Library b BARN 26 BOROUGH OF BARNES ANNUAL REPORT OF THE Medical Officer of Health For the Year 1958 BOROUGH OF BARNES the ANNUAL REPORT of the Medical Officer of Health for the year 1958 ROSETTA HILL, M.B., 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, D.P.A. (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, MA.P.H.I. *†‡ C. E. Mallett, MA.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:— G. W. Nickolls. Mrs. J. D. Wallis. Miss D. R. Day. Public Analyst:— D. D. Moir, Esq., M.Sc., F.R.I.C. PUBLIC HEALTH COMMITTEE 1958-1959. Alderman E. S. Stevens (Chairman). Councillor Mrs. M. E. Hull (Deputy Chairman). The Mayor (Councillor C. Gompels). Alderman F. W. Moore Alderman H. Thomas Councillor A. Beilby Councillor E. S. Bolton Councillor F. A. Coldman Councillor F. R. Cooper Councillor F. A. W. Counter Councillor M. A. E. Cresswell Councillor W. R. Gosling Councillor A. G. H. Lawrance Councillor D. Lee Councillor Mrs. P. K. M. Lomer Councillor G. B. Naylor 4 Telephone: PROspect 3443. 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 1958. The Report 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, regard being given to the Ministry of Health Circular, 22/58. The year has been a satisfactory one; the birth rate has remained the same, and there has been a slight decrease in the death rate. The infantile mortality, which is a good index of the health of the community, has fallen to 18.2 as compared with 20.4 last year. This rate was increased by the fact that two of the infant deaths were newly born babies whose bodies were found by the river and whose cause of death was unknown. The rate for England and Wales was 22.6. The incidence of infectious disease during the year was low; there were no epidemics. There was a slight increase in the number of Scarlet Fever Cases, but it is gratifying to report a marked decrease in the number of cases of Whooping Cough. There was an increase in the number of new cases of Pulmonary Tuberculosis, but there were no deaths — a point which emphasizes the value of the modern treatment of the disease. As this will be the last Report which I shall submit as your Medical Officer, I would like to express my thanks to the Council for all the help and support which you have so willing given me during my twelve years of office. At the same time I should like to thank all the officials for their unfailing help and co-operation, and pay tribute to all the members of the staff who have given such loyal and devoted service. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, ROSETTA HILL, 23rd July, 1959. Medical Officer of Health. 5 PREFACE STAFF AND DUTIES There were no changes in the staff of the department during the year. SECTION 'A' — STATISTICS AND SOCIAL CONDITIONS OF THE AREA 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 gives 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. The Borough of Barnes, in the County of Surrey, is situated on the South Bank of the River Thames between Richmond and Putney. One of the great advantages of the Borough is the fact that open spaces comprise almost half of its area, including Richmond Park, the River Thames, Barnes Common, Sheen Common, and other parks and recreation grounds. The Borough is mainly residential in character with some light industry. SECTION 'B' — GENERAL PROVISION OF HEALTH SERVICES IN THE AREA (a) Laboratory Facilities Public Health Laboratory, Epsom — accepts all pathological specimens and the staff are very helpful in advising in outbreaks of dysentery, food poisoning etc. Colindale, Central Public Health Laboratory — carries out special investigations. Richmond Royal Hospital Laboratory — deals with pathological specimens from the general practitioners. (b) Ambulance Facilities The Ambulance Service is based at Kings Road, Richmond, and comes under direction of the Control Station at Maiden. It is administered by Surrey County Council. 6 (c) Nursing in the Home There are two midwives and eight district nurses working in the area. They are based at 31/32, Ranelagh Avenue, Barnes. There are four health visitors in the district, two based at each clinic. (d) Treatment Centres and Clinics There are two clinics in which infant welfare, ante-natal and school medical services are provided:— (i) Essex House, Barnes. (ii) Health Centre, North Worple Way, Mortlake. These services come under Surrey County Council and are administered by the Divisional Medical Officer, Barnes and Richmond forming a division. The Chest Clinic is held also at the Health Centre, Mortlake. (e) Hospitals The only hospital in the area is the Barnes Hospital, which is now used solely for the treatment of chronic sick patients. It was previously the Barnes Isolation Hospital. The principal general Hospitals serving the area are:— West London Hospital, Hammersmith, Richmond Royal Hospital, Kingston Hospital. The hospital for infectious diseases is:— Tolworth Hospital, Surbiton. Occasionally, cases are sent to the London Hospitals. Maternity cases are booked through the clinics for admission to the Kingston Hospital and in addition a number of patients book at the following London Hospitals:— St. Mary Abbots Hospital, Kensington, Hammersmith Hospital, Ducane Road. REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION, Section 47, National Assistance Act, 1948 Under the above Section, the Council has power to apply to the Courts for an order for the removal of persons to hospitals or other suitable accommodation where they are:— (a) 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. 7 Thirty-three cases of old people in need of care and attention were investigated during the year. In only one case was it necessary to take action under Section 47, as in the remaining cases the old people either agreed to go into hospital or other arrangements were made at home for their care. The case in which action became imperative was one of an old lady aged 69 living alone in her own house. There had been a tendency for her over the years to hoard and not to dispose of rubbish satisfactorily, and on several occasions the Council had taken action to ensure that the premises were cleansed. On this occasion the conditions were very insanitary, and in addition the owner herself had deteriorated in health, and was in need of medical care. She refused to have her own Doctor, and would not under any circumstances agree to a medical examination. As I considered that she was in urgent need of hospital care, application was made to Court for an Order under Section 47, National Assistance Act 1948. This was granted, and she was removed to Grove Road Hospital, Richmond, for a period of three months. At the end of this time she was fit to be discharged home, very much improved in health. Her house had been cleaned in her absence, and when she returned home regular visits were carried out by the District Nurse and Home Help. She also agreed to register with a Doctor, who now visits her at intervals. Co-operation with Kingston Hospital remains good. The Geriatrician who holds a joint appointment with the Hospital Board and the County Council, co-operates very well with this Department, and is always most helpful in arranging for admission of urgent cases. The County Welfare Department is always extremely co-operative in arranging for admission of old people to other accommodation. SECTION 'F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Generally The incidence of infectious disease during the year was low; there were no epidemics. There were ten cases of Scarlet Fever notified during the year as compared with five in 1957; all the cases were mild and were treated at home, with two exceptions, who were admitted to hospital on account of home conditions. 8 There was a marked decrease in the number of cases of Whooping Cough — 6 being notified as compared with 37 in the previous year. All the cases were mild. The practice of giving Whooping Cough immunisation combined with Diphtheria at an early age — starting at 3 months — has done much to reduce the incidence of Whooping Cough in infancy, at the time when it is a most dangerous and distressing illness. 1958 was the inter-epidemic year for Measles. There were 136 cases notified as compared with 606 in the epidemic of the previous year. There were no cases of Diphtheria during the year; the last case notified in this Borough was in 1948. Poliomyelitis There was one case of Poliomyelitis notified during the year. The patient was a young man aged 30 years who developed the disease in January. He was very gravely ill, having paralysis of the upper limbs and respiratory muscles, and was treated in the Western Hospital. Later he was transferred to St. Benedict's Hospital where after prolonged treatment he made a complete recovery, and has now resumed his work. Tuberculosis The number of new cases of Pulmonary Tuberculosis has increased —28 being notified as compared with 19 in the previous year. There were no new cases of Non-Pulmonary Tuberculosis during 1958, compared with 4 cases in the previous year. There were no deaths from Pulmonary Tuberculosis during 1958, but four persons, who had been notified as suffering from the disease, died from other causes during the year. Mass Radiography Unit Arrangements were made for the Mass Radiography Unit of the South West Metropolitan Regional Hospital Board to visit the Borough from 6th to 22nd August to afford facilities for X-Ray of the chest for anyone wishing to attend. 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 is difficult to persuade people, who consider themselves in good health, of the value of an annual X-Ray of Chest as a check-up on health. 9 I give below a brief summary of the findings of the survey:— Total X-Rayed: Men 1,060 Women 1,260 2,320 Pulmonary Tuberculosis : Persons requiring treatment or close observation: Men 2 Women 1 Person requiring occasional supervision only: Men 1 Women 1 Primary Lung Cancer: Men 4 Women 1 At the end of the year a new Mobile Chest Radiography service for general practitioners was organized by the S.W. Metropolitan Hospital Board. Under the scheme a Mobile X-Ray Unit visits this area once weekly; it is based at the Municipal Offices. The unit can examine 40/50 people an hour, and is primarily intended for the use of general practitioners in referring their own patients. It is considered very important to X-Ray all men over the age of 45 who have not had a chest film during the past 12 months, and all young women between the ages of 15 and 25, as these age groups show the highest incidence of chest disease. In addition to examining cases referred by their general practitioners, the Mobile Unit has also agreed to X-Ray any member of the Council Staff referred from this Department, and in this way it is possible to arrange for every Council employee taking up work to have a Chest X-Ray as part of the medical examination. When this service was first introduced it was suggested by the Mass Radiography Service that it would only be continued if the response by the general practitioners was sufficient to justify its use. It is gratifying to report that at the end of four months this area showed the highest attendance in Surrey, so it is hoped that the service may be continued, as it has proved a great boon to this district. Influenza During 1958 there was no epidemic of influenza. The epidemic of the previous year had been in the autumn months, and there were only a few isolated cases in the early part of the year. There were three deaths in the year caused by Influenzal Pneumonia — all in elderly people. 10 Food Poisoning There were 5 cases of food poisoning notified during the year. One of the cases was a woman aged 50 who was admitted to the South Middlesex Hospital thought to be suffering from Dysentery, but was found to be infected with Salmonella typhi murium. The infection cleared up quickly with treatment. Another case notified of Salmonella typhi murium infection was in a child aged 9 years. On investigation it was found that although notified in this area, the child had already moved to another area, and it was arranged that he should be followed up there. There were three other isolated cases of Food Poisoning notified, but no infecting organism was isolated and the cause was unknown. Maternal Mortality There were no maternal deaths during the year. Infant Mortality Rate The number of deaths of infants under one year was 8, as compared with 9 of the previous year. The infant mortality rate for this area is 18.2 per 1,000 live births as compared with 22.6 for England and Wales. This rate was increased by the fact that two of the infant deaths were new born babies, whose bodies were found by the river, and where the cause of death was unknown. IMMUNISATION AND VACCINATION Diphtheria and Whooping Cough — Immunisation was continued throughout the year. The combined vaccine was used during the winter months, but during the summer months the separate whooping cough and diphtheria vaccines were used. This followed a recommendation from the Ministry of Health that the separate vaccines were less likely to provoke paralytic poliomyelitis. The immunisation in each case is started when the child is three months old. Smallpox — Vaccination was continued throughout the year, usually following immunisation against diphtheria and whooping cough at the age of six months. Poliomyelitis — During the year, poliomyelitis vaccination proceeded, and the numbers registering for vaccination greatly increased. At the beginning of the year the scheme approved by the Ministry of Health included children born between the years 1943 and 1957, babies who had reached the age of 6 months and expectant mothers. In the first quarter of the year, vaccine supplies were unequal to the 11 demand, but later the import of American and Canadian vaccine recommenced, and it was possible to vaccinate nearly all those registered during the summer months. In September the scheme was extended to include young people born in the years 1933-1942, and to give third or boosting doses to all those vaccinated since the beginning of the scheme. The scheme is operated by the County Council under the direction of the Divisional Medical Officer. Tuberculosis — B.C.G. vaccination is offered to every child between the age of 13 and 14. The scheme is carried out by the County Council. Lung Cancer The incidence of cancer of the lung is increasing rapidly. It is now the most common form of cancer mortality, being responsible for approximately 20,000 deaths a year, predominantly in men in the prime of life. In this area the rate is higher than in England and Wales, but the number of deaths this year is exactly the same as last year. Once again there is an increase in the number of women dying from the condition. There is now the strongest evidence to show that the more cigarettes are smoked the more liable one is to develop cancer of the lung, and it has been shown that the incidence is much reduced in those who have previously smoked and given it up. It is discouraging to note that in spite of the health education carried out in schools, Youth Clubs and young people's organizations, so many young people continue to take up the habit. 12 THE REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR Mr. W. L. LEACH, IS CONTAINED IN THE FOLLOWING SECTIONS 'C' 'D' and 'E' SECTION 'C' — SANITARY CIRCUMSTANCES OF THE AREA Water Supply The domestic water supply has been of satisfactory hygienic quality and adequate in quantity during the year 1958. The water is derived from the non-tidal portion of the River Thames, stored in the Metropolitan Water Board reservoirs at Staines, Littleton and Walton, and filtered and chlorinated at the Hampton Works. The Board's waters are not plumbo-solvent. Samples are collected at each stage of purification and in the distribution system daily. Immediate action is taken in respect of any form of contamination or of any variation in quality. All repaired mains are disinfected with chlorine before being returned to service. I am indebted to Dr. Windle Taylor, Director of Water Examination to the Board, for the information on bacteriological sampling of water supplies given in Table 12, from which it will be seen that a very high standard is maintained. SEWERAGE AND SEWAGE DISPOSAL The year under review was one in which the amount of rainfall was well above the average. There was an almost complete absence of complaints of smells from the sewers or sewage disposal works. Some of the main sewers, however, gave trouble, and substantial works of repair were effected in different parts of the Borough. This sort of work will become increasingly necessary, especially on the surface water sewers. The Borough Surveyor is preparing several re-drainage schemes and construction work on the first of these schemes will commence shortly. Mechanical equipment for more efficient and expeditious cleansing of the sewers has been ordered. VERMINOUS PREMISES ETC. Rodent Control Complaints of rats and mice were at the rate of about three per week and each infestation necessitated an average of 4 to 5 treatment visits. No undue difficulties were encountered in dealing with the infestations found. With a change in the method of payments of grants from central government funds the local authorities will now be able to exercise more freedom in the allocation of funds for such purposes as sewer baiting. A more critical examination of the usefulness of this routine can now be made. 13 Other Pests The number of complaints of vermin and other insect pests remained at a satisfactorily low level. All school kitchens and serveries are regularly treated at the beginning of the fly season as a routine measure, in Co-operation with Surrey County Education Department. As a general precaution Beverley Brook and parts of the Commons were treated where mosquitoes were likely to cause trouble. ATMOSPHERIC POLLUTION Two standard deposit gauges and two lead peroxide instruments together with one volumetric apparatus are maintained at three stations in the Borough for the measurement of pollution. Average results for the past three years are given in Table 16 of the Appendix. During the year the Council considered the implications of the Clean Air Act 1956 with particular reference to the establishment of Smoke Control Areas. It has been agreed in principle that the whole Borough will gradually be converted to the burning of smokeless fuel over a period of ten years. Such a project will entail the adaptation or conversion of something like 15,000 dwellings. Experience in other areas shows that householders readily accept the prospect of cleaner firegrates and smokeless zones. Even at this early stage many enquiries are received regarding conversion to modern appliances, and there is considerable activity in the field of conversion to oil burning, especially in the larger properties. When it is explained that the grants are not payable until a particular area has actually been declared a Smoke Control Area enquirers are critical on this point. However, the grant is intended to help those people for whom conversion will be compulsory, whether they appreciate that they will eventually benefit or not, so that no one will be able to say that they cannot afford it. No doubt it would be preferable if grants were to be made payable at an earlier stage. It would also help if such items as the provision of flue restrictors and the improvement of fuel storage arrangements were to be included in the calculation for grant. It is confidently expected that this measure will be implemented smoothly and with increasing tempo, and that the results will amply justify the expense, disturbance and change of habits involved. To ensure complete co-operation with neighbouring authorities, the Council has become a constituent member of the West London Inter Borough Smoke Control Liaison Committee. Regular meetings are held, and the representatives of the Boroughs of Hammersmith, Willesden, Fulham, Acton, Brentford & Chiswick and Barnes, discuss problems and matters of mutual interest concerning atmospheric pollution. 14 SECTION 'D' —HOUSING The effect of the introduction of the Rent Act 1957 on the standard of maintenance of rented property was quite noticeable. Owing to the publicity surrounding such a controversial measure most tenants were aware of the procedure for securing the execution of repairs and the abatement of rent. The number of applications for Certificates of Disrepair was relatively small, and the total for the whole year did not exceed the number applied for in the four months of 1957 after the Act was passed. The figures for the current year show an almost complete falling off in applications. This illustrates that tenants are generally most reluctant to operate the provisions of the law, designed for their protection, unless spurred on by publicity and agitation. A considerable amount of decontrol is being effected by the vacation of properties, either as a result of death or removal of tenants. Even poor type obsolete houses are being reconditioned and sold for owner/occupation. Quite clearly the stock of rented property is being substantially reduced, and one of the objects of the Act i.e. to improve the supply and standard of rented property, is not being fulfilled in this area. The situation in respect of the enforcement of repairs has improved. Where difficulty is experienced in getting repairs done the reason is usually lack of ready cash, unco-operative tenants, or sheer reluctance on the part of landlords to pay heavy bills for repairs. The cost of repairs, particularly to older property, with low rateable values and therefore low rents, is still prohibitive. The Council's policy of not paying Improvement Grants except in certain restricted circumstances, has again meant that no rented properties have been "improved" up to the standard for "satisfactory" houses. It will be interesting to see what use is made of the new Standard Grants scheme whereby amenities such as hot water supply, baths and washbasins, internal water closets and foodstores. can now be provided, with half the cost being paid for out of public funds. There has been considerable delay in dealing with the Stanton Road Clearance Area, owing to the intransigence of the owners in coming to a settlement for the acquisition of the property. Meanwhile the conditions under which the unfortunate tenants exist deteriorate still further, with the Council more or less powerless to insist on even emergency repairs. Legislation should be available to enable urgent stop gap repairs to be carried out to condemned property while ever it remains occupied. Most of the properties listed to be dealt with in the programme for dealing with unfit dwellings have now been considered, and it is expected that the target will be reached when the five year period ends in December 1960. 15 OVERCROWDING The position with regard to statutory overcrowding is reasonably satisfactory, owing to the special consideration which such cases receive when allocations of Corporation dwellings are made. The number of overcrowded families rehoused during the year was 7. SECTION 'E' — INSPECTION AND SUPERVISION OF FOOD I have pleasure in reporting continued progress in the improve' ment of standards for the handling, preparation and distribution of food in the district. Whenever alterations, repairs or changes of occupation occur, advantage is usually taken of the situation to improve premises and the arrangements for dealing with food. It is now rare to come across cases of real neglect. Pressure of other work has prevented the full implementation of those provisions of the Food Hygiene Regulations concerning handwashing, but some progress has been made when opportunity occurred, although the question of more precise standards has not yet been resolved. With the growth of self'service grocers shops the degree of handling of "open" food has been substantially reduced, and attention can be focussed on the activities in the "preparation" room. Of the 29 complaints relating to food no circumstances were found necessitating legal action in connection with food produced in this district. The district does not possess a slaughterhouse and no animals were slaughtered for food in this area during 1958. BOROUGH OF BARNES APPENDIX to the ANNUAL REPORT OF THE Medical Officer of Health 1958 19 SECTION 'A' — STATISTICS AND TABLES 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. TABLE 1. —STATISTICAL SUMMARY, 1958 Area 2,650 acres Population: — Census, 1931 42,440 Census, 1951 40,558 Registrar General's estimate, mid-1958 39,220 Number of inhabited houses 12,201 Rateable Value £851,017 Product of a penny rate £3,415 Males Females Total Number of Deaths 248 238 486 Death Rate per 1,000 population:— Uncorrected 12.39 Corrected (Comparability Factor 0.82) 10.16 Deaths from Cancer (all ages) 91 Deaths from Measles (all ages) NIL Deaths from Whooping Cough (all ages) NIL Deaths from Diarrhoea (under 2 years of age) NIL Live Births 440 Live birth rate per 1,000 population 11.2 Still-births 16 Still-birth rate per 1,000 live and still-births 35.09 Total live and still-births 456 Infant deaths 8 Infant mortality rate per 1,000 live births — total 18.2 Infant mortality rate per 1,000 live births — legitimat 12.3 Infant mortality rate per 1,000 live births — illegitimate 90.9 Neo Natal mortality rate per 1,000 live births (first four weeks). 13.6 Illegitimate live births per cent of total live births 7.5% Maternal deaths (including abortion) NIL Maternal mortality rate per 1,000 live and still-births NIL There has been no unusual or excessive mortality during the year. 20 COMPARATIVE BIRTH & DEATH RATES 21 Table 2.—Vital Statistics of the Borough of Barnes during 1958 and previous 5 Years Year Registered Births Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District Total Live Births Of nonresidents registered in the District Of residents registered outside the District Under 1 year of age At all ages Number Rate per 1,000 Population Number Rate per 1,000 Population Number Rate per 1,000 live births Number Rate per 1,000 Population 1 2 3 4 5 6 7 8 9 10 11 12 1953 441 434 10.8 387 9.6 17 194 10 23.0 564 14.1 1954 417 407 101 344 8.6 30 207 9 22.1 521 13.0 1955 437 430 10.7 334 8.3 20 218 5 11.6 532 13.2 1956 484 475 11.8 345 8.6 29 208 5 10.5 524 13.05 1957 446 441 11.2 313 7.9 17 220 9 20.4 516 13.1 1958 456 440 11.2 284 1.2 35 237 8 18.2 486 12.4 22 Table 3. — Birth-rate, Death-rate, and Analysis of Mortality from Certain Causes during the Year 1958, with corresponding rates for England and Wales, and for the County of London for comparison. AREA AND POPULATION Live Births Deaths (excluding Stillbirths) DEATHS FROM Stillbirths Deaths of Infants under 1 year of age Malignent neoplasm lung, bronchus Whooping cough Diphtheria Tuberculosis (all forms) Influenza Acute Poliomyelitis Pneumonia Coronary and arteriosclerotic heart disease England and Wales (45,109,000) 16.4 11.7 0.44 0.00 0.00 0.10 0.05 0.00 0.54 1.86 21.6 22.6 London ( 3,225.000) 16.7 11.8 0.64 0.00 0.00 0.13 0.05 0.00 0.70 1.84 20.2 22.6 Barnes Borough (39,220) 11.2 10.2 0.61 — — — 0.08 — 0.51 2.4 35.1 18.2 Live birth and death rates per 1,000 population. Stillbirth rates per 1,000 total (live and still) births. Infantile mortality rates per 1,000 live births. 23 Table 4.— Causes of Death during the Year 1958. Causes of Death (Registrar-General's short list of causes) Total Deaths Male Female 1 Tuberculosis, respiratory - - - 2 Tuberculosis, other - — - 3 Syphilitic diseases - - - 4 Diphtheria - - - 5 Whooping Cough - — - 6 Meningococcal infections - - — 7 Acute poliomyelitis - — — 8 Measles - - - 9 Other infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 11 4 7 11 Malignant neoplasm, lung, bronchus 24 14 10 12 Malignant neoplasm, breast 7 — 7 13 Malignant neoplasm, uterus 2 - 2 14 Other malignant and lymphatic neoplasms 47 30 17 15 Leukæmia, aleukæmia 2 - 2 16 Diabetes 4 1 3 17 Vascular lesions of nervous system 83 26 57 18 Coronary disease, angina 93 67 26 19 Hypertension with heart disease 7 3 4 20 Other heart disease 58 27 31 21 Other circulatory diseases 32 16 16 22 Influenza 3 2 1 23 Pneumonia 20 8 12 24 Bronchitis 23 15 8 25 Other diseases of respiratory system 6 4 2 26 Ulcer of stomach and duodenum 1 1 - 27 Gastritis, enteritis and diarrhoea 1 - 1 28 Nephritis and nephrosis 4 2 2 29 Hyperplasia of prostate 1 1 - 30 Pregnancy, childbirth abortion - - - 31 Congenital malformations 3 2 1 32 Other defined and ill-defined diseases 35 13 22 33 Motor vehicle accidents - - - 34 All other accidents 10 5 5 35 Suicide 8 6 2 36 Homicide and operations of war 1 1 - All Causes 486 248 238 24 Table 5. — Infant Mortality during the Year 1958. 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 1 3-6 Months 6-9 Months 9-12 Months Total under 1 year Deaths in the Borough Deaths outside Borough Hydrocephalus & Meningocaele 1 - - - 1 - - - - 1 - 1 Cerebral Oedema 1 - - - 1 - - - - 1 - 1 Prematurity 2 - - - 2 - - - - 2 - 2 Intestinal Obstruction - - - - - 1 - - - 1 - 1 Acute suppurative otitis media - - - - - - 1 - - 1 1 - *Unknown 2 - - - 2 - - - - 2 2 - 6 - - - 6 1 1 - - 8 3 5 * 2 Unknown - newly born bodies found in River Area. 25 SECTION 'F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Table 6. — Notifiable Infectious Diseases, 1948 to 1958. Year 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Diphtheria 3 - - - - - - - - - - Scarlet Fever 30 38 27 17 42 21 29 7 8 5 10 Typhoid Fever - 1 - 2 - - 1 - - - - Paratyphoid Fever - - 1 - 1 - - 2 - 1 - Puerperal Pyrexia - 1 1 - 4 1 - 3 3 1 - Erysipelas 10 8 4 2 8 7 2 7 2 1 1 Continued Fever - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - Typhus Fever - - - - - - - - - - - Small-pox - - - - - - - - - - - Cholera - - - - - - - - - - - Plague - - - - - - - - - - - Tuberculosis, Pul. 40 32 37 38 39 37 27 23 18 19 28 „ Non-Pul. 5 6 2 1 7 3 3 3 3 4 - Ac. Encephalitis (Post Infections) - 1 1 - - - - - - - - Poliomyelitis, Paralytic 4 10 1 - 8 3 1 7 4 1 1 „ Non-Paralytic - - - - - - - 1 2 - - Ophthalmia Neonatorum 1 - - - - - - - 1 - - Meningococcal Infect'n - - - 2 - - 2 - - - - Measles 158 588 124 541 249 306 5 489 16 606 136 Encephalitis Lethargica - - - - - - - - - - - Polioencephalitis - - - - - - - - - - - Malaria - - - - - 2 — 1 1 - 2 Dysentery 4 - 3 4 11 25 75 - 4 - 3 Pneumonia 20 21 13 29 21 27 11 31 25 28 47 Whooping Cough 56 15 58 82 19 136 25 42 17 37 6 Food Poisoning - - - - 1 11 5 10 - 11 5 26 Table 7.— Certain Infectious Diseases: Incidence per 1,000 of the Population in 1958. Disease Barnes London (a.c.) England and Wales Scarlet Fever 0.25 0.84 0.86 Diphtheria - 0.01 0.00 Enteric Fever - 0.01 0.00 Acute Pneumonia 1.2 0.54 0.49 Dysentery 0.76 1.4 0.84 Acute Poliomyelitis— Paralytic 0.03 0.02 0.03 Non-Paralytic - 0.01 0.01 Food Poisoning 0.13 0.4 0.19 Tuberculosis— Respiratory 0.07 0.97 0.59 Others - 0.09 0.07 Table 8. — Notifiable Infectious Diseases, 1958. Diseases Total Cases Notified Ages, in years Parish Removed to Hospita' 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 Erysipelas 1 - - - - - - - - - - - 1 - 1 - - Malaria 2 - - - - - - - - 1 1 - - - 7 - 2 Scarlet Fever 10 - — - 1 1 7 1 - - - - - - 1 3 2 Whooping Cough 6 1 1 - 3 - - - 1 - - - - - 1 5 - Measles 136 5 9 20 10 18 69 4 - - 1 - - - 26 110 1 Poliomyelitis—Paralytic 1 - - - - - - - - - 1 - - - - 1 1 „ Non-Paralytic - - - - - - - - - - - - - - - - - Pul. Tuberculosis 28 - - - - - - 2 2 2 4 4 9 5 15 13 - Non-Pul. Tuberculosis - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - Plague - - - - - - - - - - - - - - - - - Tuberculosis other f'rms - - - - - - - - - - - - - - - - - Meningococcal Infect'n - - - - - - - - - - - - - - - - - Typhus Fever - - - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - - - - - Dysentery 3 - - 1 - - 1 - 1 - - - - - - 3 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - - - - - - - - - - Acute Pneumonia 47 - 1 - 1 1 - 1 - - 3 2 12 26 26 21 7 Paratyphoid Fever - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - Food Poisoning 5 - - - - - 1 - 1 - 1 - 2 - 2 3 1 239 6 11 21 15 20 78 8 5 3 11 6 24 31 80 159 14 27 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, 1958 are as under:— Table 9. — Tuberculosis Register. Form of Disease On Register, 1st Jan., 1958 Cases Added Removed from Register Remaining on Register, 31st Dec. 1958 Primary Notif'ns Otherwise Restored Total NonTub. Cured Left District Dead Total Pulmonary 216 28 16 2 262 1 23 23 4 51 211 Non-Pulm'y 20 — 1 1 22 - 1 1 — 2 20 Totals 236 28 17 3 284 1 24 24 4 53 231 * Includes 4 Pulmonary cases deceased from other causes. Table 10. — Tuberculosis: New Cases and Mortality, 1958. Age-Periods New Cases* Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary Male Fem'le Male Fem'le Male Fem'le Male Fem'le 1- 5 years 1 - - - - - - - 5-14 „ 3 - - - - - - - 15-24 „ 2 4 - - - - - - 25-44 „ 13 7 2 - - - - - 45-64 „ 7 4 - - - - - - 65 „ and over 2 3 - - - - - - All ages 28 18 2 - - - - - * 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 1.17 Non-Pulmonary 0.05 Al1 forms 1.22 Death-rate —NIL 28 PULMONARY TUBERCULOSIS 29 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 1958 2,348 4,329 Number immunised during 1958 398 29 Number re-immunised during 1958 56 524 Total number immunised at 31st December, 1958 1,491 4,268 Percentage immunised at 31st December, 1958 63.5% 98.5% Whooping Cough Immunisation. Number of children immunised by primary course 386 Number of children who had a reinforcing injection 7 Vaccination against Smallpox. Number of Vaccinations carried out during 1958:— Children Primary Vaccination 298 Re'vaccination 10 Number of Vaccinations carried out at Clinics 199 Number of Vaccinations done by private doctors 109 Figures showing percentage of children under 1 year vaccinated during 1958:— Number Vaccinated under 1 year 267 Estimated Mid-year population under 1 year 460 Percentage Vaccinated 58% 30 SECTION 'C' — SANITARY CIRCUMSTANCES OF THE AREA Table 12.— Water Supply — Bacteriological Sampling. Type of Test RAW WATER River Thames at Walton WATER PASSING INTO PUBLIC SUPPLY — Hampton Works. Plate Count per millilitre on agar 20/24 hrs. at 37°C. Average Resu't 1,425 Average Result 8.2 Coliform Test (Count per 100 ml) 8,091 99.61 Negative Escherichia Coli Test (Count per 100 ml) 4,695 100% Negative Table 13. — Infected Rooms and Articles (dealt with by the Council). Premises disinfected 2 Lots of bedding disinfected 4 „ „ destroyed 4 Table 14. — Disinfestations (Dealt with by the Council). Disinflation by spraying or fumigation was carried out at various premises for the following infestations : — Moths 1 Flies 7 Bugs 9 Bees 3 Wasps 23 Ants 2 Fleas 4 Beetles 2 Table 15. — Rodent Control. Summary of work carried out:— Premises visited 580 Inspections made 659 Treatment visits 491 Premises treated 128 Minor infestations of Rats 146 Minor infestation of Mice 6 31 Table 16. — Atmospheric Pollution. Deposit Gauges. Average Total Deposit expressed as Tons per sq. mile: Year. 1956. 1957. 1958. Castelnau 12.67 14.25 14.11 Furness Lodge 9.25 9.2 10.97 Lead Peroxide Instruments. Average Sulphur Dioxide (Mgms per 100 sq. cms exposed): Year. 1956. 1957. 1958. Castelnau 1.75 2.129 2.4 Furness Lodge 2.8 2.125 2.05 Volumetric Apparatus. Average Smoke (Mgms per 100 cu metres): 1956. 1957. 1958. 19.03 20.24 14.9 Average Sulphur Dioxide (per 100 million parts of Air): 1956. 1957. 1958. 6.15 4.53 4.5 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 17. — Factories. No. of Premises on Register. Inspection. Number Written Notices Served Factories with mechanical power 147 55 - „ without „ „ 23 11 2 Other premises in which Sect. 7 is enforced by local authorities 5 7 — Total 175 73 2 Legal proceedings:— No legal proceedings were necessary during 1958. 32 Table 18.—Home Workers. Work Undertaken No. on Register Wearing apparel 60 Lamp Shades 13 Curtain makers and upholstery 6 Stuffed Toys and Nursery Articles 3 Xmas Crackers etc. 11 Artificial Flowers 2 Carding of buttons 3 Total 98 Table 19. — Other Premises. Nature of inspection Number of premises Number of visits Notices issued and complied with Schools 21 - - Public Houses, Public Halls, Cinemas and Public Conveniences 41 38 - Stable Yards 5 1 — In addition to the above, 77 visits were made by Public Health Inspectors to premises in connection with infectious disease. Altogether, 219 non-effective visits were made to premises of all types where no access was gained. SECTION 'D' — HOUSING Table 20. — Housing Inspections. Total number of inspections (including re-inspections) made in respect of unsatisfactory housing conditions 1,681 Number of houses inspected in respect of unsatisfactory living conditions, but where no repairs were required 103 Number of Informal Notices served 149 Number of Informal Notices complied with 103 33 Table 21.—Rent Act, 1957. Applications for Certificates of Disrepair. 6 Months Period ended:— Dec. 57. Jun. 58. Dec. 58. 1. No. of applications for Certificates 44 23 8 2. No. of decisions not to issue Certificates - - — 3. No. of decisions to issue Certificates 44 23 8 (a) in respect of some but not all defects 31 19 7 (b) in respect of all defects 13 4 1 4. No. of undertakings given by landlords under para. 5 of the First Schedule 24 16 5 5. No. of undertakings refused by local authority under proviso to para. 5 of the First Schedule - - - 6. No. of Certificates issued 10 12 6 Applications for Cancellation of Certificates. 7. Applications by landlords to local authority for cancellation of Certificates 1 7 7 8. Objections by tenants to cancellation of Certificates - 3 3 9. Decisions by local authority to cancel in spite of tenant's objection - - - 10. Certificates cancelled by local authority — 4 4 SECTION 'E'— INSPECTION AND SUPERVISION OF FOOD Table 22. — Food Premises. The following inspections were made in respect of premises where food is handled and distributed:— Nature of inspection Number of premises Number of visits Notices issued and complied with Bakehouses 8 50 3 Bread and Cakes 14 35 - Butchers 29 157 2 Cafes, Restaurants, etc. 43 158 2 Canteens, etc. 10 7 - Cooked Meats 71 61 - Dairies and Milk Shops 24 15 - Fishmongers 15 53 - Fried Fish Shops 3 4 — Greengrocers 40 112 — Grocers 79 327 4 Ice Cream:— Retailers 91 104 — Public Houses 30 18 - Street Traders 8 1 - Sweets, Confectionery 62 101 — 34 Table 23. — Milk Sampling. Chemical Analysis. 11 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 24. — Sampling of Other Food and Drugs. (a) Chemical Analysis. — 58 Samples procured under the provisions of the Food and Drugs Act, 1938, included:— Foods. Bread Sweets Cakes and Confectionery Sauces Fruit Drinks Soups Jams Tinned Meat Medicines „ Fish Packaged Food Mixes „ Fruit Pastes Hereunder I give the Public Analyst's reports on the samples examined which were found to be irregular or sub-standard. Whilst no legal proceedings were instituted the matters complained of were taken up with the manufacturers concerned with satisfactory results:— Sample No. 168. — Minced Beef and Gravy. The sample contained meat, including fat, 52 per cent. It is considered that canned minced beef and gravy should contain not less than 75 per cent of meat, including fat. Sample No. 169. — Luncheon Meat. The sample contained meat, including fat, 69 per cent. Luncheon Meat should contain not less than 80 per cent of meat, including fat, and, as judged by this minimum, the sample is deficient in meat to the extent of 13 per cent. Sample No. 174.—Chopped Chicken. The sample contained Chicken meat, 77 per cent. An article sold under the unqualified description Chopped Chicken should contain not less than 95 per cent of chicken meat. Sample No. 179. — Pork Luncheon Meat. The sample contained meat, including fat, 67 per cent. Luncheon Meat is essentially a meat product, and a meat content of only 67 per cent is not sufficient to justify the use of the description "Pork Luncheon Meat" for this article. In the absence of statutory standards for meat products the question of the quality of these products will continue to be the subject of controversy and complaint. It is evident that labelling provisions are not understood by the average housewife. 35 Table 25. — 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. lbs. Fruit. lbs. Bacon 55 Canned Fruit 162 Beef 371 Vegetables. Canned Meat 185 Pork 111½ Baked Beans—Canned 4 Canned Tomatoes 13 Poultry. Canned Vegetables 10 Chicken (Canned) 51 Other Foods. Cheese 49½ Fish. Milk (Condensed) 2 Soup 1 Canned Fish 4 Spaghetti 1 Whiting 98 Jam 2 Skate 84 Tomato Juice 3½ Dog-fish 84 Orange Juice 2½ j. h. broad 6/ co. ltd., printers. richmond.