BOROUGH OF BARNES ANNUAL REPORT OF THE Medical Officer of Health For the Year 1956 BOROUGH OF BARNES THE ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1956 ROSETTA HILL, MB., B.Ch., D.P.H. Medical Officer of Health, 3 BOROUGH OF BARNES. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health:— Rosetta Hill, M.B., B.Ch., D.P.H. Chief Public Health Inspector:— William L. Leach, DPA. (London), MA.P.H.I.*†‡ Deputy Chief Public Health Inspector:— P. J. Shannon, M.A.P.H.I. *† District Public Health Inspectors:— F. A. Sadler, M.A.P.H.I. *†‡ B. Berry, M.A.P.H.I. *† C. E. Mallett, M.A.P.H.I. *† * Certificate of Public Health Inspectors' Board (formerly R.S.I, and J.S.I.B.). †Certificate of Royal Society of Health as an Inspector of Meat and Other Foods. ‡ Certificate of Sanitary Science as applied to Buildings and Public Works. Clerical Staff:— Miss L. M. Fairclough. Mrs. J. D. Wallis. J. M. Shearer. Public Analyst:— D. D. Moir, Esq., M.Sc., F.R.I.C. PUBLIC HEALTH COMMITTEE 1956-1957. Councillor F. R. Cooper (Chairman) Alderman E. S. Stevens (Deputy Chairman) The Mayor (Councillor F. A. Counter) Alderman H. Thomas Councillor E. S. Bolton Councillor Miss E. P. Clarke Councillor F. A. Coldman Councillor I. C. Elvey Councillor W. A. Hornshaw Councillor Mrs. M. E. Hull Councillor W. J. Irwin Councillor A. G. Lawrance Councillor D. Lee Councillor F. W. Moore Councillor R. F. Wilson 4 Public Health Department, Municipal Offices, Sheen Lane, S.W.14. To the Mayor, Aldermen and Councillors of the Borough of Barnes. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1956. In accordance with the Ministry of Health Circular 19/56, the report has been prepared on the same lines as previous years, and consists of two parts— a preface in which reference is made to items of special interest, and an appendix in which is tabulated the statistics relating to the health of the district. During the year the health of the Borough has been good and the incidence of infectious disease low. From a public health point of view, the most notable event of the year was the introduction of vaccination against Poliomyelitis for the first time in this country. The supplies of vaccine were very limited and only a small proportion of the registered children could be vaccinated. It is possible that this is the beginning of a scheme which when it gains momentum' may provide the protection against poliomyelitis that immunisation has given against diphtheria. In presenting this report I should like to thank the Council for their help and support in public health matters and record my appreciation of the good work and1 loyal co-operation of the staff. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, ROSETTA HILL, Medical Officer of Health. August, 1957. 5 BOROUGH OF BARNES. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 PREFACE The Registrar General supplies local authorities with "Comparability Factors" in respect of births and deaths, and you will see that these have been used in the compilation of the various statistics. I would explain that the use of the factors supplied by the Registrar General give corrected figures to the local rates, enabling truer comparisons to be made with the remainder of the country—i.e. as though the ages and sexes of the local population were in the same proportion as those for the whole country. STAFF AND DUTIES Mr. Bernard Berry resigned from the position of Public Health Inspector on 30th April, 1956 to take up an appointment with another authority. The vacancy was filled by Mr. C. E. Mallett, who commenced duties on 10th December, 1956. There were no other changes in the staff of the Public Health Department during the year. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES Generally The incidence of infectious disease during the year was very low. There were 8 cases of Scarlet Fever notified during the year, as compared with 7 in 1955. There was a marked reduction in the number of cases of Whooping cough— 17 being notified as compared with 42 in the previous year. 1956 was the inter epidemic year for measles, and only 16 cases occurred. In the epidemic of the previous year there were 489 cases notified. There were no cases of Diphtheria. Poliomyelitis There were 6 cases of Poliomyelitis notified during the year —of these 4 were Paralytic and 2 Non-Paralytic. Two of the Paralytic 6 cases were not severe and made a complete recovery but the other two cases were of greater severity and required prolonged treatment in hospital. Three of the notified cases occurred in January, and the other three during the summer and autumn months. None of the notified cases had been vaccinated against Poliomyelitis. Tuberculosis The number of new cases of Pulmonary Tuberculosis continues to fall; there were 18 notified during the year as compared with 23 cases in the previous year. The number of new cases of Non-Pulmonary Tuberculosis was the same as in 1955 — viz. 3 cases. Death Rate There were 4 deaths from Pulmonary Tuberculosis during 1956. Six persons who had been notified as suffering from Pulmonary Tuberculosis died during the year—of these 4 died from that cause and the remaining two were due to other causes. Mass Radiography Unit Arrangements were made for the Mass Radiography Unit of the South West Metropolitan Regional Hospital Board to visit the Borough from 3rd to 20th April to afford facilities for X-ray of the chest for anyone wishing to attend. Besides sessions for the general public, special sessions were held for the staffs of business houses and large firms. The unit was based in the Public Health Department, and the visit was widely publicised. The numbers attending were not so good as on the previous visit. It seems that too few people realize that an annual chest X-ray is a most important check up on health. I give below a brief summary of the findings of the survey:— Male Female Total Total number X-rayed 1356 1389 2745 Pulmonary Tuberculosis Active — 3 3 Pulmonary Tuberculosis Inactive 62 67 129 Non-Tuberculosis abnormalities 50 20 70 Maternal Mortality There were no maternal deaths recorded during the year. Infant Mortality Rate The number of deaths of infants under one year was the same as last year — viz. 5 deaths. The infant mortality rate for this area is 10.5 per 1,000 live births. 7 REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION, Section 47, National Assistance Act, 1948 Under the above Section the Medical Officer of Health has power to apply to the Courts for an order of compulsory removal of persons to hospital or other suitable accommodation in circumstances where they (a) are suffering from grave chronic disease or being aged, infirm or physically incapacitated are living in insanitary conditions and (b) are unable to devote to themselves and are not receiving from other persons proper care and attention. There were 9 cases reported during the year of old people in need of care and attention. In no case was it necessary to take action under Section 47, of the National Assistance Act. Co-operation with Kingston Hospital remains very good ; the situation as regards admission of urgent cases to hospital is much improved, as the Geratrician visits the patients in their homes to assess their need for admission. The County Welfare Department is always most helpful in providing residential accommodation for suitable cases. Dysentery During 1956 there were 4 cases of Dysentery notified; the infecting organism was Shigella Sonne. FOOD POISONING It is very satisfactory to note that there were no cases of Food Poisoning notified during the year. FOOD The implementation of the provisions of the Food Hygiene Regulations has taken up a considerable amount of time. The requirements necessary to facilitate the hygienic handling of foodstuffs are now more clearly and specifically defined but public health officers are once more up against the thorny old question as to what is reasonable and sufficient under varying sets of circumstances. Reasonable protection against contamination is called for under the Regulations. Certain natural commodities, such as tomatoes, dessert apples, peaches, grapes etc., are in contact with contaminating materials during their growth and handling for market and it is difficult to maintain that handling with dirty hands will add much to existing contamination. However, other 'open' foods such as boiled ham, tongue and prepared meats, are still being handled in premises where hand-washing and storage facilities are remote and comparatively primitive. To provide proper facilities in a reasonably convenient and accessible position will present difficulties and expense in many cases. However, it is quite clear that traders rarely take the initiative in providing these facilities and now 8 that the Regulations have become sufficiently well known the Public Health Committee will shortly be giving further consideration to the question of establishing proper standards for the provision of washing facilities and for the storage, handling and display of susceptible foods. Of course the increasing trend to the pre-packing of all articles of food, especially in 'self service' shops, has helped considerably to reduce the unnecessary handling of food. The quantity of unsound food brought to the notice of the department has again decreased. Traders seem to have reverted to the prewar practice of dealing with claims for damage and loss within the framework of ordinary wholesale trading methods. The quality and soundness of food generally has been maintained at a satisfactory level. There is still, however, an element of sharp practice in connection with the labelling of food, especially that sold in packets. Many of these articles, however, are sold on a nation wide scale and it is an unsatisfactory feature of this type of food sampling that local authorities of all sizes and localities should each have to follow their own individual enforcement policies and procedure, restricted by slender financial and staffing resources, often without any co-ordination of effort or policy. Whilst each local authority is free to indulge in its own particular policy of sampling and thereby, perhaps, keep a certain amount of local interest and initiative, nevertheless, there must be a good deal of overlapping and waste of effort. The proper examination of food samples and the checking of the claims made by manufacturers on labels and advertisements is an expensive business and it does appear that more co-ordination is called for than at present exists. HOUSING Progress on the demolition or closing of sub-standard property has been made but only at a slow rate because of rehousing difficulties. However with the development of Westfields and other sites in the Borough it is hoped to clear off the arrears of this type of work within the next two to three years. With the advent of the latest Rent Act the problem of dealing with unfit houses which do not warrant demolition or closing has taken on a new aspect. With the old rent levels the estimated costs of repairs very soon soared above what was considered to be a 'reasonable expense' having regard to the existing and expected income from the house. With the more realistic rents now to be charged the expected yields from property will now be sufficient, in most cases, to cover the cost of substantial reconditioning. As soon as the position has settled down it will once again be reasonable to commence house to house surveys in those areas where years of neglect have brought the standards of repair to a low level. Notices can then be served and whole blocks of house property dealt with in a systematic manner. 9 There is considerable confusion in the minds of tenants about the procedure for the enforcement of repairs. Under the Rent Act a tenant of controlled property may take action to have his rent reduced if repairs are not done. Neither the tenant nor the local authority can compel the owner to do repairs under the Rent Act. Repairs can however be enforced under the Housing or Public Health Acts. Unfortunately the standard of repair expected under the Rent Act is quite different to the standard enforceable under the Housing and Public Health Acts. For instance such items as external painting, broken wash basins and defective electrical circuits are all items which may well be included in a certificate of disrepair under the Rent Act, but which could not form the subject of notices under Housing Act procedure. Many tenants are obviously bewildered by the complicated procedure for abatement of rent on account of disrepair but if they take advantage of the shorter procedure of complaining to the department with a view to the service of enforcement notices they may well find that the prescribed standard of 'fitness' falls far short of what they expect. It remains to be seen whether owners of the older type of property, obsolete in design but capable of repair up to the Housing Act standard, will be prepared to sink, say, ten years rent, in what must still be a doubtful investment, having in mind the improved standards envisaged when the present housing programme is completed. SANITARY CIRCUMSTANCES There have been no problems under this heading calling for special mention. As a result of labour difficulties it was not possible to carry out the usual half yearly treatments of the sewers for the destruction of rats. It remains to be seen whether the expected build up in the rat population will prove to be excessive when baiting is resumed. ATMOSPHERIC POLLUTION The Council has been one of the Co-operating Bodies in the Investigation of Atmospheric Pollution for some years but more practical measures were put into operation during the year by the installation of apparatus, to measure the extent of pollution, at three sites in the Borough. At two of these sites, one at East Sheen and the other at Castelnau, deposit gauges and lead peroxide instruments measure the amount of liquid and solid matter deposited over a period of one month, and also show the concentration of sulphur dioxide in the atmosphere over the same period. At the Civil Defence Training Centre other apparatus has been set up which continuously samples the atmosphere. Daily measurements are recorded showing the amount of 'Smoke' in the atmosphere and also the amount of sulphur dioxide. Although this apparatus has not been functioning long enough yet to 10 provide fully comparative readings, it is already abundantly clear that by far the largest amount of pollution in this district is coming from domestic firegrates in the winter months. The results are forwarded to the Department of Scientific and Industrial Research, Fuel Research Station, where similar records from other local authorities who are co-operating in this type of work are received and collated. No actual steps have so far been taken towards the establishment of Smoke Control Areas but informal exploratory talks with neighbouring local authorities are being planned. There have been very few complaints of specific cases of smoke nuisance. The number of solid fuel burning appliances in use by industrial firms is being steadily reduced as plant wears out and requires modernisation. The measures taken at our own Refuse Destructor to alleviate smoke nuisance have proved very effective. It is interesting to note that an average of two to three tons of grit and dust is recovered every week, which formerly found its way up the chimney. Work on the modernisation of equipment at the Crematorium, to obviate smoke nuisance, has unfortunately been considerably delayed but it is hoped that the new apparatus now being installed will soon be functioning satisfactorily. SEWERAGE AND SEWAGE DISPOSAL Arrangements for sewerage and sewage disposal have remained the same as in previous years. The new disposal works are now functioning well and only isolated complaints have been received during particularly adverse weather conditions. The Borough Engineer and Surveyor has kindly contributed the following comments:— "Since the original drainage scheme was carried out in 1888 the sewerage system has had to be greatly extended. In some areas it will be necessary to relay some of the older sewers where they are no longer adequate for the increased volume of sewage." An extensive survey of these areas is being undertaken by the Borough Engineer in order that improvements to the sewerage system can be designed. BOROUGH OF BARNES APPENDIX to the ANNUAL REPORT of the Medical Officer of Health 1956 15 STATISTICS AND TABLES BOROUGH OF BARNES. VITAL STATISTICS The following statistical information relating to the Borough has been completed on receipt of the Local and National Statistics issued by the Registrar-General in connection with Population, Birth-rate, Death-rates, Maternal Mortality, Infantile Mortality, and Incidence of Notifiable Infectious Disease. Members of the Armed Forces stationed in the area are now included in the population figures, also in the Birth and Death Rates. TABLE 1.—STATISTICAL SUMMARY, 1956 Population:— Census, 1931 42,440 Census, 1951 40,558 Estimated—Mid-year, 1956 (Registrar General) 40,140 Births:— Birth-rate (per 1,000 of population) Uncorrected 11.8 Corrected (Registrar General's Comparability Factor 1.00) 11.8 Live Births:— Total. M. F. Legitimate 454 246 208 Illegitimate 21 12 9 Total 475 258 217 Still Birth-rate (per 1,000 total births) 18.9 Total. M. F. Still Births (Legit. 9) 9 6 3 Deaths:— Death-rate, all causes (per 1,000 of population) Uncorrected 13.0 Corrected (Registrar General's Factor 0.80) 10.4 Total. M. F. Deaths (all causes) 522 264 258 Death-rate from Cancer (per 1,000 of population), 100 deaths 2.5 Death-rate from Zymotic (Epidemic) Diseases (per 1,000 of population) 0.07 Death-rate from Maternal Causes (per 1,000 total births) Pregnancy; Child-birth - Death-rate of infants (per 1,000 live births) (a) Under 4 weeks of age (3 deaths) 6.3 (b) Under 1 year (5 deaths) 10.5 Death-rate for Legitimate infants (5 deaths) 10.5 16 COMPARATIVE BIRTH & DEATH RATES 17 Table 2.—Vital Statistics of the Borough of Barnes during 1956 and previous 5 Years Year Registered Births Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District Uncorrected Number Nett Of nonresidents registered in the District Of residents registered outside the District Under 1 year of age At all ages Number Rate Number Rate Number Rate per 1,000 nett births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 1951 452 430 10.5 322 8 0 43 226 11 25.5 513 12.6 1952 443 419 10.4 350 8.7 59 218 13 31.0 508 12.6 1953 453 434 10.8 387 9.6 17 194 10 23.0 564 14.1 1954 423 407 101 344 8.6 30 207 9 22.1 521 13.0 1955 455 430 10.7 334 8.3 20 218 5 11.6 532 13.2 1956 492 475 11.8 345 8.6 29 208 5 10 5 524 13.05 18 Table 3.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1956, with corresponding rates for England and wales, 160 great towns, 160 smaller towns, and for the County of London for comparison. BirthRate per 1,000 Total Population Annual Death-rate per 1,000 Population Death-rate per 1,000 Births Maternal Mortality Rate per 1,000 Total Births All Causes Typhoid & Paratyphoid Whooping Cough Diphtheria Tuberculosis Influenza Small-pox Poliomyelitis Enceph Pneumonia Diarrhoea and Enteritis (under 2 years) Total Deaths under One Year Total Maternal Mortality Maternal causes (excluding abortion) Due to Abortion England and Wales 15.6 11.7 0. 00 0.00 0.00 0.12 0.06 - 0.00 0.52 0.51 23.8 0.56 N.A. N.A. 160 County Boroughs and Great Towns, including London 15.6 11.6 0.00 0.00 0.00 0.14 0.04 - 0.00 0.57 - 24.0 Not avail able 160 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1951) 15.6 11.6 0.00 0.00 0.00 0.11 0.05 - 0.00 0.45 - 24.1 London 15.9 11.7 - 0.00 0.00 0.14 0.04 - 0.00 0.67 0.00 21.4 0.51 0.30 0.21 Barnes Borough 11.8 10.4 - - - 0.09 0.02 - - 0.58 - 10.5 - - - 19 Table 4.—Causes of Death during the Year 1956. Causes of Death (Registrar-General's short list of causes) Total Deaths Male Female 1 Tuberculosis, respiratory 4 3 1 2 Tuberculosis, other 1 - 1 3 Syphilitic diseases 5 5 - 4 Diphtheria - - - 5 Whooping Cough — - - 6 Meningococcal infections - - — 7 Acute poliomyelitis — - — 8 Measles - - - 9 Other infective and parasitic diseases - - — 10 Malignant neoplasm, stomach 20 12 8 11 Malignant neoplasm, lung, bronchus 20 19 1 12 Malignant neoplasm, breast 7 - 7 13 Malignant neoplasm, uterus 3 - 3 14 Other malignant and lymphatic neoplasms 53 22 28 15 Leukæmia, aleukæmia 4 2 2 16 Diabetes 4 3 1 17 Vascular lesions of nervous system 92 35 57 18 Coronary disease, angina 80 47 33 19 Hypertension with heart disease 11 6 5 20 Other heart disease 55 25 30 21 Other circulatory diseases 31 10 21 22 Influenza 1 1 - 23 Pneumonia 29 16 13 24 Bronchitis 24 15 9 25 Other diseases of respiratory system 2 2 - 26 Ulcer of stomach and duodenum 12 8 4 27 Gastritis, enteritis and diarrhoea 3 1 2 28 Nephritis and nephrosis 3 1 2 29 Hyperplasia of prostate 1 1 - 30 Pregnancy, childbirth abortion - - - 31 Congenital malformations 2 - 2 32 Other defined and ill-defined diseases 46 19 27 33 Motor vehicle accidents 1 1 - 34 All other accidents 7 2 5 35 Suicide 3 1 2 36 Homicide and operations of war 1 1 - All Causes 522 258 264 20 Table 5.—Infant Mortality during the Year 1956. Causes of death, at various ages, of infants under one year. Cause of Death Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 W'ks 1-3 Months 3-6 Months 6-9 Months 9-12 Months Total under 1 year Deaths in the Borough Deaths outside Borough Hydrops Foetalis 1 - - - 1 - - - - 1 - 1 Meningitis, Encephalocele - - - - - 1 - - - 1 - 1 Atelectasis 1 - - - 1 - - - - 1 1 - Staphylococcal Pneumonia — Fibrocystic disease of Pancreas - - - - - 1 - - - 1 - l Cerebral Hæmorrhage - 1 - - 1 - - - - 1 - 1 2 1 - - 3 2 - - - 5 1 4 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Incidence of Notifiable Infectious Diseases. Comparison between the incidence of certain of the notifiable infectious diseases in Barnes, and in London and England and Wales, is shown on next page. 21 Table 6. — Certain Infectious Diseases: Incidence per 1,000 of the Population in 1956. Disease Barnes London England and Wales Scarlet Fever 0.20 0.67 0.74 Diphtheria - 0.00 0.00 Enteric Fever — 0.02 0.01 Acute Pneumonia 0.60 0.50 0.57 Dysentery 0.09 1.95 1.10 Acute Poliomyelitis— Paralytic 0.10 0.05 0 04 Non-Paralytic 0.05 0.03 0 03 Food Poisoning - 0.40 0-24 Tuberculosis— Respiratory 1.17 1.11 0-71 Others 0.12 0.10 0.09 Table 7.—Notifiable Infectious Diseases, 1956. Diseases Total Cases Notified Ages, in years Parish Removed to Hospital Total Deaths of Residents † Under 1 year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 : 20 to 25 25 to 35 35 to 45 45 to 65 65 and over Barnes Mortlake Diphtheria - - - - - - - - - - - - - - - - - - Scarlet Fever 8 - - - 2 - 5 - 1 - - - - - 2 6 1 - Poliomyelitis—Paralytic 4 - - - - - - 1 - 2 1 - - - 1 3 4 - „ Non-Paralytic 2 - - - - 1 - 1 - - - - - - 2 - 2 - Measles 16 - 1 3 - 1 5 5 - 1 - - - - 4 12 4 - Whooping Cough 17 - - 2 1 - 11 2 - - - 1 - - 12 5 - - Pul. Tuberculosis 18 - - - - - - - - 2 6 - 5 5 4 14 - 4 Non-Pul. Tuberculosis 3 - - - - - - - - 2 1 - - - - 3 - - Acute Pneumonia 25 - - - - - 2 - 1 1 1 3 9 8 16 9 1 - Erysipelas 2 - - - - - - - - - - - 1 1 1 1 - - Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - 1 - - Meningococcal Infect'n - - - - - - - - - - - - - - - - - - Puerperal Pyrexia 3 - - - - - - - - 1 1 1 - - 1 2 1 - Typhoid - - - - - - - - - - - - - - - - - - Dysentery 4 - 1 - 1 - - - - - 1 - - 1 1 3 1 - Food Poisoning - - - - - - - - - - - - - - - - - - Para-Typhoid - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - 104 1 2 5 4 2 23 9 2 9 12 5 15 15 44 60 14 4 † The deaths recorded in this column are the total corrected number of deaths assignable to the District, and are not necessarily deaths of persons recorded as notified during the year. 22 Table 8. — Notifiable Infectious Diseases, 1946 to 1956. Year 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Diphtheria 5 2 3 - - - - - - - - Scarlet Fever 43 27 30 38 27 17 42 21 29 7 8 Typhoid Fever - - - 1 - 2 - - 1 - - Paratyphoid Fever 1 - - - 1 - 1 - - 1 - Puerperal Pyrexia 1 - - 1 1 - 4 1 - 3 i Erysipelas 5 10 10 8 4 2 8 7 2 1 I Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Typhus Fever - - - - - - - - - - - Small-pox - - - - - - - - - - - Cholera - - - - - - - - - - - Plague - - - - - - - - - - - Tuberculosis, Pul. 35 62 40 32 37 38 39 37 27 23 18 Non-Pul. 5 9 5 6 2 1 7 3 3 1 3 Ac. Encephalitis (Post Infections) 2 1 - 1 1 - - - - - - Poliomyelitis, Paralytic 1 4 4 10 1 - 8 3 1 7 4 „ Non-Paralytic - - - - - - - - - 1 2 Ophthalmia Neonatorum 2 2 1 - - - - - - - 1 Meningococcal Infect'n - - - - - 2 - - 2 - - Measles 177 437 158 588 124 541 249 306 5 489 16 Encephalitis Lethargica - - - - - - - - - - - Polioencephalitis - 1 - - - - - - - - - Malaria — - - - - - - 2 — 1 1 Dysentery 71 - 4 - 3 4 11 25 75 - 4 Pneumonia 19 16 20 21 13 29 21 27 11 31 25 Whooping Cough 66 94 56 15 58 82 19 136 25 42 17 Food Poisoning - - - - - - 1 11 5 10 - 23 24 TUBERCULOSIS. Notification Register. The Register of Notifications has been kept revised in accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1952. The number of cases added to or removed from the Register during the year and the number remaining on the Register on December 31st, 1956 are as under:— Table 9.—Tuberculosis Register. Form of Disease On Register, 1st Jan., 1956 Cases Added Removed from Register Remaining on Register, 31st Dec., 1956 Primary Notif'ns Otherwise Restored Total NonTub. Cured Left District Dead Total Pulmonary 253 18 22 7 300 - 24 28 6 58 242 Non-Pulm'y 38 3 2 - 43 - 1 3 - 4 39 Totals 291 21 24 7 343 - 25 31 6 62 281 Table 10. — Tuberculosis: New Cases and Mortality, 1956. Age-Periods New Cases* Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary Male Fem'le Male Fem'le Male Fem'le Male Fem'le 1- 5 years - - - - - - - - 5-14 „ — — — — — — — — 15-24 „ - 1 - 3 - - - _ 25-44 „ 17 16 1 - - - - - 45-64 „ 2 4 - 1 1 2 - - 65 „ and over 3 4 - - 1 2 - - All ages 22 25 1 4 2 4 - - * In addition to primary notifications, all other new cases coming to the knowledge of the Medical Officer of Health are included in these figures. Incidence-rate—Pulmonary l.17 Non-Pulmonary 012 A11 forms 1.29 Death-rate —Pulmonary 0.15 All forms 0.15 25 Table 11.—IMMUNISATION and VACCINATION. Diphtheria Immunisation. The following Table shows the state of Diphtheria Immunisation of the Children of Barnes:— Infants 0-4 inclusive School Children 5-14 inclusive Estimated Child population 2,312 4,448 Number immunised during 1956 406 51 Number re-immunised during 1956 69 581 Total number immunised at 31st December, 1956 1, 574 4,252 Percentage immunised at 31st December, 1956 68.1% 95.6% Whooping Cough Immunisation. Number of children immunised by primary course 406 Number of children who had a reinforcing injection 64 Vaccination against Smallpox. Number of Vaccinations carried out during 1956:— Children Adults Primary Vaccination 344 36 Re-vaccination 35 157 Number of Vaccinations carried out at Clinics 248 13 Number of Vaccinations done by private doctors 142 180 Figures showing percentage of children under 1 year vaccinated during 1956:— Number Vaccinated under 1 year 306 Estimated Mid-year population under 1 year, 1956 465 Percentage Vaccinated 65.8% 26 Table 12. — Infected Rooms and Articles (dealt with by the Council). Premises disinfected 12 Lots of bedding disinfected 15 „ „ destroyed 10 HOUSING Table 13.—HOUSING INSPECTION FOR THE YEAR 1956. 1. Unfit Houses. Informal Action Total number of inspections (including re-inspections) made in respect of unsatisfactory housing conditions 1,248 Number of houses inspected in respect of unsatisfactory living conditions, but where no repairs were required 134 Number of unfit or defective houses repaired during the period as a result of informal action by the local authority or officers under the Public Health or Housing Acts 70 Action under Statutory Powers Public Health Acts: Number of houses in which defects were remedied after service of formal notices:— (a) By owners 12 (b) By local authority in default of owners 2 Housing Act, 1936 Number of houses made fit after service of formal notices (Sections 9, 10 and 16):— (a) By owners 8 (b) By local authority in default of owners 1 Proceedings under Sections 11 and 13 of the Housing Act, 1936 as Amended by the Local Government (Miscellaneous Provisions) Act, 1953, Sections 10 and 11:— (a) Number of dwelling-houses in respect of which Demolition Orders were made 1 (b) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (c) Number of dwelling-houses in respect of which Closing Orders were made 2 Proceedings under Section 12 of the Housing Act, 1936:— (a) Number of separate tenements or underground rooms in respect of which Closing Orders were made 5 27 (b) Number of separate tenements or underground rooms closed as a result of undertaking received 1 2. Overcrowding The position with regard to statutory overcrowding has been improved, owing to the special consideration which such cases receive when the allocation of Corporation dwellings is being made. (i) Number of inspections made to cases of alleged overcrowding Nil (ii) Number of revisits Nil (iii) Number of overcrowded families rehoused 19 3. Disinfestation. As the Borough Cleansing Station is not now in use, arrangements were made for the treatment of one person (female) for scabies at the Medicinal Baths of the Hammersmith Borough Council. Disinfestation by spraying or fumigation was carried out in 10 houses or flats, including 3 Council-owned properties, by Corporation staff. 7 lots of bedding, furniture, etc., were destroyed, mainly as a result of deaths or infestation. INSPECTION AND SUPERVISION OF FOOD. Table 14.—Food Premises. The following inspections were made in respect of premises where food is prepared, handled and distributed:— Nature of inspection Number of premises Number of visits Notices issued and complied with Bakehouses 10 29 2 Bread and Cakes 16 40 5 Butchers 29 98 4 Cafes, Restaurants, etc. 42 80 — Cooked Meats 65 37 — Dairies and Milk Shops 24 10 — Fishmongers 14 46 — Greengrocers 26 43 — Grocers 75 173 4 Ice Cream:— Note: No Ice Cream pro' duced during year. Manufacturers 2 — Retailers 79 32 Public Houses 30 28 — Street Traders 8 10 — Sweets, Confectionery 56 26 — School Kitchens 6 2 — 2S Table 15.—Milk Sampling. Chemical Analysis. 15 samples of milk were taken and submitted to the Public Analyst for chemical analysis. These samples, taken from milk roundsmen and local retailers, proved to be quite satisfactory. Table 16.— Sampling of Other Food and Drugs. (a) Chemical Analysis.—53 Samples procured under the provisions of the Food and Drugs Act, 1938, included:— Foods. Best Butter Drops Lemon Cheese Bread Roll Lemon Squash Buttered Assortment Malt Vinegar Butter Toffee Meat Pudding Cheese Spread Mint Jelly Chocolate Crunch contg. pure butter. Mint in Vinegar Coffee Nut Oil Crab Fish Paste Orange Squash Cream of Mushroom Soup Peanut Butter Creamed Rice Peas—Early Garden Sugar Cremola Foam Crystals Pineapple Flavouring Devonshire Biscuits with real butter. Real Minced Chicken Egg Scramble Soup Mix Salmon Spread Escoffier Sauce—Alexandra Smoked Rainbow Trout Savoury Ground Ginger Strawberry Flavouring Ground Nutmeg Summer County Margarine contg. Hens Eggs 10% butter. Ice Cream—ready mix Sym Gravv Ice Cream with Extra Cream Synthetic Cream Powder Instant Pudding Table Cream Jam—Apricot Tomato Juice Raspberry Tomato Puree Red Plum Treacle Toffee Junket Powders White Pepper Hereunder I give the Public Analyst's reports on the samples examined which were found to be irregular or substandard. Whilst no legal proceedings were instituted the matters complained of were taken up with the manufacturers concerned with satisfactory results:— Sample No. 2.—Tomato Juice. This article had the characteristics of a tomato drink prepared by dilution from tomato concentrate or puree and flavoured with lemon and salt. It contained no vitamin C. In my opinion an article described as tomato juice should consist of the product expressed from the tomato, and consisting of the liquid juice and some of the pulp, with or without added salt, and which has been subjected to no intermediate concentration. Such an article differs from the one analysed in possessing a superior flavour, more attractive physical characteristics, and vitamin C content comparable with that of tomatoes. Sample No. 15.—Coffee. Consisted of dried coffee extract. 29 Sample No. 29.—Sun Pat Peanut Butter. Contained several tufts of mineral fibres having the characteristics of asbestos. The specimen as received consisted of a jar from which some of the contents had been removed. The fibres which were slightly bluish-green in colour were present at or near the top of the article. Sample No. 41.—Butter Toffee. Contained only 2.9% of butter-fat instead of a minimum of 4%. Sample No. 52.—Treacle Toffee. This article was described as "Home-Made Treacle Toffee made with Best Butter", but it contained only 2.2% of butter-fat and 11.0% of other fat. In my opinion where toffees are described as "made with butter" the whole of the fat present should consist of butter-fat. Sample No. 54.—Bread Roll. Contained a small dark object embedded on the inside surface. This object consisted of partly burnt dough or other flour mixture. Sample No. 60.—Cream of Mushroom Soup. This article contained only 2.7% of edible oil or fat and no butter-fat, whereas such a product should contain not less than 3½% of edible oil or fat. Table 17.— Unsound Food. The following articles were voluntarily surrendered and destroyed as being unfit for human consumption:— Where quantities are insufficient for salvage all unsound food is collected and disposed of at the Council's Refuse Destructor, by incineration. Meat. Fruit. Bacon lbs. 14 Canned Fruit lbs. 129¾ Beef lbs. 988 Vegetables. Beef Steak with Gravy lbs. 1 Baked Beans—Canned lb. 1 Canned Tomatoes lbs. 441/8 Canned Meat lbs. 1077/8 Canned Vegetables lbs. 123/8 Ham, Bacon and Corned Beef lbs. 13 Other Foods. Lamb lbs. 34 Butter lbs. l½ Ox Tongues lbs. 24 Cheese lbs. 38½ Poultry. Jam lbs. 3 Marmalade lbs. 2 Chicken (Canned) lbs. 5 Mashed Potato Powder lbs. 40 Fish. Milk pints 121/8 Canned Fish lbs. 8¾ Milk (Condensed) lbs. 31/8 Pathfinder Crab lb. ½ Nestles Milo lb. ¼ Roker stones 14 Sifta Salt lbs. 1½ Skate (Wings) stones 3 Soup lbs. 25/8 Table 18.—Slaughter-houses. The district does not now possess a slaughter-house. No animals were slaughtered for food in this district during 1956 30 ROUTINE INSPECTIONS. The following premises are subject to inspection from time to time as a routine measure. Registers are maintained of these premises and appropriate action taken where conditions warrant it. Table 19.—Factories. No. of Premises on Register. Inspection. Number Written Notices Served Factories with mechanical power 149 51 1 „ without „ „ 21 — — Other premises in which Sect. 7 is enforced by local authorities 2 — — Total 172 51 1 Discovered Remedied Inadequate Ventilation 1 1 Sanitary Conveniences (s.7):— (a) Insufficient 1 1 (b) Unsuitable or defective 1 I Other offences against the Act (not including offences relating to Outwork) 1 1 Total 4 4 Matters referred to H.M. Inspector of Factories — Notifications received from H.M. Inspector of Factories 1 Legal proceedings:— No legal proceedings were necessary during 1956. Table 20.—Home Workers. Work Undertaken No. on Register Wearing apparel 60 Lamp Shades 11 Curtain makers and upholstery 2 Household linen 1 Stuffed Toys and Nursery Articles 3 Xmas Crackers 2 Artificial Flowers 1 Carding of button 1 Total 81 31 Table 21.—Other Premises. Nature of inspection Number of premises Number of visits Notices issued and complied with Schools 21 2 - Public Halls, Cinemas and Public Conveniences 41 15 - Stable Yards 5 12 - In addition to the above, 40 visits were made by Public Health Inspectors to premises in connection with infectious disease. Altogether, 238 non-effective visits were made to premises of all types where no access was gained. j. h. broad f# co. ltd., printers, richmond,