Barn 30 Library 2.10.63 Borough of Barnes ANNUAL REPORT of the Medical Officer of Health for the Year 1962 BOROUGH OF BARNES THE ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1962 ERIC PEREIRA, M.B., B.S., D.P.H., Medical Officer of Health, 1 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:— J. A. Brown. Mrs. J. D. Wallis. Mrs. E. R. Gathard. General Assistants:— H. Field. N. Colledge. Public Analyst:- D. D. Moir, Esq., M.Sc., F.R.I.C. PUBLIC HEALTH COMMITTEE 1962-1963. Councillor Mrs. M. E. Hull (Chairman). Councillor F. H. Rasey (Deputy Chairman). The Mayor (Councillor J. D. F. Stow). Alderman E. S. Bolton. Alderman G. T. Craker. Alderman E. S. Stevens. Councillor W. R. Adams. Councillor F. R. Cooper. Councillor A. W. C. Eales. Councillor A. B. Hart. Councillor N. A. Mann. Councillor W. F. Nation. Councillor G. H. Needs. Councillor R. H. Stevens. Councillor R. F. Whale. 4 Telephone : Public Health Department, PROspect 3443. 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 1962, 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. A full staff throughout the year has allowed a great deal of preventive work to be undertaken, and the statistical tables show that the health of the residents has remained at the usual high level. Apart from the rather troublesome outbreaks of mild dysentery amongst school children, the number of cases of notifiable infectious diseases is quite remarkably low. I am indebted to Mr. W. L. Leach, Chief Public Health Inspector, whose report on the Sanitary Circumstances of the District is included, and to Mr. J. A. Brown, Chief Clerk, 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, to my colleagues in other departments, and to all members of the staff of the Public Health Department for their unfailing co-operation. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, ERIC PEREIRA, Medical Officer of Health July 1963. 5 PREFACE STAFF Mr. G. W. Nicholls, who had been Senior Clerk during the past five years, resigned in order to take up an appointment with another Authority. The vacancy was filled by the appointment of Mr. J. A. Brown. SECTION 'A' — SUMMARY OF STATISTICS AND SOCIAL CONDITIONS Population. The Registrar-General's estimate of the population in 1962 was 38,950 which may be compared with the 1961 Census population of 39,057. Births. During the year 573 births were recorded compared with 522 in 1961. Both the still-birth and the infant mortality rates are higher than the unusually low rates recorded in 1961, but they are at a satisfactory level compared with the rates for London and for England and Wales. There were 13 infant deaths including two babies found dead. As these almost certainly did not belong to this district, the lower and probably truer infant mortality rates have been given in parenthesis in the statistical table. Deaths. The total number of deaths occurring amongst residents was 523 (235 males and 288 females) compared with 490 in 1961. The death rate when corrected to allow for the abnormally high proportion of elderly residents was 11.4 which compares satisfactorily with other parts of the country. There were 27 deaths due to cancer of the lung compared with 28 in 1961 and 19 in the previous year. One maternal death was recorded, the cause being given as "septicaemia due to abortion", following a Coroner's Inquest. 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 immunizing 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 1(i). Perhaps one of the most troublesome problems is how to deal with old people who resent any interference. Often they are living alone and, over a period of years, they have neglected themselves and their accommodation. Every effort is made to persuade them to accept the services of a Home Help, District Nurse or Meals-on-Wheels and other voluntary services. Frequently this is successful, and the old person gradually begins to appreciate the help given, and to improve both physically and mentally. 9 Sometimes the old person refuses to enter a Home or Hospital and refuses all offers of help. In other cases the living conditions may be so bad that the domiciliary services could not function. In these cases 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 to other suitable accommodation. Two such cases occurred during the year but formal action under the Act was necessary only in one instance. This was the case of an elderly woman who occupied one room in an otherwise well conducted household. She had accumulated so much rubbish over a period of years that it was difficult to enter the room in which there was no free space other than a small area in front of the gas fire. All other available space and furniture was stacked high with rubbish—some of it filthy. The old woman had neglected herself, was under-nourished and mentally incapable of making a decision. She refused help or admission to a Home. An Order was obtained from the Court and the patient was removed to a Home. She settled quickly and soon improved both physically and mentally. The greater part of the contents of her room had to be destroyed by burning. SECTION 'F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Dysentery. One hundred and fifteen cases of dysentery due to Shigella sonnei were notified, and a considerable number of additional cases were ascertained by other means. Shigella sonnei causes a mild form of dysentery and there were troublesome outbreaks affecting two primary schools and a Day Nursery. A mother suffering from the disease infected her baby at or soon after childbirth, and unfortunately the infant failed to survive. In all other cases the illness was mild and symptoms normally persisted for a few days only. However, there were cases which relapsed, and quite a number of children continued to harbour the organism for some time after apparent cure. In October cases began to occur amongst children attending Mortlake County Primary School; in November children attending St. Mary Magdalene R.C. Primary School and Castelnau Day Nursery were similarly affected. Generally the incidence increased for 10 days and then diminished during the following 10 days and by the end of three weeks very few new cases were occurring. 10 The picture was complicated by the simultaneous occurrence of 'winter vomiting'. Affected children and contacts of primary school age were excluded until free from infection. Contacts of secondary school age were not excluded. Although a number of cases did occur amongst secondary school children (and adults) there was no spread within the schools. Attempts to control these outbreaks threw a heavy burden on the Public Health Inspectors who were occupied almost entirely in this work for a considerable period. Hygiene in the schools was carefully supervised; exclusion of cases and contacts was controlled, and arrangements were made for cases to be referred to their Doctors for treatment. These arrangements provided a workable plan for doctors, teachers and parents, and it is felt that the efforts played an important part in preventing spread of the disease to other schools and limited the incidence in those affected. Food Poisoning. Twelve cases were notified but seven of these were isolated cases of gastro-intestinal upset which were investigated with entirely negative results. Three members of a household suffered from severe diarrhoea and vomiting and this was thought to be a small outbreak of food poisoning. Investigations of the suspected food and of the patients proved negative and no causal agent was discovered. A girl attending a local ballet school suffered from recurrent diarrhoea and was found to be infected with salmonella typhimurium. Investigation of home contacts and school kitchen staff were negative. After treatment she became free from infection but continued to have recurrent symptoms for some weeks. It is probable that she was infected in France some weeks before the diagnosis was made. A man aged 20 was suddenly taken ill with symptoms of gastroenteritis and was found to be infected with salmonella enteritidis. Investigation of home contacts proved that his young brother was a symptomless carrier. In both cases the infection responded to treatment. Typhoid Fever. In May a girl aged 6 years and attending a local school was admitted to hospital and found to be suffering from typhoid fever. Her father had suffered from the disease some fifteen years earlier but bacteriological investigation of all home contacts proved negative. 11 The source of the infection could not be established; no further cases occurred and the child made a complete recovery. IMMUNISATION AND VACCINATION These schemes are administered from the Surrey County Council Divisional Office and the treatment is carried out at the local clinics. Diphtheria, Whooping Cough and Tetanus. A combined vaccine providing protection against these three diseases is now given as a routine and is popular with the mothers. Every effort is made to commence treatment when the infant is three months old; and suitable reinforcing doses are given at appropriate intervals. Protection against tetanus has recently become very much in demand, and is a valuable procedure. If an immunized child sustains a wound it is generally sufficient to administer a single reinforcing dose of tetanus antigen with no fear of a serious reaction, whereas an unimmunized child would require a suitable dose of anti-tetanic serum which is quite frequently followed by severe reactions which may even be fatal. Smallpox. Cases of smallpox were imported into the country during the early part of the year and this caused an increased demand for vaccination by children and adults. Most European countries demanded a recent vaccination certificate from all travellers from England, and this placed a considerable extra burden on the Health Offices. Routine vaccination of infants was criticized by some in authority, and as a result the Ministry of Health advised that vaccination of infants should normally be delayed until the second year of life. This policy has since been adopted. Poliomyelitis. The oral vaccine came into general use during the year and almost completely replaced the Salk vaccine. It has the advantage of easy administration and in addition it is said to give greater protection by causing intestinal as well as general immunity and thus reducing the incidence of carriers in the population. It is pleasing to note that there was not a single case of poliomyelitis during the year. 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 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 26 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. The method of collection, purification and storage of the domestic water supply for the district is the same as before. Water is derived from the River Thames, stored in the Barnes reservoirs at Staines, Littleton and Walton, and filtered and chlorinated at the Hampton Works. The water supplied was of satisfactory hygienic quality, and adequate in quantity, during the year. Samples are collected daily by the Board's staff at all stages of purification and in the distribution system. Immediate action is taken in respect of any form of contamination or variation in quality. The Board's waters are not plumbosolvent. A length of 217 yards of new service main was laid in the Borough during the year. All new and repaired mains are chlorinated before being retored to service. Samples of water from them are tested bacteriologically to ensure that the quality of the water is up to the standard normally supplied. We are indebted to Dr. Windle Taylor, Director of Water Examination, to the Board, for the foregoing information, and for the statistics in Table 14. All the dwelling houses in the Borough are supplied with water from public mains. SWIMMING POOLS There is only one swimming pool of a public nature and that is the learners' swimming pool at Sheen Mount County Primary School. Six samples of swimming bath water were taken for bateriological examination and were all found to be satisfactory. The filtration plant, which gave some little trouble after its initial installation, functioned quite satisfactorily. SEWERAGE AND SEWAGE DISPOSAL It is evident that the Board's operations give rise to unpleasant odours from time to time and complaints may be made by residents in 14 Brentford and Chiswick, or in Richmond and Barnes, according to the wind direction and weather conditions prevailing at any particular time. Fortunately, the prevailing wind is from the South West so that usually smells are dissipated over the River and there is the advantage of the longer distance between the works and the dwellings and the natural turbulance of air currents along this stretch of the River Thames. When the wind direction changes, especially when it is from the North West, such odours as emanate from the works tend to be held near ground level and cause complaints. The Board is actively pursuing the question of remedies but it should be realised that any departure from the natural processes of purification adds greatly to the cost of the treatment. VERMINOUS PREMISES ETC. Rodent Control. The routine treament of the sewers, on a six monthly basis, was continued, using warfarin bait. The number of takes was negligible. It can now be said that the sewerage system is virtually free from rats and that only check treatments will be necessary in future. Complaints of surface rat infestations were again a reduction on previous years, on average, only one or two a week being reported and these were often concerned with one stray rat. This is indeed a satisfactory state of affairs especially as the time of the General Assistants is being increasingly taken up with other duties. Pigeons. The question of instituting a service for the eradication of wild (Feral) pigeons, where they have been found a nuisance, was considered by the Public Health Committee. However, in view of the many difficulties involved in operating successful methods of destruction, involving the use of narcotic baits, it was decided not to provide such a service at the present time. Public reaction to the spectacle of pigeons, squirrels etc. being destroyed is likely to be so varied that the application of modern techniques, however, painless, is likely to be severely restricted. Other Pests. As will be seen from Table 17, many types of domestic pests were dealt with including a large number of wasps nests. This service was provided without charge. To deal effectively with a wasps nest often involves work on the structure of a building which we cannot undertake. Wasps are no more of a public health problem than are 15 gnats, squirrels, or rabbits, yet when any of these pests become a nuisance residents expect the Council to provide a free eradication service, and get quite annoyed when it is explained that there is no provision for expenditure on these pests to be defrayed out of rates. Refuse Collection and Disposal. The system of disposal of household and trade refuse by incineration was reviewed by the Public Health Committee. A decision was taken to demolish the obsolete incinerator and to introduce a new system whereby all refuse, after a preliminary sorting, is transferred to large transporter vehicles in which the refuse is taken to special "controlled" tips outside the area. The scheme was devised and executed under the supervision of the Borough Engineer and Surveyor. During the interim period when the old works were being demolished, and whilst the new Transfer Station was being erected, it was necessary to have recourse to rather crude methods of transfer, in the open air. There were a few complaints from residents who chanced to see the accumulated refuse, but in effect the operation was conducted with a minimum of nuisance and there was virtually no trouble from rats, flies or smell. The system of collection whereby refuse is transferred from domestic dustbins to open skips, usually in back gardens, and then carried out to the waiting refuse collection vehicle, came under review by the Public Health Committee during the year. Whilst the system is by no means ideal, it is the most economical, and there are surprisingly few complaints received. In view of the heavy extra cost of alternative methods, such as the paper sack system, no decision was taken to alter the existing arrangements, but the officers concerned have been instructed to report further in the event of a change appearing to be practical and desirable. ATMOSPHERIC POLLUTION Clean Air Act, 1956 — Smoke Control Areas. The Third Smoke Control Order was made early in the year and was confirmed, by the Minister of Housing and Local Government, in May. It was scheduled to come into operation on the 15 th November. Owing to the delay in confirmation only the minimum period of six months was available for carrying out the necessary work. This, coupled with the reluctance of local builders to carry out conversion work at the prices allowed for grant purposes, and the tardiness of applicants in submitting their applications, made it necessary to postpone the coming into operation of the Order until 1st January, 1963, 16 As with the closing hours for shops, offices, etc., it seems that many residents will always leave doing what is necessary until the last minute, in spite of reminders. It is very difficult, administratively, to ensure that there is an even flow of work for the limited staff available and it would not be economic to employ extra staff to deal with the periodic rush of applications. The services of the Public Health Inspectors can usually be utilized at such periods, but in November and December they were actively engaged in dealing with an outbreak of mild dysentery. The necessity to follow the strict procedure laid down, especially in regard to the dates within which expenditure needs to be incurred, is an irksome requirement of the Smoke Control Area Grants scheme. All concerned with the implementation of the scheme agree that amendments in procedure are necessary but, in view of the fact that certain requirements were written into the Clean Air Act, 1956, the rules cannot be altered except by the enormous trouble and delay entailed in amending the Act itself. It is expected that the programme for Smoke Control Areas, to cover the whole of the Borough by 1968, will be implemented without undue delay. SECTION 'D' — HOUSING The number of complaints received in connection with housing defects was again much lower than the prewar figures. With the spread of decontrol the new tenancies are usually the subject of new agreements whereby the occupiers are taking an increasing responsibility for maintenance repairs. Tenants who have always been accustomed to look to landlords for every item of repair, including burst pipes and decorations, are astonished at the present day cost of even minor repairs. Unfortunately the tenancy agreements referred to rarely provide for the landlord to make good the neglect of years before passing on the liability for maintenance to the tenants, and much friction develops as a result. It has been noticed that where rents have not been raised to Rent Act levels the tenants are chary of complaining about defects and it may be necessary to carry out more routine house to house surveys to prevent the deterioration which would otherwise follow. As will be seen from the table on page 38 there were only two applications for Certificates of Disrepair and only one Certificate was actually issued. Few controlled tenants care to antagonise owners and this procedure is now little used or forgotten. Where house to house inspections have been made we were rather surprised to find that the defects noted were, though numerous, of a relatively trivial character. Lack of paint and the untidiness of front 17 paths and fences can give a most misleading impression as to the structural condition of premises. When small houses are bought by sitting tenants the improvement in general appearance and condition is very marked. The trend for more individual house ownership should lead to less work on housing repairs in the Department. The exploitation of the housing situation by unscrupulous landlords has not been very noticeable in this area, as far as instances brought to the notice of the Department are concerned. Rents for new lettings are being raised to much higher levels than was anticipated when the rent Act was passed, but on the other hand properties are being improved and maintained to a higher standard so that any problems arising from these conditions are usually confined to disputes about services and amenities. In a few cases only has it been necessary to intervene to secure better arrangements in houses in multiple occupation. There are no registered common lodging houses in the Borough. The Government scheme for the improvement of old houses has again had very disappointing results and no applications were forthcoming in respect of rented properties. The capital gains to be obtained on securing vacant possession are so great that no landlord can be expected to give a second thought to improving conditions for tenants in this area. Even where approaches have been made by the Council with an offer to help in organising a grants scheme for block treatment no response has yet been forthcoming. OVERCROWDING The preliminary figures released on the Census 1961 do not show any marked trends. The overcrowding figures are better than those for some of the older centres of population in Surrey but a detailed analysis cannot be given until the full reports on the Census are issued. Meanwhile the Housing Committee give the usual priority to deserving cases where overcrowding is evident. SECTION 'E' — INSPECTION AND SUPERVISION OF FOOD Increased competition in the food distributive trades has again encouraged individual traders to keep up their standards of goods, premises and personal conduct. Members of the public have complained less of the trivial and accidental contraventions and have displayed a more balanced approach to food hygiene matters. No prosecutions were necessary concerning the sale of food and a good standard of inspection was maintained. Certain labelling deficiencies were due more to a misunderstanding of the Regulations rather than deliberate attempts to defraud. BOROUGH OF BARNES APPENDIX TO THE ANNUAL REPORT OF THE Medical Officer of Health 1962 21 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, 1962. Area 2,520 Population : — Census, 1951 40,593 Census, 1961 39,057 Registrar-General's estimate, mid-1962 38,950 Rating:— Number of inhabited houses 12,734 Rateable Value £2,407,950 Product of a penny rate. £9,800 Mortality: — Males Females Total Number of Deaths 235 288 523 Death Rate per 1,000 population :— Uncorrected 13.4 Corrected (Comparability Factor 0.85) 11.4 Deaths from Cancer (all ages) 101 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 Illegitimate Total Number 526 38 564 Rate per 1,000 population 14.5 Illegitimate Live Births (per cent of total live births 6.7 Stillbirths:— Number 9 Rate per 1,000 total live and stillbirths 15.7 Total Live and Stillbirths 573 Infant Deaths (deaths under 1 year) 13(11) 22 Infant Mortality Rates : — Total infant deaths per 1,000 total live births 23.0 (19.5) Legitimate infant deaths per 1,000 legitimate live births 15.2 Illegitimate infant deaths per 1,000 illegitimate live births 131.6(78.9) Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 17.7(14.2) Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 16.0(12.4) Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 31.4 (27.9) Maternal Mortality (including abortion):— Number of deaths 1 Rate per 1,000 total live and stillbirths 1.7 23 Table 2. — Vital Statistics of the Borough of Barnes during 1962 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 1957 446 441 112 313 7.9 17 220 9 20.4 516 131 1958 456 440 11.2 284 7.2 35 237 8 18.2 486 12.4 1959 476 468 120 333 8.6 47 249 8 171 535 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 11.6 490 126 1962 573 564 145 264 6.8 73 259 13 (11) 23.0 (19.5) 523 13.4 24 Table 3. — Birth-rate, Death-rate, and Analysis of Mortality from Certain Causes during the Year 1962, with corresponding rates for England and Wales, and for the County of London for comparison. AREA AND POPULATION Live Births DEATHS FROM Stillbirths Deaths of Infants under 1 year of age Deaths (excluding Stillbirths) Malignant neoplasm lung, bronchus Whooping cough Diphtheria Tuberculosis (all forms) Influenza Acute Poliomyelitis Pneumonia Coronary and arteriosclerotic heart disease England and Wales (46,669,000) 18.0 11.9 0.51 0.00 0.00 0.07 0.07 0.00 0.68 2.20 18.1 21.6 London (3,185,770) 19.6 12.0 0.68 0.00 0.00 0.09 0.09 0.00 0.83 2.26 16.6 21.1 Barnes Borough (38,990) 14.5 11.4 0.69 — — 0.13 0.10 — 0.69 2.85 15.7 23.0 (19.5) 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. 25 Table 4. — Causes of Death during the Year 1962. Causes of Death (Registrar-General's short list of causes) Total Deaths Male Female 1 Tuberculosis, respiratory 5 4 1 2 Tuberculosis, other - - - 3 Syphilitic diseases 2 2 - 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal infections - - - 7 Acute poliomyelitis - — — 8 Measles - - - 9 Other infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 15 6 9 11 Malignant neoplasm, lung, bronchus 27 22 5 12 Malignant neoplasm, breast 13 - 13 13 Malignant neoplasm, uterus 4 - 4 14 Other malignant and lymphatic neoplasms 42 20 22 15 Leuksmia, aleukaemia 5 2 3 16 Diabetes 4 - 4 17 Vascular lesions of nervous system 69 24 45 18 Coronary disease, angina 111 58 53 19 Hypertension with heart disease 10 7 3 20 Other heart disease 53 17 36 21 Other circulatory diseases 30 15 15 22 Influenza 4 1 3 23 Pneumonia 27 8 19 24 Bronchitis 22 16 6 25 Other diseases of respiratory system 3 3 - 26 Ulcer of stomach and duodenum 3 - 3 27 Gastritis, enteritis and diarrhoea 4 2 2 28 Nephritis and nephrosis 1 - 1 29 Hyperplasia of prostate 4 4 - 30 Pregnancy, childbirth abortion 1 - 1 31 Congenital malformations 3 1 2 32 Other defined and ill-defined diseases 41 13 28 33 Motor vehicle accidents 3 3 - 34 All other accidents 11 4 7 35 Suicide 5 3 2 36 Homicide and operations of war 1 - 1 All Causes 523 235 288 26 Table 5. - Infant Mortality during the Year 1962. 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 Wks 1-3 Months 3-6 Months 6-9 Months 9-12 Months Total under 1 year Deaths in the Roroutrh Deains outside Borough Acute suppurative otitis media - - - - - 1 - - - 1 1 - Acute suppurative broncho pneumonia - - - 1 1 - - - - 1 1 - Foetal abnormalities 2 - - - 2 - - - - 2 - 2 Premature 6 - - - 6 - - - - 6 - 6 Sonne Dysentery 1 - - - 1 - - - - 1 - 1 9 - - 1 10 1 - - - 11 2 9 Found dead 2 - - - 2 - - - - 2 2 - 11 - - 1 12 1 - - 13 4 9 Table 6. — Laundry Service for Incontinent Patients. Number of patients using the service, as at 31.12.62 9 Number of patients admitted to hospital and the service discontinued 3 Number of patients who died and the service discontinued 2 Number of sheets laundered and issued 1,941 27 SECTION F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Table 7. — Notifiable Infectious Diseases, 1952 to 1962. Year 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 Anthrax - - - - - - - - - - - Cholera - - - - - - - - - - - Diphtheria - - - - - - - - - - - Dysentery 11 25 75 - 4 - 3 5 6 15 115 Encephalitis Acute - - - - - - - - - - - Enteric (Typhoid or Paratyphoid Fever) 1 - 1 2 - 1 - 1 - 1 1 Erysipelas 8 7 2 7 2 1 1 - 1 2 - Food Poisoning 1 11 5 10 - 11 i 1 2 7 12 Malaria - 2 - 1 1 - 2 2 - 1 - Measles 249 306 5 489 16 606 136 433 8 654 14 Membranous Group - - - - - - - - - - - Meningococcal Infect' n - - 2 - - - - - - - - Ophthalmia Neonatorum - - - - 1 - - - - - - Plague - - - - - - - - - - - Pneumonia 21 27 11 31 25 28 47 61 11 29 15 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 42 21 29 7 8 5 10 9 24 10 15 Small-pox - - - - - - - - - - - Tuberculosis, Pul. 39 37 27 23 18 19 28 19 19 17 20 ” Non-Pul. 7 3 3 3 3 4 - 1 1 1 1 Typhus Fever - - - - - - - - - - - Whooping Cough 19 136 25 42 17 37 6 2 16 8 - 28 Table 8- — Certain Infectious Diseases: Incidence per 1,000 of the Population in 1962- Disease Barnes London (a-c-) England and Wales Scarlet Fever 0-39 0-27 0-33 Diphtheria - - 0-00 Enteric Fever 0-03 0-02 0-00 Acute Pneumonia 0-39 0-26 0-27 Dysentery 2-95 0-88 0-62 Acute Poliomyelitis— Paralytic - 0-00 0-00 Non-Paralytic - 0-00 0-00 Food Poisoning 0-31 0-21 0-11 Tuberculosis— Respiratory 0-51 0-66 0-39 Others 0-03 0-07 0-05 Table 9- — Infectious Diseases Notified during the Year 1962- Diseases Total Cases Notified Ages, in years Parish Removed to Hospital Under 1 year J 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 115 3 13 - 10 6 43 14 6 _ 9 9 1 1 12 103 3 Erysipelas - - - - - - - - - - - - - - - - - Food Poisoning 12 - - - - - - - 1 1 2 - 7 1 8 4 1 Malaria — - - - - - - - - - - - - - - - - Measles 14 - 3 - 3 2 5 1 - - - - - - 4 10 - Paratyphoid Fever 1 - - - - - 1 - - - - - - - - 1 1 Pneumonia (Acute) l5 - - - - - - - - - - - 9 6 10 5 1 Poliomyeli'is, Non Para - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - - - - - - - - - - Scarlet Fever 15 - 1 - 1 3 6 1 1 1 - - l - 1 10 - Tuberculosis, Pul. 20 - - 1 - - - - - - 7 8 4 11 9 9 Tuberculosis, Non-Pul. 1 - - - - - - - - - - - - 1 - 1 - Whooping Cough - - - - - - - - - - - - - - - - - 193 3 17 1 14 11 54 16 8 2 18 9 26 13 50 143 15 29 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, 1962 are as under:— Table 10. — Tuberculosis Register. Form of Disease On Register, 1st Jan., 1962 Cases Added Removed from Register Remaining on Register, 31st Dec. 1962 Primary Notif'ns Otherwise Restored Total Cured Left District Dead Total Pulmonary 151 19 18 1 189 17 9 11 37 152 Non-Pulm'y 12 1 1 - 14 2 1 - 3 11 Totals 163 20 19 1 203 19 10 11 40 163 Table 11. — New Cases and Mortality, 1962. 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 „ - - - - - - - - 15-24 „ 1 1 - _ - - - - 25-44 „ 9 5 - 1 - 1 - - 45-64 „ 9 2 - - 2 1 - - 65 „ and over 8 2 - 1 5 2 - - All ages 27 11 - 2 7 4 - - * In addition to primary notifications, all other new cases coming to the knowledge of the Medical Officer of Health are included in these figures. 'Incidence-rate—Pulmonary 1 00 All forms 1.02 (per l,ooo population) Non-Pulmonary 0 02 Death-rate—Pulmonary 0.28 (per l ,000 population) Non-Pulmonary NIL 31 Table 12. — IMMUNISATION and VACCINATION. Diphtheria Immunisation. Number of children immunised during 1962:— Under 5 years 500 Between 5 and 15 years 17 Number of children re-immunised during 1962:— Under 5 years 175 Between 5 and 15 years 423 Total number of children immunised during last 5 years at 31st December, 1962 :— Under 5 years 1780 Between 5 and 15 years 3975 Whooping Cough Immunisation. Number of children immunised by primary course 417 Tetanus Immunisation. Number of children who have completed a primary course of three injections 719 Number of children who have received a reinforcing dose 88 Vaccination against Smallpox. Number of Vaccinations carried out during 1962 Children Primary Vaccination 576 Re-vaccination 370 Number of Vaccinations carried out at clinics 299 Number of Vaccinations done by private doctors 647 Figures showing percentage of children under 1 year vaccinated during 1962:— Number Vaccinated under 1 year 244 Estimated Mid-year population under 1 year 546 Percentage Vaccinated 44.69% 32 State of Immunity. No attempt is made to give the percentage of children immunized, because of the extreme difficulty of ascertaining the true population of any particular age group and the considerable annual transfer of children into and out of the boroughs. As a check the immunological state of 401 entrants to County Schools during the autumn term was carefully examined with the following results:— Percentage immunized in Barnes and Richmond 67.83% Percentage immunized outside Barnes and Richmond 29.43% Total immunized at entry to school . 97.26% Total not immunized 2.24% No information 0.5% 97.26% of children entering school were shown to be immunized against diphtheria. The percentage immunized against whooping cough would be almost as high, and shortly the same high state of immunity to tetanus will apply since the 'Triple' antigen is now in general use. 33 POLIOMYELITIS VACCINATION. Northern Division — Barnes and Richmond. PRIMARY COURSE. Number of persons who have received:— Salk Vaccine Oral Vaccine One injection only Two injections One dose only Two doses only Three doses (1) (2) (3) (4) (5) (a) Children born in 1962 2 6 42 125 102 (b) Children born in 1961 - 113 170 319 481 (c) Children and young persons born in the years 1943—1960 - 83 113 127 197 (d) Young persons born in years 1933-1942 3 73 27 44 80 (e) Others 4 174 80 125 174 (f) Total 9 449 432 740 1034 REINFORCING DOSES. (a) Number of persons given third injections of Salk Vaccine 999 (b) Number of persons given fourth injections of Salk Vaccine 39 (c) Number of persons given a reinforcing dose of Oral Vaccine after: (i) Two Salk doses 700 (ii) Three Salk doses 786 Total number of doses 5188. Number of record cards submitted by General Practitioners during the year: Primary Course Reinforcing doses Salk or Oral Salk (first and second injections) Oral (three doses) 312 254 940 Vaccination Against Tuberculosis. During 1962 a total of 474 boys and girls were inoculated with B,C.G. in the Northern Division (Barnes and Richmond). 34 Table 13. — Mass Radiography Service. General Practitioner's Service. Men Women Total Patients referred by their Doctors 395 438 833 Abnormalities detected:— Pulmonary tuberculosis 2 2 4 Lung Cancer 4 1 5 Barnes Borough Council employees referred by the Medical Officer of Health 26 Public Mass Radiography Service. Men Women Total Number of persons examined 175 156 331 Abnormalities detected:— Pulmonary tuberculosis 1 — 1 Lung Cancer 2 — 2 SECTION 'C' — SANITARY CIRCUMSTANCES OF THE AREA Table 14. — Water Supply — Bacteriological Sampling. Type of Test WATER PASSING INTO PUBLIC SUPPLY — Hampton Works. Plate Count per millilitre on agar 20/24 hrs. at 37°C Average Result 11.9 Coliform Test (Count per 100 ml). 99.91 Negative Escherichia Coli Test (Count per 100 ml). 100.0 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 6 — — 6 — 35 Table 16. — Infected Rooms and Articles (dealt with by the Council). Premises disinfected 2 Lots of bedding disinfected 4 ,, „ ,, destroyed 3 Household effects removed and destroyed 11 Table 17. — Disinfestations (Dealt with by the Council). Disinfestation by spraying or fumigation was carried out at various premises for the following infestations:— Flies 1 Bugs 7 Wasps 72 Ants 2 Fleas - Beetles 1 Bees 6 Cockroaches 3 Table 18.-—rodent Control. Summary of work carried out:— Premises visited 291 Inspections made 527 Treatment visits 252 Premises treated 133 Minor infestations of Rats 122 Minor infestation of Mice 8 Table 19. — Atmospheric Pollution. Volumetric Apparatus. Average Smoke (Microgrammes per cu. metre) 1956. 1957. 1958. 1959. 1960. 1961. 1962 190 202 149 140 103 90 66 Average Sulphur Dioxide (Microgrammes per cu. metre) 175 130 129 150 124 107 135 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 - - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 157 53 3 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 14 - - - Total 192 53 3 — 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 1 1 — — - (b) Unsuitable or defective 3 3 - 1 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - 1 - - Total 4 4 1 1 - 17 Table 21. — Outworkers. Work Undertaken No. on Register Notices Served Wearing apparel 80 - Lamp Shades 12 — Curtain makers 3 - Stuffed Toys and Nursery Articles 1 — Xmas Crackers etc 11 - Artificial Flowers 1 - Carding of buttons 5 — Household linen 1 — Brass Articles 1 — Total 115 — Legal proceedings under Factories Act:— No legal action was necessary during 1962. Table 22. — Other Premises. Nature of inspection Number of premises Number of visits Notices issued and complied with Schools 20 3 - Public Houses, Public Halls, and Public Conveniences 40 25 - Stable Yards 4 17 - Table 23. — Housing Inspections. Number of houses inspected in respect of defective conditions 297 Number of re-inspections 1,088 Number of houses inspected in respect of unsatisfactoryliving conditions, but where no repairs were required 104 Number of re-inspections 127 Number of Informal Notices served 150 Number of Informal Notices complied with 143 In addition to the above, 872 visits were made by Public Health Inspectors to premises in connection with infectious diseases and 419 visits in connection with offensive accumulations — 2 exhumations were supervised. Altogether, 765 non-effective visits were made to premises of all types where no access was gained. SECTION 'D' — HOUSING 38 Table 24. — Rent Act, 1957. Applications for Certificates of Disrepair. Period ended:— Dec. 1957. Dec. 1958. Dec. 1959 Dec. . 1960. Dec. 1961. Dec. 1962. 1. No. of applications for Certificates 44 31 16 8 1 2 2. No. of decisions not to issue Certificates - - - - - - 3. No. of decisions to issue Certificates: 44 31 16 8 1 2 (a) in respect of some but not all defects 31 26 8 5 - - (b) in respect of all defects 13 5 8 3 1 2 4. No. of undertakings given by landlords under para. 5 of the First Schedule 24 21 9 5 2 1 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 1 Applications for Cancellation of Certificates. Period ended:— Dec. 1957. Dec. 1958. Dec. 1959 Dec. . 1960. Dec. 1961. Dec. 1962. 7. Applications by landlords to local authority for cancellation of Certificates 1 14 9 4 5 4 8. Objections by tenants to cancellation of Certificates - 6 5 - 3 1 9. Decisions by local authority to cancel in spite of tenant's objection - - 2 - - - 10. Certificates cancelled by local authority - 8 6 1 5 3 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 43 2 Bread and Cakes 17 33 3 Butchers 28 127 4 Cafes, Restaurants, etc. 41 100 2 Canteens, etc. 10 4 - Cooked Meats 70 22 - Dairies and Milk Shops 24 7 - Fishmongers 13 30 - Fried Fish Shops 2 - - Greengrocers 39 74 2 Grocers 74 163 1 Ice Cream:— Retailers 92 49 — Public Houses 29 10 - Street Traders 8 2 1 Sweets, Confectionery 65 44 1 Table 26. — Sampling of Other Food and Drugs. (a) Chemical Analysis. — Thirty-four samples procured under the provisions of the Food and Drugs Act, 1955, included: — Artificial Colourings Honey Beef Steak Lamb Chops Cake and Confectionery Mushrooms Canned Fruits Peanut Spread Canned Vegetables Pies Cooking Oil Soups Fish Tea Gripe Water Vegetable Juices (b) Hereunder I give the Public Analyst s report on one sample submitted to him. Sample No. 366 — Lamb Chops. 'This article is described on the main top label of the tin as "Lamb Chops" and, on the side label as "Lamb Chop with Carrots and Gravy". In my opinion the full description of the article should be given on the main label as well as on the side label and, since the carrots are present only in a small proportion as a garnish, it would be more accurate to describe the article as "Lamb Chops with gravy and carrots" 40 'The illustration on the main label is of a dish containing two chops with gravy, 3 segments of tomato and a little parsley, but no carrots. Although the purchaser would not expect the tin to contain fresh parsley, he might reasonably expect it to contain tomato in the light of this illustration. In my opinion the illustration ought to be made more realistic in relation to the contents'. The manufacturers of the product were informed of the Analyst's report and that the labelling of their product contravened Article 43(b) of The Labelling of Food Order, 1953. 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 16 Chickens 104 Canned Meat 104 Vegetables. Offal 108 Mutton 20 Canned Tomatoes 34½ Rabbits 60 Canned Vegetables 2 Fish. Other Foods. Canned Fish 84 Cheese 2 Jam 48 Fruit. Milk 1 Canned Fruit 23½ Various 2