Borough of IBanus Library ANNUAL REPORT of the Medical Officer of Health for the Year 1964 BOROUGH OF BARNES THE ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1964 ERIC PEREIRA, M.B., B.S., D.P.H., Medical Officer of Health. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— Eric Pereira, M.B., B.S., D.P.H. Deputy Medical Officer of Health:— Elza Todd, M.B., Ch.B., D.P.H. Chief Public Health Inspector:— William L. Leach, D.P.A. (London), M.A.P.H.I.*†‡ Deputy Chief Health Inspector:— P. J. Shannon, M.A.P.H.I.*† District Public Health Inspectors:— C. E. Mallett, M.A.P.H.I *† G. Jones, M.A.P.H.I.*† * Certificate of Public Health Inspectors' Education 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 Assistants (Clean Air):— T. S. Rodwell, M.R.S.H. J. Hetherington. Clerical Staff :— J. A. Brown. Mrs. J. D. Wallis. Mrs. E. R. Gathard (Part-time). Mrs. L. E. Peters (Part'time). General Assistants:— H. Field. N. Colledce. Public Analyst:— D. D. Moir, Esq., M.Sc., F.R.I.C. PUBLIC HEALTH COMMITTEE 1964-1965: Alderman E. S. Bolton (Chairman). Councillor N. A. Mann (Deputy Chairman). The Mayor (Councillor A. G. H. Lawrance). Alderman G. T. Craker. Alderman E. S. Stevens. Councillor W. R. Adams. Councillor F. R. Cooper. Councillor A. W. C. Eales. Councillor H. A. V. Haggard, D.S.O., D.S.C. Councillor A. B. Hart. Councillor W. F. Nation. Councillor R. H. Stevens. Councillor R. F. Whale. Councillor L. Wortii. 3 Public Health Department, Municipal Offices, Sheen Lane, S.W.14. To the Mayor, Aldermen and Councillors of the Borough of Richmond upon Thames. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1964, upon the Sanitary Circumstances, Sanitary Administration, and Vital Statistics of the Borough of Barnes. I am indebted to Mr. W. L. Leach, Chief Public Health Inspector, for his Report on the Sanitary Circumstances of the Area, and to Mr. J. A. Brown for compiling the tables of Vital Statistics. I am, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 4 PREFACE STAFF. Mrs. J. M. Congdon resigned her appointment as part-time shorthand typist on the 26th March, and was replaced by Mrs. L. E. Peters as from the 6th April. The vacancy for a District Public Health Inspector, caused by the resignation of Mr. R. J. Hamilton, was eventually filled by the appointment of Mr. G. Jones, who commenced duty on the 1st January, 1964. SECTION 'A' — SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Population. The Registrar-General's estimate of the population in 1964 was 38,820, compared with his estimate 38,700 for 1963 and the 1961 Census figure of 39,057. During recent years the population has been more or less static, with a slight tendency to fall. At the same time the number of inhabited houses has increased each year, with a consequent gradual improvement of the housing situation generally. Births. During the year 566 births were recorded, compared with 570 in 1963. Infant mortality and still birth rates are low compared with the rates for England and Wales generally, and indicate efficient ante and post-natal care of the mothers. There were only 7 infant deaths, and of these 6 occurred very soon after birth and were due to prematurity and congenital defects. Deaths. The total number of deaths occurring amongst residents was 470 compared with 541 in 1963. The reduced number of deaths was undoubtedly due to the mildness of the winter months, as compared with the very severe conditions experienced in 1963. The death rate, when corrected to allow for the abnormally high proportion of elderly residents, was 9.9 per thousand population, which compares favourably with other towns. 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. 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 confinements 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 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-patients clinics at the Royal Hospital on Tuesdays and Fridays for residents of Barnes and Richmond. 6 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. 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. Care of the Aged and the Chronic Sick. Responsibility for providing suitable accommodation for the elderly rests with the County Welfare Officer. The principal 7 Divisional Welfare Officer investigates all cases and endeavours to arrange for their admission to Homes. Unfortunately, as in previous years, the waiting list for admission continues to lengthen, and it has become extremely difficult to obtain vacancies, even for quite urgent cases. The Geriatrician based at Kingston Hospital is responsible for the care of the chronic sick who require admission to hospital. The number of available beds is limited and sometimes the waiting period is unduly long. However, really urgent cases have always been ad' mitted without delay. Voluntary organizations which carry out a great deal of valuable work for the elderly, the housebound and the chronic sick, have been reported previously. They continue to make a most valuable contri' bution. National Assistance Act, 1948 — Section 47. National Assistance (Amendment) Act, 1951 — Section l(i). Unfortunately a number of old people who live all by themselves, in the course of time become anti-social, neglect themselves, and live in gradually deteriorating circumstances. One of the most difficult problems is to persuade these old people to accept the available services. There is a need in the Borough for a development of "Housemother Schemes" whereby lonely elderly people can be admitted to small flats before they have become anti-social, and where they will live comfortably under the watchful eye of the Housemother. When an old person refuses all offers of help and is quite unwilling to enter a home or hospital, it sometimes becomes necessary to apply to the Court or a Magistrate for an Order for the Compulsory Removal of the Patient to suitable accommodation. Two such cases occurred during the year. The first was an old woman who lived alone in a cottage, who had refused any visiting or any assistance for a number of years. When seen, she was in bed in an upstairs room, which was cluttered with furniture and rubbish. There was a commode in the bedroom and the outside water closet was barricaded. She was able to stand but she was very infirm and was in a neglected and under-nourished state. She refused to enter a home and, in the circumstances, application was made to a Magistrate for a Removal Order, and she was removed to "Kingsmead", Grove Road, Richmond, the same day. For some days she was very troublesome in the Home, but later she settled well and her health improved generally. The second case was that of an old lady living with her aged husband and who, up to that time, had been caring for her. The husband became ill and was removed to hospital, and the old lady, left alone, was quite incapable of managing for herself. She refused all offers of help and, in the circumstances, application was made to a Magistrate, who granted an Order and the patient was removed to "Kingsmead". She also settled well in her new surroundings and improved generally in health. 8 SECTION F' — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The incidence of notifiable infectious diseases was remarkably low during the year. There were four cases of food poisoning, but these were individual, isolated cases, and there were no outbreaks. The epidemic of typhoid fever in Aberdeen caused some repercussions since stocks of certain suspected tinned meat were held locally for sale. However, the proprietors of food establishments were most co-operative and all suspected stocks were rapidly withdrawn from sale and were disposed of according to instructions. In addition, a high standard of hygiene was encouraged in all food premises by the Public Health Inspectors, and in this way the misfortunes of Aberdeen were of some help to local residents. Immunization and Vaccination. The scheme for immunizing children against Diphtheria, Whooping Cough, Tetanus and Poliomyelitis continued as in previous years. Reference to tables 12 and 13 in the Appendix indicates the considerable volume of work undertaken in the local clinics. Prevention of Tuberculosis. As in previous years all children aged 13 years were offered B.C.G. vaccination. The object is to provide artificial immunity to the disease during the adolescent period when children are susceptible and can be seriously affected. During 1964 a total of 389 boys and girls were inoculated with B.C.G. 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 expeditiously 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 23 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. 9 THE REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR Mr. W. L. LEACH, IS CONTAINED IN THE FOLLOWING SECTIONS 'C', 'D' and 'E'. SECTION 'C' — SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. The domestic water supply is derived from the River Thames, is stored in the Board's reservoirs at Staines, Littleton and Walton, and filtered and chlorinated at the Hampton Works before being passed into the trunk mains for public supply. The water is of a splendid quality and adequate in quantity throughout the year. No new sources of supply were instituted and there were no substantial alterations to trunk or service mains. The Board's waters are not plumbo'solvent. Immediate action is taken in respect of any form of contamination, or variation in quality, should it be found necessary. We are indebted to Dr. Windle Taylor, Director of Water Examination, to the Board, for this information and for the statistical data in Table 15. There were no complaints received during the year concerning the quality of the water supply, but several notices were served requiring repairs to fittings, flushing cisterns, defective pipes, etc. The position relating to the urgent repair of defects in the water supply system is not very satisfactory and though the Metropolitan Water Board gives notice to the person responsible for the water rate of defective conditions it appears that the only immediate remedy avail' able is to cut off the supply, thereby preventing waste. It would appear that better arrangements are necessary to implement the provisions of Part XIII of the Third Schedule to the Water Act, 1945 so that urgent repairs can be carried out, in default if necessary, with the minimum of delay. SWIMMING POOLS. All the 7 routine samples of swimming bath water taken from the learners' pool at Sheen Mount County Primary School proved very satisfactory. There are no public swimming pools within the borough. SEWERAGE AND SEWAGE DISPOSAL. The considerable task of relaying the sewers in Sheen Lane was commenced during the year and the main operation completed by the end of the year. The work of disconnecting the old sections and picking up branch connections remained to be done. The whole operation, involving the disturbance of old and defective lengths of sewer, often exposing open lengths of foul drainage, was carried 10 through with great skill and resource by the contractors under the direction and supervision of the Borough Engineer and his staff, and not a single complaint of a public health nature was received, (except in respect of noise), nor was any smell or other nuisance noted at any time although operations continued through the summer. On the question of noise many comments were heard about the activities of the pile driving machinery, but no official complaint was received. As with the practice of burning off old road surfaces, which creates dense clouds of smoke for short periods, pile driving creates a noise nuisance for a limited period. It appears that, provided members of the public can see what is happening and can assess for themselves the likely short duration of the nuisance, they are prepared to tolerate such an interference with their normal comfort especially when it is realised that improved technique for quietening the operation are likely to increase the cost of the operation to public funds, without materially affecting the efficiency or speed of completion of the job. Another large scale reconditioning scheme involving sewage brought forth many complaints. This was the reconstruction of the sludge digestion tanks at the Richmond Main Sewerage Works, made necessary as a result of the structural failure of the tanks. The proper funtioning of the plant was seriously interfered with and emergency measures were taken to deal with the problem of drying the sludge in open lagoons. All possible practical steps were taken to minimise the nuisance, but these failed to prevent objectionable smells, causing acute distress to residents, particularly those living in the Hartington Road area of Chiswick, due to the fact that they were in the path of the prevailing wind. Constructional work has proceeded as rapidly as possible and the new tanks are now well established, although at the close of the year there was still some nuisance from effluvia. Experience in other areas shows that, however well designed and conducted, a sewage disposal plant should be in as isolated a position as possible. It is regrettable that new occupiers of property in the vicinity cannot be warned in advance that they are moving to an area where a certain amount of nuisance is almost inevitable. VERMINOUS PREMISES ETC. Rodent Control. Complaints of rats and mice continued at a satisfactory low level and no major infestations were met with. Infestation in the sewers is now confined to one small area where the sewer system connects with Richmond. This is a small pocket of residual infestation, on a minor scale, and no undue difficulty is expected in dealing with it by means of routine treatments. Other Pests. The destruction of wasps nests again predominated in the treatment of pests other than rodents. There was a slight increase in the 11 number of infestations by bugs dealt with but these were of no particular significance and eradication was effective and final. ATMOSPHERIC POLLUTION. The Clean Air Programme passed the halfway mark with the coming into operation of the No. 4 Smoke Control Area on 1st September, 1964 and the No. 5 Area on 1st December, 1964. Bearing in mind the rather drastic change in policy which occurred just as the last area was confirmed, in connection with the type of smokeless appliances being advocated for smoke control areas, the conversions were carried out with relatively little trouble. Fortunately nothing succeeds like success and the performance of the new types of room heater is such that they are usually well recommended by their users. There is now a comprehensive range of appliances burning all types of fuel, which should suit all tastes and conditions. At the close of the year the Ministry announced that, in future, grants will not be payable on direct acting electric heating appliances because the use of such appliances could create an undue strain of power resources during peak periods. Fortunately this announcement came at a time when the majority of approvals had already been issued for the No. 5 Smoke Control Area and householders in the new areas can be warned in good time of this change in policy. The Council made the No. 6 Smoke Control Order in December and it is expected that this area will come into operation on 1st December, 1965. It is worthy of note that relatively few people are now desirous of retaining an open fire, given freedom of choice, and this should lead to a better position as far as the availability of fuel supplies is concerned. Considerable difficulty was again experienced in agreeing the estimates of local builders for conversion works, and the Department was sometimes placed in the regrettable position of having to refer applicants to building firms outside the district for more reasonable estimates. The results of observations carried out by the apparatus for measuring atmospheric pollution in East Sheen indicate that no further improvement in the cleanliness of the atmosphere of this part of the Borough can be expected until the adjacent residential areas are brought under smoke control orders. Even so the weight of smoke has been halved since the passing of the Clean Air Act, 1956. The weight of sulphur dioxide has been reduced by almost one-third in the same period. SECTION 'D' — HOUSING. The most notable trend in housing conditions in the area was the accelerated modernisation of obsolescent properties. As each house becomes vacant, by the death of the statutory tenant or other circumstances, the property is promptly sold and reconditioned. The 12 standard of reconditioning depends on whether it is being carried out by the new owner/occupier, or whether it is to be resold by developers . Certainly the number of houses available for ordinary letting is becoming smaller and smaller each year. With impending amalgamation it was not considered desirable to embark on any redevelopment area schemes, although there are certain areas where the results would probably justify the enormous amount of work which would need to be put into the schemes. It seems clear that owners themselves cannot be relied on to take the initiative in these matters and it will be for the local authority to make detailed surveys and prepare outline schemes with a view to compulsory improvement powers being invoked in the event of non-cooperation by owners. The new Housing Act powers provide for ample time and opportunity being given to owners to think things over before the local authority can actually step in to commence works and provision is made for improvement works to be delayed for a few years if the occupying tenant objects to the proposed works. SECTION 'E'— INSPECTION AND SUPERVISION OF FOOD. The standard of food premises generally was maintained at a reasonably satisfactory level and there were only a few cases where conditions were bad enough to require warning of possible proceedings. The cost and difficulty of arranging for the removal of trade refuse from food premises, especially grocery and greengrocery businesses, is a factor which mitigates against the maintenance of high standards of cleanliness, and unfortunately the local authority is itself well aware of the difficulty of engaging labour for this type of work. One of the defects of the 'self-service' trend in the sale of foodstuffs is the failure by retailers to keep an adequate check on the soundness and freshness of perishable goods. It is not sufficient for the shop assistant to stack the oldest packs at the front because housewives are expert at picking out the best. Unless stocks are completely cleared daily there is always a danger of the odd pack being passed over day after day. In spite of frequent requests to maintain an adequate "coding" system complaints are received of unfit food being sold through lack of care in this respect. The only effective deterrent appears to be to publicise these complaints by means of Court proceedings where the result may be out of all proportion to the actual damage sustained by the purchaser. A comprehensive range of foodstuffs was sampled for adulteration or incorrect labelling, but little of any importance was noted, the infringements being minor omissions in the statements as to contents, which is required by the Labelling of Food Regulations, due rather to misinterpretation of the requirements than to any attempt to mislead the customer. 13 BOROUGH OF BARNES APPENDIX TO THE ANNUAL REPORT OF THE Medical Officer of Health 1964 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, 1964. Area 2,650 acres. Population:— Census, 1951 40,593 Census, 1961 39,057 Registrar-General's estimate, mid-1964 38,820 Rating:— Number of inhabited houses 12,851 Rateable Value £2,445,627 Mortality:— Males Females Total Number of Deaths 219 251 470 Death Rate per 1,000 population:— Uncorrected 12.1 Corrected (Comparability Factor 0.82) 9.9 Deaths from Cancer (all ages) 113 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 525 34 559 Rate per 1,000 population 14.4 Illegitimate Live Births (per cent of total live births) 6.1 Stillbirths:— Number 7 Rate per 1,000 total live and stillbirths 12.4 Total Live and Stillbirths 566 Infant Deaths (deaths under 1 year) 7 17 Infant Mortality Rates:— Total infant deaths per 1,000 total live births. 12.5 Legitimate infant deaths per 1,000 legitimate live births 13.3 Illegitimate infant deaths per 1,000 illegitimate live births NIL Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 11.7 Early Neo-Natal Mortality Rate (deaths under 1 week per 1,000 total live births) 10.7 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 24.7 Maternal Mortality (including abortion):— Number of deaths NIL Rate per 1,000 total live and stillbirths NIL 18 19 Table 2. — Vital Statistics of the Borough of Barnes during 1964 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 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 1962 573 564 14.5 264 6.8 73 259 13 23.0 523 13.4 1963 570 567 14.6 262 6.8 87 279 13 22.9 541 13.9 1964 566 559 14.4 230 5.9 78 240 7 12.5 470 12.1 Table 3. — Causes of Death during the Year 1964. Causes of Death (Registrar-General's short list of causes) Total Deaths Male Female 1. Tuberculosis, respiratory 2 1 1 2. Tuberculosis, other — _ _ 3. Syphilitic diseases 4 2 2 4. Diphtheria _ — _ 5. Whooping Cough _ - - 6. Meningococcal infections - — - 7. Acute poliomyelitis - - - 8. Measles - - - 9. Other infective and parasitic diseases 1 - 1 10. Malignant neoplasm, stomach 11 7 4 11. Malignant neoplasm, lung, bronchus 26 21 5 12. Malignant neoplasm, breast 17 - 17 13. Malignant neoplasm, uterus - - - 14. Other malignant and lymphatic neoplasms 59 36 23 15. Leukaemia, aleukaemia 3 1 2 16. Diabetes 3 3 - 17. Vascular lesions of nervous system 63 20 43 18. Coronary disease, angina 85 45 40 19. Hypertension with heart disease 7 4 3 20. Other heart disease 43 8 35 21. Other circulatory diseases 22 4 18 22. Influenza 1 - 1 23. Pneumonia 23 8 15 24. Bronchitis 13 10 3 25. Other diseases of respiratory system 6 4 2 26. Ulcer of stomach and duodenum 3 2 1 27. Gastritis, enteritis and diarrhoea - - - 28. Nephritis and nephrosis 6 2 4 29. Hyperplasia of prostate 2 2 - 30. Pregnancy, childbirth abortion 1 - 1 31. Congenital malformations 4 3 1 32. Other defined and ill-defined diseases 43 23 20 3 3. Motor vehicle accidents 6 2 4 34. All other accidents 10 6 4 35. Suicide 6 5 1 36. Homicide and operations of war - - - All causes 470 219 251 20 Table 4.— Premature Live Births. Weight at Birth Born in Hospital Born at Home or in a Nursing Home Premature Still births Nursed entirely at Home or in a Nursing Home Transferred to Hospital on or before 28th day Died Died Died Born Total Births Within 24 hrs. of Birth In 1 and under 7 days In 7 and under 28 days Total Births Within 24 hrs. of Birth In 1 and under 7 days In 7 and under 28 days Total Births Within 24 hrs. of Birth In 1 and under 7 days In 7 and under 28 days In Hospital At home or in a Nursing Home 1 2 3 4 5 6 7 8 9 10 11 12 13 14 l. 2 lb. 3 ozs. or less - - - - - - - - 1 - 1 - 1 - 2. Over 2 lb. 3 ozs. up to and inc. 3 lb. 4 ozs 4 1 2 - - - - - - - - - - - 3. Over 3 lb. 4 ozs. up to and inc. 4 1b. 6 ozs 4 1 1 - - - - - - - - - - - 4. Over 4 lb. 6 ozs. up to and inc. 4 lb. 15 ozs. 6 - - - 1 - - - - - - - - - 5. Over 4 lb. 15 ozs. up to and inc. 5 lb. 8 ozs. 17 - - - 4 - - - - - - - - - 6. Total 31 2 3 - 5 - - - 1 - 1 - 1 - ENVIRONMENT OF BIRTHS. Dwelling Houses (177) 31.90% Institutional (378) 68.10% 21 Table 5.— Infant Mortality during the Year 1964. 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 9-12 Months Total under 1 Yr. Deaths in the Borough Deaths outside 1 Borough Aspiration Pneumonia 1 - - - 1 - - - 1 - 1 Acute Suppurative Bronchitis - - - - - - 1 - 1 1 - Circulation Failure 1 - - - 1 - - - 1 - 1 Prematurity 4 - - - 4 - - - 4 - 4 6 - - - 6 - 1 - 7 1 6 Note: The six deaths 'Under 1 Week' were all premature live births. Table 6.— Comparative Statistics, 1964. Live Births Rate per thousand population Still Births Rate per thousand Total live and Still Deaths Rate per thousand population (All ages) Deaths Rate per thousand live births (Under 1 year) Neonatal Mortality Rate per thousand live births (Under 4 wks.) England and Wales 18.4 16.4 11.3 20.0 13.8 Barnes 14.4 12.4 9.9 12.5 11.7 22 SECTION ‘F’— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Table 7.— Notifiable Infectious Diseases, 1954 to 1964. Year 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 Anthrax - - - - - - - - - - - Cholera - - - - - - - - - - - Diphtheria - - - - - - - - - - - Dysentery 75 - 4 - 3 5 6 15 115 43 3 Encephalitis Acute - - - - - - - - - - - Enteric (Typhoid or Paratyphoid Fever) 1 2 - 1 - 1 - 1 1 - - Erysipelas 2 7 2 1 1 - 1 2 - - - Food Poisoning 5 10 - 11 5 1 2 7 12 3 4 Malaria — 1 1 — 2 2 — 1 — — — Measles 5 489 16 606 136 433 8 654 14 385 9 Membranous Group - - - - - - - - - - - Meningococcal Infect'n 2 - - - - - - - - - - Ophthalmia Neonatorum - - 1 - - - - - - - - Plague - - - - - - - - - - - Pneumonia 11 31 25 28 47 61 11 29 15 14 3 Poliomyelitis, Paralytic 1 7 4 1 1 - - - - - - Non-Paralytic - 1 2 - - 1 - 1 - - - Puerperal Pyrexia - 3 3 1 - - - 2 - - - Relapsing Fever - - - - - - - - - - - Scarlet Fever 29 7 8 5 10 9 24 10 15 1 1 Small-pox - - - - - - - - - - - Tuberculosis, Pul. 27 23 18 19 28 19 19 17 20 21 12 Non-Pul. 3 3 3 4 - 1 1 1 1 3 1 Typhus Fever - - - - - - - - - - - Whooping Cough 25 42 17 37 6 2 16 8 - 7 3 23 Table 8.— Certain Infectious Diseases: Incidence per 1,000 of the Population in 1964. Disease Barnes London (a.c.) England and Wales Scarlet Fever 0.03 0.50 0.42 Diphtheria - 0.00 0.00 Enteric Fever - 0.01 0.03 Acute Pneumonia 0.08 0.17 0.19 Dysentery 0.08 0.71 0.45 Acute Poliomyelitis— Paralytic - 0. 00 0.00 Non-Paralytic - 0.00 0.00 Food Poisoning 0.10 0.17 0.11 Tuberculosis— Respiratory 0.31 0.43 0.34 Others 0.03 0.05 0.05 Table 9.— Infectious Diseases Notified during the Year 1964. Diseases Total Cases Notified Ages, in years Parish Removed to Hospital Under 1 year 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 65 & over Barnes Mortlake Dysentery 3 - - - - 1 1 1 - - - - - - - 3 - Erysipelas - - - - - - - - - - - - - - - - - Food Poisoning 4 - - - - - - - 1 1 - 1 - 1 1 3 - malaria - - - - - - - - - - - - - - - - - measles 9 - 3 - - - 5 - - - - 1 - - 4 5 - Paratyphoid Fever - - - - - - - - - - - - - - - - - Pneumonia (Acute) 3 - - - - - - 1 - - - - - 2 2 1 - Poliomyelitis, Non-Para. - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - - - - - - - - - - Scarlet Fever 1 - - - - 1 - - - - - - - - 1 - - Tuberculosis, Pul. 12 - - - - - - - - 2 1 3 4 2 8 4 5 Tuberculosis, Non-Pul. 1 - - - - 1 - - - - - - - - - 1 1 Whooping Cough 3 - - - - 1 1 1 - - - - - - - 3 - 36 - 3 - - 4 7 3 1 3 1 5 4 5 16 20 6 24 TUBERCULOSIS. Notification Register. The Register of Notifications has been kept revised in accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1952. The number of cases added to or removed from the Register during the year and the number remaining on the Register on December 31st, 1964 are as under:— Table 10.— Tuberculosis Register. Form of Disease On Register 1st Jan., 1964 Cases Added Removed from Register Remaining on Register 31st Dec. 1964 Primary Notif’ns Otherwise Restored Total Cured Left District Dead Total Pulmonary 157 12 8 - 177 12 12 7 31 146 Non-Pulm'y 9 1 - - 10 - - - 10 10 Totals 166 13 8 - 187 12 12 7 41 156 Table 11.— New Cases and Mortality, 1964. 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 - - - 1 - - - 25-44 „ 1 3 - - - - - - 45-64 „ 4 - - - 2 1 - - 65 „ and over 1 1 - - 4 - - - All ages 7 5 1 - 6 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 0.52 (per 1,000 population) Non-Pulmonary 0.03 Death-rate—Pulmonary 0.18 (per 1,000 population) Non-Pulmonary — All form 0.55 25 Table 12.— IMMUNISATION and VACCINATION. Diphtheria Immunisation. Number of children immunised during 1964:— Under 5 years 453 Between 5 and 15 years 13 Number of children re-immunised during 1964:— Under 5 years 356 Between 5 and 15 years 474 Total number of children immunised during last 5 years at 31st December. 1964:— Under 5 years 2019 Between 5 and 15 years 2837 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 673 Number of children who have received a reinforcing dose 584 Vaccination against Smallpox. Number of Vaccinations carried out during 1964:— Children Primary Vaccination 285 Re-vaccination 11 27 Table 13.— POLIOMYELITIS VACCINATION. Northern Division— Barnes and Richmond. Age Group. Year of Birth, Primary Course. Number of Persons who completed a Primary Course of Treatment in 1964: 1964 137 1963 696 1962 188 1961 62 1943-60 235 1933-42 57 Others 66 1441 In addition 1232 reinforcing doses were given during the year. 28 Table 14. — Mass Radiography Service. General Practitioner's Chest X-Ray Service. Men Women Total Patients referred by their Doctors 389 338 727 Abnormalities detected:— Pulmonary tuberculosis 1 1 2 Lung Cancer 6 1 7 Barnes Borough Council employees referred by the Medical Officer of Health 23 Normal Mass Radiography Service. Men Women Total Number of persons examined 373 241 614 Abnormalities detected:— Pulmonary tuberculosis 1 - 1 Lung Cancer - - - SECTION 'C' — SANITARY CIRCUMSTANCES OF THE AREA. Table 15. — Water Supply — Bacteriological Sampling. Type of Test. WATER PASSING INTO PUBLIC SUPPLY — Hampton Works. Plate Count per milli'litre on agar 20/24hrs. at 37°C Average Results 13.4 Coliform Test (Percentage of samples negative in 100 ml.) 100.0% negative. Escherichia Coli Test (Percentage of samples negative in 100 ml.) 100.0% negative. SWIMMING POOL. Table 16.— 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 — — 7 — 29 Table 17. — Laundry Service for Incontinent Patients. Number of patients using the service as at 31.12.64 4 Number of patients admitted to hospital and the service discontinued 2 Number of patients who died and the service discontinued 6 Number of sheets laundered and issued 462 Table 18. — Infected Rooms and Articles (dealt with by the Council). Premises disinfected 4 Lots of bedding disinfected 4 Table 19. — Pest Control Disinfestations (dealt with by the Council). Disinfestation by spraying or fumigation was carried out at various premises for the following infestations:— Fleas 8 Bugs 11 Wasps 120 Ants 2 Bees 5 Cockroaches 1 Insects 4 Silver fish 1 Beetles 1 Table 20. — Rodent Control. Summary of work carried out:— Premises visited 113 Inspections made 412 Treatment visits 104 Premises treated 102 Minor infestation of Rats 102 Minor infestation of Mice 2 Table 21. — Atmospheric Pollution. Volumetric Apparatus. 1957. 1958. 1959. 1960. 1961. 1962. 1963. 1964. Average Smoke (Microgrammes per cu. metre) 202 149 140 103 90 66 73 100 Average Sulphur Dioxide (Microgrammes per cu. metre) 130 129 150 124 107 135 92 119 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. 30 Table 22. — 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 27 10 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 137 48 2 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 12 - - - Total 176 58 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 1 1 — — — (c) Not separate for sexea 1 1 — — — Other offences againstthe Act (not including offences relating to Outwork) — — — — — Total 2 2 — — — 31 Table 23.—Outworkers. Work Undertaken No. on Register Notices Served Wearing apparel 10 — Lamp Shades 1 — Artificial Flowers 1 — Total 12 — Legal proceedings under Factories Act:— No legal action was necessary during 1964. Table 24.— Other Premises. Nature of inspection Number of premises Numbers of visits Notices issued and complied with Schools 20 - - Public Houses, Public Halls, and Public Conveniences 38 68 - Stable Yards 4 - - In addition to the above, 162 visits were made by Public Health Inspectors to premises in connection with infectious diseases and 540 visits in connection with offensive accumulations — 4 exhumations were attended. Altogether 635 non-effective visits were made to premises of all types where no access was gained. SECTION 'D' — HOUSING. Table 25.— Housing Inspections. Number of houses inspected in respect of defective conditions 872 Number of re-inspections 752 Number of houses inspected in respect of unsatisfactory living conditions, but where no repairs were required 233 Number of re-inspections 24 Number of Informal Notices served 107 Number of Informal Notices complied with 121 32 Table 26.— Rent Act, 1957. Applications for Certificates of Disrepair. Period ended:— Dec. 1958. Dec. 1959. Dec. 1960. Dec. 1961. Dec. 1962. Dec. 1963. Dec. 1964. 1 No. of applications for Certificates 31 16 8 1 2 2 3 2. No. of decisions not to issue Certificates - - - - - - - 3. No. of decisions to issue Certificates 31 16 8 1 2 - - (a) in respect of some but not all defects 26 8 5 - - - - (b) in respect of all defects 5 8 3 1 2 2 3 4. No. of undertakings given by landlords under para. 5 of the First Schedule 21 9 5 2 1 2 3 5. No. of undertakings refused by local authority under proviso to para. 5 of the First Schedule - - - - - - - 6. No. of Certificates issued 18 8 1 1 1 - - Applications for Cancellation of Certificates. Period ended:— Dec. 1958. Dec. 1959. Dec. 1960. Dec. 1961. Dec. 1962. Dec. 963. Dec. 1964. 7. Applications by landlords to local authority for cancellation of Certificates 14 9 4 5 4 1 1 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 1 1 33 SECTION 'E' — INSPECTION AND SUPERVISION OF FOOD Table 27. — 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 5 141 1 Bread and Cakes 74 8 1 Butchers 25 77 4 Cafes, Restaurants, etc. 20 108 - Canteens, etc. 9 1 - Cooked Meats 54 43 — Dairies and Milk Shops 23 - - Fishmongers 9 54 - Fried Fish Shops 2 1 - Greengrocers 27 101 1 Grocers 61 224 - Ice Cream:— Retailers 70 58 - Public Houses 28 25 _ Street Traders — — — Sweets, Confectionery 58 57 — Table 28. — Sampling of Other Food and Drugs. (a) Chemical Analysis. — Sixtyone samples procured under the provisions of the Food and Drugs Act, 1955 included:— Apple puree Marmalade Beef sausage Milk Biscuits Minced Beef Brawn Mincemeat Butter Orange Juice Cake Pudding Mix Cheese Spread Paste Cheese Snack Pickles Chicken Pork Sausage Condensed Milk Potted Salmon Cornflour Peanut Butter Corned Meat Loaf Ravioli Cream Rice Crispbread Salmon Spread Figs Sausage Fish Cakes Soup French Mustard Sugar Crystals Gravy Browning Spaghetti Groundnut Oil Stuffing Mix Honey Table Jelly Hotpeppers Tomato Juice Jam Treacle Jelly Turkey Lard Vegetables Margarine Vinegar 34 (b) Hereunder I give the Public Analyst's report on three samples submitted to him: Sample No. 472 — Pork Sausages. 'Pork sausages must not contain the added preservative, sulphur dioxide, unless labelled or notified in the manner prescribed by Regulation 5(1) of the Preservatives in Food Regulations, 1962. The Manufacturers of the product were informed of the Analyst's report and that the labelling of their product contravened the Preservatives in Food Regulations, 1962. No further action was taken in respect of this sample. Sample No. 476 — Pickles. 'The ingredients of this article were not specified on the label as is required by the Labelling of Food Order, 1953. The manufacturers and retailer of this product were informed of the Analyst's Report and that the labelling of the product contravened the Label' ing of Food Order, 1953. Sample No. 482 — Apple Puree. The ingredients of this article are not specified on the label as required by the Labelling of Food Order, 1953. No action was taken in respect of this sample. Table 29. — 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 Transfer Station and subsequently buried on a controlled tip. jars. pkts. 1bs. tins. Beef 78 Cake Mixture 8 Cheese 4 Chicken 37½ Chips 10 Creamola 53 Fish 8 Livers 60 Luncheon Meat 2 Macaroni 30 Peel 2 Pork 10 Pickles 60 Potato Salad 1 Rice 14 Sago 7 Soup 12 Spaghetti 14 Tapioca 4 Tomato Juice 1 Tongue 1 Vegetables 160 Wheat Flakes 10 35 Printed by J. H. Broad & Co. Ltd., 8, King Street, Richmond, Surrey.