AC 4413 (1) NIMBLEDOW WIM 22 Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1949 Printed by Raynes Park Press, Lambton Road, London, S.W.20. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1949 Public Health Department, Town Hall, Wimbledon, S.W.19. July, 1950. To The Mayor, Aldermen and Councillors of the Borough of Wimbledon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the work of the Public Health Department for the year 1949. This Report is compiled in accordance with the instructions contained in Circular 2/50 of the Ministry of Health. I should like to take this opportunity of expressing to the Chairman and Members of the Health Committee my deep appreciation for their consideration and courtesy during the year. I also wish to place on record my thanks for the co-operation which I received from all members of the staff. I have the honour to be, Your obedient Servant, HAROLD ELLIS, Medical Officer of Health. 1 LIST OF CONTENTS. Page Introduction 1 List of Staff 4 SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc. 5-7 Deaths Registered 8 Infantile Mortality 9-10 Summary of Statistics 11 SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Nursing Homes 12 Establishments for Massage or Special Treatment 12 National Assistance Act, 1948 13 Mass Radiography 13 Clean Food Campaigns 14 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 15 Sanitary Inspectors' Visits 16 Notices Served 16 Nuisances abated and defects remedied 17 Factories Act, 1937, Part I. 18 Outworkers 19 Bakehouses 19 SECTION D: HOUSING 20 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk 21 Ice cream 22 Meat and other Foods 22-23 Carcases Inspected and Condemned 24 Sampling of Food and Drugs 25 Food and Drugs Act, 1938, Section 34 26 2 LIST OF CONTENTS — cont'd. Page SECTION F: PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc 27-31 Wimbledon Infectious Diseases Hospital 32 Tuberculosis 32-33 3 STAFF Medical Officer of Health: Harold EUis, M.B., B.S.(Lond.), MR.C.S., L.R.C.P., D.P.H. Senior Sanitary Inspector: D. F. S. Flynn, (b), (c). Deputy Senior Sanitary Inspector: H. R. Fry, (a), (c). Sanitary Inspectors: C. W. Southerby, (a), (c). A. N. Scotter, (a). G. R. Pope, (a). J. Hills, (a). Temporary Assistant Rodent Officer: F. J. Reddington. Chief Clerk: † Mrs. V. Dymott. Clerks: * J. E. Field. * Mrs. V. Waters. J. Burrows. S. C. Nottingham (resigned 29.5.49). † Miss S. G. Miller. F. R. Brackfield (appointed 4.7.49). † Transferred to Surrey County Council under National Health Service Act, 1946. Part-time officer to the Wimbledon Borough Council. * Officer of the Wimbledon Borough Council. In part-time employment of the Surrey County Council. (a) Certificate Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. (b) Certificate Royal Sanitary Institute for Inspector of Nuisances. (c) Certificate Royal Sanitary Institute for Inspector of Meat and other Foods. 4 SECTION A. — STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres —Census, 1931) 3,211 Population (Census, 1931) 59,515 Population (mid-1949) (a) Civilian 58,340 (b) Total 58,390 Number of inhabited houses:— 1921 (Census) 11,926 1931 (Census) 13,325 Number of families or separate occupiers:— 1921 (Census) 13,998 1931 (Census) 15,883 Rateable Value:— £807,294. Sum represented by penny rate:— £3,125 14s. 10d. Extracts from Vital Statistics of the Year 1949. (Registrar-General's Figures.) Live Births Total M. F. Legitimate 833 418 415 Illegitimate 42 21 21 Total 875 439 436 Total M. F. Stillbirths Legitimate 22 9 13 Illegitimate 1 – 1 Total 23 9 14 Birth Rate per 1,000 of the estimated resident population 15.38 Still-birth Rate per 1,000 total (live and still) births 25.61 Total M. F. Deaths 754 349 405 Crude Death Rate per 1,000 of the estimated resident population 12.92 Corrected Death Rate per 1,000 of the estimated resident population 10.72 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal and post-abortive sepis – – No. 30 Other maternal causes ... – – Total – – Death Rate of infants under one year of age:— All infants per 1,000 live births 25.14 Legitimate infants per 1,000 legitimate live births 24.01 Illegitimate infants per 1,000 illegitimate live births 47.62 Deaths from cancer (all ages) 137 ,, ,, measles (all ages) 0 ,, ,, whooping cough (all ages) 1 ,, ,, diarrhoea (under 2 years of age) 1 5 Birth Rates, Civilian Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the Year 1949. (Provisional Figures based on Quarterly Returns). Wimbledon England and Wales 126 C.B's and Great Towns including London 148 Smaller towns (resident population 25,000 -50,000 at 1931 Census) London Administrative County Rates per 1,000 Civilian Population Births:— † Live Births 14.99 16.7‡ 18.7 18.0 18.5 Still Births 0.39 0.39‡ 0.47 0.40 0.37 Deaths:— All Causes 10.72 11.7‡ 12.5 11.6 12.2 Typhoid and Paratyphoid – 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.01 0.02 0.01 0.01 Diphtheria – 0.00 0.00 0.00 0.00 Tuberculosis 0.38 0.45 0.52 0.42 0.52 Influenza 0.14 0.15 0.15 0.14 0.11 Small-pox — 0.00 0.00 – – Acute Poliomyelitis and Polioencephalitis 0.03 0.01 0.02 0.02 0.01 Pneumonia 0.51 0.51 0.56 0.49 0.59 Notifications (corrected):— Typhoid Fever – 0.01 0.01 0.01 0.01 Paratyphoid Fever – 0.01 0.02 0.01 0.01 Cerebro-Spinal Fever 0.03 0.02 0.03 0.02 0.02 Scarlet Fever 0.94 1.63 1.72 1.83 1.46 Whooping Cough 2.55 2.39 2.44 2.39 1.70 Diphtheria 0.10 0.04 0.05 0.04 0.07 Erysipelas 0.12 0.19 0.20 0.19 0.17 Small-pox – 0.00 0.00 0.00 0.00 Measles 12.12 8.95 8.91 9.18 8.54 Pneumonia 0.33 0.80 0.91 0.65 0.55 Acute Poliomyelitis 0.15 0.13 0.13 0.12 0.18 Acute Polioencephalitis 0.02 0.01 0.01 0.02 0.01 Food Poisoning 0.03 0.14 0.16 0.14 0.19 Rates per 1,000 Live Births Deaths:— All causes under 1 year of age 25 32 § 37 30 29 Diarrhoea and Enteritis (under 2 years of age) 1.1 3.0 3.8 2.4 1.7 † A dash (—) signifies that there were no deaths. ‡ Rates per 1,000 Total population. § Per 1,000 related Births. 6  Wimbledon England and Wales 126 C.B's and Great Towns including London 148 Smaller towns (resident population 25,000 -50,000 at 1931 Census) London Administrative County Rates per 1,000 Total Births (i.e., Live and Still) Notifications (corrected):— 8.91 6.31 8.14 5.30 6.82 Puerperal Fever and Pyrexia No. 140 A bortion with sepsis No. 141 Abortion without sepsis No. 147 Puerperal Infections Nos. 142-146, 148-150 Other maternal causes Maternal Mortality:— Rates per 1,000 Total Births (i.e., Live and Still) WIMBLEDON – – – – England and Wales 0.11 0.05 0.11 0.71 Mortality per Million Women aged 15-44 years No. 140 with Sepsis No. 141 without sepsis England and Wales 8 4 BIRTHS. The statistics supplied by the Registrar-General show that during 1949 the total number of registered live births belonging to Wimbledon amounted to 875. In addition 23 stillbirths were registered. This gives a birth-rate of 15.38 per thousand of the population, compared with 16.59 per thousand for the previous year. 42 live births and 1 stillbirth were illegitimate. Of the 23 stillbirths registered, only one was in respect of a home confinement; no fewer than 22 stillbirths occurred in hospitals or nursing-homes. 7 DEATHS. The total number of Wimbledon residents who died during 1949 was 754, giving a death-rate of 12.92 per thousand of the population as compared with 11.56 per thousand for 1948. The Registrar-General has, for the first time since 1940, issued an area comparability factor for 1949, for the purpose of securing comparability between local death-rates. As a result of the use of this factor, the corrected death-rate for Wimbledon for the year 1949 is 10.72 per thousand, compared with a rate of 11.7 for England and Wales. The number of Wimbledon residents who died outside the Borough during 1949 was 278, while 255 persons not normally resident in Wimbledon died in institutions, etc. in the Borough. As in previous years the following diseases were responsible for over half the total deaths:— Percentage of total deaths Diseases of the heart and circulatory system ... 47% Cancer 18% Diseases of the respiratory system11% Total 76% There were three deaths from notifiable infectious diseases during 1949 — one child aged 10 months died from whooping cough, and two children, aged six and seven years respectively, died from acute poliomyelitis. In addition, one child aged 7 months died from infective gastro-enteritis. The following is an analysis of the causes of death:— Cause Males Females Total 1. Typhoid and Paratyphoid Fevers – – – 2. Cerebro-spinal Fever – – – 3. Scarlet Fever – – – 4. Whooping Cough l – 1 5. Diphtheria – – — 6. Tuberculosis of Respiratory System 12 5 17 7. Other forms of Tuberculosis 2 3 5 8. Syphilitic Diseases 3 – 3 9. Influenza 1 7 8 10. Measles – – – 11. Acute Poliomyelitis and Polioencephalitis – 2 2 12. Acute Infectious Encephalitis – – – 13.M.Cancer of Buccal Cavity and Oesophagus (males only) 6 – 6 13.F. Cancer of Uterus (females only) – 6 6 14. Cancer of Stomach and Duodenum 9 13 22 15. Cancer of Breast 1 13 14 8 Cause Males Females Total 16. Cancer of all other sites 47 42 89 17. Diabetes 2 5 7 18. Intra-Cranial Vascular Lesions 32 58 90 19. Heart Disease 108 120 228 20. Other Diseases of the Circulatory System 15 24 39 21. Bronchitis 27 16 43 22. Pneumonia 19 11 30 23. Other Respiratory Diseases 5 3 8 24. Ulcer of the Stomach or Duodenum 5 3 8 25. Diarrhoea (under 2 years of age) – 1 1 26. Appendicitis 1 1 2 27. Other Digestive Diseases 7 9 16 28. Nephritis 3 9 12 29. Puerperal and Post-Abortive Sepsis – – – 30. Other Maternal causes – – – 31. Premature Birth – 5 5 32. Congenital Malformations, Birth Injury, Infantile Diseases 7 10 17 33. Suicide 7 4 11 34. Road Traffic Accidents 3 3 6 35. Other violent causes 8 10 18 36. All other causes 18 22 40 Totals 349 405 754 INFANTILE MORTALITY. During 1949, 22 deaths occurred in infants under one year of age, giving an infantile mortality rate for Wimbledon of 25 per thousand live births, as compared with a rate of 32 for England and Wales. Twelve of these deaths were due to congenital malformations or birth injuries and 5 were due to prematurity. 13 of these 22 deaths occurred during the first week of life. The total number of neo-natal deaths (i.e. occurring during the first month of life) was 14, giving a neo-natal death-rate of 16 per thousand live births. There were 2 infant deaths due to accidental causes. Both children were two months old. The slight rise in the infantile-mortality rate is due to the increased number of infant deaths from congential defect or birth injury, the figure having risen from 5 in 1948 to 12 in 1949. The following table shows the causes of, and ages at death, and also the ward distribution. 9 10 Infantile Mortality during the Year, Cause of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total Deaths under 1 year WARD Nth. Wimbledon Sth. Wimbledon * Unknown Total St. Mary's St. John's Cott. Park W'don Park Dundonald Trinity Sth. Park Haydon Pk. Congenital defect or birth injury 8 – – – 8 3 – 1 – 12 2 1 1 – – – 4 3 4 7 1 12 Prematurity 5 – – – 5 – – – – 5 – – 1 – – – 4 – 1 4 – 5 Infective GastroEnteritis – – – – – – 1 – 1 – – – – 1 – – – – 1 – 1 Pneumonia – – – 1 1 – – – – 1 – – 1 – – – – – 1 – – 1 Whooping Cough – – – – – – – – 1 1 – – – 1 – – – – 1 – – 1 Accidental death – – – – – 2 – – – 2 – – – – 1 1 – – – 2 – 2 Total 13 1 14 5 – 2 1 22 2 1 3 1 2 1 8 3 7 14 1 22 * Child found on Wimbledon Common. 11 Summary of Statistics The following table shows the birth-rates and death-rates for Wimbledon, as compared with England and Wales, during the last ten years. Year Live-Birth Rate Still-birth Rate Death-Rate Maternal Mortality Rate Infantile Mortality Rate Wim. E.&W. Wim. E.&W. Wim. E.&W. Wim. E.&W. Wim. E.&W. 1940 12.20 14.6 0.42 0.55 13.92* 14.3 1.67 2.16 43.40 55 1941 12.82 14.2 0.29 0.51 11.92* 12.9 – 2.23 41.15 59 1942 15.46 15.8 0.47 0.54 12.44* 11.6 – 2.01 41.95 49 1943 17.69 16.5 0.27 0.51 14.37* 12.1 1.18 2.29 50.17 49 1944 15.62 17.6 0.53 0.50 13.21* 11.6 2.76 1.93 37.14 46 1945 17.01 16.1 0.42 0.46 13.38* 11.4 2.42 1.79 36.20 46 1946 18.90 19.1 0.64 0.53 13.51* 11.5 – 1.43 23.14 43 1947 19.39 20.5 0.42 0.50 13.64* 12.0 0.88 1.17 18.03 41 1948 16.33 17.9 0.26 0.42 11.56* 10.8 1.04 1.02 19.03 34 1949 14.99 16.7 0.39 0.39 10.72 11.7 – 0.98 25.14 32 * From 1940 to 1948 it was not possible to correct the local death-rate as the publication of an area comparability factor was suspended. Consequently it is not strictly possible to compare the death-rate for Wimbledon with that for England and Wales for those years. SECTION B. — GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. PUBLIC HEALTH ACT, 1936, PART VI. — NURSING HOMES. The Wimbledon Borough Council is responsible for the supervision of nursing homes in the Borough. Twenty-nine visits of inspection were made during 1949. One nursing home was closed during the year, and one new home was registered for the reception of medical and chronic cases. At the end of 1949 the position was as follows:— No. of Homes on the Register: (a) Maternity 1 (b) Others 9 10 No. of beds provided: (a) Maternity 12 (b) Others 96 108 ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. The Wimbledon Corporation Act, 1933, Part III, makes provision for the licensing of establishments for massage or special treatment in the Borough. Part III of the Act, however, does not become operative until three months after the Council have passed a Resolution bringing that part of the Act into force. Prior to 1939 there were far fewer establishments in Wimbledon providing massage or special treatment, and as a result Part III of the Wimbledon Corporation Act, 1933 was not brought into operation. The Surrey County Council, however, possess similar powers under Part IV of the Surrey County Council Act, 1931, and as these powers were in operation in the whole of the County with the exception of the Borough of Wimbledon, the Corporation decided in 1949 to ask the Surrey County Council to extend their powers to cover the Wimbledon area. The County Council agreed to this, and as a consequence the control of establishments for massage or special treatment in Wimbledon came under that Authority on the 1st April, 1950. 12 NATIONAL ASSISTANCE ACT, 1948. Under Section 47 of this Act, power is given to the Councils of County Boroughs and County Districts to apply to a Court of Summary Jurisdiction for an Order for removal and detention, in a suitable hospital or other place, of persons who (a) are suffering from grave chronic disease, or, being aged, infirm or physically incapacitated, are living in insanitary conditions ; and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. During 1948, action under this Section was taken by the Wimbledon Borough Council on one occasion, and the patient was removed to hospital on an Order made by the local court. This Order was extended during 1949, and the patient was still in hospital at the end of the year. During 1949 five other cases were brought to the attention of the Public Health Department where it was felt that action under Section 47 might be necessary. In one of these cases there was found to be no justification for such action. In the other four cases beds were obtained for the patients in suitable hospitals or homes, and they all ultimately agreed to removal. In dealing with these old people the District Nursing Association and the Home Help Service have rendered invaluable assistance. MASS RADIOGRAPHY. By arrangement with the South-West Metropolitan Regional Hospital Board, the Surrey Mass Radiography Unit was stationed in Wimbledon from 21st March to 4th April, 1949. This X-ray Unit offered facilities for free chest x-ray to all persons over the age of 14 years. Special appointments were available for business houses, associations, schools, etc., and wide publicity was given beforehand. I am indebted to the Secretary of the Mass Radiography Unit for the following particulars of the persons who attended for examination. Number of persons examined on miniature films: Males 2010 Females 2936 4946 Number of persons recalled for large film examination 277 No. of these who failed to attend 6 13 Abnormalities discovered. Active pulmonary tuberculosis: Males 13 Females 14 – 27 Inactive pulmonary tuberculosis: Males 59 Females 73 – 132 Non-tuberculous conditions: Males 77 Females 82 – 159 The number of persons found to be suffering from active pulmonary tuberculosis was equivalent to 5.5 per thousand persons examined. CLEAN FOOD CAMPAIGNS. During 1949 the Local Authority had under consideration Circular M.F. 12/49, issued by the Ministry of Food in connection with the need for bringing home to the public, and to food traders, the importance of clean handling of food. At the end of the year, arrangements were being made to enlist the co-operation of local food traders in this matter. 14 SECTION C. — SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Metropolitan Water Board is responsible for the supply of water to the Borough and regular periodical examinations are made by them. With three exceptions all the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. During 1949 the following samples of water were sent for examination:— Nature of No. of examination Samples Results Land spring, Wimbledon Common Bacteriological 3 Unsatisfactory examination Land spring, Wimbledon Common Chemical 1 Satisfactory analysis Shallow well, Warren Farm House Bacteriological 1 Satisfactory examination Shallow well, Warren Farm Cottage Bacteriological 1 Satisfactory examination Private dwelling house Bacteriological 1 Satisfactory examination Water from the land spring on Wimbledon Common, usually known as Caesar's Well, was examined bacteriologically and chemically during the year. As the bacteriological reports were unsatisfactory the Chief Ranger was advised to take steps to render this water no longer available to the public for drinking purposes, and appropriate action was taken by him to give effect to this. Swimming Baths. During the year four samples of water were sent for bacteriological examination from the Wimbledon Corporation Swimming Baths. All four samples were reported upon as satisfactory. Disposal of Sewage and Refuse. There were no important alterations to the main sewage disposal works or refuse disposal works in Wimbledon during 1949. 15 Sanitary Inspection of District. The following is a statement showing the number and nature of inspections made during 1949 :— Reason for Visit. No. Infectious Diseases, investigations, etc. 435 Inspections under Housing Act, 1936, Part IV 213 House to House Inspections (Section 91, Public Health Act, 1936):— (a) number of houses inspected 520 (b) number of revisits 1,325 House Inspections 10,555 Inspections of Factories, Workplaces and Outworkers' premises 441 Inspections of Dairies 72 Inspections of Food, and Food Premises 1,080 Obtaining samples of Food and Drugs 138 Inspections under the Shops Acts 1912/1938 210 Inspections under the Petroleum (Regulation) Acts, 1923 and 1936 94 Applications of Test to Drains 187 Inspections under Rats and Mice (Destruction) Act, 1919 3,405 Smoke Observations 72 Miscellaneous Inspections (including visits to Nursing Homes, Caravans, Piggeries, Stables, Hairdressers' premises and Watercourses, and in connexion with the Rent (Restrictions) Acts 1,693 Total 20,440 Notices Served. Preliminary notices or intimations 3,226 Statutory Notices 647 Result of Service of Notices. (a) Legal proceedings. As a result of non-compliance with abatement notices legal proceedings were started in nine cases. In five instances, nuisance orders were made, and in the remaining four the summonses were withdrawn as the work had been completed. Fines amounting to £9 were imposed, and the costs awarded totalled £13 7s. 6d. 16 (b) Work carried out in default. In two cases where nuisance orders had been made by the Court but had not been complied with by the owners, the Corporation executed the necessary works to abate the nuisances. In two cases work was carried out by the Corporation in default of the owners under Section 39, and in one case under Section 56, of the Public Health Act, 1936. Six dustbins were supplied by the Corporation in default of the owners. Nuisances abated and defects remedied. The following table gives a summary of the nuisances abated and the sanitary improvements carried out, together with the defects remedied under the supervision of the sanitary inspectors:— Accumulations removed 27 Cisterns provided 1 Cisterns repaired, cleansed or covered 10 Drains, new, provided 20 Drains, repaired or altered 89 Drains, stoppages removed 114 Dustbins provided 218 Flushing cisterns, new, provided 16 Flushing cisterns, repaired 98 Manure receptacles provided 2 Rain-water pipes disconnected 3 Roofs repaired 549 Rooms stripped and cleansed 1,598 Verminous rooms cleansed 17 Soilpipes, new, provided 8 Soilpipes, repaired or altered 4 Vent pipes, new, provided 7 Vent pipes, repaired or altered 28 Waste pipes, new, provided 25 Waste pipes, repaired, disconnected or trapped 23 Water-closets, new, provided 67 Water-closets, repaired or ventilated 103 Water services restored 15 Water supply direct from main 9 Yards paved 9 Yards repaired 61 Guttering repaired 222 Floors ventilated 19 Nuisances from damp walls abated 763 Sinks provided 12 Other nuisances remedied 6,909 Rooms disinfected 273 Total 11,319 Work executed by the Borough Surveyor and rechargeable under Section 24 of the Public Health Act, 1936. Twenty-six sewers vested in the Local Authority by Section 20 of the Public Health Act, 1936, were cleared or repaired. 17 FACTORIES ACT, 1937. PART I. 1. Inspections for Purposes of Provisions as to Health. Premises Number on Register Number of Inspections Written Notices Prosecutions Factories without mechanical power 109 107 6 – Factories with mechanical power 233 257 27 – Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 3 9 – – Totals 345 373 33 – 2. Defects Found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of Cleanliness (S.1) 16 10 – 4 – Overcrowding (S.2) – – – – – Unreasonable temperature (S.3) – – – – – Inadequate v e n t i l a tion (S.4) 2 2 – 1 – Ineffective drainage of floors (S.6) 1 – – – – Sanitary Conveniences (S.7):— Insufficient 7 6 – 3 – Unsuitable or Defective 45 46 – 7 – Not Separate for Sexes 3 2 – 3 – Other Offences (Excluding offences relating to outwork) 2 – 2 – – Totals 76 66 2 18 — 18 PART VIII. OUTWORK - SECTIONS 110 & 111. Nature of work Section 110 Section 111 No. of outworkers in Auggust list required by Sec. 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 unwhole some premises Notices served Prosecutions Wearing Apparel — Making etc. 42 — — — — — Others — — — — — — Total 42 — — — — — Number of addresses received from other Councils 37 Number of addresses forwarded to other Councils 37 Number of premises where outwork was carried on at the end of 1949 46 Inspections of outworkers' premises 56 Outwork in infected premises (Section 153 Public Health Act, 1936) Nil. OTHER MATTERS. Failure to affix Abstracts of Act notified to H.M. Inspector of Factories 2 Underground bakehouses in use at the end of the year 3 19 SECTION D. — HOUSING. Housing Act, 1936, (Part IV)—Overcrowding. The following table shows the position in Wimbledon at the end of 1949 with regard to overcrowding. (a) (i) Number of dwellings known to the Department to be overcrowded at the end of the year 47 (ii) Number of families dwelling therein 57 (iii) Number of persons dwelling therein 212½ (b) Number of new cases of overcrowding reported during the year 42 (c) (i) Number of cases of overcrowding known to have been relieved during the year 28 (ii) Number of persons concerned in such cases 146 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 1* *In one case where the Local Authority had taken steps to secure the abatement of overcrowding, the dwelling-house concerned again became overcrowded to the extent of ½ unit. Details of this case were considered very carefully, and in the light of all the circumstances it was decided not to take legal action. Rehousing. I am indebted to the Housing Manager for the following information regarding rehousing in Wimbledon:— No. of houses requisitioned since the beginning of the war, and still held under requisition at the end of 1949 485 No. of prefabricated bungalows provided since the end of the war 71 No. of families rehoused by the Council, or by private owners at the Council's instigation, since the beginning of the war 1,557 No. of live applications on the housing waitinglist 2801 New houses erected, etc. I am indebted to the Borough Engineer and Surveyor for the following information:— No. of new houses erected in Wimbledon during 1949 101 No. of flats created by building or conversion 79 20 SECTION E. — INSPECTION AND SUPERVISION OF FOOD. Milk. Under the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949, and the Milk (Special Designation) (Raw Milk) Regulations 1949, the following licences were granted to retailers:— Pasteurisers' Licences Nil Dealers' Licences— Tuberculin Tested Milk 12 Pasteurised Milk 17 Sterilised Milk 15 Supplementary Licences— Tuberculin Tested Milk 10 Pasteurised Milk 10 Sterilised Milk 1 65 During the year 65 samples of designated milk were sent for bacteriological examination. The results were as follows:— Class of Milk. Satisfactory. Unsatisfactory. Pasteurised 34 — Tuberculin Tested Pasteurised 10 6 Tuberculin Tested Certified 8 4 Heat Treated 3 - Investigations were made in connection with the unsatisfactory samples, and where appropriate, communications were sent to the County Medical Officers of the areas concerned in order that investigations could be carried out at the source of production. In addition to the foregoing, 2 samples of ungraded milk were taken during the year. Experience has shown that all the milk sold in the Borough as ungraded milk has been previously pasteurised. In the two foregoing samples the milk was found to come up to the standard laid down for pasteurised milk. Under the Milk and Dairies Regulations 1926 to 1943 there were 3 prosecutions against a firm of dairymen for selling milk in dirty bottles. In the first case the Company pleaded not guilty, but in the remaining two cases pleaded guilty. Fines amounting to £15 were imposed, and the costs awarded amounted to £4 13s. Od. 21 Ice Cream. During the year, 96 samples of ice cream were taken for bacteriological examination:— The results of these samples were as follows:— Grade 1 44 Grade 2 21 Grade 3 25 Grade 4 6 Total 96 The results of the methylene blue test divide ice cream into four categories—Grades 1, 2, 3, and 4. It is suggested that if ice cream consistently fails to reach Grade 1 or 2 it would be reasonable to regard this as indicating defects of manufacture or handling which call for further investigation. Repeated visits were made to premises from which unsatisfactory results had been received, and communications were sent to the Medical Officers of Health of the areas in which the ice cream was manufactured. Further samples were taken from time to time. In all, 336 visits were paid during the year to premises where the manufacture or sale of ice cream was being carried on. Sixteen applications were received for registration for the sale of ice cream. Registration was granted in all cases. Meat and Other Foods. The following inspections of food premises etc., were made by the Sanitary Inspectors during 1949:— Inspections of dairies 72 Inspections of food premises 381 Inspections of premises where ice-cream is manufactured or sold 181 Visits to obtain samples of food and drugs 138 Visits to obtain samples of designated milk 37 Visits to obtain samples of ice-cream 155 Inspections of other foods 366 Unsound Food. The following is a list of the unsound food surrendered for destruction during the year:— Apricots (dried) 13½ lbs. Bacon 40¾ lbs. Biscuits 24 packets Brawn 20 lbs. Butter 3 lbs. Cake Mixture 78 packets Cereals 77 packets Cheese 105 lbs. 22 Cheese, Camembert 90 cartons Cheese, Italian Cream 10 lbs. Coffee Essence 10 bottles Cooking Fat 2 lbs. Eggs 702 Fish 29 stones Fish cakes 60 Fish paste 5 jars Flour 13 lbs. Greens 150 lbs. Margarine 3 lbs. Marmite 2 jars Meat 1405¼ lbs. Meat paste 1 jar Mincemeat 2 jars Mustard 1 packet Offal 32 lbs. Olive Oil 2 bottles Pickles 113 jars Plums 3 bottles Prawns 228 lbs. Preserves 57 jars Pudding Mixture 5 packets Rabbits 60 lbs. Sage and Onion Stuffing 1 packet Sauce 10 bottles Sausages 237 lbs. Soup Powder 194 packets Sugar 50 lbs. Sweets 3 lbs. Tea ½ lb. Various tinned foods 2179 tins Under Section 9 of the Food and Drugs Act 1938 there was one prosecution for the sale of food (bread) unfit for human consumption. The firm pleaded guilty, and a fine of £20 was imposed. Costs awarded amounted to £6 6s. Od. 23 Carcases Inspected and Condemned Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — — — — 8 Number inspected — — — — 8 All diseases except Tuberculosis:— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — — Percentage of the number inspected affected with diseases other than tuberculosis - - - - - Tuberculosis only:— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — - — Percentage of the number inspected affected with tuberculosis — — — — — 24 Sampling of Food and Drugs. During 1949 samples were taken for analysis as under:— Articles Analysed Inferior or Adulterated Formal Informal Total Formal Informal Total Milk 17 36 53 - 6 6* Beef Aspic Jelly - 1 1 - - - Blancmange - 1 1 - - - Breadcrumbs - 1 1 - - - Butter 2 - 2 - - - Bicarbonate of Soda - 1 1 - - - Carraway Seeds - 1 1 - - - Cherryade - 1 1 - - - Chocolate Spread - 1 1 - - - Cloves - 1 1 - - - Coffee - 9 9 - - - Coffee and Chicory - 1 1 - - - Coffee Extract - 1 1 - - - Cough Mixture - 1 1 - - - Cornflour - 1 1 - - - Creamola - 1 1 - - - Cake Flour - 1 1 - 1 1† Cocoa - 1 1 - - - Custard Powder - 2 2 - - - Essence - 2 2 - - - Fish Paste - 2 2 - - - Flavouring - 3 3 - - - Ginger Ale - 1 1 - - - Ginger Spread - 1 1 - - - Ground Ginger - 2 2 - - - Gelatine - 2 2 - - - Glauber's Salts 1 1 2 - - - Horseradish - 3 3 - - - Ice Cream - 5 5 - - - Lemonade Powder - 3 3 - - - Meat Paste - 1 1 - - - Mint Sauce - 1 1 - - - Pepper - 2 - - - _ Phensic Tablets - 1 1 - - - Pickling Spice — 1 1 - - - Potato Crisps — 5 5 - - - Potato Powder - 1 1 - - - Propax Tablets — 1 1 - - - Pudding Mixture — 2 2 - - - Sausages, Beef 2 — 2 - - - Sausages, Liver — 2 2 - - - Sausages, Pork 2 — 2 - - - Salad Cream 1 3 4 - - - Soup Powder — 1 1 - - - Squash — 1 1 - - - Syrup of Figs — 1 1 - - - Sweetened Fat - 1 1 - - - Verox Cubes — 1 1 - - - Vinegar — 1 1 - — - Totals 25 113 138 — 7 7 * Adulterated t Inferior 25 Food and Drugs Act, 1938—Section 34. During the year 1949 one application was received for the registration of premises for wholesale dealing in margarine. It was intended that these premises should be used only in emergency, for example if a breakdown occurred in transport between the firm's permanent wholesale factory and their retail shops in the neighbourhood. Registration under Section 34 of the Food and Drugs Act was granted by the Local Authority. 26 SECTION F. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 969 cases of infectious disease notified, as compared with 849 during 1948. Of the total notifications 707 were in respect of measles and 149 in respect of whooping cough. Diphtheria. Six cases of diphtheria were notified during the year. Four of these were physically handicapped children who travelled from Wimbledon to special schools in the L.C.C. area by coach daily. Three of these children had been immunised against diphtheria, but one had received only one immunising injection. Two of the immunised children were found to be only diphtheria carriers, whilst the other two had a mild form of the disease. With regard to the two remaining cases of diphtheria one was a child aged 4 years who was stated to have been immunised in South Africa in 1945, and the other was an unimmunised girl of 19 who had a rather severe attack of the disease. All the patients were removed to hopsital. Immunisation against Diphtheria. The following table shows the state of immunisation in Wimbledon in relation to the child population under the age of 5 years. The authority responsible for immunisation is now the Surrey County Council. Age at 31-12-49. No. immunised. Total child population. Under 1 25 4547 1 year 615 2 years 861 3 years 768 4 years 595 2864 Poliomyelitis and Polioencephalitis. There were nine confirmed cases of poliomyelitis and one of polioencephalitis during the year. Seven other patients, suspected to be suffering from poliomyelitis, were removed to hospital for 27 observation. The final diagnosis in these seven cases was as follows:— Tonsillitis 2 Influenza 1 Primary tuberculosis 1 B. coli pyelitis 1 Septicaemia 1 Arthritis of elbow 1 Eight of the nine confirmed cases of poliomyelitis were removed to hospital for treatment. Two of these patients-a girl aged 6 years and a girl aged 7 years—contracted severe bulbar types of the disease and died shortly after admission to hospital. Measles. The number of cases of measles notified during the year (707) was the highest recorded since the disease became notifiable in 1939. Food Poisoning. Two cases of food poisoning were notified during the year. One of these patients, a baby aged 11 months, was seriously ill, and was removed to a general hospital for treatment. After admission the infant was found to be suffering from an infection due to salmonella typhimurium. Investigations as to how this case of food poisoning arose were rendered difficult by the lapse of time which occurred before the diagnosis was established. Other members of the household were investigated bacteriologically but with negative results. The patient was ultimately transferred to the Wimbledon Infectious Diseases Hospital and remained under treatment there, as a temporary carrier of salmonella typhimurium for three months. At the end of this period the child was found to be bacteriologcally clear and was discharged to her home. The remaining case of food poisoning notified was that of an adult, whose illness appeared to have been connected with an outbreak which occurred at her place of employment in Westminster, where a number of people were taken ill. Investigations both at Westminster and in connection with the patient living in Wimbledon failed to reveal the causative organisms or the source of infection. Gastro-Enteritis. There was one death from primary infective gastro-enteritis during the year in a child under 2 years of age. The patient, a girl aged 7 months, was admitted to a hospital at Lewisham, and died there. 28 Smallpox. Twelve smallpox contacts, from a ship on which a case of smallpox had occurred, were kept under supervision in Wimbledon by the staff of the Health Department. A number of these were re-vaccinated by the medical staff. One man, whose home was in Essex, and who was an indirect contact of one of the passengers from this ship, developed chickenpox in Wimbledon. He was removed to the Wimbledon Infectious Diseases Hospital. Investigations carried out through the Central Public Health Laboratoy confirmed the diagnosis of chickenpox in this case. The following tables show (a) the notifications of infectious diseases received during 1949, and (b) a comparison of notifications received during the last 10 years. 29 Notifiable Diseases during 1949. DISEASE Number of Cases Notified in Various Age Groups Total Cases Notified Total Cases removed to Hospital Under 1 1-3 3-5 5-10 10-15 15-25 25-45 45-65 65 and over Scarlet Fever _ 6 13 23 4 6 3 — — 55 31 Diphtheria — — 1 3 1 1 — — — 6 6 Puerperal Pyrexia — — — — — 5 3 — — 8 5 Measles 16 173 181 317 5 6 9 — — 707 9 Whooping Cough 8 54 38 45 2 — 2 — — 149 — Acute Primary or Influenzal Pneumonia — 2 2 2 1 1 3 2 6 19 1 Cerebro-Spinal Fever — 1 — 1 — — — — — 2 2 Acute Poliomyelitis — 1 1 6 1 — — — — 9 8 Polioencephalitis — — — — 1 — — — — 1 1 Ophthalmia Neonatorum 2 — — — — — — — — 2 1 Erysipelas — — — — — — 4 2 1 7 1 Dysentery — — — — — — 1 — 1 2 — Food Poisoning 1 — — — — 1 — — — 2 1 TOTALS 27 237 236 397 15 20 25 4 8 969 66 30 Notifications of Infectious Disease during the last 10 years. DISEASE 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 Cerebro-Spinal Fever 12 9 7 10 3 6 5 5 3 2 Diphtheria 9 15 10 20 24 8 7 4 4 6 Dysentery — — 3 — 89 18 4 2 — 2 Encephalitis Lethargica, acute - - - - - - - - 1 - Enteric Fever (including Paratyphoid) 19 8 6 - 1 — Erysipelas 11 9 12 11 11 11 12 5 2 7 Food Poisoning 4 3 - — — 1 — — 5 2 Malaria — — 1 — 1 1 7 — — — Measles 56 77 556 272 57 586 339 253 481 707 Ophthalmia Neonatorum 3 6 8 6 9 10 8 4 2 2 Pneumonia 23 20 20 30 25 27 26 32 15 19 Polioencephalitis 1 — — — — — — 12 2 1 Poliomyelitis — 1 — — 1 4 2 13 2 9 Puerperal Pyrexia 6 2 6 9 6 8 10 3 5 8 Scarlet Fever 40 39 100 186 77 46 37 51 95 55 Whooping-cough 10 144 34 115 117 54 114 157 231 149 194 333 763 659 420 780 571 541 849 969 Tuberculosis:— Pulmonary 58 71 64 59 66 76 84 87 87 96 Non-Pulmonary 9 12 16 12 10 16 12 8 6 10 31 WIMBLEDON INFECTIOUS DISEASES HOSPITAL. As mentioned in the Annual Report for 1948, the Wimbledon Infectious Diseases Hospital, Gap Road, was transferred from the control of the Wimbledon Borough Council to the South-West Metropolitan Regional Hospital Board on the 5th July, 1948, as a result of the coming into force of the National Health Service Act, 1946. This hospital was used for the treatment of practically all types of infectious disease occurring in Wimbledon, and also admitted a number of patients from other areas. In 1949 the Regional Hospital Board decided that this hospital should no longer be used for infectious cases, and it was closed for the admission of patients on 17th November, 1949. Persons needing hospital treatment for infectious diseases are now dealt with through the Emergency Bed Service, who arrange for their admission to various Infectious Diseases Hospitals outside the Borough. TUBERCULOSIS. During the year, 106 cases of tuberculosis were added to the register, as compared with 93 in 1948. Of these, 85 were new cases and the remainder were tranfers from other areas. The following cases were removed from the Register:— Deaths 22 Patients stated to have recovered 3 Removals from district 40 65 There were 21 admissions to hospitals or sanatoria during the year. The following table gives an analysis of the notifications received:— 32 TUBERCULOSIS — 1949. AGE GROUPS CASES ADDED TO THE REGISTER DEATHS Primary Notifications (Form A) Cases Discovered otherwise than by Notification Total Cases added to the Register Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females Under 1 Year - - - - - - - - - - - - - - - - 1—5 Years 1 2 - - - - - - 1 2 - - - - - - 5-10 1 1 2 — — - - 1 1 1 2 1 — — - - 10—15 4 - - - - - - - - - - - - - - - 15—20 2 5 - - - - - - 2 5 - - - - - - 20—25 3 6 1 2 — - - — 3 6 1 2 — 1 - - 25—30 4 6 — — 5 5 - — 9 11 — — 1 1 1 - 30—35 3 6 — — 1 1 - — 4 7 — — 2 — - - 35—45 10 4 — — 1 — 1 1 11 4 1 1 1 — 1 1 45—55 8 2 — 1 — — - — 8 2 — 1 — 1 - - 55—65 6 3 — — 2 — - 1 8 3 — 1 6 1 - 2 65 and Over 2 — — — 2 — - — 4 - — — 2 1 - — 44 35 3 3 11 6 1 3 55 41 4 6 12 5 2 3 79 6 17 4 96 10 17 5 85 21 106 22 33