Ac. 4388 Library II WAN 100 Metropolitan Borough of Wandsworth ANNUAL REPORT of the Medical Officer of Health for the Year 1963 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 1963 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting to you the Annual Report on the health and sanitary conditions in the Borough for the year 1963, which follows the general form of previous Reports. The publication of the 1961 Census showed the population of Wandsworth as nearly 8,000 more than the estimate for 1960; the Registrar General's estimate of the mid-year population in 1963 was 348,450 which is 640 more than 1962. The crude birth rate was 18.3 per thousand persons living, a very slight increase over the previous year. After taking into account the area comparability figure, the adjusted rate works out at 17.5 as against 17.4 for last year, a barely perceptible change. The rate for England and Wales as a whole was 18.2 and for London 20.1. The crude death rate for the year was 14.9 per thousand compared with 14.4 for 1962 and the adjusted rate 11.08 as against 11.2, the changes again being minimum. The corresponding figures for England and Wales and London were 12.1 and 12.4. The number of deaths of children under one year of age was 126 which was 4 more than the previous year and this gives an infant mortality rate of 19.6 per thousand live births, as compared with 19.3 for 1962. There were 3 deaths from puerperal causes in 1963 compared with 2 for 1962, a maternal mortality rate of 0.46 per thousand births. The incidence of infectious diseases did not present any particular features except for the expected increase in the number of measles cases, since 1963 was a measles year; there were in fact 3,427 as against 691 for 1962. I reported last year a comparatively low figure for whooping cough cases, namely, 54; there was an increase in 1963 to 337 cases. The majority of these cases, however, were mild and in some at least the diagnosis may have been 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 in doubt due to immunisation against this disease which is now practised. There were no deaths from whooping cough or measles. Two cases of typhoid fever arose in the Borough but these were cases where the disease was contracted abroad and not in this country. No confirmed case of poliomyelitis occurred during the year. Last year the number of cases of tuberculosis coming to our notice did not vary very much from 1961, but this year I am happy to report there was a marked reduction in the number of cases of which we became aware, namely, 293 as compared with 320. Since the transfers from other authorities and those un-notifiable until death, remained identical with 1962, the reduction to the number of 27 was in respect of new notifications, namely, 165 as compared with 192 in the previous year. There was also a small reduction in the number of deaths from the various forms of tuberculosis, namely, 25 compared with 27 in 1962 and 30 in 1961. These are very gratifying reductions in a disease which is less of a scourge than was the case in the not so distant past, yet still remains a considerable public health problem. The winter of 1962/63 was one of the most severe in living memory and the cold weather extended into March. During the period the Health Department was asked to help with a number of problems, notably in relation to burst pipes and the difficulties of some old people were accentuated during the cold weather. Nevertheless, there was no obvious deterioration in the general health of the Borough so far as one was able to judge. This, in general, is confirmed by the statistics for the year although there were one or two features which might be related to the severe winter. For instance, although, owing to the increase in population, the adjusted death rate did not differ very much from 1962, the total number of deaths, in fact, was greater in 1963 than in 1962 by 212. Looking at the different causes of death, there were, as is inevitable, some variations between 1962 and 1963 but for two causes of death, namely, pneumonia and bronchitis, there were distinctive increases. For instance, for pneumonia, there were 414 deaths against 312 in 1962, an increase of 102 and in the case of bronchitis, there were 377 deaths as against 271 in 1962, an increase of 106. Deaths from pneumonia include broncho-pneumonia which is not notifiable as such. There were as many deaths from these two causes in the first quarter of the year as in the rest of the year and predominantly in old people. It is difficult to be absolutely certain of the cause and effect in conditions such as these but it is possible that the increase in the mortality from pneumonia and bronchitis in 1963 was related to the severe weather in the early part of the year. I reported last year in some detail on the work undertaken by the public health inspectors in connection with houses in multiple occupation. This work continued in 1963 and included in the body of this Report is a table showing the work accomplished so far. This work can be arduous for it is not merely a matter of making REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 3 one visit and serving a notice with follow-up to see how the work is progressing. Each property presents its own separate problem in terms of the number of families in the premises and the facilities and amenities existing. Many properties are in different ownerships with owners having different ideas on what they are prepared or able to do. Sometimes it is difficult to make contact with tenants or to gain access to the properties and evening visits may be required. When the condition of the property has been assessed and the owners interviewed, it is then necessary to explain what is required and to advise how it can be done and this may in itself entail several interviews with the owners. Although progress is being made, this work requires constant review. A full report was made to the Committee towards the end of the year. The provisions of the Housing Bill, 1963, which has not yet become law, will cover many houses let in multiple occupation and it seems clear that these two separate, but related, pieces of legislation, will need to be dealt with side by side. The whole problem of houses in multiple occupation and the improvement of existing houses as envisaged in the Housing Bill, 1963. will need careful study and review. The work under the Clean Air Act, 1956, continued in 1963 and during the year the General Purposes Committee of the Council, as a matter of policy, decided that the whole area of the Metropolitan Borough of Wandsworth should be converted into a Smoke Control area by 1970. During the year, the Council's fifth area was confirmed and the sixth Order made by the Council has been submitted to the Minister for approval. Preliminary work is continuing in area No. 7 and is now nearing completion. The plan on page 43 shows pictorially the progress achieved and proposed. I should like again to thank the many people who have contributed to the work of the Health Department, particularly the Committees and their Chairmen with whom I have been mainly concerned. I should like especially to thank Councillor Miss Joan Lestor, Chairman of the Public Health Committee, for her help and guidance during the year and to express my appreciation to the members of my own staff and the Chief Officers and staff of other Departments of the Council. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, J. TUDOR LEWIS, Medical Officer of Health. 4 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 P. O.'Grady A. E. Handley K. J. Winton (Retired) J. D. Morritt J. H. Massey R. C. Charlton P. P. Leacock A. Stewart A. J. Lansley S. E. helner S. R. Coomber (Resigned) A. W. Lock G. Pike C. Jones J. B. Sainsbury J. Smith J. F. Burlem D. J. Hughes J. L. Gill Trainee Public Health Inspectors M. Timlin D. S. Burtenshaw G. P. W. Chambers Administrative and Clerical S. F. Jennings A. J. K. Green A. E. Hollis E. Harris W. Pitman F. Chislett S. Taylor D. H. Barnes N. Lane G. Harwood Mrs. F. Hull Miss J. Eley REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 5 STAFF OF PUBLIC HEALTH DEPARTMENT—continued Technical Smoke Control C. F. Harrison J. Weir L. W. Clifton F. B. Capes Disinfecting Station F. Stennings J. Williams (Retired) W. E. Stringer G. W. Price A. E. Clement T. Price J. C. Prowen (Resigned) Mrs. E. King (part-time) Rodent Operatives J. W. Taylor J. Wells G. J. Langrish W. Maxwell V. T. Athaide The following changes occurred in 1963: Appointments Mr. G. W. P. Chambers, Trainee Public Health Inspector, appointed in September. Resignations and Retirements Mr. S. E. Thelner, Public Health Inspector, resigned in June. Mr. A. E. Handley, Public Health Inspector, retired in September. Mr. J. Williams, Stoker, retired in May. Mr. J. C. Prowen, Driver, resigned in June. 6 1 STATISTICS AND SOCIAL CONDITIONS Area 9,109 acres Resident population in 1963 348,450 Wandsworth is the largest of the Metropolitan Boroughs. It has an area of 9,109 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. STATISTICS AND SOCIAL CONDITIONS 7 Extracts from Vital Statistics Number of Live Births: Male Female Total Legitimate 2,913 2,704 5,617 Illegitimate 401 384 785 3,314 3,088 6,402 Rate per 1,000 population: Crude 18.3 Adjusted 17.5 Number of stillbirths 41 50 91 Rate per 1,000 total live and stillbirths 14.0 Percentage of illegitimate live births to total live births 12.2 Number of deaths: All ages 2,422 2,800 5,222 Under 1 year 80 46 126 Puerperal causes — 3 3 Rate per 1,000 population: Crude 14.9 Adjusted 11.8 Infantile Mortality Rates: Total infant deaths per 1,000 total live births 19.6 Legitimate infant deaths per 1,000 legitimate live births 19.4 Illegitimate infant deaths per 1,000 illegitimate live births 21.6 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births) 13.2 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births) 11.2 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 25.1 Maternal Mortality Rate (per 1,000 total live and stillbirths) 0.46 Total Number of deaths from Cancer ... ... 909 „ „ „ „ Diphtheria ... ... 0 „ „ „ „ Scarlet Fever ... ... 0 „ „ „ „ Measles ... ... 0 „ „ „ „ Whooping Cough ... ... 0 „ „ „ „ Tuberculosis ... ... 25 „ „ „ „ Meningococcal Infection ... ... 1 I here has been no unusual or excessive mortality during the year. 8 2 VITAL STATISTICS Population The overall civilian population at the middle of the year was estimated by the Registrar-General to be 348,450, and all the rates used in this Report are based on this figure. Table I below shows the mid-1963 estimate of population for the Parliamentary Divisions of the Borough, based on the overall figure, and also shows the more detailed ward figures of the 1961 Census. In Table 1(a) a comparison is made of the population in fiveyearly age groups and sexes for the two census years, 1951 and 1961. TABLE I mid-1961 963 Putney Parliamentary Division Putney Ward 35,444 105,524 105,800 Thamesfield „ 16,902 Fairfield „ 14,632 West Hill „ 23,436 Southfield „ 15,110 Central Parliamentary Division Earlsfield „ 17,236 90,500 90,750 Springfield „ 17,337 Tooting „ 17,933 Graveney „ 20,095 Bedford „ 17,899 Clapham Parliamentary Division Larkhall „ 13,778 79,983 80,250 Clapham North „ 14,370 Clapham Park „ 17,294 Thornton „ 19,778 Balham „ 14.763 Streatham Parliamentary Division Streatham Hill „ 18,120 71,435 71,650 St. Leonards „ 13,116 Streatham Common „ 12,636 Streatham South „ 11,810 Furzedown „ 15,753 347,442 348,450 Births The total number of births belonging to the Borough registered during 1963 was 6,402, consisting of 3,314 males and 3,088 females. The number for 1962 was 6,312. The crude birth-rate was 18.3 per 1,000 persons living compared with 18.1 for 1962. The adjusted rate works out at 17.5 after taking into account the area comparability factor supplied by the RegistrarGeneral. The birth-rate for England and Wales as a whole was 18.2 and for London 20.1. Seven hundred and eighty-five illegitimate births took place in the Borough compared with 725 in 1962. VITAL STATISTICS 9 POPULATION IN AGE GROUPS AND SEXES FOR 1951 AND 1961 Age groups Persons Males Females 1951 1961 Variation + or — 1951 1961 1951 1961 0- 4 24,956 22,333 — 2,623 12,900 11,397 12,056 10,936 5- 9 21.125 20,339 — 786 10,930 10,320 10,195 10,019 10-14 16,640 25,050 + 8,410 8.514 12,947 8,126 12,103 15-19 15,289 23,335 + 8,046 6,570 11,654 8,719 11,681 20-24 20,352 24,090 + 3,738 9,405 11,852 10.947 12,238 25-29 25,602 22,457 — 3,145 12.312 11,758 13,290 10,699 30-34 25,343 21,989 — 3,354 12,226 10,946 13.117 11,043 35-39 27,561 24,607 — 2,954 13,241 11,969 14,320 12,638 40-44 26,946 24,200 — 2,746 12,985 11.524 13,961 12,676 45-49 23,999 26,641 + 2,642 11,196 12.802 12,803 13,839 50-54 21,492 26,085 + 4,593 9,435 12,470 12,057 13.615 55-59 19,640 22,281 + 2.641 8,301 10,312 11,339 11,969 60-64 18,180 18,430 + 250 7,557 7.806 10,623 10,624 65-69 15,867 14,908 — 959 6,208 5,814 9.659 9,094 70-74 12.407 12,620 + 213 4,714 4,549 7,693 8,071 75-79 8.338 9,390 + 1,052 2,980 2.978 5,358 6.412 80-84 4,503 5,598 + 1.095 1,368 1,652 3.135 3,946 85-89 1,767 2,386 + 619 438 573 1,329 1,813 90-94 430 585 + 155 93 123 337 462 95 and up 56 118 + 62 12 19 44 99 330,493 347,442 + 16,949 151,385 163,465 179,108 183,977 Density of population —persons per acre 36.3 38.1 Deaths The number of registered deaths which took place in the Borough during the year was 4,143 but 1,051 of these did not belong to the Borough, while 2,130 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 5,222 of whom 2,422 were males and 2,800 females. The crude death-rate for the year was 14.9 compared with 14.4 for 1962, but after taking into account the area comparability factor supplied by the Registrar-General, the adjusted rate works out at 11.8. The death-rate for England and Wales as a whole was 12.1 and for London 12.4. Table II shows the total number of registered deaths and the death-rates for each division based on the approximate population in each division. 10 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 TABLE II Corrected Deaths Death Males Females Total ###] Putney 565 587 1,152 10.8 Central 890 1,083 1,973 21.7 Clapham 531 636 1,167 14.5 Streatham 436 494 930 12.9 Whole Borough 2,422 2,800 5,222 14.9 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. The larger number of deaths shown in the Central Division as compared with the other Parliamentary Divisions is due mainly to the fact that in that area are located a number of hospitals for the mentally disordered. Such hospitals are classified by the RegistrarGeneral for the purpose of deaths statistics as non-transferable and consequently, deaths occurring in these Institutions are allocated to this area. VITAL STATISTICS 11 TABLE III. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1963 CAUSES OF DEATH DEATHS IN OR BELONGING TO WHOLE DISTRICT AT SUBJOINED AGES DEATHS IN OR BELONGING TO LOCALITIES (ALL AGES) All Ages Males Females Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and upwards Putney Central Clapham Streatham Tuberculosis, Respiratory 22 13 9 — — — 4 10 8 6 5 8 3 Tuberculosis, Other 3 1 2 — — — 1 1 1 1 1 1 — Syphilitic Disease 12 5 7 — — — — 1 11 2 8 1 1 Diphtheria — — — — — — — — — — — — — Whooping Cough — — — — — — — — — — — — ___ Meningococcal Infections 1 1 — — — 1 — — — — 1 — — Acute Poliomyelitis — — — — — — — — — — — — — Measles — — — — — — — — — — — — — Other Infective and Parasitic Diseases 7 3 4 1 — — 1 1 4 1 4 — 2 Malignant Neoplasm, Stomach 101 46 55 — — — 3 25 73 29 33 20 19 Malignant Neoplasm, Lung, Bronchus 264 215 49 — — — 4 127 133 70 76 73 45 Malignant Neoplasm, Breast 87 1 86 — — — 5 34 48 21 24 27 15 Malignant Neoplasm, Uterus 24 — 24 — — —. 6 8 10 7 8 5 4 Other Malignant and Lymphatic Neoplasms 409 203 206 — 1 4 24 130 250 105 113 124 67 Leukaemia, Aleukaemia 24 10 14 — — 2 9 8 5 8 6 7 3 Diabetes 21 7 14 — — — — 7 14 4 10 5 2 Vascular Lesions of Nervous System 545 207 338 1 — — 12 79 453 154 156 125 110 Coronary Disease, Angina 879 526 353 — — — 15 234 630 210 268 190 211 Hypertension, with Heart Disease 74 25 49 — — — — 6 68 16 30 14 14 Other Heart Disease 861 282 579 — — 1 11 50 799 136 510 95 120 Other Circulatory Disease 284 98 186 — — — 7 42 235 50 108 60 66 33 14 19 — — — 1 9 23 6 15 8 4 Pneumonia 414 167 247 22 2 1 7 51 331 70 180 113 51 Bronchitis 377 231 146 5 — 1 4 76 291 68 140 103 66 Other Diseases of Respiratory System 37 25 12 — — — — 9 28 10 10 10 7 Ulcer of Stomach and Duodenum 38 26 12 — — — 1 9 28 6 12 13 7 Gastritis, Enteritis, Diarrhoea 23 11 12 6 1 — 1 4 11 4 8 5 6 Nephritis and Nephrosis 33 18 15 1 — — 2 15 15 8 11 6 8 Hyperplasia of Prostate 27 27 — — — — — 27 8 12 5 2 Pregnancy, Childbirth, Abortion 3 — 3 — — — 3 — — — 1 1 1 Congenital Malformations 30 20 10 17 2 1 1 6 3 4 10 8 8 Other Defined and Ill-defined Disease 394 141 253 70 4 1 13 80 226 92 165 88 49 Motor Vehicle Accidents 46 29 17 — 2 3 14 10 17 10 12 12 12 All other Accidents 91 36 55 2 3 22 18 46 30 23 25 13 Suicide 57 34 23 — — — 25 22 10 15 13 15 14 Homicide and Operations of War 1 — 1 — — — — — — 1 — — — All Causes 5,222 2,422 2,800 126 15 15 196 1,072 3,798 1,152 1,973 1,167 930 12 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 TABLE III(a). DEATHS FROM HEART DISEASE, 1963 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. — — 14 185 327 526 — — 1 49 303 353 879 Hypertension with Heart Disease — — — 5 20 25 — — — 1 48 49 74 Other Heart Disease — 1 6 27 248 282 — — 5 23 551 579 861 Total — 1 20 217 595 833 — — 6 73 902 981 1,814 Infantile Mortality There were 126 deaths of children under one year, giving an infant mortality rate of 19.6 per 1,000 live births. This compares with a rate of 19.3 for 1962. For the 10 years ended 1953 the average infant mortality rate was 30, while for the 10-year period ending 1963 the average rate was 20. Table 111(b) shows causes of death of children under one year of age. TABLE III(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 — 1 4 5 17 22 18 2. Bronchitis — — 1 1 4 5 4 3. Gastritis, Enteritis, Diarrhoea — — 1 1 5 6 5 4. Congenital Malformations 6 4 2 12 5 17 14 5. Prematurity 28 13 3 44 — 44 34 6. Other Causes 10 10 2 22 10 32 25 TOTALS 44 28 13 85 41 126 100 APPROXIMATE PERCENTAGE OF TOTALS 34 22 11 67 33 100 Maternal Mortality Three deaths occurred from accidents and diseases of pregnancy or child-birth. This is equivalent to a rate of 0.46 per 1,000 live and still-births. 13 3 INFECTIVE DISEASES The number of deaths from all notifiable infectious diseases was 74. This included 25 from all forms of tuberculosis and 48 from the notifiable forms of pneumonia. There was one death from meningococcal meningitis. From all notifiable infective diseases the death-rate was 0.21 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 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 staff of the Public Health Department. Additional work in connection with smallpox now devolves on the public health staff by reason of the fact that, under the Public Health (Aircraft) Regulations, 1952-63, persons arriving in this country by air, who are not in possession of valid international certificates of vaccination against smallpox, must be placed under surveillance for up to 14 days. It is now the prevailing practice of the Airport Health Control Units to inform local authorities of any persons arriving by air who are proceeding to addresses in their areas, in order that those authorities may arrange the necessary surveillance. With the ever increasing flow of air travel, more and more people come to this country to stay, permanently or otherwise, and consequently, many notifications are received by the Health Department from Airport Authorities in accordance with the Regulations. Diphtheria Several suspected cases were reported and investigated but in no case was the diagnosis confirmed. Whooping Cough Three hundred and thirty-seven cases were notified during the year. No death occurred. 14 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 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 d upwards Anthrax Diphtheria — — — — — — — — — — Dysentery 247 9 41 23 43 9 21 59 28 14 Encephalitis, Acute — — — — — — — — — — Erysipelas 24 — — — — 2 1 7 12 2 Food Poisoning 36 2 1 2 2 12 11 5 1 Malaria — — — — — — — — — — Measles 3,427 123 827 939 1,433 58 29 16 2 — Meningococcal Infection 6 2 1 — 1 — 2 — — — Ophthalmia Neonatorum 5 5 — — — — — — — — Pneumonia: Acute Influenzal 43 3 3 2 — — — 4 21 10 Acute Primary 97 3 3 — 5 3 6 12 33 32 Poliomyelitis, Acute — — — — — — — — — — Puerperal Pyrexia 35 — — — — — 18 17 — — Scabies 14 — — — — 3 6 5 — — Scarlet Fever 89 1 7 10 53 11 4 3 — — Smallpox — — — — — — — — — — Tuberculosis 291 1 4 1 3 3 58 124 76 21 Typhoid Fever and Paratyphoid Fever 2 — — — — — 2 — — — Whooping Cough 337 25 82 76 124 23 3 4 — — Total 4,653 172 970 1,052 1,664 114 162 262 177 80 INFECTIVE DISEASES 15 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 Diphtheria — — — — — — — — — — — — — — — — — — — — — — Dysentery 4 — 16 45 13 10 41 18 30 22 3 8 6 4 7 8 4 5 1 2 247 — Encephalitis, Acute — — — — — — — — — — — — — — — — — — — — — — Erysipelas — 1 1 2 3 — 2 2 1 2 — 1 — 1 1 — 1 2 2 2 24 — Food Poisoning 1 1 2 3 2 11 3 2 — 3 — — 3 1 3 1 — — — 36 — Malaria — — — — — — — — — — — — — — — — — — — — — — Measles 373 84 127 209 148 130 174 214 254 179 147 121 145 148 90 105 150 230 197 202 3,427 — Meningococcal Infection — 1 2 — 1 — — — — — — — — 1 — — — — — 1 6 1 Ophthalmia Neonatorum — — — — — — 2 1 — 1 — 1 — — — — — — — — 5 — Pneumonia, Acute Influenzal — 1 — — — — 2 2 2 17 2 3 1 1 7 1 — 3 — 1 43 13 „ Acute Primary 1 — 3 9 7 2 14 5 10 12 4 3 2 — 10 — 3 1 1 5 97 35 Poliomyelitis, Acute — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia — — — 1 — — — — — 3 — — 5 11 11 1 1 — 1 1 35 — Scabies 1 — — — — — 1 — 1 — 1 — 1 6 — 2 1 — — — 14 — Scarlet Fever 9 8 2 6 4 3 6 11 4 — 9 7 4 2 3 1 1 3 4 2 89 — Smallpox — — — — — — — — — — — — — — — — — — — — — — Tuberculosis—all forms 20 18 10 16 9 20 8 22 17 27 9 12 13 14 24 17 15 7 7 6 291 25 Typhoid Fever and typhoid Fever — — — — 2 — — — — — — — — — — — — — — — 2 — Whooping Cough 17 11 19 24 44 15 16 19 17 17 14 6 7 12 20 12 5 27 14 21 337 — Total 426 125 182 315 233 191 269 296 336 283 189 162 187 206 176 148 181 278 227 243 4,653 74 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 Measles The number of cases notified during the year was 3,427 compared with 691 in 1962, 4,912 in 1961 and 825 in 1960. Poliomyelitis Six cases of this disease were reported and investigated during the year, compared with 12 in the previous year, but all were subsequently not confirmed. The figures of poliomyelitis from 1947 to 1963, the period during which the incidence of the disease in this country has been high, is shown in the following table: No. of cases reported as suspected poliomyelitis and investigated No. of cases confirmed: Deaths 1947 119 78 4 1948 31 15 6 1949 89 58 4 1950 71 40 7 (a) (b) paralytic non-paralytic 1951 29 4 7 — 1952 73 23 16 5 1953 73 19 8 2 1954 41 5 2 — 1955 104 22 27 1 1956 85 24 15 2 1957 147 43 28 4 1958 65 11 9 1 1959 73 13 4 1 1960 31 1 4 — 1961 33 2 1 1 1962 12 2 — — 1963 6 — — — Meningococcal Infection Six confirmed cases were notified, one of which proved fatal. Forty-one other cases were investigated but these were subsequently not confirmed. In 1962 there were six confirmed cases with one death. Acute Encephalitis No cases occurred during the year. Typhoid and Paratyphoid Fever Two confirmed cases of typhoid fever were notified early in March in the persons of a man and his wife who had been on holiday in Zermatt, Switzerland, where a major outbreak of typhoid had occurred, affecting, among others, many holiday makers from this country. INFECTIVE DISEASES 17 In addition to the surveillance of contacts of the two cases notified to the department, it was also necessary to keep under surveillance a number of other persons who had been in contact with confirmed cases resident in other areas. Scarlet Fever Eighty-nine cases were notified compared with 109 in 1962 and 107 in 1961. No deaths occurred. Puerperal Pyrexia During the year 35 cases were notified, of which 29 occurred in hospital and six at home. Seven of the hospital notifications referred to patients whose home addresses were outside the Borough. Information was also received of 11 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. Approximately one half of the total cases for the year were single unrelated cases and the remaining cases were made up of minor outbreaks which occurred at four day nurseries and one hospital in the borough. Details of these minor outbreaks are given below: Date Outbreak No. of cases No. of faecal specimens examined from cases and contacts Jan./Feb. Day Nursery 13 65 Jan./Feb. „ „ 35 152 June/July „ „ 5 93 June/Aug. „ „ 21 201 Nov./Dec. Hospital 19 Taken by Hospital The figure of 247 cases finally arrived at for the year does not reflect fully the amount of work involved on visiting and following up. Many other cases reported as dysentery were investigated. Most of these proved negative on bacteriological examination. In 1962, there were 175 cases. 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 Influenza, Acute Influenzal Pneumonia and Acute Primary Pneumonia Acute influenzal pneumonia and acute primary pneumonia are the notifiable forms of pneumonia, and in 1963, 43 of the former and 97 of the latter were notified, as compared with 25 and 118 respectively for the previous year. Deaths attributable to acute influenzal pneumonia were 13; this figure is classified under influenza in the death table on page 11. Acute primary pneumonia accounted for 35 deaths. There were 414 deaths from all forms of pneumonia compared with 312 in 1962. Deaths in 1962 from acute influenzal pneumonia and acute primary pneumonia were respectively 6 and 34. Malaria No cases were reported. Erysipelas Twenty-four cases were notified. Other Infective Diseases Twelve deaths occurred from syphilis. Scabies Fourteen notifications were received. Sixteen treatments were given at the Council's Disinfecting Station during the year. At the Battersea Cleansing Station, a total of 59 treatments for scabies and verminous conditions was given to women residents (and children under school age) of Wandsworth in accordance with arrangements made by this Council with the Battersea Borough Council in 1955. Food Poisoning Investigations were made in 95 notified or otherwise reported cases during the year. Fifty-one of these were deemed to be not food poisoning after laboratory examination of faecal specimens from those affected. Of the remaining notifications, 38 were single unrelated cases and two involved two or more persons. Most of the single cases were only slightly affected. As a result of bacteriological examination carried out, causative agents were found in 18 cases. The organisms isolated were Salmonellae typhimurium (10), heidelberg (2), brandenburg (2), and one each of anatum, bredeney, irumu and johanesberg. INFECTIVE DISEASES 19 Diseases Reported from Schools A total of 3,732 infective diseases was reported from schools in the Borough throughout the year. The numbers of each disease were: Scarlet Fever 72 Measles 1,370 German Measles 277 Meningococcal Infection 5 Chicken Pox 778 Scabies 4 Whooping Cough 107 Mumps 679 Dysentery 81 Other Complaints 359 Disinfection During the year 153 rooms were disinfected after infectious and other disease, 248 rooms disinfested for vermin, and 43 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, to whom I would like to express thanks for the help and assistance that he and his staff have given to my Department during the year. The following is a summary of examinations made during the year: Nose and throat swabs 1,058 Faeces and urine for the typhoid and dysentery groups 2,987 Miscellaneous specimens 3 Total 4,048 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. 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 two contacts of infectious disease who were excluded from work were issued with certificates enabling them to draw National Health sickness benefit. 20 TUBERCULOSIS Notifications The total number of new cases which came to the notice of the Department during 1963 was 293 compared with 320 in 1962. The sources of information regarding the new cases were as follows: Primary notifications on Form A 165 Unnotified at death 2 Transfers from other sanitary authorities 26 Total 93 Deaths The number of deaths certified as due to various forms of tuberculosis was 25. 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 2 2 — — — — — — 3- 4 — — — 1 — — — — 5- 9 1 2 — 1 — — — — 10-14 — 1 — 1 — — — — 15-24 21 24 9 4 — — — 1 25-44 60 35 19 12 2 2 — — 45-64 50 18 6 2 7 3 1 — 65 and upwards 14 7 — — 4 4 — 1 Totals 148 90 34 21 13 9 1 2 21 NON-INFECTIVE DISEASES The total number of deaths from cancer and malignant disease was 909, the number of males being 475 and females 434. The death rate was 2.60 per 1,000. The number of deaths in 1963 was 11 less than in the previous year. Deaths from disease of the heart and circulatory system were 2,098 compared with 2,079 in 1962. Of these deaths 1,732 were of persons of 65 years of age and above. There were 861 deaths from diseases of the respiratory system compared with 638 in 1962. The number of deaths from bronchitis was 377 compared with 271 in 1962, and from pneumonia (all forms) 414 compared with 312 in 1962. One hundred and ninety-five deaths were due to violence, 46 of them due to motor accidents, 57 to suicide and 92 to other forms of violence. CERTIFICATES OF VACCINATION AND INOCULATION Two thousand, six hundred and sixty-five 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. As referred to in last year's Report, the risk of importation of smallpox to countries by travellers from smallpox endemic areas has caused a tightening up by most countries of their regulations in regard to vaccination, and in consequence, many more requests than was previously the case are now made to Health Departments for the authentication of international certificates. 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 three members of the Council's staff to undergo special medical examinations. The purpose of the examination was to determine the employee's future fitness for his occupation, following serious illness, and in one case it was found necessary to recommend superannuation. Sixty-one shorter reports on members of the staff who were sick were obtained from doctors at the request of the departments concerned. 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 1 Inspections ReInspections  To investigate complaints 6,353 15,243 21,596 Inspections under Shops Act 289 — 289 Infectious Diseases 996 665 1,661 Inspections under Factories Act 1,638 — 1,638 Housing Clearance Area Scheme 127 — 127 Housing Reports 4,496 — 4,496 Hairdressers 254 —— 254 Other inspections 7,856 4,226 12,082 Totals 22,009 20,134 42,143 Smoke observations 332 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 371 and 1,055 were cleansed or repaired, and 80 drains were partially reconstructed. Damp conditions have been remedied in 735 premises, and in two of these damp courses were inserted. SANITARY INSPECTION OF THE BOROUGH 23 TABLE II Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 208 253 263 83 807 2. Drains tested 31 128 40 72 271 3. Drains cleansed or repaired 244 396 215 200 1,055 4. Water closets cleansed, repaired or renewed 109 139 127 70 445 5. Soil pipes altered or repaired 6 26 16 6 54 6. Waste pipes provided, altered or repaired 48 85 74 45 252 7. Rainwater pipes repaired 22 23 34 8 87 8. Roofs and gutters repaired 76 109 175 48 408 9. Damp courses inserted 1 1 – – 2 10. Damp conditions otherwise remedied 113 127 124 59 423 11. Yards drained or paved – 5 1 – 6 12. Dustbins provided 7 23 13 11 54 13. Water cisterns cleansed, covered or repaired 2 2 11 3 18 14. Water supply reinstated 169 60 59 69 357 15. Defective stoves and fireplaces remedied 6 13 7 2 28 16. Animals improperly kept – – 1 1 2 17. Accumulations of rubbish, etc., removed 16 47 28 5 96 18. Urinals cleansed or repaired 2 2 5 9 19. Smoke nuisances 9 6 7 3 25 20. Other nuisances 10 27 25 15 77 Total 1,079 1,472 1,225 700 4,476 Number of Preliminary Notices served 311 445 492 159 1,407 Number of Preliminary Notices complied with 305 464 484 155 1,408 Number of Nuisance Notices served 86 112 142 31 371 Number of Nuisance Notices complied with 81 110 137 33 361 Water Supply—Cutting-off Notices During the year notices with respect to 372 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 56 premises the water supply was cut off for non-payment of rates, and 316 premises because of defects in the service. 24 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 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 27 premises and during this period 37 dustbins were provided. Dustbins were also provided at 17 premises without the necessity of action under the Acts. Rodent Control One thousand, four hundred and ninety-five rat and mice complaints were received during the year. Following is a summary of the work of the rodent operatives: Number of operatives' visits to premises 8,457 „ „ premises treated with "Warfarin" 1,332 „ „ premises "Warfarin" laid and found not troubled 33 „ „ premises investigated and found not troubled 81 „ „ "Warfarin" baits laid 4,892 „ „ drains tested by Public Health Inspector 155 „ „ drains found defective 107 „ „ rats estimated killed 2,064 At the close of the year there were five rodent operatives and one clerk engaged on rodent control duties. 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. 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; slight deviations from normal were found initially in a few samples but subsequent tests all proved satisfactory. SANITARY INSPECTION OF THE BOROUGH 25 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 plants but continuous chlorination operates in two only. In the two baths remaining, chlorine is added by hand. Samples of water taken from these baths during the year all proved satisfactory on bacteriological examination. Welfare of Old People Once again, it is a pleasure to record that firm links have been established between the Health Department and Wandsworth Old People's Welfare Council. With Councillor Mrs. O. Haines as Chairman and Mr. A. N. Bransom as General Secretary, progress continues. Alderman Mrs. A. E. Bush, J.P., is Chairman of the Welfare Council's Finance and Meals Committee and Mrs. M. Nutting, O.B.E., has the responsibility for the detailed arrangements relating to the Meals on Wheels service of approximately 1,200 meals per week. There are six Luncheon Clubs and in this context, the Catering Organiser, Miss M. E. V. Hood, supervises an organisation which serves approximately 3,000 meals every week. Mrs. E. Peacock, M.B.E., J.P., Chairman of the Clubs' Committee, maintains an active interest in the Wandsworth clubs for old people which now number 46 and Miss L. S. Reid, B.A., Chairman of the Visiting Committee, reports that more than 900 old people have been visited by nearly 250 visitors, all of whom work entirely on a voluntary basis. Mrs. M. Lumley was the pioneer for the voluntary visiting of old people residing in Streatham and the Visiting Organiser, Mr. G. Locke, shows every intention of extending this service throughout the Borough. More than 100 patients attend the six chiropody clinics every week. In addition, 120 domiciliary visits have been made. As for holidays, the Wandsworth Old Folks Trust enabled nearly 400 old people to enjoy a holiday at the seaside. Aged Persons in Need of Care and Attention Under the provisions of the National Assistance Acts, the Medical Officer of Health is empowered to apply for an Order for the compulsory removal to a hospital or other suitable place of persons who are suffering from grave chronic disease or being aged, infirm, or physically incapacitated, are living in insanitary conditions, unable to devote to themselves and not receiving from others proper care and attention. Although compulsory removal is sometimes 26 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 unavoidable, it is a step which is taken with the greatest reluctance, for the element of compulsion in itself may exert an adverse effect upon the patient. The aim is always to help aged persons in every way possible by virtue of the day-to-day services of the voluntary and statutory organisations. In almost every case, these services provide aged persons with sufficient care and attention to avoid the need for resorting to legal action. In January, however, during one of the worst winters in living memory, compulsory removal to hospital was required in two cases. The first was a bed-ridden old lady aged 87, residing alone in distressing circumstances in the basement of a house scheduled for demolition. After her admission to hospital, investigation revealed that the patient was suffering from cancer from which she later died. The second patient, an old lady aged 81, bed-ridden and also suspected of suffering from cancer, had consistently refused hospital treatment despite the fact that her condition was deteriorating. In this case, the patient succumbed to her illness two weeks after her admission to hospital. Bathing Attendance A part-time woman bathing attendant is employed to visit the homes of frail old people who require and would like assistance with bathing in their own homes. This service continued to be greatly appreciated by all those old persons who received help during the year. Thirty-eight such persons were visited, mostly at weekly intervals, by the attendant. Cleansing of Soiled Linen of Aged and Infirm The demand for assistance under this service continued to increase throughout the year, the soiled bed linen or clothing of ninety-six separate elderly and infirm persons being dealt with, involving the collection, cleansing and return of 2,449 lots of linen during the year. This constitutes an increase of 70% over 1962 figures. 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. Spraying of rooms by the disinfecting staff of the Council is carried out, proprietary insecticides being used and infested bedding is removed to the Disinfecting Station and treated by steam. SANITARY INSPECTION OF THE BOROUGH 27 During the year 75 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 one family was dealt with during the year. Bedding is not subjected to hydrogen cyanide but is disinfested by steam at the Council's Disinfecting Station. Mortuary Reference was made in last year's Report to the Council's decision to close and demolish its mortuary in York Road, it having been, for some years, retained solely as a reserve mortuary in case of emergency. In conformity, therefore, with the Council's decision, the mortuary, which was built in 1920, was duly demolished during the year under review and the site is now being developed for housing purposes. The existing arrangements with Battersea Borough Council for the use of their mortuary for the reception of bodies of Wandsworth residents continued to work most satisfactorily and in 1963, 846 bodies of persons who died in Wandsworth were received in the Battersea mortuary. Crematorium Under the Crematorium Regulations, 1930, 1,672 cremations were authorized during 1963, compared with 1,490 in 1962. 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 1963 was 36. Sewerage The arrangements for sewerage and sewage disposal in the district are reasonably adequate although occasional flooding has occurred in the Borough due to surcharging of sewers following periods of heavy rain. 28 5 HOUSING STATISTICS RELATING TO HOUSES Public Health (London) Act, 1936 Number of houses inspected on account of complaints or illness 7,349 Re-inspections 15,908 Number of statutory notices served : Intimation notices 1,407 Nuisance notices 371 Number of houses in which nuisances were abated 1,408 The number of cases referred to the Solicitor for legal action during 1963 was 74 The following is a summary of Police Court Proceedings: Number of summonses served 31 „ „ „ withdrawn 17 „ „ „ adjourned 5 „ „ Orders made for abatement of nuisances 9 Housing Acts, 1936 and 1957 Clearance of Unfit Houses: Number of houses included in representations under Section 157 of the Housing Act, 1957 6 Number of houses included in declared Clearance Areas under Section 42 of the Housing Act, 1957 63 Number of houses demolished following action under Section 42 of the Housing Act, 1957 14 Number of houses demolished following action under Section 43(2) of the Housing Act, 1957 Nil 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 ing Act, 1957 Nil Closing Orders: Number of Closing Orders made on houses under Section 17(1) of the Housing Act, 1957 3 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 7 Number of undertakings given by owners to close parts of buildings under Section 16(4) of the Housing Act, 1957 1 Number of Closing Orders determined under Section 27 of the Housing Act, 1957 9 HOUSING 29 New Accommodation The following table shows the number of new dwellings built by the Wandsworth Borough Council, the London County Council and private persons over the past 10 years. NUMBER OF NEW DWELLINGS ERECTED IN THE BOROUGH SINCE 1954 Built by 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 Total (a) Borough Council 777 575 431 263 215 353 180 408 316 339 3,857 (b) L.C.C. 2,023 1,613 735 1,012 1,224 152 170 227 261 74 7,491 (c) Private persons 72 69 26 39 75 169 294 493 328 415 1,980 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE Clearance Areas The following properties were declared Clearance Areas following my representations : 1-57 (odd), and 4-58 (even), Avening Road. 1-6 (consec.) The Triangle, Zennor Road. Unfit Houses Closed Closing Orders were made in respect of whole houses as follows : 202A, 202D and 202F Beechcroft Road. Closing Orders were made in respect of parts of buildings as follows : Premises 25 Balham Grove 42 Boundaries Road 82 The Chase 13 Silverthorne Road 19, 34 and 35 Fernlea Road In each case the owners had been invited to submit proposals to render the premises fit for human habitation, but none were received. An undertaking was given by the owner to close part of the building in respect of 11 Cambalt Road. 30 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 HOUSES IN MULTIPLE OCCUPATION Statistical results of the survey made of houses in multiple occupation were included in last year's Report and the opportunity is now taken to show below further results and work done up to the end of 1963: 1962 1963 Total Total number of primary visits made 1,500 1,287 2,787 „ „ „ houses fully inspected 453 789 1,242 „ „ „ revisits — 841 841 Number of interviews with owner — 319 319 „ „ properties where basic requirements satisfied — — 339 Work Done Baths provided 16 W.C's provided 4 Sinks provided 25 Cooking facilities provided 10 Water supply (cold) provided 18 Water supply (hot) provided 9 New dustbins provided 16 Refrigerators provided 6 Staircases, landings, etc., redecorated 17 W.C's redecorated 21 Bathrooms redecorated 9 Accumulations of rubbish removed 8 Electric lighting renewed or provided 7 Electric heating points provided 9 Other works 12 Overcrowding abated 26 Number of houses where Section 19 might be applied 72 Control of Movable Dwellings London County Council (General Powers) Act, 1959 In accordance with the provisions of the London County Council (General Powers) Act, 1959, 6 Licences were granted during the year in respect of sites for movable dwellings. The total number of dwellings permitted on these sites was 71. HOUSING 31 The Rent Act, 1957 Applications for Certificates of Disrepair. Thirty-five applications were received for Certificates of Disrepair and were dealt with as follows : (a) In five cases it was decided not to issue Certificates of Disrepair as the premises were not in disrepair by reason of defect. (b) In thirty cases it was decided to serve notices on landlords proposing to issue Certificates of Disrepair unless undertakings to do repairs were given. (c) Fourteen undertakings were received from landlords to remedy defects proposed to be included in Certificates of Disrepair. (d) Nine Certificates of Disrepair were issued. Applications for Cancellation of Certificates. (a) Twelve applications were received from landlords for the cancellation of Certificates of Disrepair. (b) Three objections were received from tenants for cancellation of Certificates. (c) In one case it was considered that the tenant's objections were not justified and the Certificate was cancelled. (d) Ten Certificates of Disrepair were cancelled. Housing Accommodation—Medical Priority During the year 987 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 237 recommendations for transfer on health grounds in respect of applications received from tenants of the Council's properties for the provision of more suitable alternative accommodation. 32 6 FOOD AND FOOD PREMISES With the object of ensuring that 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 2,601 and during 1963 they were visited on 10,344 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 Inspectors for Food and Drugs carry out the day-to-day supervision of the catering establishments in their respective areas. Food and Drugs Act, 1955, and Food Hygiene (General) Regulations, 1960 Work in connection with food hygiene continued throughout the year, and as has been generally found to be the case, since the Food Hygiene Regulations of 1955 came into operation, occupiers of food premises were co-operative and receptive to suggestions made by the inspectors for necessary improvements to their premises. A Court Summons was taken out by the Council against a trader for the presence of foreign matter in food and a fine of £5 and costs of £3 3s. Od. were awarded by the Court. FOOD AND FOOD PREMISES 33 TABLE I SUMMARY OF VISITS TO FOOD PREMISES Putney Central Clapham Streatham Whole Borough Dairies 15 18 46 37 116 Restaurant Kitchens 420 415 397 449 1,731 Ice Cream Premises 48 84 5 49 186 Butchers' Shops 298 189 217 100 804 Greengrocers' Shops 160 39 122 109 430 Fishmongers' Shops 42 16 47 32 137 Fried Fish Shops 77 50 192 8 327 Market Stalls 172 1,223 856 171 2,422 Grocers' Shops 584 355 597 391 1,927 Confectioners' Shops 302 225 245 279 1,051 Bakehouses 146 157 64 21 388 Other Premises 342 143 225 115 825 Total Visits 2,606 2,914 3,013 1,811 10,344 The following shows the number and type of premises in the Borough where food is sold, stored or prepared: Dairies and Milk Depots 8 Food Factories 22 Restaurants, Cafes and Canteens 571 Bakers and Confectioners 484 Butchers 193 Greengrocers 210 Fishmongers 67 Fish Friers 56 Bakehouses 50 Grocers 557 Off Licences 93 Public Houses 148 Stalls 142 2,601 The amount of work completed during 1962 to comply with the requirements of the Regulations is indicated in the following details: Washhand basins provided 49 Sinks provided 15 Provision of hot water over sink and washhand basin 31 Accommodation for clothing provided 6 Soap, towel and nailbrush 1 Premises repaired or redecorated 48 Adequate protection for open food 7 Notices to employees 8 Dustbins 5 W.C. accommodation 23 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 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. During the year 21 applications were received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Eighteen notices of cancellation of registration were received. At the end of the year there were 242 persons on the register. 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 twenty-one samples of milk were submitted for analysis. Of these 33 were samples of Channel Island and South Devon milks with an average fat content of 4.55 per cent. The remaining 188 samples had an average fat content of 3.70 per cent. The Milk (Special Designation) Regulations, 1960 These Regulations which came into force on 1st October, 1960, provide for the issue of Dealer's (Prepacked Milk) Licences for the sale of milk under any of the following designations : " Pasteurized " " Sterilized " " Tuberculin Tested " 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. The following licences for the sale of milk under these designations and which will be valid for a period of five years, were granted during the year: Dealer's (Prepacked Milk) Licence " Pasteurized " 29 " Sterilized " 17 " Tuberculin Tested " 20 Total 66 A person who holds a "Tuberculin Tested" licence and a " Pasteurized " or " Sterilized " licence may use the designations " Tuberculin Tested (Pasteurised)" or " Tuberculin Tested (Sterilized) " as the case may be. FOOD AND FOOD PREMISES 35 Meat There are 193 butchers' shops in the Borough. The majority are registered under Section 16 (1) (b) of the Food and Drugs Act, 1955, for the preparation or manufacture of sausages or potted, preserved, pickled or pressed foods. There were 804 visits made to these shops during the year. Slaughter of Animals There are no private slaughterhouses in the Borough. Slaughter of Animals Act, 1958 Section 3 of this Act provides that no animals 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-two 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 1963 was 297, and 528 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 Durvevors of food. TABLE H PART 11 OF POISONS LIST Principal Business Number of Premises Number of Visits Domestic stores, ironmongers, etc 79 84 Drug stores 19 19 Grocers 187 413 Hairdressers 7 7 Nurserymen and florists 5 5 Total 297 528 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 Bakehouses There are 50 bakehouses in the Borough, of which 10 are in basements and subject to the provisions of Section 70 of the Factories Act, 1961. Three hundred and eighty-eight visits by the Food Inspectors were made to these premises during the year. Certificates of suitability under the Factories Act, 1961 were granted in respect of 9 underground bakehouses. It was decided not to issue a certificate of suitability in respect of one underground bakehouse until certain work had been carried out to bring it up to the required standard. 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. All dwelling houses, approximately 97,000, and the population of 348,450 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 76 applications for registration under the provisions of Section 16(l)(a) and 19 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. FOOD AND FOOD PREMISES 37 Bacteriological Examination of Food and Waters Two hundred and eighty-four samples were examined bacteriologically at the Public Health Laboratory during the year. They were as follows: Milk Ice-cream Artesian Well Waters Swimming Pool Waters Others Total 180 39 3 59 3 284 Milk Of the 180 samples of milk, 84 were submitted to the phosphatase test, 84 to the methylene-blue test, and 12 to the turbidity test. These samples were reported satisfactory. Ice-cream The 39 samples of ice-cream 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 17 2 11 3 3 4 8 Total 39 Examination of Water from Artesian Wells Three samples were submitted for examination, and were reported satisfactory. Examination of Water from Swimming Baths Fifty-nine samples were submitted for examination. Satisfactory results were obtained in 57 samples. In the remaining samples there were slight deviations from normal, but subsequent tests proved satisfactory in all cases. Others The three miscellaneous samples proved to be free of pathogenic organisms. 38 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 Analysis of Food and Drugs During the year 1,000 samples of food and drugs were procured for analysis; 221 samples of milk, 711 other foodstuffs and 68 drugs. Of these, 190 were submitted as formal samples, while 810 were purchased informally. No adulteration was found in the formal samples, but 52 or 6.70 per cent, of the informal samples or 5.2 per cent, of the total samples submitted were found to be adulterated or not up to standard. The 52 samples found to be adulterated were : Nine samples of fish paste, four samples each of bread, meat paste, ammoniated tincture of quinine, seasoning and soft drink crystals, two samples each of orange juice, seidlitz powder, salmon spread and chopped pork and one sample each of beef chipolatas, margarine, spirit of sal volatile, dirty milk bottle, cream soda, chocolate eclair, ice cream, children's aspirin, pork chipolatas, asparagus soup mix, liver pills, scotch egg, steak and kidney pudding, milk and buttered bun. Noise Abatement Act, 1960 Court summonses were taken out against two traders for the sounding of chimes; in both instances a fine of £2 was awarded by the Court. 39 7 FACTORIES ACT, 1961 Prescribed particulars required by Section 153 (1) 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 412 116 2 — (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,126 899 5 — (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' Premises) 291 67 — — Total 1,829 1,082 7 — (2) DEFECTS Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 1 1 — — — Overcrowding — — — — — Unreasonable temperature 1 1 — 1 — Inadequate ventilation — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences: — (a) insufficient 2 2 — — — (b) unsuitable or defective 29 27 — 7 — (c) not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to outwork) — — — Total 34 32 — 8 — 40 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 FACTORIES ACT, 1961 PART VIII OUTWORK (SECTIONS 133 AND 134) Nature of Work Section 133 Section 134 No. of outworkers in August list required by Section 133 (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. Curtains and furniture 540 — — — — hangings 10 — — — — Brass and brass articles 1 — — — — Umbrellas, etc. 2 — — — — Artificial flowers 6 — — — — Paper bags 1 — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 20 — — — — Carding, etc., of buttons, etc 6 — — — — Stuffed toys 2 — — — — Cosaques, Christmas stockings, etc. 9 — — — — Textile weaving 2 — — — — Lampshades 202 — — — — Total 801 — — — — 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 19 new registrations were made, and the total number on the register at the end of the year was 291. Pet Animals Act, 1951 Twenty-seven licences were issued by the Council in relation to premises subject to the provisions of this Act. 41 8 ATMOSPHERIC POLLUTION AND CLEAN AIR During the year, a fifth Smoke Control Order was confirmed by the Minister of Housing and Local Government and at the date of writing, a sixth Order made by the Council has been submitted to the Minister for his approval. The preliminary survey of Area 7 is nearing completion. A map of the Borough showing areas covered by Smoke Control Orders and areas in which it is proposed to make Orders in future years, incorporated in this Annual Report for the past two years, is again reproduced in the following pages. In accordance with the provisions of Section 12(2) of the Clean Air Act, 1956, one notice was served in connection with premises within the Council's third Smoke Control Area, requiring works of adaptation to fireplaces, and one notice was served in respect of Section 11 of the Act relating to offences in a Smoke Control Area. Furnaces Notices of intention to install a furnace were received in respect of thirty 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 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 TABLE I Station Roof— Municipal Buildings Valley Road, S.W.16 Tooting Library Queen Mary's Hospital, Roehampton South London Hospital, Clapham Month—1963 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 Smoke SO2 January 298 482 271 298 318 448 258 123 291 489 February 293 483 229 257 270 393 197 343 271 404 March 141 437 70 121 173 406 66 73 112 381 April 128 335 82 132 154 258 60 197 118 288 May 106 181 70 104 92 133 28 56 94 160 June 44 171 31 127 37 148 21 66 32 150 July 26 99 20 117 34 69 12 50 23 76 August 35 126 14 103 38 84 31 140 19 63 September 52 161 57 99 68 145 35 67 50 160 October 74 259 71 112 108 162 No Recording 75 155 November 116 280 99 130 136 199 76 62 131 193 December 275 277 282 436 263 251 191 101 227 224 Average 132 274 108 169 141 224 81 106 120 228 MAP OF SMOKE CONTROL AREAS IN WANDSWORTH ATMOSPHERIC POLLUTION AND CLEAN AIR 43 44 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 1963, calculated as described in the 1958 Report. HOME ACCIDENT CASES DURING 1958 to 1963 TABLE I Cause of Accident 1958 1959 1960 1961 1962 1963 Fall- On stairs 122 130 131 109 76 92 From ladder 12 19 20 8 9 19 From chair 21 29 21 22 19 16 Outside 16 35 21 17 24 29 In garden 25 43 35 34 30 23 In bath 1 4 2 2 2 3 From one level to another 33 32 35 45 52 45 On same level 105 115 110 110 86 103 Unspecified 255 268 338 373 387 392 Hit by object 14 16 20 21 32 28 Cooking stove 13 17 15 13 12 17 Teapots 6 7 7 6 6 6 Other boiling water 12 17 13 16 25 26 Electric shock 1 3 2 3 3 6 Poisoning 24 24 48 48 45 45 Gassing 12 19 12 14 13 33 Knife-like wounds 36 47 48 38 45 38 Fires 24 11 10 15 16 22 Windows 6 9 7 7 4 4 Suffocation 2 10 3 2 5 5 Not specified 44 31 39 41 41 59 Totals 784 886 937 944 930 1,011 Rate per 10,000 population 23.2 26.2 27.6 26.9 27.1 29.0 TABLE II AGE GROUPS AND PERCENTAGES 1958 % 195< % 1960 % 196 % 1962 % 1963 % Under 1 14 1.7 11 1.3 12 1.3 14 1.6 14 1.7 18 1.6 1- 29 3.7 31 3.4 33 3.6 35 3.9 36 4.0 35 3.4 2- 30 3.8 35 3.8 35 3.9 82 8.6 84 9.0 96 9.5 3 and 4 36 4.6 40 4.5 45 4.8 83 8.7 84 8.9 83 8.2 5-19 84 10.8 102 11.8 110 11.6 71 7.4 69 7.3 77 7.6 20-59 239 30.5 268 30.5 280 30.4 129 13.7 123 13.2 141 14.0 60-69 82 10.5 102 11.6 110 11.8 168 17.7 167 17.8 188 18.7 70-79 141 17.9 155 17.3 157 16.4 124 13.0 124 13.3 134 13.3 80 + 129 16.5 142 15.8 155 16.2 238 25.4 229 24.8 239 23.7 Totals 784 100 886 100 937 100 944 100 930 100 1,011 100 45 10 REPORT OF THE WORK OF THE PUBLIC ANALYST FOR 1963 The Public Analyst, D. G. Forbes, b.sc., f.r.i.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, 1963 ; 932 were articles of food and the remaining 68 drugs. All were submitted by the Council's Food Inspectors, 190 having been taken with the formalities required by the Act and 810 informally. Samples of the following substances were analysed : fats (butter, margarine, etc.), 109 ; beverages (cocoa, coffee, tea, etc.), 36 ; cereal preparations, 41; cheese products, 23; confectionery, 93; cream, 11; fish (canned, etc.), 59 ; fruit (canned and dried), 10 ; ice-cream, 7 ; meat products (including sausages), 82 ; milk, 221 ; pickles and condiments (including spices), 63 ; preserves, 14 ; soup, 46 ; vegetables, 11 ; aspirin tablets, 8 ; Beecham's powders, 6; Friar's balsam, 3 ; Glaubers salts, 4 ; ointments, 3 ; linctus, 6 ; tincture of quinine, 3 ; sal volatile, 2; seidlitz powders, 3. Adulterated Samples Particulars of the samples reported as adulterated or not up to standard are given in the following table . Case No. Nature of Sample Nature of Report Informal 1043 Buttered Bun Found to contain other fat mixed with the butter 1061 Pork chipolatas Excessive amount of preservative 1064 Soft drink crystals Labelling offence. No declaration of ingredients 1065 Soft drink crystals Labelling offence. No declaration of ingredients 1066 Soft drink crystals Labelling offence. No declaration of ingredients 1067 Soft drink crystals Labelling offence. No declaration of ingredients 1085 Asparagus soup mix Milk fat virtually absent 1092 Liver pills Contained 37 parts of lead per million 1098 Scotch egg Meat content of casing not more than 25 per cent. 1100 Chopped pork Excess added water (9.5 per cent.) 1108 Steak and kidney pudding Low meat content (not more than 23 per cent.) 1175 Ammoniated tincture of quinine Deficient in ammonia by 4.5 per cent, of requirement 1178 Milk Excessive acidity 1179 Bread Rodent excrement 1243 Bread " Rope " organisms present 46 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 Case No. Nature of Sample Nature of Report Informal 1261 Salmon spread 8.5 per cent, deficient in fish 1267 Chopped pork Low in meat. Starchy matter present 1302 Ammoniated tincture of quinine 4.7 per cent, deficient in ammonia. Excess quinine present. 1303 Spirit of sal volatile Excess of ammonia and ammonia carbonate present 1304 Ammoniated tincture of quinine 78 per cent deficient in ammonia. 1305 Ammoniated tincture of quinine 4.7 per cent, deficient in ammonia 1307 Dirty milk bottle Dirty oil and mould mycelium 1337 Cream Soda Petroleum residue 1393 Salmon spread 12 per cent, deficient in fish 1399 Meat paste High propotion of fat 1418 Chocolate eclair Foreign matter, feather (not characterised) 1425 Seasoning Labelling offence — preservative not declared 1426 Seasoning Labelling offence — preservative not declared 1427 Seasoning Labelling offence — preservative not declared 1428 Seasoning Labelling offence — preservative not declared 1432 Ice cream 8.5 per cent, deficient in milk solids not fat 1433 Orange juice 85 per cent, deficiency of Vitamin C 1447 Children's aspirin 0.86 per cent, free salicytic acid 1452 Meat paste 5.5 per cent, deficient in meat 1454 Fish paste 7 per cent, deficient in fish 1463 Bread Contained splinter of wood 1471 Orange juice Apparent dilution with water 1480 Fish paste Deficient in fish content 1484 Fish paste Deficient in fish content 1485 Fish paste Deficient in fish content 1489 Fish paste Deficient in fish content 1496 Meat paste Deficient in meat content 1497 Meat paste Deficient in meat content 3 Fish paste Deficient in fish content 11 Bread Contained cigarette end 38 Beef chipolatas Deficient in meat content 63 Margarine 0.5 per cent, excess water 64 Fish paste Deficient in fish content 68 Fish paste Deficient in fish content 90 Fish paste Deficient in fish content 106 Seidlitz powder Damp. Slightly deficient in Sodium Potassium Tartrate 107 Seidlitz powder Damp. Slightly deficient in Sodium Potassium Tartrate Adulteration The amount of adulteration detected during the year was : For formal samples nil For informal samples 6.70 per cent. For all samples 5.20 per cent. REPORT OF THE PUBLIC ANALYST FOR 1963 47 Complaint Samples Case No. 1015. Yoghurt. Submitted on the complaint that it contained mould. The complaint was considered not justified. Case No. 1016. Deposit in tea cup. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 1017. Tea. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 1159. Mild Beer. Submitted on the complaint that it was sour. The complaint was considered not justified. Case No. 1177. Milk. Submitted on the complaint that it was of poor quality. The complaint was considered not justified. Case No. 1178. Milk. Submitted on the complaint that it caused sickness. The complaint was considered justified. Case No. 1179. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 1242. Milk. Submitted on the complaint that it had an objectionable flavour. The complaint was considered not justified. Case No. 1243. Bread. Submitted on the complaint that it was sour. The complaint was considered justified. Case No. 1307. Milk Bottle. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 1337. Cream Soda. Submitted on the complaint that it had an objectionable flavour. The complaint was considered justified. Case No. 1418. Chocolate eclair. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 1463. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 11. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered justified. Case No. 57. Bread. Submitted on the complaint that it contained foreign matter. The complaint was considered not justified. Case No. 161. Grapes. Submitted on the complaint that they had a peculiar taste. The complaint was considered not justified. 48 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 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 25 12.82 3.98 8.84 February 19 12.83 3.95 8.88 March 21 12.48 3.75 8.73 April 21 12.38 3.69 8.69 May 13 12.13 3.42 8.71 June 18 12.39 3.69 8.70 July 20 12.40 3.75 8.65 August 16 12.41 3.76 8.65 September 16 12.70 3.88 8.82 October 20 12.85 3.98 8.87 November 16 12.73 3.90 8.83 December 16 12.70 4.01 8.69 The average composition of the 221 samples of milk analysed during the year and returned as genuine was as under : Total milk solids 12.57 per cent. Milk fat 3.82 per cent. Non-fatty solids 8.75 per cent. The average composition of the 40 samples of Channel Island and South Devon milks was as under : Total milk solids 13.53 per cent. Milk fat 4.55 per cent. Non-fatty solids 8.98 per cent 49 INDEX Accidents, Deaths from 21 Accidents, Home 44 Acute Encephalitis 16 Analyst, Report of 45 Atmospheric Pollution 41 Bacteriological Examinations of Milk 37 „ „ Ice-cream 37 Bakehouses 36 Bathing Pools and Swimming Pools 24 Bed Bugs, Eradication of 26 Births, Birth-rates 8 Butchers' Shops 35 Cancer 21 Care of Old People 25 Childbirth, Deaths from 12 Circulatory Diseases 21 Clean Air 41 Closing Orders 29 Crematorium 27 Cutting-off Notices—Water Supply 23 Deaths, Causes of 11 Death-rates 9 Death-rate from Infective Diseases 13 Death-rate, Infantile 12 Deaths, Number of 9 Diphtheria 13 Disinfection 19 Dysentery, Sonne 17 Enteric Fever 16 Erysipelas 14 Factories Act, 1961 39 Factories and Workshops 39 Food Hygiene Regulations 32 Foods and Drugs Act, 1955 32 Food Poisoning 18 Food, Supervision of 32 Food Places, Inspection of 33 Food Places, Number on Register 32 Hairdressers and Barbers 40 Home Accidents 44 Houses in Multiple Occupation 30 Houses and Premises Inspected 22 Housing Act, 1936 28 Housing Statistics 29 50 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1963 PAGE Hydrogen Cyanide Disinfection 27 Illegitimate Children, Births of 8 Infant Mortality 12 Infective Diseases 13 Infective Diseases, Cases of 14 Infective Diseases, Death-rate from 13 Influenza, Deaths 11 Influenzal Pneumonia and Acute Primary Pneumonia 18 Malaria 18 Maternal Mortality 12 Meat 35 Meningococcal Infection 16 Milk Analysis 48 Milk, Bacteriological Examination of 37 Milk Premises, etc., on Register 34 Milk (Special Designations) Regulations, 1960 34 Mortuary 27 Non-Infective Diseases, Deaths from 21 Notification of Infective Diseases 14 Old People, Care of 25 Outworkers 40 Pet Animals Act 40 Pharmacy and Poisons Act, 1933 35 Pharmacy and Medicines Act, 1941 35 Poliomyelitis 16 Population 8 Pregnancy, Deaths from Accident and Diseases of 12 Public Analyst, Report of 45 Puerperal Pyrexia 17 Pulmonary Tuberculosis, Notification of cases of 20 Rent Act 31 Rodent Control 24 Samples, Formal and Informal, Number of 45 Sanitary Inspection of Borough 22 Scabies 18 Scarlet Fever 17 Slaughter-houses 35 Slaughter of Animals Acts, 1933-1954 35 Smallpox 13 Smoke Control Areas 43 Staff 4 Statistics for the Borough 7 Suicide, Deaths from 21 Swimming Baths and Bathing Pools 24 Syphilis, Deaths from 18 Tuberculosis 20 Unfit Houses 29 Unsound Food 35 Water Supply 36 Water Supply, Cutting-off Notices 23 Whooping Cough 13 Rowling & Sons Ltd. (t.u.), 34 & 36 York Road, Battersea, S.W.11.