METROPOLITAN BOROUGH OF LEWISHAM LEW 52 Report OF THE Medical Officer of Health for the Year 1964 CONTENTS Page Staff 2 Introduction 3 Vital Statistics 4 General Provision of Health Services 14 The Care of the Elderly 24 Sanitary Circumstances of the Area 28 Housing 36 Inspection and Supervision of Food 40 Infectious Diseases 45 Welfare of the People 54 Appendix A — Statutory Instruments 100 „ B — Legal Proceedings 102 "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 31/12/64 Medical Officer of Health F. R. Waldron, md, 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) (6) *C. L. Connor (a) (b) *R. L. Davis (a) (b) *G. E. Fallows (a) (b) *E. A. Howard (a) (6) *W. J. Wilcox (a) (6) J. T. Smith (a) (b) R. W. Bradstock (a) (b) (c) B. Boyd (a) K. F.' Hill (a) (6) (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) M. Chapman C. R. Coleman, dma D. Boon Mrs. D. J. Handford K. Richardson Miss M. E. Hinchcliff D. Barber Mrs. M. G. James Mrs. II. I. Barnes Miss F. E. Smifh I. Soper 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 4 Drain tester 1 Handymen 2 Public Analyst J. H. Shelton, fric Bacteriologist E. H. Bailey, mrcs, lrcp, of the Public Health Laboratory Service. 3 To the Mayor, Aldermen and Members of the Council. I have the honour to submit my report for the Health Department which will be the last in a series for the metropolitan borough and thus marks the end of an era. Under the London Government Act, 1963, the appointed day for the fusion of Deptford and Lewisham into the new London Borough of Lewisham is April 1st 1965. Because of this, it is opportune to include references to earlier reports to indicate in some measure how health problems have changed over the years. The year 1964 disclosed no noteworthy episode of infectious disease. The vigilance of the inspectorate was, however, in no way lessened and preventive supervision of food and housing matters continued unabated. Progress in clean air procedures has been satisfactory. The excellent services for the elderly sponsored by the Council directly or through liaison with voluntary societies and clubs have continued to expand. Much, however, remains to be done. It is to be hoped that the new Local Health Authority will take the initiative in the effort to establish a co-ordinated comprehensive scheme for the elderly in the New Borough. This has been a particularly testing period for the staff of the department. They have all been involved in arrangements for the transfer which have increased in volume and momentum as the 'appointed day' approached. Every individual has amply demonstrated loyalty to the Council and the needs of the public whom we all serve. For 10 months, up to April, 1965, the department was without a full-time Medical Officer of Health and, consequently great responsibility fell especially on Mr. Phillips, Senior Public Health Inspector, and Mr. E. Cheesman, Senior Administrative Officer. I am most grateful to these two gentlemen and all my colleagues on the staff whose friendship and support have lightened my task since my part-time appointment in October, 1964. In conclusion my thanks are due to the Town Clerk and other Chief Officers and to the Chairman and Members of the Public Health Committee for their generous forbearance and readily available help at all times. F. R. Waldron, 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 T. I. Bradley (The Mayor) 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 1964 was 223,170. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1964 £8,993,901 Estimated net product of a penny rate 1964/5 £35,975 Estimated number of separately assessed dwellings at April 1, 1964 66,477 Births (adjusted for inward and outward transfers) Total Livebirths 4,142 Males Females Total Legitimate 1,828 1,820 3,648 (3,578) Illegitimate 239 255 494 (418) Totals 2,067 2,075 4,142 (3,996) Crude birth rate per 1,000 of the estimated population 18.6 (17.9) Adjusted birth rate for comparative purposes (Area comparability factor = 0.97) 18.0 (17.4) Birth rate for England and Wales Adjusted birth rate for London Administrative 18.4 (18.2) County 17.2 (17.2) Stillbirths Total (26 males and 18 females) 44 (54) Rate per 1,000 live and stillbirths) (males 12.4 (14.3): females 8.6 (12.2) 10.5 (13.3) Deaths Total (1,343 males, 1,220 females) 2,563 (2,639) Crude death rate per 1,000 population 11.5 (11.8) Adjusted death rate (Area comparability factor = 0.97) 11.2 (11.4) Death rate for England and Wales 11.3 (12.2) ,, ,, „ London Administrative County 10.7 (12.5) Infant mortality Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 41 34 75 (81) Illegitimate 4 6 10 (11) Total 45 40 85 (92) 3 Rates: 1. All infants per thousand livebirths 20.5 (23.0) 2. Legitimate infants per thousand legitimate livebirths 20.6 (22.6) 3. Illegitimate infants per thousand illegitimate livebirths 20.2 (26.3) 4. Male infants per thousand male livebirths 21.8 (29.1) 5. Female infants per thousand female livebirths 19.3 (16.5) Neonatal deaths (under 4 weeks of age) 58 (63) Neonatal death rates:— Males, per 1,000 male livebirths 16.4 Females, per 1,000 female livebirths 11.6 All infants, per 1,000 livebirths 20.5 (15.8) Early neonatal deaths (under 1 week of age) 48 (53) Males, per thousand male livebirths 13.1 Females, per thousand female livebirths 10.1 All infants per thousand livebirths 11.6 (13.3) Perinatal mortality (deaths under 1 week plus stillbirths) 92 (107) Males, per thousand live and still male births 25.3 Females, per thousand live and still female births 18.6 All infants, per thousand live and stillbirths 22 0 (26.4) Reproductive wastage—(Stillbirths plus all infant deaths) 129 (146) Males, per 1,000 live and still male births 33.9 Females, per 1,000 live and still female births 27.7 All infants, per 1,000 live and still births 30.8 (36.0) 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) 7 (15) Motor vehicle accidents 34 (19) Suicide 30 (40) Respiratory diseases (other than tuberculosis) (Code Nos. 22-25) 370 (401) Cancer (Code Nos. 10-15) 569 (490) Heart and circulation diseases (Code Nos. 17-21) 1,198 (1,325) Comparative statistics for the year 1964 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 18.0 10.5 11.2 20.5 England and Wales 18.4 16.3 11.3 20.0 London Administrative County 17.2 14.9 10.7 21.2 6 7 Causes of death at different periods of life during the year 1964 The following table shows the causes of and ages at death during the calendar year 1964:— Tables Code No. Causes of death Nett deaths at the subjoined ages of " residents" whether occurring within or without the borough Causes of death Nett deaths at the subjoined ages of " residents" whether occurring within or without the borough MALES Toll pers (i.e incl. table opp. Code No. FEMALES Total persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1343 45 7 7 24 43 356 363 498 254 Totals all causes 1220 40 4 5 1 29 198 293 644 2563 1 Tuberculosis, respiratory 5 - - - - - 1 2 2 5 1 Tuberculosis, respiratory - - - - - - - - - 5 2 Tuberculosis, other forms 2 - - - - - 2 - - 2 2 Tuberculosis, other forms - - - - - - - - - 2 3 Syphilitic diseases 4 - - - - 1 1 1 1 6 3 Syphilitic diseases 2 - - - - - - - - 6 4 Diphtheria - - - - - - - - - - 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - 8 Measles - - - - - - - - - - 8 Measles - - - - - - - - - - 9 Other infective and parasitic diseases 3 - 2 - - - 1 - - 3 9 Other infective and parasitic diseases - - - - - - - - - 3 10 Malignant neoplasms, stomach 40 - - - - 1 20 8 11 68 10 Malignant neoplasms, stomach 28 - - - - - 6 8 14 68 11 Malignant neoplasms, lung and bronchus 151 - - - - 3 58 58 32 181 11 Malignant neoplasms, lung and bronchus 31 - - - - - 14 11 6 182 12 Malignant neoplasms, breast - - - - - - - - - 50 12 Malignant neoplasms, breast 50 - - - - 2 29 9 10 50 13 Malignant neoplasms, uterus - - - - - - - - - 9 13 Malignant neoplasms, uterus 9 - - - - - 3 4 2 9 14 Other malignant and lymphatic neoplasms 134 - - 1 1 7 35 41 49 242 14 Other malignant and lymphatic neoplasms 108 - - 1 - 2 32 37 36 242 15 Leukaemia, aleukaemia 9 - - - - 1 1 3 4 18 15 Leukaemia, aleukaemia 9 1 - - 1 - 1 2 4 18 16 Diabetes 2 - - - - - 1 - 1 12 16 Diabetes 10 - - - - - 1 3 6 12 17 Vascular lesions of nervous system 117 - - - 2 3 23 32 57 338 17 Vascular lesions of nervous system 221 1 - - - 4 22 52 142 338 18 Coronary disease, angina 314 - - - - - 107 91 108 515 18 Coronary disease, angina 201 - - - - 1 21 64 115 515 19 Hypertension with heart disease 15 - - - - - 2 5 8 38 19 Hypertension with heart disease 23 - - - - - 2 7 14 38 20 Other heart disease 83 - - 1 1 2 20 16 43 194 20 Other heart disease 111 - - - - 1 7 20 83 194 21 Other cirulatory disease 48 - - - - 2 11 15 20 113 21 Other circulatory disease 65 - - - - - 10 7 38 113 22 Influenza - - - - - - - - - 1 22 Influenza 1 - - - - - - - 1 1 23 Pneumonia 85 7 1 - - - 3 17 57 180 23 Pneumonia 95 6 - 2 - - 4 18 65 180 24 Bronchitis 120 5 - - - 1 29 41 44 158 24 Bronchitis 38 1 - - - - 7 3 27 158 25 Other diseases of respiratory system 12 - - - 1 - 2 4 5 21 25 Other diseases of respiratory system 9 - - - - 1 2 1 5 21 26 Ulcers of stomach and duodenum 18 - - - - 1 5 8 4 28 26 Ulcer of stomach and duodenum 10 - - - - - 1 5 4 28 27 Gastritis, enteritis and diarrhoea 3 - - - - - 2 - 1 12 27 Gastritis, enteritis and diarrhoea 9 - - - - - 2 4 3 12 28 Nephritis and nephrosis 4 - - - - - - 3 1 10 28 Nephritis and nephrosis 6 - - - - 1 2 1 2 10 29 Hyperplasia of prostate 17 - - - - - 1 5 13 17 29 Hyperplasia of prostate - - - - - - - - - 17 30 Pregnancy, childbirth, abortion - - - - - - - - - 2 30 Pregnancy, childbirth, abortion 2 - - - 2 - - - - 2 31 Congenital malformations 12 9 1 - - - - - 2 28 31 Congenital malformations 16 9 - 1 1 1 3 1 - 28 32 Other defined and ill defined causes 83 24 1 1 - 1 16 13 27 206 32 Other defined and ill defined causes 123 19 3 - - 12 18 18 53 206 33 Motor vehicle accidents 27 — — 2 13 3 6 1 2 34 33 Motor vehicle accidents 7 1 — 1 1 — 1 2 1 34 34 All other accidents 19 — 2 2 2 3 4 1 5 30 34 All other accidents 22 2 1 — 1 2 3 3 10 41 35 Suicides 16 — — — 4 6 5 — 1 30 35 Suicides 14 — — — 1 2 6 2 3 30 36 Homicide and operations of war - - - - - - - - - - 36 Homicide and operations of war - - - - - - - - - - 8 The social class, related to cause of death, was as follows :— Table 3 Code No. Cause of death Male Female 1 II Ill IV V Total 1 II III IV V Total 1 Tuberculosis, respiratory - - 3 2 - 5 - - - - - - 2 Tuberculosis, other forms - - 1 - 1 2 - - - - - - 3 Syphilitic disease - - 1 2 1 4 - - 2 - - 2 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases - - 3 - - 3 - - - - - - 10 Malignant neoplasm, stomach - 4 22 8 6 40 - 5 15 6 3 29 11 Malignant neoplasm, lung, bronchus 4 14 81 29 20 148 3 2 15 6 5 31 12 Malignant neoplasm, breast - - - - - - 1 2 35 10 3 51 13 Malignant neoplasm, uterus - - - - - - 1 1 2 1 1 6 14 Other malignant and lymphatic neoplasms 5 17 75 19 14 130 2 16 56 16 18 108 15 Leukaemia, aleukaemia - 1 5 2 1 9 1 1 5 — 2 9 16 Diabetes - 1 — 1 — 2 - 2 7 1 — 10 17 Vascular lesions of nervous system 5 16 49 20 9 99 4 28 77 29 21 159 18 Coronary disease, angina 9 28 152 61 33 283 5 23 91 16 16 151 19 Hypertension with heart disease 2 4 10 4 5 25 1 4 11 4 6 26 20 Other heart disease 3 11 59 16 15 104 16 18 66 16 12 128 21 Other circulatory disease 5 7 25 15 2 54 4 10 65 22 8 109 4 22 Influenza - - - - - - - - 1 - - 1 23 Pneumonia 1 8 36 9 8 62 1 10 40 23 10 84 24 Bronchitis 2 11 80 29 17 139 1 3 25 13 7 49 25 Other diseases of respiratory system - - 3 3 - 6 1 3 2 1 - 7 26 Ulcer of stomach and duodenum - 1 6 3 4 14 - - 6 3 1 10 27 Gastritis, enteritis and diarrhoea - - 2 1 - 3 - - 6 2 1 9 28 Nephritis and nephrosis - - 1 2 1 4 1 1 2 — 2 6 29 Hyperplasia of prostate - 3 9 2 2 16 - - - - - 2 30 Pregnancy, childbirth, abortion - - - - - - - - 2 - - 2 31 Congenital malformations - - 8 2 2 12 - 2 8 4 1 15 32 Other defined and ill defined diseases 4 24 27 15 10 80 10 16 55 18 22 121 33 Motor vehicle accidents 1 4 12 8 2 27 - - 5 1 - 6 34 All other accidents 1 3 8 5 2 19 - 3 10 4 5 22 35 Suicides - 1 10 3 2 16 3 — 5 5 1 14 36 Homicide and operations of war - - - - - - - - - - - - Totals 42 158 688 261 157 1306 55 150 614 201 145 1165 l/V) Percentage 3 12 53 20 12 100 5 13 53 17 12 100 No social class assessed - - - - - 37 - - - - - - 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 an circulation. Similarly 22 to 25 are best grouped together. 9 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 diease 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 4 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. 9 36 183 58 41 327 8 27 128 39 32 234 % 3 11 56 18 12 100 3 11 55 17 14 100 17-21 Heart and circulation No. 74 66 295 116 64 565 30 83 310 87 A3 573 % 4 12 52 21 11 100 5 15 54 15 11 100 22-25 Lung, not TB or cancer No. 3 19 119 41 25 207 3 16 68 37 17 141 % 1 9 58 20 12 100 2 12 48 26 12 100 33,34 Accidents No. 2 7 20 13 4 46 - 3 15 5 5 28 % 4 5 44 28 9 100 — 11 53 18 18 100 15 Suicides No. - 1 10 3 2 16 3 - 5 5 1 14 % - 6 63 19 12 100 21 - 36 36 7 100 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 5 Morbidity shown in insurance certificates Weekly average for period ending "Lewisham & Downham" Weekly average for period ending "Lewisham & Downham" January 28 1075 August 11 463 February 25 1153 September 8 509 March 24 809 October 6 628 April 21 698 October 31 881 May 19 574 December 1 878 June 16 555 December 31 608 July 14 547 Weekly average for the year 1964 722 „ „ 1963 765 10 Heart disease The incidence of deaths from the heart and circulation diseases were fewer than in the previous year, but a glance at table 6 shows that the percentage of deaths from such afflictions in the age group 45 to 65 remained as high as ever. Table 6 Heart and circulation mortality Year Deaths from Total heart and circulation (all ages) Age group 45-65 Total deaths in borough Percentage Coronary diseases Other heart diseases* Other circulatory diseases† Total Coronary diseases (e) of (h) (f) of (h) (g) of (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) 1928 357 97 454 115 - 1993 23 5.8 ? 1933 516 117 633 162 - 2271 28 7.1 ? 1938 659 139 798 178 - 2403 33 7.4 ? 1943 583 64 647 129 - 2359 27 5.5 ? 1948 696 63 759 155 - 2253 34 6.9 ? 1953 775 113 888 140 - 2502 35 5.6 3.4 1958 770 109 879 150 - 2433 36 6.2 4.1 1963 866 113 979 180 - 2639 37 6.8 4.9 1959 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 4 515 232 113 860 180 128 2563 34 7.0 5.0 ? means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. 11 Lung cancer The number and percentage of deaths from all forms of cancer was higher than in the previous year, and once again attention is drawn to the high number of lung cancer deaths. The increasing percentage of such deaths among females is particularly disturbing. It cannot be repeated too often that the way to lessen the risk of getting lung cancer is not to smoke. That is all the good advice that need be given about the subject, which if it were obeyed would undoubtedly result in a dramatic lessening of the incidence of this fatal disease. Table 7 Year MALE FEMALE All cancer deaths Lung cancer deaths (c)as % of (b) All cancer deaths Lung cancer deaths (f) as % of (e) (a) (b) (c) (d) (e) (f) (g) 1952 246 77 31 238 9 4 1953 237 83 35 215 13 6 1954 238 76 32 192 13 7 1955 303 102 34 226 19 8 1956 259 96 37 226 12 5 1957 267 101 38 229 21 9 1958 271 114 42 201 21 10 1959 297 118 40 235 22 9 1960 315 145 46 254 17 7 1961 271 119 44 210 15 7 1962 324 155 48 224 19 8 1963 266 117 44 224 22 10 1964 334 151 45 235 31 13 K General statistics from 1901 Table 8 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. rote†† 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 - - 7 - 1903 136,405 11.1 - 72 26 - 2.5 - - - 92 - - 78 - 1904 140,401 12.0 - 70 26 - 3.6 - - - 122 - - 84 - 1905 144,420 11.7 - 67 25 - 2.8 - 30 63 93 - - 87 - 1906 148,463 12.0 - 72 23 - 2.0 - 30 83 113 - - 80 - 1907 152,532 11.5 - 67 24 - 2.5 - 34 56 90 - - 90 - 1908 156,627 110 - 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 Table 8- 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 25 23 54 86 123 59 11 1933 221,100 10.2 22 50 12 - 2.6 31 31 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 21 19 43 78 126 58 13 1936 224,000 10.9 23 48 13 - 2.0 37 24 32 55 92 131 62 12 1937 226,000 10.9 20 47 13 - 1.3 39 23 29 47 86 156 59 12 1938 229,000 10.5 23 49 14 - 2.1 26 18 - 47 73 116 61 12 1939 220,300 10.8 - 14 - 2.9 34 — - 42 76 111 64 12 1940 192,540 15.8 22 50 15 - 1.0 24 — - 45 69 111 67 11 1941 148,150 14.3 22 48 14 - 1.9 29 - - 34 63 176 93 10 1942 161,800 12.0 18 44 17 - 3.2 37 — - 37 74 175 73 15 1943 168,530 13.9 20 45 19 - 3.1 25 - - 42 67 194 76 14 1944 163,320 14.8 21 49 19 - 1.0 22 - - 40 62 196 79 11 1945 171,280 12.1 20 43 18 - 1.9 18 - - 34 52 179 71 13 1946 207,410 10.6 17 43 22 - 1.1 21 - - 33 54 193 53 15 1947 221,170 11.9 17 42 22 - 1.0 21 - - 33 54 166 55 12 1948 226,100 9.9 16 41 19 - 1.5 15 15 13 28 43 198 48 16 1949 227,700 10.2 11 35 17 - 0.3 16 13 6 19 35 146 40 12 1950 228,300 10.6 11 35 15 - 0.6 15 19 7 26 40 158 29 13 1951 227,200 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 11 1957 220,900 11.0 8 32 15 65 0.6 18 12 4 16 33 100 14 10 1958 221,000 11.0 8 29 15 78 Nil 18 19 5 24 42 98 8 11 1959 221,000 11.8 7 28 16 75 0.8 18 13 5 18 36 56 5 8 1960 221,300 11.3 8 28 16 69 Nil 17 13 6 19 36 54 5 10 1961 220,910 11.7 7 28 17 72 0.3 19 14 6 20 39 51 8 9 1962 222,170 11.6 7 30 18 73 0.5 13 13 6 19 32 37 10 11 1963 222,730 11.8 8 29 18 78 0.5 13 16 7 23 36 48 7 9 1964 223,170 11.5 8 30 18 62 0.5 11 14 7 21 32 56 2 18 *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. 14 GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows :— Disinfecting Station Table 9 West North South Total Disinfection Premises visited 39 26 18 83 Rooms disinfected 100 50 35 185 Articles disinfected 802 854 611 2267 Disinfestation Premises visited 56 39 20 115 Rooms disinfested 215 118 53 386 Articles disinfested 17 6 4 27 Articles treated Beds 13 19 12 44 Mattresses 33 35 34 102 Bolsters 12 11 7 30 Pillows 81 38 42 161 Cushions 9 11 3 23 Quilts 14 11 20 45 Blankets 112 48 50 210 Sheets 25 30 74 129 Household articles 262 251 232 745 Wearing apparel 258 406 141 805 Total articles 819 860 615 2294 Articles received from the cleansing station - 1892 - 1892 Articles received from the Coroner's court - 1159 - 1159 Burnt Ash Centre 128 47 89 264 The Saville 2 - 25 27 Public library books treated after infection - 677 - 677 Private library books treated after infection - 624 - 624 Articles treated under the Public Health (London) Act s.122 17361 17390 18600 53351 Treatments for verminous conditions and for scabies were as follows : Verminous conditions Table 10 1st Cleansing 2nd Cleansing 3rd Cleansing 4th Cleansing Children under 5 6 1 - - School children 33 - - - Adults 11 1 - - TOTALS 50 2 - - 15 Scabies Table 10—continued Cases Contacts Treatments Children under 5 10 - 14 School children 36 - 82 Adults 14 — 25 TOTALS 60 — 121 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 During the period, June to September, special measures were again taken to deal with control of fly breeding. Regular calls were made to potential sources, such as stables, piggeries and similar premises throughout the Borough. Vacant sites which were well known to the department as rubbish dumps were visited and deposits of litter removed and the ground sprayed with insecticide when considered necessary. Fortunately there has been a reduction in the number of vacant sites due to building development and some improvement in the condition of the remaining sites was noted, probably as a result of the Councils scheme to clear rubbish from houses on request. The contractors of blocks of flats were supplied with the necessary equipment and material to enable them to deal with refuse chutes and chambers. The Borough Engineer again co-operated in the treatment of dustbins with powder supplied by the health department. 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. 16 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 11 Month Bodies received from Institutions Others Post-mortem examinations Inquests held Lewisham residents Others January 44 35 44 35 10 February 32 64 58 38 16 March 73 69 70 72 21 April 50 30 47 33 10 May 41 31 39 33 18 June 53 26 38 41 13 July 45 30 47 28 4 August 43 30 43 30 9 September 43 28 40 31 13 October 44 41 57 28 12 November 60 34 62 32 17 December 51 49 66 34 16 TOTALS 579 467 611 435 159 Rodent control In his report on rodent control work during 1964, Mr. Phillips, the Senior Public Health Inspector states:— The number of premises where rat infestation was found has again shown a slight decrease from 961 to 908. This may be due to the effective baiting of the sewers but is more likely to have been the result of a very extensive baiting and gassing of the river banks, where 1,150 base points were laid compared with 187 in 1963. A great deal of this work was necessary to reduce the infestation of several business premises adjoining the rivers and this can be seen in the reduction in the number of rat infestations found during the year in this type of property, namely 62 instead of 93 in the previous year. In most cases baiting was carried out by the use of Warfarin, although in a few cases where more rapid results were required, zinc phosphide was employed. Whilst there was a reduction in the number of premises infested with rats, the number of mice remained almost the same and in dealing with these it was found that a considerable time was taken in some instances before a complete clearance was obtained. In these latter cases it was thought that some immunity to the effects of Warfarin had been built up but it is early to assess how great this immunity may be. The use of the break back trap is still a most useful control of premises where there are mice which the occupier can carry out for himself but the most effective of all is the careful storage of food, for it is the readily available supply of this which encourages the mice and helps in the rapid increase in numbers. 17 Table 12 Location Base points River Ravensbourne 716 River Quaggy 434 During the year continuous baiting has been undertaken in more than 4,000 manholes. This work has been carried out by a team of two men, using in the early part of the year 1081, sodium fluoracetamide, of which the take was very small. In the later part of the year Warfarin was used and a check made of the takes which again showed a remarkably small infestation. Prevention of Damage by Pests Act, 1949 A copy of the report covering the calendar year 1%4 submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended :— Table 13 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 16 1,865 147 2,028 — (b) survey 7 243 8 258 — (c) otherwise — 12 — 12 — Total inspections 23 2,120 155 2,298 Properties inspected which were found to be infested by:— (a) Rats — major — — — — — (b) —minor 10 836 62 908 — (c) Mice—major — — — — — (d)—minor 6 338 42 386 — Infested properties treated 16 1,174 104 1,294 - Total treatments (including retreatments) 41 2,647 404 3,092 — "Block" control schemes carried out Nil Laboratory facilities The following summary relates to the work carried out by the public health laboratory on behalf of the Council during 1964. 18 Table 14 Specimens Number Remarks Faeces 551 Negative 82 Shigella sonnei 10 Salmonella typhimurium 4 „ anatum 8 2 paratyphi B 1 B. coli 0 55 2 Salmonella typhi 3 „ brandenburg 3 Staphylococcus aureus 1 Shigella flexneri 1 Ova of Trichuris trichuria Urine 6 Routine Swabs from nose and throat etc. 27 Negative 1 H. pertussis 1 B. coli 9 B-haem. strep. 2 Staph.aureus 1 Proteus Cough plates 1 Negative 1 H. pertussis Sputum 1 Negative Water (various) 2 Food 2 Salmonella typhimurium Other food 2 722 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 15 Bath Tests Variation of chlorine (p. p.m.) Chlorine Bact. Ladywell West 7 — 0.1—1.6 Ladywell East 7 — 0.1—2.0 Forest Hill North 4 — 0.2—2.8 Forest Hill South 4 — 0.1—1.8 Downham 5 — 0.1—2.1 Bellingham (openair) 3 — 0.1—1.8 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 metaphosphaite 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. 19 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 £13 0s. Od. 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 Where a complaint is received concerning the fouling of footpaths by dogs it is the practice to exhibit a byelaw notice at a convenient site nearby. During the year 45 complaints were received, and dealt with. No legal proceedings were instituted regarding the complaints. Water supply The Director of Water Examination of the Metropolitan Water Board states that the water supply to the Borough of Lewisham, has been satisfactory both in quantity and quality during 1964. The water supply to the Borough is well-derived water from Darenth, Deptford, Bexley and Wilmington wells and occasionally from Merton well, together with river Thames derived filtered water. There was no new source of supply instituted by the Board during 1964. 2,120 yards of new main were laid in the Borough, including 737 yards of trunk main. Tables 16 and 17 give the average results of the chemical and bacteriological analyses of the various supplies for 1964. to Table 16 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1964 milligrams per litre (unless otherwise stated) Description of the Sample No. of Samples acal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Chlorides as C1. Oxygen abs. from KMnO4 4 hrs. at27ºC. Turbidity units Colour (Burgess) scale Hardness (total) Hardness (noncarbo nate) pH value Phosphate as PO4 Silicate as SiO, Sulphate so4 Magnesium as Mg. Natural Fluoride as F. Surface active material as 0X0/ OT Electrical Conduc tivity (microm hos) Bexley 21 0.005 0.019 5.6 18 0.08 Nil Nil 314 68 7.2 0.1 570 Darenth 4 0.003 0.019 5.1 18 0.08 0.1 Nil 272 40 7.3 0.2 490 Deptford 4 0.007 0.026 6.0 37 0.14 Nil Nil 362 118 7.2 0.2 680 Wilmington 6 0.010 0.031 8.3 24 0.12 0.3 Nil 288 50 7.2 0.15 550 Merton Abbey Not in supply during the year. Thames-derived 159 0.031 0.075 5.0 34 1.06 0.1 11 264 64 7.6 1.4 9 60 5 0.25 0.09 550 South of River Table 17 Bacteriological Results—Yearly Averages, 1964 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 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C 3 days at 22º C Per cent, samples negative in 100 ml. Per cent. samples negative in 100 ml. Bexley 253 0.1 12 100.0 — 100.0 — 257 0.3 2 99.61 100.0 Darenth 251 0.2 6 98.80 — 98.80 - 248 0.1 4 100.0 100.0 Deptford 254 0.2 7 99.21 - 99.61 - 257 3.0 61 99.61 100.0 Wilmington No. 1 61 0.1 114 100.0 - 100.0 — 189 0.1 16 100.0 100.0 Wilmington No. 2 127 0.2 141 97.64 0.1 99.21 - Thames-derived South of River 1 ,883 10.6 99.95 100.0 21 Atmospheric pollution Clean Air Act During 1964 three more areas were made the subject of Smoke Control Orders and particulars with regard to these are as follows :— No. 18 No. 19 No. 20 Name (Sunderland) (Sydenham) (Moyow) Acreage 150 600 250 No. of industrial premises 12 11 16 No of commerical premises 111 245 129 No. of dwellings 2,020 4,034 2,000 No. of other premises 9 17 7 Present annual tonnage of bituminous coal to be replaced 2,000 3,000 1,500 Likely additional fuel required annually:— (a) Electricity (KWHS) 350,000 700,000 450,000 (b) Gas (therms) 250,000 500,000 350,000 (c) Oil, etc. Nil Nil Nil (d) Solid smokeless fuel (tons) 200 600 800 Total estimated cost of works £36,538 £57,760 £21,700 Date:—Order made 30.9.64 11.11.64 30.12.64 Order confirmed 25.2.65 26.1.65 12.3.65 Order operative 1.9.65 1.10.65 1.11.65 The progressive total (when these Orders are operative) will be 6,390 acres covering 60,312 dwellings. Programme At the end of December 1964, the position in relation to areas which have been or still are the subject of smoke control action was as follows:— Table 18 Area No. and name No. of dwellings Dote 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 2,020 1.9.65 19 Sydenham 4,034 1.10.65 20 Mayow 2,000 1.11.65 Measurement of atmospheric pollution Table 19, on pages 22 and 23, 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. 22 1 23 Atmospheric Condition 1964 Table 9 January February March April May June July August September October November December Average or actual (as applic.) Temperature— Mean maximum1 °C 5.8 7.5 7.4 12.6 19.1 19.4 22.8 21.6 20.3 13.3 11.0 6.7 14.0 Mean minimum1 °C 2.3 3.3 3.1 6.2 10.4 11.4 13.9 12.8 10.7 5.9 6.7 3.0 7.5 Mean1 ºC 4.1 5.4 5.3 9.4 14.7 15.4 18.3 17.2 15.5 9.6 8.9 4.9 10.7 Diff. from average1 ºC —0.2 +0.8 —1.4 00 +2.2 -0.5 +0.7 -0.1 + 0.6 —1.5 + 1.2 —0.5 + 0.2 Highest maximum2 ºC 90 12.0 13.0 21.0 25.0 27.0 27.0 28.0 26.0 19.0 15.0 13.0 28.0 Lowest minimum2 °C —3.0 —3.0 —2.0 0.0 8.0 7.0 11.0 9.0 8.0 2.0 —2.0 —5.0 —5.0 Rainfall— Total2 in. 0.67 0.59 2.75 2.60 3.6 307 0.75 1.54 1 . 54 1 . 57 1.46 1.14 21 . 3 Percent of average1 25 45 225 175 94 225 80 82 21 54 54 65 95 Sunshine1 Daily mean hrs. 1. 20 2.22 2.27 4.31 6.71 5.73 7.24 7.10 7.31 4.26 1 .83 1.61 4 32 Percent of average 81 98 62 81 105 81 113 117 154 135 103 126 105 Wind1 ne/e/se % 30 37 62 20 23 22 10 16 24 24 31 19 27 S/SW/W % 50 39 13 66 47 54 62 45 59 48 41 51 48 NW/N/Calm % 20 24 23 14 30 24 28 39 17 28 28 30 25 Atmospheric pollution— West Division3 Water insol. matter tpm 13.82 8.04 14.11 13.74 9.95 19.82 15.04 11.54 11.54 9.16 6.70 11.99 12.12 Water sol. matter tpm 4.97 3.94 8.12 4.82 8.84 6.25 4.16 4.07 4.07 4.45 4.75 5.23 5.31 Sulphur † 2.26 1.80 1.68 1.23 1.14 0.62 0.82 0. 66 0.83 1.27 1.44 2.81 1.38 Smoke, daily average * 231 181 90 46 98 23 21 24 38 86 111 175 94 „ maximum * 680 684 248 244 276 66 48 85 109 200 464 592 — „ minimum * 40 44 40 8 8 8 6 3 10 16 16 24 - Sulphur, daily average * 355 262 185 126 102 79 87 81 92 194 219 282 172 „ maximum * 1220 753 364 553 376 213 236 197 257 381 1218 873 — „ minimum * 104 61 73 17 25 31 31 21 25 49 48 43 — North Division4 : Smoke, daily average * 195 161 71 51 119 23 25 27 38 88 123 156 90 „ maximum 616 632 140 244 344 68 56 80 109 206 588 604 — „ minimum * 24 40 16 12 44 9 10 4 10 12 16 24 - Sulphur, daily average * 96 98 81 62 47 29 94 98 105 189 295 278 123 „ maximum * 238 275 266 196 120 76 320 188 278 301 1582 781 - „ minimum * 17 17 37 12 6 9 24 30 32 43 50 57 — South Division5: Water insol. matter tpm 8.55 8.63 9.05 11.98 10.92 7.98 10.96 9.25 9.25 8.85 8.87 10.11 9.53 Water sol. matter tpm 6.11 4.86 7.86 5.71 7.14 6.58 3.71 4.35 4.35 4.60 5.05 4.90 5.43 Sulphur † 1.90 1.66 1.50 1.11 0.61 0.59 0.60 0.59 0.58 1.23 2.30 1.76 1. 20 Smoke, daily average * 206 186 79 38 108 21 20 23 34 84 114 148 88 „ maximum * 560 736 204 208 332 48 50 66 103 200 452 640 - „ minimum * 32 28 24 4 104 1 3 7 7 12 20 8 - Sulphur, daily average * 360 277 196 130 104 92 81 79 115 182 256 299 181 „ maximum * 1174 821 330 548 363 203 222 154 248 397 1039 986 — „ minimum * 94 70 79 24 13 25 23 13 19 45 57 40 Weather summary Very dry Dry and dull Cold, dull and wet Cloudy and wet Changeable warm special Changeable High Rainfall Dry and warm Dry; warm spells Sunny and dry Dry and cold Dry and mild Cold and mildly stormy Notes : 1Kew; 2Lewisham; 3Valentine Court for smoke and sulphur, Pool allotments for other Paragon Place for smoke and sulphur; 5Pendragon school for smoke and sulphur, Verdant Lane for others tpm : tons per square mile per month; †as trioxide in mg per 100 sq. cms. Per day Paicgrammes per cubic metre 24 CARE OF THE ELDERLY 1. General The year was marked by a growing awareness among the elderly of the services that are now available to them, This is shown by the increase in numbers who participate in the activities arranged for them apart from those who are members of the various old people's clubs. There is more variety of interests, and it is gratifying to see a willingness among club members to suggest new ideas and ways of helping some of the less fortunate among them. 2. Direct Work (a) The Saville Activities at The Saville continued throughout the year except for Christmas week during which essential repairs were carried out to the building. The pattern of activities carried on by the clubs remained much the same as in 1963, and club memberships remained at their maximum during the whole period. Again there were a number of outings organised by the Management Committee, and it is pleasing to note that members of the "housebound clubs" were taken on a number of afternoon tours of the countryside. A week's holiday at Llandudno with arranged tours was taken by some 41 members in June, and was reported to be a great success. A number of London County Council classes were arranged for members where handicrafts, dressmaking, old time dancing and singing in choir were taught. There was some difficulty in the supply of meals to club members by the meals-on-wheels service, so it was decided to introduce frozen meals into the meals service and the services of a cook. This was started in January 1965 and has proved a successful solution to the problem. The hiring of the Saville hall to outside organisations and individuals continued throughout the year. The hall is always well booked up and provides a very necessary service to the public for wedding receptions and other meetings. (b) Burnt Ash The number of elderly workers taking advantage of the facilities for employment provided in the workshop at Burnt Ash Centre averaged 74 per week all through the year, but dropped off at the end of May for two weeks to 52 because some of the members were on holiday. The workshop is used to its full capacity, and there is a waiting list of people wishing to be employed there. The hours of work continued to be restricted to 2 hours a day per person and the pocket money earned remained at 1s. 6d. per hour during the whole of the year. There was little difficulty in finding suitable work which was adequate at all times, although there were seasonal fluctuations in the type of work available. 25 The venture has undoubtedly been an unqualified success to date, and it is to be hoped that it will not be long before another workshop is opened elsewhere in the Borough so that others may take advantage of the scheme. There was maximum membership of the Gaytime and Rendezvous clubs maintained over the year, and the club for the handicapped increased its membership to 24 with an average attendance of 22 at each meeting. The clubs again had a number of outings during the year, including visits to various well known factories. A garden at the rear of Burnt Ash Centre has been laid out and a strip of ground has been set aside for members interested in gardening. The meals service for club members continued, but as with The Saville arrangements were being made towards the end of the year for the meals to be prepared on the premises and this was put into effect at the beginning of 1965. (c) Holidays for the elderly Off peak holidays for elderly people were again arranged by the Health Department. The cost of a holiday for an elderly person remained on the same terms as in 1963 which was fully explained in the annual report of that year. The number of holidays arranged was 462 and the number taken was 414, the same as in 1963. (d) Laundry During the year 53,351 articles of laundry of incontinent elderly people were dealt with at the Disinfecting Station as compared with 51,948 articles in 1963, an increase of 1,403 articles. (e) Bathing attendants The domiciliary bathing and cleansing of usually frail and bedridden old people carried out by the bathing attendants under the direction and supervision of the Ranyard Nurses is an expanding service, and by the end of the year three female bathing attendants and one male were employed in this service. The number of cleansings and bathings carried out during the year were 5,668 as compared with 1,286 in 1963. (f) S.47 S.47 of the National Assistance Act, 1948 as amended by the National Assistance (Amendment) Act, 1951, allows application to be made to a justice of the peace or a magistrate's court for an order for the compulsory removal of an old person from his home in certain very limited circumstances to a place of safety where the old person can receive proper care and attention. In 1964 although several cases were investigated in no case was it necessary to use compulsory procedure. 26 (g) Visiting The women health officers visit old people in their homes when it is brought to the attention of the Health Department that such persons are in need of care and attention. It is the function of the visitors to call in such welfare services as are necessary to help prevent the further deterioration of the old person to such a condition where they have to be considered for either voluntary or compulsory removal to a place of safety. This procedure has proved to be very successful, and it is rarely nowadays that an old person cannot be properly cared for in his own home with the support of the domiciliary welfare services. The number of visits paid to the elderly is shown in the following table: Table 20 W N S Total First visits 75 77 129 281 Futile visits 93 195 72 360 Revisits 846 1671 506 3023 Total 1014 1943 707 3664 27 3. 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 £24,700 (to include LOPWA) was eventually put in the annual estimates for the year 1964-65 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:— £ Lewisham Old People's Welfare Association 22,000 Lewisham Darby and Joan Club 450 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 40 The Over 60's Friendly Club 56 The Bellingham Community Association Darby and Joan Club 44 Lee Branch of the National Federation of Old Age Pensions Associations 58 Welcome Club 40 St. Hilda's Senior Citizens' Club 68 Blackheath Branch of the National Federation of Old Age Pensions Associations 24 September Club 66 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 42 Saville Club 220 Burnt Ash Club 160 Sunset Club 25 Primrose Club 30 Silver Lining Club 50 Happy Old Folks' Club 20 This left a sum of money available for new clubs which might qualify for grant. Additional grants were paid to nearly all the clubs as a help towards fares. 28 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 21 Reason for inspection West North South Total On complaint 798 1,027 395 2,220 House to house 14 141 148 303 Improvement grants 151 162 115 428 Houses in multiple occupation 101 89 20 210 Rent Acts 27 20 5 52 Mortgage survey 473 532 267 1,272 Other Housing Act visits 149 137 44 330 Notice from builder 723 1,050 135 1,908 Infectious diseases 80 91 81 252 Infestation 85 89 37 211 Factories, mechanical 16 12 43 71 Factories, non-mechanical 1 3 2 6 Outworkers 30 26 66 122 Clean air inspections 6,741 3,201 60 10,002 Pet animals Act. 22 5 9 36 Water certificates 64 73 — 137 Fireguards 16 2 - 18 Hairdressers 23 16 16 55 Pharmacy and poisons 52 56 32 140 Icecream premises 121 5 25 151 Restaurants, cafes, etc. 169 52 141 362 Bakehouses 7 1 6 14 Food shops and stalls 403 305 297 1,005 Other shops and stalls 14 13 24 51 Food inspections 186 307 467 960 Sampling 112 77 108 297 Offices, shops, etc. Act. 1 127 56 184 Futile visits 3,585 3,405 1,226 8,216 All other matters 2,503 1,308 1,081 4,892 Revisits 3,425 3,887 4,397 11,709 Total — all inspections 20,092 16,219 9,303 45,614 Smoke abatement Observations — Intimations served - Complaints 14 Statutory notices served Legal proceedings Convictions - 29 Summary of notices served Table 22 West North South Total Intimation notices:— Public Health (London) Act, 1936 155 183 87 425 Factories Act, 1937 1 3 — 4 Informal intimations, Housing Acts 3 11 — 14 Informal Intimations, Offices, Shops, etc., Act — 48 31 79 Total intimations 159 245 118 522 Statutory notices :— Public Health (London) Act, 1936 137 116 52 305 Factories Act, 1961 4 — 1 5 Clean Air Act, 1956* 156 127 283 Housing Acts 10 29 — 39 Byelaws 23 36 43 102 Total statutory notices 330 308 96 734 *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 23 Repairs West North South Total Wall and ceiling plaster repaired 82 38 52 172 Roofs repaired 36 20 16 72 Dampness remedied 147 108 75 330 Brickwork repaired 3 3 3 9 Chimneys repaired 2 1 3 6 Drains cleared 22 14 10 46 Drains repaired 6 5 4 15 Drinking water cisterns repaired 1 — — 1 Dustbins supplied 6 3 1 10 Doors and door frames repaired or renewed 10 8 13 31 Flushing cisterns repaired, renewed or cleansed 9 9 3 21 Flush pipes repaired or renewed 3 4 3 10 Firegrates, etc., repaired or renewed 4 4 8 16 Flooring repaired or renewed 43 27 15 85 Dry rot remedied 4 10 3 17 Gullies renewed, repaired or cleansed 5 2 7 14 Gutters repaired 25 24 25 74 Refuse cleared 2 2 2 6 Rainwater pipes repaired 7 10 6 23 Soil pipes repaired, ventilated or renewed 5 9 2 16 Sinks provided 13 10 9 32 Sashcords renewed 38 18 18 74 Water closets repaired or renewed 28 13 14 55 Walls and ceilings cleansed. — — — — Windows and frames repaired or renewed 15 13 14 42 Water service pipes repaired or renewed, water supply restored 8 6 9 23 Yards and areas paved 5 1 3 9 Glazing 2 6 2 10 Painting 2 — 4 6 Other repairs 19 13 19 51 TOTALS 552 381 343 1,276 30 Consumer Protection Act, 1961 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. Twenty 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 177 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, except in one instance where legal proceedings were pending at the end of the year. 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 354 premises and 8 blocks of flats certifying that under the provisions of the Public Health (London) Act, 1936, a proper and sufficient supply of water had been provided. Factories Section 7 of the Factories Act, 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 31 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 24 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 6 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 465 71 1 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 11 11 — — TOTAL 522 88 1 — 32 Cases in which defects were found Table 25 Defects No. of defects Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S 1) 2 2 2 Overcrowding (S 2) — — — — — Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) — — — — Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S 7): (a) insufficient 1 1 - 1 - (b) unsuitable or defective 16 16 - 16 - (c) not separate for sexes 1 1 - 1 - Other offences against the Act (not including offences relating to outwork) — — - — _ TOTAL 20 20 — 20 — 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 51 Brushes 1 Boxmaking 4 Lampshades — Buttons Surgical Appliances 2 Millinery 1 Knitting 1 33 Trade Outworkers employed Rosettes 2 Wig Making 1 65 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. Offices, Shops and Railway Premises Act, 1963 Under the Offices, Shops and Railway Premises Act, 1963 anyone intending to employ people in offices, shop or railway premises is required to send a notification in the prescribed form to the authority responsible for enforcing the Act in the premises. The responsibilities of this Authority are for all premises which are classified as retail shops, offices, catering establishments open to the public, canteens, wholesale shops, warehouses and fuel storage depots. Premises which are classified as factories or part of factories, and offices belonging to local authorities are the responsibility of H.M. Inspector of Factories. There are one or two other exceptions which also are not the responsibility of this Authority. The objects of the Act are that premises should be inspected, and where necessary brought up to the standards laid down with regard to, inter alia, space, temperature, sanitary conveniences, washing facilities, first aid equipment, dangerous machinery, and cleanliness. Provisions relating to fire precautions are the responsibility of the Fire Authority, i.e. with regard to this Borough's area, the London County Council. The following statistical information has been passed to the -Ministry of Labour under provisions contained in the Act. Registrations and General Inspections Table 26 Class of premises Number of premises registered during the year Total number of registered premises at end of year Number of registered premises receiving a general inspection during the year Offices 413 412 16 Retail shops 1,245 1,238 140 Wholesale shops, warehouses .. 57 56 4 Catering establishments open to the public, canteens 120 119 5 Fuel storage depots 8 8 — 34 Persons Employed in Registered Premises by Workplace Table 27 Class of work place Number of persons employed (1) (2) Offices 3,923 Retail shops 7,384 Wholesale departments, warehouses 592 Catering establishments open to the public 1,079 Canteens 123 Fuel storage depots 61 Total 13,162 Total Males 5,357 Total Females 7,805 It is considered that over seven-tenths of the premises which are thought to be eligible for registration were registered by the end of the year, this is after one reminder had been sent out in October to all those that had not registered by that time. A start has been made of the general inspection of premises by the public health inspectors, but it is obvious that to complete this task will take some little while. 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 The destruction of pigeons was continued at an increased rate with the employment of two part-time pigeon catchers during 1964. There is no doubt that the numbers have been cut down by an appreciable extent, but the problem is a neverending one, and will have to be continually tackled energetically. During the year the pigeon catchers altogether accounted for the destruction of 2,673 birds, 128 eggs and 79 nests. 35 Sanitary work generally Mr. Phillips, the senior public health inspector, reports that during 1964 an advance in the facilities provided for staff in shops and offices was begun by the registration of premises under the Offices, Shops and Railway Premises Act, 1963. Although some inspections were carried out in 1964, the greater effect of the Act will be felt in 1965 by the enforcement of its requirements and those of the subsequent Regulations. A number of accidents have already been reported and seem fortunately to be of a minor charactor and due to lack of care rather than the absence of guards to machinery which will nevertheless have to be carefully watched. In several instances it was found that lack of proper stacking of stock was the cause of accidents and suggestions for remedying this was readily put into practice by the firms concerned. The work of dealing with areas under the Clean Air Act, 1956, continued and three further areas were submitted for confirmation, which will come into force in the latter part of 1965. Over a thousand visits were paid in connection with this work. Inspections under the Housing Act continued to increase in all sections but especially in applications for mortgages from would be owner occupiers, houses in multi-occupation and particularly pleasing to note, improvement grants. Whilst the number of applications for these grants continued to increase, there are still many cases where tenants would like these additional facilities but the owner is not prepared to co-operate. With the passing of the Housing Act 1964 this difficulty may now be overcome by the declaration of an Improvement Area when notice may be served to enforce the improvement of properties. The number of visits on complaint continued to fall during 1964, 2,220 visits being made compared with 2,513 during the previous year. The number of notices served was lower, a total of 1,256 formal and informal notices compared with 2,075 in 1963. There was a marked increase in the visits paid to food shops, cafes, restaurants and premises where ice cream is sold. The number of hairdressers premises registered increased from 167 to 177 and although most of these continued to provide good hygienic conditions, it is regretted that in one instance it was necessary to institute legal proceedings to enforce compliance with standards required by the Bye-laws. A further reduction is noted in the number of outworkers and the work involved now is almost entirely the making up of articles of clothing. It is unfortunate that after considerable publicity on the inflammability of children's nightdresses and the subsequent regulations made under the Consumer Protection Act, 1961, that three of the test purchases made were found to be below the required standard. The legal proceedings which are being taken in these cases will, it is hoped, give even further publicity to this subject. Finally it will be noticed that the pigeon catcher and his assistant have dealt with more than twice as many birds during the year compared with the previous year and a marked improvement in the clearance of nesting places under the railway bridges has resulted. Every endeavour will be made to keep these as clear as possible during the coming year and the public can help in keeping down the number of pigeons by refraining from the regular feeding of them. 36 HOUSING Building 409 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 287 (b) in temporary bungalows 3 290 2. By the London County Council (figures supplied by district offices) 75 365 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 ... ... ... 213 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 5 informal and 6 formal notices were served. 2 properties were repaired by the owners after service of notices; in one 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 1964, together with the present position of cases originating in previous years which had not been complied with at the end of 1963:— Table 28 Properties Dwellings involved Present position 47 Molesworth Street 1 Works completed. Order determined. 25, 26 Horton Street 2 Order made 1964 23, 24, 27 Horton Street. 3 Orders made 1964 29a Brandram Road 1 Order made 1964 63 Drysdale Road 1 Order made 1964 20 Stanton Square 1 Order made 1964 163 Burnt Ash Hill 1 Order made 1964 13 Claremont Terrace 1 Order made 1964 37 Closing Orders in respect of part of house Table 29 Properties Part of house Present position 46 St. Germans Road Semi-basement rooms, hall, larder. Works completed. Order determined 65 St. Germans Road Basement front room Order made 1964 52a Horniman Drive Semi-basement flat, three rooms, kitchen and bathroom Order made 1964 18 Ryecroft Road Semi-basement rooms and scullery Order made 1964 67 Summerfield Street Self contained flat ground floor (2 rooms, scullery, W.C.) Order made 1964 106 Lee High Road Three rooms, kitchen, bathroom in basement Order made 1964 140 Blackheath Hill Basement 3 rooms and kitchen Order made 1964 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 7 2 Houses included by reason of bad arrangement — — — Houses or land acquired under s. 43 — — — Not in clearance areas Formal or informal procedure under s. 17 (1) 4 4 3 Local authority houses certified unfit by medical officer of health — — — B —UNFIT HOUSES CLOSED (Housing Act, 1957) ss 16, 17 and 35 5 ss 17(3) and 26 — - - Parts of buildings closed under s.18 7 10 4 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 11 - After formal notice under Public Health Acts — — After formal notice under Housing Act, 1957 9 Under s.24 Housing Act, 1957 - - 38 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 1964, and for the whole period. Table 31 1964 1957-64 Applications for certificates 23 1160 Decisions not to issue certificates — 29 Decisions to issue certificates (a) in respect of some but not all the defects 9 672 (b) in respect of all defects 8 426 Undertakings given by landlords to repair 8 526 Undertakings refused for special reasons — 2 Certificates of disrepair issued 9 547 Applications by landlords for cancellation of certificates 7 382 Objections by tenants to cancellation 3 133 Decisions to cancel in spite of tenants' objection 2 25 Certificates cancelled 6 267 House purchase loans 1272 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 per cent 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, unless to provide a bathroom it is necessary to build an extension or convert existing outbuildings attached to the dwelling and it is not practicable to provide it in any other way, the maximum grant then becomes £350. 39 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. This has been extended by the Housing Act, 1964 to £500 per dwelling where a building of three or more stories is converted into self-contained flats. During the year 81 applications were investigated and reported on. Housing work generally A very useful piece of legislation came into operation during August, namely the Housing Act 1964. This gives local authorities the power to compel owners of tenanted dwellings to carry out improvements where these are necessary. If the local authority are satisfied that any area in their district contains dwellings lacking in one or more of the standard amenities and that at least half are so lacking the area may be defined on a map and declared to be an 'improvement area'. In 1963 such an area was dealt with on a voluntary basis but with poor results. It was considered that this block of 186 houses, some of which had been improved, was suitable for the use of the new compulsory powers and a preliminary survey was carried out. Of the 111 dwellings which were found to be lacking one or more of the standard amenities, 40 were tenanted properties. During the year 81 discretionary grants and 100 standard grant applications were investigated, the total, as last year, showing an annual increase of over 20%. Nine of the applications concerned conversions into two or more self-contained dwellings and will provide an additional ten units of accommodation. The standard grant which, unlike the discretionary grant had no fixed minimum cost of work, did have a maximum possible grant of £155 for the five amenities. Under the Housing Act 1964 this figure is increased to £700 giving a possible maximum grant of £350 where the provision of a bathroom necessitates building an extension or the conversion of outbuildings attached to the dwelling. Under the Housing Act 1957, action was taken for the demolition or closure of houses or parts thereof in 23 cases and 16 orders were made during the year. Two properties subject to closing orders were made fit for habitation and brought back into use. Repair notices under Section 9 involved 11 properties one of which was dealt with by the Council in default. Public inquiries were held in respect of two small areas of the 1960/65 clearance programme each of which was subsequently confirmed. 40 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 106 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 19 (138) „ sale of tuberculin tested milk 5 (103) „ sale of sterilised milk 16 (146) Examination of heat-treated milk 44 samples of pasteurised milk and 27 samples of tuberculin tested (pasteurised) milk were submitted for examination during the year and all were found to be satisfactory. Analysis of milk During the year under review, 44 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 3.54 8.71 12.25 Second quarter 11 3.44 8.71 12.15 Third quarter 10 3.63 8.93 12.56 Fourth quarter 4 3.85 8.86 12.71 TOTALS 44 3.61 8.80 12.41 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. (total solids 11.5%) 41 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 14 samples submitted to the public analyst were found to have the composition shown in the appended table :— Table 33 Samples Average percentage composition Fat Milk solidsnot fat Water 14 9.5 10.2 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 22 samples of icecream were submitted for bacteriological examination with the following results :— Table 34 Grading Samples submitted ‰ Grade 1 14 64 Grade II 5 23 Grade III 3 13 Grade IV — — TOTAL 22 100 In general, grades I and II are satisfactory, while grades III and IV nay indicate some defect in manufacture, handling or storage. Such :ases are followed up and advice is given. 42 FOOD GENERALLY Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 520; of these, 11 were formal and 509 informal. After examination the public analyst reported that 1 of the formal samples and 13 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 9.1 in the formal samples, 2.6 in the informal samples, and to 2.7 of all the samples submitted, compared with 6.2 in the previous year. Samples analysed Table 35 Articles Examined Adulterated Formal Informal Total Formal Informal Total Beverages 18 18 - 1 1 Bread, biscuits, cake flour 1 16 17 — — — Colouring matter — 3 3 — — — Drugs — 8 8 — — — Fats, cheese — 35 35 — 1 1 Fish 1 15 16 — Flavourings and condiments — 98 98 — 3 3 Fruit, nuts — 56 56 — 1 1 Icecream — 16 16 — — — Jams, pastes, etc. — 10 10 — — — Meats and preserved meats 5 60 65 1 6 7 Milk and cream — 66 66 — — — Sausages 2 40 42 — — — Sweet confectionery 1 19 20 — 1 1 Vegetables and cereals 1 25 26 — — — Miscellaneous — 24 24 — — — TOTALS 11 509 520 1 13 14 Non-genuine samples Table 36 Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Chicken pie Informal Incorrect labelling Manufacturer notified Chopped ham and pork Formal Deficient in meat content .. .. Chopped pork Informal .. .. .. Chopped ham and pork Informal .. .. .. Egg pasta Informal Incorrect statement of ingredients Labels amended Rum butter Informal Deficient in rum Further sample taken and found genuine 43 Table 36—continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Preserved pork sausages Informal Contained a large excess of sulphur dioxide preservative Formal sample taken and found genuine Strawberry syrup Informal Label misleading Formal sample to be taken Sausage roll Informal The sample contained the remains of a cigarette end Legal proceedings taken Beef Milano Informal Label misleading Manufacturer notified Butter sponge syrup pudding Informal .. .. .. .. Ground almonds Informal Sample rancid Remainder of stock withdrawn Drinking chocolate Informal Label misleading Label amended Ground cloves Informal Sample contained an excessive amount of sand and siliceous matter Manufacturer notified Other samples In addition to samples submitted to the public analyst or bacteriologist for routine sampling, the following were submitted for various reasons, but mainly because of complaints received or as a result of enquiries made into cases of food poisoning:— Bread (9) Meat sauce Kidneys (2) Tinned meat (3) Dress material Chicken Strawberry jam Savoury stuffing Meat Liquorice cuttings Milk (3) Sausage Fish Rice Drinking chocolate Sherry 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 1964 Total Sale and storage of icecream 12 366 Manufacture of icecream 1 8 Fish frying 1 35 Fish curing — 18 Preparation or manufacture of sausages 1 57 Preparation or manufacture of potted, pressed, pickled or preserved food 5 147 44 Unsound food Approximately 11 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. 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 10 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 136 persons previously registered were retained on the register. 146 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. The proportion of unfit food is again small (last year 0.004%). Totals for the year are shown in the table:— Table 37 Country of origin Tonnage imported Amount unfit and remarks (tons) Spain 84,555 1 potatoes Italy 40,420 ¾ plums 1¾ peaches ½ grapes France 28,543 Belgium 1,410 Israel 135 Yugoslavia 12,486 Algeria 5.994 Morocco 9 Cameroons 10 Total 173,562 45 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 Number of Notified Cases (corrected for revised diagnosis) during the year 1964 with comparative figures for the previous six years. Table 38 Diseases Cases notified 1964 1963 1962 1961 1960 1959 1958 Diphtheria - - - - - - - Dysentery 111 341 162 96 367 233 214 Encephalitis (acute) — — — 1 — — 1 Enteric or typhoid fever 2 12 3 2 — 6 4 Erysipelas 13 4 1 14 20 16 13 Food poisoning 16 10 13 26 31 49 27 Malaria 1 — 2 — 2 Measles 1180 2408 423 4278 262 2613 835 Meningococcal infection 2 1 4 5 8 3 3 Ophthalmia neonatorum 1 3 1 — 1 1 1 Pneumonia 15 42 23 62 33 108 61 Poliomyelitis (acute) — — — — 2 6 2 Puerperal pyrexia 52 42 71 46 78 48 59 Scabies 21 9 9 8 9 9 9 Scarlet fever 146 76 53 94 172 303 210 Tuberculosis 141 122 103 123 134 143 236 Whooping cough 153 186 41 65 333 229 154 TOTALS 1854 3256 909 4820 1452 3767 1829 46 Notifications of infectious diseases in 1964 showing sex and age groups Table 39 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 2 4 9 16 10 7 8 7 5 1 7 5 9 13 2 4 2 — 54 57 Erysipelas — — — — — — — — — — — — — 2 4 2 3 2 7 6 Food poisoning — 1 2 — — 2 — — — — i 1 J 2 1 1 — — 9 7 Malaria — — — — — — — — — — — — 1 — — — — — 1 — Measles 21 14 147 137 173 163 257 249 7 4 2 1 4 1 — — — — 611 569 Meningococcal infection - - 1 1 - - - - - - - - - - - - - - 1 1 Ophthalmia Neonatorum 1 - - - - - - - - - - - - - - - - - 1 _ Paratyphoid fever - - 1 - - - - - - - - - - - - - - - 1 — Pneumonia... - - - - 1 - - - 1 - 1 2 3 1 3 2 1 — 10 5 Puerperal pyrexia - - - - - - - - - - - 25 - 27 - - - - - 52 Scabies — 1 1 — 1 1 1 1 1 1 5 3 2 3 — 1 — — 11 10 Scarlet fever 1 - 4 15 13 44 35 9 13 4 2 - - - - - - 79 67 Tuberculosis (respiratory) _ 1 1 1 1 1 1 3 8 7 7 12 27 15 27 2 9 3 81 45 Tuberculosis (non-respiratory) - - - - - - - - - - - - - - - - - - - - — — — 1 — — — — — — 3 — 2 4 — 5 — — 5 10 Typhoid fever — — — — — — — — — — — 1 — — — — — — — 1 Whooping cough 7 9 21 19 10 16 26 27 4 9 — — 1 3 — 1 — — 69 84 Totals 32 30 189 179 211 203 337 322 35 35 32 52 52 71 37 17 15 5 940 914 47 Analysis of certain diseases in table 39 into divisional areas— Table 40 Disease Div. areas Under 1 /- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 4 3 4 2 3 4 - 20 N 5 14 8 3 — 2 3 4 2 41 S 1 7 6 8 4 7 15 2 — 50 Total 6 25 17 15 6 12 22 6 2 111 Measles W 20 97 102 133 4 2 2 360 N 8 99 108 156 4 1 376 S 7 88 126 217 3 1 2 — — 444 Total 35 284 336 506 11 3 5 — — 1180 Pneumonia W 1 1 2 3 4 1 12 N - - - - - - - - - - S - - - - - 1 1 1 — 3 Total — — 1 — 1 3 4 5 1 15 Scarlet fever W 1 7 14 40 11 1 - 74 N — 2 4 10 4 20 S — 1 10 29 7 5 — — — 52 Total 1 10 28 79 22 6 — — — 146 Tuberculosis (respiratory) W 1 1 1 8 5 15 9 4 44 N — — — 1 1 5 15 9 3 34 S 1 1 1 2 6 9 12 11 5 48 Total 1 2 2 4 15 19 42 29 12 126 Whooping cough W 3 11 7 16 3 - 40 N 7 15 8 12 4 — 1 - 47 S 6 14 11 25 9 — — 1 — 66 Total 16 40 26 53 13 — 4 1 — 153 Poliomyelitis In 1964 no cases of poliomyelitis was notified—the fourth year in succession. Dysentery The number of cases were only a third of those of the previous year, and no significant outbreaks occurred during the year. In spite of this, there is no reason to assume that local outbreaks will not occur in the future, and it must be emphasised again that the only real bar to the quick spread of the disease is for an extremely high hygenic standard in connection with all apparatus of the water-closet and with hand washing. 48 Measles In spite of the fact that 1964 was not an "endemic" year a fair number of cases were recorded—1180 as compared with 2408 the previous endemic year. They were of mild degree, and no deaths were recorded. Pneumonia The number of cases was only 15. Although the absence of any influenza outbreak was probably responsible for this low number, it is likely that many cases of pneumonia were not formally notified. Scarlet fever The number of cases was 146 in 1964, the disease appears to be becoming more prevalent again after the encouraging decline in numbers between 1960 and 1962 Whooping cough The number of cases was 153, a decrease of 33 over those of the previous year. Whooping cough is a preventable disease, and yet again attention is drawn to the desirability of young children being protected by immunisation. Tuberculosis The number of cases notified again increased in 1964, but it is not thought that the increase is particularly significant as there are bound to be fluctuation in the numbers notified from year to year. Table 41 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- 1 1 - - 1 1 _ _ - _ _ - 2- 1 1 _ 1 1 2 _ _ _ _ _ - 5- 1 3 _ _ 1 3 _ _ _ _ _ _ 10- 8 7 _ - 8 7 _ _ _ _ _ - 15- 3 4 1 _ 4 4 _ _ _ _ - 20- 4 8 2 - 6 8 _ _ _ _ _ - 25- 13 10 2 3 15 13 _ _ _ _ _ - 35- 14 5 - 1 14 6 _ _ _ _ _ - 45- 15 1 _ 3 15 4 _ _ 1 _ 1 - 55- 12 1 - 2 12 3 1 _ 1 _ 2 - 65- 6 3 _ _ 6 3 2 _ _ _ 2 - 75 + 3 - - - 3 - 2 - - - 2 - 81 45 5 10 86 55 5 - 2 - 7 - 49 Analysis of new cases of tuberculosis into divisional areas:— Table 42 Division Sex 0- /- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Respiratory M - 1 - - 4 2 1 4 4 5 4 1 1 27 F - - 1 1 4 - 2 S 2 - - 2 - 17 Non-respiratory M - - - - - 1 2 - - - - - - 3 F - - - - - - - 1 - - 1 - - 2 North Respiratory M - - - - 1 - 2 8 4 5 4 3 - 27 F - - - 1 - - 3 1 2 - - - - 7 Non-respiratory M - - - - - - - 1 - - - - - 1 F - - 1 - - - - 1 1 1 1 - - 5 South Respiratory M - - 1 1 3 1 1 - 6 6 4 2 2 27 F 1 1 - 1 3 4 3 3 3 - 1 1 - 21 Non-respiratory M - - - - - - - 1 - - - - - 1 F - - - - - - - 1 - 2 - - - 3 Summary of statistics as to tuberculosis for the last ten years Table 43 Year Population New cases notified (all forms) (excluding inward transfers) Notif. rate per 100,000 pop. Deaths Death rate from resp. tuberculosis per 100,000 pop. All forms Respiratory Lewisham County of London 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 1969 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 1964 223,170 141 63 7 5 3 6 50 Tuberculosis—environmental conditions Case papers showing the environmental conditions of new patients attending the Lewisham Chest Clinic in 1964 have been analysed in 164 cases with the following results :— Table 44 Cases %* Males 53 67 Females 26 33 Social classification:— Class I 1 2 Class II 1 2 Class III 47 77 Class IV 8 13 Class V 4 6 Not classifiable 18 — Rooms occupied:— 2 or more rooms per person 12 16 1—2 rooms per person 37 50 Less than 1 room per person 25 34 No information 5 — Accommodation :— Separate bed 26 33 Separate bedroom 18 23 Condition of premises occupied:— Good 60 79 Fair 13 17 Poor 3 4 No information 3 — *Lxcluding cases not classified Food poisoning The cases last year formally notified further decreased from 12 to 8. 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 and include cases which were admitted to a hospital within the borough, but who were not residents of the Borough. (1) Food poisoning cases Table 45 Notifications (corrected) Cases otherwise ascertained Symptomless excreters Fatal cases 1st quarter 6 1 — 2nd quarter 5 1 — — 3rd quarter 4 1 — — 4th quarter 1 — — — Year 16 4 — - 51 (2) Single cases Notified Otherwise ascertained Total cases Agent identified:— Salmonella group B 3 — 3 „ Boreilli — 1 1 „ typhimurium 3 — 3 ,, Panama 1 — 1 „ brandenburg 1 — 1 Staphylococci— including toxin 1 — 1 Agent not identified 7 — 7 (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 1964 on which the following tables are based. Table 46 Patients Men Women Total General analysis X-rayed 5,350 5,693 11,043 Previously x-rayed 3,494 1,738 5,232 Reviewed 205 169 374 Abnormal after review 135 89 224 Analysis of abnormal films :— Cases considered tuberculous :— (a) no further action required — — - (b) occasional supervision only 6 4 10 (c) requiring treatment 4 2 6 (d) still under investigation 2 — 2 (e) refused further investigation — 1 1 Previously known tuberculous cases 8 4 12 Non-tuberculous cases:— (a) investigated 27 16 43 (b) still under investigation 5 4 9 Cardio-vascular lesions 10 16 26 No action required 67 29 96 Commenting on the year's work, Dr. J. M. Morgan, director of the south-east London mass x-ray service, states :— "Of the six cases of active tuberculosis found, five were discovered among those not previously x-rayed within five years. A total of six cases of bronchial carcinoma were found, two being women. The figures are approximately average for a borough of this type." 52 Table 47 Numbers examined Cases of tuberculosis requiring treatment or close supervision Not previously examined Numbers Cases Public Surveys Men Women Total Men Women Total Men Women Total Men Women Total 1,742 2,949 4,691 3 1 4 833 1,901 2,734 2 1 3 Public Survey— Examination of special groups 654 94 748 — — — 66 54 120 — — — Firms—full-scale visits 749 747 1,496 — 1 1 292 445 737 — 1 1 Firms—examination of special groups 570 32 602 — - - 47 12 59 — — — Hospitals, Colleges, Schools, etc. 1,473 1,764 3,237 — — — 506 1,480 1,986 — — — Lodging Houses, etc. 162 107 269 1 — 1 112 63 175 1 — 1 TOTAL 5,350 5,693 11,043 4 2 6 1,856 3,955 5,811 3 2 5 53 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 Age at December 31, 1964 Under 1 1 2 3 4 5-9 10-14 Total under 15 Born in year 1964 1963 1962 1961 I960 1955-59 1950-54 (i) Diphtheria (including combined and triple):- immunised during year 2260 1332 304 108 56 204 44 4,308 immunised at end of year 2260 4094 3288 3308 4558 14370 14113 45,991 Estimated mid-year population 17,700 28,400 46,100 (ii) Whooping cough (including combined and triple):— Immunised during year 2256 1312 296 96 48 104 32 4,144 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 32 1520 12 18 1,582 Revaccination — 28 10 97 135 (iv) Poliomyelitis Immunised against Poliomyelitis 1st Injection or dose 2nd Injection or dose 3rd Injection or dose 4th Injection or dose (booster) Salk vaccine 116 103 98 25 Sabin (oral) vaccine 2261 2085 2362 1564 54 THE WELFARE OF THE PEOPLE IS THE MOST IMPORTANT CONSIDERATION It is perhaps fitting that the following account of the work of the Health Department, since the formation of the Metropolitan Borough Council of Lewisham, should be headed by a translation of the motto "Salus Populi Suprema Lex" which appears on the coat of arms of the Borough. The Lewisham Borough Council was formed in November 1900 and became administratively responsible for the Borough's present area of 7,015 acres. The population in 1901 was 127,495, in 1925, 185,600, in 1950, 228,300 and in 1964, 223,170. Fuller information of the population trends can be seen from table 8 on page 12 of this report. The first report of the Medical Officer of Health for the new borough was for the year 1901, and he said in his preface to the report that "The health of the district is highly satisfactory. The death rate from all causes amounted to 13.0 per 1,000, the lowest in London except Hampstead, and far below the average for England and Wales and the 33 great towns". The number of inhabited homes in 1901 was 22,750 and Dr. Wellesley Harris, the then Medical Officer of Health was able to report that "it is fortunate that buildings were erected which provided accommodation slightly in excess of the increased population thus avoiding overcrowding". The total number of tenements—the home of a separate family or separate occupier—amounted to 27,701 of which 19,140 contained five rooms and over. Among these tenements there was some overcrowding, but speaking of one room tenements the doctor said that there was an absence of any serious overcrowding in the district. This favourable situation was not destined to last, however, as can be seen from the section on Housing where the later history of this subject is continued. The average number of persons to the acre was 18.03 in 1901 and the Medical Officer of Health said about the health of the district that "the borough is most fortunate in this respect, compared with other London districts. It has a good elevation and is bounded for the most part by open country, while nearly half its area is unbuilt upon". According to the 1961 census report the number of persons to the acre was 31.6 a quite different environment to that of 1901. There has however, been a continual overall improvement in health through the years in spite of the increasing urbanisation of the district. Some comparative statistics from 1901 to 1964 are shown in table 8 on page 12. The decline in the tuberculosis notification and death rate, and in infant mortality are perhaps the most significant indications of the improvement in standards of hygiene over the years. Infectious diseases It may be of interest to recall the major outbreaks of disease occurring since 1901. These will emphasize that continuing vigilence is necessary at all times. Early in the century the number of cases of enteric fever averaged 50, but by 1915 had dropped to 12 each year. No special comment was apparently called for during that period, but undoubtedly improving 55 standards of food hygiene accounted for the decline in the number of cases. During the year 1929 a major outbreak of typhoid fever occurred involving some 110 Borough cases. The outbreak occurred in Sydenham and in portions of Beckenham and Penge. Altogether there were 129 cases with 17 deaths recorded. After exhaustive enquiries had been made, circumstantial evidence pointed to a carrier in a food shop, who, soon after the outbreak commenced was taken ill and died nearly a month later. Post mortem findings pointed to the employee as having been infected with the disease, and in all probability he had infected food sold in the shop before he became too ill to continue. From September 1901 and continuing for the greater part of 1902, an epidemic of smallpox occurred when some 90 cases were recorded in the Borough. This was part of a large outbreak in the County of London which involved some 8,000 cases. Lewisham, in fact, was fortunate in that the attack rate, 0.63 per thousand was much below the overall for the County which was 1.67 per thousand, the highest being that of Stepney with an attack rate of 4.58 per thousand. The first case occurred in January. The person was attacked shortly after arrival from Paris, where the disease was prevalent. In February a sailor was attacked shortly after his arrival home. In May, a lady on her return home from Egypt was notified in Highbury. In June a case was notified in Bethnal Green. In the same month cases occurred in Wandsworth, two of which were due to laundry infection. During the week ending August 24th there were 16 cases. From this date the disease spread, chiefly in the boroughs north of the Thames. The borough of Lewisham enjoyed complete immunity until 19th September, when the first case occurred. The 1901 outbreak of smallpox was the largest the borough has suffered since its incorporation, but other outbreaks occurred through the years. In 1905 there were 8 cases and 4 deaths were recorded; all the cases were either members of the same family or very close contacts. This outbreak was of the more severe haemorrhagic smallpox. The source of infection proved impossible to trace as the first patient, who was a commercial traveller, had visited many towns prior to his illness. The next case of small pox in the borough occurred many years later in 1923. This was an isolated case, the original source of infection being a visitor from Spain who was thought to have infected five other people living in London. Smallpox was prevalent in London from 1929 to 1934 and over these years Lewisham was fortunate in having only 51 cases of a mild character. None of the cases in any of these years could be traced back to an ascertainable source of origin. Since that time the borough has been completely free from this disease except for two cases which occurred among servicemen during the war. Between 1901 and 1938 the average number of cases of diphtheria occurring in the Borough each year was 330 with 21 deaths. This incidence, however, dramatically changed in 1939 when only 137 cases were recorded, and from then on the number rapidly fell until in 1950 none were recorded. Since 1950 only two cases have been notified, the last in 1955. In July 1935 a scheme for the immunisation of children against diphtheria was started. The Borough Council made arrangements with medical practitioners to pay the doctor's fee for the protection of children between the ages of one and twelve years. A modest 56 start was made in this first year when about 236 children were immunised. In 1964 the number immunised was 2,260. By 1946 68% of children under 5 years of age in the Borough had been immunised against diphtheria. 1946 saw the passing of the National Health Service Act which transferred the personal health services to the London County Council. Undoubtedly diphtheria immunisation has played a major part in reducing the incidence of the disease. It cannot be too strongly emphasised that parents should continue to ensure that their children are immunised at the appropriate time. Through the years under review the battle against tuberculosis has been continuous, and a major part of the work of the department was concerned with reducing the incidence of this disease. In 1903 the Medical Officer of Health reported that "comparing Phthisis with other infectious diseases it was again responsible for a greater loss of life than smallpox, measles, scarlet fever, diphtheria and enteric fever combined." "The total deaths from the diseases mentioned were:— Table 49 Lewisham County of London Smallpox — 13 Measles 36 2,046 Scarlet fever 11 362 Diphtheria 20 740 Enteric fever 9 368 Total 76 3,528 Phthisis 104 7,124" "In addition to Phthisis 62 deaths were registered as due to various forms of tubercular disease." In spite of these figures the Medical Officer of Health was able to report that the position in Lewisham, in comparison with other Boroughs, was most satisfactory, because Lewisham's death rate 0.78 per 1000 was the lowest in London except for Hampstead (0.74 per thousand). It must be remembered, however, that tuberculosis was not a notifiable disease at this time. No specific measures were taken by the department, in which there were eight Public Health Inspectors to combat the disease in the improvement of sanitary conditions. As a result of a communication from the London County Council in 1906 the Public Health Committee introduced a system of voluntary notification of pulmonary tuberculosis and medical practitioners were invited to notify such cases to the Medical Officer of Health for a small fee. The medical practitioners were informed that ". . . . . On receipt of notification a competent inspector will call at the house, make a few necessary inquiries, and examine the sanitary condition of the house. 57 A card containing precautionary instructions will be left with the patient or relatives. Where possible disinfection will be carried out on the death or removal of a patient " This proved to be ineffectual as only some 56 cases per year were notified under this system, and a quarter of these refused visits by the inspectors. The Public Health (Tuberculosis) Regulations of 1908 brought an improvement in notification rates, although compulsory notification was restricted to medical officers of poor law institutions, and district medical officers who were only concerned with the poor. As a result of the Public Health (Tuberculosis in Hospitals) Regulations 1911 and the Public Health (Tuberculosis) Regulations, 1911, pulmonary tuberculosis became fully notifiable, and in 1912, 344 fresh cases were notified. It was estimated that this number represented about a third of the persons in the Rorough thought to be suffering from pulmonary tuberculosis at the time. The notifications were followed by a visit to the homes of the patients by the women public health inspectors (there were two employed) who found that many of the patients were sadly ignorant of the precautions which they should have adopted for the protection of other occupants of their homes. Further, many of the sufferers could only afford occasional medical treatment locally and others were in attendance at one or other of the London hospitals as out-patients. In 1911 the Medical Officer of Health requested the establishment of a central tuberculosis dispensary in the Borough and for more places to be made available in sanitoria. The Medical Officer of Health's views received powerful support in 1912 by the Astor committee which recommended inter alia the establishment of tuberculosis dispensaries and of sanitoria and hospitals throughout the country. A tuberculosis health visitor was appointed in 1914, and a second in 1915, and in June 1916 a tuberculosis dispensary in Catford Hill was opened with one tuberculosis officer, one clerk-dispenser, and two health visitors. In the first three years of its operation the tuberculosis dispensary sent 1097 reports to public authorities and 213 reports to practitioners, the volume of work increasing each year. The number of attendances at the dispensary in 1919 was 2,379 and the two tuberculosis health visitors made a total of 2112 visits to cases in that year. The medical Officer of Health reported in 1919 that "the interim tuberculosis care committee have given useful help in many directions in spite of having been obliged to carry out its functions with insufficient funds and assistants. There is great scope for the activities of a representative care committee with ample funds at its disposal". The interim tuberculosis care committee became a committee of the Lewisham Borough Council in 1923, and the value of its work cannot be over emphasised. It discussed the requirements of tuberculous patients and it assessed the amount of payment towards institutional treatment. Members of the committee visited patients' families, arranged convalescence, made grants of milk; helped to find suitable employment, and assisted with clothing, among many other things, to help ease the lot of tuberculous patients and their families. A handicrafts class was started at the Dispensary in 1926 and proved most beneficial as occupational therapy. 58 In May 1936 a new purpose built tuberculosis dispensary was opened at Blagdon Road to replace the one in Catford Hill which had become structurally dangerous. This new dispensary has been fully used ever since for the detection and treatment of tuberculosis, and latterly for other diseases of the chest. In 1936 the number of cases on the Dispensary register was 987, of which 808 were of pulmonary tuberculosis and 179 of non-pulmonary tuberculosis. In this same year the three health visitors concerned paid over 4,870 visits to the homes of patients; they gave advice on the arrangement of the home for the benefit of the patient and the protection of the contacts and also arranged for the disinfection of rooms, bedding, etc. When the care of tuberculosis patients was transferred from the Borough to the Lewisham Group Hospital Management Committee in 1948 under the National Health Service Act, 1946, the number of cases on the tuberculosis dispensary register was 2,140. Since 1948 the fight against tuberculosis has continued. The tuberculosis dispensary is now known as the Chest Clinic as its scope has broadened to include the treatment of other diseases of the chest. The health department is kept informed of the environmental conditions of tuberculous patients by the London County Council tuberculosis health visitors, and, where necessary, action is taken by the public health inspectors to improve matters. The success of the campaigns against tuberculosis in the Borough can be judged by the statistics shown in table 8, but there is no room for complacency and parents are urged to have their children immunised against the disease at the appropriate time and to take full advantage of the services of the mass miniature x'ray unit. Of the other infectious diseases occurring in the borough since 1901, mention should be made of scarlet fever which was until 1938 responsible for a few deaths each year, and whooping cough, a very distressing disease. The incidence of whooping cough can be controlled by immunisation, and again parents are urged to see to it that their children are protected against this illness. With the decline in infections, and the great improvement in general health, there has come a change in the major causes of death, and the pattern of disease. The long drawn out chronic diseases have superseded the shorter acute illnesses; malignant disease, and chronic degenerative ailments are now more in evidence reflecting the aging of the population. Lung cancer and heart disease are more prevalent than in the past. Another disease contributing considerably to the total is chronic bronchitis. These effects require a different approach today. Much more of the department's work is in the field of health education. The persuasion of the public to acquire positive health attitudes and persistant action towards the abatement of overcrowding and improvement of housing condtiions will be ever increasing responsibilities of the modern health department. 59 Maternity and child welfare The year 1904 marked the start of a serious attempt by the Health Department to do something about infant mortality which in this particular year was exceptionally high due to epidemic diarrhoea and enteritis, "diseases which must be considered to a great extent evidence of the improper feeding and care of infants, and therefore preventable." The infant mortality rate in that year was 122 per thousand births. The number of deaths of children under one year of age was 440 and represented more than one-fourth of the total deaths from all causes at all ages. The background to the subsequent action by the Department is explained by the Medical Officer of Health when he stated in his report of 1904 regarding epidemic diarrhoea and enteritis that . the disease is almost entirely limited to bottle-fed children, and that the majority of deaths occur among the poorer classes. It is most probable that hot and dry seasons are conditions which encourage active changes in the milk to which harmful bacteria have gained access. That the poorer homes suffer most is probably due to the greater facilities for food contamination arising from its improper storage and the insanitary condition of the home, or to the stale and infected milk supplied by small vendors, who have not the facilities for cooling and properly storing milk which has often travelled a long distance under conditions favourable to deterioration before reaching them." The Woman Sanitary Inspector visited 65 homes at which deaths had occurred from epidemic diarrhoea or enteritis, and elicited the following facts with regard to the methods of feeding:— Table 50 Breastfed 0 Cows'milk 13 Diluted condensed milk 21 Cows' milk and condensed milk 12 Indefinite (boiled bread, tea, potatoes. etc.) 19 It was found that practically all the infants who died from this disease were artificially fed, and that the parents did not show any concern on the advent of diarrhoea among infants during the summer months, attributing it to the fact that "it is the fruit season". The woman Sanitary Inspector said that "the majority of the parents visited displayed amazing ignorance in regard to the most rudimentary principles essential for the feeding and rearing of their children. In many cases the houses were in an uncleanly condition." In eleven cases the children were illegitimate. Proper means of storing food was rarely provided in the houses in the poorer parts of the Borough, and, when present not infrequently remained unused. The Medical Officer of Health went on to report in 1904 that "it may be fairly assumed from information collected that a large proportion of the infantile deaths was due to improper feeding, and consequently preventable. The fact that so much life is wasted through ignorance is lamentable in itself, but one cannot estimate the baneful effect upon 60 the children who survive, showing deformities due to rickets, or various forms of mental and nervous diseases resulting from improper nutrition and care during infancy". "Until the end of the year we were seriously handicapped in any attempt to improve the unhealthy conditions under which many infants exist. To begin with it is absolutely essential that we should be in possession of the knowledge of every birth that occurs in the Borough with the least possible delay. Repeated attempts have been made to obtain this information, and in January, 1904, I applied to the local Registrars of Births for the necessary returns, upon payment of suitable fees. The Registrars were, I believe, willing to supply the information provided they received permission from the Registrar-General, but this permission was witheld, the Registrar-General stating that he saw "grave objection to the proposal that Registrars should furnish a detailed return of births to the local authority, and that he had uniformly declined to approve such an application." In consequence of this decision we were unable to adopt any useful and direct measures towards reducing the mortality from preventable disease amongst infants, but could only revert to the useless action of making enquiries and giving advice after a death had been recorded. Even supposing that the advice proved useful in future births it was absurd to advise parents of their errors after their loss". This difficulty was resolved towards the end of the year after some correspondence with the Registrar-General who eventually agreed to authorize the local Registrars to furnish all Sanitary Authorities who desired them, detailed returns of births on payment of similar fees to which registrars were entitled for detailed returns of deaths. This obstacle having been overcome, another presented itself immediately because it was proposed to employ the woman sanitary inspector to visit a selection of homes from the birth list supplied by the local registrar each week. This course was objected to by the London County Council who paid a contribution towards the inspector's salary, as they considered that visiting homes where births had occurred was not included in the list of duties approved when the inspector was appointed. After consultation with the then Local Government Board a course, not explained, was adopted by which this technical difficulty was overcome. To summarise the information available at the end of 1904 the following causes were in great measure responsible for the high infantile mortality:— The increasing unwillingness of mothers to suckle their offspring; Inability to suckle child when mother is the bread-winner; Ignorance of mothers in the elementary principles necessary for successful artificial feeding in regard to suitable foods, the methods of preparing same, frequency of feeding, and the amount required; Absence of cleanliness in the home; Uncleanly personal habits; Unhealthy environment of infants, due to overcrowded, badly- lighted and badly-ventilated rooms; 61 Absence of food storage accommodation; The inability of the poorer classes during temporary lack of employment to purchase the necessary milk supplies; The difficulty, particularly among the poorer classes of obtaining pure and fresh milk; The use of patent foods, which are largely advertised as substitutes for milk; The perverseness of parents who prefer to adhere to the traditional methods adopted by their mothers and grandmothers rather than listen, and much less act, upon advice offered to them by skilled observers, which they are pleased to designate "doctors fads" or "new-fangled ideas". The failure to recognise the danger of diarrhoea in infants, and to obtain immediate medical advice. Having determined the causes of the high infant mortality the Medical Officer of Health made the following suggestions of measures for the prevention of infant mortality:— "Every means should be taken to encourage breast-feeding, and information given to all mothers of its advantages; "Mothers should receive instructions from competent persons in regard to the measures to be adopted for successful artificial feeding when breast-feeding is impossible; "Pamphlets and cards should be issued by the Council to every house in which a birth occurs, followed in the poorer districts at homes selected by the Medical Officer of Health by a visit from one of the Woman Sanitary Inspectors; "That objections should not be raised by other governing bodies to this valuable work by the Women Sanitary Inspectors who may be competent to give information under the direction of the Medical Officer of Health; "In the event of parents, by reason of destitution, being unable to procure milk, Local Authorities should have power to grant from time to time temporary supplies on satisfactory evidence that the recipient is without means; "No person should be registered to follow the trade of cowkeeper, dairyman, or purveyor of milk, unless it be first ascertained that his premises are fit for such business; "Fresh legislative measures should be enacted and enforced throughout the country for the better protection of milk supplies". Mention should be made of the Women's Health Society which was formed in the Borough at this time (1904), the objects of the Society were: The delivery of popular lectures to mothers on infant feeding and management. These lectures were given regularly in various parts of the Borough, and were well attended. The Society arranged for tuition in domestic hygiene for ladies whom it was hoped would act as Voluntary Health Visitors. Popular lectures were also given upon general hygiene. 62 The Society was supported by the Council, and assisted the Health Department by distributing pamphlets in the poorer homes. This then was the modest beginning to the extensive maternity and child welfare services that have developed since in the Borough. In 1907 the Medical Officer of Health commented upon the creches that were established in the Borough by philanthropic people. The background to these establishments was that working women found it difficult to place their young children under suitable protection whilst away at work. Children were handed over to neighbours, who having many children of their own could only offer indifferent attention to their temporary visitors. The existence of a number of creches helped to ameliorate these conditions, and an example of such an establishment was the one known as the Forest Hill Day Nursery, in Beadnell Road. The number of attendances at this nursery in 1907 was 6,832. The nursery opened daily from 7.45 a.m. to 8 p.m., and children between the ages of one month and three years were received at a charge of 4d per day tor each child, and 6d per day for two children from one family. As a comment on the value of this home it is stated that "at times during the year children who were doing well have been unavoidably kept from the nursery owing to the inability of the parents, through lack of work, to find the necessary fees. On the return of some of these children they were found to be pale and thin for want of the good food so necessary for their well-being and which they had previously enjoyed". Further, the Medical Officer of Health said that "I feel confident that the good work carried out by the above-mentioned institutions has been of considerable help, not only to young infants, but in educating mothers who have come under their influence". Towards the end of 1909 the Council adopted the Notification of Births Act, 1907 which placed a duty upon the father of the child, and of any person in attendance upon the mother to notify within 6 hours of the birth of the child, the Medical Officer of Health of the fact. At the same time the Medical Officer of Health recommended to the Council that women health visitors should be appointed to carry out the work which would devolve upon the department under the Act. During 1910 the first full year of the operation of the Notification of Births Act in the Borough, some 3388 notifications were received, and the woman sanitary inspector made 1601 visits to selected homes where it was thought that such visits would be of advantage. In 1914 the first woman health visitor was appointed by the Council, and the following is a summary of her visits during 1915, her first full vear working in the Boroueh: Table 51 Notifications of illness from schools 213 Measles 54 Puerperal fever 1 Ophthalmia neonatorum 6 Birth notifications 447 „ „ revisits 276 Infant mortality 28 Miscellaneous 19 Total 1,044 63 This of course, was in addition to the work done by the two women sanitary inspectors who were also still making visits in the same field in addition to their normal work. By 1919 there were four full-time health visitors and two women sanitary inspectors. The establishment of a municipal maternity home together with a child welfare and ante-natal clinic in June 1918 considerably enhanced the value of the work done in relation to maternity and child welfare. The maternity home was opened by Queen Mary on 1 June 1918 at 41 Rushey Green. The upper portion of the building was used as a maternity home containing 12 beds, and the lower portion as a child welfare and ante-natal clinic. To the child welfare clinic all children under five years of age requiring treatment were referred by the six voluntary centres which were then existing in the Borough. In its first full year (1919) there were 176 confinements in the maternity home. Applications for admission to the maternity home far exceeded the available accommodation, so it was necessary to give preference to those whose home conditions were such that a confinement could not take place there, and to cases recommended by medical practitioners where danger was anticipated at the time of the confinement. The Voluntary Infant Welfare Centres in the Borough numbered six in 1919, and the attendances were as follows:— Table 52 Centre No. of infants attending No. of attendances Catford 401 4,227 Forest Hill 282 2,716 Hither Green 232 1,530 Lee 143 2,372 Lewisham 250 2,911 Sydenham 381 3,208 TOTAL 1,689 16,964 Each voluntary centre was held once during the week, the consultation being presided over by the assistant Medical Officer of Health, and the Health Visitor for the district was also in attendance, lectures were given on health, hygiene, nursing, etc., and prizes were awarded every year for attendance and proficiency in mothercraft. No financial assistance was given to their centres, by the Council, but a grant equivalent to 50 per cent of the working expenses was given by the Minister of Health. In addition to the advice in regard to the health of their children given to the mothers who attended the centres, facilities for the purchase of clothing, dried milk, virol etc., at costprice were afforded. As far as could be ascertained there were 24 midwives practising in the Borough in 1919, eighteen of these midwives were practising on their own account and six were employed by nursing associations. The number of cases attended, by the midwives was estimated at 410, and was increasing with each year. 64 Thus it was that by the end of 1919, only one year after the end of the first World War the maternity and children welfare services of the Borough were well established, but much remained to be done, and the following is an account of the improving services up to the transfer of the Maternity and Child Welfare services to the County Authority in 1948 under the National Health Service Act, 1946. During 1924 five additional beds were provided at the Maternity Home, bringing the total to seventeen. Even so a considerable number ot applicants had to be refused. The extension of the Home reduced the cost of maintenance per patient. Also, as a result of this extension a new home had to be found for the Council's Infant and Maternity Clinics, the work which had increased considerably, and the use of the Wesleyan Church Hall in Rushey Green was secured for this purpose. The Ante-natal clinic was still held at the Maternity Home and the attendance at this had greatly increased. The nursing staff at the maternity home by 1927 consisted of the Matron, five nurses, and two probationers. The domestic staff included a cook, two housemaids, a laundry maid and a daily cleaner. There was also a clerk dispenser. During 1934 certain necessary improvements were carried out at the maternity home including, inter alia the conversion of one of the wards into an isolation room with bathroom and water closet. To accommodate the tour beds displaced by these alterations two of the existing wards were extended to take four additional beds. A sterilizing room leading off the labour room was also provided. On the subject of maternal mortality the Medical Officer of Health included the following table for the years 1919 to 1925. Table 53 Year Deaths from Puerperal Sepsis Other causes Total 1919 2 7 9 1920 2 13 15 1921 2 6 8 1922 1 7 8 1923 2 10 12 1924 2 9 11 1925 5 5 The Medical Officer of Health commented that Lewisham was one of the first Municipalities to establish a Maternity Home and clinics to which expectant mothers would attend for advice during treatment. The value of this foresight is no doubt reflected in our low maternal mortality. 65 A summary of the work of the six whole-time health visitors in 1925 gives an indication of the types of case they concentrated on at this Deriod. Table 54 Preliminary visits to Infants 2,645 Return 14,509 Visits to Children between 1 and 5 years 2,809 Infantile death enquiries 51 Stillbirth enquiries 49 Ante-Natal visits 541 Milk Assistance scheme enquiries 1,291 Visits to Enteritis Cases 33 Return visits to Enteritis Cases 33 Visits to Ophthalmia Cases 14 Return visits to Ophthalmia Cases 45 TOTAL 22,027 In addition to this district work each visitor attended at a voluntary centre which was held in her district. Two of the Maternity Visitors were also in attendance at the Council's Infant Clinic to assist the Medical Officer. In January 1930, the Council gave its sanction to a scheme for the provision of Maternity outfits, consisting of sterilized dressings, etc., on the recommendation of a doctor or midwife. These outfits were supplied free or at part cost price according to the financial circumstances of the recipient. In the first full year of operation (1931) the number of maternity outfits issued was:— Issued free 62 Issued reduced price 28 Issued at cost price 32 The provision of "Home Helps" was sanctioned by the Council in 1930, and came into operation on April 1st of that year, but got off to a slow start, only three cases in 1930 and two in 1931 took advantage of the scheme. Under the Milk (Mothers and Children) Orders 1918 and 1919 the Council was given power to supply milk free or at less than cost price for expectant and nursing mothers for children under five years of age. The quantity of milk to be supplied was not to exceed the following scale:— for children under 18 months—li pints daily. for children between 18 months and 5 years—1 pint daily for expectant and nursing mothers—the quantity prescribed by the person certifying. During 1920 the following approximate quantities of milk were supplied:— 32,490 pints free 64,490 pints on payment by the consumer of Id. per pint. 1,445 „ „ „ „ „ „ of 2½d. per pint. 12,560 „ „ „ „ „ „ of 3d. per pint. 350 „ „ „ „ „ „ of 3½d. per pint. 66 By 1930 the provision of milk was in the form of dried milk, and the total amount issued at less than cost price was 8,419 lbs. and 4,854 lbs. of dried milk were sold at cost price to families to whom, in the opinion of the Health Visitors, the ordinary retail price was prohibitive. Under the Transfer of Powers (London) Order, 1933, certain functions exerciseable by the London County Council were transfered to Borough Councils in relation to infant life protection. These duties, were the reception of notices given by persons who undertake for reward the nursing and maintenance of infants, and the inspection of premises by infant life protection visitors or other persons appointed by the Council for that purpose : fixing the number of infants to be kept in a dwelling in which any infant was reserved for reward and applications to a court of justice for an order directing the removal of an infant to a place of safety. Accordingly the officer who was carrying out the work under the L.C.C. was transferred to this council in April 1933. At the end of the year there were 179 nurse-children on the register, under the care of 127 foster-mothers. A new Health Centre was opened by the Duchess of Kent at 410, Lewisham High Street, on 7 May 1936. The centre was designed to provide ample facilities for; A dispensary. An artificial sunlight clinic. A "toddlers" room, a staff room, kitchen, store rooms etc. Accommodation was also provided for a resident caretaker. To summarise the maternity and child welfare services as they were just prior to the second world war the following were the health services for which the Borough Council was responsible: I. The Municipal Maternity Home. II. Clinics for Expectant Mothers. III. Post-natal Clinics. IV. Clinics for Mothers and Infants. V. Artificial Sunlight Clinics. VI. Toddler's Clinics. VII. Dental Treatment. VIII. Treatment for minor ailments including operative treatment for Tonsils and Adenoids and Orthopaedic treatment. IX. The provision of milk and drugs for necessitous mothers and their infants. X. The supply of Maternity Outfits. XI. The provision of Home Helps for confinement cases. XII. The services of a Consultant in cases of Puerperal Fever and Pyrexia as well as difficult or complicated obstetric cases. XIII. Convalescent Home Treatment for Mothers and Children. XIV. Home Visiting by Health Visitors. XV. Nursing in the Home. XVI. Infant Life Protection. These services are closely linked up with the Voluntary Organisations engaged in Infant Welfare work in the Borough. 67 The staff employed is as follows:— A Medical. One whole-time Medical Officer in charge of the Municipal Maternity Home as well as Clinics for Infants, Toddlers, Antenatal cases and Artificial Sunlight Treatment. One whole-time Medical Officer in charge of Ante-natal. Infants' and Toddlers' Clinics. One part-time Medical Officer in charge of Clinics for Mothers and Infants. Three Consultants for Puerperal Fever and Pyrexia cases as well as difficult and complicated obstetric cases. B Nursing. Maternity Home Staff (Vide under 1). Thirteen Health Visitors. One Infant Life Protection Officer. The war brought a number of changes, chief among these being the closure of the Maternity Home at Rushey Green and the large increase in the number of domiciliary confinements brought about by the shortage of hospital beds. This had a profound affect upon the home help service which had to expand very rapidly to cope with the new demand. It may also be recalled that under Defence Regulations 68E made in 1944 which extended the provisions made in the Public Health (London) Act 1936 welfare authorities were enabled to supply domestic help to the sick and infirm as well as hitherto for maternity cases. The introduction of rationing heralded the start of the vitamin schemes for expectant and nursing mothers, with the distribution of National Dried Milk, orange juice and vitamin pills as notable features of these schemes. During the war years the reports were necessarily less detailed than usual. There was at this time a great deal of rethinking on the organisation of these services which manifested itself later on when the National Health Service Act, 1946 came into operation. Under the National Health Service Act 1946 the administration of the Maternity and Child Welfare Services inter alia were transferred from the Borough Council to the London County Council and the following short account of the expansion of these services as far as Lewisham is concerned, gleaned from the annual reports of the London County Council. The division consists of the combined areas of Lewisham and Camberwell for administrative purposes. The divisional medical officer of the London County Council reporting in the annual report for 1948 said that there were seven voluntary infant welfare centres in the borough and that these clinics were held in church halls which were not ideally suitable for the purpose. Additional accommodation was being sought. Ante-natal clinics which the London County Council and district nursing association midwives attend were set up in the area. Routine blood examination (including the Rh factor) of expectant mothers was carried out at a number of these clinics, and was being rapidly extended to the remainder. Vaccination clinics were set up in the borough. 68 The Home Help scheme which was very comprehensive and well organised prior to the transfer in July 1948 was continued under the local direction of the existing organiser. Close liaison was maintained with hospital almoners, family welfare and old people's association and the District Nursing Association. This of course was an essential factor in a successful home help scheme. Day nurseries which had sprung up through the war under the control of the Borough Council were also transfered to the London County Council in 1948, and these continued to have a considerable waiting list. The period of transition was difficult, technically, but went off smoothly as all concerned co-operated to the fullest extent ensuring that this should be so. In 1949 male home helps were introduced mainly in the houses of aged males, and in this connection it can be said that at this time more than half of the work of home helps was in connection with the aged. By 1956 the findings of an investigation into attendances at child welfare clinics in the division were published and ways were suggested in which improvements could be carried out. A large majority of mothers favoured attendances at clinics because they provided a means of obtaining expert advice, checking progress and relieving anxiety. As the size of families increased, the mothers found difficulty in attending, and may have felt that the knowledge gained with the first child at the clinic equipped them to deal adequately with those that followed. It was found that the ability to purchase welfare foods (including Ministry of Food preparations) was not as significent a reason for attendance as was suggested by investigations elsewhere. Criticisms of the service were few and those relating to staff and premises were investigated. The demand for child welfare clinics continued but their value was insufficiently appreciated and the atmosphere of the centre, if it had not changed with the times, may have been largely to blame for this. In May 1957 an Open Day was held at the Central Lewisham Welfare centre, 410 Lewisham High Street, to commemorate the 21st Anniversary of the opening of the centre by H.R.H. the Duchess of Kent on 7 May 1936. Special tributes were paid to the Catford School for Mothers who had started child welfare activities 37 years ago and had worked at the centre since it opened for voluntary work done. By 1958 the Maternity and Child Welfare services of the borough had been under the control of the London County Council, administered from the divisional offices at Camberwell for ten years, Dr. Mower White, the divisional M.O. in a review of these ten years, said of the whole division (Camberwell and Lewisham combined) "During the period, 12 new welfare centres have been opened, in rented or adapted premises, to serve new areas or to replace unsatisfactory accommodation often in church halls. Seven new school treatment centres have been started. Of the ten voluntary committees who ran centres in 1948, seven still continue. The number of day nurseries has fallen from eight (with 439 places) to six (with 294 places, and the average daily attendance from over 350 to 225. Associated with this 69 decline in the day nurseries is an increase in child-minding from 103 children minded by 39 minders in 1948 to 329 children minded by 133 minders in 1958. The home help service has responded to the national policy of using it as an ancillary to the other medical and hospital services for confinement cases and for chronic sick persons. The full-time equivalent number of helps employed has grown from 185 to 380, and the number of households served from 1,160 to 3,075. Among the new activities undertaken have been the sale of government welfare foods at child welfare clinics, B.C.G. and polio vaccination, the detection of signs of mental ill-heath and physical disabilities in very young children and priority dental services. Progress has been made towards the integration of the health visiting and school nursing services and, whereas in the early days the staff in these grades were divided almost equally into two self-contained groups, now, half of the fulltime staff are doing combined duties. There have been several well-marked trends since 1948. A fall in attendances at ante-natal and child welfare sessions reflects the fall in the birth-rate, but may also owe something to the increased activity of family doctors, especially during the latter part of the period, when the birth rate has somewhat rallied. In school treatment centres, although the number of new cases at vision sessions has grown by over a thousand, the number of attendances has dropped: this may be due to the use of hyoscine for the refraction of older pupils which reduces the number of attendances per child. At bathing centres the sharp fall in attendances is attributable to higher standards of cleanliness and improved cleansing methods. There has been an appreciable decline in cases and attendances at minor ailment centres, but the special investigation of pupils referred from school medical inspections has grown considerably. The most noticeable fall has been in cases and attendances at rheumatism supervisory clinics; and, although this may be partly offset by a diversion of cases to special investigation clinics or to hospital departments, it undoubtedly reflects a decrease in the overall number of cases, which in turn may be associated with the greatly increased use of ear, nose and throat sessions over the same period. A well-defined pattern of co-operation has evolved with other branches of the National Health Services, with other local authority services and public bodies. These efforts have been made to meet the needs of special classes in the community, in the care of expectant mothers, of problem families and maladjusted children, of old persons, in the prevention and control of infectious disease, and in health education and the avoidance of accidents." The elderly The first allusion made by the Medical Officer of Health in his Annual Report to the question of help for elderly people was in 1948 when he said "The question of help for old people has been coming more to the fore in recent years. This is because of the gradual realisation that it is almost inevitable that the proportion of old people in the population will considerably increase during the next 40 years or so " In the same report he went on to say 70 "It must not be assumed that more than a very small proportion of old people require help. The vast majority of them would in fact spurn it, as they like to feel independent, but as old age increases so frailty and illness increases and as a result an enlarging proportion of old people require some sort of help according to the age they have reached. Further, the proportion of old people who work after they become of pensionable age varies according to particular circumstances. At the moment, when increased production is required, there is a considerable propaganda movement to keep old people in industry. I am quite sure, however, that should there be anything corresponding to the slump which occurred between the wars the propaganda would be reversed and old people would be unemployed when they reached pensionable age. There are two other general considerations: with the smaller families which have become increasingly common in the last half-century there are less grown-up children to look after the old person and therefore the chances of the old person being left on his own are considerably increased. Secondly, even though the proportion of old people who require help may be small, or very small (and no-one knows at the moment what it really is), when we are dealing with a matter of thirty to fifty thousand old people even a "very small" proportion might well mean some thousands." "Help to old people can be of various kinds, some of which is obtainable through voluntary agencies and some of which can be given by the local authority, whether it be the local health authority (i.e., the L.C.C.) or the local sanitary authority (i.e., the borough council). There are at least 20 local agencies (possibly many more) who are interested in the care of old people, and in 1947 the Lewisham Old People's Welfare Council was formed, and included representatives of most of these agencies. This Council, in spite of many difficulties, financial and otherwise, has made a start in the care of old people and by the end of 1948 it had organised a small "Meals on Wheels" service. There are, however, many other ways in which the Old People's Council and other local agencies can help old people. As far as the health department is concerned, such help might be of great benefit in postponing for a considerable time, if not indefinitely, the date when an old person becomes a burden on his or her friends, relatives or neighbours, and may, as a result, require admission to hospital or a home." Old people's services were reorganised in 1949 as the following extract from the Annual Report of that year shows. "At the end of the year the Lewisham Old People's Welfare Council decided to change its name to the Lewisham Old People's Welfare Association. The Lewisham Old People's Welfare Association is regarded by the Council as its main link with the voluntary work in the borough for the care of old people. The borough makes grants to all other approved organisations who are prepared to agree to the provisos set out above and therefore it has a direct link with those organisations, but it would clearly be an administrative difficulty to remain in close touch with them individually, particularly as it is hoped that they will multiply in the years to come, and therefore although it makes a direct grant its chief connection with them is through their being affiliated to the Lewisham Old People's Welfare Association. On that association 71 the borough council is strongly represented in that, in addition to the Mayor being President, on the executive committee of that association it has four members of its public health committee (two elected and two coopted), one other member, and further, the Borough Treasurer is the honorary treasurer of the association and I am its honorary medical adviser. The association, towards the end of the year, decided to appoint a wholetime organising secretary and Miss L. H. Ellis, who has had a large experience of social welfare work, was selected and took up her duties at the very beginning of 1950. To help the association still further the council agreed to office accommodation being found for the organising secretary in the health department, in return for a nominal rental." "The Lewisham Old People's Welfare Association besides being a coordinating body for the work for old people in the borough, has executive functions. The main one of these is the Meals on Wheels service for which there is one van in existence now and for which there will be two vans a little later in 1950. Other functions are the ascertainment of old people, particularly those in need such as the house-bound; help in the formation of luncheon clubs, with the possibility of a chiropody service being included; friendly visiting of old people (which will normally be, it is hoped, through the agency of other old people's organisations in the borough, but some of which will have to be an executive duty of the association); the possible formation of a care committee (which might be the welfare committee of the association, or a sub-committee of that committee) to help old people in cash or kind or advice. For the future, when the association is on a sound financial footing and can extend, it has in mind the question of homes, more particularly a holiday home where old people can get away for two weeks or so at much expected benefit to themselves and also in some cases to the benefit of relatives who look after them for the rest of the year, and secondly, residential homes on an almost selfsupporting basis where old people can have their own apartments and yet have the addition of some communal services if they so desire." "In effect therefore considerable progress was made during the year on the care of old people in the borough, but possibly it could be said that the progress was relatively greater on the administrative side, i.e., on the setting up the machinery, than on the actual executive side, i.e. work in the field. There is no reason however, now that the machinery has been reasonably well assembled, that the field work should not increase rapidly. The two main requirements are sufficient financial support and sufficient voluntary effort. The borough council can help the former, but additional financial help will without doubt be required, and an almost unlimited amount of voluntary effort can be absorbed." "The care of old people now is in some ways in a rather similar position to the care of babies and young people some 30 years ago. Before the advent of the Maternity and Child Welfare Act of 1918 a great amount of work had been done for infants and mothers by voluntary effort, and in fact the voluntary workers were the pioneers in such activities. In the same way care for old people is starting with a great deal of voluntary effort and this will probably need to continue 72 indefinitely. At the same time however it must be remembered that all statistics indicate that the proportion of old people will rise steeply over the next 30 or 40 years, so that as time goes on there will be relatively more old people and relatively less younger people to look after them. It is therefore likely that local government authorities will have to help out more and more as time goes on." "During the year domestic helps were supplied by the LCC to 456 old people in the borough." In 1957 a report, reproduced below, on the Council's laundrv service for old people was made which shows how essential this service is. This service has now become a permanent feature of the work of the Health Department. Under s.122 of the Public Health (London) Act, 1936, the sanitary authority, in cases where it appears that the cleansing of a filthy article is necessary through health being endangered, may arrange for the article to be cleansed. This covers articles of bedding or clothing of incontinent persons, and nearly all incontinence, whether of urine or faeces, is through physical deterioration such as occurs in old age. It is very difficult to get laundries to accept such articles and it is even more difficult (particularly in the winter months) for the articles to be washed at home by relatives, or home helps, or other persons. It was because of the great need for such help to be given that the Council decided in the latter part of 1950 to arrange for such articles as fell within s.122 of the Public Health Act to be dealt with at the Council's Disinfecting Station. This service grew rapidly and has now been in operation for seven years. It is almost unique in that it from time to time attracts letters of thanks, thereby proving beyond doubt that the comfort it gives both to the deteriorating patient and to the patient's relatives is immense. Since the demand for the facility now appears to be stabilised, it may be desirable to review the position as it has developed over the seven-year period. The number of new cases in each calendar year is set out in table 55 which shows that in the first year 33 new cases were taken on. This figure rapidly increased until 1955 when it was 126, while in the last two years it has dropped somewhat to 96 and 94 respectively. The proportion of women to men over the seven years has been a little less than 2 to 1, and this proportion has remained fairly constant in each of the years under review, the widest difference being last year, 1957, when the proportion was almost 3 to 1. There is nothing very abnormal about these ratios since in table 55 it will be seen that nearly all cases are over 65 years of age (and most cases are over 75 years of age) and from the Census figures of 1951 there were then in the borough some 14,000 women and 9,000 men over 65 (of whom some 5,000 women and 3,000 men were over 75, 750 of these women and 330 of the men being over 85). Thus the older the age group the greater the proportion of women. Nevertheless the proportion of women helped is slightly greater than would be expected after allowing for these figures. 73 Table 55 1957 1956 1955 1954 1953 1952 1951 All Cases % New Cases M no. °/o 25 32 42 45 29 17 11 201 27 33 33 40 39 40 33 35 F no. °/o 69 64 84 68 45 26 22 378 73 67 67 60 61 60 67 65 TOTAL 94 96 126 113 74 43 33 579 Collections 3.466 3,595 3,367 3,427 2,693 1,477 607 18,632 Articles cleansed 40,902 41,367 37,432 36,311 26,912 17,029 5,334 205,287 — Referred by Private doctor 19 23 21 17 14 3 2 99 17 Hospital 4 3 5 7 1 4 — 24 4 Ranyard Nurse 56 54 80 62 41 17 16 326 56 LOPWA or Home Help 9 14 16 23 15 17 14 108 19 Others 6 2 4 4 3 2 1 22 4 Reasons for referral Debility or senility 42 33 46 35 28 16 10 210 36 Stroke 23 25 36 39 25 10 14 172 30 Cancer 17 17 22 20 11 8 6 101 17 Others (mainly heart cases) 12 21 22 19 10 9 3 96 17 Incontinence Urine 43 37 50 53 26 18 16 243 42 Faeces 4 7 10 14 14 14 8 71 12 47 52 66 46 34 11 9 265 46 The total articles cleansed in the course of each year rose from 5,000 odd in the first year to over 41,000 in 1956. As stated above the women patients far exceeded the men (table 56). 10% of the total cases were under the age of 65 (14% of the men and 8% of the women); 21% were between the ages of 65 and 75 (23% men and 20% women); while 69% were over the age of 75 (63% men and 72% women). In other words over two-thirds of the total cases were over the age 75, and about one-fifth were between 65 and 75. Table 56 Ages Under 65 65 -75 75+ Total % Total °/o Total % Male 28 14 47 23 126 63 Female 32 8 75 20 271 72 TOTAL 60 10 122 21 397 69 74 The mode of referral is also shown in table 55, and lumping the years together it will be seen that 56% of cases came to our attention through being referred by one of the district nurses; 19% were referred by the Old People's Welfare Association or by the home help service; 17% by the private doctor and only 4% by hospital. These percentages are much what might be expected, the district nurse being the person on the spot who knows what help is required, but it does rather indicate that the cases were being referred only at a late stage of deterioration. It is pleasing therefore to see that an analysis of the figures shows that the proportion referred by private doctor is tending to increase—thus, whereas in the first year this was only some 6%, last year it was 20% (and was in fact 24% the year before). There may also be another reason for this: in the early days there were some doubts about one or two legal points involved and we did not specifically call the attention of the district nurses or the doctors to the service. It therefore spread by word of mouth and so it is rather more natural that it would spread more rapidly through the few district nurses concerned than through the very much greater number of doctors who practise in the borough. Table 55 also shows the reasons for referral, and from the total figures for the period it will be seen that the most common reason was debility or senility—in other words the slow deterioration of old age. This accounted for over a third of the total number of cases. Rather under a third were cases of stroke, and about one-sixth were cases of cancer. Other figures in table 55 indicate whether the cases were due to urinary or faecal incontinence. Here however the figures require explanation. Some 46% are put down as but the vast majority of these were cases which were taken on for only one or two collections while being removed to hospital. The exact type of incontinence is not recorded in these cases, but it is safe to assume that nearly all of them were cases of faecal incontinence. In certain other cases the fouled articles were due to discharges from other parts of the body. Collection of soiled laundry is made once, or more usually twice, a week, depending on the severity of the case, and the articles are taken back the next day, or on some occasions the same day. Table 55 shows that the number of collections rose from 607 in 1951 to 3,427 in 1954 and has remained at about that figure since. Deliveries of course double the visits paid as they are made at different times to the collections. No issue of replacement articles is made and if the patient has not sufficient material, such as bed linen, it is found that the National Assistance Board will sometimes help in this matter, or additional help may be obtained from the Red Cross or the WVS. The soiled articles, before being collected from the house, are put into open mesh bags, which are numbered. At the time of collection the person is asked if the bag contains woollen or highly coloured articles and if so these are taken out at the disinfecting station and washed separately by a special process. People are asked to avoid the use of this type of article as much as possible The bag on arrival at the disinfecting station is put into the foul washing machine which is capable of dealing with 40 lbs. dry weight. The average weight of the bags as received is 12 lbs. Although normally washed in the bag in which it is collected, if the case is known to be a particularly bad one the contents of the bag are emptied out and washed loose. 75 In the washing machine the articles are first flushed in cold water, to which soda ash has been added, for ten minutes to remove the worst of the foul matter. The machine is then drained through the foul attachment which is connected direct to the drain in the same way as is a water closet. The articles are then washed for 15 minutes in warm water at a temperature of 110°—120 F., to which soap flakes and soda ash have been added. The machine is then drained off over a gully in the usual way. The articles are then washed for 15 minutes in hot water at a temperature of 180°—200°F, to which soap flakes and sodium metasilicate have been added. This is then drained off and the articles rinsed firstly in hot water for five minutes, then in warm water for five minutes and finally in cold water, to which blue has been added, for a final five minutes. The articles then pass from the infected side of the station to the clean side where they are placed in the hydro-extractor for ten minutes. Each bag is then checked; this is not done before this stage in order to avoid too much handling of the foul articles by the staff. The articles are now nearly dry, the final drying and sterilization taking place when the articles are ironed on the calendar where they are subjected to a temppcrature of approximately 300°F. They are then placed on the airers which are steam heated to a temperature of some 100 F. for thirty minutes. The articles are then removed, again checked, folded and placed in clean linen bags and returned. The year 1957 also saw, the appointment of a woman health officer who together with the existing visitors (trained nurses whose work had hitherto been mainly in connection with infectious diseases) for work on behalf of old people. These three nurses were to spend an increasing part of their time visiting old people and less on infectious diseases. (Most of their infectious disease work has lately been transferred to the public health inspectors). By bringing in help where needed the visitors can very often prevent the necessity for action under Section 47 of the National Assistance Act, 1948 which involves the compulsory removal of an old person to a place of safety. Not only this, the mere fact of a visit to a lonely old person can be very beneficial, and therefore once such a person becomes known to the department regular visits are made. As help from other agencies such as the home help service, meals on wheels or invalid aids is required these are arranged. During 1961 and 1962 work for old people by the Borough Council increased and the following is an account of the wide variety of activities regarding the aged that is now being undertaken. 1. General The "Elderly" for administrative purposes arc 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. 76 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 arc 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. Powers available Until 1962 the metropolitan boroughs had very limited powers with regard to carrying out this work, and apart from a few minor more or less indirect duties in connection with the elderly, their power was limited to making grants to those voluntary organisations which provided meals or recreation for old people. The Borough Council took full advantage of this, as will have been seen in previous annual reports, and apart from that made to some twenty voluntary clubs of varying size and complexity, a very large grant, increasing each year has been made to the Lewisham Old People's Welfare Association, which is the main coordinating organisation for old people in the borough. The power to make grants was contained in the National Assistance Act, 1948, but last year there was passed the National Assistance Act 1948 (Amendment) Act, 1962, which empowered local authorities, as an alternative to giving grants to voluntary organisations, to carry out similar work directly themselves. Direct Work The Saville premises in Lewisham High Street were opened in October 1961 as a centre for various activities for old people. At these premises there are three flourishing afternoon clubs, two morning handicraft classes and a well-equipped kitchen loaned to LOPWA for the provision of meals. During the year 1963 for example, 29,784 meals were prepared of which 12,338 were taken up by the luncheon club at the Saville itself. There is also two clubs for the homebound and handicapped that meet at these premises. These elderly people arc picked up from their homes and returned by special transport which is provided with a lift, and which is accompanied by a paid escort. The Burnt Ash Centre in Burnt Ash Hill was opened in October 1962 by the Mayor, and consists of a workshop for the elderly and other rooms used by the afternoon clubs for the elderly. The number of elderly workers who attend each week at the workroom is about 80 and many of these people attend 4 or 5 times a week. The hours of work are restricted to 2 hours a day per person, and pocket money is earned at the rate of 1s. 6d. per hour. The problem of finding suitable work for the elderly has not proved as difficult as anticipated and work was available for all the workpeople during the whole of each year since the inception of the scheme, although there were fluctuations in the type of work available at various times. The type of work carried out included the following. 77 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. Two clubs with a restricted membership of a 100 for each—no member allowed membership of both clubs—together with a club for the handicapped also operate from Burnt Ash Centre. The members of the club for the handicapped are picked up by special transport, and are entertained and looked after by members of the other two clubs. In addition to the normal social activities of the old peoples clubs at both The Saville and Burnt Ash Centre a number of outings and shows are organised, and the clubs for the handicapped have their own parties at the end ot the year. During 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 are nearly 500. Holidays arc confined to the off-peak season, usually the early part ot May and the latter part of September. The majority of elderly persons go to boarding houses and guest houses, and stay for two weeks. The seaside resorts to which the old people go are mainly those situated on the south-east and south coasts, from Broadstairs to Boscombe, but some go as far as Dawlish on the Devonshire coast. The cost of a holiday to the elderly person is based upon a simple method of assessment of the persons net income after deducting the rent and insurances, and should the home 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. 0d., and to a married couple £4 10s. 0d. 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. 0d. 78 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 it has since been necessary to employ two more women and a male bathing attendant in order to cope with the increase. The first of a series of Concerts run by the Public Health Committee at the Town Hall for the elderly was held in March 1963, 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. Monthly concerts have since been held during the winter season. Apart from LOPWA the Council makes grants to organisations in the borough which carry out work for old people, whether by recreational facilities or by the provision of meals. For instance a sum of £18,800 for 1963/64 (to include LOPWA) was allocated for such organisations as accepted the Council's condition and to assist any such organisations as might be established during that year. It is not easy to give a definite indication 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 there has often been a hidden subsidy to LOPWA in the rent charged to them for their office accommodation. Bearing in mind, these provisions, however, it seems that in the financial year 1964/65 the sum of about £53,500 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 in the year 1952/53, the corresponding expenditure was £1,750. Home safety Towards the end of 1959 it was decided by the Public Health Committee to publish a quarterly "Home Safety Bulletin" which would have as wide a distribution as possible among local clubs of various kinds, general practitioners, dentists and other organisations that would agree to distribute it among its members and friends. The bulletin was first published in 1960, and some 500 copies were distributed. By 1964 the number distributed had grown to around 3,500 and it has in fact achieved no small measure of success. The bulletin's contents vary from issue to issue to some extent according to the season of the year, but it attempts to inculcate some care in the home and so cut down the appalling number of accidents that occur through ignorance, neglect or sheer carelessness. ENVIRONMENTAL HEALTH The Medical Officer of Health's annual report for 1901 gives a good indication of the sanitary conditions observed by the six inspectors of nuisances at that time. The samples of water from seven wells were analysed. Five wells were found to be polluted, and were immediately closed. 79 House to house inspections were carried out in various streets in the Borough and the following is a random selection of nuisances found to exist. Table 57 Street Number of houses inspected Number of houses in which nuisances existed Rushey Green 35 31 Comerford Road 75 71 Courthill Road 117 89 Wildfell Road 34 32 Ardmere Road 37 37 Braxfield Road 75 73 Hindsley Place 22 17 Twenty-four houses let in lodgings were registered in the borough, nearly all in the Ladywell Park area. There were 16 licensed cowsheds and 18 slaughterhouses. The following is a list of workshops on the register. Table 58 Laundries 80 Millineries 14 Saddlers 5 Upholsterers 5 Joiners 23 Dressmakers 61 Watch repairers 9 Tailors 16 Boot repairers 49 Cycle repairs 13 Various 18 Total 290 To complete the description of work that concerned the inspectors of nuisances in this first year of the new borough a copy of the register of sanitarv work is as follows:— Table 59 Description of Work No. Description of Work No. Complaints by Residents 1285 Soil Pipes repaired and Premises inspected 4,652 lated 400 Re-inspections of Works in progress 13,319 Dustbins provided 424 Water Supply to Houses reinstated 62 Intimation Notices served 1,833 Statutory Notices ordered 942 Cisterns repaired, cleansed or covered 424 Statutory Notices served 300 Premises repaired, cleansed, &c 550 Water Certificates issued 1,184 Premises over-crowded 8 Defective Roofs, Stack- pipes, &c., remedied Drains reconstructed 346 Yards paved 726 Removal of offensive accumulations 180 623 Drains repaired 514 Dung Vaults erected or repaired 33 Drains ventilated 219 Stackpipes, Sinks, Bathwastes, &c., disconnected from Drains Gulley Traps provided 545 Animals improperly kept— Nuisances abated 28 Lodging Houses registered 24 1360, Bake Houses visited 89 Water Closets reconstructed 906 Milk Shops visited 120 Cow Sheds visited 16 Water Closets repaired 293 Workshops visited 290 Water Closets supplied with water 261 Slaughter Houses visited 18 House-to-house inspections 561 Soil Pipes reconstructed 417 Legal proceedings 1 80 During the year 1903 complaints were received concerning refuse tips belonging to the Council situated in the borough. The question of house refuse disposal was considered by the Council and arrangements were made for the removal of such material out of the borough without causing a serious nuisance. Complaints also resulted from the deposit of fish offal used for manuring land in Hither Green. This had been spread over the farmer's land and allowed to remain uncovered thus creating a serious offence. The farmer was fined £5 and costs. Under the Factory and Workshop Act, 1901, the occupiers of all underground bakehouses existing in the borough were compelled to bring their premises into such a state as would entitle them to a certificate of fitness issued by the Council. Twenty-three such underground bakehouses were reported to be satisfactory in 1903, and the necessary certicates were granted. Another subject of interest in 1903 was the pollution of the rivers Pool and Ravensbourne. Tests were carried out and both rivers and their tributaries proved to be heavily polluted. This was mainly due to the effluent from the filter beds of the then Croydon Sewage Farm at Elmers End. The real danger was from the consumption of possibly polluted water cress grown at the time in Southend Lane. A further nuisance arose from the escape of water-gas tar into the river Pool from containers in the grounds of the Crystal Palace District Gas Company at Sydenham. This material covered the surface of the river and seriously fouled its bed and banks, creating a most serious and offensive nuisance in the districts through which the river flowed. The Council instituted proceedings in the High Court, and were successful. The company then took the necessary steps in 1904 to remedy the nuisance. The register of sanitary work for the year 1901 which is reproduced at the beginning of this section gives a good indication of the type of general inspections of premises carried out by the sanitary inspectors. The designation Sanitary Inspector was changed in 1956 to "Public Health Inspectors". Over the years the inspectorate has increased from six in 1901 to nineteen in 1964. There has been considerable diversification in inspectors work, and many extra duties have been given to them. Much of the work of the inspectorate is done informally and does not show up in statistics. It is therefore difficult to give an accurate assessment of their work. In this section for instance, it would appear that the inspection of premises has fallen off considerably in the last several years. This is true to a degree, but whereas before, mostly due to economic circumstances it was necessary to take formal action against owners to force them to put their premises in good order, nowadays an informal meeting, a letter, or a telephone call will often have the desired effect. The figure quoted overleaf are for the last full year before the 1914-18 war and for the last full year before the last war. These may be compared with those on page 29 of this report. 81 Sanitary Inspection of the Borough, 1913 The work of the Sanitary Inspectors is summarised in the following statement:— Table 60 Description of work No. Description of work No. Complaints by Residents 715 Soil Pipes repaired & Premises inspected 5,295 lated 134 Re-inspections of works in progress 20,739 Dustbins provided 401 Water Supply to Houses reinstated 33 Premises repaired, cleansed, &c. 1,238 Cisterns repaired, cleansed or covered 340 Defective Roofs, Stackpipes, &c., remedied 572 Water Certificates issued 204 Drains re-constructed 350 Premises over-crowded 33 Drains repaired 322 Yards paved 534 Drains ventilated 133 Removal of offensive accumulations 121 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains 445 Dung Vaults erected or repaired 21 Gulley Traps provided 626 Animals improperly kept 37 Water Closets re-constructed 536 Visits to Houses let in lodgings Bake-houses visited 14 198 Water Closets, repaired 321 Milk-shops visited 274 Water Closets supplied with water 265 Cow-sheds visited 125 Workshops visited 591 Soil Pipes re-constructed 160 Slaughter-houses visited 115 Sanitary Inspection of the Borough, 1938 The work of the Sanitary Inspectors is summarised in the following statement Inspections: Table 61 On Complaint 1,664 After Infectious Disease 1,064 Notice from Builder 845 Other Inspections 5,684 Re-inspections 8,497 New Dwellings, forWater Certificates — Notices: Number of Intimation Notices Served 1,628 Number of Statutory Notices Served 328 Sanitary Improvements Effected: Table 62 Premises Cleansed and Repaired 1,208 Drains Entirely Reconstructed 139 Drains Repaired 279 Water-closets Cleansed or Repaired 338 Soil-pipes Renewed or Repaired 187 Waste-pipes Renewed or Repaired 350 Rainwater Pipes Renewed or Repaired 148 Roofs and Gutters Repaired 496 Dampness in Premises Remedied 563 Yards Drained or Paved 189 Dustbins Provided 217 Water-cisterns Cleansed or Covered 18 Water Fittings Repaired 110 Additional water supplies provided to tenement houses 6 Defective Fire-places remedied 234 Offensive Accumulations Removed 62 Urinals Cleansed or Repaired 12 Other Nuisances Remedied 695 82 Factories and workshops A report on the administration of the Factory and Workshop Act, 1901 relating to factories, workshops, laundries, workplaces and home work in the Borough was made in 1905, of which the following are extracts:— "Workshops,—There are in the Borough 548 workshops, containing 863 workrooms to which provisions of the Factory and Workshops Act apply. The number of workers found on inspection amounted to 2,154 of which 542 were men, 1,214 women, and 398 young persons." "The largest proportion of these workers were engaged in the dressmaking, laundry and millinery trades, there being 1,180 women, 305 young persons, and 18 men employed." "Domestic workshops—i.e. private houses, places, or rooms where no power is used, and in which the only persons employed are members of the same family dwelling there. There are 351 domestic workshops in the Borough." An analysis of the work carried out by the sanitary inspectors was as follows:— Statement of Defects Found Table 63 Defect or Infringement No. found No. remedied Referred to H.M. Inspector Dealt with under Public Health (London) Act— 423 410 3 Under the Factory and Workshop Act— 1 1 1 Workshops and Workrooms on the Register at the end of 1905. Table 64 Class of Work No. Number of Rooms Number of Workers Allowed Number of Workers Found Part Time and Domestic Day Artificial Light Overtime Men Women Young Persons Number No. of Rooms Dress 152 196 1486 1423 915 738 258 77 77 Millinery 39 49 266 254 157 — 62 41 4 4 Laundry 85 266 1109 1043 672 18 380 6 114 192 Tailor 46 49 218 200 138 85 19 8 13 13 Boot 74 75 263 244 163 113 — 16 73 73 Joiner 15 30 515 483 367 51 — 12 4 4 Smith 22 25 301 297 217 58 — 8 3 3 Furrier 4 4 16 14 9 3 3 — — — Cycles 19 36 194 176 134 38 — 9 10 10 Coachbuilder 10 23 294 279 213 37 — 7 — — Cabinet and Upholsterer 20 26 351 326 238 37 6 6 3 3 Blindmaker 3 5 28 26 17 6 — 3 1 1 Photography 5 13 41 39 25 4 3 1 5 5 Picture-framer 7 8 39 37 27 9 — 2 5 5 Jeweller 16 17 79 69 47 23 — 7 18 18 Piano 2 2 9 9 6 2 - 1 1 1 Saddler 8 9 55 46 36 19 — 4 2 2 Mason 4 5 62 60 43 8 — 3 1 1 Lathrender 3 5 23 19 14 8 — — — — Various 14 20 118 114 86 23 3 6 17 17 Total 548 863 5467 5158 ;3524 542 1214 398 351 429 *Note:—Not including Bakehouses (94) and Restaurants (32) 83 In 1921 the statistical tables formerly furnished to the Home Office under the Factory and Workshop Act and subsequently published in the Annual Report were no longer required, and only an abbreviated account was published that year, however, in 1922 it was decided to give a full account of the work carried out, and for comparative purposes with the figures already given for 1905 the following is a copy of the report made in 1922. Factories and Workshops.—Particulars of the work carried out under the Factory and Workshops Acts have been compiled, and are set out in tabular form herewith: Workshop on Register (other than Domestic Workshops) Table 65 Trade or business Workshops Workrooms No. of Employees Male Female Blacksmith 15 16 36 - Boot Repairers 44 45 75 - Builders 56 72 205 - Cabinet-making and Joinery 15 16 31 - Carriage Builders 13 20 37 - Cycle Repairers 25 28 48 - Dentists 40 40 66 7 Dressmakers 86 125 5 437 Ironmongers 6 8 14 — Jewellery, Watch, etc., Repairs 24 25 42 4 Laundries 21 69 12 75 Millinery 37 49 — 173 Motor Repairers 53 55 127 - Photographers 20 34 33 44 Picture Framers 11 12 18 2 Tailors 49 57 72 50 Umbrella Makers and Repairers 14 16 14 15 Undertakers 9 9 16 - Uphosterers 30 36 68 13 Miscellaneous 124 140 233 93 Totals 693 872 1,152 913 Factories on Register Table 66 Trade or Business No. Trade or Business No. Boot-making & Repairing 42 Motor Manufactureres and Repairers 30 Builders 18 Carriage Builders 7 Printers 21 Electrical and other Engineering 39 Timber Merchants 13 Miscellaneous 59 Laundries 14 Totals 243 84 Workplaces on Register Table 66 Trade or Business Number Inspections Cab Proprietors 6 18 Contractors 10 27 Motor Garages 17 17 Stable Yards 7 24 Restaurants 92 184 Domestic Workshops on Register (excluding Outworkers) Table 67 Trade or Business No. Employees Male Female Boot Repairers 8S 87 - Cabinet-making and Joinery 4 4 — Cycle Repairers 7 7 — Dressmakers 31 - 35 Jewellery and Watch Repairs 20 20 — Laundry 10 — 16 Millinery 6 — 6 Picture Framers 5 5 — Tailors 30 30 - Unbrellas 5 5 1 Wig -makers 3 3 — Miscellaneous 15 17 2 Totals 221 178 60 Homework — Outworkers on Register Table 68 Nature of Work No. of Workpeople Nature of Work No. of Workpeople Costumes 68 Millinery 12 Collars 7 Shirts 5 Boots 62 Tailoring 23 Blouses 99 Woollen Goods 18 Lace and Embroidery 12 Underclothing 71 Mantles 2 Miscellaneous 40 Lists of Outworkers received from Employers 91 Addresses of Outworkers:— Received from other Authorities 234 Forwarded to 109 Visits made to Outworkers 182 85 Inspections and Defects Found Table 69 Inspections Premises Number of Inspections Written Notices Prosecutions Factories 529 39 (including Factory Laundries) Workshops 1,655 47 - (including Workshops Laundries) Workplaces (other than Outworkers' premises) 686 5 — Total 2,870 91 — Table 70 Defects Found Particulars Number of Defects No. of Prosecutions Found Remedied Referred toH.M. inspector Nuisances under the Public Health Acts— Offences under the Factory and 91 89 — - shop Acts:— - - - - In 1937 the Factories Act, of that year came into force. It was a consolidating and amending measure which replaced the Factory and Workshop Act of 1901. It followed broadly the lines of that Act, but contained new provisions based on modern practice. It greatly reduced the permissible working hours laid down in previous Factory Acts, both for women and young persons. The 1937 Act continued in force with amending and additional smaller Factories Acts until the present major Act of 1961. This Act consolidated the previous Acts of 1937 to 1959, and certain other enactments relating to the safety, health and welfare of employed persons. The latest account of the work of the department is contained on page 30 of this report. The work is carried out by the Public Health Inspectors as has always been the case, as part of their normal duties. Rats and Mice The beginning of the continuous campaign of destruction of rats and mice in the Borough was in 1922 under powers contained in the Rats and Mice (Destruction) Act, 1919. This made it an offence for any person to fail to take such steps as may be necessary and practicable for the destruction of rats and mice on or in any land, building, etc., of which he was the occupier When the Act came into force attention was called to its provisions by means of posters which also advised as to the most effective methods of destruction. This information was also contained in handbills which were issued when occasion demanded. 86 Numerous complaints concerning these pests were investigated during 1922, and the occupiers advised and assisted. The Prevention of Damage by Pests Act, 1949 which replaced the Act of 1919 emphasises that the primary obligation is on the local authority to ensure that so far as practicable its area is kept free from rats and mice. Under the old Act the primary duty was laid upon the individual occupier, coupled with a right of the local authority to enforce the requirement upon him. As an indication of the work carried out by the Department a copy of the report for 1951, the first full year of the working under the new Act, is as under. Table 71 Type of property (i) (ii) (iii) (iv) (v) Total in borough Properties inspected as a result of (a) notification or (b) otherwise Properties (under ii) found to be rat infested Properties found to be seriously mouse infested Infested properties (under Hi) and iv) treated (a) (b) Major Minor Local authorities' property 128 11 - - 6 1 7 Dwelling houses 61,800 1,084 1,130 9 955 205 1,169 Agricultural property 48 — 5 — 5 — 5 All other property (including business and industrial) 3,635 98 19 1 95 5 89 TOTAL 65,611 1,193 1,154 10 1,061 211 1,270 Number of "block " control schemes carried out 3 In addition to the work reported above the Department carries out regular programmes for the destruction of rats along the banks of the rivers in the Borough. Also with the co-operation of the Borough Surveyor's Department, and other peripheral Authorities regular treatments of sewers are carried out to keep the rat population within reasonable limits. Disinfection and Personal cleansing Disinfection is only briefly referred to in Dr. Wellesley Harris's first Report for 1901. During the year 13,982 articles were disinfected at the Council's Central Station. Further information appeared in the Report for 1902 where it is learned that 1,148 rooms were disinfected and 32,201 articles were removed for treatment in the steam disinfector at Molesworth Street Depot. During the smallpox outbreak it was 87 necessary to burn 33 articles, which were replaced by the Council. More details appeared in the Annual Report for 1912, which is interesting because of the type of diseases for which disinfection was then considered advisable. The details are as follows:— Table 72 Premises Rooms Articles Scarlet fever 432 1,064 19,241 Diphtheria 412 1,035 16,141 Enteric fever 26 65 1,068 Puerperal fever 6 7 124 Pulmonary tuberculosis 154 228 920 Erysipelas 12 12 54 Cancer 26 54 360 Other diseases 120 306 799 Totals 1,188 2.771 38,707 In addition to the above, 39 verminous rooms were fumigated with sulphur. In 1930 the Disinfecting Station which was housed at the Council's Depot in Molesworth Street was considered to be quite inadequate for the needs of the Borough. When the Station was erected some 37 years before, the population of the Borough was 89,000 and had grown to over 200,000 by 1930. It was stated that in the event of an extensive outbreak of infectious disease great difficulty would be experienced in carrying out the work. No provision had hitherto been made in the Borough for the cleansing of dirty and verminous persons and their clothing, these having been passed on to and dealt with at Cleansing Stations belonging to adjoining Boroughs, as also had school children found to need cleansing. Owing to the limited facilities available the School authorities had found it impossible to deal with the number of children needing attention. In view of these facts the Council decided to erect the present Disinfecting and Cleansing Station at Wearside Road. These premises have since been modified from time to time. The latest report on the work carried out at the Disinfecting and Cleansing Station is to be found on page 14 of this report. Campaign against flies and mosquitoes The Public Health Committee during the winter of 1947/1948 made arrangements for a campaign during the summer months against flies and mosquitoes. This has continued each summer since then and lasts from the beginning of May until the end of September. The Borough is toured area by area and any potentially infested sites are 88 treated with insecticides. Many of the sites were originally bomb sites and static water tanks, but nowadays such sites are no longer prominent and emphasis is mainly on ditches and grass verges, river banks, stables and allotments. At the same time as the sites are being treated the Borough Surveyor co-operates with the department by making arrangements for the dustmen to place gammexane powder in the dustbins when they are emptied. Clean air It is an interesting historical fact that in 1273 the use of coal was prohibited in London as being "prejudicial to health". In 1306 a Royal Proclamation was issued prohibiting artificers from using coal and it is said that a man was hanged for disobeying this injunction. Part of the Clean Air Act, 1956 came into force in 1957 and the rest by the middle of 1958. In a borough such as this, with relatively little industry, the main application of the Act is in relation to smoke control areas. In the middle of 1957 the M.O.H. reported to the committee that there were three areas in the borough any one of which might serve as the first smoke control area to be instituted, and eventually it was decided that an area of 320 acres in the Ladywell district should be the first to be dealt with. Of the 320 acres about 200 were of open space and the area itself included Ladywell Lodge and Ladywell Nursery and several roads of private dwellings of intermediate age. Altogether there were about 1,450 premises, of which some 1,380 were structurally separate dwellings. The area also included a laundry, baths, mortuary, police station, library and Lewisham Hospital; it was therefore one of moderately mixed development. A preliminary report, as required by the Ministry, was put up to the Ministry of Fuel and Power in July, and the Minister's approval to going ahead with a detailed inspection of the area for the purposes of a Smoke Control Order was received in September. In anticipation of the Minister's approval it was decided to stage an exhibition in the area in the early autumn. This was to be on a fairly large scale, as it was in the first proposed smoke control area of the borough, and it was open for about a week in the middle of October. Although primarily addressed to the inhabitants of the proposed smoke control area (who were specifically invited to an opening meeting for general explanation and questions), the exhibition was advertised in the borough generally and attracted many visitors, including quite a number from outside the borough. The main exhibitors were the Coal Utilisation Council (who work in close cooperation with the Solid Smokeless Fuels Federation), the Electricity Board and the Gas Board. It was a wellarranged exhibition and one of considerable interest to any person who desired to be informed on the question of smoke control. Immediately the exhibition was over the detailed examination and inspection of individual houses in the proposed area was started, the necessary information being recorded on a specially designed card. At the same time a descriptive eight-page pamphlet was got out, copies being given to each householder and, where necessary, sent to each house owner. 89 The Council's proposal to make its first smoke control area in the Ladywell part of the borough was formally objected to by one householder. As a result the Minister held a Public Inquiry in August 1958 but nevertheless confirmed the Order, the only modification being that the date it became operative was postponed from May 30, 1959 to September 1, 1959. As a result of the experience gained in the first few areas of the Borough it was decided to foreshorten the programme to bring the whole of the Borough's area under Smoke Control Orders by 1965 instead of 1968 as originally planned. As can be seen from the table published on page 21 of this report there is no doubt now that the task will be accomplished by the earlier date, a fact that reflects great credit upon all concerned with the work. Housing In 1922 the Medical Officer of Health felt obliged to say that "The shortage of proper housing accommodation in the Borough is very acute and this fact is almost daily brought to our notice, while many incidents of serious overcrowding are seen for which there is no available remedy under present conditions." "The Bellingham Estate erected by the London County Council although containing over two thousand dwellings, has afforded but little relief to this Borough, as only a small proportion of the homes were allotted to Lewisham residents." Dealing with this subject again in 1923 the doctor said, "We receive a large number of applications for vacancies on the Bellingham Estate from residents of this Borough, who are not aware of the fact that it is by mere accident that these houses were erected within this Borough, and that they are for the benefit of London people generally Lewisham applicants obtaining only a small proportion of tenancies. The London County Council is now proceeding with the development of the Downham Estate, on the southern boundary of the Borough, on which it is proposed to erect about 2000 houses." "As a result of house-to-house inspection of working-class dwellings in the Borough, we find that many houses originally occupied by one family only are now occupied by two families or more." "In many instances where a family has been in occupation of a three-roomed tenement for some years, it was found they had outgrown the accommodation owing to the increase in number of the family, while the advance in the age of children of different sex, or the number in occupation, made a reasonable standard of health, comfort and morality impossible." "It was also found that where two or more families were occupying a house, the sanitary conveniences, facilities for washing, water supply, provision of food storage and disposal of house refuse were inadequate, with the result that closets were found choked, refuse deposited over the yard, and the rooms generally dirty and dilapidated." 90 Once more in 1925 the doctor reported on the housing conditions in the Borough as follows:— "The requirement of the Ministry of Health for a statement under this heading can be best met by the following extract from a report made in 1926, when the question of erecting the Grove Park Estate was under consideration:— At the beginning may I say that it is exceedingly difficult to form any true estimate of the existing need of houses in the Borough below a reasonable standard of fitness, and also it is difficult to produce exact figures of the number of premises overcrowded without a census of the worst portions of the district being taken. It may safely be assumed, however, that the worst cases of hardship caused by overcrowded conditions are present in one, two and three-roomed tenements. It will be readily understood that if the number of persons housed in those tenements averages two or more for each room, difficulties in finding adequate sleeping accommodation are inevitable. The Census of 1921 affords the only actual statistics available for the Borough and the following has been extracted from the official Returns:— 813 families, consisting of 2 or more persons, were occupying one-roomed tenements. 761 families, consisting of 4 or more persons, were occupying two-roomed tenements. 784 families consisting of 6 or more persons, were occupying three-roomed tenements. From the above it may be estimated in round figures that some 10,000 persons were in 1921 badly housed. We have no certain means of judging as to the extent to which these conditions have improved or otherwise, although the statistics obtained by routine house-to-house inspection of a certain type of house may be considered to afford some indication of present conditions. We have on our register 135 streets in which it is customary to carry out a periodical inspection, comprising about 5,500 houses. During the past two years 2,600 of these houses have been inspected and the results of our enquiries recorded. It was found that 845 of this number contained two families and 204 contained three or more families. It was also ascertained that 450 families living in tenements consisting of three rooms or less averaged two or more persons per room. If it can be assumed that similar conditions exist in the remaining 2,900 houses on our register it follows that about 950 families in these streets alone average two or more persons per room, and there is no doubt that to a lesser extent similar conditions exist in houses of a better class than those to which routine inspection has been applied and in respect of which no statistics are obtainable. 91 During the inter-censal period 1901-11, when the population of the Borough increased by 33,000, no less than 8,655 new houses were occupied, equivalent to one additional house for about every 4 persons, and when the Census of 1911 was taken, the average number of persons per house was 5.6. Between 1911 and 1921, the increase in the population was 13,360, so that to maintain the 1911 standard of occupancy 2,385 new houses should have been erected between 1911 and 1921. Actually, owing, of course, to the War, only 1,200 houses were erected during this period. During the past 4 years, 1,126 houses have been erected by private enterprise, but as these have been erected for sale and not for letting, it is doubtful whether they have to any extent relieved the situation which has existed since the War. In investigating several cases of overcrowding which have been brought to my notice from time to time, I find that the overcrowding has been produced by the inability of persons, who at one time were suitably accommodated, but were placed in great hardship by reason of increase in the number of their family, to obtain better accommodation. From my personal knowledge and experience, I believe the class of home that is required most in this district is to meet those whose incomes are in the neighbourhood of £3 per week, and from my interviews with many of them, I am of opinion that the maximum rent they could afford would be in the neighbourhood of 12s. to 14s. per week. The public find it difficult to understand the shortage of houses when they know that two large estates, Bellingham and Downham, have been erected by the London County Council, and it is very difficult to convince them that these houses are for the whole of London and not for Lewisham in particular, and that only a small proportion of them are available for Lewisham residents. I have no doubt in my own mind that there is urgent need for a housing scheme to relieve the unsatisfactory conditions which exist. "Under the Housing, Town Planning, etc., Act, 1919, the Ministry of Health, on behalf of the Council, acquired 36 houses in the Borough, which were converted into 119 flats, which were let at rentals varying between £24 and £60. In order to provide additional accommodation, the Council in the latter part of 1919 acquired an area consisting of about 9 acres in Lewisham Park, and erected 86 houses, which are let at inclusive rentals of between 17s. l1d. and 23s. l1d. per week". "The number of rooms overcrowded, from the legal point of view of actual cubic space, which came to my notice during the year was 113. This number of course represents only overcrowded conditions discovered by the Sanitary Inspectors and in the course of their ordinary work, or during the routine house-to-house inspections. Figures in regard to overcrowding, however, afford little indication of the congested conditions under which many hundreds of families are living. The problem is to a great extent an economic one, as it can be readily 92 stood that the poorer classes are forced to accept accommodation to accord in some degree with their means, while the fortunate possessor of a spare room is glad to obtain a tenant for it to augment his perhaps scanty income, while the position is further aggravated when the inevitable increase in the family occurs. "The problem of dealing with overcrowded conditions remains a difficult one. Harsh procedure is out of the question, as in practically every case the offender is the victim of circumstances, and no alternative accommodation is procurable. It is sometimes possible to alleviate the conditions a little by suggesting a re-arrangement of the sleeping accommodation, and whenever possible this is done." "The general standard of fitness of houses seems to be improving, and there is a gradual recovery from the neglected condition of property generally, which resulted from the War. The principal defects discovered during routine inspection were defective roofs and rain-water gutters, and dirty and dilapidated condition of interiors, the latter, of course, more prevalent now than hitherto on account of the greater proportion used as actual living rooms." At the end of 1938 the position with regard to overcrowding in the Borough was reported as follows. (a) (1) Number of dwellings overcrowded at the end of the year 343 (2) Number of families dwelling therein 343 (3) Number of persons dwelling therein 2,424 (b) Number of new cases of overcrowding reported during the year 94 (c) (1) Number of cases of overcrowding relieved during the year 277 (2) Number of persons concerned in such cases 1,643 The war years saw a great change in the housing situation of the residents of the Borough largely due to enemy action, but also, not a little by the fact that no new building took place during that period. To deal with the new conditions the Council in November 1945 adopted a "Points" scheme for the allocating of housing accommodation to families inadequately housed, in order to provide a fair means of distinguishing the most urgent cases. All applications for accommodation were referred by the Town Clerk (Housing Controller) to the Public Health Department for the award of "points" in relation to medical factors, overcrowding and insanitary conditions. In 1947 it was reported that some 1,811 families were rehoused. It is interesting to recall how this was done and the following table is included to show this. 93 By 1948 the total number of housing applicants referred to by the Health department was 4,041 of which some 1,401 were overcrowded according to the standards laid down in the Housing Act of 1936. In October 1951 an amended points scheme was put into operation and a bedroom deficiency standard adopted from that date in substitution of the former overcrowding standard, and the points for this were allocated by the Housing Section. Another aspect of the housing problem was the difficulty experienced by the sanitary inspectors in getting dwelling-houses repaired. This was partly due to shortage of material, partly to shortage of labour, and partly to the multiplicity of licences and permits required. As from May 1948 the health department was allocated a monthly quota of the money which could be authorised for repair work in the borough, and the sanitary inspector issued the necessary licences, either at the same time or following the issue of nuisance notices under the Public Health (London) Act, 1936. During this first year the value of the quota of money authorised through the issue of civil building licences amounted to £340,034. As time went on more and more work under the Housing Act was undertaken and preparatory work was done in 1949 and 1950 relating to projected clearance areas. The size of the problem in the administrative County of London then was staggering it being estimated that in Category 1—probably representable at once there were 10,347 properties in Category 2—for consideration after say five years there were 9,066 properties and in Category 3—for consideration later, probably not within, say, ten years there were 19,614 properties. The Minister of Health explained he was not contemplating authorising a general resumption of slum clearance at this time, but he did fix the number of slum dwellings which might be dealt with in certain specified areas year by year. Accordingly the County Council formulated a modified slum clearance programme for the whole of the L.C.C. area for the five year period 1951-55, involving some 3,000 dwellings per annum. The County Council reached agreement with the various Metropolitan Borough Councils with respect to the number of homes unfit for human habitation to be dealt with by clearance area Table 73 1. By the Lewisham Borough Council (a) In dwellings erected by the Council:— (1) Emergency hutments 28 (2) Temporary bungalows 174 (3) L.B.C. properties 13 215 (b) In requisitioned properties 1,039 Total 1,254 2. By the London County Council 557 Grand Total 1,811 94 procedure each year in each borough and as to which of these houses should be dealt with by the County Council and the Borough Councils respectively. The programme for Lewisham was as follows:— Table 74 Year Locality Approximate No. of dwellings Responsible authority 1951 Southend Lane 12 Lewisham Borough Council 1952 Willow Way, Sydenham 16 Lewisham Borough Council Wells Park Road, Sydenham 55 London County Council Lee Church Street 120 Lewisham Borough Council 1953 Davids Road, Forest Hill 10 Lewisham Borough Council Dartmouth Road, Forest Hill 9 Lewisham Borough Council 1954 Hither Green Lane 7 Lewisham Borough Council 1955 — — 229 In his report for 1955 upon work under the Housing Acts, the Health Inspector-in-charge of housing work stated: "The survey of older properties in the borough, started during 1954, was completed early in the year. In cases where action was found to be necessary, a classification was made under the Housing Act, 1936 indicating that 667 properties required repair and 159 properties closure or demolition. From this survey, together with previous knowledge and records in the department, the programme required by the Ministry of Housing and Local Government under the Housing Repairs and Rents Act, 1954 was compiled and recommended for action in the five years 1956-60. Under this 12 properties were regarded as fit for demolition as individual units, and 147 properties as fit for demolition in 10 clearance areas." Continuing on with clearance area work: Inspections of houses included in the clearance area programme for the years 1956/60 were begun. The selection of areas to be dealt with and the order of priority was based on knowledge available in the department in relation to degree of unfitness. As a result preliminary work was completed prior to representation under section 25 of two areas, with a total of 35 houses." In 1960 the Health Inspector concerned with housing was able to report that "The last group of houses in the Council's clearance area programme for 1956/60 had been represented at the end of 1959. An additional group of three houses was represented during 1960 and 95 tion of the Clearance Orders made in each case was received from the Ministry of Housing and Local Government. Consideration was given during the year to the clearance programme for 1961/65 and a large number of houses which were thought to be of a suitable type were inspected. From these a combined programme part of which will be dealt with by the London County Council was evolved. It is becoming increasingly difficult in the borough, to find the type of house which is obviously worn out and beyond repair as was the case about ten years or more ago. One can visualise that, as the general standard improves so will sights be set higher and houses which get by as borderline now will be considered to be well below standard". A most notable event was the coming into operation of the Rent Act, 1957 with consequent effects on certain aspects of housing work. In some instances the provisions of this Act showed undoubted benefits, but in one respect it would appear to be somewhat retrogressive. "Because of the new rent limits, it was found that the 'reasonable' cost of carrying out repairs to individual unfit properties was more likely and therefore the latter half of the year saw a decline in the proportion of cases where it was necessary to recommend action for possible demolition or closure. Again, because of the new rent limits, owners were encouraged to submit offers to make fit for habitation houses which had been previously subject to preliminary action leading to demolition or which had been closed. Thus many properties which, although in disrepair, had a reasonably long life were brought up to a good standard and in several instances houses which had been vacated were eventually re-occupied. "The unfortunate feature of the new Rent Act has been a reduction in the number of enquiries and applications for improvement grants for conversions of larger properties into self-contained flats. This is thought to be due to the discouraging effect of the new rent limits specifically applied to these cases by the Act. Conversions carried out under this scheme prior to the 1957 Rent Act, when the rents were fixed by the Council, attained a very good standard because owners made improvements beyond the minimum required, thus adding to the comfort and convenience of the tenants. The rent limits now allowed by the Act, namely twice the gross assessment, are much below the figures previously fixed by the Council for accommodation of a comparable size. It is thus thought that because of the relatively high cost of conversion, together with in many cases extensive maintenance work, owners will find it uneconomic to carry out work to the standard so far attained. The result may be that expenditure will be cut to a minimum, with a consequent lowering of standards, or worse still, owners may not be in a position to carry out conversions at all. Discretionary Grants and Standard Grants Standard grants—given for the establishment of certain facilities otherwise lacking—are equivalent to 50 per cent, of the cost, with maxima of £25 for a bath or shower, £5 for a wash-hand basin, £75 for a hot water supply, £40 for a w.c. and £10 for a food store. The largest possible grant is therefore £155. These grants are made under the House Purchase and Housing Act, 1959, and during the year 21 applications were investigated and reported on. 96 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 arc 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. The Housing Act, 1961 amended the House Purchase and Housing Act 1959 so that, where improvements are made with the aid of a standard grant, the water closet must now wherever practical be internal. This brings the two forms of grant into line with regard to this amenity. The interest in discretionary grants in 1961 declined somewhat compared with 1960, especially during the last quarter of the year while, on the other hand, there was a small increase in the number of applications for standard grants. The latter form of grant enables the owner of a house which has some of the necessary amenities to obtain assistance in providing the remainder however small the cost, whereas the discretionary grant requires that the work shall cost at least £100. Both forms of grant require that any repairs that are necessary to make the house fit shall be carried out, the requirements being more stringent in the case of discretionary grants. The majority of applications come from owner-occupiers, but now that the permissible rent increase for improvements has been raised from 8% to 121%, more owners of tenanted property may be encouraged to take advantage of the scheme. With regard to the volume of work involved in dealing with the Council's house purchase loans it only needs mention that in 1959 approximately 600 properties, a record number, were surveyed and reported on by the inspectors during the year for house purchase loans made by the Council. In many of these cases schedules of work were agreed and the repairs supervised and approved in order to make the premises "in all respects fit for habitation" as required by s.43 of the Housing (Financial Provisions) Act 1958 under which loans are made. This work increased year by year and in 1963, 958 cases were dealt with. Moveable dwellings During 1962 the overall position in London as far as homeless families were concerned became acute and in an effort to ameliorate this, the County Council decided 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. This outline of housing work must of necessity be incomplete, but it is hoped that it will give an indication of some of the factors that the Health Department has to deal with. Housing work is very complex and there is an ever growing tendancy for some public health inspectors to specialise in this field. The Housing Act of 1964 has greatly extended the powers available, particularly in connection with compulsory improvements dealing with houses in multi-occupation and developments to the improvement grant schemes with a view to making them more attractive. 97 Food and drugs In 1902 the Medical Officer of Health who was also the public analyst commenced dealing with articles in his newly completed Laboratory. During the year he reported that of 228 samples of milk analysed 47 were adulterated (20.6%), and of 149 samples of butter 15 (101%) were adulterated. Needless to say, the offenders were proceeded against and numerous fines and cautions were imposed by the magistrates concerned. Food sampling continued through the years, and the M.O.H. as the Public Analyst reported upon many thousands of samples until the time of his retirement in 1927. As an example of the samples submitted to Dr. Wellesley Harris for examination, the statistics below are extracted from the doctor's last Annual Report. Sale of Food and Drugs Acts Four hundred and seventy-three samples were taken under the Sale of Food and Drugs Acts, and submitted to the Public Analyst during the year. Of this number 368 were purchased officially in conformity with the provisions of the Acts, and the remaining 105 were bought informally as "test" samples. Twelve or 3.2 per cent, of the official samples were certified by the Public Analyst as being adulterated, or below legal standard, compared with 1.1 per cent. in 1926 The following Table shows the nature and number of samples analysed, and the number found to be adulterated Table 75 Article submitted for Analysis No. of Samples Submitted Number Genuine Number Adulterated Official Samples Milk 364 352 12 Separated Milk 4 4 — Total Official Samples 368 356 12 Informal Samples Butter 20 20 — Cream 15 15 — Cocoa 10 10 — Coffee 19 19 — Camphorated Oil 3 3 — Flour 10 10 — Lard 12 12 — Mustard 9 9 — Medicinal Prescriptions 3 3 — Salmon and Shrimp Paste 1 1 — Tincture of Bark 3 3 — Total Informal Samples 105 105 Totals, all Samples 473 461 98 Milk.—364 samples of milk were submitted for analysis and of this number twelve or 3.2 per cent. were certified as adulterated or below the standard fixed by the Board of Agriculture and Fisheries. The average composition of these milk samples is set out below:— Table 76 Period Average Composition of all Samples submitted. Genuine and Adulterated Average Composition of CenuineSamples Board of Agriculture Standard Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. First Quarter 3.44 8.94 3.46 8.97 3.0 8.5 Second 3.36 8.86 3.37 8.86 Third 3.44 8.85 3.46 8.86 Fourth „ 3.44 8.88 3.47 8.88 Average for the Year 3.42 8.88 3.44 8.89 By the early nineteen twenties the number of cowsheds or cowhouses in the Borough was gradually diminishing, there being 11 licensed with a total of 428 cows in 1914 and in 1919 6 cowsheds and 270 cows. The increasing urbanisation accounted for this. This trend continued after the war, and for many years now there have not been any cowsheds or cows kept within the Borough boundaries. The number of slaughterhouses too has lessened, there being 12 in 1919 and none in 1961. The colouring of milk a practice which is illegal nowadays was quite common at the beginning of the century and was commented on in the reports for 1908. "Of the milks examined during 1908, 51.5 per cent were artificially coloured compared with 66.4 per cent in 1907 and 77.4 per cent in 1906. From these figures it would appear that the practice of colouring milk with various colouring matters to suit the demands of the public is slowly decreasing in this Borough, Annatto is the material most commonly used, but aniline dyes are not infrequently reverted to". As can be seen from the following table the adulteration of milk dramatically decreased through the years until in recent years it appeared to increase. The explanation for this is simple, and was not harmful. A number of samples of hot milk were taken from cafes during this period when the practice of heating milk by steam injection was in vogue. This method raised the water content of the milk to an illegal extent. After a number of prosecutions the practice ceased as far as this Borough was concerned. Nowadays it is usual for milk in cafes to be heated by air injection. 99 Adulteration of Milk 1905 to 1964 Table 77 years No. of samples taken Number adulterated Percentage adulterated 1905—1909 1,239 101 7.6 1910—1914 1,455 87 6.0 1915—1919 341 (war years) 13 3.8 1920—1924 1,973 65 3.3 1925—1929 1,876 52 2.8 1930—1934 1,176 27 2.3 1935—1939 560 5 0.9 1940—1944 Figures not available (war yea rs) 1945—1949 348 Nil 0.0 1950—1954 462 8 1.7 1955—1959 542 15 2.8 1960—1964 432 Nil 0.0 There is no doubt that the setting up of the Milk Marketing Board in 1933 had a salutary affect upon the milk produced in this Country, as of course had the mass of legislation relating to milk and milk products. Today, it can probably be said that we enjoy in this country the highest standard of milk purity and quality in the World. Public Health (Milk and Cream) Regulations None of the samples of milk were reported as containing any preservative or colouring matter. Seven samples of preserved cream were submitted and in each instance the statement as to the preservative on the declaratory label was correct. The percentage of preservative found in each sample of Preserved Cream was as follows:— Table 78 Sample Marked No. Percentage of Preservative Remarks 287 030 per cent Boric Acid Sold as Preserved Cream and labelled in accordance with the Regulations. 288 0.25 291 0.35 293 0.30 447 0.30 449 0.35 452 0.30 After 1927 samples were submitted to a public analyst appointed by the Council, a practice which has continued ever since. The amount of adulteration found was generally very low, and many of the offences were improper labelling or insufficiency of a particular ingredient, rather than deliberate adulteration. This is a tribute to the high standards insisted upon in this country, enforced by Act and Regulation, and the vigilance of the food inspectors. A copy of the latest report will be found on page 42. F. R. WALDRON, Medical Officer of Health. 100 APPENDIX A Acts of Parliament, Statutory Instruments and Circulars issued by Government Departments with regard to the public health services during the year 1964:— Statutes— Housing Act, 1964 Statutory Instruments The Meat (Treatment) Regulations 1964 The Slaughter of Animals (Prevention of Cruelty) Regulations (appointed Day) Order 1964 The Slaughterhouses (Hygiene) Regulations (appointed Day) Order 1964 The Weights and Measures (Equivalents for dealing with drugs) Regulations 1964 The Offices, Shops and Railway Premises Act, 1963 (Commencement No. 1) Order 1964 The Slaughter of Animals (Prevention of Cruelty) Regulations (appointed Day No. 2) Order 1964 The Slaughterhouses (Hygiene) Regulations (appointed Day No. 2) Order, 1964 Shops and Offices: The Notification of Employment of Persons Order 1964 The Soft Drinks Regulations, 1964 The Factories Act, 1961 (appointed Day) Order 1964 The Dried Milk Regulations 1964 The Poisons List Order, 1964 The Poisons Rules, 1964 The National Health Services (Qualifications of Health Visitors) Regulations, 1964 Offices, Shops and Railway Premises First Aid Order 1964 Offices, Shops and Railway Premises Prescribed Dangerous Machines Order 1964 Offices, Shops and Railway Premises Act, 1963 (Exemption No. 1) Order 1964 The Washing Facilities Regulations, 1964 The Sanitary Conveniences Regulations 1964 Consumer Protection: The Children's Nightdresses Regulations, 1964 The Mineral Hydrocarbons in Food Regulations 1964 The Offices, Shops and Railway Premises Annual Reports Order 1964 The Offices, Shops and Railway Premises Act, 1963 (Commencement No. 2) Order 1964 The Offices, Shops and Railway Premises Act, 1963 (Exemption No. 2) Order 1964 The Slaughter of Animals (Prevention of Cruelty) Regulations (appointed Day —No. 4) Order 1964 The Slaughterhouses (Hygiene) Regulations (Appointed Day—No. 4) Order 1964 Ministry of Health Circulars No. 3 National arrangements for dealing with incidents involving radioactive substances 6 Health Education 12 Change of address of certain of the Ministry's Branches 13 Development of Local Authority Health and Welfare Services 22 Food and Drugs Act, 1955, Procuring Samples of Drugs 101 Ministry of Housing and Local Government Circulars No. 46 Housing Act, 1964, Section 95; Amendment of the Clean Air Act, 1956 51 Housing Act, 1964; Part IV. Houses in Multiple occupation 60 Clean Air Act, 1956; Housing Act, 1964, Designation of Direct Acting Electric Space-Heaters Ministry of Labour Circulars No. 1 Offices, Shops and Railway Premises Act, 1963. Commencement Order Home Office Circulars No. 233 Authorised Testing Laboratories for the purpose of the Children's Nightdresses Regulations 1964 Ministry of Agriculture, Fisheries and Food Circulars No. 1 The Meat (Treatment) Regs. 1964 3 Milk and Dairies (General) Regs. 1959. Approved Chemical Agents. 4 Public Health (Imported Food) Regs. 1937 and 1948 Singapore; Official Certificate 5 Public Health (Imported Food) Regs. 1937 and 1948 Roumania; Official Certificate 6 Public Health (Imported Food) Regs. 1937 and 1948 United States of America; Official Certificate 7 Soft Drinks Regulations, 1964 8 Public Health (Imported Food) Regs. 1937 and 1948 Austria; Official Certificate 9 Dried Milk Regulations 1964 10 Public Health (Imported Food) Regs. 1937 and 1948 Argentine, Brazil, Paraguay and Uruguay; Official Certificates 11 Public Health (Imported Food) Regs. 1937 and 1948 Argentine Republic; Official Certificate 12 Milk and Dairies (General) Regs. 1959, Approved Chemical Agents 13 The Slaughter Houses (Meat Inspection Grant) Regs. 1958 14 Mineral Hydrocarbons in Food Regs. 1964 15 Antibiotics in Milk 16 Public Health (Imported Food) Regs. 1937 and 1948 Ethiopia; Official Certificate 17 Public Health (Imported Food) Regs. 1937 and 1948 Brazil: Official Certificates 18 Public Health (Imported Food) Rega, 1937 and 1948 Argentine Republic: Official Certificate 19 Public Health (Imported Food) Regs. 1937 and 1948 New Zealand: Official Certificate 21 Milk and Dairies (General) Regs. 1959 Approved Chemical Agents 22 Public Health (Imported Food) Regs. 1937 and 1948 Hong Kong: Official Certificate 23 Public Health (Imported Food) Regs. 1937 and 1948 Brazil: Official Certificate 24 Public Health (Imported Food) Regs. 1937 and 1948 United States of America: Official Certificate 26 Public Health (Imported Food) Regs. 1937 and 1948 Austria: Official Certificate 25 Milk and Dairies (General) Regs. 1959. Approved Chemical Agents 102 General Register Office Circular No. MOH 3 Annual Reports of Medical Officers of Health, 1964:—Vital Statistics APPENDIX B Legal Proceedings, 1964 The following are details of legal proceedings during the year:— Nature of summons No. Total fines Total costs Remarks Public Health (London) Act 1936 Non-compliance with Nuisance Notices 15 £ s. £ s. 55 0 27 6 5 summonses withdrawn (work completed); 9 Abatement orders made London County Council Byelaws Street vehicle for carrying offensive matter not properly covered 1 5 0 Water closet byelaws 2 2 2 1 summons withdrawn (work done) Drainage byelaws 2 7 0 3 3 London County Council (General Powers) Acts Caravans on unlicensed sites 25 77 0 5 summonses withdrawn (caravans removed from site) Food and Drugs Act, 195S Section—2 12 110 0 25 2 103 INDEX SUBJECT PAGE Acts, regulations and orders 100 Anti-fly and anti-mosquito campaign 15 Area of borough 4 Atmospheric conditions 22 Atmospheric pollution 21 Bathing attendants 25 Births and birth rate 4 Burnt Ash centre 24,76 Cancer of lung 11,58 Care of the elderly 24 Clean Air Act 21, 88 Clearance areas 37 Clubs for the elderly 27 Consumer Protection Act 30 Continental Goods Depot 44 Coronary disease 10 Creches 62 Deaths and death rate 4 Deaths, cause of 6 Discretionary grants and standard grants 38 Disinfection and personal cleansing 14, 86 Dog nuisances 19 Dysentery 47 Environmental health 78 Factories 30,81 Flies and mosquitoes 15 Food, adulteration of 42,97 Food Hygiene Regulations 44 Food inspection and supervision 40 Food poisoning 50 Food premises—registration 43 General statistics from 1901 12 Hairdressers 30 Health centre 66 Health education 15 Health Services, general provision of 14 Health visitors 65 Heart disease 10 Heattreated milk 40 Historical Account 54 Holidays 25 Home helps 68 Home safety 78 House purchase loans 38 Housing:— Building 36 Families rehoused 36 Housing Act, 1957 36 Housing, historical 89 Icecream composition 41 Icecream grading 41 Immunisation 53 Infant mortality 4 Infectious diseases 45,54 SUBJECT PAGE Laboratory facilities 17 Laundry service 72 Legal proceedings 102 LCC (General Powers) Act, 1953 section 43 15 LOPWA 71 Mass miniature radiography 51 Maternal deaths 5, 64 Maternity and child welfare 59 Maternity home 63 Meals for the elderly 24 Measles 48 Milk, analysis of 40,98 Milk and Dairies Regulations 40 Milk, special designations 40 Mortuary and Coroner's Court 16 Moveable dwellings 96 National Assistant Act, 1948 s. 50 19 s. 47 19 Notification of births 62 Offensive trades 44 Old People 24, 69 Outworkers 32 Pet animals 30 Pharmacy and Poisons 44 Pigeons 34 Pneumonia 48 Poliomyelitis 47 Population 4, 54 Prevention of Damage by Pests 17, 86 Rag flock, etc. 34 Rateable value 4 Rent Act 38 Repairs carried out 29, 81 River pollution 80 Rodent control 17 Sampling 42 Sanitary circumstances of the area 28 Saville, The 24, 76 Scarlet fever 48 Sickness, local 9 Slaughterhouses 44, 79 Smoke nuisances 28 Social medicine statistics 8 Staff 2 Stillbirths 4 Swimming baths 18 Tuberculosis 48, 56 Unsound food 44 Vaccination 53 Vital statistics 4 Water certificates 30 Water supply 20 Welfare of the people 54 Whooping cough 48 Workshop for the elderly 24 104 TABLES TABLE NO. SUBJECT PAGE TABLE NO. SUBJECT PACE 1 Comparative statistics 5 44 Tuberculosis—environmental conditions 50 2 Causes of death by age groups 6 45 Food poisoning cases 50 3 Deaths by social class 8 46 Mass Radiography 51 4 Grouped causes of death bv social class 9 47 Mass Radiography—surveys 52 5 Morbidity 9 48 Immunisation against infectious disease 53 6 Heart and circulation mortality 10 49 Deaths from infectious diseases, 1903 56 7 Lung cancer 11 8 General Statistics 12 50 Methods of feeding infants, 1904 59 9 Disinfecting station 14 10 Verminous conditions, etc 14 51 Visits of health visitor 1914 62 11 Public mortuary 16 12 Rodent control—treatment of rivers 17 52 Attendances at Voluntary Infant Welfare Centres 1919 63 13 Prevention of Damage by Pests Act 17 53 Maternal mortality, 1919 64 14 Laboratory facilities 18 54 Visits of health visitors 1925 65 15 Swimming Baths 18 16 Water, chemical samples 20 55 Laundry service 1951/57 73 17 Water, Bacteriological samples 20 56 Laundry service—age groups 1951/57 73 18 Smoke Control Areas 21 57 House to house inspections, 1901 79 19 Atmospheric conditions 22 20 Old People's visits 26 58 Workshops, 1901 79 21 Sanitary inspection 28 59 Register of sanitarv work, 1901 79 22 Summary of notices 29 23 Repairs carried out 29 60 Sanitary inspections, 1931 81 24 Factory inspections 31 61 Sanitary inspections, 1938 81 25 Factory defects 32 62 Sanitary improvements, 1938 81 26 O.S.R. Registrations and general inspections 33 63 Factories and workshops, 27 Persons employed in registered premises by work place 34 64 defects, 1905 Workshops and workrooms, 1905 82 82 28 Demolition orders 36 65 Workshops on register, 1922 83 29 Closing orders 37 30 Clearance areas 37 66 Factories on register, 1922 84 31 Rent Act, 1957 38 67 Domestic workshops on register, 1922 84 32 Analysis of milk 40 33 Icecream composition 41 68 Outworkers on register, 1922 84 34 Icecream grading 41 35 Samples analysed 42 69 Factories and workshops —inspections, 1922 85 36 Adulterated samples 42 37 Continental Goods Depot 44 70 Factories and workshops, defects, 1922 85 38 Notified cases of infectious diseases 45 71 Destruction of rats and mice, 1951 86 39 Notifications of infectious diseases by age and sex 46 72 Disinfection, 1912 87 73 Rehousing, 1947 93 40 Analysis of certain diseases into divisional areas 47 74 Slum Clearance Programme 1951/55 94 41 Tuberculosis notifications and deaths 48 75 Samples analysed, 1927 97 76 Milk samples, 1927 98 42 Analysis of new cases of tuberculosis into divisional areas 49 77 Adulturation of milk 1905/ 1964 99 78 Preserved cream, 1927 99 43 Tuberculosis 10 year statistics 49