E-4388 LSAN 97 Metropolitan Borough of Wandworth ANNUAL REPORT of the Medical Officer of Health for the Year 1960 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 1960 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, I have much pleasure in presenting to you the Annual Report on the health of Wandsworth for the year 1960. The Report follows the usual form, being mainly statistical with comments on some points of interest. The population of the borough has been trending slowly upwards but 1960 saw the trend halted, for the population remained unchanged at 338,800. The crude birth rate was 16.3 per 1,000 persons living, an increase over the previous year. After taking into account the area comparability factor supplied by the Registrar General, the adjusted rate works out at 15.6 compared with 15.0 for 1959. The rate for England and Wales as a whole was 17.1 and for London 17.8. The crude death rate for the year was 14.7 compared with 14.8 for 1959 but the adjusted rate works out at 10.8, a slight increase over the previous year. The corresponding rates for England and Wales and London were 11.5 and 11.4 respectively. In 1960 there was an increase in the deaths of infants under one year and the infant mortality rate rose to 22.7 per thousand live births compared with 19.5 for the previous year. As I have mentioned in previous Reports, when these rates are reduced to comparatively low figures, chance fluctuations from year to year over a comparatively small area are bound to influence the rates one way or another. It is the over-all decline over the years which is important. Nevertheless, one cannot but regard this temporary set-back with anything but disappointment and below I deal a little more fully with this important subject. To offset this disappointment, only one death from accidents or disease of pregnancy occurred in 1960, as against three for 1959, the corresponding rates being 0.1 per 1,000 live and still births, compared with 0.5. 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Returning to the subject of infant mortality, it can be said that the increase in the deaths of infants over the previous year was mainly due to a miscellany of abnormal conditions presenting no clear-cut common factor or form. To this extent, they may be regarded as fortuitous, due to the chance variations which, from year to year are to be expected. More light on the general causes of infant deaths is given by the Table on page 13 which breaks down the infant deaths under age at death. It is traditional to distinguish between deaths in the first month of life, usually known as the neonatal infant death rate, and those arising in months two to twelve. In addition, it is a useful exercise to distinguish between deaths in the first 24 hours of life and deaths in the first week of life. These are shown in the Table. It is well-recognised that deaths within the first four weeks of life and even more so within the first week of life and still more so within the first 24 hours of life, are most likely caused by factors operating before or during birth on the expectant mother and the unborn child. It is clear from the figures shown in the Table that those harmful influences which are likely to have an adverse effect on the child's life and well-being during the first year of life are now of less importance than those influences which affect the expectant mother and unborn child. This is borne out by a study of the causes of infant deaths in Wandsworth for 1960, although, for statistical purposes, they are a small sample. The conditions which are most likely to cause death within the first four weeks of life, are congenital malformations and ill-defined conditions such as prematurity, which accounted for 35 of the neonatal deaths. It follows that the next big advance in the reduction in the infant mortality rate is to be achieved by an attack on those adverse factors which affect the expectant mother and her unborn child. These factors and how they act, are much less clearly defined and understood than are the adverse influences acting on the infant during its first year of life which, in the main, are associated with environmental and social conditions. To determine what these adverse influences acting during pregnancy are and how they are likely to give rise to prematurity and, what is more important, how they can be overcome, is a complex problem involving the complicated interplay of many factors including genetic, obstetric, biochemical, environmental and social matters and probably others even less clearly understood. These complexities are to be unravelled only by research of the most advanced kind. I have not mentioned the problem of still-births but it is likely that the adverse factors which cause prematurity and death within the first week also operate to cause still-births and the combined still-births and deaths in the first month of life is usually referred to as the perinatal mortality. A good deal of attention has been paid to this problem of perinatal mortality over recent years and we in this area have participated in a nation-wide investigation into these problems. At the moment, the results are being collated and they are awaited with considerable interest. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 3 The year was not one of any particular mote as regards infectious diseases, the total number notified being 3,032 against 5,647 in 1959. This reduction was accounted for in the main by the fewer number of measles cases which were notified, since 1960 was a "non-measles year", but there was also a drop in the number of scarlet fever cases to 172 from 329; on the other hand, there was an increase in the number of whooping cough cases to 492 from 111. There were. however, no deaths from whooping cough and reports received from time to time from local doctors with whom we have contacts, indicated that generally the disease was of a mild type and in many cases was modified by previous immunisation. Poliomyelitis did not present any major worry in 1960, for although 31 cases of this disease were reported to us and the usual home investigations made, in 26 cases the diagnosis was not confirmed; of the remaining five confirmed cases, only one had any form of paralysis and none proved fatal. During the year, under the arrangements of the London County Council, it is estimated that 13,449 people received injections against poliomyelitis. I referred in 1959 to the increase in deaths to the number of 80 from influenza compared with 18 in 1958. In 1960, no deaths were attributable to influenza and there was during the year much less disease of the influenza type than in 1959. Deaths from influenza are likely to be paralleled by deaths from acute influenzal pneumonia and this was certainly so in 1960, for only 15 cases of acute influenzal pneumonia were notified in 1960 compared with 134 in 1959 and there were only four deaths compared with 45 in 1959. Other acute respiratory infections were similarly reduced in incidence, for there were only 124 cases of acute primary pneumonia notified, with 26 deaths, against 58 in 1959. This amelioration of the toll that respiratory infections can take, particularly on old people, may be related to the mild winter months we experienced in 1960. Moreover, there was mercifully little fog with its accompanying smog. The number of cases of tuberculosis of which we became aware was 395 compared with 491; thus the downward trend continues. The number of primary notifications reported to us was 218 compared with 260 in 1959. I have in previous years noted the improvement which has taken place in the outlook for patients with tuberculosis and to the change of emphasis which has come about in our approach towards diseases of the chest. It is interesting to compare the number of deaths from tuberculosis, bronchitis and lung cancer in 1950 and in 1960. Tuberculosis caused 34 deaths in 1960 against 146 in 1950; bronchitis caused 211 deaths in 1960 against 259 in 1950; while cancer and malignant diseases of the lung gave rise to 952 deaths in 1960 but only 762 in 1950. These figures tell their own story. The reduction in the number of deaths from tuberculosis over the decade has been remarkable. The number of deaths from bronchitis over the same period has been reduced but not to any appreciable extent. The number of deaths from cancer and malignant diseases of the lung, 4 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 however, has risen by more than one quarter. In general terms, while the outlook for tuberculosis has greatly improved, for bronchitis it is only a little better, while for cancer of the lung it is 25 per cent. worse. There is, therefore, no cause to slacken efforts to reduce the amount of sickness and mortality from diseases of the chest. In this connection, it gives particular pleasure to refer to the inauguration of the new Wandsworth Chest Clinic. This started functioning in 1960 although the formal opening by the Minister of Health took place in 1961. The physician in charge of this clinic is Dr. K. N. Citron who, in addition, has responsibilities at the Brompton Hospital for Diseases of the Chest. The clinic is provided with the most modern diagnostic equipment and is intended to offer facilities for the instruction of post-graduate students and for research as well as, of course, giving a first-rate service for the community. Although, in general, Chest Clinics should form an integral part of hospital design, an appropriate exception has been made in the case of the Wandsworth Chest Clinic. It is located in close proximity to the Health Departments of the Wandsworth Borough Council and the London County Council and one cannot but feel that this, in itself, is a happy emblem of the liaison which must exist between the preventive and curative services in medicine generally and not least in the diseases of the chest The figures showing the general trend of home accidents in Wandsworth are continued in 1960 in the Table on page 45. The figures are not an absolutely accurate record of the individual accidents occurring in the borough but are computed from returns supplied by the London Ambulance Service. It is thought, however, that they do provide a general, but only a general, guide to the occurrence of accidents in the home. Even though they illustrate only a trend, they do not provide much scope for satisfaction for they suggest an increase for 1960 over previous years and the main increase is to be seen in accidents due to falls. The distribution of the various accidents among different age groups has not changed very much. Allowing for the fact that these figures are only a general guide, one may assume that, taking the optimistic view, there was no improvement in 1960 over the previous years. The prevention of home accidents is essentially one of education and it is difficult to know how to get across to the public and particularly the age groups at special risk, the dangers of accidents taking place in the home. In the main, reliance must be placed on the personal approach by members of our staff who come into contact with those of the population who are most likely to meet with accidents, particularly the elderly. Thus, in the main, we must rely on health visitors, home helps and social workers and also public health inspectors who have access to people's houses. Unfortunately, it is in the groups most at risk that it is often-times most difficult to effect even those quite small changes of routine which might lessen the chances of an accident. The elderly become fixed in their ways and their habits and it is not easy to persuade them to REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 5 change their routine in anticipation of a mishap which may never occur. During the year, further progress was made in the Council's programme for implementing the Clean Air Act, 1956. The second Smoke Control area came into operation in September, 1960, and at the time of writing, the third area has been confirmed while progress is being made with the preliminary work for the next areas to be made. Wandsworth is a large borough, both in terms of acreage and population, and the problems we have from this cause alone are greater than those of smaller and less populated areas. We have given some thought as to when it will be possible to anticipate the whole of the borough being a smoke control area. In the light of our experience we feel that progress may be more rapid than was at one time thought and it may not be unreasonable to hope that by 1975 and possibly even earlier, we shall have completed the work of converting this township of a third of a million people into a complete smoke-free area. However, Wandsworth in relation to the vast London conurbation, is only a small part and the true benefits to health are not likely to be seen until most or at least a substantial part of the greater London area is free from smoke The preparation of an Annual Report provides a pleasant opportunity of thanking many people for the help (often taken for granted) which they have given to the Health Department during the year. Thus, it is a great pleasure, once again, to thank the Chairman of the Health Committee, Mrs. Olive Haines, and the members of the Committee for their help and support in 1960; and also members of other Committees of the Council who have, from time to time, rendered assistance to the Health Department. I should also like to thank the Chief Officers and their staffs of other departments for their help and co-operation. Particularly do I thank my own colleagues in the Health Department, in all categories, for their good work and help throughout the year. 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., m.r.c.p., 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 A. J. Lansley S. R. Coomber A. W. Lock C. Jones J. Smith D. J. Hughes P. O'Grady K. J. Winton E. R. Potts A. F. Cayley Trainee Public Health Inspectors J. D. Morritt M. Timlin J. F. Burslem J. L. Gill 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 Mrs. F. Hull 6 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 7 STAFF OF PUBLIC HEALTH DEPARTMENT—continued Miss J. Eley Mrs. P. McKeown C. F. Harrison J. Weir L. W. Clifton F. B. Capes Disinfecting Station F. Stennings J. Williams H. Coster G. W. Price L. D. Dean A. E. Clement J. C. Prowen Mortuary J. Anderson Rodent Operatives J. W. Taylor J. Wells G. J. Langrish W. Maxwell V. T. Athaide The following changes occurred in 1960: Appointments Mr. J. L. Gill, Trainee Public Health Inspector. Appointed in October. Mr. L. W. Clifton and Mr. F. B. Capes, Technical Officers, appointed in May. Resignations Mr. J. A. Sands, Public Health Inspector. Resigned in June. Mr. R. A. Levey, Motor Driver. Resigned in July. 1 STATISTICS AND SOCIAL CONDITIONS Area 9,201 acres Resident population in 1960 338,800 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 have rapidly been 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 2,592 2,426 5,018 Illegitimate 276 246 522 Total live births 2,868 2,672 5,540 Number of stillbirths 50 48 98 Number of deaths 2,319 2,672 4,991 Birth Rate—Crude 16.3 Adjusted 15.6 Death Rate—Crude 14.7 Adjusted 10.9 Rate per 1,000 (Live and Still) Births Deaths from puerperal causes .. 1 0-17 Infantile mortality per 1,000 live births: All infants .. .. 22-7 Legitimate infants 22-9 Illegitimate infants 21-0 Deaths from Cancer 952 „ „ Diphtheria 0 „ „ Scarlet Fever .. 0 „ „ Measles 0 „ „ Whooping Cough 0 „ „ Tuberculosis 34 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 338,800 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 1960 Putney 88,000 Central 96,500 Clapham 81,250 Streatham 73,050 Whole Borough 338,800 Births The total number of births belonging to the Borough registered during 1960 was 5,540 consisting of 2,868 males and 2,672 females. The number for 1959 was 5,321. The crude birth-rate was 16.3 per 1,000 persons living compared with 15.7 for 1959. The adjusted rate works out at 15.6 after taking into account the area comparability factor supplied by the RegistrarGeneral. The birth-rate for England and Wales as a whole was 17.1 and for London 17.8. Five hundred and twenty-two illegitimate births took place in the Borough compared with 460 in 1959. 10 VITAL STATISTICS 11 Deaths The number of registered deaths which took place in the Borough during the year was 3,910 but 893 of these did not belong to the Borough, while 1,974 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,991, of whom 2,319 were males and 2,672 females The crude death-rate for the year was 14.7, compared with 14.8 for 1959, but after taking into account the area comparability factor supplied by the Registrar-General, the adjusted rate works out at 10.9. The death-rate for England and Wales as a whole was 11.5 and for London 11.4. 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 571 636 1,207 13.7 Central 814 1,010 1,824 18.9 Clapham 530 572 1,102 13.5 Streatham 404 454 858 11.7 Whole Borough 2,319 2,672 4,991 14.7 12 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 CAUSES OF DEATH DEATHS IN OR BELONGING TO WHOLE DISTRICT AT SUBJOINED AGES DEATHS IN OR BELONGING TO LOCALITIES (ALL AGES) Table 111 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. 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 TABLE III CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1960 Tuberculosis, Respiratory 27 20 7 — — — 3 12 12 8 7 10 2 Tuberculosis, Other 7 3 4 — 1 — 1 2 3 — 3 2 2 Syphilitic Disease 12 7 5 — — — — 2 10 4 4 3 1 Diphtheria — — — — — — — — — — — — — Whooping Infections — — — — — — — — — — — — — Meningococcal Infections 1 — 1 1 — — — — — — — 1 — Acute Poliomyelitis — — — — — — — — — — — — — Measles — — — — — — — — — — — — — Other Infective and Parasitic Diseases 15 9 6 — 1 1 3 4 6 3 5 5 2 Malignant Neoplasm, Stomach 99 51 48 — — — 1 28 70 24 33 30 12 Malignant Neoplasm, Lung, Bronchus 237 195 42 — — — 6 112 119 72 72 54 39 Malignant Neoplasm, Breast 103 1 102 — — — 8 50 45 29 23 36 15 Malignant Neoplasm, Uterus 39 — 39 — — — 4 14 21 7 9 13 10 Other Malignant and Lymphatic Neoplasms 474 248 226 1 1 4 21 142 305 108 115 161 90 Leukaemia, Aleukaemia 23 14 9 —_ 1 2 2 5 13 8 2 7 6 Diabetes 22 8 14 — — — — 6 16 4 6 9 3 Vascular Lesions of Nervous System 506 173 333 — — — 7 66 433 135 174 100 97 Coronary Disease, Agina 769 445 324 — — — 14 178 577 207 204 173 185 Hypertension, with Heart Disease 64 23 41 — — — — 5 59 10 29 16 9 Other Heart Disease 941 350 591 — — — 11 44 886 184 479 150 128 Other Circulatory Disease 276 122 154 — — 1 5 44 226 77 95 58 46 Influenza 4 1 3 — — — 1 1 2 — 3 — 1 Pneumonia 301 129 172 21 4 — 5 23 248 60 147 48 46 Bronchitis 211 141 70 1 — 1 1 35 173 59 49 59 44 Other Diseases of Respiratory System 58 38 20 1 1 2 — 14 40 18 14 16 10 Ulcer of Stomach and Duodenum 39 21 18 — — — 1 4 34 10 10 12 7 Gastritis, Enteritis, Diarrhœa 27 12 15 — 2 1 1 7 16 6 11 5 5 Nephritis and Nephrosis 30 20 10 — — 1 7 11 11 7 12 5 6 Hyperplasia of Prostate 24 24 — — — — — 1 23 4 6 8 6 Pregnancy, Childbirth, Abortion 1 — 1 — — — 1 — — — 1 — — Congenital Malformations 41 13 28 25 3 3 4 2 4 8 8 13 12 Other Defined and Ill-defined Disease 466 149 317 70 3 1 21 57 314 102 245 72 47 Motor Vehicle Accidents 55 43 12 — 1 3 24 13 14 18 17 9 11 All Other Accidents 65 29 36 6 1 3 9 12 34 17 29 12 7 Suicide 51 29 22 — — 16 24 11 17 11 14 9 Homicide and Operations of War 3 1 2 — — — 1 1 1 1 1 1 — All Causes 4,991 2,319 2,672 126 19 23 178 919 3,726 1,207 1,824 1,102 858 13 VITAL STATISTICS TABLE 111(a). DEATHS FROM HEART DISEASE, 1960 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. — — 14 145 286 445 — — — 33 291 324 769 Hypertension with Heart Disease — — — 4 19 23 — — — 1 40 41 64 Other Heart Disease — — 9 18 323 350 — — 2 26 563 591 941 — — 23 167 628 818 — — 2 60 894 956 1,774 Infantile Mortality There were 126 deaths of children under one year giving an infant mortality rate of 22.7 per 1,000 live births. This compares with a rate of 19 for the years 1958 and 1959. For the ten years ended 1950 the average infant mortality rate was 35, while for the ten year period ending 1960, the average rate was 20. Table II 1(b) shows causes ot death of children under one year of age. TABLE 111(b). DEATHS OF CHILDREN UNDER ONE YEAR OF AGE Cause of Death Under 24 hours 1-7 days 1-4 weeks Total under 4 weeks 1-12 months TOTAL DEATHS UNDER 1 YEAR Approximate Percentage of Total 1. Pneumonia — 3 4 7 14 21 16 2. Bronchitis — — — — 1 1 1 3. Gastritis, Enteritis, Diarrhoea — — — — — — — 4. Congenital Malformations 5 8 4 17 8 25 20 5. Prematurity 21 10 4 35 — 35 28 9. Other Causes 13 10 6 29 15 44 35 TOTALS 39 31 18 88 38 126 100 APPROXIMATE PERCENTAGE OF TOTALS 31 25 14 70 30 100 100 Maternal Mortality One death occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.17 per 1,000 live and still-births. 3 INFECTIVE DISEASES The number of deaths from all notifiable infectious diseases was 65. This included 34 from all forms of tuberculosis and 4 from the notifiable forms of pneumonia. There was one death from meningococcal meningitis. From all notifiable infective diseases the death-rate was 0.19 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 Several suspected cases were reported and investigated, but in no case was the diagnosis confirmed. Scarlet Fever One hundred and seventy-two cases were notified compared with 329 in 1959 and 301 in 1958. No deaths occurred. Whooping Cough Four hundred and ninety-two cases were notified, compared with 111 cases in 1959. There were no deaths. Measles The number of cases notified during the year was 825 compared with 3,212 in 1959, 1,602 in 1958 and 3,802 in 1957. 14 15 TABLE I INFECTIVE DISEASES 15 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 Anthrax — — — — — — — — — — Diphtheria — — — — — — — — — — Dysentery 315 8 20 34 79 40 31 82 21 — Encephalitis, Acute — — — — — — — — — — Erysipelas 42 — — — — 4 6 7 20 5 Food Poisoning 527 3 18 36 95 168 113 50 33 11 Malaria 1 — — — — — — 1 — Measles 825 32 184 210 379 9 6 5 — — Meningococcal Infection 5 3 — 1 — — — 1 — — Ophthalmia Neonatorum 5 5 — — — — — — — — Pneumonia: Acute Influenzal 15 — — 1 1 1 3 4 2 3 Acute Primary 124 1 2 4 4 6 4 17 49 37 Poliomyelitis, Acute 5 1 1 — 2 — — 1 — — Puerperal Pyrexia 87 — — — — — 39 48 — — Scabies 16 — — — 2 4 8 2 — — Scarlet Fever 172 1 16 35 74 35 10 1 — — Smallpox — — — — — — — — — — Tuberculosis 395 1 3 3 6 12 77 169 96 28 Typhoid Fever and Paratyphoid Fever 6 — 1 — — 1 1 1 1 1 Whooping Cough 492 45 110 89 203 33 6 6 — — Total 3,032 100 355 413 845 313 304 395 222 85 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 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 Anthrax — — — — — — — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — — — — — — — — Dysentery 43 6 20 15 8 26 11 20 45 28 5 13 6 2 14 10 16 15 2 10 315 — Encephalitis, Acute — — — — — — — — — — — — — — — — — — — — — — Erysipelas 2 — 2 1 2 2 10 2 3 3 2 2 3 2 — 1 1 3 — 1 42 — Food Poisoning 68 2 26 4 4 63 5 296 23 9 — 1 2 14 — 1 4 1 — 4 527 — Malaria — — — — — — — — — — — — — — — — — — — 1 1 — Measles 65 3 24 14 9 20 26 69 25 118 24 14 13 49 76 48 62 116 30 20 825 — Meningococcal Infection 1 — — — — — — 1 — 1 — 1 1 — — — — — — — 5 1 Ophthalmia Neonatorum — — — — — 2 — 1 — — — — — — — — — — — 2 5 — Pneumonia, Acute Influenzal — 2 — — — 1 2 3 — — 1 2 — — 2 — 1 — 1 — 15 4 Acute Primary 5 12 3 10 6 7 11 17 4 10 7 6 5 5 9 3 1 1 2 — 124 26 Poliomyelitis, Acute — — — 1 — 1 — — — — — 2 — — — 1 — — — — 5 — Puerperal Pyrexia 1 — —, 1 2 1 2 6 7 6 — 2 11 16 17 1 2 2 1 7 87 — Scabies — — 1 — 1 4 — 1 — — 5 — 1 1 1 — — — — 1 16 — Scarlet Fever 3 2 3 6 4 8 20 16 4 9 15 10 9 7 10 10 9 13 6 8 172 — Smallpox — — — — — — — — — — — — — — — — — — — — — — Tuberculosis—all forms 46 20 18 24 24 40 12 21 18 20 20 13 17 11 25 12 14 18 10 12 395 34 Typhoid Fever and Paratyphoid Fever — — — — 1 — — 1 — — — — 1 — — — — — — 3 6 — Whooping Cough 46 11 21 37 18 38 33 51 15 26 34 17 14 18 19 18 19 20 8 29 492 — Total 280 58 120 113 79 213 132 505 144 230 113 83 83 125 173 105 129 189 60 98 3,032 65 INFECTIVE DISEASES 17 Poliomyelitis Thirty-one cases of this disease were reported and investigated during the year, compared to 73 in the previous year. In 26 cases the diagnosis was not confirmed. Of the remaining five confirmed cases, one was of the paralytic type and four non-paralytic. None proved fatal. The figures of poliomyelitis from 1947 to 1960, 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 1959 1960 No. of cases reported as suspected poliomyelitis and investigated 119 31 89 71 29 73 73 41 104 85 147 65 73 31 No. of cases confirmed (a) paralytic 78 15 58 40 4 23 19 5 22 24 43 11 13 1 (b) non-paralytic .. 7 16 8 2 27 15 28 9 4 4 Deaths 4 6 4 7 — 5 2 — 1 2 4 1 1 — Meningococcal Infection Five confirmed cases were notified, one of which proved fatal. Thirty other cases were investigated but these were subsequently not confirmed. In 1959 there were eight confirmed cases with no deaths. Acute Encephalitis Six cases were reported and investigated, but were subsequently not confirmed. Typhoid and Paratyphoid Fever Eight cases were reported during the year, of which one was subsequently confirmed as typhoid and five as paratyphoid. Four of these confirmed cases had previously been abroad on holiday. The diagnosis was not confirmed in the two remaining cases. 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Puerperal Pyrexia During the year 87 cases were notified, of which 83 occurred in hospital and four at home. Twenty-seven of the hospital notifications referred to patients whose home addresses were outside the borough. Information was also received of 30 cases, referring to Wandsworth residents whose confinements took place in hospitals located in other Metropolitan boroughs. Sonne Dysentery Investigation and systematic follow-up of all cases of dysentery, in which general practitioners co-operated fully with the Health Department, continued throughout the year and where it was considered necessary, stool specimens were obtained from family contacts for bacteriological examination. The bulk of the cases investigated were single unrelated cases and minor outbreaks occurred in only two instances during the early part of the year. In the first of these outbreaks, at one of the schools in the borough, 36 cases occurred and a total of 172 stools specimens bacteriologically examined. The second outbreak involved seven cases in a day nursery and a total of 42 stools specimens were examined before clearance. The figure of 315 cases finally arrived at for the year does not reflect fully the amount of work involved in visiting and following up. Many other suspected cases were investigated but a number of these proved negative on bacteriological examination. In 1959 there were 403 cases. Influenza, Acute Influenzal Pneumonia and Acute Primary Pneumonia Acute influenzal pneumonia and acute primary pneumonia are the notifiable forms of pneumonia and in 1960 the number notified, 15 of the former and 124 of the latter, shows a considerable drop in numbers of the first type, as compared with the number notified in the previous year. Deaths attributable to acute influenzal pneumonia were correspondingly low, the number being four; this figure is classified under influenza in the death table on page 12. Acute primary pneumonia accounted for 26 deaths, making a total of 301 deaths for all forms of pneumonia compared with 358 in 1959. INFECTIVE DISEASES 19 Malaria One recurrent case was notified, that of a person who had been living in Africa. Erysipelas Forty-two cases were notified. Other Infective Diseases Twelve deaths occurred from syphilis. Scabies Sixteen notifications were received. Thirty-three treatments were given at the Council's Disinfecting Station during the year. At the Battersea Cleansing Station, a total of 62 treatments for scabies and verminous conditions was given to women residents (and children under school age) of Wandsworth in accordance with the arrangements made by this Council with the Battersea Borough Council in 1955. Food Poisoning Investigation was made in 275 notified or otherwise reported cases during the year. One hundred and seven of these were deemed to be not food poisoning after laboratory examination of faecal specimens from those affected. Of the remaining notifications, 152 were single, unrelated cases and 42 comprised 16 minor 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 20 cases. The organisms involved were Salmonellae typhimurium (12), saint paul (2), anatum, heidelberg, enteriditis, newport, tennessee and mihaiama. In five of the minor outbreaks, Salmonellae typhimurium (3), heidelberg and reading were isolated; it was not possible in the remaining seven to identify the causative agent. There were, in addition to the above cases, three other outbreaks reported, two of which, involving respectively 210 and 73 persons, occurred at a hospital in the borough and the third, involving 50 persons, occurring at a factory. In all three outbreaks, bacteriological investigations indicated the causative agent as heat resistant Clostridium welchii and full reports were submitted to the Ministry of Health in accordance with existing procedure. 20 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Diseases Reported from Schools A total of 3,539 infective diseases was reported from schools in the Borough throughout the vear. The numbers of each disease were: scarlet Fever 139 Measles 348 German Measles 65 Poliomyelitis 4 Chicken Pox 1,130 Scabies 5 Whooping Cough 148 Mumps 1,349 Dysentery 149 Other complaints 202 Disinfection During the year 326 rooms were disinfected after infectious and other disease, 573 rooms disinfected for vermin, and 62 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 941 Faeces and urine for the typhoid and dysentery groups 2,982 Miscellaneous specimens 16 Total 3,939 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 diseases. 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. In connection with such exclusions from work, it should be noted that since the inclusion of Section 26 in the London County Council (General Powers) Act, 1959, it is now possible, if the borough council sees fit, to compensate persons for any loss occasioned by their compliance with the request of the Medical Officer of Health. During the year, no case arose that necessitated action under this Act but four contacts of infectious disease who were excluded from work were 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 952, the number of males being 495 and females 457. The death-rate was 2.81 per 1,000. The number of deaths in 1960 was 97 more than in the previous year. Deaths from diseases of the heart and circulatory system were 2,050 compared with 1,927 in 1959. Of these deaths, 1,748 were of persons of 65 years of age and above. There were 570 deaths from diseases of the respiratory system compared with 736 in 1959. The number of deaths from bronchitis was 211 compared with 325 in 1959, and from pneumonia (all forms) 301 compared with 358 in 1959. One hundred and seventy-four deaths were due to violence, 55 of them being due to motor accidents, 51 to suicide and 68 to other forms of violence. CERTIFICATES OF VACCINATION AND INOCULATION Two thousand, three hundred and thirty-eight 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 endorsed accordingly. Occasional requests were also received by the Medical Officer of Health for a certificate to the effect that no recent cases of smallpox have occurred in the area. Such requests are made by persons proceeding to the U.S.A. who do not wish to be vaccinated. STAFF MEDICAL EXAMINATIONS At the request of the Committees and Chief Officers concerned, arrangements were made during the year for four 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 two cases it was found necessary to recommend superannuation. Twenty-three reports on members of the staff who were sick were obtained from doctors 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 1960 was 395 compared with 488 in 1959. The sources of information regarding the new cases were as follows: Primary notifications on Form A 218 Notifications from H.M. Forces 2 Unnotified at death 0 Transfers from other sanitary authorities 175 Total 395 Three hundred and ninety-five cases were added to the notification register during the year and 172 cases who had removed, recovered or died, were taken off. The number remaining on the register at the end of the year was 6,284. Deaths The number of deaths certified as due to various forms of tuberculosis was 34. 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 1 — — — 1 — 3-4 1 2 — — — — — — 5-9 1 5 — — — — — — 10-14 5 7 — — — — — — 15-24 28 43 1 5 — — — — 25-44 87 79 — 3 2 1 1 — 45-64 66 28 — 2 9 3 — 2 65 and upwards 24 2 — 2 9 3 1 2 Totals 213 168 2 12 20 7 3 4 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 5,431 13,525 18,956 Inspections under Shops Act 291 — 291 Infectious Diseases 1,686 757 2,443 Inspections under Factories Act 1,374 — 1,374 Housing Clearance Area Scheme 86 — 86 Housing Reports 1,798 — 1,798 Hairdressers 335 — 335 Other inspections 9,581 2,397 11,978 Totals 20,582 16,679 37,261 Smoke observations 558 Legal proceedings, attendances at court 29 Table II gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 488 and 1,006 were cleansed or repaired. The drain of one house was reconstructed, and 139 drains were partially reconstructed. Damp conditions have been remedied in 756 premises, and in eight of these damp courses were inserted. 23 24 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 TABLE II Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 202 200 243 85 730 2. Drains tested 72 234 65 117 488 3. Drains cleansed or repaired 273 326 234 173 1,006 4. Water closets cleansed, repaired or renewed 81 102 98 67 348 5. Soil pipes altered or repaired 10 26 15 10 61 6. Waste pipes provided, altered or repaired 58 89 72 50 269 7. Rainwater pipes repaired 14 11 31 9 65 8. Roofs and gutters repaired 136 151 133 45 465 9. Damp courses inserted 6 — 1 1 8 10. Damp conditions otherwise remedied 115 106 164 55 440 11. Yards drained or paved 4 6 1 3 14 12. Dustbins provided 7 13 41 7 68 13. Water cisterns cleansed, covered or repaired 9 4 2 1 16 14. Water supply reinstated 53 49 30 47 179 15. Defective stoves and fireplaces remedied 6 24 5 6 41 16. Animals improperly kept 1 2 4 1 8 17. Accumulations of rubbish, etc., removed 12 12 16 7 47 18. Urinals cleansed or repaired — 2 — 1 3 19. Smoke nuisances 18 13 9 — 40 20. Other nuisances 15 14 11 7 47 Total 1,092 1,384 1,175 692 4,343 Number of Preliminary Notices served 301 414 416 154 1,285 Number of Preliminary Notices complied with 319 444 433 159 1,355 Number of Nuisance Notices served 101 132 120 33 386 Number of Nuisance Notices complied with 88 115 146 30 379 SANITARY INSPECTION OF THE BOROUGH 25 Water Supply—Cutting-off Notices During the year notices with respect to 183 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 39 premises the water supply was cut off for non-payment of rates, and in 144 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 73 premises and during this period 64 dustbins were provided. Dustbins were also provided at four premises without the necessity of action under the Acts. Rodent Control One thousand, eight hundred and twenty-seven 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 9,108 „ „ premises treated with "Warfarin" 1,263 „ „ premises "Warfarin" laid and found not troubled 74 „ „ premises investigated and found not troubled 179 „ „ "Warfarin" baits laid 5,029 „ „ drains tested by Public Health Inspector 347 „ „ drains found defective 259 „ „ rats estimated killed 2,293 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. Public Swimming Baths The position remains much the same as described in my Report last year. There are in the Borough the following public swimming baths: Four indoor swimming baths owned by the Borough Council. One open air swimming bath owned by the Borough Council. One open air swimming bath owned by the London County Council. The source of water for one of the Borough Council's baths is from an artesian well and for the other baths, including that owned by the London County Council, from the Metropolitan Water Board's supply. Up to approximately two years ago, one of the 26 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Borough Council's baths was operated on the "fill and empty" system but a modern filtration and chlorinating plant has now been installed so that all the public swimming baths in the Borough now operate a modern process of continuous circulation through a filtration plant with chlorination of the water. The same process operates in the case of the London County Council open air swimming bath. During the year bacteriological samples were taken from the Borough Council baths and the bacteriological reports were satisfactory. In the case of the London County Council open air bath, I am informed that samples were also taken which also were found to be satisfactory. In addition to the public swimming baths, there are four private swimming baths in the Borough, to one of which the public may be admitted. These all have continuous filtration and chlorination plants and some bacteriological samples were taken during the year which proved to be satisfactory. Care of Old People In the maintenance of the welfare and well-being of old people residing in the Borough, firm links have been established between the statutory bodies and the voluntary associations, particularly the Wandsworth Old People's Welfare Council. The links become stronger as the years go by. Co-ordination of effort has resulted in the provision of amenities such as clubs, holidays, Meals on Wheels, home visits and chiropody. Relatively recent innovations include the Jordan and Lebanon Luncheon Clubs organised by the Wandsworth Old People's Welfare Council and seaside holidays sponsored by the Wandsworth Old Folks' Trust. So far as the welfare and health of old people are concerned, it is a pleasure to acknowledge the co-operation of the officers of the Welfare Department of the London County Council and the expert guidance of the geriatricians of St. Benedict's Hospital, Tooting, St. John's Hospital, Battersea, and the South Western Hospital, Stockwell. On the other hand, although from time to time it may become necessary for old people to be admitted to a Home or a hospital, it is the constant endeavour of the staff of the Public Health Department to give every assistance to all old people who are not in need of institutional care and who wish to remain in their own homes. In this context, I express my gratitude for the excellent work of the general practitioners of the Borough, the health visitors, the district nurses, the community care workers and the home helps. Difficult problems are likely to arise, however, in cases of frail elderly people, living alone, who lack the support of relatives or SANITARY INSPECTION OF THE BOROUGH 27 neighbours. When an aged person's physical enfeeblement is associated with deterioration in environmental hygiene, the district public health inspectors are always ready to advise, not only on the remedying of defects but also on the procedures to be adopted in order to prevent any further deterioration. When other measures have failed to achieve the desired result, removal to a Home or hospital may be necessary as empowered under the National Assistance Acts. This procedure is always contemplated with the greatest reluctance, for the element of compulsion in itself may produce an adverse effect upon the patient's condition. Fortunately, by virtue of much perseverance and great efforts on the part of all concerned, it was possible throughout the year to make satisfactory arrangements, without resort to legal action. 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 six such cases were being dealt with and a further 37 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 1,113 lots of fouled linen were collected and cleansed in 1960. 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 259 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. The furniture of 15 families was dealt with during the year. Bedding is not subjected to hydrogen cyanide but is disinfested by steam at the Council's Disinfecting Station. 28 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Mortuary The arrangement, made in 1956, between this Council and Battersea Borough Council, whereby the latter undertook, on agreed terms, to use their mortuary for the reception of bodies of Wandsworth residents, continued and is working satisfactorily. During the year 718 bodies of persons who died in Wandsworth were received in the Battersea mortuary in addition to the reception of bodies of persons dying in Battersea. Crematorium Under the Crematorium Regulations, 1930, 1,565 cremations were authorised during 1960, compared with 1,582 in 1959. 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 1960 was 19. Sewerage The arrangements for sewerage and sewage disposal in the district are reasonably adequate although flooding has occurred in the borough due to surcharging of sewers following periods of heavy rain. 5 HOUSING STATISTICS RELATING TO HOUSING Public Health (London) Act, 1936 Number of houses inspected on account of complaints or illness 7,117 Re-inspections 14,282 Number of statutory notices served: Intimation notices 1,285 Nuisance notices 386 Number of houses in which nuisances were abated 1,355 The number of cases referred to the Solicitor for legal action during 1960 was 84 The following is a summary of Police Court proceedings: Number of summonses served 47 „ „ „ withdrawn 25 „ „ adjourned 12 „ „ Orders made for abatement of nuisances 10 Costs awarded in respect of three cases £8-8-0 Housing Acts, 1936 and 1957 Clearance of Unfit Houses Number of houses included in representations under Section 157 of the Housing Act, 1957 8 Number of houses included in declared Clearance Areas under Section 42 of the Housing Act, 1957 8 Number of houses demolished following action under Section 25 of the Housing Act, 1936 31 Number of houses demolished following action under Section 42 of the Housing Act, 1957 9 Demolition Orders Number of Demolition Orders made under Section 17(1) of the Housing Act, 1957 Nil Number of houses demolished as a result of formal or informal procedure under Section 17(1) of the Housing Act, 1957 1 Closing Orders Number of Closing Orders made on houses under Section 17(1) of the Housing Act, 1957 3 29 30 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Number of houses closed in pursuance of an undertaking given by the owner under Section 16(4) of the Housing Act, 1957 Nil Number of Closing Orders made on parts of buildings under Section 18 of the Housing Act, 1957 6 Number of undertakings given by owners to close parts of buildings under Section 16(4) of the Housing Act, 1957 Nil Number of Closing Orders determined under Section 27 of the Housing Act, 1957 7 Overcrowding Number of families found to be living in overcrowded conditions 32 Number of overcrowded families who have obtained alternative accommodation 15 New Accommodation Number of dwellings erected: (a) by the Borough Council 98 (b) by the L.C.C 152 (c) by other persons 303 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE Clearance Areas The following properties were declared Clearance Areas following my representations: 473-477 (odd), 481-489 (odd) York Road. Unfit Houses Closed Closing Orders were made in respect of whole houses as follows: 43 Angles Road 65 Warple Road 8a Zennor Road Closing Orders were made in respect of parts of buildings as follows: Premises 175 Bedford Hill 179 Bedford Hill 166 Clapham Park Road 37 South Side, Clapham Common 38 South Side, Clapham Common 318 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. HOUSING 31 The Rent Act, 1957 Applications for Certificates of Disrepair. Sixty-one 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. (b) In fifty-nine cases it was decided to serve notices on landlords proposing to issue Certificates of Disrepair unless undertakings to do repairs were given. (c) Thirty-eight undertakings were received from landlords to remedy defects proposed to be included in Certificates of Disrepair. (d) Nineteen Certificates of Disrepair were issued. Applications for Cancellation of Certificates. (a) Twenty-eight applications were received from landlords for the cancellation of Certificates of Disrepair. (b) Ten objections were received from tenants for cancellation of Certificates. (c) In one case it was considered that the tenant's objection was not justified and the Certificate cancelled. (d) Sixteen Certificates of Disrepair were cancelled. Housing Accommodation—Medical Priority During the year 647 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 269 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. 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 2,687 and during 1960 they were visited on 9,955 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. Court summonses were taken oat by the Council against two local traders and a manufacturer for the presence of foreign matter in food. Costs of £3-3-0, a fine of £6 and costs of £3-3-0 and a fine of £2 and costs of £5-5-0 were awarded by the Court respectively in these three cases. A Court summons was also taken out against a local trader for the presence of mould in food. A fine of £10 and costs of £3-3-0 were awarded by the Court. A further Court summons was taken out against a local trader for smoking a cigarette whilst handling open food. Costs of £3-3-0 were awarded by the Court. The following list shows the number and type of premises in the Borough where food is sold, stored or prepared: 32 TABLE I SUMMARY OF VISITS TO FOOD PREMISES Putney Central Clapham Streatham Whole Borough Dairies 12 33 55 36 136 Restaurant Kitchens 509 369 473 312 1,663 Ice Cream Premises 28 49 9 30 116 Butchers' Shops 379 195 232 61 867 Greengrocers' Shops 220 93 104 78 495 Fishmongers' Shops 69 25 41 25 160 Fried Fish Shops 50 41 75 22 188 Market Stalls 124 1,436 951 197 2.708 Grocers' Shops 644 435 592 392 2,063 Confectioners' Shops 288 281 181 128 878 Bakehouses 48 31 32 9 120 Other Premises 248 138 116 59 561 Total Visits 2,619 3,126 2,861 1,349 9,955 FOOD AND FOOD PREMISES 33 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 Dairies and Milk Depots 9 pood Factories 24 Restaurants, Cafes and Canteens 466 Bakers and Confectioners 529 Butchers 215 Greengrocers 242 Fishmongers 73 Fish fryers 58 Bakehouses 55 Grocers 621 Off Licences 97 Public Houses 150 Stalls 148 2,687 The amount of work completed during 1960 to comply with the requirements of the Regulations is indicated in the following details: Washhand basins provided 69 Sinks provided 10 Provision of hot water over sink and washhand basin 34 Accommodation for clothing provided 6 Soap, towel and nailbrush 3 First-aid materials provided 2 Premises repaired or redecorated 68 Adequate protection for open food 6 Notices to employees 5 Dustbins 4 W.C. accommodation 19 Milk Supply The Milk and Dairies General Regulations, 1959 These Regulations came into force on 8th March, 1959, 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. FOOD AND FOOD PREMISES 35 During the year 30 applications were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Sixteen notices of cancellation of registration were received. At the end of the year there were 225 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 Two hundred and seventy-six samples of milk were submitted for analysis. Of these 34 were samples of Channel Island and South Devon milks with an average fat content of 4-44 per cent. The remaining 242 samples had an average fat content of 3-62 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 219 29 248 Sterilized 233 33 266 Tuberculin Tested 152 28 180 Total 604 90 694 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. 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 On 1st October, 1960, new regulations came into operation which supersede the Milk (Special Designation) (Raw Milk) Regulations, 1949-1954, and the Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949-1953. They are known as The Milk (Special Designation) Regulations, 1960, but as renewals of licences are made in the first month of the year, the alterations contained in the new regulations do not actually take effect until January, 1961. Under the new regulations dealers' licences will permit sales outside as well as inside the area of the licensing authority and supplementary licences are to be discontinued. A dealer's (prepacked milk) licence will permit the sale of all three kinds of specially designated milk where milk is obtained by the dealer in the container in which it is to be supplied to the consumer or is pasteurized or sterilized by the dealer. Period of licence is extended from one to five years for licences renewed on 1st January, 1961. Meat There are 215 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 867 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 Fifty-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. FOOD AND FOOD PREMISES 37 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 1960 was 353, and 574 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. TABLE II PART II OF POISONS LIST Principal Business Number of Premises Number of Visits Confectioners 3 5 Domestic stores, ironmongers, etc 74 76 Drug stores 17 16 Grocers 245 463 Hairdressers 9 9 Nurserymen and florists 5 5 Total 353 574 Bakehouses There are 55 bakehouses in the Borough, of which 11 are in basements and subject to the provisions of Section 54 of the Factories Act, 1937. One hundred and twenty 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 1958 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. The water to the whole of the area is piped by the Metropolitan Water Board. It is known that this large undertaking carries out bacteriological and chemical tests of raw water and after treatment. No specific action has been necessary in respect of contamination of the water supply but in the case of individual premises, following inspection by public health inspectors, close liaison is maintained with the Metropolitan Water Board whenever necessary. 38 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 All dwelling houses, approximately 96,000, and the population of 338,800 in the Borough are supplied from water piped direct to houses.'It is not known if any standpipes are still in existence. Registration of Premises The Food and Drugs Act, 1955 Section 16(1) of the above Act provides that no premises shall be used for: (a) the sale, or manufacture for the purpose of sale, of ice-cream or the storage of ice-cream intended for sale; or (b) the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale, unless they are registered under this section for that purpose with a local authority. During the year 95 applications for registration under the provisions of Section 16(l)(a) and 21 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. Bacteriological Examination of Food and Waters Two hundred and fifty-nine samples were examined bacteriologically at the Public Health Laboratory during the year. They were as follows: Milk Ice-cream Imitation Cream Artesian Well Waters Swimming Pool Waters Others Total 216 20 1 4 12 6 259 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 20 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. FOOD AND FOOD PREMISES 39 The following table gives a summary of the results: Methylene-Blue Reduction Test Provisional Grade Number of Samples 1 15 2 2 3 3 4 — Total 20 Imitation Cream One sample was examined for the presence of pathogenic organisms, and was reported satisfactory. Examination of Water from Artesian Wells Four samples were submitted for examination, and were reported satisfactory. Examination of Water from Swimming Baths Twelve samples were submitted for examination, and all were reported satisfactory. Others The six 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: 276 samples of milk, 668 other foodstuffs and 56 drugs. Of these, 223 were submitted as formal samples, while 777 were purchased informally. One or -44 per cent, of the formal and 43 or 5-53 per cent, of the informal samples were found to be adulterated or not up to standard. The total adulterations reported were 44 or 4-4 per cent, of the samples submitted. The 44 samples found to be adulterated were: Sixteen samples of chocolate liqueurs, four samples of bread, three samples of pork chipolatas, two samples each of creamery butter, pork sausages, margarine and glauber's salt and one sample each of non-brewed condiment, corned beef, Australian apples, shredded beef suet, salted peanuts, chocolate cream bun, lamb kidneys, milk bottle, orange juice, bread roll, cream cake, fruit cake and glace cherries. 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 436 150 1 — (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,051 825 5 — (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' Premises) 231 59 — Total 1,718 1,034 6 — (2) DEFECTS Number of cases in which defects were found Number of Particulars Found Remedied Referred cases in which prosecutions were instituted To H.M. Inspector By H.M. Inspector Want of cleanliness 12 9 — 2 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors 1 — — — — Sanitary Conveniences: (a) insufficient 6 3 — 1 — (b) unsuitable or defective 64 49 — 18 — (c) not separate for sexes 3 2 — 3 — Other offences against the Act (not including offences relating to outwork) 17 16 1 — — Total 103 79 1 24 — 40 FACTORIES ACT, 1937 AND 1948 41 PART VIII OUTWORK (SECTIONS 110 AND 111) Section 110 Section 111 Nature of Work No. of outworkers in August list required by Section 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Prosecutions Wearing apparel- making, etc. 621 — — — — Wearing apparel— cleaning and washing 2 — — — — Curtains and furniture hangings 3 — _ — — Umbrellas, etc. 3 — — — — Artificial flowers 3 — — — Paper bags 10 — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 17 — — — — Brush making 1 — — — — Carding, etc., of — tons, etc. 5 — — — — Stuffed toys 4 — — — Cosaques, Christmas — stockings, etc. 30 — — — — Lampshades 208 — — — — Total 907 — — — — 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 20 new registrations were made, and the total number on the register at the end of the year was 267. Pet Animals Act, 1951 Thirty-four licences were issued by the Council in relation to premises subject to the provisions of this Act. 8 ATMOSPHERIC POLLUTION AND CLEAN AIR Considerable progress has been made in implementing the Clean Air Act, 1956. In addition to the two Smoke Control Orders already made by the Council, a third Order has now been confirmed by the Minister of Housing and Local Government, subject to the modification that the operative date will be 1st November, 1961, and not 1st September, 1961, as proposed. The survey of Smoke Control Area No. 4 is now complete, and at the time of writing, a preliminary survey of Area No. 5 is being carried out. In accordance with the provisions of Section 12(2) of the Clean Air Act, 1956, four notices were served in connection with premises within the Council's second Smoke Control area, requiring works of adaptation to fireplaces. These works were considered necessary in order to avoid contravention of the provisions of Section 11 relating to offences in Smoke Control areas. The notices have been complied with. New Furnaces Under Section 3 of the Clean Air Act, application may be made to the local authority for prior approval to the installation of a furnace. No such applications were received during 1960. Notices of intention to install a furnace were received in respect of 13 premises, in accordance with the provisions of Section 3(3) of the Act. Measurement of Atmospheric Pollution Daily readings of the concentration of smoke and sulphur dioxide (S02) in the atmosphere were continued during the year at the five stations in different parts of the Borough where recording apparatus has been set up, and as in the previous year, a record of these readings for the year under review is given in Table I. A comparison of smoke and S02 concentration for the past two years is shown in Table II. 42 TABLE I Station Roof— Municipal Buildings Valley Road, S.W.I6 Tooting Library Queen Mary's Hospital, Roehampton South London Hospital, Clapham Month—1960 Smoke so2 Smoke so2 Smoke so2 Smoke so2 Smoke so2 January 37.42 10.2 650 10.5 23.4 5.8 21.0 9.9 26.0 9.5 February 22.55 10.2 51.0 9.2 26.0 7.12 11.5 8.0 23.7 12.2 March 19.36 8.8 26.6 6.6 No ► readings available 13.2 11.4 20.0 7.7 April 12.03 4.2 22.0 4.5 7.1 5.2 No readings May 11.45 3.78 161 5.0 6.7 6.1 9.4 6.67 June 6.74 3.15 2.1 3.2 1.63 3.4 8.0 4.25 July 2.2 2.7 1.7 2.2 3.5 2.13 0.77 1.6 3.2 2.6 August 4 13 3.0 2.2 1.8 4.9 2.2 1.3 2.7 6.4 2.7 September 4.2 2.9 4.3 3.2 6.8 3.2 3.3 3.8 5.8 3.4 October 9.1 5.0 8.0 4.3 8.6 3.8 5.6 5.5 9.0 3.9 November 9.3 7.1 12.5 6.3 10.7 6.0 7.0 5.2 9.7 6.2 December 14.0 9.6 22.8 14.0 12.0 11.5 10.0 6.4 13.0 10.3 Average 12.7 5.885 19.5 5.9 11.9 5.22 7.42 5.77 1118 5.78 ATMOSPHERIC POLLUTION AND CLEAN AIR 43 TABLE II ATMOSPHERIC POLLUTION COMPARISON OF SMOKE AND S02 CONCENTRATION 1959 AND 1960 44 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 9 ACCIDENTS IN THE HOME Tables showing figures of accidents in the home, introduced for the first time in 1958, are reproduced below, and include figures for 1960, calculated as described in the 1958 Report. HOME ACCIDENT CASES DURING 1956 to 1960 TABLE I Cause of Accident 1956 1957 1958 1959 1960 Fall. On stairs 120 112 122 130 131 From ladder 21 18 12 19 20 From chair 18 18 21 29 21 Outside 32 18 16 35 21 In garden 45 31 25 43 35 In bath 1 3 1 4 2 From one level to another 42 42 33 32 35 On same level 77 57 105 115 110 Unspecified 222 240 255 268 338 Hit by object 45 15 14 16 20 Cooking stove 15 7 13 17 15 Teapots 4 2 6 7 7 Other boiling water 18 25 12 17 13 Electric shock 2 2 1 3 2 Poisoning 27 34 24 24 48 Gassing 9 9 12 19 12 Knife.like wounds 69 51 36 47 48 Fires 24 10 24 11 10 Windows 7 5 6 9 7 Suffocation 1 3 2 10 3 Not specified 13 53 44 31 39 Totals 812 755 784 886 937 Rate per 10,000 population 24.0 22.4 23.2 26.2 27.6 TABLE II AGE GROUPS AND PERCENTAGES 1956 % 1957 % 1958 % 1959 % 1960 % Under 1 10 1.2 10 1.4 14 1.7 11 1.3 12 1.3 1. 26 3.2 25 3.3 29 3.7 31 3.4 33 3.6 2. 30 3.7 26 3.4 30 3.8 35 3.8 35 3.9 3 and 4 31 3.8 35 4.6 36 4.6 40 4.5 45 4.8 5.19 96 11.7 81 10.7 84 10.8 102 11.8 110 11.6 20.59 252 31.0 232 30.7 239 30.5 268 30.5 280 30.4 60.69 93 11.6 91 12.0 82 10.5 102 11.6 110 11.8 70.79 150 18.5 133 17.7 141 17.9 155 17.3 157 16.4 80+ 124 15.3 122 16.2 129 16.5 142 15.8 155 16.2 Totals 812 100 755 100 784 100 886 100 937 100 45 10 REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1960 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, 1960, 944 were articles of food and the remaining 56 drugs. All were submitted by the Council's Food Inspector, 223 having been taken with the formalities required by the Act and 777 informally. Samples of the following substances were analysed: fats (butter, margarine, etc.), 73; beverages (cocoa, coffee, tea, etc.), 38; cereal preparations, 14; cheese products, 27; confectionery, 36; cream, 34; fish (canned, etc.), 35; fruit (canned and dried), 42; ice-cream, 24; meat products (including sausages), 83; milk, 276; pickles and condiments (including spices), 89; preserves, 38; soup, 29; vegetables, 42; aspirin tablets, 6; Beecham's powders, 5; bicarbonate of soda, 3; camphorated oil, 6; friars balsam, 7; glaubers salts, 4; ointments, 5. 46 REPORT OF THE PUBLIC ANALYST FOR 1960 47 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 411 Glauber's Salt Anhydrous sodium sulphate Informal 169 Non-brewed condiment 2% deficient in acetic acid 180 Corned beef Material composed in part of skin and hair 181 Bread Dirty mineral grease present 182 Creamery butter Contained mould structures 183 Creamery butter Contained mould structures 195 Australian apples In wrappers treated with paraffin oil 218 Pork chipolatas Meat content 58 % 257 Pork chipolatas Meat content 48 % 258 Pork chipolatas Meat content 57% 259 Pork sausages Meat content 56% 320 Bread Contained a small flour moth 361 Shredded beef suet 7 % deficient in fat 364 Salted peanuts Rancid 501 Chocolate cream bun Contained a sliver of wood baked in the bun 514 Lamb kidneys Contained calculi of calcium oxalate 547 Milk bottle Contained dirt; chiefly mycelia of moulds 548 Margarine Rancid 549 Margarine Rancid 561 Pork sausages Meat content 55 % 563 Orange juice Contained dirt; chiefly mycelia of moulds 671 Bread Contained a bundle of artificial fibres 733 Bread roll Machinery grease present 765 Cream cake Matted fibres present 825 Fruit cake Glass baked in cake present 829 Glauber's Salt Anhydrous sodium sulphate 888-903 Chocolate liqueurs Minute amounts of proof spirit only present 904 Bread Appearance unsatisfactory, due to unsightly dough 923 Glace cherries Preserved with benzoic acid Adulteration The amount of adulteration detected during the year was: For formal samples 0.44 per cent. For informal samples 5.53 per cent. For all samples 4.4 per cent. 48 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR I960 Complaint Samples Case No. 166. Culinary Flavour. Submitted on the complaint that it caused a burning sensation on the skin. The complaint was considered not justified. Case No. 180. Corned Beef. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 181. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 195. Apples. Submitted on the complaint that it had an unusual taste. The complaint was considered justified. Case No. 208. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 246. Lemonade. Submitted on the complaint that it caused sickness. The complaint was considered not justified. Case No. 260. Pork Luncheon Meat. Submitted on the complaint that it contained no pork. The complaint was considered not justified. Case No. 277. Salted Peanuts. Submitted on the complaint that it had an unusual taste. The complaint was considered not justified. Case No. 320. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 363. Grapefruit. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 364. Salted Peanuts. Submitted on the complaint that it was rancid. The complaint was considered justified. Case No. 398. Minced Beef. Submitted on the complaint of the unusual colour. The complaint was considered not justified. Case No. 472. Cherry Cake. Submitted on the complaint of the unusual taste of the cherries. The complaint was considered not justified. Case No. 501. Chocolate Cream Bun. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Cases Nos. 548 and 549. Margarine. Submitted on the complaint that they were rancid. The complaints were considered justified. Case No. 562. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. REPORT OF THE PUBLIC ANALYST FOR 1960 49 Case No. 563. Orange Juice Bottle. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 610. Tinned Salmon. Submitted on the complaint that contents were not genuine salmon. The complaint was considered not justified. Case No. 640. Sliced Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 671. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 733. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 734. Sterilized Milk. Submitted on the complaint that it had a bitter taste. The complaint was considered not justified. Case No. 749. Tinned Pears. Submitted on the complaint that it was unsound. The complaint was considered not justified. Case No. 750. Tinned Soup. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 751. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 752. Milk. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 753. Bread Roll. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 765. Cream Cake. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 775. Blackcurrant Syrup. Submitted on the complaint that it caused sickness. The complaint was considered not justified. Case No. 825. Fruit Cake. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 904. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. 50 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 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 22 12·40 3·64 8·76 February 20 12·30 3·57 8·73 March 28 12·29 3·54 8·75 April 17 12·14 3·42 8·72 May 22 12·20 3·39 8·81 June 16 12·33 3·59 8·74 July 20 12·14 3·54 8·60 August 24 12·28 3·55 8·73 September 16 12·50 3·70 8·80 October 16 12·69 3·83 8·86 November 19 12·67 3·86 8·81 December 22 12·65 3·84 8·81 The average composition of the 242 samples of milk analysed during the year and returned as genuine was as under: Total milk solids 12·38 per cent. Milk fat 3·62 per cent. Non·fatty solids 8·76 per cent. The average composition of the 34 samples of Channel Island and South Devon milks was as under: Total milk solids 13·53 per cent. Milk fat 4·44 per cent. Non·fatty solids 9·09 per cent. INDEX PAGE Accidents, Deaths from 21 Accidents, Home 45 Acute Encephalitis 17 Analyst, Report of 46 Atmospheric Pollution 42 Bacteriological Examinations of Milk 38 „ „ of Ice-cream 38 Bathing Pools and Swimming Pools Bed Bugs, Eradication of 27 Births, Birth-rates 10 Butchers' Shops 36 Cancer 21 Care of Old People 26 Childbirth, Deaths from 13 Circulatory Diseases Clean Air 42 Closing Orders 29 Crematorium 28 Cutting-off Notices—Water Supply 25 Deaths, Causes of 12 Death-rates 11 Death-rate from Infective Diseases 14 Death-rate, Infantile Deaths, Number of 12 Diphtheria 14 Disinfection 20 Dysentery, Sonne 18 Enteric Fever Erysipelas 19 Factories Act, 1937 and 1948 40 Factories and Workshops 40 Food and Drugs Act, 1955 35 Food Poisoning 19 Food, Supervision of 32 Food Places, Inspection of 33 Food Places, Number on Register 32 Food Hygiene Regulations 32 Hairdressers and Barbers 41 Home Accidents 45 Houses and Premises Inspected 23 Housing Act, 1936 29 Housing Statistics 29 Hydrogen Cyanide Disinfection 27 Illegitimate Children, Births of 10 Infant Mortality 13 Infective Diseases 14 Infective Diseases, Cases of 15 Infective Diseases, Death-rate from 14 Influenza, Deaths 18 Influenzal Pneumonia and Acute Primary Pneumonia 18 51 52 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1960 PAGE Insanitary Areas 30 Malaria 19 Maternal Mortality 13 Meat36 Meningococcal Infection 17 Milk Analysis 50 Milk, Bacteriological Examination of 38 Milk Premises, etc., on Register 34 Milk (Special Designations) Regulations, 1949-54 Mortuary 28 Non-infective Diseases, Deaths from 21 Notification of Infective Diseases 15 Outworkers 41 Overcrowding 30 Pet Animals Act 41 Pharmacy and Poisons Act, 1933 37 Pharmacy and Medicines Act, 1941 37 Poliomyelitis Population 10 Pregnancy, Deaths from Accident and Diseases of 13 Preserved Meat, etc., Manufacture of 36 Public Analyst, Report 46 Puerperal Pyrexia 18 Pulmonary Tuberculosis, Notification of cases of Rent Act 31 Rodent Control 25 Samples, Formal and Informal, Number of 47 Sanitary Inspection of Borough 23 Scabies 19 Scarlet Fever 14 Slaughter-houses 36 Slaughter of Animals Acts, 1933-1954 36 Smallpox 14 Staff 6 Statistics for the Borough 9 Suicide, Deaths from Swimming Baths and Bathing Pools 25 Syphilis, Deaths from 19 Tuberculosis 22 Unfit Houses 30 Unsound Food 36 Water Supply Water Supply, Cutting-off Notices 25 Whooping Cough 14