AAc. 4388 WAN 95 Metropolitan Borough of Mandsmorth ANNUAL REPORT of the Medical Officer of Health for the Year 1958 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 1958 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, I beg to present to you the Annual Report on the health of the Borough for the year 1958. The population of the Borough which levelled off in 1957 resumed its slight upward trend, the total population being estimated at 337,900, some 300 over the previous year. The crude birth rate for 1958 was 15.30 per thousand, a slight increase over the previous year and the adjusted birth rate was 14.68. The crude death rate for the year was 15.36, the adjusted rate being 10.75 per thousand of the population. The adjusted rates were arrived at after taking into account the area comparability factor. The record infant mortality rate of 15 which I noted in my last year's report was not improved upon in 1958 for this year the rate per 1,000 live births was 19.3. This rate was based on a total of 100 deaths of infants under one year as compared with 79 in the previous year, and although not as good as in 1957, is still not unsatisfactory and compares with 22.6 for the County of London and 22.6 for the country as a whole. As these rates become smaller, fortuitous fluctuations from year to year must be expected. In noting last year that for the first time in our history no woman had died from the effects of pregnancy or child birth, I said it would be too much to hope that in every future year I should be able to report an equally satisfactory result. In 1958, in fact, five mothers died from accidents or diseases of pregnancy and child birth, giving a maternal mortality rate of 0.94 per thousand live and still births. There was a big drop in the number of cases of infectious disease in 1958 compared with 1957 due in the main to the much smaller number of cases of measles that were notified and to a lesser extent 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 the smaller number of cases of whooping cough. On the other hand there was an increase in the number of cases of scarlet fever and also an increase in the number of cases of tuberculosis to which I make more reference later on. It is satisfactory to note that the number of cases of food poisoning notified was reduced from 579 to 232 and I make some reference to this also a little later on in this preamble. There were 20 confirmed cases of poliomyelitis as compared with 71 in the previous year. The differences in the numbers of other infectious diseases notified were not particularly noticeable. I referred in my Report for 1955 to the increasing toll which coronary arterial disease is taking, particularly in males, in what is probably the most important economic and productive period of life. The figures for 1958 are shown in Table III(a) and they indicate that there were 650 deaths from coronary arterial disease, angina, etc., compared with 598 in 1957. This, however, does not give the full picture, for of the 650 deaths from this cause in 1958, 386 were in men. In the age groups 15-45 and 45-65, the contrast between the sexes is even more marked. For instance, in the age group 15-45, 15 males died compared with one female and in the age group 45-65, 142 males died compared with 29 females. The trend of increasing deaths with a particularly heavy incidence in males in the age groups 15-65 continues. It will be asked what, if anything, is being done or can be done to prevent this destruction of the manpower of the nation. More particularly, what can public health departments, who are charged with safeguarding the health of the community, do. Unfortunately, the answer must be that at the present time there seems to be comparatively little that we can do. There may well be social and environmental conditions at present not known, which account for the high prevalence of deaths from this disease at these age groups in men, but if so, they are not clearly definable. A great deal of research the world over is being undertaken into the problem and such factors as the effect of diet, exercise and occupation have been carefully investigated without, so far, any unqualified opinions emerging. For instance, investigations by biochemists have suggested that one factor may be a disordered state of the fatty constituents of the blood and other tissues arising possibly from dietary factors. When large amounts of fatty food, especially animal fats, are taken over many years, there is a suggestion that this form of disease may arise although clear proof is lacking. The investigations suggest that vegetable fats are probably not harmful. The effect of exercise and the type of work in relation to exercise has been looked into and it may be that people working in active routine jobs are less likely to become victims than those engaged in more sedentary occupations. These research findings at the moment are little more than indications of the more definite answers which eventually will emerge. In the meantime, what can be done in the light of existing knowledge to prevent this form of heart disease? So far, as I have said, no REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 3 definite answer can be given but at least observance of what are usually known as the rules of health can certainly do no harm and might quite well do a great deal of good. Regular habits, steady work within the individual's capacity, reasonable outdoor exercise in relation to age and fitness, temperance in eating and drinking, particularly of fatty foods, are all part of the kind of life which most sensible people would, in any case, wish to lead. Nevertheless, people who consciously or unconsciously conform to these rules, do and will become victims of the disease, whereas others who prefer to ignore them and live for the day may not be affected. Medicine and public health are not exact sciences and there is a great deal that is hidden, although the Ancients may have had an inkling of the truth for we read in the Apocrypha "A cheerful and good heart will have a care for his meat and diet". The number of notifications of tuberculosis at 589 was 40 above the previous year, this increase being in part due to the transfer of cases from other boroughs of London into Wandsworth consequent upon the extensive new housing construction which has been going on in the Borough. A better idea of what is happening in the field of chest diseases can be obtained by considering deaths from tuberculosis and other chest diseases, particularly lung cancer and bronchitis. In 1958, there were 43 deaths from pulmonary tuberculosis in Wandsworth and the corresponding figure in 1950 was 136. In the case of lung cancer, there were 264 deaths in 1958 compared with 139 in 1950 and in the case of bronchitis there were 305 deaths in 1958 compared with 259 in 1950. In other words, while there has been quite an astounding reduction in the number of deaths from tuberculosis in the eight years from 1950, there has been an equally marked increase in the number of deaths from lung cancer and to a lesser extent from chronic bronchitis. It is clear that while tuberculosis still remains a problem, it is proportionately much less so, whereas lung cancer and to a lesser extent bronchitis, have become more of a problem. In spite of advances which have been made in the diagnosis and treatment of tuberculosis, there are no grounds for complacency and it is not likely that we shall see the end of this disease in the foreseeable future although we may have reached the beginning of the end. As regards lung cancer and chronic bronchitis, the immediate outlook is not hopeful. Associated as they are in different measure with heavy cigarette smoking and atmospheric pollution, social and environmental factors not capable of quick and easy change, the expectation is that in the years immediately ahead there will be more deaths from these diseases. No doubt if and when heavy cigarette smoking becomes less ingrained as a social habit, there will be fewer cases of lung cancer and similarly as clean air campaigns in our large towns and cities get under way, then the outlook for chronic bronchitis will be improved. In the immediate and near term, the greatest hope lies in early diagnosis of lung cancer 4 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 cases and more research into the physiological causes and means of prevention of chronic bronchitis. In this connection, it is interesting to know of the proposals to set up in Wandsworth a "model" chest clinic which will work closely with and be staffed from the Brompton Hospital. It is hoped that there will thus be provided not only a maintenance of the existing service but facilities for research and if the local public health departments can play any part, we shall certainly do so. This year, for the first time, I have devoted a small section of the Report to accidents in the home. It is not possible to obtain absolutely accurate figures of home accidents but from data provided by the London Ambulance Service I have been able to calculate for the years 1956, 1957, and 1958, figures which I believe are reasonably accurate. I hope to be able to continue this year by year so that we shall have a record over the years of home accidents in our population. As I mention in the body of the Report, the measures most likely to reduce these accidents are educative through the medium of our public health inspectors, health visitors and other workers. The routine work of the public health inspectors has continued, handicapped, as I have pointed out in previous years, by the shortage of staff. Headway has been made in implementing the Food Hygiene Regulations, much help being received from tradespeople and retailers. In this connection, it is interesting, as I pointed out earlier, to note the reduction in the number of cases of food poisoning notified in 1958 as compared with 1957 and it is tempting to relate the one to the other. While certainly we may hope that part of this reduction may indeed be due to our various efforts in this field, there are also other and more fortuitous factors at work. Nevertheless, we may be seeing some results of this legislation and it will be interesting to watch the trend of food poisoning notifications in future years. In my last year's Report, I referred briefly to the important problem of Clean Air and the fact that a public enquiry had been held in connection with the Council's first Smoke Control Area. The Minister in due course confirmed the Order which will come into operation shortly. In the meantime, considerable steps have been taken by the Health Department staff, working in close liaison with the Town Clerk's Department, in advising, supervising and approving the work done in many premises to enable the various approved fuels to be burned. Work under the Rent Act, 1957, continued; apart from inspections of property by the Inspectors a large volume of administrative and "office" routine is necessary to ensure that the various procedures possible under the Act are being complied with. During the year, all my colleagues in the Health Department have worked well, energetically supported as usual by the Chairman of the Health Committee, Councillor T. V. Rowlands to whom REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 5 thanks are due for his help and guidance. I should like particularly to thank my Deputy, Dr. Garland and Mr. E. V. Roots, the Chief Public Health Inspector, for their continued diligence and the conscientious way in which they carried out their duties and the staff of the other Departments of the Council for their co-operation and help in many problems. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, J. TUDOR LEWIS Medical Officer of Health. STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health .. J. Tudor Lewis, m.d., d.p.h. Deputy Medical Officer of Health A. Garland, m.d., d.p.h. Chief Public Health Inspector .. E. V. Roots Deputy Chief Public Health Inspector C. F. Standish Public Health Inspectors W. H. Jones A. E. Handley J. H. Massey P. P. Leacock J. H. Sands A. J. Lansley S. R. Coomber A. E. Lock C. Jones J. Smith D. J. Hughes P. O'Grady K. J. Winton J. R. Holloway A. F. Cayley Student Public Health Inspectors J. D. Morritt M. Timlin Administrative and Clerical .. S. F. Jennings A. J. K. Green A. E. Hollis E. Harris W. Pitman F. Chislett S. Taylor A. J. Brown D. H. Barnes N. Lane A. G. Wyatt (deceased) Mrs. F. Hull Miss J. Eley Miss D. Scott Mrs. P. McKeown Mrs. S. Couper Mrs. M. Pitman Resigned C. F. Harrison seconded from J. Weir Housing Dept. 6 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 7 STAFF OF PUBLIC HEALTH DEPARTMENT—Continued Disinfecting Station F. Stennings G. Bamborough J. Williams H. Coster G. W. Price L. D. Dean A. E. Clement D. Reed Mortuary J. Anderson The following changes occurred in 1958: Appointments Mr. A. F. Cayley, Student Public Health Inspector. Appointed Public Health Inspector in July. Mr. M. Timlin. Appointed Student Public Health Inspector in August. Resignation Mrs. M. Pitman. General Assistant, service 11 years. Resigned in August. Death Mr. A. Wyatt. Clerical Assistant, service 18 years. Died in August. 1 STATISTICS AND SOCIAL CONDITIONS Area 9,201 acres Resident population in 1958 337,900 Wandsworth is the largest of the Metropolitan Boroughs. It has an area of 9,201 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. 8 STATISTICS AND SOCIAL CONDITIONS 9 Extracts from Vital Statistics Number of Live Births: Males Females Total Legitimate 2,446 2,305 4,751 Illegitimate 216 206 422 Total live births 2,662 2,511 5,173 Number of Stillbirths 60 53 113 Number of deaths 2,396 2,797 5,193 Birth-rate—Crude 15.30 Adjusted 14.68 Death-rate—Crude 15.36 Adjusted 10.75 Rate per 1,000 (Live and Still) Births Deaths from puerperal causes 5 0.94 Infantile mortality per 1,000 live births: All infants 19.3 Legitimate infants 18.9 Illegitimate infants 23.9 Deaths from Cancer 1,174 „ „ Diphtheria 0 „ „ Scarlet Fever 0 „ „ Measles 0 „ „ Whooping Cough 0 „ „ Tuberculosis 48 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 337,900 and all the rates used in this Report are based on this figure. Table I shows the approximate population of each Parliamentary Division, based on the above estimation. TABLE I Population estimated to middle of 1958 Putney 87,700 Central 96.320 Clapham 81,040 Streatham 72,840 Whole Borough 337,900 Births The total number of births belonging to the Borough registered during 1958 was 5,173 consisting of 2,662 males and 2,511 females. The number for 1957 was 5,037. The crude birth-rate was 15.30 per 1,000 persons living compared with 14.92 for 1957. The adjusted rate works out at 14.68 after taking into account the area comparability factor supplied by the Registrar-General. The birth-rate for England and Wales as a whole was 16.4 and for London 16.4. Four hundred and twenty-two illegitimate births took place in the Borough compared with 388 in 1957. 10 VITAL STATISTICS 11 Deaths The number of registered deaths which took place in the Borough during the year was 3,705 but 480 of these did not belong to the Borough, while 1,972 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 5,193, of whom 2,396 were males and 2,797 females. The crude death-rate for the year was 15.37, compared with 14.72 for 1957, but after taking into account the area comparability factor supplied by the Registrar-General, the adjusted rate works out at 10.75. The death-rate for England and Wales as a whole was 11.7 and for London 11.8. 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 545 604 1,149 13.10 Central 785 946 1,731 17.97 Clapham 629 746 1,375 16.97 Streatham 437 501 938 12.88 Whole Borough 2,396 2,797 5,193 15.37 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 1958 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 43 30 13 — — — 8 16 19 13 9 9 12 Tuberculosis, Other 5 3 2 — — — 2 1 2 2 1 1 1 Syphilitic Disease 18 10 8 — — — 1 3 14 3 10 4 1 Diphtheria — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — — Meningococcal Infections — — — — — — — — — — — — — Acute Poliomyelitis 1 1 — — — — 1 — — 1 — — — Measles – – – – – – – Other Infective and Parasitic Diseases 5 2 3 1 3 1 1 3 1 Malignant Neoplasm, Stomach 137 70 67 7 32 98 28 43 41 25 Malignant Neoplasm, Lung, Bronchus 264 217 47 6 129 129 54 48 109 53 Malignant Neoplasm, Breast 136 1 135 16 50 70 26 23 67 20 Malignant Neoplasm, Uterus 54 54 3 25 26 10 7 30 7 Other Malignant and Lymphatic Neoplasms 583 273 310 1 4 29 179 370 113 106 283 81 Leukaemia, Aleukaemia 17 8 9 1 2 3 11 2 7 5 3 Diabetes 34 10 24 – – 5 28 7 10 8 9 Vascular Lesions of Nervous System 489 168 321 9 81 399 128 134 117 110 Coronary Disease, Angina 650 386 264 16 171 463 157 182 160 151 Hypertension, with Heart Disease 76 26 50 I 12 63 17 22 16 21 Other Heart Disease 1.004 414 590 9 56 939 204 442 151 142 Other Circulatory Disease 225 85 140 4 32 189 58 61 54 52 Influenza 18 8 10 1 1 2 4 10 3 9 4 2 Pneumonia 295 110 185 7 10 7 2 28 241 68 138 53 36 Bronchitis 305 190 115 1 4 2 4 67 227 71 88 80 66 Other Diseases of Respiratory System 46 26 20 2 17 27 14 8 13 11 Ulcer of Stomach and Duodenum 45 26 19 10 35 9 13 14 9 Gastritis, Enteritis, Diarrhœa 19 4 15 _ – 7 12 5 4 6 4 Nephritis and Nephrosis 21 10 11 1 6 14 3 8 3 7 Hyperplasia of Prostate 27 27 – – – – – – 26 9 7 6 5 Pregnancy, Childbirth, Abortion 5 5 5 – – – 4 – Congenital Malformations 23 10 13 15 3 3 1 I 5 5 8 5 Other Defined and Ill-defined Disease 487 177 310 56 13 4 21 62 331 79 276 76 56 Motor Vehicle Accidents 36 27 9 2 14 7 13 9 13 8 6 All other Accidents 70 44 26 4 3 4 9 17 33 19 31 12 8 Suicide 53 31 22 – – – 13 27 13 11 17 10 15 Homicide and Operations of War 2 2 – – 2 – – – – – – 2 – All Causes 5,193 2,396 2,797 83 37 28 190 1,052 3,803 1,149 1,731 1,375 938 12 VITAL STATISTICS 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. VITAL STATISTICS 13 TABLE III (a). DEATHS FROM HEART DISEASE, 1958 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. — — 15 142 229 386 — — 1 29 234 264 650 Hypertension with Heart Disease — — 1 7 18 26 — — — 5 45 50 76 Other Heart Disease — — 3 28 383 414 — — 6 28 556 590 1,004 — — 19 117 630 826 — — 7 62 835 904 1,730 Infantile Mortality There were 100 deaths of children under one year giving an infant mortality rate of 19.3 per 1,000 live births. This compares with a rate of 15 for 1957 and 17 for 1956. For the ten years ended 1948 the average infant mortality rate was 39, while for the ten year period ending 1958, the average rate was 21. Maternal Mortality Five deaths occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.94 per 1,000 live and still-births. 3 INFECTIVE DISEASES The number of deaths from all notifiable infectious diseases was 95. This included 48 from all forms of tuberculosis and 46 from the notifiable forms of pneumonia. There was one death from poliomyelitis. From all notifiable infective diseases the death-rate was 0.28 per 1,000. Table I shows the number of cases of the notifiable diseases reported, arranged in age groups, and Table II 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 One case only was bacteriologically confirmed, in the person of a staff nurse at one of the local hospitals. Where it was considered advisable, nose and throat swabs from patients of the ward in which the nurse worked were bacteriologically examined, all with negative results. Several other cases were reported and investigated as suspected diphtheria during the year, but in all cases, the diagnosis was not confirmed. Scarlet Fever Three hundred and one cases were notified compared with 235 in 1957 and 202 in 1956. The diagnosis was not confirmed in one case. No deaths occurred. Whooping Cough One hundred and twenty-six cases were notified. There were no deaths. Measles The number of cases notified during the year was 1,602 compared with 3,802 in 1957, 677 in 1956 and 5,206 in 1955. 14 INFECTIVE DISEASES 15 TABLE I 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 300 5 22 49 158 39 19 7 1 Measles 1,602 98 258 395 802 42 5 2 Whooping Cough 126 18 26 29 49 4 Enteric Fever and Paratyphoid Fever 6 — 2 2 2 Malaria 1 1 Dysentery 341 7 27 30 108 68 24 61 16 Erysipelas 39 — — 1 1 4 8 14 11 Scabies 15 — 2 4 1 4 3 1 Puerperal Pyrexia 114 — 45 69 — Ophthalmia Neonatorum 2 2 — Meningococcal Infection 13 5 5 1 2 Acute Poliomyelitis 20 1 4 5 5 1 1 3 Acute Encephalitis 7 1 1 2 1 2 Anthrax Pneumonia: Acute Influenzal 67 2 2 5 5 6 6 10 17 14 Acute Primary 132 2 3 10 10 11 17 20 31 28 Tuberculosis—All forms 589 I 5 8 20 15 79 309 122 30 Food Poisoning 232 2 12 17 17 19 53 40 48 24 Total 3,607 143 365 551 1,184 208 259 540 250 107 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 TABLE II 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 10 4 15 28 13 30 36 23 10 10 26 18 9 5 2 3 16 19 13 10 300 Measles 239 64 80 225 145 70 56 154 49 107 87 23 30 35 83 25 24 22 33 51 1,602 — Whooping Cough 9 5 21 10 1 9 13 7 3 4 8 3 5 1 2 3 3 12 4 3 126 Enteric Fever and Paratyphoid Fever 1 — 1 — — — — — — 1 1 1 1 6 — Malaria — — — — — — — — — — — 1 — — — — 1 — Dysentery 15 2 13 34 5 24 23 36 15 33 4 6 7 58 9 35 5 8 5 4 341 — Erysipelas 1 1 4 3 2 5 3 2 2 5 1 2 2 1 1 1 3 39 Scabies 1 1 3 — 2 1 — 2 1 — — 1 1 — 2 15 Puerperal Pyrexia — — — 2 — 6 4 4 6 8 3 6 19 19 14 4 5 7 3 4 114 — Ophthalmia Neonatorum 1 1 2 — Meningococcal Infection 1 2 2 1 1 2 2 1 1 13 — Acute Poliomyelitis 2 — — 4 2 — — — — 1 2 3 1 2 — — 1 1 1 20 1 Acute Encephalitis 1 1 1 1 1 1 — 1 7 — Anthrax — — — — — — — — — — — — — — — — — — — — — — Pneumonia:— Acute Influenzal 3 2 1 4 4 2 3 4 5 6 4 4 3 4 5 2 3 3 2 3 67 9 Acute Primary 4 5 8 10 11 16 9 6 5 6 6 g 4 4 8 4 5 4 5 4 132 37 Tuberculosis—all forms 136 24 24 23 20 29 24 32 28 19 24 26 23 27 18 22 24 24 19 23 589 48 Food Poisoning 18 6 35 11 12 105 3 8 2 3 3 4 4 7 — 3 4 — 2 2 232 — Total 441 114 206 356 220 298 174 281 127 206 170 105 105 165 145 106 90 101 88 109 3,607 95 INFECTIVE DISEASES 17 Poliomyelitis 65 cases of this disease were reported and investigated during the year, compared to 147 in the previous year. In 45 cases the diagnosis was not confirmed. Of the remaining 20 confirmed cases, 11 were of the paralytic type and nine nonparalytic. One death occurred, in a male aged 37 years. Three-fourths of the number of cases were in age group 5 to 9 years. Main incidence of the cases occurred in the last four months of the year. The figures of poliomyelitis from 1947 to 1958, 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 1958 No. of cases reported as suspected poliomyelitis and investigated 119 31 89 71 29 73 73 41 104 85 147 65 No. of cases confirmed (a) paralytic 78 15 58 40 4 23 19 5 22 24 43 11 (b) non-paralytic 7 16 8 2 27 15 28 9 Deaths 4 6 4 7 — 5 2 — 1 2 4 1 Meningococcal Infection Thirteen confirmed cases were notified, none of which proved fatal. Sixteen other cases were investigated but these were subsequently not confirmed. In 1957 there were eight confirmed cases with no deaths. Acute Encephalitis Of 12 cases reported, five were confirmed as Acute Lymphocytic Meningitis (Acute Infective Encephalitis) and two as Post Infectious Encephalitis. Total seven cases for the year. No deaths occurred. 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 Typhoid and Paratyphoid Fever Of nine cases reported during the year, one was subsequently confirmed as typhoid and five as paratyphoid. Two of the latter had previously been on holiday on the Continent. Diagnosis was not confirmed in the three remaining cases. Puerperal Pyrexia During the year 114 cases were notified, of which 113 occurred in hospital and one at home. Thirty-seven of the hospital notifications referred to patients whose home addresses were outside the borough. Information was also received of 40 cases, referring to Wandsworth residents whose confinements took place in hospitals located in other Metropolitan boroughs. Sonne Dysentery Investigation of outbreaks of diarrhoea among pupils of six schools in the borough resulted in a number of cases being bacteriologically confirmed as Sonne dysentery. Details of these outbreaks showing numbers of positive cases discovered and faecal specimens examined from actual and suspected cases is given below. In addition to these outbreaks there were other unrelated cases for which formal notifications were received. All cases were closely followed up and where considered necessary bacteriological examination of stools specimens from family contacts was made. Date Outbreak No. of cases discovered No. of specimens examined from cases and contacts May July July July September October 1 2 3 4 5 6 50 9 8 17 Nil 39 414 44 37 78 12 330 Influenza The number of deaths from Influenza was 18 compared with 58 in 1957, 30 in 1956 and 30 in 1955. Influenzal Pneumonia and Acute Primary Pneumonia These are the notifiable forms of pneumonia. Sixty-seven cases of acute influenzal pneumonia and 182 cases of acute primary pneumonia were notified. Nine of the former, and 37 of the latter died. The total number of deaths credited to all forms of pneumonia during the year was 295, compared with 252 in 1957. INFECTIVE DISEASES 19 Malaria One case was reported. It was a recurrent case. Erysipelas Thirty-nine cases were notified. Other Infective Diseases Eighteen deaths occurred from syphilis. Scabies Fifteen 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 1958. A fee of 5s. Od. per treatment is paid by Wandsworth to Battersea for this service. A total of 121 treatments was given during the year at the Battersea Cleansing Station. At the Council's Disinfecting Station, 32 treatments were given. Food Poisoning Two hundred and thirty-two formal notifications were received during the year. One hundred and forty-four were single unrelated cases and 88 comprised 31 minor family outbreaks involving two or more persons. Most of the single cases were only slightly affected and where bacteriological examination was carried out, organisms likely to have caused the illness were discovered in 11 cases only. The organisms found were Salmonellae typhimurium, montevideo, heidelberg and Saint Paul. It was not possible to identify the causative agent in 27 of the minor outbreaks. 9 In two of the remaining four, Salmonella newport was isolated and in the other two Salmonellae typhimurium and heidelberg respectively. 20 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 Diseases Reported from Schools A total of 2,659 infective diseases was reported from schools in the Borough throughout the year. The numbers of each disease were: Scarlet Fever 215 Measles 563 German Measles 494 Poliomyelitis 4 Chicken Pox 774 Whooping Cough 56 Mumps 321 Dysentery 72 Other Diseases 160 Disinfection During the year 537 rooms were disinfected after infectious and other disease, 283 rooms disinfected for vermin, and 150 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 563 Faeces for the typhoid and dysentery groups 2,549 Miscellaneous specimens 15 Total 3,127 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 three 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 1,174, the number of males being 561 and females 613. The death rate was 3.47 per 1,000. The number of deaths in 1958 was 13 more than in the previous year. Deaths from diseases of the heart and circulatory system were 1,955 compared with 1,802 in 1957. Of these deaths 1,654 were of persons of 65 years of age and above. There were 646 deaths from diseases of the respiratory system compared with 537 in 1957. The number of deaths from bronchitis was 305 compared with 242 in 1957, and from pneumonia (all forms) 295 compared with 252 in 1957. One hundred and sixty-one deaths were due to violence, 36 of them being due to motor accidents, 53 to suicide and 72 to other forms of violence. CERTIFICATES OF VACCINATION AND INOCULATION One thousand, six hundred and thirty-two 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 seven 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 three cases it was found necessary to recommend superannuation. Forty-six shorter reports on members of the staff who were sick were obtained from doctors and hospitals at the request of the departments concerned. 21 TUBERCULOSIS Notifications The total number of new cases which came to the notice of the Department during 1958 was 589 compared with 549 in 1957. The sources of information regarding the new cases were as follows: Primary notifications on Form A 267 Notifications from H.M. Forces 4 Unnotified at death 1 Transfers from other sanitary authorities 317 Total 589 Five hundred and eighty-eight cases were added to the notification register during the year and 228 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 5,783. Deaths The number of deaths certified as due to various forms of tuberculosis was 48. Particulars of the new cases and deaths during the year, classified by sexes and age-groups are given in the following table: Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year 1 – – – – – – – 1-2 1 1 – – – – – – 2-5 4 2 3 3 — — — — 5-10 8 9 1 – – – – – 10-15 7 6 — 2 — — — — 15-25 35 34 5 2 — — — 1 25-45 151 139 11 10 4 4 1 — 45-65 81 33 4 2 12 4 1 — 65 and upwards 26 1 3 3 14 5 1 1 Totals 314 225 27 22 30 13 3 2 22 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 I. TABLE I Inspections ReInspections Total To investigate complaints 6,150 16,603 22,753 Inspections under Shops Act 253 — 253 Infectious Diseases 1,372 494 1,866 Inspections under Factories Act 1,270 4 1,274 Housing Clearance Area Scheme 279 — 279 Housing Reports 495 — 495 Hairdressers 315 — 315 Other inspections 7,397 2,864 10,261 Totals 17,531 19,965 37,496 Smoke observations 255 Legal proceedings, attendances at court 25 Table II gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 395 and 930 were cleansed or repaired. The drains of 19 houses were reconstructed, and 148 drains were partially reconstructed. Damp conditions have been remedied in 1,103 premises, and in 13 of these damp courses were inserted. 23 24 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 TABLE II Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 192 280 217 106 795 2. Drains tested 93 145 71 86 395 3. Drains cleansed or repaired 306 231 161 232 930 4. Water closets cleansed, repaired or renewed 125 143 91 95 454 5. Soil pipes altered or repaired 18 27 14 9 68 6. Waste pipes provided, altered or repaired 59 84 58 59 260 7. Rainwater pipes repaired 22 34 30 11 97 8. Roofs and gutters repaired 172 263 197 94 726 9. Damp courses inserted 5 4 3 1 13 10. Damp conditions otherwise remedied 130 179 198 79 586 11. Yards drained or paved 7 14 4 5 30 12. Dustbins provided 20 32 31 24 107 13. Water cisterns cleansed, covered or repaired 5 5 7 4 21 14. Water supply reinstated 89 57 43 37 226 15. Defective stoves and fireplaces remedied 17 37 26 21 101 16. Animals improperly kept – 3 – 3 6 17. Accumulations of rubbish, etc., removed 6 14 9 9 38 18. Urinals cleansed or repaired 3 2 1 – 6 19. Smoke nuisances 5 16 – 1 22 20. Other nuisances 13 15 5 10 43 Total 1,287 1,585 1,166 886 4,924 Number of Preliminary Notices served 388 590 492 259 1,729 Number of Preliminary Notices complied with 446 587 528 271 1,832 Number of Nuisance Notices served 99 243 140 71 553 Number of Nuisance Notices complied with 106 222 133 65 526 25 SANITARY INSPECTION OF THE BOROUGH Water Supply — Cutting-off Notices During the year notices with respect to 238 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 38 premises the water supply was cut off for non-payment of rates, and in 200 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 98 premises and during this period 100 dustbins were provided. Dustbins were also provided at seven premises without the necessity of action under the Acts. Rodent Control One thousand, seven hundred and twenty-eight 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 8,564 „ „ premises treated with "Warfarin" 823 „ „ premises "Warfarin" laid and found not troubled 72 „ „ premises investigated and found not troubled 187 „ „ "Warfarin" baits laid 4,197 „ „ drains tested by Public Health Inspector 304 „ „ drains found defective 226 „ „ rats estimated killed 2,135 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. 26 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 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. Laundering of Bed Linen of Aged and Infirm Facilities have been made available by the Council for the cleansing of fouled bed linen and personal effects of aged and incontinent persons living alone. At the beginning of the year collections and washing of bed linen in respect of eight such cases were being dealt with and a further 15 cases were investigated during the year. In the majority of these, it has been necessary to arrange for the articles to be collected at regular intervals for cleansing and return to the owners. A total of 624 lots of fouled linen were collected and cleansed in 1958. 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 162 houses were found to be infested with bed bugs and disinflation 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 27 SANITARY INSPECTION OF THE BOROUGH 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 Under the arrangements made in 1956 with Battersea Borough Council, their mortuary continued to be used for the reception of bodies of Wandsworth residents. During the year, in addition to the reception of bodies of persons dying in Battersea, the mortuary received 619 bodies of persons who died in Wandsworth. Crematorium Under the Crematorium Regulations, 1930, 1,495 cremations were authorised during 1958, compared with 1,403 in 1957. 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 1958 was 29. 28 5 HOUSING STATISTICS RELATING TO HOUSING Public Health (London) Act, 1936 Number of houses inspected on account of complaints or illness 7,522 Re-inspections 17,097 Number of statutory notices served: Intimation notices 1,729 Nuisance notices 553 Number of houses in which nuisances were abated 1,787 The number of cases referred to the Solicitor for legal action during 1958 was 166 The following is a summary of Police Court proceedings: Number of summonses served 33 „ „ „ withdrawn 13 „ „ „ adjourned 9 „ „ Orders made for abatement of nuisances 11 Costs awarded in respect of four cases £1 1s.0d. Housing Acts, 1936 and 1957 Demolition Orders (a) Demolition Orders made under Section 17 (1) of the Housing Act, 1957 1 (b) Houses demolished as the result of formal or informal procedure 2 (c) Houses closed in pursuance of an undertaking given by the owner and still in force Nil Closing Orders (a) Closing Orders made under Sections 16 (4), 17(1) and 35 (1), Housing Act, 1957 5 (b) Closing Orders made on parts of buildings under Section 18, Housing Act, 1957 6 (c) Closing Orders determined 2 (d) Undertakings not to use parts of buildings for human habitation accepted 1 Slum Clearance Number of houses included in representations under Section 157 of the Housing Act, 1957 15 Number of houses demolished following action under Section 25 of the Housing Act, 1936 52 29 HOUSING Overcrowding Number of families found to be living in overcrowded conditions 24 Number of overcrowded families who have obtained alternative accommodation 26 New Accommodation Number of dwellings erected:— (a) by the Borough Council 58 (b) by the L.C.C 1,304 (c) by other persons 109 The Rent Act, 1957 Applications for Certificates of Disrepair. Three hundred and ninety applications were received for Certificates of Disrepair and were dealt with as follows:— (a) In eight cases it was decided not to issue Certificates of Disrepair as the premises were not in disrepair by reason of defects. (b) In three hundred and eighty-two 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 forty-seven undertakings were received from landlords to remedy defects proposed to be included in Certificates of Disrepair. (d) One hundred and fifty-three Certificates of Disrepair were issued. Applications for Cancellation of Certificates. (a) Seventy-eight applications were received from landlords for the cancellation of Certificates of Disrepair. (b) Twenty-five objections were received from tenants for cancellation of Certificates. (c) In ten cases it was considered that the tenants' objections were not justified and the Certificates cancelled. (d) Fifty-five Certificates of Disrepair were cancelled. 30 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 Housing Accommodation—Medical Priority During the year 1,027 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 187 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 The following properties were declared Clearance Areas following my representations: 7/9 (odd) Balham New Road, 23/35 (odd) Balham New Road, 65/67 (odd) Balham New Road, 22/38 (even) Balham New Road and 7/7a (odd) Old Town. On the 19th June, 1958, I submitted official representations upon the condition of the properties, Nos. 165/169, 177/187, 189/189a, 193/195 (odd) Clapham Park Road and these representations are now being considered by the Council. INDIVIDUAL UNFIT HOUSES Closing Orders were made on premises at 47a Felsham Road, 31 Fernlea Road, 3 and 34 Jews Row, 146 Tooting High Street, 3, 4 and 11 Turnchapel Mews, 296, 322 and 489 York 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, a Demolition Order was made in respect of the premises at 55 Oldridge Road. 31 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 to 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 2,776 and during 1958 they were visited on 19,330 occasions. Table I has been drawn up to show the number of visits to various food premises in different parts of the Borough. Supervision of the food supply is 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. Occupiers of food premises were, on the whole, co-operative and receptive to suggestions made by the Inspectors for necessary improvements, and a good deal of work was completed during the year. 24 applications for Certificates of Exemption under the Regulations were made to the Council. Eight of these were granted. Court summonses were taken out against a local trader on two occasions, during the year for smoking in a food shop. Fines of 10/on the first occasion and £2 on the second occasion were imposed by the Court. The following list shows the number and type of premises in the Borough where food is sold, stored or prepared:— Dairies and Milk Depots 9 Food Factories 25 Restaurants, Cafes and Canteens 461 Bakers and Confectioners 535 Butchers 219 32 TABLE I SUMMARY OF VISITS TO FOOD PREMISES REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 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 1 12 15 2 9 8 1 6 8 5 10 10 31 9 13 3 7 46 3 25 224 Restaurant Kitchens 78 156 116 48 71 113 68 88 38 64 58 138 36 67 109 75 150 53 20 45 1,591 Ice Cream Premises 7 – 4 7 2 – – 5 3 1 1 1 1 1 2 1 1 2 2 19 60 Butchers'Shops 101 64 105 59 111 32 21 24 43 18 29 23 45 40 63 37 54 10 8 57 944 Greengrocers' Shops 43 39 26 36 41 43 5 9 22 13 20 11 12 5 14 30 61 23 35 54 542 Fishmongers' Shops 26 25 24 2 17 8 5 2 3 – 1 15 8 11 5 5 12 2 7 7 185 Fried Fish Shops 14 19 10 3 18 16 4 2 5 13 14 20 11 1 4 2 5 – – 18 179 Market Stalls 3 90 23 – 18 – 13 86 768 – 2 255 8 499 95 1 97 – – – 1,958 Grocers' Shops 128 156 93 60 132 120 59 84 102 43 120 180 66 90 78 117 224 51 57 133 2,093 Confectioners' Shops 47 53 25 36 45 46 29 29 46 23 16 42 19 34 18 24 43 4 16 31 626 Bakehouses 19 24 24 1 33 5 15 4 3 10 23 26 7 10 4 11 – 1 10 2 232 Other Premises 49 55 43 20 45 54 20 37 61 23 50 52 18 34 26 19 40 13 6 31 696 Total Visits 516 693 508 274 542 445 240 376 1,102 213 344 773 262 801 431 325 694 205 164 422 9,330 33 FOOD AND FOOD PREMISES Greengrocers 271 Fishmongers 78 Fish fryers 62 Bakehouses 60 Grocers 652 Off Licences 98 Public Houses 152 Stalls 154 2,776 The amount of work completed during 1958 to comply with the requirements of the Regulations is indicated in the following details Wash hand basins provided 180 Sinks provided 68 Provision of hot water over sink and wash hand basin 66 Accommodation for clothing provided 22 Soap, Towel and Nailbrush 10 First Aid Materials provided 12 Premises repaired or redecorated 145 Adequate protection for open food 32 Notices to employees 51 Dustbins 12 W.C. Accommodation 37 Smoking 4 Shops Act, 1950 One application for a certificate of exemption was granted in respect of the absence of a sanitary convenience due to restricted accommodation. 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. 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 During the year 49 applications were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Fifty notices of cancellation of registration were received. At the end of the year there were 232 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 Three hundred and seven samples of milk were submitted for analysis. Of these 47 were samples of Channel Island and South Devon milks with an average fat content of 4.47 per cent. The remaining 260 samples had an average fat content of 3.75 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: Dealers' Dealers' Supplementary Total Pasteurized 268 35 303 Sterilized 312 38 350 Tuberculin Tested 182 33 215 Total 762 106 868 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. 35 FOOD AND FOOD PREMISES Meat There are 219 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 944 visits made to these shops during the year. 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-three 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 1958 was 376, and 584 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 II. The majority of the listed sellers are also purveyors of food. 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 TABLE II PART II OF POISONS LIST Principal Business Number of Premises Number of Visits Confectioners 3 7 Domestic stores, ironmongers, etc. 73 79 Drug stores 15 15 Grocers 262 460 Hairdressers 14 14 Nurserymen and florists 9 9 Total 376 584 Bakehouses There are 60 bakehouses in the Borough, of which 11 are in basements and subject to the provisions of Section 54 of the Factories Act, 1937. Two hundred and thirty-two visits by the Food Inspectors were made to these premises during the year. Certificates of suitability under the Food Hygiene Regulations, 1955, were granted in respect of the 11 underground bakehouses. 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-crea m 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 63 applications for registration under the provisions of Section 16 (l)(a) and 11 applications for registration 37 FOOD AND FOOD PREMISES 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 seventy-eight samples were examined bacteriologically at the Public Health Laboratory during the year. They were as follows: Milk Ice-cream Ice Lollie Egg Albumen Artesian Well Waters Swimming Pool Waters Others Total 216 14 5 13 7 6 17 278 Milk Of the 216 samples of milk, 96 were submitted to the phosphatase test, 96 to the methylene-blue test, and 24 to the turbidity test. These samples were reported satisfactory. Ice-cream The 14 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 11 2 3 3 – 4 – Total 14 38 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 Ice Lollie The five samples of ice lollies were examined for the presence of pathogenic organisms and all were reported satisfactory. Egg Albumen Thirteen samples were examined for the presence of pathogenic organisms, and all were reported satisfactory. Artesian Well Water Seven samples were submitted for examination, and were reported satisfactory. Swimming Pool Water Six samples were submitted for examination, and all were reported satisfactory. Others The seventeen 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: 307 samples of milk, 634 other foodstuffs and 59 drugs. Of these, 319 were submitted as formal samples while 681 were purchased informally. Five or 1.6 per cent. of the formal and 16 or 2.4 per cent. of the informal samples were found to be adulterated or not up to standard. The total adulterations reported were 21 or 2.1 per cent. of the samples submitted. The 21 samples found to be adulterated were: Three samples of shredded suet. Two samples each of sausages, milk, margarine, sweets and ice cream and one sample each of gingerbread, block salt, bread, orange drink, cream in bottle, butter, salad dressing and Jusoda. 39 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 461 154 3 – (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,104 785 15 – (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' Premises) .. 107 10 – – Total 1,672 949 18 – (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 – 3 – Overcrowding – – – – – Unreasonable temperature .. – – – – – Inadequate ventilation 1 1 – 1 – Ineffective drainage of floors – – – – – Sanitary Conveniences (a) insufficient 2 1 – 1 – (b) unsuitable or defective 36 31 – 12 – (c) not separate for sexes – – – 1 – Other offences against the Act (not including offences relating to outwork) 3 2 – 2 – Total 43 36 – 20 – 40 FACTORIES ACT. 1937 AND 1948 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 8 – – Carding etc. of buttons etc. 2 – – Artificial flowers 6 – – Paper bags 11 – – Boxes or other receptacles made wholly or partially of paper 21 – – Stuffed toys 3 – – Cosaques, Christmas crackers, Christmas stockings, etc. 12 – – Lampshades 137 – – Total 762 – – 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 17 new registrations were made, and 9 cancellations received. The total number on the register at the end of the year was 241. Pet Animals Act, 1951 37 licences were issued by the Council during the year in relation to premises subject to the provisions of this Act. 41 8 ACCIDENTS IN THE HOME The Committee charged with matters relating to home accidents in Wandsworth is the Accident Prevention Committee which deals, of course, not only with home accidents but with road accidents as well. As with all public health matters, information as to what is happening is essential to preventive action and I, therefore, have gone to some pains to obtain data about home accidents in Wandsworth. Unfortunately, there is no very definite information to hand relating to home accidents. There are certain national figures but not many relating to individual areas or boroughs. Recently, however, the County Medical Officer of Health for London informed me that he was taking steps to obtain from hospitals certain data relating to admission to hospitals of home accident cases, both in-patients and out-patients. These would be obtained for a period of six months and will, it is hoped, be a representative crosssection of the types of accidents occurring in the London boroughs, including Wandsworth. It will be some time before this data is available but in the meantime, from returns made by the London Ambulance Service, I have been able to calculate figures for Wandsworth. I should say that the figures provided do not refer to any individual borough but they are available for the nine health divisions of the County. By means of certain calculations, I have been able to extract figures relating to Wandsworth from the overall figures presented for Health Division 9 of the London County Council and these are shown in Tables I and II. They represent the home accident cases conveyed to hospitals in London by London ambulances and they include both fatal and non-fatal cases and also some that are treated as out-patients as well as others treated as in-patients. I have calculated the figures for Wandsworth for 1956, 1957 and 1958. I would stress that the figures as set out are not absolutely accurate although I do not think that the errors are likely to be very large. Generally speaking, they can be taken as a reasonably accurate picture of the home accidents which have occurred in Wandsworth in 1956, 1957 and 1958. The figures speak for themselves and need little explanation. The main points of interest are the high proportion of cases occurring in the age groups over 60 and also in the age group under five. Falls of various kinds provide the greatest number of accidents although quite a percentage are also brought about by knife-like wounds. What is to be learnt from these figures? In most households where a severe accident has already occurred, this very fact is probably enough to ensure caution and care in the future. Our main effort, therefore, should be directed towards education of the 42 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 public, particularly in those age groups most likely to be affected, that is to say, in early and later life. This has now become a routine part of the work of health visitors and public health inspectors working closely with other organisations, both statutory and voluntary. The trend of the figures in future years will be watched with interest as some indication of the effect which our efforts are having. HOME ACCIDENT CASES DURING 1956, 1957 and 1958 TABLE I Cause of Accident 1956 1957 1958 Fall– On stairs 120 112 122 From ladder 21 18 12 From chair 18 18 21 Outside 32 18 16 In garden 45 31 25 In bath 1 3 1 From one level to another 42 42 33 On same level 77 57 105 Unspecified 222 240 255 Hit by object 45 15 14 Cooking stove 15 7 13 Teapots 4 2 6 Other boiling water 18 25 12 Electric shock 2 2 1 Poisoning 27 34 24 Gassing 9 9 12 Knife-like wounds 69 51 36 Fires 24 10 24 Windows 7 5 6 Suffocation 1 3 2 Not specified 13 53 44 Totals 812 755 784 Rate per 10,000 population 24.0 22.4 23.2 TABLE II AGE GROUPS AND PERCENTAGES 1956 % 1957 % 1958 % Under 1 10 1.2 10 1.4 14 1.7 1– 26 3.2 25 3.3 29 3.7 2– 30 3.7 26 3.4 30 3.8 3 and 4 31 3.8 35 4.6 36 4.6 5–19 96 11.7 81 10.7 84 10.8 20–59 252 31.0 232 30.7 239 30.5 60–69 93 11.6 91 12.0 82 10.5 70–79 150 18.5 133 17.7 141 17.9 80+ 124 15.3 122 16.2 129 16.5 Totals 812 100 755 100 784 100 43 9 REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1958 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, 1958, 941 were articles of food and the remaining 59 drugs. All were submitted by the Council's Food Inspector, 319 having been taken with the formalities required by the Act and 681 informally. Samples of the following substances were analysed: fats (butter, margarine, etc.), 56; beverages (cocoa, coffee, tea, etc.), 31; cereal preparations, 14; cream, 22; fish (canned etc.), 33; fruit (canned and dried), 54; meat products (including sausages), 42; milk, 307; pickles and condiments (including spices), 37; preserves, 24; soup, 20; vegetables 38; bicarbonate of soda, 7; iodine solutions, 6; ointments, 6; seidlitz powders, 3. 44 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 Adulterated Samples Particulars of the samples reported as adulterated or not up to standard are given in the following table: Case No. Nature of Sample Nature of Report Formal 362 Margarine 0.3% of water in excess 385 Shredded Suet 2.8% deficient in beef fat 386 Ice Cream 0.48% deficient in fat 401 Shredded Suet 1.9 % deficient in beef fat 405 Sweets Copper 2450 parts per million Informal 152 Beef Sausages Meat content 42.5% 153 Pork Sausages Meat content 60.0% 192 Ginger bread Mould and insect fragments present 249 Milk Mould growth 475 Block salt Extraneous matter including broken china and tea leaves 488 Margarine 0.6% of water in excess 506 Bread Contained a piece of slate 536 Orange drink In dirty bottle coated with moulds 553 Milk In dirty bottle coated with moulds 574 Shredded suet 5.5% deficient in beef fat. 584 Cream in bottle Contained cement. 586 Ice Cream 0.5% deficient in fat 606 Butter 0.38% of water in excess 617 Sweets Copper 2450 parts per million 627 Salad Dressing Rancid 751 Jusoda Contained phenolic compounds Adulteration The amount of adulteration detected during the year was: For formal samples 1.6 per cent. For informal samples 2.4 per cent. For all samples 2.1 per cent. 45 REPORT OF THE PUBLIC ANALYST FOR 1958 Complaint Samples Case No. 331. Dates. Submitted on the complaint of smell and taste. The complaint was considered not justified. Case No. 460. Luncheon Meat. Submitted on the complaint of a mauve stain on the surface. The complaint was considered not justified. Case No. 475. Block Salt. Submitted on the complaint that it contained a foreign matter. The complaint was considered justified. Case No. 506. Bread. Submitted on the complaint that it contained a foreign matter. The complaint was considered justified. Case No. 536. Orange Drink. Submitted on the complaint that it contained a foreign matter. The complaint was considered justified. Case No. 553. Milk in bottle. Submitted on the complaint that it contained a foreign matter. The complaint was considered justified. Case No. 584. Cream in bottle. Submitted on the complaint that it contained a foreign matter. The complaint was considered justified. Case No. 585. Bread. Submitted on the complaint that it contained a foreign matter. The complaint was considered not justified. Case No. 752. Corned Beef. Submitted on the complaint that it was not of the quality expected. The complaint was considered not justified. Case No. 763. Potted Salmon with Butter. Submitted on the complaint that it was not of the quality expected. The complaint was considered not justified. 46 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 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 18 12.68 3.87 8.81 February 12 12.36 3.60 8.76 March 17 12.63 3.79 8.84 April 19 12.37 3.60 8.77 May 13 12.44 3.62 8.82 June 12 12.30 3.53 8.77 July 26 12.27 3.60 8.67 August 32 12.39 3.67 8.72 September 34 12.54 3.78 8.76 October 23 12.79 3.97 8.82 November 24 12.67 3.92 8.75 December 30 12.53 3.81 8.72 The average composition of the 260 samples of milk analysed. during the year and returned as genuine was as under: Total milk solids 12.51 per cent. Milk fat 3.75 per cent. Non-fatty solids 8.76 per cent. The average composition of the 47 samples of Channel Island and South Devon milks was as under: Total milk solids 13.57 per cent. Milk fat 4.47 per cent. Non-fatty solids 9.10 per cent. 47 INDEX PAGE Accidents, Deaths from 21 Accidents, Home 41 Acute Encephalitis 17 Analyst, Report of 43 Bacteriological Examinations of Milk 37 „ „ of Ice-cream 37 Bathing Pools and Swimming Pools 25 Bed Bugs, Eradication of 26 Births, Birth-rates 10 Butchers' Shops 35 Cancer 21 Childbirth, Deaths from 13 Circulatory Diseases 21 Closing Orders 28 Crematorium 27 Cutting-off Notices—Water Supply 25 Deaths, Causes of 12 Death-rates 11 Death-rate from Infective Diseases 14 Death-rate, Infantile 13 Deaths, Number of 11 Diphtheria 14 Diseased or Infirm Persons, Removal of 26 Disinfection 20 Dysentery, Sonne 18 Enteric Fever 18 Erysipelas 19 Factories Act, 1937 and 1948 39 Factories and Workshops 39 Food and Drugs Act, 1955 34 Food Poisoning 19 Food, Supervision of 31 Food Places, Inspection of 32 Food Places, Number on Register 31 Food Hygiene Regulations 31 Hairdressers and Barbers 40 Home Accidents 41 Houses and Premises Inspected 23 Housing Act, 1936 28 Housing Statistics 28 Hydrogen Cyanide Disinfection 26 Illegitimate Children, Births of 10 Infant Mortality 13 Infective Diseases 14 Infective Diseases, Cases of 15 48 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1958 Infective Diseases, Death-rate from 14 Infirm or Diseased Persons, Removal of 26 Influenza, Deaths 18 Influenzal Pneumonia and Acute Primary Pneumonia 18 Insanitary Areas 30 Malaria 19 Maternal Mortality 13 Meat 35 Meningococcal Infection 17 Milk Analysis 46 Milk, Bacteriological Examination of 46 Milk Premises, etc., on Register 33 Milk (Special Designations) Regulations, 1949-54 34 Mortuary 27 Non-infective Diseases, Deaths from 21 Notification of Infective Diseases 18 Outworkers 40 Overcrowding 29 Pet Animals Act 40 Pharmacy and Poisons Act, 1933 35 Pharmacy and Medicines Act, 1941 35 Poliomyelitis 17 Population 10 Pregnancy, Deaths from Accident and Diseases of 13 Preserved Meat, etc., Manufacture of 36 Public Analyst, Report 43 Puerperal Pyrexia 18 Pulmonary Tuberculosis, Notification of cases of 22 Rent Act 29 Rodent Control 25 Samples, Formal and Informal, Number of 43 Sanitary Inspection of Borough 23 Scabies 19 Scarlet Fever 14 Slaughter-houses 35 Slaughter of Animals Acts, 1933-1954 35 Smallpox 14 Statistics for the Borough 9 Suicide, Deaths from 21 Swimming Baths and Bathing Pools 25 Syphilis, Deaths from 19 Shops Act 33 Tuberculosis 22 Unfit Houses 30 Unsound Food 35 Water Supply 36 Water Supply, Cutting-off Notices 25 Whooping Cough 14 Printed by Geo. Gibbons Ltd., Leicester & London