 1963:— Statutes London County Council (General Powers) Act, 1963 Animal Boarding Establishments Act, 1963 Betting, Gaming and Lotteries Act, 1963 Contracts of Employments Act, 1963 Local Government (Financial Provisions) Act, 1963 London Government Act, 1963 Offices, Shops and Railway Premises Act, 1963 Statutory Instruments The Public Health (Ships) (amendment) Regulations, 1963 The Local Government (Compensation) Regulations, 1963 The Poisons List Order, 1963 The Poisons Rule, 1963 The Merchandise Marks (Imported Goods) (Raw Cucumbers) Order, 1963 The Bread and Flour Regulations, 1963 The Liquid Egg (Pasteurisation) Regulations, 1963 The Smoke Control Areas (Authorised Fuel) Regulations, 1963 The Slaughter of Animals (Prevention of Cruelty) Regulations, 1963 The Milk (Special Designation) Regulations, 1963 The Shops Regulations, 1963 The Alkali, etc. Works Order, 1963 The Housing (Payments for Well-Maintained Houses) Order, 1963 The Soft Drink Regulations, 1963 The Ice Cream (Heat Treatment, etc.) (Amendment) Regulations, 1963 The Slaughterhouses (Hygiene) Regulations (Appointed Day-No. 2) Order, 1963 The Meat Inspection Regulations, 1963 The Public Health (Aircraft) (Amendment) Regulations, 1963 The National Assistance (Powers of Inspection) (Amendment) Regulations, 1963 The Slaughterhouses (Hygiene) Regulations (Appointed Day-No 4) Order, 1963 Ministry of Health Circulars No. 7 Fluoridation of Water Supplies 10 Vaccination against Poliomyelitis 13 Port Health Control 14 Incontinence Pads 15 The Liquid Egg (Pasteurisation) Regulations, 1963 16 Poisons Information Service. 22 The National Assistance (Powers of Inspection) (Amendment) Regulations, 1963 66 67 Ministry of Housing and Local Government Circulars No. 3 Radioactive Substances Act, 1960 6 London Government 7 Clean Air Act, 1956,1. Gas Cokes as open fire fuels 23 Alkali, etc. Works Regulations, 1906 25 Chimney Heights 28 Housing Act, 1957. Slum Clearance-Payments for Well-Maintained Houses 37 Fluoridation of Water Supplies 48 Storm Overflows and the Disposal of Storm Sewage 53 London Government Act, 1963 54 (1) Smoke Control Areas (Authorised Fuels) Regulations, 1963 (2) Local Land Charges Register 69 Clean Air Act, 1956,—Smoke Control Areas Ministry of Agriculture, Fisheries and Food Circulars No. 1 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents. 4 The Slaughterhouses (Meat Inspection Grant) Regulations 1958 5 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents. 6 Soft Drink Regulations, 1956 7 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents 8 Bread and Flour Regulations, 1959 9 The Meat Inspection Regulations, 1963 11 The Milk (Special Designation) Regulations, 1963 12 Arsenic in Food Regulations, 1959. Sampling of Brewing Materials 15 Milk and Dairies (General) Regulations, 1959. Approved Chemical Agents. General Register Office Circular No. MOH 3 Annual Reports of Medical Officers of Health, 1963:—Vital Statistics Home Office Circular No. 180 London Government Reorganisation—Children's Services. 68 1 APPENDIX B Legal Proceedings, 1963 The following are details of legal proceedings during the year: — Nature of summons No. Total fines Total costs Remarks £ s. £ s. [/##] Public Health (London) Act, 1936 Non-compliance with nuisance notices 9 14 0 3 3 2 summonses withdrawn (work completed) ; 4 abatement orders made 2 adjourned sine die. (work completed) Food and Drugs Act, 1955 sections:— 2 10 90 0 18 18 Food Hygiene (General) Regulations, I960 Regulations 26 (1), 33(2)(a) 2 20 0 2 2 London County Council (General Powers), Acts Caravans on unlicensed sites 56 152 0 19 adjourned sine die (caravans removed from site) Failure to supply dustbin 1 5 0 APPENDIX C List of special reports submitted to the Health Committee by the medical officer of health during 1963 :— May 28 Royal Society of Health Congress at Eastbourne Burnt Ash Centre Workroom July 2 Old People Generally—Holidays September 10 Basement Bakehouses November 5 Day Care for the Aged and Infirm in their Homes 69 INDEX SUBJECT PAGE Acts, regulations and orders 66 Anti-fly and anti-mosquito campaign 19 Area of borough 4 Atmospheric conditions 28 Atmospheric pollution 26 Bathing attendants 33 Births and birth rate 4 Boarding-out scheme for the elderly 35 Cancer of lung 14 Care of the elderly 30 Clean Air Act 26 Clearance areas 45 Clubs for the elderly 32 Concerts for the elderly 34 Consumer Protection Act 39 Continental Goods Depot 54 Coronary disease 12 Deaths and death rate 4 Deaths, cause of 6 Discretionary grants and standard grants 46 Disinfection and personal cleansing 18 Dog nuisances 23 Drainage work 23 Dysentery 60 Factories 39 Flies and mosquitos 19 Food, adulteration of 50 Food Hygiene Regulations 54 Food inspection and supervision 48 Food poisoning 63 Food premises—registration 54 General statistics from 1901 16 Hairdressers 39 Health education 19 Health Services, general provision of 18 Heart disease 12 Heattreated milk 48 Holidays and holiday home 32 Home safety 25 House purchase loans 46 Housing:— Building 44 Families rehoused 44 Housing Act, 1957 44 Icecream composition 49 Icecream grading 49 Immunisation 65 Infant mortality 4 Infant mortality analysis 8 Infectious diseases 56 SUBJECT PAGE Infectious disease visiting 58 Laboratory facilities 22 Legal proceedings 68 LCC (General Powers) Act, 1953, section 43 19 LOPWA 34 Mass miniature radiography 63 Maternal deaths 5 Meals for the elderly 32 Measles 60 Milk, analysis of 48 Milk and Dairies Regulations 48 Milk, special designations 48 Mortuary and Coroner's Court 20 Moveable dwellings 47 National Assistance Act, 1948 s. 50 22 s. 47 23 Offensive trades 54 Old people 30 Outworkers 41 Paratyphoid B. fever 59 Pet animals 39 Pharmacy and Poisons 54 Pigeons 42 Pneumonia 60 Poliomyelitis 60 Population 4 Prevention of Damage by Pests 21 Rag flock etc. 42 Rateable value 4 Rent Act 46 Repairs carried out 38 Rodent control 20 Sampling 50 Sanitary circumstances of the area 37 Saville, The 30 Scarlet fever 60 Shops Act 54 Sickness, local 11 Slaughterhouses 54 Smoke nuisances 37 Social medicine statistics 10 Staff 2 Stillbirths 4 Swimming baths 22 Tuberculosis 60 Unsound food 54 Vaccination 65 Vital statistics 4 Water certificates 39 Water supply 23 Whooping cough 60 Workshop for the elderly 31 70 TABLES TABLE SUBJECT PAGE NO. 1 Comparative statistics 5 2 Causes of death by age groups 7 3 Deaths under one year 8 4 Deaths by social class 10 5 Grouped causes of death by social class 11 6 Morbidity 11 7 Heart and circulation ality 13 8 Lung cancer 14 9 General Statistics 16 10 Disinfecting station 18 11 Verminous conditions etc. 18 12 Public mortuary 20 13 Rodent control—treatment of rivers 21 14 Prevention of Damage by Pests Act 21 15 Laboratory facilities 22 16 Swimming Baths 22 17 Water, chemical samples 24 18 Water, Bacteriological samples 24 19 Accidents 25 20 Smoke Control Areas 26 21 Atmospheric conditions 28 22 Old People's visits 34 23 Sanitary inspection 37 24 Summary of notices 38 25 Repairs carried out 38 26 Factory inspections 40 27 Factory defects 41 TABLE SUBJECT PAGE NO. 28 Demolition orders 44 29 Closing orders 45 30 Clearance areas 45 31 Rent Act, 1957 46 32 Analysis of milk 48 33 Icecream composition 49 34 Icecream grading 49 35 Samples analysed 50 36 Adulterated samples 50 37 Continental Goods Depot 55 38 Notified cases of infectious diseases 56 39 Notifications of infectious diseases by age and sex 57 40 Analysis of certain diseases into divisional areas 58 41 Infectious disease visiting 59 42 T uberculosis notifications and deaths 61 43 Analysis of new cases of tuberculosis into divisional areas 61 44 Tuberculosis 10 year statistics 62 45 Tuberculosis—environmental conditions 62 46 Food poisoning cases 63 47 Mass Radiography 63 48 Immunisation against fectious disease 65 CHART First applications for sickness benefit 1951 - 63 12