Library BARN 29 Borough of Barnes ANNUAL REPORT of the Medical Officer of Health for the Year 1961 BOROUGH OF BARNES THE ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1961 ERIC PEREIRA, M.B., B.S., D.P.H., Medical Officer of Health. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— Eric Pereira, M.B., B.S., D.P.H. Deputy Medical Officer of Health:— C. J. Radway, B.M., B.Ch., D.P.H. Chief Public Health Inspector:— William L. Leach, D.P.A. (London), M.A.P.H.I.*†‡ Deputy Chief Public Health Inspector:— P. J. Shannon, M.A.P.H.I.*† District Public Health Inspectors:— C. E. Mallett, M.A.P.H.I.*† R. J. Hamilton, 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. Technical Assistant (Clean Air):— T. S. Rodwell. Clerical Staff:— G. W. Nickolls. Mrs. J. D. Wallis. Mrs. E. R. Gathard. Public Analyst:— D. D. Moir, Esq., M.Sc., F.R.I.C. PUBLIC HEALTH COMMITTEE 1961-1962. Councillor Mrs. M. E. Hull (Chairman). Councillor F. H. Rasey (Deputy Chairman). The Mayor (Councillor A. Beilby, J.P.) Alderman E. S. Bolton. Alderman F. W. M. Moore. Alderman E. S. Stevens. Councillor W. R. Adams. Councillor F. R. Cooper. Councillor F. A. W. Counter. Councillor G. T. Craker. Councillor A. R. Kendrick. Councillor H. L. Mason. Councillor G. H. Needs. Councillor E. T. Rann (died 30th October, 1961). Councillor R. F. Whale. 4 Telephone: PROspect 3443. Public Health Department, Municipal Offices, Sheen Lane, S.W.I4. To the Mayor, Aldermen and Councillors of the Borough of Barnes. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1961, upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the Report is in accordance with the instructions of the Minister of Health, and special mention is made of certain items at the Minister's request. The report shows that the health of the residents has been maintained at the usual high level and that a great deal of preventive work has been carried out from the Health Department. I am indebted to Mr. W. L. Leach, Chief Public Health Inspector, whose report on the Sanitary Circumstances of the District is included; and I would draw your attention to the remarks on the difficult problem of 'Housing' with which I am in complete agreement. Mr. G. W. Nicholls, Chief Clerk, resigned his appointment during this year and I am grateful to Mr. J. A. Brown, his successor, who has dealt with the Vital Statistics and has prepared the Report for the printers. Finally, I wish to express my thanks to the Chairman and Members of the Health Committee for their support throughout the year, and to every member of staff of the Public Health Department for their loyalty and co'operation. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, ERIC PEREIRA, Medical Officer of Health. August, 1962. 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 Population. The Registrar-General's estimate of the population in 1961 was 38,990 which can be compared with the 1961 Census population of 39,757 and the estimated population in 1960 which was 38,800. Births. During the year 522 births were recorded, compared with 468 in 1960. Both the still-birth and the infant mortality rates have fallen as compared with the previous year and in both cases the rates are lower than those for London and for England and Wales. There were 6 infant deaths compared with 12 in 1960. Of these, 5 deaths took place in hospital soon after birth, and one infant developed pneumonia at home and failed to respond to treatment. Deaths. The total number of deaths occurring amongst residents was 490 compared with 475 in 1960. The death rate, when corrected to allow for the high proportion of elderly residents, was 10.6 per thousand population which compares favourably with the rates for London and other towns in this country. There were 28 deaths due to cancer of the lung compared with 19 such deaths in the previous year and 30 in 1959. These figures are too small to be of much significance but it is interesting to note that no less than 12 of these deaths occurred in women. One maternal death was recorded during the year. This was an unusual case. The mother was delivered of a healthy male child in Fulham Maternity Hospital in November, 1960. She was discharged home at the normal time and she and the baby appeared to be in good health. In the third week of January, 1961 she died from a pulmonary embolus said to have been due to a venous thrombosis following parturition. Social Conditions. The Borough of Barnes, in the County of Surrey, is situated on the South Bank of the River Thames between Richmond and Putney. 6 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) Services Provided by the Surrey County Council. These are organized on a Divisional Basis, the Northern Division comprising the boroughs of Barnes and Richmond. The Medical Officer of Health for the Districts is also the Divisional Medical Officer, and this arrangement assists Co-ordination of the personal health services and environmental health. Administrative, Infant Welfare and School Medical functions are carried out from the following Centres:— Divisional Health Office and Welfare Centre, King's Road, Richmond. Welfare Centre, Essex House, Barnes. Welfare Centre, North Worple Way, Mortlake. Health Visitors are employed and are based at the above centres. District Nurses and Midwives are provided and their main centre in Barnes is the Nurses Home, 31/32, Ranelagh Avenue, Barnes. They work under the direct supervision of the general practitioners. Moral Welfare or the care of unmarried mothers and illegitimate children, is undertaken by an officer based at the Divisional Health Office. A Home Help Service provides for domestic help in the home in cases of home confinement or illness. The service is under the management of the Home Help Supervisor who is based at the Divisional Health Office. An Ambulance Service is provided from the Station in King's Road, Richmond, which operates under the Control Station in Maiden. A Day Nursery for the care of children up to the age of 5 years is located at 45, Castelnau, Barnes. (b) Services Provided by the Regional Hospital Board. Hospitals. The Royal Hospital and Kingston Hospital provide general treatment for both in-patients and out-patients. In addition, many residents 7 make use of the West London Hospital, Hammersmith and other London Hospitals. Patients suffering from infectious diseases are admitted to the South Middlesex Fever Hospital, to Tolworth Isolation Hospital, and to the Western Fever Hospital, Fulham. Psychiatric Services. The Medical Staff of Banstead Hospital hold out-patient clinics at the Royal Hospital on Tuesdays and Fridays for residents of Barnes and Richmond. Diseases of the Chest. A Chest Clinic is run jointly by the Regional Hospital Board and the Surrey County Council, and is located over the Welfare Centre, North Worple Way, Mortlake. Laboratory Facilities. The Laboratory of the Royal Hospital is available for specimens sent in by general practitioners. The Public Health Laboratory, Epsom is available for the examination of samples of milk and ice-cream, and any pathological specimens. The Staff is always available to assist the Medical Officer of Health in the case of epidemics or outbreaks of food poisoning. The Central Public Health Laboratory, Colindale, is available for advice, special immunising agents and special investigations. Mortuary. This is provided and maintained by Richmond Borough Council on a site close to the Petty Sessions Court. It is well equipped with two post-mortem tables. Barnes Borough Council make an annual payment for this service. (c) Services Provided by the Surrey Executive Council. The Surrey Executive Council provides General Medical and Dental Services, Pharmaceutical Services and Supplementary Ophthalmic Services. More than twenty doctors living within the borough have undertaken to provide General Medical Services. Several of these have also undertaken to provide Maternity Medical Services. Care of the Aged and the Chronic Sick. The scheme for the care of the aged and the chronic sick is working fairly well. 8 The Geriatrician based at Kingston Hospital has the services of a full-time Health Visitor and is able to visit and assess the needs of all cases reported as requiring admission to hospital. Continued shortage of beds in Hospitals and Homes causes delay in admission during certain months of the year, but a desperate case is invariably admitted in a very short time. Cases awaiting admission are supervised by the Geriatric Health Visitor while those who are in frail health are visited by the general Health Visitors. A great deal is done to assist the aged by the local voluntary services through schemes such as "Meals on Wheels", Old Peoples' Clubs, Chiropody, etc. The Barnes Day Club was first opened in March, 1958 in an attempt to alleviate the pain and loneliness of severely handicapped men and women living in the borough. It soon proved to be an outstanding success and in 1960 it was transferred to its own well equipped premises on a site at Mortlake Green. It now opens on three days each week and the whole organization is a remarkable example of the excellent results that can be obtained by enthusiastic voluntary workers. Laundry Service. The Council acts as an Agent for the County Council in providing this service. It is confined exclusively to patients who are incontinent, and articles laundered are limited to sheets and draw sheets. Although the number of cases served is small, the benefits to exhausted relatives are enormous. It enables them to nurse at home in comfort a patient who otherwise would have had to be admitted to hospital. Sheets are collected from the patients' homes every Tuesday and Friday and at the same time an appropriate number of clean sheets is issued. A charge of sixpence per sheet is made, which is no hardship, since the cost is covered by a supplementary allowance where patients are in Receipt of National Assistance. National Assistance Act, 1948, Section 47. National Assistance (Amendment) Act, 1951, Section l(i). In some cases the old people create their own problems by refusing to leave their homes when they can only be properly cared for in a Hospital or a Home. Under these circumstances it becomes necessary for the Council to apply to the Court for an Order for the compulsory removal of the patient to a hospital or other suitable accommodation. During the year 4 cases of old people in need of care and attention were investigated, but formal action under the above sections of the Acts was taken only in one instance. This was 9 the case of an old man who shared a flat with his physically handicapped daughter. He had become ill and his daughter had made great efforts on his behalf but was quite unable to provide the care and attention he required. He refused to leave his home but as hospital treatment was urgently needed, an application was made for a Removal Order under the National Assistance (Amendment) Act, 1951. He was removed the same day to Barnes Hospital where he remained quite willingly until his death a few weeks later. SECTION 'F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Measles. The usual biennial epidemic of measles occurred, there being no less than 654 cases notified during the year. Several cases were quite severe but all made satisfactory recoveries. Whooping Cough. Only 8 cases were notified and these were not severe. The high proportion of infants immunized against this disease is undoubtedly reducing both the incidence and the severity. Poliomyelitis. One case of non-paralytic poliomyelitis was notified. This was a little girl aged four years who sickened in June and was proved bacteriologically to be infected with polio virus type I. She had been immunized, together with the other members of the family, one year previously. She made a complete recovery. Bacteriological investigations showed that both parents and her sister and brother were also infected with the same organism, but no other members of the family suffered any ill-effects. It seems very probable that one or more members of this family escaped serious and crippling disease through taking advantage of the immunization scheme. Dysentery. Fifteen cases were notified during the year. Of these, fourteen were due to Shigella sonnei, an organism which is prevalent throughout the country and which causes a mild form of dysentery. There was some spread of the disease amongst members of the families concerned, but there was no outbreak in a school or other institution. 10 The remaining case was a man who had returned from a holiday in Istanbul. He developed symptoms of dysentery and was found to be infected with Shigella flexneri. There was no spread of infection and the patient made a good recovery. Food Poisoning. Seven cases were notified, five being due to Salmonella organisms, and in the others the cause was not established. A young man was found to be suffering from infection by Salmonella paratyphi which he had presumably contracted in Malta. There was no spread of the disease and he made a good recovery. Isolated cases also occurred due to Salmonella enteritidis, Salmonella newport, Salmonella typhimurium and Salmonella anatum. Apart from the above, the following occurrences are of some public interest:— A woman purchased a small tin of Scotch Broth and on the same day noticed that there was a peculiar smell when she opened it. However, she heated and consumed it at lunch-time. Within half an hour she was vomiting violently and this continued throughout the rest of the day. She had recovered by the following morning. All bacteriological investigations proved negative and the remaining stock of Scotch Broth was declared fit. It seems probable that the tin purchased was defective and that chemical changes had taken place in the broth. Anyone consuming tinned food which smells or appears to be unfit runs a risk of acute food poisoning. Another small outbreak of food poisoning was due to the coiv sumption of oysters. Early in the year the Health Department was notified that seven people who had consumed a batch of 50 oysters had all been taken ill with symptoms of food poisoning. Subsequently, it appeared that similar outbreaks had occurred in two other districts and that, in each case, the oysters had come from the same bed. The bed in question was not the usual one, but was a bed of lower salinity higher up the river. This had not been taken into account in London and so the purification process was less effective. Bacteriological examination of specimens from the patients were all negative so that the nature of the infecting organism was not established. IMMUNISATION AND VACCINATION This work is organized from the Divisional Health Office, Sheen Road, Richmond, and is carried out at the Clinics and in the Schools. 11 The schemes for protecting infants and children against Diph' theria, Whooping Cough, Tetanus, Smallpox and Poliomyelitis, have been actively pursued as in previous years, and every effort has been made to obtain a high degree of immunity. The percentage of children protected against Poliomyelitis was brought to a very high level by carrying out the injection in the schools. During the year a fourth 'booster' dose was offered to children aged between 5 and 11 years and again the acceptance rate was in the region of 100%. Vaccination against Smallpox. Late in the year Smallpox was imported into the country and this led to a heavy demand for vaccination and re-vaccination in the early part of 1962. Much has been said concerning vaccination since then and I feel that some remarks on this subject would be appropriate. The immunity conferred by vaccination fades gradually with the passage of time. In some individuals it appears to fade more rapidly and completely than in others. If an individual is to be kept permanently immune he would have to be re-vaccinated at least every three years. It is not practical to immunize a population in this way. An outbreak of Smallpox is controlled by vaccinating without delay all possible contacts. The incubation period of the disease is 12 days. Primary vaccination leads to immunity in 10 days and so can prevent an attack if given very early. Re-vaccination leads to immunity in 5 days and so has a much greater chance of preventing the disease. This is the most important argument in favour of vaccination of infants; in addition there is an added risk with primary vaccination in later life. Certificates of Vaccination and Inoculation. A considerable number of requests were received from residents in the borough for a certificate of vaccination or inoculation to be authenticated for the purpose of travel abroad. The signature of the person issuing the certificate was verified in each case as that of a registered medical practitioner practising in the Borough of Barnes and the certificate was endorsed accordingly. Requests were also received by the Medical Officer of Health for a certificate to the effect that no recent cases of smallpox have occurred in the borough. Such requests are made by persons travelling to the United States of America who do not wish to be vaccinated. Prevention of Tuberculosis. B.C.G. inoculation is offered to all children who are in their 13th year. The object is to provide artificial immunity during the 11 adolescent period when young people are most susceptible to this disease. Mobile Radiography Unit. The Mobile Chest Radiography service for general practitioners has proved to be a great convenience to the local doctors and their patients and good use has been made of the service. The Unit operates outside the Municipal Offices every Monday evening from 5.45 p.m. to 6.45 p.m. Patients are X'Rayed expeditously and the Unit can readily cover the demand. Prospective Council employees who have not proof of recent Chest X'Ray are referred to the Unit, and the report can be of considerable help in assessing their fitness for employment. During the year 29 employees were examined prior to inclusion in Sickness and Superannuation Schemes. In addition, the Unit is available to members of the public who can visit during the time stated without any prior appointment. 13 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. There has been no change in the method of collection, purification and storage of the domestic water supply for the district. Daily samples are taken by officers of the Metropolitan Water Board at each stage, and the average result of the bacteriological examinations of 1,835 samples is given in Table 14. A uniformly high standard of purity and quality was maintained. All houses in the district have a supply of piped water. Not all, of course, have drinking water direct from the mains, many taking all supplies from a main storage tank. These storage tanks may not be in a state of thorough cleanliness. Finding out is often quite a task as the tanks are invariably in most inaccessible positions. All drinking water should be taken direct from the mains. In this district, however, this is not a legal requirement. It sometimes happens that the presence of small feathers in a beaker of drinking water leads to the discovery of a dead bird or something similar in an uncovered tank ! The Board's waters are not plumbo-solvent and are 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. We are indebted to Dr. Windle Taylor, Director of Water Examination to the Board, for the information in Table 14. SEWERAGE AND SEWAGE DISPOSAL The work of thoroughly cleansing and overhauling sections of the public sewers has proceeded very well largely due to the successful operation of the new cleansing apparatus purchased in 1960. Some complaints were received when parts of the Beverley Brook became stagnant as a result of a diversion of flow made necessary by the reconstruction of the main surface water sewer in Rocks Lane and Church Road, but these were soon remedied. There were again a few complaints of unpleasant odours and flies in the vicinity of the Sewage Works. It is unfortunate that, in this congested built up area, dwellings must be situated within such a 14 short distance of the Sewage Works as it appears impossible to operate even a modern plant without some inconvenience, especially after a spell of hot weather. Local residents can rest assured, however, that every possible step is taken by the Richmond Main Sewerage Board to minimise the risk of nuisance. VERMINOUS PREMISES ETC. Rodent Control. Satisfactory progress has again been made towards our aim of completely eradicating rats from the sewers. Only a very small proportion of the sewer manholes now show 'takes' of rodent bait. It is hoped to concentrate now on some small but intensive campaigns to eliminate, if possible, the pockets of infestation which remain. Pigeons. With the coming into operation of the Public Health Act, 1961, local authorities generally can now undertake the destruction of feral (wild) pigeons. Although we have been instrumental in assisting a few householders troubled by these pests inside their premises, no organised large scale measures have so far been undertaken. Modern techniques are being developed to deal more adequately with these birds which cause such a lot of damage and nuisance, but care is needed so as not to cause distress to bird-lovers, who, like the dog owners, do not seem to mind what mess their protegees make — on other people's property. Other Pests. No undue difficulties were encountered in dealing with the few cases of infestation by other pests. With the increased use made of the Barn Elms Playing Field, investigation was needed on the identity and origin of swarms of insects which appeared in the vicinity of the small lake. These were identified as Chironomidae and remedial measures appear to have had a fair degree of success. The routine spraying of school kitchens to deal with flies has been suspended as a matter of policy and it will be interesting to see whether this has been justified. At the time of writing no complaints of flies have been received from workers in the kitchens. Swimming Pool. In June of this year a learners' swimming pool was opened at Sheen Mount County Primary School. The source of the water is from the Metropolitan Water Boards supply and a modern filtration and chlorination plant has been installed. A process of continuous 15 circulation through a filtration plant with chlorination of the water is ensured. During the year 13 bacteriological samples were taken from the Bath of which six were found to be unsatisfactory. The unsatisfactory samples were due to a minor defect in the plant which has now been rectified by the manufacturers. ATMOSPHERIC POLLUTION One of the chimneys which frequently gave rise to complaints was converted from coal to oil firing and has since operated satisfactorily, in a Smoke Control Area, without causing smoke. The old Generating Station chimney, which also used to give trouble, has now gone out of use. There were a few minor complaints of smoke from small installa' tions. With the progress of Smoke Control Areas residents are certainly becoming much more sensitive to smoke nuisances and this has led to an increase in the number of visits and investigations. The Smoke Control Area programme progressed fairly satisfact' orily. The No. 1 Area came into operation in November, 1961 but not all works were completed by then. Due to delay from the hearing of objections at a local Public Inquiry, the date for the operation of No. 2 Area was postponed until 1st July, 1962. Work is well in hand to bring in the No. 3 Area and it is expected that this will be in operation by 15th November, 1962. About a third of the borough will then have been made smokeless. It is confidently expected that the full programme for the whole borough will be completed by 1968. From the experience gained in the introduction of the first areas in this borough, it is clear that, whilst the Grants Scheme is fundamentally sound, the legal provisions of the Clean Air Act, 1956, which govern the making of grants, are too restrictive and do not allow sufficient latitude and time for conversions and claims to be made. The biggest single point of difficulty in dealing with applicants is that in nearly all cases the work proposed by them constitutes a considerable improvement in their heating arrangements and goes far beyond what is necessary to comply with the Smoke Control Order. Much disappointment is expressed when the amount which actually ranks for grant is disclosed. This amount is, of course, based on such work of adaptation or conversion as is essential in order to burn smokeless fuel instead of coal. New tiled surrounds and hearths rarely rank for grant ! Very few grumbles have been heard from householders, once the new grates are in use. Those noted have been concerned with poor work by builders and the difficulty which some elderly people have in managing the gas or electric firelighters, 16 Survey of Atmospheric Pollution. The Department co-operates in the National Survey on atmospheric pollution carried on under the aegis of the Department of Scientific and Industrial Research. As a result of a critical review of methods of observation it was recommended that the use of Lead Peroxide instruments, for measuring sulphur in the air, and the Deposit Gauge, should be confined to the study of special local pollution problems. This policy has been adopted in Barnes and the use of these instruments was discontinued. The measurement of smoke and sulphur dioxide by the more accurate daily volumetric apparatus has, however, been continued, and the information obtained is supplied to the Department of Scientific and Industrial Research. This apparatus is situated at the Civil Defence Training Centre in East Sheen. Although daily visits and tests are necessary the running expenses are much less than those previously incurred. SECTION 'D' — HOUSING Housing work has not been of a spectacular nature during the past year. The Stanton Road Clearance Area was finally cleared and so brought to an end the slum clearance programme for Barnes as far as the old type of slums were concerned. It cannot be said, however, that housing conditions are now to be considered satisfactory. Whilst freedom from rent control has certainly produced a new mobility in housing there are certain aspects of this mobility which should cause concern. Where long standing tenancies are brought to an end, usually by the death or dispossession of an elderly tenant, the vacant property is invariably put on the market, possibly improved and reoccupied, not by a tenant of the same income group as the old tenant, but by someone who can afford to pay four or five times the old rent. Often the new occupants are from outside this area — or even from abroad! The result of this trend is that the reservoir of housing accommodation, available for the lower income groups, becomes smaller and smaller every week. Those workers who, for centuries, have been able to find reasonably priced accommodation near their work, now not only cannot find such cheap, convenient accommodation but they cannot find any accommodation at all locally. Their only recourse is to go back, complete with family, to Mum and Dad, or to other relatives, and from there register for a house and a job in one of the New Towns. A healthy district needs workers of all grades of income to keep things balanced, to provide services of all kinds and to maintain a varied flourishing community. Recruitment of labour for local purposes will become increasingly difficult unless something can be 17 done to maintain, at least, the same proportion of houses and flats suitable for occupation by the lower paid workers and their families. There are relatively few blocks of old rented properties in the area which have any architectural or aesthetic merit. Because of the low utilitarian standard of unfitness and the very high cost of redevelopment on a large scale, most of this poor type property seems destined to be repaired and 'modernised' and given a new lease of life. The older congested areas are likely to remain so. Parts of Town Ward and the northern part of Palewell Ward are amongst the most congested areas in London. Even some of the basements which have been closed during the last few years have now been reconditioned and are back in use, much improved, of course, as regards structural amenities. During surveys carried out for other purposes it has been noted that in certain areas of the borough, particularly in Barnes, there is considerable 'over-housing' in that one or two elderly people continue to occupy relatively large properties. These are usually owner-occupiers of the more expensive houses so that even if, in some way, a redistribution of accommodation could be effected, it is doubtful whether the rents or purchase price would be within the reach of the average family man. Of course, much subdivision of house property is being carried out, often without the submission of proposals to the local authority, and the resultant 'adaptations' often fall short of decent housing standards, especially from the point of view of lack of sound proofing and privacy. Certainly housing in Barnes is no longer a problem from the unfitness point of view, but it is obvious that the supply will never meet the demand and some of the last comers will inevitably create public health problems by putting up with what they can get until the local authority waves the magic wand and rehouses them; for no one else will. There have already been a few cases where larger houses have been turned into typical 'houses let in lodgings'. The new Codes of Management, prescribed in Regulations made under the Housing Act, 1961, should assist materially in the control of conditions in such premises. OVERCROWDING The position with regard to statutory overcrowding is still reasonably satisfactory. Special consideration is given when allocations of Corporation dwellings are made. The figures which will indicate the present degree of overcrowding in the borough as revealed by the 1961 Census, have not yet been received. 18 SECTION 'E' — INSPECTION AND SUPERVISION OF FOOD The conditions under which food for human consumption is prepared, handled, exposed for sale, and sold, continued to receive careful attention during 1961. There was only one prosecution in respect of the sale of food involving the substitution of margarine for butter. As will be seen in the Statistical Section, a few samples taken at random revealed some doubtful practices. There are still some processes in the preparation of food where it is economically not possible to guarantee 100% purity. Routine samples were taken from time to time of confectionery products and prepared foodstuffs and it was found necessary to take action to prevent risk of infection from the manufacture of such things as cream buns, cakes etc., and the sale of chickens and shellfish. With one exception, all the manufacturers or retailers concerned co-operated willingly and promptly when informed of their short'comings. BOROUGH OF BARNES APPENDIX TO THE ANNUAL REPORT OF THE Medical Officer of Health 1961 13 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, 1961. Area 2,650 acres Population:- Census, 1951 40,558 Census, 1961 39,757 Registrar-General's estimate, mid-1961Rating:— 38,990 Number of inhabited houses 12,486 Rateable Value £897,771 Product of a penny rate £3,654/ 19/2d. Mortality: — Males Females Total Number of Deaths 216 274 490 Death Rate per 1,000 population:— Uncorrected 12.6 Corrected (Comparability Factor 0.84) 10.6 Death from Cancer (all ages) 105 Deaths from Measles (all ages) NIL Deaths from Whooping Cough (all ages) NIL Deaths from Diarrhoea (under 2 years of age) NIL Live Births: — Legitimate Illegitima Total Number 486 32 518 Rate per 1,000 population 13.3 Illegitimate Live Births per cent of total live births 6.2 Stillbirths:— Number 4 Rate per 1,000 total live and stillbirths 7.7 Total Live and Stillbirths 522 Infant Deaths (deaths under 1 year) 6 Infant Mortality Rates:— Total infant deaths per 1,000 total live births 11.6 Legitimate infant deaths per 1,000 legitimate live births 12.3 Illegitimate infant deaths per 1,000 illegitimate live births NIL Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 9.7 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 3.9 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 11.5 Maternal Mortality (including abortion):— Number of deaths 1 Rate per 1,000 total live and stillbirths 1.9 14 Table 2.— Vital Statistics of the Borough of Barnes during 1961 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 1956 484 475 11.8 345 8.6 29 208 5 10.5 524 13.1 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 1959 476 468 12.0 333 8.6 47 249 8 17.1 535 13.8 1960 468 458 11.8 271 7.0 43 247 12 26.2 475 12.2 1961 522 518 13.3 268 6.9 40 222 6 11.6 490 12.6 25 Table 3. — Birth-rate, Death-rate, and Analysis of Mortality from Certain Causes during the Year 1961, 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 Malignant neoplasm lung, bronchus Whooping cough Diphtheria Tuberculosis (all forms) Influenza Acute Poliomyelitis Pneumonia Coronary and arteriosclerotic heart disease England and Wales (46,166,000) 17.4 12.0 0.49 0.00 0.00 0.07 0.15 0.00 0.65 2.07 19.1 21.6 London (3,179,980) 18.7 11.9 0.67 0.00 0.00 0.10 0.08 0.00 0.76 2.05 18.3 21.5 Barnes Borough (38,990) 13.3 10.6 0.72 — — 0.03 0.05 — 0.51 2.69 7.7 11.6 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. 26 Table 4. — Causes of Death during the Year 1961. Causes of Death (Registrar-General's short list of causes) Total Deaths Male Female 1 Tuberculosis, respiratory 1 1 - 2 Tuberculosis, other - - - 3 Syphilitic diseases 2 1 1 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal infections - - - 7 Acute poliomyelitis - - - 8 Measles - - - 9 Other infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 12 3 9 11 Malignant neoplasm, lung, bronchus 28 16 12 12 Malignant neoplasm, breast 13 - 13 13 Malignant neoplasm, uterus 4 - 4 14 Other malignant and lymphatic neoplasms 48 28 20 15 Leukaemia, aleukæmia - - - 16 Diabetes 5 - 5 17 Vascular lesions of nervous system 72 25 47 18 Coronary disease, angina 105 47 58 19 Hypertension with heart disease 3 1 2 20 Other heart disease 49 16 33 21 Other circulatory diseases 28 13 15 22 Influenza 2 - 2 23 Pneumonia 20 8 12 24 Bronchitis 27 23 4 25 Other diseases of respiratory system 5 2 3 26 Ulcer of stomach and duodenum 1 1 - 27 Gastritis, enteritis and diarrhoea 4 3 1 28 Nephritis and nephrosis 1 - 1 29 Hyperplasia of prostate 4 4 - 30 Pregnancy, childbirth abortion 1 - 1 31 Congenital malformations 1 - 1 32 Other defined and ill-defined diseases 34 16 18 33 Motor vehicle accidents 5 1 4 34 All other accidents 8 3 5 35 Suicide 7 4 3 36 Homicide and operations of war - - - All Causes 490 216 274 27 Table 5.—Infant Mortality during the Year 1961. 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 Pneumonia - 1 1 - 2 - - - - - 1 2 Birth Accident 1 - - - 1 - - - - - - 1 Prematurity - 1 - - 1 - - - - - - 1 Cerebral Haemorrhage 1 - - - 1 - - - - - - 1 2 2 1 - 5 1 - - - 6 1 5 Table 6.— Laundry Service for Incontinent Patients. Number of patients using the service, as at 31.12.61 12 Number of patients admitted to hospital and the service discontinued 1 Number of patients who died and the service discontinued 8 Number of sheets laundered and issued 2,208 28 SECTION 'F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Table 7.—Notifiable Infectious Diseases, 1951 to 1961. Year 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 Anthrax - - - - - - - - - - - Cholera - - - - - - - - - - - Diphtheria - - - - - - - - - - - Dysentery 4 11 25 75 - 4 - 3 5 6 15 Encephalitis Acute - - - - - - - - - - - Enteric (Typhoid or Paratyphoid Fever) 2 1 - 1 2 - 1 - 1 - 1 Erysipelas 2 8 7 2 7 2 1 1 - 1 ? Food Poisoning - 1 11 5 10 11 5 1 2 7 Malaria - - 2 - 1 1 - 2 2 - 1 Measles 541 249 306 5 489 16 606 136 433 8 654 Membranous Group - - - - - - - - - - - Meningococcal Infect'n 2 - - 2 - - - - - - - Ophthalmia Neonatorum - - - - - 1 - - - - - Plague - - - - - - - - - - - Pneumonia 29 21 27 11 31 25 78 47 61 11 29 Poliomyelitis, Paralytic - 8 3 1 7 4 1 1 - - - „ Non-Paralytic - - - - 1 2 - - 1 - 1 Puerperal Pyrexia - 4 1 - 3 3 1 - - - 2 Relapsing Fever - - - - - - - - - - - Scarlet Fever 17 42 21 29 7 8 5 10 9 24 10 Small-pox - - - - - - - - - - - Tuberculosis, Pul. 38 39 37 27 23 18 19 78 19 19 17 „ Non-Pul. 1 7 3 3 3 3 4 - 1 1 1 Typhus Fever - - - - - - - - - - - Whooping Cough 82 19 136 25 42 17 37 6 2 16 8 29 Table 8.—Certain Infectious Diseases : Incidence per 1,000 of the Population in 1961. Disease Barnes London (a.c.) England and Wales Scarlet Fever 0.26 0.43 0.43 Diphtheria - 0.01 0.00 Enteric Fever 0.03 0.01 0.01 Acute Pneumonia 0.74 0.37 0.40 Dysentery 0.38 0.57 0.44 Acute Poliomyelitis— Paralytic - 0.01 0.02 Non-Paralytic 0.03 0.00 0.00 Food Poisoning 0.18 0.25 0.17 Tuberculosis— Respiratory 0.44 0.74 0.42 Others 0.03 0.08 0.06 Table 9. — Infectious Diseases Notified during the Year 1961. Diseases Total Cases Notified Ages, in years Parish Removed to Hosnital Under 1 year 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 9 10 to 14 15 to 19 20 to 24 25 to 34 35 to 44 45 to 64 65and over Barnes Mortlake Dysentery 15 - - 2 3 - 1 2 - 1 4 - - 2 - 15 - Erysipelas 2 - - - - - - - - 1 - - 1 - 1 1 - Food Poisoning 7 1 - - - - 1 1 - - 3 1 - - 5 2 1 Malaria 1 - - - - - - - - - 1 - - - 1 - - Measles 654 13 52 84 87 100 297 16 2 - 1 2 - - 303 351 2 Paratyphoid Fever 1 - - - - - - - - 1 - - - - - 1 - Pneumonia (Acute) 29 - - - - - - - - - 1 4 10 14 18 11 5 Poliomyelitis, Non Para. 1 - - - 1 - - - - - - - - - 1 - - Puerperal Pyrexia 2 - - - - - - - - 1 1 - - - - 2 - Scarlet Fever 10 - - - 3 2 4 1 - - - - - - 4 6 - Tuberculosis, Pul. 17 - - - 2 - - - - 2 4 1 6 2 11 6 9 Tuberculosis, Non-Pul. 1 - - - - - - - - - 1 - - - 1 - 1 Whooping Cough 8 - 2 1 4 1 - - - - - - - - 5 3 - 748 14 54 87 100 103 303 20 2 6 16 8 17 18 350 398 18 30 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, 1961 are as under:— Table 10.—Tuberculosis Register. Form of Disease On Register, 1st Jan., 1961 Cases Added Removed from Register Remaining on Register, 31st Dec. 1961 Primary Notif'ns Otherwise Restored Total NonPul. Cured Left District Dead Total Pulmonary 161 17 8 2 188 - 17 19 1 37 151 Non-Pulm'y 15 1 2 - 18 - 4 1 1 6 12 Totals 176 18 10 2 206 - 21 20 2 43 163 Table 11.—Tuberculosis: New Cases and Mortality, 1961. 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 1 5-14 „ 1 - - - - - - - 15-24 „ 1 5 - - - - - - 25-44 „ 3 4 1 1 1 - - - 45-64 6 3 - - - - - 65 „ and over 1 1 - 1 1 - - 1 All ages 13 14 1 2 1 - - 1 * 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 0.69 All forms 0.77 (per 1.000 population) Non-Pulmonary 0.08 Death-rate—Pulmonary 0.03 (per 1,000 population) Non-Pulmonary NIL 32 Table 12. — IMMUNISATION and VACCINATION. Diphtheria Immunisation. Number of children immunised during 1961:— Under 5 years 389 Between 5 and 15 years 44 Number of children re-immunised during 1961:— Under 5 years 42 Between 5 and 15 years 601 Total number of children immunised at 31st December, 1961:— Under 5 years 1589 Between 5 and 15 years 4261 Whooping Cough Immunisation. Number of children immunised by primary course 413 Tetanus Immunisation. Number of children who have completed a primary course of three injections 408 Number of children who have received a reinforcing dose 138 Vaccination against Smallpox. Number of Vaccinations carried out during 1961:— Children Primary Vaccination 384 Re-vaccination 67 Number of Vaccinations carried out at Clinics 262 Number of Vaccinations done by private doctors 189 Figures showing percentage of children under 1 year vaccinated during 1961:— Number Vaccinated under 1 year 257 Estimated Mid-year population under 1 year 500 Percentage Vaccinated 51.4% 33 POLIOMYELITIS VACCINATION. Northern Division—Barnes and Richmond. Number of persons vaccinated during year 1961 1st injection 2nd injection 3rd injection 4th injection A. Children born in years 1943—1961 1837 1460 — — B. Young Persons born in years 1933—1942 388 340 — — C. Person born before 1933 who have not passed their 40th birthday 970 869 — D. Others 154 134 — — E. Total A to D 3349 2803 5692 4279 H. Number of record cards submitted by G.P's during the year. (a) Recording 1st and 2nd injections 1247 (b) Recording 3rd injection 1265 (c) Recording 4th injection 472 Total number of Poliomyelitis Injections given during 1961 = 20,354. Vaccination Against Tuberculosis. During 1961 a total of 612 boys and girls were inoculated with B.C.G. in the Northern Division (Barnes and Richmond). 34 Table 14.—Water Supply—Bacteriological Sampling. Type of Test WATER PASSING INTO PUBLIC SUPPLY— Hampton Works. Average Result Plate Count per millilitre on agar 20/24 hrs. at 37°C 10.0 Coliform Test (Count per 100 ml). 99.84% Negative Escherichia Coli Test (Count per 100 ml). 99.89% Negative SWIMMING POOL. Table 15.—Summary of Bacteriological Examination. Standards. Agar count 1ml. 37°C. 24 hours Samples Satisfactory Samples Unsatisfactory 0-10 11-100 Over 100 Number of samples 7 2 4 7 6 Table 13.—Mass Radiography Service. General Practitioner's Service. Men Women Total Patients referred by their Doctors 481 486 967 Abnormalities detected:— Pulmonary tuberculosis 4 1 5 Lung Cancer 4 2 6 Barnes Borough Council employees referred by the Medical Officer of Health 29 Public Mass Radiography Service. Men Women Total Number of persons examined 647 173 820 Abnormalities detected:— Pulmonary tuberculosis 1 — 1 SECTION 'C'—SANITARY CIRCUMSTANCES OF THE AREA 35 Table 16.—Infected Rooms and Articles (dealt with by the Council). Premises disinfected 3 Lots of bedding disinfected 6 „ „ „ destroyed 6 Household effects removed and destroyed 31 Table 17.—Disinfestations (Dealt with by the Council). Disinfestation by spraying or fumigation was carried out at various premises for the following infestations:— Mosquitoes 1 Flies 15 Bugs 15 Wasps 63 Ants 4 Fleas 3 Beetles 8 Bees 1 Table 18.—Rodent Control. Summary of work carried out:— Premises visited 454 Inspections made 569 Treatment visits 539 Premises treated 114 Minor infestations of Rats 105 Minor infestation of Mice 15 Table 19.—Atmospheric Pollution. Volumetric Apparatus. 1956. 1957. 1958. 1959. 1960. 1961. Average Smoke (Microgrammes per cu. metre) 190 202 149 140 103 90 Average Sulphur Dioxide (Microgrammes per cu. metre) 175 130 129 150 124 107 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. 36 Table 20.—Factories. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 21 9 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 151 82 2 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 11 4 - - Total 183 95 2 — Cases in which DEFECTS were found:— Particulars Number of cases in which defects were found. Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) — — — - — Unreasonable temperature (S.3) — — - - — Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7): (a) Insufficient - - - - - (b) Unsuitable or defective 3 3 - 2 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 3 3 - 2 - 37 Table 21.—Outworkers. Work Undertaken No. on Register Notices Served Wearing apparel 88 - Lamp Shades 13 - Curtain makers 3 - Stuffed Toys and Nursery Articles 1 - Xmas Crackers etc 11 Artificial Flowers 1 - Carding of buttons 4 - Household linen 3 - Brass Articles 1 — Total 125 — Legal proceedings under Factories Act:— No legal action was necessary during 1961. Table 22.—Other Premises. Nature of inspection Number of premises Number of visits Notices issued and complied with Schools 20 24 - Public Houses, Public Halls, and Public Conveniences 40 21 - Stable Yards 4 16 - In addition to the above, 77 visits were made by Public Health Inspectors to premises in connection with infectious diseases and 472 visits in connection with offensive accumulations—3 exhumations were supervised. Altogether, 440 non-effective visits were made to premises of all types where no access was gained. SECTION 'D'—HOUSING Table 23.—Housing Inspection. Number of houses inspected in respect of defective conditions 295 Number of re-inspections 1,433 Number of houses inspected in respect of unsatisfactory living conditions, but where no repairs were required 82 Number of re-inspections 90 Number of Informal Notices served 138 Number of Informal Notices complied with 115 38 Table 24.— Rent Act, 1957. Applications for Certificates of Disrepair. Period ended:— Dec. 1957. Dec. 1958. Dec. 1959. Dec. 1960. Dec. 1961. 1. No. of applications for Certificates 44 31 16 8 1 2. No. of decisions not to issue Certificates - - - - - 3. No. of decisions to issue Certificates 44 31 16 8 1 (a) in respect of some but not all defects 31 26 8 5 - (b) in respect of all defects 13 5 8 3 1 4. No. of undertakings given by landlords under para. 5 of the First Schedule 24 21 9 5 2 5. No. of undertakings refused by local authority under proviso to para. 5 of the First Schedule - - - - - 6. No. of Certificates issued 10 18 8 1 1 Applications for Cancellation of Certificates. Period ended:— Dec. 1957. Dec. . 1958. Dec. 1959. Dec. 1960. Dec. 1961 7. Applications by landlords to local authority for cancellation of Certificates 1 14 9 4 5 8. Objections by tenants to cancellation of Certificates - 6 5 - 3 9. Decisions by local authority to cancel in spite of tenant's objection - - 2 - - 10. Certificates cancelled by local authority - 8 6 1 5 39 SECTION 'E'—INSPECTION AND SUPERVISION OF FOOD Table 25.—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 6 17 1 Bread and Cakes 17 15 — Butchers 28 89 — Cafes, Restaurants, etc. 41 81 3 Canteens, etc. 10 10 - Cooked Meats 70 53 - Dairies and Milk Shops 24 10 - Fishmongers 13 31 — Fried Fish Shops 2 — — Greengrocers 39 95 2 Grocers 74 202 4 Ice Cream:- Retailers 92 76 — Public Houses 29 10 — Street Traders 8 — — Sweets, Confectionery 65 54 — Table 26.—Sampling of Other Food and Drugs. (a) Chemical Analysis.—52 Samples procured under the provisions of the Food and Drugs Act, 1955, included:— Butter Pastes Coffee Pickles Cheese Sweets Flour Sauces Milk Soups Cakes and Confectionery Canned Meats Fruit Drinks „ Fish Medicines „ Fruit Packaged Food Mixes „ Veg. Wine Peppers Meat Dried Fruit Ice Cream „ Veg. Lard Fish Cakes. (b) Overleaf I give the Public Analyst's reports on the three samples examined which were found to be irregular or sub-standard. Legal proceedings were instituted in one case. The other matters complained of were taken up with the manufacturers concerned with satisfactory results, as indicated:— 40 Sample No. 337—Bread and Butter. The Analyst was of the opinion that this was a sample of bread and margarine. As a result of this report a summons was issued and at the Mortlake Magistrates Court the defendant pleaded guilty, was convicted and fined £5 with £5/5/- costs. Sample No. 352—Butter Macaroons. This was a sample of buttered coconut macaroons. In the Analyst's opinion the term 'macaroons' without qualification is applicable only to those made with almonds as the nut ingredient. The Manufacturers contested the opinion of the Public Analyst and maintained that it was common commercial practice to describe these articles as macaroons. A snap check was carried out at a local representative meeting of housewives. Although a majority stated that they would expect macaroons to contain ground almonds, a substantial minority did not agree. No further action was taken. Sample No. 355 — Patum Pepper. The Analyst stated that 'Patum Pererium is literally "Paste of Peppers" and in practice is a savoury paste intended for making sandwiches. This sample is a kind of anchovy paste and if it be regarded as a fish paste the ingredients need not be specified on the label as required by the Labelling of Food Order, 1953. It is curious that the ingredients of this article are stated as Anchovies, Butter, Salt, Vegetable Flavouring and Rusk and do not include pepper as such although peppers are present. Under the Labelling of Food Order vegetable flavouring would not be regarded as an appropriate description for peppers'. In view of the amount of work involved in tracing this commodity back to its sourcq and its relative insignificance, no further action was taken in respect of this sample. Table 27.—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. Poultry lbs. Bacon and Ham 87 Chickens 5 Beef 552 Canned Chicken 6 Canned Meat 37 Offal 21 Vegetables. Fish. Canned Tomatoes 16 Canned Fish 1 Canned Vegetables 9 Skate 55 Other Foods. Various 40 Cheese 45 Fruit. Jam 43 Canned Fruit 59 Milk 6 Fresh Peaches 40 Various 5 j. h. broad ξ co. ltd., printers, richmond.