- . >i r. A AC 4388 1 Mr ghuara 'NW OB 2 Library " ..y' WAN 91 Metropolitan Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health for the Year 1954 by J. TUDOR LEWIS, M.D., D.P.H. together with the Report of the Public Analyst 68680 REPORT of the Medical Officer of Health for the year 1954 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, I beg to present to you the Annual Report on the health and sanitary conditions of the Borough for the year 1954, the third year for which I have had the privilege of being responsible for the health services in this Area. As in previous reports, most aspects of our work are covered, and in this introduction I refer mainly to one or two of the more interesting features of the work as they appeared during the year. In my last Report, I drew attention to the slight reduction in the population of the Borough. In 1954, however, there was an increase from 331,000 to 333,900. This is associated with the new Housing Estates which have arisen in the Borough and to which families from other parts of London came. I make a little more reference later on to this question as a health and social problem. The birth rate was 13.27, a slight decrease from the previous year; while the standardized death-rate was 12.58, slightly lower than that of 1953. The infant mortality rate was 19.1. This figure is the lowest ever recorded in Wandsworth and is below that for the County of London and England and Wales which in 1954 was 20.7 and 25.5 respectively There were two deaths from causes associated with childbirth. The number of cases of infectious disease notified was less than in the previous year owing to the diminished incidence of measles and whooping cough. The number of cases of tuberculosis which were primarily notified remained the same but the number of cases transferred from other Authorities showed a big increase—342 as compared with 253. The total number of new cases which came to the notice of the department, therefore, during 1954 was 738 compared with 663 in the previous year. This increase is associated with 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 the movement of populations into Wandsworth from other parts of London, following on the development of the new estates in the Borough. There were only seven cases of confirmed poliomyelitis and no deaths. Once again, I am pleased to report that there were no confirmed cases of diphtheria notified. I referred last year to the importance of housing as a social and public health problem and to the importance of good and adequate housing as a basic need for the family in the same way as are good food, pure and wholesome water and fresh air. During the year, the Housing Repairs and Rents Act, 1954, became law and its working imposed additional responsibility on the health department, particularly as to that part of the Act dealing with the issue of Certificates of Disrepair. In spite of the fact that these sections of the Act allowed some scope for differences of interpretation, no real difficulty was experienced and the work under the Act proceeded quite smoothly. As anticipated, after a period of inertia, there was a flood of applications by tenants which, however, have gradually tailed off. I should like to take the opportunity of expressing my appreciation for the work of the Sanitary Inspectors, on whom the bulk of the responsibility for the initial inspection and the making of reports fell. In spite of shortage of staff, I am glad to say that they met their extra responsibility very adequately. The other important part of the Housing Repairs and Rents Act is that dealing with slum clearance and at the end of the year, measures had been taken to complete the returns necessary under the Act. In terms of legally unfit properties, it may be that Wandsworth has no problem of the magnitude of some of the large industrial areas in the North and the Midlands. But while the number of houses which are statutorily unfit for human habitation may be comparatively small in Wandsworth, the number of houses which are sub-standard in terms of modern ideas is large. The type of house I have in mind is the house which originally was intended for one family but which is now occupied by two or possibly three families. Such houses do not possess those modern amenities which are now generally accepted as being necessary for a happy family life. One of the big problems to which it will be necessary to turn our attention in the not distant future is how to provide housing accommodation for each family unit which is in accord with modern ideas. In other words, to effect a transformation of old and, sub-standard property into family housing units which comply with modern standards. A great deal is being done in Wandsworth, both by the Borough Council and by the London County Council to provide homes for REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 3 the people and there are large new estates being developed. So far as the estates developed by the Borough Council are concerned, the new tenants are already Wandsworth residents. In the case of the L.C.C. estates a high proportion of the tenants come from areas outside Wandsworth. We are experiencing something in the nature of a small social revolution in that large numbers of families are being brought into the Borough into new and up-to-date houses and flats from many areas in London where housing and living conditions have long presented a problem. The main estates where this is occurring are the Ackroyden and Argyle (population 5,400) and the Ashburton (population 4,500) Estates, and these will be further added to when the development of the large estate in the Roehampton Lane area is completed. I have referred in the body of the Report to a slight increased incidence of scarlet fever on one of these estates, thought to be associated with children from many areas of London coming together and playing together on the estate. The social problems which the erection of these new estates provide are not, at this stage, clearly defined and are not the immediate concern of the Borough Council Health Department although, of course, since health and welfare are indivisible they have an indirect health and social bearing on our work. In connection, however, with the personal health services, my colleagues and I have a responsibility for these matters and the whole situation is one which is being watched with a good deal of care and interest. I made some mention in my Report for 1952 of the arrangements in this area by which the duties of Medical Officer of Health for Wandsworth, Medical Officer of Health for Battersea and Divisional Medical Officer for the London County Council Health Division 9 are combined in a single appointment. I ventured the opinion, writing at that time on the basis of some 18 months' experience of the work, that the idea was basically sound and offered many advantages over forms of administration where there was a functional division between the environmental health services and the personal health services. Now, two years later, after some three and a half years' experience of the work, I am confirmed in my opinion that this form of public health administration is highly satisfactory and satisfying. From the point of view both of the services and of those responsible for operating them, there is a tremendous advantage in abolishing lines of demarcation between the personal and the environmental health services which, from the functional or working aspect, are largely artificial. Over the past three and a half years, no difficulties have been encountered, and a very important contributory 4 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 factor has been the ready help and co-operation which has been forthcoming from everyone connected with the work. Over and above the statutory or generally accepted duties of a Medical Officer of Health are two ancillary functions which ought to be undertaken whenever opportunity presents, since apart from their intrinsic worth, they are valuable and stimulating adjuncts to the routine work of the Medical Officer of Health and the Health Department. I refer to the academic teaching of public health work and to the conduct of research into problems of public health and preventive medicine. I should like to say a word about some of the work which we are doing in this area which, although not exclusive to the Borough Council Health Department, has an interest and bearing on our work in the environmental health services. Firstly, to deal with the question of teaching. We have been fortunate in making an arrangement with the London School of Hygiene and Tropical Medicine whereby a number of lectures on public health administration are given, and thereafter students of the School, who are all medical men and women studying for the London University Postgraduate Diploma in Public Health, attend our departments to study methods and practice of public health administration in this country. During the Spring and Summer terms, for one session per week, we receive about a dozen students from the School. Dealing as we do with both environmental and personal health services, we are able to give to the students what we hope is a wide, all-embracing, and at the same time well-balanced exposition of the principles and practice of public health administration in this country. Over the past three years some 70 students from many parts of the world and Commonwealth have passed through our departments. We hope that they will carry back with them to the various countries from which they come, useful ideas of what we have been able to show them. Turning to the problem of research, there are many questions in public health and preventive medicine which need investigation. One of them is to decide whether three injections of a combined diphtheria/whooping cough preventative are as effective in the prevention of both diphtheria and whooping cough as injections against the two diseases given separately. The advantage of the "combined" method is that a child has to have only three injections instead of five. Research of this kind is an expensive and a prolonged procedure and unless special staff and facilities are available, it is rarely that a REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 5 reliable answer can be provided. We are, however, fortunate in being enabled to participate in an investigation of this kind in conjunction with the staff of the Medical Research Council. A special team of nurses and clerical staff is available and the giving of the injections is a responsibility of the personal health services. By the participation of the Borough Health Department, a considerable advantage accrues to the investigation since we are able to utilize administrative services such as transport for taking specimens quickly to the Laboratory, and the ready access of certain records is also very useful. My senior medical colleagues and I supervise the team of workers in the field, while at the same time we work in close conjunction with the medical staff of the Medical Research Council and the local general practitioners, and we hope that in the course of a year or two we shall be able to give an answer to this important question. I would not wish to end this introduction to my Report for 1954 without saying something about Mr. A. E. Vickers, Chief Sanitary Inspector for Wandsworth. Mr. Vickers was due to retire from the service of the Council in December 1954, but by an extension of his services, he continued with us until July 1955. Mr. Vickers joined the staff of the Wandsworth Public Health Department in 1915, and, apart from his war service with the R.A.M.C. in the first World War, he has been in the service of the Council since that date. He has been successively District Sanitary Inspector, Senior Sanitary Inspector and Chief Sanitary Inspector, and has given long years of loyal, unstinted and most efficient service to the Council. My own personal debt to Mr. Vickers is a very considerable one for when I took up my appointment, he placed all his knowledge of public health work in general and his knowledge of Wandsworth in particular, at my disposal. I was very glad to take advantage of his assistance and advice. Mr. Vickers will unquestionably be greatly missed, not only by his Departmental colleagues but by the members of the Health Committee and indeed of the Council. He leaves with an abundance of good will from everybody and best wishes for a long, happy and fruitful retirement. Once again it is a great pleasure to acknowledge the kindness and help which I have received from all persons concerned with the work of my department. Again, I especially thank the Chairman of the Health Committee, Councillor T. V. Rowlands, for his courtesy and ready assistance; and the various Committees, particularly the Health Committee, with whose work I am concerned, for their continued confidence. The Chief Officers of the Council, and not least Major Jerman, the Town Clerk, have been very helpful to me, 6 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 and as in previous years, the officers and staff of the Health Department, in all sections, have given me every support. I would like again to thank my colleague, Dr. W. G. Harding, for the most efficient and competent way in which he carries out his duties. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, J. TUDOR LEWIS, Medical Officer of Health. July 1955 STAFF The following changes occurred during the year: Resignations Mr. D. E. Williams, Sanitary Inspector (service, 1 year 5 months), resigned in January. Mr. R. Lamey, Sanitary Inspector (service, 6 months), resigned in August. Appointments Mr. R. Lamey, Sanitary Inspector, appointed in January. Mr. D. J. Hughes, Sanitary Inspector, appointed in March. Mr. P. O'Grady, Sanitary Inspector, appointed in September. Mrs. P. McKeown, Typist, appointed in April. Mr. G. Langrish, Rodent Operative, appointed in August. Mr. W. Maxwell, Rodent Operative, appointed in August. 1 STATISTICS AND SOCIAL CONDITIONS Area 9,107 acres Resident population in 1954 333,900 Wandsworth is the largest of the Metropolitan Boroughs. It has an area of 9,107 acres which includes a number of open spaces, with an approximate combined area of 1,200 acres. The population is a varied one, as the Borough contains residential neighbourhoods which are rapidly being added to by the development of new housing estates by the Borough Council and London County Council. The chief industries carried on are the manufacture of gas, electricity and motor accessories, laundries and general engineering. STATISTICS AND SOCIAL CONDITIONS 9 Extracts from Vital Statistics Number of Live Births: Males Females Total Legitimate 2,124 2,043 2,167 Illegitimate 131 134 265 Total live births 2,255 2,177 4,432 Number of Stillbirths 43 44 87 Number of deaths 2,333 2,555 4,888 Birth-rate 13.27 Death-rate—Crude 14.63 Standardized 12.58 Rate per 1,000 (Live and Still) Births Deaths from puerperal causes 2 0.44 Infantile mortality per 1,000 live births: All infants 19 Legitimate infants 18 Illegitimate infants 26 Deaths from Cancer 1,110 „ „ Diphtheria 0 „ „ Scarlet Fever 0 „ „ Measles 0 „ „ Whooping Cough 0 „ „ Tuberculosis 68 Tuberculosis death-rate 0.20 There has been no unusual or excessive mortality during the year. 2 VITAL STATISTICS Population The civilian population at the middle of the year was estimated by the Registrar-General to be 333,900, and all the rates used in this Report are based on this figure. Table I shows the approximate population of each Parliamentary Division, based on the above estimation. TABLE I Population estimated to middle of 1954 Putney 85.452 Central 95,845 Clapham 80,374 Streatham 72,229 Whole Borough 333,900 Births The total number of births belonging to the Borough registered during 1954 was 4,432, consisting of 2,255 males and 2,177 females. The number for 1953 was 4,483. The birth-rate was 13.27 per 1,000 persons living, compared with 13.54 for 1953. The rate for the whole of London during 1954 was 15.2 and for England and Wales 15.2. Two hundred and sixty-five illegitimate births took place in the Borough compared with 284 in 1953. 10 VITAL STATISTICS 11 Deaths The number of registered deaths which took place in the Borough during the year was 3,195 but 269 of these did not belong to the Borough, while 1,962 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,888 of whom 2,333 were males and 2,555 females. The crude death-rate for the year was 14.63, compared with 14.86 for 1953, but after taking into account the area comparability factor supplied by the Registrar General, the adjusted rate works out at 12.58. This compares with 10.7 for the whole of London and 11.3 for England and Wales. Table II shows the total number of registered deaths and the death-rates for each division based on the approximate population in each division. TABLE II Corrected Deaths Death Rate Males Females Total Putney 482 548 1,030 12.05 Central 771 824 1,595 16.64 Clapham 683 749 1,432 17.71 Streatham 397 434 831 11.51 Whole Borough 2,333 2,555 4,888 14.63 12 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Table III is the general mortality Table for the whole Borough and shows the number of deaths from each cause divided into sexes, age-groups and sub-districts. TABLE III. causes of, and ages at death, during the year 1954 causes of death deaths in or belonging to whole district at subjoined ages deaths in or belonging to localities (all ages) All Ages Males Females Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards Putney Central Clapham Streatham Tuberculosis, Respiratory 64 43 21 - - - 14 25 25 14 26 13 11 Tuberculosis, Other 4 2 2 - - - 2 1 1 2 1 1 - Syphilitic Disease 21 14 7 - - - - 7 14 8 6 5 2 Diphtheria - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - Meningococcal Infections 3 2 1 1 1 - - - 1 1 - 2 - Acute Poliomyelitis - - - - - - - - - - - - - Measles - - - - - - - - - - - - - Other Infective and Parasitic Diseases 10 5 5 1 1 2 2 4 - 3 1 4 2 Malignant Neoplasms 1,110 548 562 1 2 - 57 418 632 201 238 520 151 Leukaemia, Aleukaemia 22 16 6 - 2 - 2 8 10 5 4 8 5 Diabetes 15 4 11 - - - 2 1 12 4 6 3 2 Vascular Lesions of Nervous System .. 551 210 341 - - - 13 95 443 132 160 142 117 Diseases of Heart 1,710 783 927 - - 1 23 214 1,472 322 773 371 244 Other Circulatory Disease 276 95 181 - - 1 2 37 236 63 75 71 67 Influenza 23 12 11 - - - - 4 19 6 4 9 4 Pneumonia 192 92 100 5 14 5 3 21 144 54 52 49 37 Bronchitis 231 157 74 2 1 1 - 48 179 56 61 65 49 Other Diseases of Respiratory System 20 13 7 - 1 1 1 7 10 4 5 7 4 Ulcer of Stomach and Duodenum 54 39 15 - - - 1 16 37 12 16 15 11 Gastritis, Enteritis, Diarrhoea 17 6 11 2 - - 2 2 11 4 6 4 3 Nephritis and Nephrosis 40 23 17 1 1 1 6 12 19 9 11 10 10 Hyperplasia of Prostate 40 40 - - - - 1 3 36 7 10 13 10 Pregnancy, Childbirth, Abortion 2 - 2 - - - 2 - - - - 2 - Congenital Malformations 29 12 17 18 3 3 1 1 3 8 7 8 6 Other Defined and Ill-defined Disease 312 140 172 51 2 4 28 69 158 79 85 76 72 Motor Vehicle Accidents 22 15 7 - - 2 6 5 9 7 5 6 4 All other Accidents 70 32 38 3 - 1 10 11 45 16 27 17 10 Suicide 45 26 19 - - - 14 19 12 12 13 11 9 Homicide and Operations of War 5 4 1 - - - 2 3 - 1 3 - 1 All Causes 4,888 2,333 2,555 85 28 22 194 1,031 3,528 1,030 1,595 1,432 831 VITAL STATISTICS 13 Infantile Mortality The number of deaths under one year was 85, the infantile mortality-rate being 19.1 per 1,000 births. This compares with a rate of 23 for 1953, and 20 for 1952, and is the lowest rate ever recorded. For the ten years ended 1944 the average infantile mortality rate was 48 while for the ten years ended 1954 the average rate was 26. Maternal Mortality Two deaths occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.44 for 1,000 live and still births, compared with 0.43 in 1953. 3 INFECTIVE DISEASES The number of deaths from notifiable infectious diseases was 120. This included 68 from all forms of tuberculosis and 48 from the notifiable forms of pneumonia. There was one death from meningococcal infection, and two other deaths were subsequently attributed to this condition after post-mortem examination. One death was due to erysipelas. From all notifiable infective diseases the death-rate was 0.36 per 1,000 Table IV shows the number of cases of the notifiable diseases reported, arranged in age groups, and Table V shows the same figures arranged in the sub-district in which they occurred. Smallpox No case occurred in the Borough during the year. Notification is frequently received from Port and Local Authorities of persons coming into the Borough who may have been in contact with Smallpox. Observation for the necessary period is kept on these persons by members of the Public Health Department. Diphtheria There were no confirmed cases. Scarlet Fever Three hundred and forty-five cases of scarlet fever were notified, compared with 336 in 1953, and 563 in 1952. The diagnosis was not confirmed in 7 cases. No deaths occurred. On one of the new estates in Wandsworth a number of scarlet fever cases arose. The cases were carefully investigated and it was thought that the probable cause was the large number of children from many parts of London coming together on the new Estate. The children on the Estates naturally play together and during these play periods, there are probably opportunities for spread of infection. The same, of course, applies to school pupils where new schools are opened on the estate containing children from widely dispersed parts of the Metropolitan area. If a child or children harbouring one serological type of haemolytic streptococcus should come into contact with other children who have previously not had experience of that particular type, it is possible that a number of cases might occur. Whooping Cough Four hundred and thirty-one cases were notified during the year. There were no deaths. 14 15 INFECTIVE DISEASES TABLE IV notifiable diseases no. of cases of infective diseases grouped in age-period Total Under 1 1-2 3-4 5-9 10-14 15-24 25-44 45-64 65 and upwards Smallpox - - - - - - - - - - Diphtheria - - - - - - - - - - Scarlet Fever 338 5 23 57 201 35 15 2 - - Measles 303 20 55 76 145 6 1 - - - Whooping Cough 431 29 92 122 159 14 9 6 - - Enteric Fever and Paratyphoid Fever 3 - - - - 1 1 1 - - Malaria 2 - - - - - 1 1 - - Dysentery 156 9 28 37 36 14 20 8 4 - Erysipelas 58 - - - - 6 7 27 15 3 Scabies 42 - - - 9 4 12 12 5 - Puerperal Pyrexia 138 - - - - - 59 78 1 - Ophthalmia Neonatorum 9 9 - - - - - - - - Meningococcal Infection 8 1 4 - 1 1 - - - 1 Acute Poliomyelitis 7 - 1 - 3 - 1 2 - - Acute Encephalitis - - - - - - - - - - Anthrax - - - - - - - - - - Pneumonia Acute Influenzal 98 1 - 2 - 3 2 19 43 28 Acute Primary 171 1 5 12 14 13 19 37 53 17 Tuberculosis—All forms 738 3 11 8 27 16 159 353 115 46 Food Poisoning 124 4 9 14 8 11 24 47 7 - Continued Fever - - - - - - - - - - Total 2.626 82 228 328 603 124 330 593 243 95 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 TABLE V notifiable diseases total cases of infective diseases occurring in each ward Whole Borough Deaths putney central clapham streatham Putney Thamesfield Fairfield West Hill Southfield Earlsfield Springfield Tooting Graveney Bedford Larkhall Clapham North Clapham Park Thornton Balham Streatham Hill St. Leonards Streatham Common Streatham South Furzedown Smallpox - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 20 13 12 58 24 34 36 18 5 19 18 9 10 3 5 9 10 17 6 12 338 - Measles 15 4 14 14 8 15 9 15 8 29 10 14 37 58 14 14 9 8 4 4 303 - Whooping Cough 21 8 17 36 18 19 39 40 28 43 9 6 9 7 15 10 21 31 21 33 431 - Enteric Fever and Paratyphoid Fever - - - - - - - - - 1 - - - 1 - - 1 - - - 3 - Malaria - - - 1 1 - - - - - - - - - - - - - - - 2 - Dysentery 8 7 9 6 12 22 6 29 14 5 7 3 3 3 2 2 6 3 2 7 156 - Erysipelas 3 1 5 2 5 4 4 7 7 1 3 - 3 - 1 1 2 2 5 2 58 1 Scabies 1 1 2 4 1 9 1 1 2 1 4 1 2 1 1 1 1 2 - - 42 - Puerperal Pyrexia 1 - 1 1 - 5 3 4 3 2 - 8 64 21 13 4 2 3 3 - 138 - Ophthalmia Neonatorum 1 - 2 2 - - - - 2 1 - - - - 1 - - - - - 9 - Meningococcal Infection - - - 3 - - - - 1 - 1 3 - - - - - - - - 8 3 Acute Poliomyelitis 1 - - - 1 - - - - - 1 1 1 - 1 1 - - - - 7 - Acute Encephalitis - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - Pneumonia:— Acute Influenzal 3 4 6 4 6 5 5 7 12 10 8 2 2 3 7 2 2 2 4 4 98 14 Acute Primary 6 7 8 8 11 11 10 21 14 11 8 7 6 8 9 5 3 4 5 9 171 34 Tuberculosis—All forms 91 39 35 46 47 39 29 41 34 29 25 36 43 41 41 26 23 28 19 24 738 68 Food Poisoning 13 3 13 12 8 26 8 4 1 9 1 1 2 3 1 3 4 1 7 4 124 - Continued Fever - - - - - - - - - - - - - - - - - - - - - - Total 184 87 124 199 142 189 150 193 131 161 95 91 182 149 111 78 84 101 76 99 2,626 120 INFECTIVE DISEASES 17 Measles The number of cases notified during the year was 303, compared with 2,850 in 1953, 2,290 in 1952 and 4,299 in 1951. Acute Poliomyelitis Forty-one cases of this disease were notified or reported during the year, of which 34 were subsequently not confirmed. Of the remaining 7 confirmed cases, 5 were of the paralytic type and 2 non-paralytic. There were no deaths. In 1953, 27 cases were confirmed, with two deaths. Acute Encephalitis Of five cases investigated, none were confirmed. Meningococcal Infection Six confirmed cases were notified, of which one proved fatal. Two other deaths were attributed to this disease on post-mortem examination making a total of eight cases for 1954. Twenty-seven other cases were investigated, but were subsequently not confirmed. In 1953 there were five cases with two deaths. Typhoid and Paratyphoid Fever Of six cases reported during the year, three were subsequently confirmed as paratyphoid. Diagnosis was not confirmed in the remaining three cases. There were no deaths. Puerperal Pyrexia During the year 138 cases were notified, of which 133 occurred in hospital and 5 at home. Sixty of the hospital notifications referred to patients whose home addresses were outside the borough. Information was also received of 61 cases, referring to Wandsworth residents whose confinements took place in hospitals located in other Metropolitan boroughs. Sonne Dysentery Systematic follow-up of all cases of Dysentery continued throughout the year and where it was considered necessary, stool specimens were obtained from family contacts for bacteriological examination. In addition to the cases for which formal notifications were received and which, in the main, were single unrelated cases, a number of other cases were discovered by investigation of diarrhoea outbreaks which occurred at Day Nurseries and Schools. 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Influenza The number of deaths from Influenza was 23 compared with 64 in 1953, 26 in 1952 and 122 in 1951. Influenzal Pneumonia and Acute Primary Pneumonia These are the notifiable forms of pneumonia. Ninety-eight cases of acute influenzal pneumonia and 171 cases of acute primary pneumonia were notified. Fourteen of the former, and 34 of the latter died. The total number of deaths credited to all forms of pneumonia during the year was 192, compared with 261 in 1953. Malaria Two cases were notified. One, a soldier, was a recurrent case, and the other was the wife of a Pakistan Army Captain, and had recently arrived in this country from Pakistan. Erysipelas Fifty-eight cases were notified. One death occurred. Other Infective Diseases Twenty-one deaths occurred from syphilis. Scabies Forty-two cases were notified. Eighty-one cases of scabies were treated at the Council's Cleansing Station under the supervision of the two bathing attendants. The majority of the cases were treated by two applications of benzyl benzoate and received a course of two baths each. Fourteen other persons received cleansing treatment for various conditions. Food Poisoning One hundred and twenty-four formal notifications were received during the year. One hundred and two were unrelated cases and 12 were outbreaks involving two or more persons. The majority of the single cases were only slightly affected and where bacteriological investigation was carried out, organisms likely to have caused the illness were discovered in only 4 cases. The organism isolated was Salmonella typhimurium. In 11 of the outbreaks reported it was not possible to identify the causative agent and in the remaining one, which affected 73 persons at a factory in the Borough, the organism Clostridium welchii was isolated. Full reports on the major outbreaks were submitted to the Ministry of Health in accordance with Circular 46/49 and revised Memo. 188/Med. INFECTIVE DISEASES 19 Diseases Reported from Schools A total of 2,356 infective diseases was reported from schools in the Borough throughout the year. The numbers of each disease were: Scarlet Fever 239 Chicken Pox 306 Diphtheria — Whooping Cough 108 Measles 402 Mumps 1,149 German Measles 20 Dysentery 31 Poliomyelitis 4 Other Diseases 97 Disinfection During the year 911 rooms were disinfected after infectious and other disease and 340 rooms disinfested for vermin. Bacteriological Examinations All bacteriological examinations are carried out at the Public Health Laboratory at County Hall under its Director, Dr. A. J. H. Tomlinson. The following is a summary of examinations made during the year: Nose and throat swabs 696 Faeces for the typhoid and dysentery groups 1,301 Miscellaneous specimens 27 Total 2,024 NON-INFECTIVE DISEASES The total number of deaths from cancer and malignant disease was 1,110, the number of males being 548 and females 562. The death-rate was 3.33 per 1,000. The number of deaths in 1954 was 54 more than in 1953. Deaths from disease of the heart and circulatory system were 1,986 compared with 1,872 in 1953. Of these deaths 1,708 were of persons of 65 years of age and above. There were 443 deaths from diseases of the respiratory system compared with 651 in 1953. The number of deaths from bronchitis was 231 compared with 353 in 1953, and from pneumonia (all forms), 192 compared with 261 in 1953. Further particulars relative to pneumonia are given on page 18. One hundred and forty-two deaths were due to violence, 22 of them being due to motor accidents, 45 to suicide and 75 to other forms of violence. CERTIFICATES OF VACCINATION AND INOCULATION Nine hundred and fifty-six requests were received from residents in the Borough for a certificate of vaccination or inoculation to be authenticated for the purpose of travel abroad. The signature of the person issuing the certificate was verified in each case as that of a registered medical practitioner practising in Wandsworth and the certificate was endorsed accordingly. STAFF MEDICAL EXAMINATIONS At the request of the Committees and Chief Officers concerned, arrangements were made during the year for 16 members of the Council's staff to undergo special medical examinations. In the majority of cases the purpose of the examination was to determine the employee's future fitness for his occupation, following serious illness, and in ten cases it was found necessary to recommend superannuation. Thirty-eight shorter reports on members of the staff who were sick were obtained from doctors and hospitals at the request of the departments concerned. 20 TUBERCULOSIS Notifications The total number of new cases which came to the notice of the Department during 1954 was 738 compared with 663 in 1953. The sources of information regarding the 738 new cases were as follows: Primary notifications on Form A 387 Notifications from H.M. Forces 5 Unnotified at death 4 Transfers from other sanitary authorities 342 Total 738 It will be noted that the number of transfers from other boroughs was 342 compared with 253 in 1953. This increase is explained by the growth of the new housing estates in Wandsworth. A degree of medical priority is, of course, given to tuberculosis patients with regard to new housing and a proportion of the occupants of the new housing estates are cases of tuberculosis rehoused under medical and health priority. Deaths The number of deaths certified as due to various forms of tuberculosis was 68. Particulars of the new cases and deaths during the year, classified by sexes and age-groups are given in the following table: TABLE VI Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year 2 1 - - - - - - 1-2 7 3 1 1 — — — — 2-5 1 6 - - - - - - 5-10 12 10 3 2 — — — — 10-15 5 9 — 2 — — — — 15-25 52 98 3 6 - — — — 25-45 175 157 10 11 5 9 1 1 45-65 83 25 1 6 22 3 1 — 65 and upwards 36 9 — 1 16 9 — 1 Totals 373 318 18 29 43 21 2 2 21 4 SANITARY INSPECTION OF THE BOROUGH Work of the Sanitary Inspectors A summary of the inspections carried out by the Inspectors is given in Table VII. TABLE VII Inspections ReInspections Total To investigate complaints 7,876 25,476 33,352 Housing Reports 1,158 332 1,490 Notifiable diseases 1,140 583 1,723 Piggeries 5 — 5 Factories, Workplaces, etc. (including Outworkers) 1,490 54 1,544 Sanitary conveniences 40 — 40 Mews and stables 300 — 300 Other inspections 6,165 2,055 8,220 Totals 18,174 28,500 46,674 Smoke observations 93 Legal proceedings, attendances at court 14 Table VIII gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 434 and 980 were cleansed or repaired. The drains of 42 houses were reconstructed. Damp conditions have been remedied in 1,597 premises, and in 83 of these damp courses were inserted. 22 23 SANITARY INSPECTION OF THE BOROUGH TABLE VIII Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 318 353 423 218 1,312 2. Drains tested 121 96 98 119 434 3. Drains cleansed or repaired 260 239 236 245 980 4. Water closets cleansed or repaired .. 101 185 169 116 571 5. Soil pipes altered or repaired 8 22 25 14 69 6. Waste pipes provided altered or repaired 61 77 111 116 365 7. Rainwater pipes repaired 23 27 40 21 111 8. Roofs and gutters repaired 225 253 341 98 917 9. Damp courses inserted 27 42 8 6 83 10. Damp conditions otherwise remedied 205 239 298 140 882 11. Yards drained or paved 17 3 4 1 25 12. Dustbins provided 15 36 40 38 129 13. Water cisterns cleansed, covered or repaired 6 11 9 5 31 14. Water supply reinstated 145 125 80 151 501 15. Defectivestovesandfireplaces remedied 36 98 79 35 248 16. Defective coppers remedied — 1 — — 1 17. Accumulations of rubbish, etc., removed 7 10 24 3 44 18. Urinals cleansed or repaired — 5 — 1 6 19. Animals improperly kept 1 1 1 — 3 20. Smoke nuisances 5 13 4 — 22 21. Other nuisances 13 21 26 7 67 Total 1,594 1,857 2,016 1,334 6,801 Number of Preliminary Notices served .. 604 841 831 375 2,651 Number of Preliminary Notices complied with 609 827 860 389 2,685 Number of Nuisance Notices served 139 208 218 107 672 Number of Nuisance Notices complied with 140 170 220 98 628 24 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Water Supply—Cutting-off Notices During the year notices with respect to 501 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 22 premises the water supply was cut off for non-payment of rates, and in 479 premises because of defects in the service. Dustbin Accommodation—Section 105, Public Health (London) Act, 1936, and Section 12, London County Council (General Powers) Act, 1954 During the year new legislation was initiated in respect of dustbin accommodation by the provisions of Section 12 of the London County Council (General Powers) Act, 1954; with certain provisos, this section enables the Council to serve a notice on the owner of a house, requiring him to provide dustbin accommodation where the existing accommodation is insufficient or unsuitable. Section 105 of the Public Health (London) Act, has been, in consequence, amended. Action was taken under the above-mentioned Acts in respect of 116 premises and during this period 117 dustbins were provided. Dustbins were also provided at 12 premises without the necessity of action under the Acts. Rodent Control One thousand nine hundred and sixty rat and mice complaints were received during the year. Following is a summary of the work of the rodent operatives: Number of operatives' visits to premises 10,568 „ „ of premises prebaited and treated with poison 405 „ „ of premises treated with "Warfarin" 692 „ „ premises prebaited and found not troubled 107 „ „ premises "Warfarin" laid and found not troubled 119 „ „ premises investigated and found not troubled 2,122 „ „ prebaits laid 12,294 „ „ poison baits laid 8,083 „ „ drains tested by Sanitary Inspector 288 „ „ drains found defective 150 „ „ rats estimated killed 6,924 It is interesting to note that in March 1954 two live ship rats (Rattus Rattus) were trapped in a soil sewer—this is believed to be the first substantiated case of ship rats gaining entry to a house through sewers and drains. At the close of the year there were six rodent operatives and one clerk engaged on rodent control duties under the supervision of a Sanitary Inspector. 25 SANITARY INSPECTION OF THE BOROUGH Swimming Baths and Bathing Pools There are four public swimming bath establishments and one open air swimming pool belonging to the Council, one open air swimming bath owned by the London County Council, one public swimming pool privately owned, and a number of private bathing pools in the Borough. The Queensmere pond on Wimbledon Common has also for many years past been a recognized bathing pond. In four of the Borough Council's swimming baths, the water is purified by a process of continuous circulation through a filtration plant whereby the whole of the water is dealt with every three to four hours and chlorinated automatically during its circulation from the filtration plant to the bath. In the other bath belonging to the Council, each bath is emptied of water as often as necessary and refilled with fresh water which is continuously circulated and chlorinated automatically the whole time the bath is in use. Disinfection and Fumigation of Clothing and Rags for Export At one factory in the Borough rags are washed and disinfected prior to export, under the supervision of the Council's Inspector, and certificates are issued for which a charge is made. During 1954, 166 certificates were issued and the amount received by this department was £49 16s. Od. Removal to suitable premises of persons in need of care and attention— National Assistance Act, 1948, Section 47 In dealing with the problems of the many aged and infirm persons in the Borough, close liaison has been maintained between the Public Health Staff and those members of the London County Council divisional staff who are concerned with the care of the aged. This co-operation with the County Council has meant that in dealing with the large number of aged persons whose capacity to look after themselves adequately was in question, it was again possible to make satisfactory arrangements for their care and attention without the necessity of having to take action under Section 47 of the National Assistance Act, 1948. 26 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Eradication of Bed Bugs The methods employed for freeing infested houses include the stripping of all paper from the walls, the removal of wooden mouldings and skirtings and application of a blow lamp to the room surfaces. Candles are often used by house owners and the spraying of rooms by the disinfecting staff of the Council is carried out, proprietary insecticides being used. Infested bedding is removed to the Disinfecting Station and treated by steam. During the year 174 houses were found to be infested with bed bugs and disinfestation was carried out in all cases. Special steps are taken to ensure that the furniture and clothing of families about to be accommodated in the Council's houses or flats are freed from vermin. Hydrogen cyanide gas is used for the disinfestation of the furniture, which is placed in special vans constructed for the purpose, the process being carried out by a contractor. Bedding is not subjected to hydrogen cyanide but is disinfested by steam at the Council's Disinfecting Station. Mortuary and Crematorium The mortuary at Wandsworth was used throughout the year and 315 bodies were received there. Under the Crematorium Regulations, 1930, 1,190 cremations were authorized during 1954 as compared with 1,175 in 1953. Towards the end of the year certain improvements and additions were made in the lighting and heating at the mortuary, it having become evident that the existing arrangements were defective and inadequate. Fluorescent lighting was installed over the post-mortem tables, an additional light fixed over the table used by the Coroner and two convector type electric heaters installed to replace the old defective gas fire. Burial of the Dead • Under Section 50 of the National Assistance Act, 1948, it is the responsibility of the Council to arrange for the burial of persons who die or are found dead in the Borough, and for whom no suitable burial arrangements are made or are being made. The number of persons buried under the provisions of the Act during 1954 was 19. 5 HOUSING STATISTICS RELATING TO HOUSING Public Health (London) Act, 1936 Number of houses inspected on account of complaints or illness 9,016 Re-inspections 26,059 Number of statutory notices served: Intimation notices 2,651 Nuisance notices 672 Number of houses in which nuisances were abated 2,643 The number of cases referred to the Solicitor for legal action during 1954 was 132 The following is a summary of Police Court proceedings: Number of summonses served 33 „ „ „ withdrawn 18 adjourned 3 „ „ Orders made for abatement of nuisances 12 Costs Awarded in respect of six cases £18. 18s. Od HOUSING ACT, 1936 Number of houses inspected—house to house (Housing Consolidated Regulations, 1925) Nil Repair of Houses Number of notices served under Section 9 of the Housing Act 1936 Nil Number of houses made fit for habitation: (a) by owners Nil (b) by Local Authority in default of owners Nil Demolition Orders Number of orders made under Section II of the Housing Act 1936 Nil Number of houses demolished: (a) as the result of such orders Nil (b) voluntarily Nil Closing Orders (other than underground rooms) Number of houses closed (Local Government (Miscellaneous Provisions) Act 1953) Nil Number of such orders determined Nil Number of rooms in respect of which Closing Orders were made under Section 12 of the Housing Act 1936 Nil Number of such orders determined Nil 27 28 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Closing Orders (underground rooms) Number of rooms found to be unfit for habitation 23 Number closed or modified occupation approved 22 Number of Closing Orders determined Nil Slum Clearance Number of houses included in representations under Section 25 of the Housing Act 1936 69 Number of houses demolished following such action 23 Overcrowding Number of families found to be living in overcrowded conditions 87 Number of overcrowded families who have obtained alternative accommodation 103 New Accommodation Number of dwellings erected by the borough council during the year 777 The Housing Repairs and Rents Act, 1954 This Act came into operation on the 30th August, 1954, "to make further provision for the clearance and redevelopment of areas of unfit housing accommodation, and for securing or promoting the reconditioning or maintenance of houses; and otherwise to amend the enactments relating to housing, the exercise of certain powers relating to land, and rent control." Part II of the Act, inter alia, deals with certain amendments of the Rent Acts, and sets forth the conditions under which a landlord may recover from the tenants a repairs increase in excess of the normal rent. Under Sections 25-30 conditions are also laid down for the recovery of repairs increase by the tenant. If a tenant considers that his premises are not in good repair, or not reasonably suitable for occupation he can apply to the Local Authority for a Certificate of Disrepair. If this is granted, and the tenant has served a copy of the certificate on the landlord and his agent, then so long as the certificate is in force no sum is recoverable by way of repairs increase in respect of the premises. These sections are administered by the Public Health Department and 202 applications were received up to the end of the year for Certificates of Disrepair. (a) One hundred and ninety-seven Certificates of Disrepair were granted; (b) Four Applications were withdrawn at the request of the tenants; (c) One Application was not granted as the premises were found to be in good repair and reasonably suitable for occupation. Nineteen Applications were received for revocation of Certificates of Disrepair and these were granted. 29 HOUSING Housing Accommodation—Medical Priority During the year 1,429 of the applications made to the Council for rehousing were referred to me for consideration of additional points on health grounds in accordance with the Council's Points Scheme. I also made 362 recommendations for transfer on health grounds in respect of applications received from tenants of Council's permanent and requisitioned properties for the provision of more suitable alternative accommodation. UNFIT HOUSES slum clearance 3-7 (cons.) Newtons Yard Following my official representations under Part III of the Housing Act, 1936, the Council gave instructions that the London County Council be formally notified that it was the Council's intention to declare these properties a Clearance Area. The London County Council replied to the effect that as the area in question was zoned for light industry, they were desirous of dealing with it themselves. In the circumstances, the Council decided to take no further action with regard to my representations. Prescott Place, Chip Street, Stonhouse Street, Cressett Street, East Hill, Oak Park, Emily Villas These properties were declared Clearance Areas following my representations, and after the London County Council had been formally notified. 1, 2, 3 and 4 Kings Cottages, Streatham High Road Following my representations, the Council gave instructions that the London County Council be formally notified that it was the Council's intention to consider a proposal that the above-named area should be declared a Clearance Area. individual unfit houses Closing Orders were made on basement premises at 10a Colinette Road, 41 Fernlea Road, 78 Lebanon Gardens, 16 Pitcairn Street, and 3 and 4 Waterman Street, comprising, in all, 14 underground rooms. In each case the owners had been invited to submit proposals to render the premises fit for human habitation, but none were received. Eight other underground rooms were voluntarily closed by the owners after consultation with the Sanitary Inspector. At the end of the year proposals were still awaited from the owners of 199 New Park Road, in respect of basement premises there. 6 FOOD AND FOOD PREMISES There are four Inspectors engaged wholly in the supervision of the food supply. One of them is the Food and Drugs Inspector of the Borough who is occupied in procuring samples of food and drugs for analysis by the Public Analyst and the Public Health Laboratory and the supervision of dairy premises. The other three Inspectors are designated Food Inspectors and supervise other premises where food is sold, stored, manufactured, or prepared for sale. One-third of the Borough is allocated to each Inspector. The three Inspectors also carry out the duties required under the Pharmacy and Poisons Act, 1933, and the Pharmacy and Medicines Act, 1941. The district Sanitary Inspectors who hold the additional certificate of Inspector for Food and Drugs carry out the day-to-day supervision of the catering establishments in their respective areas. With the object of ensuring that all food businesses are supervised systematically, a register of all premises where a food business is carried on has been compiled and is kept up to date. This Register includes not only those premises which are subject to some form of legal control, but also all other premises in which a food business of any description is carried on. The total number of food premises on the register in the Borough is 2,779 and during 1954 they were visited on 44,588 occasions. Table IX has been drawn up to show the number of visits to various food premises in different parts of the Borough. Milk Supply The Milk and Dairies Regulations, 1949—1954 These Regulations came into force on 1st October, 1949, and require local authorities to keep a register of all persons carrying on the trade of distributor in their district and of all premises within their district which are used as dairies, not being dairy farms. During the year 29 applications have been received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Sixteen notices of cancellation of registration have been received. At the end of the year there were 220 persons on the register, including 17 persons with premises outside the Borough. There were 31 dairies on the register at the end of the year. The bulk of the milk sold by retail within the Borough is sent out in bottles filled in properly constructed dairies and its quality is good. 30 31 FOOD AND FOOD PREMISES TABLE IX SUMMARY OF VISITS TO FOOD PREMISES Putney Thamesfield Fairfield West Hill Southfield Earlsfield Springfield Tooting Graveney Bedford Larkhall Clapham North Clapham Park Thornton Balham Streatham Hill St. Leonards Streatham Common Streatham South Furzedown Whole Borough Dairies and Shops distributing Milk 90 178 100 82 98 105 78 142 137 61 153 166 153 94 157 113 105 139 84 80 2,315 Restaurant Kitchens 148 204 161 111 112 69 59 143 87 54 120 174 44 49 54 59 193 27 30 36 1,934 Ice Cream Premises 105 104 75 57 57 37 29 101 157 33 113 176 63 106 91 77 225 38 52 62 1,758 Butchers' Shops 280 256 168 112 191 144 70 141 340 60 242 215 70 286 169 168 381 36 73 161 3,563 Greengrocers' Shops 75 80 48 57 41 46 38 185 275 55 149 124 32 201 291 37 102 14 70 45 1,965 Fishmongers' Shops 31 69 24 37 22 28 20 84 89 10 92 124 49 132 107 34 171 11 32 35 1,201 Fried Fish Shops 7 27 13 4 28 24 15 4 48 1 124 103 1 15 6 6 — 5 15 32 478 Market Stalls 284 688 306 348 432 206 1,102 1,683 8,625 — 118 629 66 6,860 603 — 1,027 — — 176 23,153 Other Premises 343 565 845 269 454 426 215 373 592 132 536 589 201 634 375 329 624 116 249 291 8,158 Slaughterhouses — 28 — — — — — — — — 35 — — — — — — — — — 63 Total Visits 1,363 2,199 1,740 1,077 1,435 1,085 1,626 2,856 10,350 406 1,682 2,300 679 8,377 1,853 823 2,828 386 605 918 44,588 32 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Food and Drugs Act, 1938-1954 Three hundred and sixty-four samples of milk were submitted for analysis. Of these 19 were samples of Channel Island and South Devon milks with an average fat content of 4.43 per cent. The remaining 345 samples had an average fat content of 3.57 per cent. Twelve samples failed to comply with the regulations. The Milk (Special Designation) (Raw Milk) Regulations, 1949-1954, and the Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949-1954 These regulations, which came into force on 1st October, 1949, provide for the issue of licences to persons who sell milk under any of the following designations: "Pasteurized" "Sterilized" "Tuberculin Tested" The following licences for the sale of milk under these designations were granted during the year: Dealers' Dealers' Supplementary Total Pasteurized 186 34 220 Sterilized 261 34 295 Tuberculin Tested 145 31 176 Total 592 99 691 Three dealers' (pasteurizers') licences were granted during the year and are included in the above figures. A person who holds a "Tuberculin Tested" licence and a "Pasteurized" or "Sterilized" licence may use the designations "Tuberculin Tested (Pasteurized)" or "Tuberculin Tested (Sterilized)" as the case may be. 33 FOOD AND FOOD PREMISES Meat There are 218 butchers' shops in the Borough. The majority are registered under Section 14(l)(b) of the Food and Drugs Act, 1938-1954, for the preparation or manufacture of sausages or potted, preserved, pickled or pressed foods. There were 3,563 visits made to these shops during the year. Slaughter of Animals There are three private slaughter-houses in the Borough and they were visited on 63 occasions during the year. The carcases of two pigs and two cows were inspected after slaughter. Slaughter of Animals Act, 1933-1954 Section 3 of this Act provides that no animal shall be slaughtered or stunned in a slaughterhouse or knacker's yard by any person who is not the holder of a licence granted by a local authority and in force under this section. During the year four applications from persons desirous of acting as slaughtermen were submitted to the Council and granted. Piggeries There are now seven piggeries in this Borough and they were inspected on five occasions. Unsound Food One hundred and thirty-five varieties of foodstuff suspected to be unsound were examined at the request of the owners and afterwards either destroyed or released for animal feeding. The owners were granted a certificate to this effect. 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Pharmacy and Poisons Act, 1933, and Pharmacy and Medicines Act, 1941 These Acts provide for the listing with the Local Authority of all persons dealing in poisons included in Part II of the Poisons List. The number of persons on the Council's list at the end of 1954 was 399, and 796 visits were made to the premises of the listed persons by the Food Inspectors. The principal business conducted on the premises of these applicants is shown in Table X. The majority of the listed sellers are also purveyors of food. TABLE X PART II OF POISONS LIST Principal Business Number of Premises Number of Visits Confectioners 3 5 Domestic stores, ironmongers, etc 101 205 Drug stores 24 48 Grocers 248 479 Hairdressers 17 43 Nurserymen and florists 6 16 Total 399 796 Bakehouses There are 78 bakehouses in the Borough, of which 18 are in basements and subject to the provisions of Section 54 of the Factories Act, 1937. Two hundred and ninety-four visits were made to these premises by Food Inspectors during the year. 35 FOOD AND FOOD PREMISES Water Supply The bulk of the water supply in the Borough is provided by the Metropolitan Water Board and this has been satisfactory both in quality and quantity. Registration of Premises The Food and Drugs Act, 1938-1954 Section 14 (1) of the above Act provides that no premises shall be used for: (a) the sale, or manufacture for the purpose of sale of ice-cream, or the storage of ice-cream intended for sale; or (b) the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale, unless they are registered under this section for that purpose with a local authority. During the year 51 applications for registration under the provisions of Section 14(l)(a) and 18 applications for registration under the provisions of Section 14(l)(b) were submitted to the Council. In all cases the premises were found to be satisfactory and the registration granted. Public Health (London) Act, Sec. 144 During the year there have been no applications for licences under the provisions of Sec. 144, to use premises as slaughterhouses. Bacteriological Examination of Food Six hundred and seventy-five samples of food were examined bacteriologically at the Public Health Laboratory during the year. They were as follows: Milk including Raw Milk Fresh Cream including Tinned Cream Synthetic Cream Artesian Well waters Icecream Others Total for 1954 494 30 26 13 88 24 675 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Milk Of the 494 samples of milk, 222 were submitted to the phosphatase test, 232 to the methylene-blue test, and 26 to the turbidity test. In 16 cases the atmospheric shade temperature exceeded 65°F., making the methylene-blue test void. In addition 14 samples of raw milk were examined for the presence of Mycobacterium tuberculosis and Brucella abortus. In each case negative results were obtained. Fresh Cream Thirty samples of fresh cream were examined for the presence of pathogenic organisms. Twenty-four of these were taken in conjunction with a national investigation, and as the results were reported collectively, we have no individual results for these creams taken in our borough. The remaining six were all reported sterile. Synthetic Cream Twenty-six samples were examined for the presence of pathogenic organisms. All were reported free of contamination, with the exception of four, which had high bacterial counts. These have since been rechecked and reported satisfactory. Artesian Well Water Thirteen samples were submitted for examination, of these twelve were reported satisfactory. The remaining one was found to contain faecal coli. The water from this well has now been rechecked and found free of contamination. Ice-cream During the year 88 samples of ice-cream were tested in accordance with the technique suggested by the Ministry of Health and Public Health Laboratory Service. These samples were examined at the Public Health Laboratory. 37 FOOD AND FOOD PREMISES The following table gives a summary of the results: Methylene-Blue Reduction Test Number of Samples Provisional Grade 47 1 21 2 8 3 12 4 Total 88 In addition 12 samples of ice-lollies were submitted for examination. These have all been reported satisfactory. Others The remaining miscellaneous samples were all reported free of pathogenic organisms. Analysis of Food and Drugs During the year 1,002 samples of food and drugs were procured for analysis: 364 samples of milk, 572 other foodstuffs and 66 drugs. Of these 328 were submitted as formal samples while 674 were purchased informally. Fourteen or 4.3 per cent. of the formal and eleven or 1.6 per cent. of the informal samples, were found to be adulterated or not up to standard. The total adulterations reported were 25 or 2.5 per cent. of the samples submitted. The 25 samples found to be adulterated were: twelve samples of milk, three samples of ice-cream, two samples each of Ammoniated Tincture of Quinine, Friars Balsam, Citrate of Magnesia, and one sample each of butter, stuffing, tinned meat, bread and butter. 7 FACTORIES ACT, 1937 Prescribed particulars required by Section 128 PART I (1) INSPECTIONS Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) Factories in which Sections 1, 2, 3, 4 and 6 of the Act are to be enforced by Local Authorities 540 229 6 — (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,100 987 7 — (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) .. 56 19 — Total 1,696 1,235 13 — (2) DEFECTS 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 Want of cleanliness 12 6 1 6 Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation 2 1 — — — Ineffective drainage of floors — — — — — Sanitary Conveniences (a) insufficient — (b) unsuitable or defective 28 5 — 2 — (c) not separate for sexes 1 — 1 — — Other offences against the Act (not including offences relating to outwork) 14 4 4 — Total 57 16 6 8 — 38 39 FACTORIES ACT 1937 PART VIII SECTION 110. OUTWORK Nature of work Number of outworkers in August list Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Wearing apparel—making, etc. 801 — — „ „ cleaning and washing 5 — — Household linen 3 — — Curtains and furniture hangings 4 — — Fur pulling 1 — — Umbrellas, etc 1 — — Artificial flowers 5 — — Paper bags 13 — — Boxes or other receptacles made wholly or partially of paper 26 — — Brush making 1 — — Feather sorting 1 — — Stuffed toys 1 — — Chocolates and sweetmeats 16 — — Lampshades 57 — — Total 935 — — REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1954 The Public Analyst, J. E. Woodhead, B.Sc., F.R.I.C., Ph.C. reports as follows. By virtue of the requirements of the Food and Drugs Act, 1938-1954, 1,002 samples were examined during the year ended 31st December, 1954, 936 of these were articles of food, and the remaining 66, drugs. All were submitted by the Council's Food Inspector, 328 having been taken with the formalities required by the Act and 674 informally. Samples of the following substances were analysed: cooking fat and lard, 16; beverages (cocoa, colfee, etc.) 20 samples; cereal preparations, 21; cream, 24; fish, canned, 24; fruit, canned, 67; meat products (other than sausages), 36; milk, 364; pickles and condiments (including spices), 46; preserves, 46; sausages, 17; soup, 17; vegetables, canned, 17; friars balsam, 4; iodine solutions, 5; ointments, 13; seidlitz powders. 40 41 REPORT OF THE PUBLIC ANALYST FOR 1954 Adulterated Samples Particulars of the samples reported as adulterated or not up to standard are given in the following table: Case No. Nature of Sample Nature of Report Formal 492 Milk 1 % deficient in fat 493 ,, 1 % 499 ,, 13% 571 Bread and butter Fat, margarine with 10% butter 575 Milk Added water 4% 582 Friars Balsam Total solids 25% deficient 388 Milk 7 % deficient in fat 415 ,, 8 % extraneous water 433 ,, 11 % deficient in fat 434 ,, 18% 435 ,, 4% ,, ,, ,, 436 ,, 13% ,, ,, ,, 438 ,, 23% ,, ,, ,, 439 ,, 10% ,, ,, ,, Informal 243 Ice-cream 6% deficient in fat 260 ,, 6% ,, ,, ,, 194 Ammoniated Tincture of Quinine 25 % deficient in ammonia 223 Citrate of magnesia Excess of magnesium sulphate 228 ,, ,, ,, ,, ,, ,, 438 Stuffing Infested 481 Butter Musty flavour and taste 409 Friars Balsam Total solids 29% deficient 413 Ammoniated Tincture of Quinine 20% deficient in ammonia 51 Ice-cream 35 % deficient in fat 78 Luncheon meat Housefly in meat Adulteration The amount of adulteration detected during the year was: For formal samples 4.3 per cent. For informal samples 1.6 per cent. For all samples 2.5 per cent. 42 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 Complaint Samples Case No. 1906.Milk. Submitted on the complaint that water had been added. The complaint was considered not justified. Case No. 78. Luncheon Meat. Submitted on the complaint that there was a housefly partly buried in it. The complaint was considered justified. Case No. 176. Oxtail Soup. This complaint was considered not justified. Case No. 277. Roll and butter. Submitted on the complaint that the roll did not contain butter. The complaint was considered not justified. Case No. 302. Bread. Submitted on the complaint that it contained rodent excrement. The complaint was considered not justified. Case No. 480. Cream. Submitted on the complaint that it had a chemical taste suggestive of preservative. The complaint was considered not justified. Case No. 481. Butter. Submitted on the complaint that it had a musty flavour. The complaint was considered justified. Special Sample. Chocolate Milky Lunch. Submitted on the complaint that it had a "disinfectant" taste. The complaint was considered justified. 43 REPORT OF THE PUBLIC ANALYST FOR 1954 Milk The average composition of the samples of milk submitted during each month of the year and returned as genuine was as under: Month Number Total solids Milk fat Non-fatty solids January 36 % 12.31 % 3.62 % 8.69 February 31 12.31 3.64 8.67 March 39 12.31 3.58 8.73 April 33 12.14 3.48 8.66 May 47 12.32 3.97 8.85 June 39 12.18 3.40 8.78 July 29 12.24 3.51 8.73 August 42 12.44 3.67 8.77 September 17 12.58 3.74 8.84 October 17 12.98 4.04 8.94 November 10 13.03 4.06 8.97 December 24 12.71 3.89 8.82 The average composition of the 19 samples of Channel Island and South Devon milks was as under: Total milk solids 13.58 per cent. Milk fat 4.43 per cent. Non-fatty solid 9.15 per cent. The average composition of the 345 samples of milk analysed during the year and returned as genuine was as under: Total milk solids 12.32 per cent. Milk fat 3.57 per cent. Non-fatty solids 8.75 per cent. INDEX PAGE Accidents, Deaths from 12 Acute Encephalitis 17 Analyst, Report of 40 Bacteriological Examinations of Milk 36 „ „ of Ice-cream 36 Bathing Pools and Swimming Pools 25 Bed Bugs, Eradication of 26 Births, Birth-rates 9 Butchers'Shops 31 Cancer 20 Childbirth, Deaths from 13 Circulatory Diseases 20 Closing Orders 29 Crematorium 26 Cutting-off Notices—Water Supply 24 Deaths, Causes of 12 Death-rates 11 Death-rate from Infective Diseases 14 Death-rate, Infantile 13 Deaths, Number of 12 Diphtheria 14 Diseased or Infirm Persons, Removal of 25 Disinfection 19 Enteric Fever 17 Erysipelas 18 Factories Act, 1937 38 Factories and Workshops 38 Food and Drugs Act, 1938-1954 32 Food Poisoning 18 Food, Supervision of 30 Food Places, Inspection of 31 Food Places, Number on Register 30 Houses and Premises Inspected 22 Housing Act, 1936 27 Housing Repairs and Rents Act 1954 28 Housing Statistics 27 Hydrogen Cyanide Disinfection 26 Illegitimate Children, Births of 9 Infant Mortality13 45 46 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1954 PAGE Infective Diseases 14 Infective Diseases, Cases of 15 Infective Diseases, Death Rate from 14 Infirm or Diseased Persons, Removal of 25 Influenza, Deaths 18 Influenzal Pneumonia and Acute Primary Pneumonia 18 Insanitary Areas 29 Malaria 18 Maternal Mortality 13 Meat 33 Meningococcal Infection 17 Milk Analysis 43 Milk, Bacteriological Examination of 36 Milk Premises, etc., on Register 30 Milk (Special Designations) Regulations, 1949-54 32 Mortuary 26 Non-infective Diseases, Deaths from 20 Notification of Infective Diseases 15 Outworkers 39 Overcrowding 28 Pharmacy and Poisons Act, 1933 34 Pharmacy and Medicines Act, 1941 34 Piggeries 33 Poliomyelitis 17 Population 8 Pregnancy, Deaths from Accident and Diseases of 13 Preserved Meat, etc., Manufacture of 33 Public Analyst, Report 40 Puerperal Pyrexia 17 Pulmonary Tuberculosis, Notification of cases of 21 Ragwashing and Sterilisation, Certificates 25 Rodent Control 24 Samples, Formal and Informal, Number of 40 Sanitary Inspection of Borough 22 Scabies 18 Scarlet Fever 14 Slaughter-houses 33 Slaughter of Animals Acts, 1933-1954 33 Smallpox 14 Statistics for the Borough 9 Suicide, Deaths from 20 47 INDEX PAGE Swimming Baths and Bathing Pools 25 Syphilis, Deaths from18 Tuberculosis 21 Unfit Houses 29 Unsound Food 33 Water Supply 35 Water Supply, Cutting-off Notices 24 Whooping Cough 14 Printed by Geo. Gibbons Ltd., Leicester