Metropolitan Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health for the Year 1957 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 1957 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you the Annual Report on the health of the Borough for the year 1957. Following precedent, the report is mainly statistical with comments on the figures as may be necessary and in this introduction, I draw your attention to some of the more interesting items which occurred during the year. The population of the Borough has been increasing over the past two or three years due in the main to the new housing estates which have been going up and are still going up in parts of the Borough. In 1957, however, there was a levelling off of the population which, in fact, was 20 fewer than in the previous year, being 337,580. The crude birth rate for 1957 was 14.92 per 1,000 persons, a slight increase over the previous year. The adjusted birth rate, taking into account the area comparability figure, works out at 14.32. The crude death rate for the year was 14.72 compared with 15.57 for 1956 but after taking into account the area comparability figure, the adjusted rate works out at 10.15 compared with 10.89 the previous year. I referred in my report last year to the importance of the infant mortality rate as a yardstick of the public health and social status of a community, pointing out that in 1956 we had the lowest figure ever recorded in Wandsworth, namely 17 per 1,000 live births. It is highly gratifying, therefore, to record that this figure was even further 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 reduced in 1957 to 15.6 per 1,000 live births. This is a low rate for a large urbanised area containing mixed conditions like Wandsworth. It is right, however, that I should point out that where we are dealing with comparatively small figures, small increases or decreases in these numbers can make quite a substantial difference to the rate. Over large areas and dealing with larger numbers, these comparatively small differences, of course, even out. Allowing for this, however, the fact that in Wandsworth in 1957 there were 5 fewer deaths (at 79) of infants under one year of age than in the previous year is very satisfactory. The problem of further reducing the infant death rate, particularly of deaths of children in the first month of life and even more particularly of children in the first week of life is a considerable one. It is closely associated with the causation of still-births. This problem of peri-natal mortality, that is to say, stillbirths and deaths of infants in the first week of life, is at the moment being actively investigated and we are participating in this enquiry in this area. It is equally gratifying to report another milestone in the health of the Borough, closely associated with the health of infants. No death occurred in Wandsworth during 1957 from accidents and diseases of pregnancy or childbirth. This is the first year that it has been possible to report this. Many agencies, institutions and services as well as individuals are concerned with reducing the risk to mothers during pregnancy and labour. General practitioners, consultants, obstetric hospitals, domiciliary midwives, health visitors, home helps and the health services generally all have their part to play. It would be invidious to single out any one particular service as having made a particular contribution to this highly gratifying record but I have no doubt that all concerned in their various spheres have played their part. In 1956, four mothers died from causes associated with pregnancy and childbirth, in 1955 there were also four deaths. It would be too much to hope that in every future year I shall be able to report an equally satisfactory result but the fact that in a large area like Wandsworth, it is possible to achieve a reduction in maternal mortality to nil makes one hope that this achievement will not be an isolated one. The total number of cases of infectious disease notified was almost REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 3 double that of the previous year, accounted for in the main by the very large number of cases of measles, namely 3,802; 1957 was a measles year. I referred in my report last year to the amount of Sonne dysentery which we had experienced. Although the disease was still prevalent, the number of cases was considerably fewer being 232 in 1957 compared with 750 in 1956. The routine measures as outlined last year continued to be taken and the disease, although difficult to control, was kept within reasonable limits. The year saw an increase in the number of cases of poliomyelitis, a total of 147 cases being reported and investigated but only 71 of these being ultimately confirmed as true cases of poliomyelitis. Advances in pathological methods have enabled the virus of the disease to be isolated and in appropriate cases this has helped in the investigation of some of the cases. We have again received considerable help from the Public Health Laboratory Service who have always been prepared to discuss our problems and to examine specimens where such examinations would be helpful. In the autumn, Wandsworth, like most areas in the country, was swept by an epidemic of "Asian" influenza. It was not possible to ascertain exactly how many cases arose since influenza as such is not a notifiable disease. From information we received from schools and other institutions, it was clear that the disease was wide-spread although, fortunately, in general, it appeared to be comparatively mild. Towards the end of the year, the cases tailed off although there seemed to be a slight secondary but much smaller prevalence in the New Year. Reference is made in the body of the report to work under the Food Hygiene Regulations. During the year, attention was further concentrated on this problem and to provide greater flexibility in dealing with food hygiene generally and particularly in view of our shortage of Public Health Inspectors, some of the Inspectors were given additional responsibility in relation to food hygiene. This has worked well and although a great deal still remains to be done before the Food Hygiene Regulations can be regarded as being fully complied with, considerable headway has been and is still being made. The other important new part of our work to which much attention was paid during the year was the implementation of the Clean 4 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Air Act, particularly the establishment of Smoke Control Areas. There were many difficulties to be overcome, particularly in view of our shortage of inspectorial staff in the Health Department, but I am happy to say that the greatest help and co-operation was received from other departments of the Council. So far as the establishment of Smoke Control Areas is concerned, it can be said that the work was a combined effort, particularly with the Town Clerk's Department. The end result has been that at the end of the year much headway had been made in the establishment of a smoke control area. At the time of writing, the Council has made its first Order, the Public Enquiry by the Minister has been held and we are now awaiting the result of that Enquiry. In the meantime the Committee has agreed in principle to two other areas being designated as Smoke Control Areas and preliminary work is now proceeding on these areas. In a large highly urbanised borough like Wandsworth, it will be some time before even a substantial part of the area will be free from smoke but in the meantime a good start has been made, valuable experience has been obtained and it is possible, at least, to look forward to the time when, without in any way minimising the difficulties which will certainly be met, Wandsworth, like other urbanised areas, will be free from smoke. I venture to draw attention to the references to William Harvey in this report. It is usual when statements of a scientific or quasiscientific nature are made, for the evidence on which they are based to be given at the same time. It is hoped that this will be done elsewhere. In the meantine, I feel that it is not inappropriate to record in my Annual Report for 1957, the 300th anniversary year of the great physician's death in Roehampton, something of his links with Wandsworth. I mentioned last year that Dr. W. G. Harding, formerly Deputy Medical Officer of Health, left the Department on being promoted to take charge of one of the London County Council Health Divisions. In Dr. Harding's place, the Council appointed Dr. Anderson Garland who took up his duties in June 1957. It was with considerable pleasure that we welcomed Dr. Garland to the Department since he was already well-known to us having on many occasions helped us under the "tripartite" arrangement which exists in this area. I should like to take this opportunity of thanking Dr. Garland for the help he REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 5 has already given me during his term of office. I should like also to thank the other members of the staff of the Health Department, particularly Mr. E. V. Roots, the Chief Public Health Inspector, for their continued loyalty and the diligence in the way they carried out their duties, sometimes under circumstances which were quite difficult. As usual, the Chairman of the Health Committee, Mr. T. V. Rowlands, has given the Department his support and encouragement and I am very grateful to him for his help. I should also once again like to thank my fellow Chief Officers of the Council for their co-operation and assistance in the many matters concerning the work of the Health Department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, J. TUDOR LEWIS Medical Officer of Health GUILIELMUS HARVEIUS ANGLUS Medicus Regius et Professor Anatomiae in Collegio Medicorum Londinensi William Harvey and Roehampton William Harvey, as almost everyone knows, discovered and described the circulation of the blood. This is not merely of academic interest because his epoch making discovery inaugurated a new era and is the foundation of modern medical practice. Since in presentday urbanised countries it is given to few to escape the need of consulting a doctor at some time or other, Harvey's discovery directly or indirectly affects each one of us. Harvey, however, was more than one of the greatest, probably the greatest of all physicians. He has been described as "one of the three or four greatest intelligences of all time" and I have little doubt that this is a just appraisal. Harvey died on 3rd June, 1657, at the age of 79, in Roehampton, which is situated in this Borough, although he was buried in Hempstead in Essex. To commemorate the tercentenary of his death last year, many functions were held in many parts of the world. Books were published, banquets held, lectures given and there was a pilgrimage to the place where he lies buried in Hempstead, Essex. The Russians issued a special stamp bearing Harvey's picture. My colleagues and I felt that we could best pay our tribute to Harvey's memory by visiting the place in our Borough where he died. Unfortunately, no-one could tell us where this was although a number of Harveian authorities were consulted. It was felt that this should, if possible, be remedied and over the past year, as time has permitted, I have been carrying out an investigation to find out where, in fact, it was that Harvey died. In this, I have been greatly helped by many people. My researches are now almost concluded and it is hoped that they will later be made available in full but in the meantime, in this Annual Report for 1957, 300 years after Harvey died, the following may be briefly stated as a modest contribution to mark the occasion. William Harvey died in the house of his brother in Roehampton on 3rd June, 1657. The house was a substantial mansion situated in extensive grounds which are now owned and occupied by the Convent of the Sacred Heart in Roehampton Lane in Roehampton in this Borough. The house was burnt down about 1796 and its site is now partly covered by other buildings. 6 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 7 Harvey went to live there about 1650 and it is likely that he spent the remaining seven years of his life for the most part with his brother's family in this house although he may, on occasions, have stayed temporarily elsewhere. There is reason to think that during this time he was by no means lacking in the intellectual companionship which his great mind would have demanded and almost certainly Thomas Hobbes, the well-known philosopher, writer and freethinker of that period, was one of his companions. No signs of the house are now to be seen but the grounds in which it was situated remain although probably changed since Harvey's day. However, one large lawn or small field flanked by trees can be seen today much as it was in Harvey's time although, of course, the trees (with the exception of some well-grown oaks) are not the trees which Harvey saw. It is, one feels, a matter for great satisfaction that with all the building which has been proceeding in Roehampton over the past four or five years, these grounds where the great physician and scientist spent the last years of his life in pleasant and congenial retirement, should still be seen, in part at least, much as they were in his day. They present almost a direct link with Harvey. STAFF The following changes occurred in 1957:- Retirements Mr. E. Catherine, Motor Driver, Service 16½ years. Retired in July. Resignations Mr. E. Wall, Public Health Inspector, Service 11½ years. Resigned in March. Mr. G. A. Fraser, Public Health Inspector, Service 1 year. Resigned in September. Mr. A. Norton, Clerical Assistant, Service 4½- years. Resigned in December. Death Mr. J. P. Smith, Clerical Assistant, Service 19 years. Died in July. Appointments Mr. J. R. Holloway, Public Health Inspector, Appointed in August. Mr. D. Reed, Motor Driver, Appointed in August. 8 1 STATISTICS AND SOCIAL CONDITIONS Area 9,199 acres Resident population in 1957 337,580 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. 9 10 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Extracts from Vital Statistics Number of Live Births: Males Females Total Legitimate 2,444 2,205 4,649 Illegitimate 199 189 388 Total live births 2,643 2,394 5,037 Number of Stillbirths 58 42 100 Number of deaths 2,314 2,657 4,971 Birth-rate—Crude .. 14.92 Adjusted .. 14.32 Death-rate—Crude .. 14.72 Adjusted .. 10.15 Rate per 1,000 (Live and Still) Births Deaths from puerperal causes, Nil Infantile mortality per 1,000 live births: All infants 15.6 Legitimate infants 15.4 Illegitimate infants 18.0 Deaths from Cancer 1,161 „ „ Diphtheria 0 „ „ Scarlet Fever 0 „ „ Measles 1 „ „ Whooping Cough 0 „ „ Tuberculosis 36 Tuberculosis death-rate 0.10 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 337,580 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 1957 Putney 87,600 Central 96,240 Clapham 80,970 Streatham 72,770 Whole Borough 337,580 Births The total number of births belonging to the Borough registered during 1957 was 5,037 consisting of 2,643 males and 2,394 females. The number for 1956 was 4,812. The crude birth-rate was 14.92 per 1,000 persons living compared with 14.25 for 1956. The adjusted rate works out at 14.32 after taking into account the area comparability factor supplied by the Registrar-General. Three hundred and eighty eight illegitimate births took place in the Borough compared with 351 in 1956. 11 12 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Deaths The number of registered deaths which took place in the Borough during the year was 3,529 but 415 of these did not belong to the Borough, while 1,857 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,971, of whom 2,314 were males and 2,657 females. The crude death-rate for the year was 14.72, compared with 15.57 for 1956, but after taking into account the area comparability factor supplied by the Registrar-General, the adjusted rate works out at 10.15. 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 534 595 1,129 12.89 Central 744 848 1,592 16.54 Clapham 617 726 1,343 16.58 Streatham 419 488 907 12.46 Whole Borough 2,314 2,657 4,971 14.72 VITAL STATISTICS 13 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 1957 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 30 22 8 8 12 10 7 10 9 4 Tuberculosis, Other 6 1 5 — — — 1 3 2 3 1 1 1 Syphilitic Disease 16 9 7 — — — — 5 11 4 5 5 2 Diphtheria — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — Meningococcal Infections — — — — — — — — — — — — — Acute Poliomyelitis 4 3 1 — — 3 — 1 — 2 1 1 Measles 1 1 — 1 — — — — — 1 Other Infective and Parasitic Diseases 11 6 5 1 7 3 2 4 5 Malignant Neoplasm, Stomach 152 71 81 — — — 5 34 113 28 29 71 24 Malignant Neoplasm, Lung, Bronchus 240 196 44 4 118 118 44 48 101 47 Malignant Neoplasm, Breast 138 — 138 9 51 78 15 17 93 13 Malignant Neoplasm, Uterus 54 — 54 2 28 24 7 7 33 7 Other Malignant and Lymphatic Neoplasms 577 250 327 1 1 1 24 186 364 111 113 273 80 Leukaemia, Aleukaemia 29 15 14 4 6 6 13 5 11 7 6 Diabetes 27 10 17 1 6 20 8 7 8 4 Vascular Lesions of Nervous System 499 181 318 12 81 406 139 135 114 111 Coronary Disease, Angina 598 359 239 17 152 429 154 163 141 140 Hypertension, with Heart Disease 86 38 48 10 76 27 27 17 15 Other Heart Disease 871 352 519 13 65 793 214 359 146 152 Other Circulatory Disease 247 100 147 7 34 206 66 64 56 61 Influenza 58 30 28 2 5 5 14 32 14 25 11 8 Pneumonia 252 104 148 6 11 6 11 33 185 42 106 56 48 Bronchitis 242 166 76 1 62 179 65 86 47 44 Other Diseases of Respiratory System 43 29 14 2 4 4 33 10 8 11 14 Ulcer of Stomach and Duodenum 35 19 16 1 5 29 10 11 7 7 Gastritis, Enteritis, Diarrhoea 22 8 14 1 3 18 6 5 6 5 Nephritis and Nephrosis 26 13 13 9 7 10 6 7 4 9 Hyperplasia of Prostate 21 21 1 20 4 6 5 5 Pregnancy, Childbirth, Abortion Congenital Malformations 36 18 18 20 5 4 3 2 2 12 5 11 8 Other Defined and Ill-defined Disease 503 219 284 45 4 2 18 70 364 87 289 69 58 Motor Vehicle Accidents 21 15 6 1 2 9 2 7 8 3 3 7 All other Accidents 78 34 44 2 4 1 8 10 53 21 27 18 12 Suicide 46 23 23 14 21 11 7 11 13 15 Homicide and Operations of War 2 1 1 1 — — 1 1 1 All Causes 4,971 2,314 2,657 79 29 28 190 1,032 3,613 1,129 1,592 1,343 907 14 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 TABLE III (a). DEATHS FROM HEART DISEASE, 1957 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. — — 15 119 225 359 — — 2 33 204 239 598 Hypertension with Heart Disease — — — 6 32 38 — — — 4 44 48 86 Other Heart Disease — — 6 31 315 352 — — 7 34 478 519 871 — — 21 156 572 749 — — 9 71 726 806 1,555 Infantile Mortality There were 79 deaths of children under one year giving an infant mortality rate of 15.6 per 1,000 live births. This rate is the lowest ever recorded in the Borough, and compares with a rate of 17 for 1956 and 24 for 1955. For the ten years ended 1947 the average infant mortality rate was 40, while for the ten year period ended 1957 the average rate was 22. Maternal Mortality No deaths occurred from accidents and diseases of pregnancy or child-birth. This is the first year that no deaths from these causes have been recorded in the Borough. In 1956 there were four deaths, giving a rate of 0.81 per 1,000 live and still births. 3 INFECTIVE DISEASES The number of deaths from all notifiable infectious diseases was 113. This included 36 from all forms of tuberculosis and 72 from the notifiable forms of pneumonia. There were four deaths from poliomyelitis and one death from measles. From all notifiable infective diseases the death-rate was 0.34 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 A number of cases reported as suspected diphtheria were investigated, but in one case only, that of a boy aged 6 years, admitted to hospital, was the diagnosis confirmed. This diagnosis was based on clinical evidence only, as no subsequent bacteriological confirmation was obtained. Nose and throat swabs from all other members of the patient's family were bacteriologically examined and found negative. Scarlet Fever Two hundred and thirty-five cases were notified compared with 202 in 1956 and 289 in 1955. The diagnosis was not confirmed in two cases. No deaths occurred. Whooping Cough Three hundred and forty-five cases were notified. There were no deaths. Measles The number of cases notified during the year was 3,802 compared with 677 in 1956, 5,206 in 1955 and 303 in 1954. 15 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 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 1 — — — 1 — — — — — Scarlet Fever 233 — 12 36 141 28 8 8 Measles 3,802 105 805 994 1,812 48 18 20 Whooping Cough 345 31 72 63 154 16 1 8 — Enteric Fever and Paratyphoid Fever 4 — — 1 1 2 Malaria 2 2 Dysentery 232 5 20 22 84 40 4 40 16 1 Erysipelas 43 — — 1 — 2 3 8 16 13 Scabies 20 — 1 1 9 6 3 Puerperal Pyrexia 102 41 60 1 Ophthalmia Neonatorum 3 3 Meningococcal Infection 8 1 1 3 1 1 1 Acute Poliomyelitis 71 1 6 11 20 15 4 12 2 Acute Encephalitis 3 — 1 1 1 Anthrax __ Pneumonia: Acute Influenzal 126 2 5 9 7 10 12 17 35 29 Acute Primary 202 2 4 16 15 19 23 25 51 47 Tuberculosis—All forms 549 1 3 3 15 14 117 271 96 29 Food Poisoning 579 4 53 75 102 125 74 61 66 19 Total 6,325 155 982 1,232 2,357 318 317 539 287 138 INFECTIVE DISEASES 17 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 — — — — — — — — 1 — — — — 1 — Scarlet Fever 26 5 10 29 13 10 12 3 5 12 26 20 12 11 5 2 8 7 12 5 233 — Measles 485 217 235 191 56 128 112 250 210 154 208 191 167 168 145 156 195 234 163 1 37 3,802 1 Whooping Cough 29 8 26 9 19 22 38 34 11 18 13 11 14 12 13 4 9 16 7 32 345 — Enteric Fever and Paratyphoid Fever — — — — — — — 1 — 1 1 — — — 1 — — — — — 4 — Malaria — 1 — 1 — — — — — — — — — — — 2 — Dysentery 8 2 11 2 3 56 4 45 67 3 3 2 4 3 5 2 3 3 4 2 232 — Erysipelas 3 2 — 3 1 4 8 8 2 5 1 — 3 — 1 1 1 — 43 Scabies — — 1 4 1 2 2 1 2 1 2 1 — 3 20 — Puerperal Pyrexia — — 2 — 5 6 4 1 6 2 5 11 22 23 5 1 3 1 5 102 — Ophthalmia Neonatorum — — 1 — — 1 1 — — — — — — — — — — — — 3 — Meningococcal Infection — — — — 1 1 1 1 1 — 1 — 1 1 — — — — 8 — Acute Poliomyelitis 7 2 1 5 6 3 1 3 4 1 3 4 5 3 12 4 1 6 71 4 Acute Encephalitis — — — — — — — — — — — — — — — — — — — — 3 — Anthrax — — ,— — — — — — — — — — — — — Pneumonia:— Acute Influenzal 6 3 3 6 6 4 5 4 9 16 9 5 4 5 17 5 4 6 4 5 126 34 Acute Primary 7 5 18 21 13 30 16 10 3 11 17 9 5 3 7 4 5 3 3 12 202 38 Tuberculosis—All forms 101 22 22 24 15 32 15 35 21 30 36 23 22 19 29 28 22 18 15 20 549 36 Food Poisoning 22 4 41 8 7 111 11 319 13 2 3 1 4 1 13 2 4 3 7 3 579 — Total 694 271 370 300 140 410 230 721 346 262 320 268 250 249 267 214 266 299 218 230 6,325 113 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Poliomyelitis 147 cases of this disease were reported and investigated during the year, compared to 85 in the previous year. In 76 cases the diagnosis was not confirmed. Of the remaining 71 confirmed cases, 43 were of the paralytic type and 28 non-paralytic. Four deaths occurred, in males aged respectively 6, 12 and 52 years, and a female aged 10 years. Approximately half the number of cases were in age group 5 to 9 years. Of the total cases for the year, slightly more than one third came from the S.E. corner of the borough and the bulk of these cases occurred during the first 6 months. From July onwards, the cases became more widely distributed with a slight concentration in the N.W. area. The figures of poliomyelitis from 1947 to 1957, the period during which the incidence of the disease in this country has been high, is shown in the following table:- 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 No. of cases reported as suspected poliomyelitis and investigated 119 31 89 71 29 73 73 41 104 85 147 No. of cases confirmed (a) paralytic 78 15 58 40 4 23 19 5 22 24 43 (b) non-paralytic 7 16 8 2 27 15 28 Deaths 4 6 4 7 — 5 2 — 1 2 4 Meningococcal Infection Eight confirmed cases were notified, none of which proved fatal. Eighteen other cases were investigated but these were subsequently not confirmed. In 1956 there were four confirmed cases with no deaths. Acute Encephalitis Of 16 cases reported one was confirmed as Acute Infective Encephalitis and two as Post Infectious Encephalitis. Total three cases for the year. No deaths occurred. INFECTIVE DISEASES 19 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 holiday in France. Diagnosis was not confirmed in the two remaining cases. Puerperal Pyrexia During the year 102 cases were notified, of which 101 occurred in hospital and one at home. Thirty-six of the hospital notifications referred to patients whose home addresses were outside the borough. Information was also received of 39 cases, referring to Wandsworth residents whose confinements took place in hospitals located in other Metropolitan boroughs. Sonne Dysentery In addition to the cases for which formal notifications were received, a number of other cases were discovered by investigation of an outbreak which occurred at a school in the borough. Bacteriological examination of specimens taken from affected pupils, and where considered necessary, family contacts, resulted in 41 being confirmed as Sonne dysentery. All cases were systematically followed up and a total of 338 faecal specimens from cases and contacts were examined over a period of several weeks. The final overall total of cases for the year was 232, a considerably lower figure than that in the previous year, when a very heavy incidence at schools and day nurseries resulted in 436 cases being confirmed and making a total of 750 for the year. The outbreak referred to above for 1957 was the only major outbreak during the year. Influenza The number of deaths from Influenza was 58 compared with 30 in 1956, 30 in 1955 and 23 in 1954. Influenzal Pneumonia and Acute Primary Pneumonia These are the notifiable forms of pneumonia. One hundred and twenty-six cases of acute influenzal pneumonia and 202 cases of acute primary pneumonia were notified. Thirty-four of the former, and 38 of the latter died. The total number of deaths credited to all forms of pneumonia during the year was 252, compared with 231 in 1956. 20 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Malaria Two cases were reported. Both were recurrent cases. Erysipelas Forty-three cases were notified. Other Infective Diseases Sixteen deaths occurred from syphilis. Scabies Twenty 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 1957. A fee of 5s.0d. per treatment is paid by Wandsworth to Battersea for this service. A total of 102 treatments was given during the year at the Battersea Cleansing Station. At the Council's Disinfecting Station, 45 treatments were given. Food Poisoning Two hundred and sixty-four formal notifications were received during the year. One hundred and seventy-five were unrelated cases and 24 were minor 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 22 cases. The organisms were Salmonella typhimurium, heidelberg, newport, thompson and anatum. In 22 of the minor outbreaks it was not possible to identify the causative agent and in the remaining two, Salmonella typhimurium and Salmonella newport were respectively isolated. In addition to the above cases, an outbreak involving 315 persons occurred at an institution in the borough. From bacteriological investigation of stools from a number of those affected it appeared that the outbreak was due to heat resistant Clostridium welchii. A full report on this outbreak was submitted to the Ministry of Health in accordance with Circular 46/49 and revised memorandum 188/Med. INFECTIVE DISEASES 21 Diseases Reported from Schools A total of 3,337 infective diseases was reported from schools in the Borough throughout the year. The numbers of each disease were: Scarlet Fever 174 Chicken Pox 644 Diphtheria 1 Whooping Cough 161 Measles 1,338 Mumps 565 German Measles 132 Dysentery 81 Poliomyelitis 15 Other Diseases 223 Disinfection During the year 614 rooms were disinfected after infectious and other disease, 416 rooms disinfested for vermin, and 102 rooms for miscellaneous conditions. 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 504 Faeces for the typhoid and dysentery groups 1,727 Miscellaneous specimens 15 Total 2,246 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 seven 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 1,161, the number of males being 517 and females 644. The death rate was 3.5 per 1,000. The number of deaths in 1957 was 12 more than in the previous year. Deaths from diseases of the heart and circulatory system were 1,802 compared with 1,959 in 1956. Of these deaths 1,339 were of persons of 65 years of age and above. There were 537 deaths from diseases of the respiratory system compared with 597 in 1956. The number of deaths from bronchitis was 242 compared with 335 in 1956, and from pneumonia (all forms) 252 compared with 231 in 1956. Further particulars relative to pneumonia are given on page 17. One hundred and forty-seven deaths were due to violence, 21 of them being due to motor accidents, 46 to suicide and 80 to other forms of violence. CERTIFICATES OF VACCINATION AND INOCULATION Two thousand, two hundred and ninety 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 thirteen 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 four cases it was found necessary to recommend superannuation. Forty-one shorter reports on members of the staff who were sick were obtained from doctors and hospitals at the request of the departments concerned. 22 TUBERCULOSIS Notifications The total number of new cases which came to the notice of the Department during 1957 was 549 compared with 546 in 1956. The sources of information regarding the 549 new cases were as follows: Primary notifications on Form A 272 Notifications from H.M. Forces 6 Unnotified at death 2 Transfers from other sanitary authorities 269 Total 549 Five hundred and forty-seven cases were added to the notification register during the year and 178 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 5,423. Deaths The number of deaths certified as due to various forms of tuberculosis was 36. 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 3 1 — — — — — 5-10 6 2 — — — — — — 10-15 8 7 1 1 — — — — 15-25 44 51 5 2 — — — 1 25-45 130 137 5 12 3 5 — — 45-65 77 28 1 2 11 1 1 2 65 and upwards 20 1 — 1 8 2 — 2 Totals 287 229 14 19 22 8 1 5 23 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 5,868 15,578 21,146 Housing Reports 947 — 947 Notifiable diseases 1,370 639 2,009 Factories, Workplaces, etc. (including Outworkers) 1,828 3 1,831 Sanitary conveniences 19 — 19 Other inspections 7,639 1,626 9,265 Totals 17,671 17,846 35,517 Smoke observations 278 Legal proceedings, attendances at court 24 Table VIII gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 402 and 872 were cleansed or repaired. The drains of 9 houses were reconstructed, and 202 drains were partially reconstructed. Damp conditions have been remedied in 894 premises, and in 16 of these damp courses were inserted. 24 SANITARY INSPECTION OF THE BOROUGH 25 TABLE VIII Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 174 182 201 94 651 2. Drains tested 106 104 57 135 402 3. Drains cleansed or repaired 279 164 258 171 872 4. Water closets cleansed, repaired or renewed 74 125 122 98 419 5. Soil pipes altered or repaired 18 16 21 7 62 6. Waste pipes provided, altered or repaired 47 82 69 77 275 7. Rainwater pipes repaired 22 25 18 9 74 8. Roofs and gutters repaired 117 177 138 79 511 9. Damp courses inserted 10 2 2 2 16 10. Damp conditions otherwise remedied 119 117 159 84 479 11. Yards drained or paved 6 5 6 1 18 12. Dustbins provided 20 23 20 35 98 13. Water cisterns cleansed, covered or repaired 6 1 4 2 13 14. Water supply reinstated 57 51 26 55 189 15. Defective stoves and fireplaces remedied 20 17 36 8 81 16. Defective coppers remedied — — — 1 1 17. Accumulations of rubbish, etc., removed 11 5 8 5 29 18. Urinals cleansed or repaired — — 2 — 2 19. Smoke nuisances 9 6 2 2 19 20. Other nuisances 35 21 24 11 91 Total 1,130 1,123 1,173 876 4,302 Number of Preliminary Notices served 416 428 473 231 1,548 Number of Preliminary Notices complied with 394 429 485 249 1,557 Number of Nuisance Notices served 77 118 103 62 360 Number of Nuisance Notices complied with 85 145 131 71 432 26 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Water Supply—Cutting-off Notices During the year notices with respect to 199 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 18 premises the water supply was cut off for non-payment of rates, and in 181 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 75 premises and during this period 63 dustbins were provided. Dustbins were also provided at 35 premises without the necessity of action under the Acts. Rodent Control One thousand, eight hundred and fifty 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 9,544 „ „ premises treated with "Warfarin" 892 „ „ premises "Warfarin" laid and found not troubled 83 „ „ premises investigated and found not troubled 201 „ „ "Warfarin" baits laid 4,446 „ „ drains tested by Public Health Inspector 274 „ „ drains found defective 218 „ „ rats estimated killed 3,082 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. 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. 27 SANITARY INSPECTION OF THE BOROUGH 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. 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, proprietary insecticides being used. Infested bedding is removed to the Disinfecting Station and treated by steam. During the year 167 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 Mention was made in last year's report to the current policy of concentrating, at fewer public mortuaries in the London area than was previously the case, bodies upon which post-mortem examination for forensic purposes is required. In view of this policy, the whole question of accommodation for bodies in relation to the 28 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Wandsworth and Battersea mortuaries was reviewed early in the year, and for the purposes of this report it may be well to state briefly the conditions that existed to that date and the conclusions arrived at from that review. In 1946 a contribution of £250 was made by the Council to the Battersea Borough Council towards the running costs of that Council's mortuary at Sheepcote Lane, S.W.I 1., owing to the number of bodies taken there from the Borough of Wandsworth and this contribution was renewed annually. The Battersea mortuary is nearer to considerable areas of Wandsworth than is the Council's mortuary in York Road, and large areas of the Borough are approximately equidistant from the two mortuaries. There is also a Coroner's Court adjoining the Battersea mortuary, while Wandsworth has no such Court. Bodies have also been admitted to the Wandsworth mortuary during the above mentioned period. In April, 1956, arrangements were made with the Battersea Borough Council to place its mortuary at the disposal of this Council pending consideration as to the future use of the York Road mortuary. During this time, H.M. Coroner for this district (which includes the Boroughs of Wandsworth and Battersea) decided that bodies upon which postmortem examinations were required from the two Boroughs should be taken to the Battersea mortuary. The whole question was most carefully considered and it was decided that the Council's mortuary at York Road should be retained for use as it might be required, particularly following a serious catastrophe or during epidemic periods. Moreover, the Council have a statutory obligation to provide mortuary accommodation. In view of the Coroner's decision, however, the question of a further contribution in respect of the additional bodies taken to the Battersea mortuary was raised and after careful consideration of the recommendations arising out of a discussion of the questions involved, by the Chairman of the Council's Public Health Committee and the appropriate member of the Battersea Borough Council, it was decided:- (a) that the existing annual payment of £250 be increased to £475 in respect of the financial years 1956/1957 and 1957/1958 and that these arrangements be reviewed at the expiration of the financial year 1957/1958 by which time further experience would have been gained in the matter; and (b) that in the event of the facilities at the Battersea mortuary being fully extended during peak periods of the year or during an epidemic, bodies from the area of the Battersea Borough Council should be accommodated at Wandsworth mortuary without any expense to the Battersea Borough Council. The experience of the past year has shown that (ignoring major emergencies or serious epidemics) the Battersea mortuary was able to cope with the bodies from the whole area of Battersea and Wandsworth. During this year, in addition to the reception of bodies of 29 SANITARY INSPECTION OF THE BOROUGH persons dying in Battersea, the mortuary received 603 bodies of persons who died in Wandsworth. As regards the Wandsworth mortuary, it is now, of course, little used, 28 bodies only being received there during 1957. The mortuary attendant has been seconded to work at the Disinfecting Station where he spends approximately two thirds of his time, the remaining one-third being given to maintaining the mortuary in a good condition (cleaning, etc) and dealing with the occasional body brought there. Crematorium Under the Crematorium Regulations, 1930, 1,403 cremations were authorised during 1957 compared with 1,391 in 1956. 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 1957 was 16. 5 HOUSING STATISTICS RELATING TO HOUSING Public Health (London) Act, 1936 Number of houses inspected on account of complaints or illness 7,238 Re-inspections 16,217 Number of statutory notices served: Intimation notices 1,548 Nuisance notices 360 Number of houses in which nuisances were abated 1,563 The number of cases referred to the Solicitor for legal action during 1957 was 86 The following is a summary of Police Court proceedings: Number of summonses served 26 „ „ „ withdrawn 9 „ „ „ adjourned 8 „ „ Orders made for abatement of nuisances 9 Costs awarded in respect of four cases £4. 4s. 0d. Housing Acts, 1936 and 1957 Repairs Number of houses made fit after service of formal notices (a) by owners Nil (b) by local authority in default of owners Nil Demolition and Closing Orders Housing Act, 1936 and Housing Act, 1957 (a) Demolition Orders made under Section 17 (1) of Housing Act 1957 2 (b) Houses demolished as the result of formal or informal procedure Nil (c) Houses closed in pursuance of an undertaking given by the owner and still in force Nil (d) Parts of buildings closed by Closing Orders (1) Underground rooms 15 (2) Other rooms Nil (3) Closing Orders determined 3 30 31 HOUSING Local Government (Miscellaneous Provisions) Act, 1953, and Housing Act, 1957 (a) Closing Orders made 3 (b) Closing Orders determined Nil (c) Closing Orders revoked and Demolition Orders made 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 57 Overcrowding Number of families found to be living in overcrowded conditions 22 Number of overcrowded families who have obtained alternative accommodation 12 New Accommodation Number of dwellings erected (a) by the borough council 187 (b) by the L C C 951 (c) by other persons 103 The Housing Repairs and Rents Act, 1954 The Rent Act, 1957 The Housing Repairs and Rents Act, 1954 Three Applications were received for Certificates of Disrepair and were dealt with as follows (a) Two Certificates of Disrepair were granted. (b) In one case the Certificate was not granted as the premises were found to be in good repair and reasonably suitable for occupation. Twenty-seven Applications were received for revocation of Certificates of Disrepair and these were granted. The Rent Act, 1957 Applications for Certificates of Disrepair. Five hundred and thirteen applications were received for Certificates of Disrepair and were dealt with as follows:- (a) In two cases it was decided not to issue Certificates of Disrepair as the premises were not in disrepair by reason of defects. 32 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 (b) In five hundred and eleven cases it was decided to serve notices on landlords proposing to issue Certificates of Disrepair unless undertakings to do repairs were given. (c) Two hundred and ninety-two undertakings were received from landlords to remedy defects proposed to be included in Certificates of Disrepair. (d) In one case it was decided not to accept the undertaking given by the landlord as it did not include all the defects specified in the notice served by the Council. (e) One hundred and four Certificates of Disrepair were issued. Applications for Cancellation of Certificates. (a) Thirty-two applications were received from landlords for the cancellation of Certificates of Disrepair. (b) Eight objections were received from tenants for cancellation of Certificates. (c) In two cases it was considered that the tenants' objections were not justified and the Certificates cancelled. (d) Twenty Certificates of Disrepair were cancelled. Housing Accommodation—Medical Priority During the year 662 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 234 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 On the 20th June, 1957 I submitted official representations under Part III of the Housing Act, 1936 upon the condition of the properties, Nos. 7/9, 23/35, 65/67 (odd) and 22/38 (even) Balham New Road and these representations are now being considered by the Council. INDIVIDUAL UNFIT HOUSES Closing Orders were made on premises at 177a Bedford Hill, 26 Boundaries Road, 130a Cavendish Road, 31 Fernlea Road, 69 Lydden Grove, 35a Ramsden Road, 43 Rectory Grove, 144 Tooting High Street, 29 Werter Road. In each case the owners had been invited to submit proposals to render the premises fit for human habitation, but none were received. In addition Demolition Orders were made in respect of 51 and 53 Wandsworth High Street. 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 2,747 and during 1957 they were visited on 10,066 occasions. Table IX has been drawn up to show the number of visits to various food premises in different parts of the Borough. Arising out of the re-organisation of the work of the inspectorial staff, supervision of the food supply is now carried out by four senior Inspectors who each procure samples of food and drugs for analysis by the Public Analyst and the Public Health Laboratory. They also supervise premises where food is sold, stored, manufactured or prepared for sale and carry out the duties required under the Pharmacy and Poisons Act 1933 and 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. Food Hygiene Regulations, 1955 The work in connection with food hygiene was continued throughout the year to premises in the Borough where food is handled. The initial inspections under the new Regulations took up much more time than previous inspections as additional information was required and much time was taken up in discussing with occupiers the question of necessary improvements. The following list shows the number and type of premises in the Borough where food is sold, stored or prepared :- Dairies 2 Food Factories 13 Restaurants, Cafes and Canteens 498 Confectioners 472 Butchers 212 Greengrocers 327 Fishmongers 86 Fish fryers 61 Bakers and Bakehouses 114 Grocers 670 Off Licences 87 Public Houses 58 Stalls 147 2,747 33 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 22 63 54 15 39 33 24 40 39 18 34 55 51 17 34 23 15 44 12 21 653 Restaurant Kitchens 138 207 84 69 74 80 45 95 40 64 59 98 59 97 77 57 154 67 27 47 1,638 Ice Cream Premises 21 10 17 — 3 10 4 15 7 3 — 4 1 7 5 7 7 7 4 16 148 Butchers' Shops 43 58 98 40 65 32 16 27 66 26 14 27 21 37 34 21 46 4 6 15 696 Greengrocers' Shops 31 34 50 23 26 21 11 12 27 10 10 19 6 19 9 48 46 14 9 9 434 Fishmongers' Shops 11 41 22 3 16 5 3 — 7 — 1 19 4 7 4 8 5 4 1 1 162 Fried Fish Shops 13 13 15 4 20 9 4 6 2 1 2 26 2 1 3 5 1 — 1 1 129 Market Stalls 4 99 26 2 15 7 32 139 891 1 9 336 — 794 87 5 106 — — — 2,553 Other Premises 172 212 204 102 189 208 87 168 215 88 240 320 95 183 197 255 277 78 92 127 3,509 Bakehouses 9 11 15 1 12 10 18 4 8 5 12 17 3 3 4 3 — 1 7 1 144 Total Visits 464 748 585 259 459 415 244 506 1,302 216 381 921 242 1,165 454 432 657 219 159 238 10,066 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 FOOD AND FOOD PREMISES 35 The amount of work completed during 1957 to comply with the requirements of the Regulations is indicated in the following details:- Washhand basins provided 73 Sinks provided 13 Provision of hot water over sink and washhand basin 101 Accommodation for clothing provided 5 Refrigeration provided 1 First Aid Materials provided 4 Premises repaired or redecorated 47 Food preparation tables covered with non-absorbent materials 10 Adequate protection for open food 13 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 32 applications were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Twenty nine notices of cancellation of registration were received. At the end of the year there were 233 persons on the register, including 21 persons with premises outside the Borough. There were two 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. Food and Drugs Act, 1955 Ninety-three samples of milk were submitted for analysis. Of these 10 were samples of Channel Island and South Devon milks with an average fat content of 4.46 per cent. The remaining 83 samples had an average fat content of 3.76 per cent. The following licences for the sale of milk under these designations were granted during the year: Dealers' Dealers' Supplementary Total Pasteurized 274 35 309 Sterilized 324 38 362 Tuberculin Tested 196 33 229 Total 794 106 900 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 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" Two distributors' (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. Meat There are 212 butchers' shops in the Borough. The majority are registered under Section 16(1)(b) of the Food and Drugs Act, 1955, for the preparation or manufacture of sausages or potted, preserved, pickled or pressed foods. There were 696 visits made to these shops during the year. 37 FOOD AND FOOD PREMISES Slaughter of Animals There are no private slaughterhouses in the Borough. 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. Unsound Food Seventy-nine 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. 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 1957 was 382, and 456 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. 38 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 TABLE X PART II OF POISONS LIST Principal Business Number of Premises Number of Visits Confectioners 3 4 Domestic stores, ironmongers, etc. 85 97 Drug stores 16 21 Grocers 254 307 Hairdressers 15 18 Nurserymen and florists 9 9 Total 382 456 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. One hundred and forty-four 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. 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. 39 FOOD AND FOOD PREMISES During the year 55 applications for registration under the provisions of Section 16 (l)(a) and 28 applications for registration under the provisions of Section 16(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 no applications were received for licences under the provisions of Sec. 144, to use premises as slaughterhouses. Bacteriological Examination of Food and Waters Two hundred and eighty-five samples were examined bacteriologically at the Public Health Laboratory during the year. They were as follows: Milk Ice-cream Egg Albumen Artesian Well Waters Swimming Pool Waters Others Total 236 22 18 2 18 3 285 Milk Of the 236 samples of milk, 106 were submitted to the phosphatase test, 106 to the methylene-blue test, and 24 to the turbidity test. These samples were reported satisfactory. Ice-cream The 22 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 Wealth T flhnratnrv The following table gives a summary of the results: Methylene-Blue Reduction Test Provisional Grade Number of Samples 1 7 2 7 3 4 4 4 Total 22 40 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Egg Albumen Four samples were examined for the presence of pathogenic organisms. The organism Solmonella typhimurium was isolated in three of the four samples. Artesian Well Water Two samples were submitted for examination, and were reported satisfactory. Swimming Pool Water Eighteen samples were submitted for examination, and all were reported satisfactory. Others The three miscellaneous samples 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; 67 samples of milk, 879 other foodstuffs and 54 drugs. Of these 69 were submitted as formal samples while 931 were purchased informally. None of the formal but nine or 0-96 per cent, of the informal samples were found to be adulterated or not up to standard. The total adulterations reported were 9 or 0-9 per cent, of the samples submitted. The 9 samples found to be adulterated were: One sample each of the following:- milk, bread, butter, margarine with 10% butter, sponge role, cake, coffee beans, two samples of ice-cream. 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 447 231 1 - (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,099 1,034 8 - (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 93 14 - - Total 1,639 1,279 9 — (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 6 6 - 6 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences (a) insufficient 3 1 — — — (b) unsuitable or defective 42 34 — 6 — (c) not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to outwork) 1 1 — 1 — Total 53 43 — 13 — 41 42 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 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. 562 - - „ „ cleaning and washing 2 - - Household linen 1 - - Furniture and upholstery 2 - - Artificial flowers 4 - - Paper bags 13 - - Boxes or other receptacles made wholly or partially of paper 21 _ Stuffed toys 15 — - Cosaques, Christmas crackers, Christmas stockings, etc. 22 Lampshades 116 — - Total 758 — — London County Council (General Powers) Act, 1954 Hairdressers and Barbers Section 18 of the above Act requires, inter alia, that, 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. During the year 25 new registrations were made, and 12 cancellations received. The total number on the register at the end of the year was 233. REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1957 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, 1957, 946 were articles of food and the remaining 54, drugs. All were submitted by the Council's Food Inspector, 69 having been taken with the formalities required by the Act and 931 informally. Samples of the following substances were analysed: fats (butter, margarine, etc.), 48; beverages (cocoa, coffee, tea, etc.), 42; cereal preparations, 18; cream, 37; fish (canned etc.), 41; fruit (canned and dried), 72; meat products (including sausages), 38; milk, 67; pickles and condiments (including spices), 42; preserves, 29; soup, 21; vegetables 47; bicarbonate of soda, 7; iodine solutions, 4; ointments, 13; seidlitz powders, 5. 43 44 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 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 720 Coffee beans Spoiled by overroasting 770 Cake Contained rodent excrement 1132 Ice cream 12% deficient in fat 1134 Ice cream 9 % deficient in fat 1135 Sponge roll Stale and soapy flavour 1166 Margarine with 10% butter 0-28% excess water 1191 Bread Contained mineral grease 1277 Butter 0-55% excess water 3 Milk Contained a mould Adulteration The amount of adulteration detected during the year was: For formal samples 0.0 per cent. For informal samples 0.96 per cent. For all samples 0.9 per cent. 45 REPORT OF THE PUBLIC ANALYST FOR 1957 Complaint Samples Case No. 648. Bread. Submitted on the complaint of light brown streaks in loaf. The complaint was considered not justified. Case No. 971. Tea. Submitted on the complaint of the unusual colour when brewed. The complaint was considered not justified. Case No. 972. Lemonade. Submitted on the complaint that it had caused sickness. The complaint was considered not justified. Case No. 991. Sterilised Milk. Submitted on the complaint of smell and taste. The complaint was considered not justified. Case No. 1096. Anchovy Paste. Submitted on the complaint of the taste. The complaint was considered not justified. Case No. 1148. Orange Squash. Submitted on the complaint of the flavour. The complaint was considered not justified. Case No. 1190. Sweets. Submitted on the complaint that they had caused sickness. The complaint was considered not justified. Case No. 1292. Tinned Pineapple. Submitted on the complaint that it had caused sickness. The complaint was considered not justified. Case No. 1429. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. 46 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 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 4 12.65 3.88 8.77 February 5 12.63 3.80 8.83 March 9 12.25 3.58 8.67 April — — — — May — — — — June 8 12.23 3.52 8.71 July 20 12.27 3.59 8.68 August — — — — September 9 12.67 3.72 8.95 October — — — — November 9 12.76 3.89 8.87 December 19 13.13 3.91 9.22 The average composition of the 83 samples of milk analysed during the year and returned as genuine was as under: Total milk solids 12.64 per cent. Milk fat 3.76 per cent. Non-fatty solids 8.88 per cent. The average composition of the 10 samples of Channel Island and South Devon milks was as under: Total milk solids 13.56 per cent. Milk fat 4.46 per cent. Non-fatty solids 9.10 per cent. INDEX PAGE Accidents, Deaths from 22 Acute Encephalitis 18 Analyst, Report of 43 Bacteriological Examinations of Milk 39 „ „ of Ice-cream 39 Bathing Pools and Swimming Pools 26 Bed Bugs, Eradication of 27 Births, Birth-rates 11 Butchers' Shops 34 Cancer 22 Childbirth, Deaths from 14 Circulatory Diseases 22 Closing Orders 30 Crematorium 29 Cutting-off Notices—Water Supply 26 Deaths, Causes of 13 Death-rates 12 Death-rate from Infective Diseases 15 Death-rate, Infantile 14 Deaths, Number of 12 Diphtheria 15 Diseased or Infirm Persons, Removal of 27 Disinfection 21 Dysentery, Sonne 19 Enteric Fever 19 Erysipelas 20 Factories Act, 1937 and 1948 41 Factories and Workshops 41 Food and Drugs Act, 1955 35 Food Poisoning 20 Food, Supervision of 33 Food Places, Inspection of 34 Food Places, Number on Register 33 Houses and Premises Inspected 24 Housing Act, 1936 30 Housing Repairs and Rents Act, 1954 31 Housing Statistics 30 Hydrogen Cyanide Disinfection 27 47 48 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1957 Illegitimate Children, Births of 11 Infant Mortality 14 Infective Diseases 15 Infective Diseases, Cases of 16 Infective Diseases, Death-rate from 15 Infirm or Diseased Persons, Removal of 27 Influenza, Deaths 19 Influenzal Pneumonia and Acute Primary Pneumonia 19 Insanitary Areas 32 Malaria 20 Maternal Mortality 14 Meat 36 Meningococcal Infection 18 Milk Analysis 46 Milk, Bacteriological Examination of 46 Milk Premises, etc., on Register 35 Milk (Special Designations) Regulations, 1949-54 36 Mortuary 27 Non-infective Diseases, Deaths from 22 Notification of Infective Diseases 17 Outworkers 42 Overcrowding 31 Pharmacy and Poisons Act, 1933 37 Pharmacy and Medicines Act, 1941 37 Poliomyelitis 18 Population 9 Pregnancy, Deaths from Accident and Diseases of 14 Preserved Meat, etc., Manufacture of 38 Public Analyst, Report 43 Puerperal Pyrexia 19 Pulmonary Tuberculosis, Notification of cases of 23 Rodent Control 26 Samples, Formal and Informal, Number of 44 Sanitary Inspection of Borough 24 Scabies 20 Scarlet Fever 15 Slaughter-houses 37 Slaughter of Animals Acts, 1933-1954 37 INDEX 49 Smallpox 15 Statistics for the Borough 9 Suicide, Deaths from 22 Swimming Baths and Bathing Pools 26 Syphilis, Deaths from 20 Tuberculosis 23 Unfit Houses 32 Unsound Food 37 Water Supply 38 Water Supply, Cutting-off Notices 26 Whooping Cough 15 Printed by Geo. Gibbons Ltd., Leicester