AC4388 WAN 93 Metropolitan Borough of Mandsmorth ANNUAL REPORT of the Medical Officer of Health for the Year 1956 by J. TUDOR LEWIS, M.D., D.P.H. together with the Report of the Public Analyst REPORT of the Medical Officer of Health for the year 1956 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, Once again it is a pleasure and privilege to present to you the Annual Report on the health and sanitary conditions of the Borough for the year 1956. As usual, the report is mainly statistical with comments on the figures as may be necessary. In 1956, the increase in the population which had been noted in the previous year was continued, the year end population of Wandsworth being 337,600 showing an increase of 1,100. As I have mentioned in previous reports, this increase is associated with the new Housing estates which are going up in the Borough, particularly in the Southfields and Roehampton areas. The crude birth rate for 1956 was 14.25 which was an increase over the previous year, while the adjusted death rate was 10.89, being three points lower than that for 1955. The infant mortality rate, that is to say, the number of infants who died before reaching their first birthday per 1,000 live births was 17. This is the lowest figure ever recorded in Wandsworth and is two points lower than the previous low record which was achieved in 1954. The infant mortality rate is usually looked upon as a fairly accurate index of the public health and social status of a community and this low figure can be taken as an indication of the gradually improving public health and social circumstances of the 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 people. There were four deaths from cases associated with child birth, the same as in the previous year. The number of cases of infectious disease showed a reduction— 3,682— accounted for mainly by the large reduction in the number of measles cases. The number of cases of tuberculosis primarily notified to us was 100 less than in the previous year. In 1956, we experienced a considerable increase in the number of cases of dysentery compared with previous years, there being in all 750 cases notified during the year. This is a mild form of dysentery known as Sonne dysentery and it has become very much more prevalent in many areas of the country over the last decade. It is fortunately not a serious disease in the sense that it threatens life except possibly in very young children or old people. It is a disease predominantly of children, especially school children, and it has a considerable nuisance value. Outbreaks of this disease occurred at a number of schools and day nurseries in the area and we regard the problem of prevention very seriously although many of the cases are mild and only detected by bacteriological examination. Reference to the Table on page 16 will give some idea of the number of specimens which were taken from these cases in bringing the outbreaks under control. The handling of these outbreaks entails a great amount of routine work by Public Health Inspectors and staff generally and I am happy to say we obtain the greatest possible help from the Public Health Laboratory to whom specimens are sent for bacteriological examination. I am also happy to record that we enjoy the greatest help and co-operation from head teachers who, of course, are only too glad to do all possible to limit the number of cases. I have to report this year, unfortunately, that four cases of diphtheria occurred in the Borough of which one died. This is the first death from diphtheria we have had in the Borough for many years. In spite of the efforts which are constantly being made to increase the number of children immunised against diphtheria and the consequent virtual disappearance of the disease, we must be on our guard not to become complacent with the results so far achieved. Diphtheria is a disease 3 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 which is always likely to recur and the best guarantee is to ensure as high a proportion of children being immunised as possible. Probably the most important item of public health legislation during the year was the introduction of the Food Hygiene Regulations. Part of these Regulations came into operation in January but the more important ones did not take effect until July 1st. A good deal of attention has been given in the Department to the implementation of these Regulations. It is not to be expected that they will have much short time effect on general food hygiene; their operation is essentially long term and will be achieved as much by education and persuasion of those food traders whose standards of hygiene are lower than is desirable, as by legislative action. The amount of work entailed is again very considerable but I have no doubt that in due course the Regulations will have the effect of raising materially the general standard of food hygiene in the community. I should like to take the opportunity briefly of referring to my former colleague, Dr. W. G. Harding, formerly Deputy Medical Officer of Health, who, in September, 1956, was appointed as Divisional Medical Officer to one of the London County Council Health Divisions. Although Dr. Harding left the Department early in 1957, it is appropriate that I should make a brief reference to him in this Report. Dr. Harding came into the service of the Borough on the same day as I did myself, on the inauguration of the tripartite form of health administration in this area. He proved himself to be most helpful to me in our work and I should like to take the opportunity of thanking him for his assistance and support during the five years that I had the pleasure of having him as a colleague. He left Wandsworth with the good wishes for the future of all members of the staff of the Health Department. Once, again, I would like to express my thanks to the main Committees of the Council with whose work I am concerned and particularly, of course, the Public Health Committee. The Chairman of the Committee, Mr. T. V. Rowlands, has given me his usual support and encouragement in the many matters with which we have had to 4 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 deal. My fellow Chief Officers of the Council have again been most helpful in assisting the work of the Public Health Department and lastly, the staff of the Public Health Department itself, under Mr. Roots the Chief Public Health Inspector, in each and all sections have again worked with great efficiency and competentcy and I should like to thank them for the way they have carried out their duties. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, J. TUDOR LEWIS, Medical Officer of Health August, 1957 STAFF The following changes occurred in 1956:- Retirements Mr. R. E. Jones, Public Health Inspector, Service 45 years in Local Government. Retired in February. Mr. W. T. Willimott, Public Health Inspector, Service 31 years. Retired in June. Mr. F. Cox, Disinfector, Service 14 years. Retired in January. Resignations Mr. G. Farrell, Rodent Operative, Service 10 years. Resigned in November. Mr. W. A. Saxby, Motor Driver, Service 4 years. Resigned in September. Mr. D. C. Ellender, Disinfector, Service two months. Resigned in May. Death Mr. A. Seeley, Mortuary Keeper, Service 27 years. Died in April. Appointments Mr. K. J. Winton, Public Health Inspector. Appointed in May Mr. G. A. Fraser, Public Health Inspector. Appointed in July. Mr. A. F. Cayley, Trainee Public Health Inspector. Appointed in August. Mr. J. D. Morritt, Trainee Public Health Inspector. Appointed in August. Mr. D. Dean, Disinfector. Appointed in March. Mr. A. E. Clement, Motor Driver. Appointed in October. Mr. J. Anderson, Mortuary Keeper. Appointed in September. 5 1 STATISTICS AND SOCIAL CONDITIONS Area 9,199 acres Resident population in 1956 337,600 Wandsworth is the largest of the Metropolitan Boroughs. It has an area of 9,199 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. 6 7 STATISTICS AND SOCIAL CONDITIONS Extracts from Vital Statistics r of Live Births: Males Females Total Legitimate 2,279 2,182 4,461 Illegitimate 199 152 351 Total live births 2,478 2,334 4,812 Number of Stillbirths 52 46 98 Number of deaths 2,474 2,785 5,259 Birth-rate—Crude 14.25 Adjusted 13.53 Death-rate—Crude 15.57 Adjusted 10.89 Rate per 1,000 (Live and Still) Births Deaths from puerperal causes 4 0.81 Infantile mortality per 1,000 live births: All infants 17 Legitimate infants 17 Illegitimate infants 22 Deaths from Cancer 1,149 „ „ Diphtheria 1 „ „ Scarlet Fever 0 „ „ Measles 2 „ „ Whooping Cough 0 „ „ Tuberculosis 47 Tuberculosis death-rate 0.14 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 337,600 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 1956 Putney 87,602 Central 96,245 Clapham 80,974 Streatham 72,779 Whole Borough 337,600 Births The total number of births belonging to the Borough registered during 1956 was 4,812, consisting of 2,478 males and 2,334 females. The number for 1955 was 4,623. The crude birth-rate was 14.25 per 1,000 persons living compared with 13.73 for 1955. The adjusted rate works out at 13.53 after taking into account the area comparability factor supplied by the Registrar-General. Three hundred and fifty one illegitimate births took place in the Borough compared with 319 in 1955. 8 9 VITAL STATISTICS Deaths The number of registered deaths which took place in the Borough during the year was 3,876 but 332 of these did not belong to the Borough, while 1,715 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 5,259, of whom 2,474 were males and 2,785 females. The crude death-rate for the year was 15.57, compared with 15.47 for 1955, but after taking into account the area comparability factor supplied by the Registrar-General, the adjusted rate works out at 10.89. 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 603 656 1,259 14.37 Central 846 967 1,813 18.84 Clapham 597 680 1,277 15.77 Streatham 428 482 910 12.49 Whole Borough .. 2,474 2,785 5,259 15.57 10 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 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. causes of death deaths in or belonging to whole district at subjoined ages deaths in or belonging to localities (all ages) TABLE III. causes of, and ages at death, during the year 1956 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 44 34 10 _ 6 16 22 12 19 8 5 Tuberculosis, Other 3 1 2 1 1 1 1 2 Syphilitic Disease 19 12 7 _ 6 13 8 4 1 5 Diphtheria 1 1 1 _ _ 1 _ _ _ Whooping Cough _ _ _ _ _ _ _ _ _ _ _ _ _ Meningococcal Infections 1 1 1 _ _ _ _ _ _ _ 1 _ Acute Poliomyelitis 2 _ 2 _ 2 _ _ 1 1 _ Measles 2 2 1 _ _ 1 _ 1 _ 1 Other Infective and Parasitic Diseases.. 17 7 10 1 3 13 4 7 3 1 Malignant Neoplasms 1,149 542 607 _ 3 1 57 424 664 228 200 559 162 Leukaemia, Aleukaemia 29 18 11 1 2 5 8 13 7 X 10 4 Diabetes 23 11 12 2 2 5 14 11 5 3 4 Vascular Lesions of Nervous System 576 200 376 2 95 479 168 188 117 103 Diseases of Heart 1,697 804 893 23 226 1,448 452 686 232 327 Other Circulatory Disease 262 93 169 _ 8 40 214 51 87 58 66 Influenza 30 16 14 _ 2 5 23 5 6 9 10 Pneumonia 231 103 128 11 2 4 5 28 181 63 89 45 34 Bronchitis 335 229 106 3 1 1 3 69 258 73 183 39 40 Other Diseases of Respiratory System 31 18 13 1 5 16 9 9 9 9 4 Ulcer of Stomach and Duodenum 51 39 12 12 39 12 22 7 in Gastritis, Enteritis, Diarrhoea 23 12 11 2 1 1 1 4 14 7 7 6 3 Nephritis and Nephrosis 43 27 16 1 6 14 22 14 11 11 7 Hyperplasia of Prostate 30 30 _ 2 28 6 g 9 7 Pregnancy, Childbirth, Abortion 4 4 _ _4 _ _ 2 _ 2 _ Congenital Malformations 22 12 10 11 1 1 3 2 4 7 8 3 4 Other Defined and Ill-defined Disease 479 183 296 55 4 6 26 74 314 78 230 96 75 Motor Vehicle Accidents 31 23 8 1 9 11 10 6 5 10 10 All other Accidents 78 34 44 1 2 _ 7 8 60 21 23 20 14 Suicide 42 24 18 12 14 16 13 6 15 g Homicide and Operations of War 4 1 3 — — — 2 1 1 1 1 2 All Causes 5,259 2,474 2,785 84 21 18 191 1,084 3,861 1,259 1,813 1,277 910 11 VITAL STATISTICS TABLE III (a). DEATHS FROM HEART DISEASE, 1956 Males in age groups Females in age groups M. & F. Total 1-5 5-15 1545 4565 65 up Total 1-5 5-15 1545 4565 65 up Total Coronary Disease, Angina, etc. _ _ 7 135 249 391 _ _ 2 20 207 229 620 Hypertension with Heart Disease _ _ _ 11 30 41 _ _ _ 7 60 67 108 Other Heart Disease — — 8 27 337 372 — — 6 26 565 597 969 — — 15 173 616 804 — — 8 53 832 893 1,697 Infantile Mortality The number of deaths under one year was 84, the infantile mortality-rate being 17-4 per 1,000 births. This compares with a rate of 24 for 1955, 19 for 1954, and is the lowest rate ever recorded in the Borough. For the ten years ended 1946 the average infantile mortality rate was 43 while for the ten years ended 1956 the average rate was 23. Maternal Mortality Four deaths occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.81 for 1,000 live and still births, compared with 0.85 in 1955. 3 INFECTIVE DISEASES The number of deaths from all notifiable infectious diseases was 111. This included 47 from all forms of tuberculosis and 53 from the notifiable forms of pneumonia. There were two deaths from poliomyelitis and two deaths from measles. From all notifiable infective diseases the death-rate was 0.32 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 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 Four cases of diphtheria (in children aged 2,4, 5, and 6 of the same family) occurred during the latter half of the year. One child unfortunately died. Investigation of family and school contacts was carried out and nose and throat swabs taken from those contacts with a history of sore throats. All swabs proved negative on bacteriological examination. Scarlet Fever Two hundred and two cases were notified compared with 289 in 1955 and 345 in 1954. The diagnosis was not confirmed in one case. No deaths occurred. Whooping Cough Five hundred and forty-eight cases were notified. There were no deaths. Measles The number of cases notified during the year was 677 compared with 5,206 in 1955, 303 in 1954 and 2,850 in 1953. 12 13 TABLE IV NOTIFIABLE DISEASES NO. OF CASES OF INFECTIVE DISEASES GROUPED IN AGE-PERIOD INFECTIVE DISEASES Total Under 1 1-2 3-4 5-9 10-14 15-24 25-44 45-64 65 and upwards Smallpox _ _ _ _ _ _ _ _ _ _ Diphtheria 4 1 1 2 — — — — Scarlet Fever 201 5 21 32 99 36 7 1 — — Measles 677 42 119 179 321 14 2 — — — Whooping Cough 548 19 118 140 249 10 10 2 — — Enteric Fever and Paratyphoid Fever 4 — 1 — 1 — — — 2 _ Malaria — — — — — — — — — _ Dysentery 750 17 78 94 287 119 41 73 34 7 Erysipelas 54 — — — 2 7 19 23 3 Scabies 25 — — — 4 4 8 8 1 — Puerperal Pyrexia 101 — — — — — 47 53 1 — Ophthalmia Neonatorum 2 2 — — — — — — — — Meningococcal Infection 5 2 1 1 1 — — — — — Acute Poliomyelitis 39 — 2 4 17 6 3 7 — — Acute Encephalitis 9 — — — 4 1 1 3 — — Anthrax — — — — — — — — — — Pneumonia: Acute Influenzal 135 1 2 2 2 5 6 23 54 40 Acute Primary 220 1 3 4 12 17 24 46 74 39 Tuberculosis—All forms 546 1 1 3 13 12 122 260 99 35 Food Poisoning 362 3 9 10 18 34 60 77 57 94 Total 3,682 93 356 470 1,030 260 338 572 345 218 14 TABLE V total cases of infective diseases occurring in each ward Whole Borough Deaths REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 putney central clapham streatham notifiable diseases 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 — — 4 — — 4 1 Scarlet Fever 18 3 7 24 7 11 24 9 4 4 12 6 14 2 6 5 5 15 18 7 201 _ Measles JO 26 25 68 76 77 49 25 9 32 48 43 24 46 70 77 ?l 1? 10 9 677 2 Whooping Cough 35 16 30 10 20 23 25 40 32 41 37 18 21 33 39 11 ?? 74 75 46 548 _ Enteric Fever and Paratyphoid Fever I 1 _ _ _ _ 1 _ _ _ _ _ 1 _ 4 _ Malaria — — — _ — — _ _ — — — — — _ _ _ Dysentry 12 9 32 6 10 19 23 41 44 35 51 10 46 71 26 48 78 4? 73 74 750 _ Erysipelas 1 4 1 — 4 6 3 6 8 3 1 3 3 1 3 1 7 4 54 _ Scabies 1 — 4 3 2 3 1 1 — 1 2 — 2 1 1 1 1 1 25 _ Puerperal Pyrexia 2 — 3 — 1 1 4 7 2 10 — 4 19 16 16 4 3 3 7 4 101 _ Ophthalmia Neonatorum — — — 1 — — — 1 — — — — _ _ _ 2 _ Meningococcal Infection — — 1 — — 1 — 1 — — 1 — 1 — — 5 1 Acute Poliomyelitis 4 3 1 i i 2 — 1 2 2 4 3 1 1 1 3 2 1 39 7 Acute Encephalitis 1 — I 1 — — 2 — 1 — 1 1 9 _ Anthrax — — — — — — — — — — _ _ _ rneumonia:— Acute Influenzal 5 4 2 10 10 2 6 5 8 31 2 1 2 6 26 1 3 6 7 3 135 15 Acute Primary 8 6 2 3 23 12 35 15 11 1 14 20 7 3 4 6 3 4 7 5 18 220 38 Tuberculosis—All forms 98 17 18 22 30 19 18 29 16 32 26 33 79 ?? 30 33 75 14 15 70 546 47 Food Poisoning 80 4 50 11 8 78 6 3 72 9 9 1 _ 3 5 5 3 6 5 4 362 5 Total 296 92 199 186 185 278 176 180 199 214 213 129 166 205 176 141 169 128 158 192 3,682 111 15 INFECTIVE DISEASES Acute Poliomyelitis Eighty-five cases of this disease were reported and investigated during the year compared to 104 cases the previous year. In 46 cases the diagnosis was not confirmed. Of the remaining 39 confirmed cases, 24 were of the paralytic type and 15 non-paralytic. There were two deaths. No unusual concentration of cases occurred but they were fairly distributed over the whole Borough. Approximately half the number of cases occurred in age group 5 to 9 years. Meningococcal Infection Four confirmed cases were notified, none of which proved fatal. There was, however, one death attributed to this disease on postmortem examination making a total of five cases for 1956. Twenty-two other cases were investigated but these were subsequently not confirmed. In 1955 there were six confirmed cases with no deaths. Acute Encephalitis Of 15 cases reported seven were confirmed as Acute Infectious Encephalitis and two as Post Infectious Encephalitis. Total nine cases for the year. Typhoid and Paratyphoid Fever Of six cases reported during the year, two were subsequently confirmed as typhoid and two as paratyphoid. One of the former had previously been on a holiday tour on the Continent. Diagnosis was not confirmed in the two remaining cases. Puerperal Pyrexia During the year 101 cases were notified, of which 94 occurred in hospital and 7 at home. Thirty-seven of the hospital notifications referred to patients whose home addresses were outside the borough. Information was also received of 59 cases, referring to Wandsworth residents whose confinements took place in hospitals located in other Metropolitan boroughs. 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 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. Outbreaks occurred at three Day Nurseries and at six Schools in the borough and details of positive cases and number of faecal specimens examined bacteriologically from actual and suspected cases is given below. given below. The first outbreak mentioned was confined to one area but included pupils from a number of schools. Date Outbreak No. of cases discovered No. of specimens examined from cases and contacts February 1 54 240 March 2 70 361 March 3 20 149 April 4 26 218 April 5 25 263 April 6 49 284 April 7 16 127 May 8 29 147 June 9 82 297 July 10 58 350 November 11 7 55 Influenza The number of deaths from Influenza was 30 compared with 30 in 1955, 23 in 1954 and 64 in 1953. Influenzal Pneumonia and Acute Primary Pneumonia These are the notifiable forms of pneumonia. One hundred and thirty-five cases of acute influenzal pneumonia and 220 cases of acute primary pneumonia were notified. Fifteen of the former, and 38 of the latter died. The total number of deaths credited to all forms of pneumonia during the year was 231, compared with 251 in 1955. 17 INFECTIVE DISEASES Malaria No cases were reported. Erysipelas Fifty-four cases were notified. Other Infective Diseases Nineteen deaths occurred from syphilis. Scabies Twenty-five notifications were received. The arrangement made in 1955 with the Battersea Borough Council whereby the cleansing of women residents (and children under school age) of Wandsworth was undertaken by the Battersea Cleansing Station, continued to operate during 1956. A fee of 5s. Od. per treatment to be paid by Wandsworth to Battersea for this service has now been agreed on. A total of 91 treatments was given during the year at the Battersea Cleansing Station. At the Council's Disinfecting Station, 30 treatments were given. Food Poisoning Three hundred and sixty-two formal notifications were received during the year. Two hundred and forty-nine 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 28 cases. The organisms were Salmonellae typhimurium, enteriditis, anatum, bovis morbificans, heidelberg, and emek. In nine of the 12 outbreaks it was not possible to identify the causative agent; in the remaining three, Clostridium welchii, Staphylococci and Salmonella typhimurium were respectively isolated. Full reports on the major outbreaks were submitted to the Ministry of Health in accordance with Circ. 46/49 and revised Memo. 188/Med. 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 Diseases Reported from Schools A total of 2,693 infective diseases was reported from schools in the Borough throughout the year. The numbers of each disease were: Scarlet Fever 119 Diphtheria 2 Measles 233 German Measles 164 Poliomyelitis 10 Chicken Pox 1,100 Whooping Cough 255 Mumps 508 Dysentery 222 Other Diseases 80 Disinfection During the year 520 rooms were disinfected after infectious and other disease and 471 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 591 Faeces for the typhoid and dysentery groups 5,764 Miscellaneous specimens 15 Total 6,370 Contacts of Infectious Disease—Exclusion from work It is sometimes considered necessary, in order to prevent the spread of infection, to exclude from work for a period certain contacts of infectious disease. This applies particularly to persons engaged in food handling and the requisite authority for the Medical Officer of Health to exclude such persons from work is given under regulations made under the National Insurance Act, 1946, and the Public Health (Infectious Disease) Regulations, 1953. During the year six contacts of infectious disease were excluded from work and issued with certificates enabling them to draw National Health sickness benefit. NON-INFECTIVE DISEASES The total number of deaths from cancer and malignant disease was 1,149, the number of males being 542 and females 607. The death rate was 3.4 per 1,000. The number of deaths in 1956 was 79 more than in the previous year. Deaths from diseases of the heart and circulatory system were 1,959 compared with 2,124 in 1955. Of these deaths 1,662 were of persons of 65 years of age and above. There were 597 deaths from diseases of the respiratory system compared with 590 in 1955. The number of deaths from bronchitis was 335 compared with 289 in 1955, and from pneumonia (all forms) 231 compared with 251 in 1955. Further particulars relative to pneumonia are given on page 16. One hundred and fifty-five deaths were due to violence, 31 of them being due to motor accidents, 42 to suicide and 82 to other forms of violence. CERTIFICATES OF VACCINATION AND INOCULATION One thousand, six hundred and forty-three 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 eight 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 six cases it was found necessary to recommend superannuation. Forty-four shorter reports on members of the staff who were sick were obtained from doctors and hospitals at the request of the departments concerned. 19 TUBERCULOSIS Notifications The total number of new cases which came to the notice of the Department during 1956 was 546 compared with 644 in 1955. The sources of information regarding the 546 new cases were as follows: Primary notifications on Form A 299 Notifications from H.M. Forces 3 Unnotified at death 1 Transfers from other sanitary authorities 243 Total 546 Five hundred and forty-five cases were added to the notification register during the year and 243 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 5,054. Deaths The number of deaths certified as due to various forms of tuberculosis was 47. 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 1 1-2 1 _ — — — — — — 2-5 — 2 1 — — — — — 5-10 6 3 4 10-15 3 6 2 1 — — — — 15-25 53 61 2 6 — — — — 25-45 126 117 8 9 4 2 1 — 45-65 64 30 — 5 14 2 — 1 65 and upwards 23 12 — — 16 6 — 1 Totals 276 231 17 22 34 10 1 2 20 4 SANITARY INSPECTION OF THE BOROUGH Work of the Public Health Inspectors A summary of the inspections carried out by the Inspectors is given in Table VII. TABLE VII Inspections ReInspections Total To investigate complaints 7,529 19,808 27,337 Housing Reports 1,508 28 1,536 Notifiable diseases 2,604 2,091 4,695 Piggeries 8 — 8 Factories, Workplaces, etc. (including Outworkers) 1,442 28 1,470 Sanitary conveniences 19 — 19 Mews and stables 32 6 38 Other inspections 5,791 1,456 7,247 Totals 18,933 23,417 42,350 Smoke observations 375 Legal proceedings, attendances at court 35 Table VIII gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 443 and 978 were cleansed or repaired. The drains of 16 houses were reconstructed, and 136 drains were partially reconstructed. Damp conditions have been remedied in 1,254 premises, and in 26 of these damp courses were inserted. 21 22 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 TABLE VIII Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 227 266 290 138 921 2. Drains tested 147 137 73 86 443 3. Drains cleansed or repaired 229 251 224 274 978 4. Water closets cleansed, repaired or renewed 106 185 168 104 563 5. Soil pipes altered or repaired 12 17 22 9 60 6. Waste pipes provided, altered or repaired 100 50 88 101 339 7. Rainwater pipes repaired 21 20 29 24 94 8. Roofs and gutters repaired 178 206 244 144 772 9. Damp courses inserted 8 7 7 4 26 10. Damp conditions otherwise remedied 153 192 195 117 657 11. Yards drained or paved 10 5 5 5 25 12. Dustbins provided 16 12 41 18 87 13. Water cisterns cleansed, covered or repaired 8 2 11 7 28 14. Water supply reinstated 298 299 216 289 1,102 15. Defective stoves and fireplaces remedied 38 29 48 17 132 16. Defective coppers remedied — — 2 — 2 17. Accumulations of rubbish, etc., removed 5 7 15 6 33 18. Urinals cleansed or repaired — 2 — — 2 19. Animals improperly kept — — 1 1 2 20. Smoke nuisances 21 4 11 — 36 21. Other nuisances 27 16 37 6 86 Total 1,604 1,707 1,727 1,350 6,388 Number of Preliminary Notices served .. 494 656 576 352 2,078 Number of Preliminary Notices complied with 491 669 594 363 2,117 Number of Nuisance Notices served 115 174 165 93 547 Number of Nuisance Notices complied with 117 178 179 120 594 23 SANITARY INSPECTION OF THE BOROUGH Water Supply—Cutting-off Notices During the year notices with respect to 1,104 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 23 premises the water supply was cut off for non-payment of rates, and in 1,081 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 Action was taken under the above-mentioned Acts in respect of 89 premises and during this period 77 dustbins were provided. Dustbins were also provided at 10 premises without the necessity of action under the Acts. Rodent Control One thousand, eight hundred and five 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 7,769 „ „ premises treated with "Warfarin" 820 „ „ premises "Warfarin" laid and found not troubled 94 „ „ premises investigated and found not troubled 185 „ „ "Warfarin" baits laid 4,417 „ „ drains tested by Public Health Inspector .. 299 „ „ drains found defective 178 „ „ rats estimated killed 3,042 At the close of the year, there were five rodent operatives and one clerk engaged on rodent control duties under the supervision of a Public Health Inspector. 24 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 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 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. 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. 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, SANITARY INSPECTION OF THE BOROUGH 25 proprietary insecticides being used. Infested bedding is removed to the Disinfecting Station and treated by steam. During the year 175 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 Owing to a period of sickness and to the subsequent death of the mortuary keeper, the mortuary was used for the reception of bodies for approximately 4-5 months only during 1956. Eighty-seven bodies were received during this period. It is the current policy for bodies upon which post-mortem examination for forensic purposes is required, to be concentrated at fewer public mortuaries in the London area than was previously the case and also for more post-mortems undertaken at the Coroner's direction to be carried out in hospital mortuaries if the person died in hospital. Following this policy, a much larger number of bodies from the Wandsworth area was sent to the Battersea Mortuary, quite apart from the fact that for a substantial part of the year we were without a mortuary attendant. At the end of the year, the whole question of accommodation for bodies in relation to the Wandsworth Mortuary was under review. Under the Crematorium Regulations 1950, 1,391 cremations were authorised during 1956, compared with 1,244 in 1955. 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 1956 was 30. 5 HOUSING STATISTICS RELATING TO HOUSING Public Health (London) Act, 1936 Number of houses inspected on account of complaints or illness 10,133 Re-inspections 21,899 Number of statutory notices served: Intimation notices 2,078 Nuisance notices 547 Number of houses in which nuisances were abated 2,246 The number of cases referred to the Solicitor for legal action during 1956 was 144 The following is a summary of Police Court proceedings: Number of summonses served 62 „ „ „ withdrawn 19 „ „ „ adjourned 11 „ „ Orders made for abatement of nuisances 32 Costs awarded in respect of two cases £5. 5s. Od. HOUSING ACT, 1936 Number of houses inspected—house to house (Housin 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 1 Number of houses demolished: (a) as the result of such orders Nil (b) voluntarily Nil 26 HOUSING Closing Orders (other than underground rooms) Number of houses closed (Local Government (Miscellaneous Provisions) Act 1953) 1 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 Closing Orders (underground rooms) Number of rooms found to be unfit for habitation 1 Number closed or modified occupation approved 1 Number of Closing Orders determined Nil Slum Clearance Number of houses included in representations under Section 25 of the Housing Act 1936 20 Number of houses demolished following action under Sections 25 and 27 of the Housing Act 1936 65 Overcrowding Number of families found to be living in overcrowded conditions 45 Number of overcrowded families who have obtained alternative accommodation 39 New Accommodation Number of dwellings erected by the borough council during the year 397 27 The Housing Repairs and Rents Act, 1954 During the year 39 applications were received for Certificates of Disrepair and were dealt with as follows: (a) Thirty-four Certificates of Disrepair were granted; (b) In five cases Certificates were not granted as the premises were found to be in good repair and reasonably suitable for occupation; Sixty-three Applications were received for revocation of Certificates of Disrepair and these were granted. 28 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 Housing Accommodation—Medical Priority During the year 804 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 387 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 Gay Street Area 1-35 (odd) inclusive, 2-42 (even) inclusive, Gay Street. 7-31 (cons.) inclusive, Waterman Street. 40-64 (even) inclusive, Felsham Road. Glegg Place Area 1-8 (cons.) Taylors Villas. 1, 2, Providence Cottages, Modder Place. 1-9 (cons.) Prices Folly. Hereford Cottage, Cardinal Place. These properties were declared Clearance Areas following my representations and the Clearance Orders were subsequently confirmed by the Minister of Housing and Local Government. individual unfit houses Closing Orders were made on premises at 10b Old Town and 496 Wandsworth Road. In both cases the owners had been invited to submit proposals to render the premises fit for human habitation, but none were received. In addition a Demolition Order was made in respect of the premises at 1 Atney Road. 6 FOOD AND FOOD PREMISES 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 2,727 and during 1956 they were visited on 16,635 occasions. Table IX has been drawn up to show the number of visits to various food premises in different parts of the Borough. In 1956, only three inspectors were 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 two Inspectors supervise other premises where food is sold, stored, manufactured, or prepared for sale. These Inspectors also carry out the duties required under the Pharmacy and Poisons Act, 1933, and the Pharmacy and Medicines Act, 1941. District Inspectors holding the additional certificate of Inspector for Food and Drugs carry out the day-to-day supervision of the catering establishments in their respective areas. Implementation was given during 1956 to the Food Hygiene Regulations 1955, the main provisions of which came into effect on 1st July. Reference is made to these Regulations in the Preface to this Report. 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 were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Twenty-eight notices of cancellation of registration were received. At the end of the year there were 230 persons on the register, including 29 persons with premises outside the Borough. There were three 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. 29 30 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 51 121 27 50 76 43 25 59 57 49 79 94 99 81 97 34 20 65 18 46 1.191 Restaurant Kitchens 94 163 87 91 113 66 31 69 110 62 66 134 32 44 43 41 149 60 26 44 1,527 Ice Cream Premises 41 41 26 26 16 17 23 72 97 22 53 58 31 54 27 31 61 20 14 44 776 Butchers' Shops 155 106 165 96 82 81 51 62 110 16 94 62 28 50 79 59 162 13 7 57 1,485 Greengrocers' Shops 77 43 35 52 37 20 14 14 46 4 30 19 16 2 - 16 28 10 13 17 493 Fishmongers' Shops 10 42 34 11 13 18 12 4 8 3 30 35 9 6 8 10 62 6 10 2 333 Fried Fish Shops 3 53 14 2 18 23 16 6 14 7 32 29 9 - 2 1 5 3 7 7 251 Market Stalls 147 338 150 181 207 75 188 243 2,202 - 57 423 41 1,454 148 6 352 - - 60 6,272 Other Premises 246 268 156 177 307 181 141 233 352 157 280 245 91 259 705 178 260 64 78 196 4,024 Bakehouses 33 24 32 1 36 21 35 21 8 9 20 4 4 6 6 4 - 3 10 6 283 Total Visits 857 1,199 726 687 905 545 536 783 3,004 329 741 1,103 360 1,956 565 332 1,101 244 183 479 16,635 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 FOOD AND FOOD PREMISES 31 Food and Drugs Act, 1955 One hundred and eighty samples of milk were submitted for analysis. Of these 17 were samples of Channel Island and South Devon milks with an average fat content of 4-41 per cent. The remaining 163 samples had an average fat content of 3.68 per cent. The Milk (Special Designation) (Raw Milk) Regulations, 1949-1954, and the Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949-1953. 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: v Dealers'" Dealers' Supplementary Total Pasteurized 221 34 255 Sterilized 280 37 317 Tuberculin Tested 163 33 196 Total 664 104 768 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. 32 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 Meat There are 218 butchers' shops in the Borough. The majority are registered under Section 16(l)(b) of the Food and Drugs Act, 1955, for the preparation or manufacture of sausages or potted, preserved, pickled or pressed foods. There were 1,485 visits made to these shops during the year. Slaughter of Animals There are no private slaughterhouses in the Borough. The carcases of six pigs were examined 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 no applications from persons desirous of acting as slaughtermen were received by the Council. Piggeries There is now one piggery in the Borough and it was visited on eight occasions. Unsound Food Ninety-six 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. FOOD AND FOOD PREMISES 33 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 1956 was 384, and 570 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 n OF POISONS LIST Principal Business Number of Premises Number of Visits Confectioners 3 5 Domestic stores, ironmongers, etc 96 141 Drug stores 18 27 Grocers 240 360 Hairdressers 16 22 Nurserymen and florists 11 15 Total 384 570 Bakehouses There are 63 bakehouses in the Borough, of which 12 are in basements and subject to the provisions of Section 54 of the Factories Act, 1937. Two hundred and eighty-three visits were made to these premises by Food Inspectors during the year. 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. 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 Registration of Premises The Food and Drugs Act, 1955 Section 16 (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 39 applications for registration under the provisions of Section 16 (l)(a) and 20 applications for registration under the provisions of Section 16( 1 )(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 no applications were received for licences under the provisions of Sec. 144, to use premises as slaughterhouses. Bacteriological Examination of Food Three hundred and eighty-three samples of food were examined bacteriologically at the Public Health Laboratory during the year. They were as follows: Milk Ice-cream Imitation Cream Artesian Well Waters Others Total 310 33 18 7 15 383 Milk Of the 310 samples of milk, 143 were submitted to the phosphatase test, 143 to the methylene-blue test, and 24 to the turbidity test. These samples were reported satisfactory. FOOD AND FOOD PREMISES 35 Imitation Cream Eighteen samples were examined for the presence of pathogenic organisms. Coliforms were not isolated. Artesian Well Water Seven samples were submitted for examination, and all were reported satisfactory. Ice-cream During the year 33 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. The following table gives a summary of the results: Methylene-Blue Reduction Test Provisional Grade Number of Samples 1 20 2 5 3 7 4 1 Total 33 Others Of the 15 miscellaneous samples two were found to contain coliforms but the remaining 13 proved to be free of pathogenic organisms. Analysis of Food and Drugs During the year 1,000 samples of food and drugs were procured for analysis; 180 samples of milk, 785 other foodstuffs and 35 drugs. Of these 162 were submitted as formal samples while 838 were 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 purchased informally. None of the formal but eleven or 1.2 per cent. of the informal samples were found to be adulterated or not up to standard. The total adulterations reported were 11 or 1.1 per cent, of the samples submitted. The 11 samples found to be adulterated were: Four samples of milk flavourings, three samples each of condensed milk and ginger beer, and one sample of toffee. 7 FACTORIES ACT, 1937 and 1948 Prescribed particulars required by Section 128 (3) 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 495 158 2 - (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,151 793 10 - (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 105 24 1 - Total 1,751 975 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 1 1 - — — Overcrowding — — — — — Unreasonable temperature — — — — - Inadequate ventilation — — — — - Ineffective drainage of floors Sanitary Conveniences — — — — - (a) insufficient 2 - - 1 - (b) unsuitable or defective 30 22 — 4 - (c) not separate for sexes — — — — - Other offences against the Act (not including offences relating to outwork) 10 6 - 2 - Total 43 29 — 7 - 37 38 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 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 568 — — „ „ cleaning and washing — — — Household linen 4 — — Curtains and furniture hangings 1 — — Artificial flowers 3 — — Paper bags 2 — — Boxes or other receptacles made wholly or partially of paper 40 — — Brush making 1 — — Stuffed toys 39 — — Cosaques, Christmas crackers, Christmas stockings, etc. 9 — — Lampshades 196 — — Total 863 — — London County Council (General Powers) Act, 1954 Hairdressers and Barbers Section 18 of the above Act requires, inter alia, that, as from an appointed day to be fixed by the Council, no person shall carry on a business as a hairdresser or barber on any premises in a borough unless he or those premises are registered by the Borough Council. On 18th October, 1955, the Council decided to exercise the duties and powers contained in the above Section, and fixed the appointed day to be 1st April, 1956. During the year 220 registrations were made. REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1956 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, 1955, 1,000 samples were examined during the year ended 31st December, 1956, 965 were articles of food and the remaining 35, drugs. All were submitted by the Council's Food Inspector, 162 having been taken with the formalities required by the Act and 838 informally. Samples of the following substances were analysed: fats (butter, margarine, etc), 52; beverages (cocoa, coffee, tea, etc.), 30; cereal preparations, 21; cream, 45; fish (canned etc.), 32; fruit (canned and dried), 63; meat products (including sausages), 45; milk, 180; pickles and condiments (including spices), 47; preserves, 33; soup, 24; vegetables, 51; bicarbonate of soda, 5; iodine solutions, 4; ointments, 4; seidlitz powders, 2. 39 40 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 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 Informal 12 Gingerbeer Cake of mould 25 „ Floating pieces of paper 26 „ Cake of mould 175 Milk flavouring Preserved with benzoic acid 239 Strawberry flavouring 350 parts per million benzoic acid 240 Pineapple flavouring 430 parts per million benzoic acid 241 Chocolate flavouring 500 parts per million benzoic acid 381 521 Toffee Condensed Full Cream milk Foreign matter in the nature of celluloid 3.3 % deficient in milk fat 630 „ „ 9.0% „ „ 631 „ „ 9.0% „ „ Adulteration The amount of adulteration detected during the year was: For formal samples 0.0 per cent. For informal samples 1.2 per cent. For all samples 1.1 per cent. REPORT OF THE PUBLIC ANALYST FOR 1956 41 Complaint Samples Case No. 144. Tea. Submitted on the complaint that it had caused sickness. The complaint was considered not justified. Case No. 188. Coffee Extract. Submitted on the complaint that it was excessively bitter. The complaint was considered not justified. Case No. 318. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 325. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case. No. 350. Meat Pie. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 381. Toffee. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 480. Cream Bun. Submitted on the complaint that when eaten it caused a burning sensation in the mouth. Nothing was found to justify the complaint. Case Nos. 931/932. Milk. Submitted on the complaint that it was of poor keeping quality. The complaint was considered not justified. 42 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 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 12 12.67 3.80 8.87 February 27 12.29 3.60 8.69 March 13 12.56 3.75 8.81 April 34 12.09 3.40 8.69 May 22 12.12 3.33 8.79 June 9 12.34 3.50 8.84 July 6 12.60 3.75 8.85 August — — — — September 9 12.60 3.72 8.88 October 5 12.63 3.70 8.93 November 11 12.58 3.78 8.80 December 15 12.81 3.92 8.89 The average composition of the 163 samples of milk analysed during the year and returned as genuine was as under: Total milk solids 12.63 per cent. Milk fat 3.68 per cent. Non.fatty solids 8.95 per cent. The average composition of the 17 samples of Channel Island and South Devon milks was as under: Total milk solids 13.48 per cent. Milk fat 4.41 per cent. Non-fatty solids 9.07 per cent. INDEX PAGE Accidents, Deaths from 19 Acute Encephalitis 15 Analyst, Report of 39 Bacteriological Examinations of Milk 34 „ „ of Ice-cream 35 Bathing Pools and Swimming Pools 24 Bed Bugs, Eradication of 24 Births, Birth-rates 7 Butchers' Shops 30 Cancer 19 Childbirth, Deaths from 11 Circulatory Diseases 19 Closing Orders 27 Crematorium 25 Cutting-off Notices—Water Supply 23 Deaths, Causes of 10 Death-rates 7 Death-rate from Infective Diseases 12 Death-rate, Infantile 11 Deaths, Number of 9 Diphtheria 12 Diseased or Infirm Persons, Removal of 24 Disinfection 18 Dysentery, Sonne 16 Enteric Fever 15 Erysipelas 17 Factories Act, 1937 37 Factories and Workshops 37 Food and Drugs Act, 1955 34 Food Poisoning 17 Food, Supervision of 29 Food Places, Inspection of 29 Food Places, Number on Register 29 Houses and Premises Inspected 21 Housing Act, 1936 26 Housing Repairs and Rents Act, 1954 27 Housing Statistics 26 Hydrogen Cyanide Disinfection 25 43 44 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1956 Illegitimate Children, Births of 8 Infant Mortality 11 Infective Diseases 12 Infective Diseases, Cases of 13 Infective Diseases, Death-rate from 12 Infirm or Diseased Persons, Removal of 24 Influenza, Deaths 16 Influenzal Pneumonia and Acute Primary Pneumonia 16 Insanitary Areas 28 Malaria 17 Maternal Mortality 11 Meat 32 Meningococcal Infection 15 Milk Analysis 42 Milk, Bacteriological Examination of 34 Milk Premises, etc., on Register 29 Milk (Special Designations) Regulations, 1949-54 31 Mortuary 25 Non-infective Diseases, Deaths from 19 Notification of Infective Diseases 14 Outworkers 38 Overcrowding 27 Pharmacy and Poisons Act, 1933 33 Pharmacy and Medicines Act, 1941 33 Piggeries 32 Poliomyelitis 15 Population 8 Pregnancy, Deaths from Accident and Diseases of 11 Preserved Meat, etc., Manufacture of 34 Public Analyst, Report 39 Puerperal Pyrexia 15 Pulmonary Tuberculosis, Notification of cases of 20 Rodent Control 23 Samples, Formal and Informal, Number of 35 Sanitary Inspection of Borough 21 Scabies 17 Scarlet Fever 12 Slaughter-houses32 Slaughter of Animals Acts, 1933-1954 32 INDEX 45 Smallpox 12 Statistics for the Borough 8 Suicide, Deaths from 19 Swimming Baths and Bathing Pools 24 Syphilis, Deaths from 17 Tuberculosis 20 Unfit Houses 28 Unsound Food 32 Water Supply 33 Water Supply, Cutting-off Notices 32 Whooping Cough 12