AC 4413(1) WIMBLEDON WIN 24 Borough of Mimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1951 Printed by Raynes Park Press, Lambton Road, London, S.W.20. V- ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1951 Public Health Department, Town Hall, Wimbledon, S.W.I9. August, 1952. 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 1951. This report is compiled in accordance with the instructions contained in Circular 42/51 of the Ministry of Health. From the statistics it will be seen that the corrected death-rate for the Borough in 1951 was 10.93 per thousand as compared with 12.5 for England and Wales. The infantile mortality rate was 20.41 per thousand live births, the comparative figure for England and Wales being 29.6. For the third year in succession there were no maternal deaths amongst women resident in Wimbledon. With regard to infectious diseases, 1,158 cases were notified during 1951 as compared with 668 during 1950. This increase was largely due to an outbreak of measles. No cases of diphtheria occurred during the year. Four cases of poliomyelitis were notified. Three of these cases were associated with paralysis, and one proved fatal. 1 I should like to take this opportunity of expressing to the Chairman and Members of the Health Committee my appreciation of the consideration and courtesy which they have all shown me during the year. My thanks are also due to all members of the staff for the loyal and efficient way in which they have carried out their duties. I am also indebted to my colleagues in other departments for their ready help on all occasions. I have the honour to be, Your obedient Servant, HAROLD ELLIS, Medical Officer of Health. 2 LIST OF CONTENTS. Page Introduction 1-2 List of Staff 4 SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc. 5-7 Deaths Registered 8-9 Infantile Mortality 9-10 Summary of Statistics 11 SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Nursing Homes 12 National Assistance Act, 1948 13 Mass Radiography 13-14 Clean Food Campaigns 14 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 15 Sanitary Inspectors' Visits 15-16 Notices Served 16 Nuisances abated and defects remedied 16-17 Factories Act, 1937, Part I. 18 Outworkers 19 Bakehouses 19 SECTION D: HOUSING 20 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk 21-22 Ice cream 22 Meat and other Foods 22-24 Sampling of Food and Drugs 25 SECTION F : PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES : Diphtheria Immunisation 26 Notifiable Infectious Diseases, etc 26-30 Tuberculosis 31-32 3 STAFF Medical Officer of Health: Harold Ellis, M.B., B.S.(Lond.), M.R.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), (Resigned 23/9/51). A. N. Scotter, (a), (c), (Resigned 31/5/51). G. R. Pope, (a), (Resigned 15/7/51). J. Hills, (a), (c). P. W. Smith, (a), (Appointed 15/8/51). P. W. Jolly, (a), (Appointed 27/9/51). Assistant Rodent Officer: F. J. Reddington. Chief Clerk: † Mrs. V. Dymott. Clerks: * J. E. Field. * Mrs. V. Waters. J. Burrows, (Resigned 18/11/51). † Miss S. G. Miller. F. R. Bracktield. Miss P. Martin (Appointed 3/12/51—temporary appointment). † 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, 1951) 3,212 Population (Census, 1951) 58,158 Home Population (mid-1951) 58,430 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:— £820,382. Sum represented by penny rate:— £3,310 0s. 0d. Extracts from Vital Statistics of the Year 1951. (Registrar-General's Figures.) Live Births Legitimate Total M. F. 798 412 386 Illegitimate 35 11 24 Total 833 423 410 Total M. F. Stillbirths Legitimate 10 4 6 Illegitimate 4 2 2 Total 14 6 8 Live birth rate per 1,000 of the estimated home population 14.26 Corrected live birth rate per 1,000 of the estimated home population 13.26 Still-birth Rate per 1,000 total (live and still) births 16.53 Total M. F. Deaths 779 366 413 Crude Death Rate per 1,000 of the estimated home population 13.33 Corrected Death Rate per 1,000 of the estimated home population 10.93 Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births. Puerperal and post-abortive sepsis — — Other maternal causes — — Total — — Death Rate of infants under one year of age :— All infants per 1,000 live births 20.41 Legitimate infants per 1,000 legitimate live births 20.05 Illegitimate infants per 1,000 illegitimate live births 28.57 Deaths from cancer 136 „ „ diphtheria 0 „ „ poliomyelitis 1 „ „ measles 1 „ „ whooping cough 0 5 Birth Rates, Death Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the Year 1951. (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 Home Population Births: — Live Births 13.26 15.5 17.3 16.7 17.8 Still Births 0.24 0.36 0.45 0.38 0.37 Deaths:— All Causes 10.93 12.5 13.4 12.5 13.1 Typhoid and Paratyphoid — 0.00 0.00 0.00 — Whooping Cough — 0.01 0.01 0.01 0.01 Diphtheria — 0.00 0.00 0.00 0.00 Tuberculosis 0.27 0.31 0.37 0.31 0.38 Influenza 0.27 0.38 0.36 0.38 0.23 Smallpox — 0.00 0.00 0.00 — Acute Poliomyelitis (including Polioencephalitis) 0.02 0.00 0.01 0.01 0.00 Pneumonia 0.60 0.61 0.65 0.63 0.61 Notifications (corrected): — Typhoid Fever — 0.00 0.00 0.00 0.01 Paratyphoid Fever — 0.02 0.03 0.02 0.01 Meningococcal Infection 0.04 0.03 0.04 0.03 0.03 Scarlet Fever 2.33 1.11 1.20 1.20 1.10 Whooping Cough 2.84 3.87 3.62 4.00 3.11 Diphtheria — 0.02 0.02 0.03 0.01 Erysipelas 0.09 0.14 0.15 0.12 0.15 Smallpox — 0.00 0.00 0.00 — Measles 12.97 14.07 13.93 14.82 14.64 Pneumonia 0.46 0.99 1.04 0.96 0.72 Acute Poliomyelitis (including Polioencephalitis)— Paralytic 0.05 0.03 0.03 0.03 0.02 Non-paralytic 0.02 0.02 0.02 0.03 0.02 Food Poisoning 0.07 0.13 0.15 0.08 0.23 Rates per 1,000 Live Births Deaths: — All causes under 1 year of age 20.41 29.6 § 33.9 27.6 26.4 Diarrhoea and Enteritis (under 2 years of age) — 1.4 1.6 1.0 0.7 5 Per 1,000 related live births. 6 Rates per 1,000 Total Births {i.e.. Live and Still) 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 Notifications (corrected): — Puerperal Fever and Pyrexia 2.36 10.66 13.77 8.08 14.90 Maternal Mortality in England and Wales. Cause No. of deaths Rates per 1,000 total (live and still) births Rates per million women aged 15-44 Sepsis of pregnancy, childbirth and the puerperium 70 0.10 0 Abortion with toxaemia 3 0.00 Other toxaemias of pregnancy and the puerperium 167 0.24 Haemorrhage of pregnancy and childbirth 91 0.13 Abortion without mention of sepsis or toxaemia 37 0.05 4 Abortion with sepsis 66 0.09 7 Other complications of pregnancy, childbirth and the puerperium 125 0.18 As previously stated in the Report there were no maternal deaths in Wimbledon during 1951. BIRTHS. The statistics supplied by the Registrar-General show that during 1951 the total number of registered live births belonging to Wimbledon was 833. In addition 14 stillbirths were registered. This gives a birth-rate of 14.26 per thousand of the population compared with a rate of 13.40 per thousand for the previous year. A comparability factor has been supplied by the RegistrarGeneral which enables the birth-rate for Wimbledon to be compared with that for England and Wales. The corrected birth-rate for Wimbledon for 1951 is 13.26 per thousand of the population, whilst the rate for England and Wales is 15.5. Of the 14 stillbirths registered, 13 occurred in hospitals or nursing homes, and one occurred at home. 7 DEATHS. The total number of Wimbledon residents who died during 1951 was 779, giving a death-rate of 13.33 per thousand of the population as compared with 12.65 per thousand for 1950. The corrected death-rate for 1951 is 10.93 per thousand as compared with a rate of 12.5 per thousand for England and Wales. The number of Wimbledon residents who died outside the Borough was 311, while 276 persons not normally resident in Wimbledon died in institutions, etc., in the Borough. The three principal causes of death were as follows:— Percentage of total deaths Diseases of the heart and circulatory system 47% Cancer 17% Diseases of the respiratory system 13% Total 77% The following is an analysis of the causes of death :— Cause Males Females Total 1. Respiratory tuberculosis 9 5 14 2. Other tuberculosis 1 1 2 3. Syphilitic disease 2 2 4 4. Diphtheria — — — 5. Whooping cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — 1 1 8. Measles 1 — 1 9. Other infective and parasitic diseases 2 — 2 10. Malignant neoplasm, stomach 8 5 13 11. Malignant neoplasm, lung, bronchus 17 10 27 12. Malignant neoplasm, breast — 21 21 13. Malignant neoplasm, uterus — 5 5 14. Other malignant and lymphatic neoplasms 35 29 64 15. Leukaemia, aleukaemia 5 1 6 16. Diabetes 1 3 4 17. Vascular lesions of nervous system 34 63 97 18. Coronary disease, angina 44 38 82 19. Hypertension with heart disease 12 14 26 20. Other heart disease 51 77 128 21. Other circulatory disease 15 19 34 22. Influenza 5 11 16 8 Cause Males Females Total 23. Pneumonia 14 21 35 24. Bronchitis 24 17 41 25. Other diseases of respiratory system 5 3 8 26. Ulcer of stomach and duodenum 5 2 7 27. Gastritis, enteritis and diarrhoea 5 1 6 28. Nephritis and nephrosis 4 2 6 29. Hyperplasia of prostate 17 — 17 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 4 4 8 32. Other defined and ill-defined diseases 26 47 73 33. Motor vehicle accidents 1 2 3 34. All other accidents 12 6 18 35. Suicide 6 3 9 36. Homicide and operations of war 1 — 1 Totals 366 413 779 INFANTILE MORTALITY. During 1951 there were 17 deaths in infants under one year of age, giving an infantile mortality rate for Wimbledon of 20.41 per thousand live births as compared with a rate of 29.6 for England and Wales. Fourteen of the 17 deaths occurred during the first four weeks of life, giving a neo-natal death-rate of 16.81 per thousand live births. 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 Total St. Mary's St. John's Cott. Park W'don Park Dundonald Trinity Sth. Park Haydon Pk. Congenital defect or birth injury 5 1 1 — 7 1 — — 1 9 2 1 2 1 — 2 — 1 6 3 9 Haemolytic disease of the newborn 2 — — — 2 — — — — 2 — — — — — — — 2 — 2 2 Prematurity 2 1 — — 3 — — — — 3 — — — — — — — 1 2 1 3 Pneumonia — 1 — — 1 — — — — 1 — — — — — — — 1 — 1 1 Septicaemia — 1 — — 1 — — — — 1 1 — — — — — — — 1 — 1 Accidental death — — — — — — 1 — — 1 1 — — — — — — — 1 — 1 Total 9 4 1 — 14 1 1 — 1 17 4 1 4 1 — 2 — 5 10 7 17 11 Summary of Statistics. The following table shows the birth-rates and death-rates for Wimbledon as compared with England and Wales since 1939. 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. 1939 10.86 15.0 0.37 0.59 10.53 12.1 1.57 2.82 29.41 50 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 1950 12.46 15.8 0.24 0.37 10.37 11.6 — 0.86 18.13 29.8 1951 13.26 15.5 0.24 0.36 10.93 12.5 — 0.79 20.41 29.6 * From 1940 to 1948 the local death-rate could not be corrected 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 registration and supervision of nursing homes in the Borough. Two homes were discontinued during the year. Two homes were exempted, on an annual basis, from registration under Section 192 of the Public Health Act, 1936. The position at the end of 1951 was as follows:— Number of homes on the register:— Maternity Nil Others 6 Re-registration under consideration 1 Number of beds provided 83 Number of visits of inspection during the year 15 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. In one case during 1951 it was found necessary for the Council to apply to the Court for an Order under this Section. Every effort had been made to improve conditions under which this old woman was living through the assistance of the district nurses, the home help service and the W.V.S. This however had not been successful and in December an Order was granted by the Court for the old person to be removed for a period of three months to a County Welfare establishment. At the beginning of 1951 there was one patient already in hospital as the result of an Order made by the local Court in 1948 under this Section. In January 1951 application was made for a Varying Order enabling the patient to be transferred from hospital to a County Welfare establishment, thus releasing a hospital bed. The Order was granted, and the old lady was transferred accordingly. She remained there during the course of the year. MASS RADIOGRAPHY. By arrangement with the South-West Metropolitan Regional Hospital Board, the Mass Radiography Unit was stationed at West Wimbledon from 18th to 30th May, 1951, when facilities were offered to all persons over the age of 14 years for x-ray examination of the chest. Such examinations are of course carried out without charge. I am indebted to the Secretary of the Mass Radiography Unit for the following particulars of the persons who attended for examination. As the facilities were available to all, the statistics do not necessarily relate only to Wimbledon residents. Number of persons examined: Males 619 1,384 Females 765 A bnormalities discovered: (i) Active pulmonary tuberculosis : Males 2 5 Females 3 (ii) Inactive pulmonary tuberculosis: Males 26 49 Females 23 13 (iii) Non-tuberculous conditions : Males 19 Females 17 36 CLEAN FOOD CAMPAIGNS. Clean Food Advisory Committee. Three meetings of the Clean Food Advisory Committee were held during the year. Codes of Practice drawn up in the Public Health Department were considered by the Committee and finally approved after consultation with the representatives of the various retail food industries concerned. Copies of these Codes of Practice were sent to the owners or managers of all premises in the Borough concerned with the handling and distribution of food. The Codes of Practice comprise general Codes applicable to all food traders and other persons handling food, and additional Codes applicable to specific food trades. Much that is contained in them goes beyond what is enforceable by law at the present time. The Clean Food Advisory Committee felt that the voluntary acceptance of the standards laid down in the Codes would be a most valuable factor in enhancing the standard of hygiene in the preparation and distribution of food in the Borough. The Clean Food Advisory Committee also had under consideration the establishment of a Clean Food Guild. No decision in this matter had been reached at the end of the year. Ministry of Food Circular 20/51. This Circular, issued by the Ministry of Food in October, 1951, recommended the issue to food traders of a notice signed by the Medical Officer of Health requesting customers not to bring dogs into food shops. The recommendation was adopted by the Health Committee, and printed notices were issued to all food traders in the Borough for exhibition on their premises. 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 the year samples of water were taken for bacteriological examination as follows:— Wimbledon Corporation Swimming Baths 12 samples Warren Farm, Wimbledon Common 1 sample Roman Well Laundry Cottage, Wimbledon Common 1 sample All fourteen samples were reported on as being satisfactory. Sanitary Inspection of District. The following is a statement showing the number and nature of inspections made during 1951:— Reason for Visit. No. Infectious Diseases, investigations, etc. 696 Inspections under Housing Act, 1936, Part IV 134 House to House Inspections (Section 91, Public Health Act, 1936): — (a) number of houses inspected 169 (b) number of revisits 593 House Inspections 8,748 Inspections of Factories, Workplaces and Outworkers' premises 532 Inspections of Dairies 59 Inspections of Food, and Food Premises 1,408 Obtaining samples of Food and Drugs 93 Inspections under the Shops Act 1950 152 Inspections under the Petroleum (Regulation) Acts, 1923 and 1936 129 Applications of Tests to Drains 164 15 Inspections under The Prevention of Damage by Pests Act, 1949 2,707 Smoke Observations 33 Miscellaneous Inspections (including visits to Nursing Homes, Caravans, Piggeries, Stables, Hairdressers' premises and Watercourses) 1,158 Total 16,775 Notices Served. Preliminary notices or intimations 2,259 Statutory Notices 566 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 seven instances nuisance orders were made, and in the remaining two cases the summonses were withdrawn as the work had been started. The costs awarded amounted to £15. 14s. 6d. (b) Work carried out in default. Two dustbins were supplied by the Corporation in default of the owners. The Corporation executed necessary works to abate nuisances in four cases where nuisance orders had been made by the Court but had not been complied with by 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 :— Drains, new, provided 10 Drains, altered or repaired 111 Drains, cleared 114 Fresh air inlets, provided or repaired 8 Gullies, new, provided — Gullies, curbs, provided or repaired 6 Gutters, repaired or renewed 184 Inspection chambers, new, provided 9 Inspection chambers, altered or repaired 8 Rainwater pipes, repaired or cleared 42 Rainwater pipes, disconnected 8 Soil and vent pipes, new, provided 5 Soil and vent pipes, repaired 29 Waste pipes, new, provided 5 16 Waste pipes, repaired, cleared or trapped 33 W.C. accommodation, provided or improved 2 W.C. accommodation, ventilated lobbies provided 4 W.C. accommodation, apartments cleaned or repaired 1 Water-closets, new, provided 27 Water-closets, cleared, cleansed or repaired 50 Flushing cisterns, new, provided 11 Flushing cisterns, repaired or regulated 68 Sinks or lavatory basins provided 9 Urinals provided 2 Urinals, cleaned or repaired — Accumulations removed 23 Animal nuisances abated 2 Dustbins provided 130 Brickwork, repaired or repointed 28 Dampness remedied 479 Roofs, renewed or repaired 522 Yards, paved 1 Yards, repaired 30 Floors, renewed or repaired 175 Floors, ventilated 1 Fireplaces or ranges, repaired or renewed 58 Rooms, walls and ceilings, cleansed or redecorated 689 Rooms, verminous, cleansed 3 Rooms, plasterwork repaired 351 Ventilated cupboards provided 1 Water pipes, repaired 2 Water storage cisterns, repaired, cleansed or covered 5 Windows, repaired 98 Windows, sills renewed or repaired 16 Windows, sashcords renewed 113 Factories or Workplaces, cleansed 1 Food Rooms, cleansed 31 Smoke nuisances abated 4 Other nuisances abated 1,962 Rooms disinfected 269 Total 5,740 Work executed by the Borough Surveyor and rechargeable under Section 24 of the Public Health Act, 1936. Fifteen 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 112 96 11 — Factories with mechanical power 204 356 15 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 4 8 — — Totals 320 460 26 — 2. Defects Found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of Cleanliness (S.l) 12 9 — 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 2 2 — 2 — Inadequate v e n t i 1 ation (S.4) 2 2 — 2 — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) :— Insufficient — 3 — — — Unsuitable or Defective 32 31 — 1 — Not Separate for Sexes 1 1 — — — Other Offences (Excluding offences relating to outwork) 1 2 1 — — Totals 50 50 1 6 — 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. 23 — — — — — Others — — — — — — Total 23 — — — — — Number of addresses received from other Councils 58 Number of addresses forwarded to other Councils 29 Number of premises where outwork was carried on at the end of 1951 87 Inspections of outworkers' premises 64 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 1 Underground bakehouses in use at the end of the year 2 19 SECTION D. - HOUSING. Housing Act, 1936, (Part IV) — Overcrowding. The following table shows the position in Wimbledon at the end of 1951 with regard to overcrowding. (a) (i) Number of dwellings known to the Department to be overcrowded at the end of the year 64 (ii) Number of families dwelling therein 75 (iii) Number of persons dwelling therein 291 (b) Number of new cases of overcrowding reported during the year 33 (c) (i) Number of cases of overcrowding known to have been relieved during the year 15 (ii) Number of persons concerned in such cases 74 (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 - 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 1951 478 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 1,720 No. of live applications on the housing waitinglist 3,425 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 1951:— Private enterprise 7 Local Authority Nil No. of new flats created by conversion during 1951:— Private enterprise 41 Local Authority 8 20 SECTION E. — INSPECTION AND SUPERVISION OF FOOD. Milk. Under the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949 and 1950, and the Milk (Special Designation) (Raw Milk) Regulations 1949 and 1950, the following licences were granted to retailers by the Council:— Pasteurisers' Licences Nil Dealers' Licences— Tuberculin Tested Milk 16 Pasteurised Milk 20 Sterilised Milk 25 Supplementary Licences— Tuberculin Tested Milk 8 Pasteurised Milk 9 Sterilised Milk 6 84 During the year 43 samples of designated milk were sent for bacteriological examination. The results were as follows:— Class of Milk. Satisfactory. Unsatisfactory. Pasteurised 23 — Tuberculin Tested (Pasteurised) 3 — Tuberculin Tested 9 1 Sterilised 7 — Investigations were made in connection with the unsatisfactory sample, and a communication was sent to the appropriate authority in order that investigations could also be carried out at the source of production. Four samples of tuberculin tested milk were sent to the Public Health Laboratory for animal inoculation. All four samples were found to be negative for tubercle bacilli. Food and Drugs (Milk, Dairies and Artifical Cream) Act, 1950. The above Act came into operation on the 1st January, 1951, and consolidated certain enactments relating to milk, dairies and artificial cream. Under Section 23 of the Act the Minister of Food is empowered to make Orders specifying areas within which the use of Special Designations in relation to milk sold by retail becomes obligatory. Such an Order—the Milk (Special Designations) (Specified Areas) Order 1951— specifying certain areas including Wimbledon, was made by the Minister 21 in July, 1951, and came into operation on the 1st October, 1951. From that date it became an offence to sell undesignated milk in Wimbledon. All retailers likely to be affected were notified of the Order beforehand. Ice Cream. On 1st March, 1951, the Food Standards (Ice Cream) Order, 1951, came into operation, prescribing standards for ice-cream. To comply with this Order ice-cream must contain not less than 5% fat, 10% sugar and 7½% milk solids other than fat. An alternative standard is prescribed for ice-cream containing fruit, and for Kosher ice. Fifteen samples of ice-cream were sent for analysis and with one exception were found to comply with the standards laid down in this Order. Further samples taken at the premises from which the unsatisfactory sample was received were found to comply with the standard. During the year 65 samples of ice-cream were taken for bacteriological examination. The results of these samples were as follows:— Grade 1 33 Grade 2 17 Grade 3 12 Grade 4 3 Total 65 The results of the methylene blue test divide ice-cream into four grades. If ice-cream consistently fails to reach Grades 1 and 2 in the test, this is regarded as indicating a defect of manufacture or handling which calls 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. Ten applications for registration for the sale of ice-cream were received, and registration was granted in all cases. Registration for the manufacture of ice-cream was granted in one case. In all, 133 visits were paid during 1951 to premises where the manufacture or sale of ice-cream was being carried on. Meat and Other Foods. The following inspections of food premises etc. were made by the Sanitary Inspectors during 1951:— Inspections of dairies 59 Inspections of food premises 668 Inspections of premises where ice-cream is manufactured or sold 133 Visits to obtain samples of food and drugs 93 Visits to obtain samples of designated milk 33 Visits to obtain samples of ice-cream 48 Inspections of other foods 526 No carcases were inspected or condemned during the year. 22 Unsound Food. The following is a list of the unsound food surrendered during the year:— Baby Food 69 tins Bacon 125½ lbs. Beans 9 tins Biscuits 28 lbs. Butter 4 lbs. Cake Mixture 170 pkts. Cereal 49 pkts. Cheese 46 lbs. Cheese, Gruyere 35 cartons Cheese, Processed 3 cartons Chicken, Frozen 2 Chicken Paste 1 jar Coffee 3 bottles Confectionery, Sweet 95½ lbs. Custard Powder 12 pkts. Figs, Dried 34½ lbs. Fish. Fresh 65 stones Fish 80 tins Fish Paste 3 jars Fish Roes 2½ stones Flour 6 pkts. Fruit 841 tins Fruit Juice 6 tins Haddock Liver 63 tins Ham 29½ lbs. Ham 254 tins Ham Sandwiches 54 Hors d'oeuvre 4 tins Margarine 4 lbs. Maws 1 barrel Meat 994½ lbs. Meat 576 tins Milk 469 tins Olive Oil 3 bottles Onion, Dehydrated 14 cartons Orange Squash 2 bottles Ox Tongue 38 lbs. Peanut Butter 2 jars Pears in Syrup 21 jars Pears 14 tins Pepper 3 ozs. Pickles 10 bottles Pickles 32 tins Pigs' Feet 200 lbs. Potato Crisps 300 lbs. Prawns 9 lbs. Preserves 97 jars Preserves 130 tins Prunes 150 lbs. Puddings 25 tins Salad Cream 41 bottles 23 Salmon 22 tins Sauce 12 bottles Sausages 115 lbs. Sausages 84 tins Sausage Rolls 24 Soups and Stews 387 tins Sugar 8 lbs. Sultanas 28 lbs. Tomatoes 90 tins Vegetables 2,381 tins Vermicelli 9 pkts. Vinegar 303 bottles Legal Proceedings. There were three prosecutions under Section 9 of the Food & Drugs Act, 1938. Details of these cases are given below. (1) A retailer was summonsed for selling a meat pie containing a piece of medicated lint. The defendant pleaded guilty and was fined £5. Costs amounting to £3 were awarded. (2) A retailer was summonsed for selling a cream sponge cake with a piece of cigarette embedded in the cream. The defendant pleaded guilty and was fined £5. Costs awarded amounted to £2 9s. 0d. (3) A retailer was summonsed for selling a loaf of bread in a dirty condition and with a piece of string-like material embedded in the crust. The defendant pleaded guilty and was fined £3. Costs of £1. Is. Od. were awarded. 24 Sampling of Food and Drugs. During 1951 samples were taken for analysis as under:— Articles Analysed Inferior or Adulterated Formal Informal Total Formal Informal Total Arrowroot — 1 1 — — — Bicarbonate of soda — 1 1 — — — Blancmange Powder — 2 2 — — — Brawn — 1 1 — 1 1 Butter — 1 1 — — — Calves feet jelly — 1 1 — — — Caraway seeds — 1 l — — — Cayenne pepper — 1 1 — — — Chocolate milk — 1 1 — — — Cocoa — l 1 — — — Coco-cola — 1 1 — — — Coffee (pure) — 2 2 — — — Coffee and chicory — 1 1 — — — Cooking fat — 1 1 — — — Cream of tartar — 1 1 — — — Dessert powder — 1 1 — — — Dessicated coconut — 1 1 — — — Flavouring, strawberry — 1 1 — — — Flavouring, orange — 1 1 — — — Gelatine — 2 2 — — — Ginger — 1 1 — — — Gravy powder — 1 1 — — — Ground rice — 1 1 — — — Honey — 1 1 — — — Horse radish sauce — 1 1 — — — Ice-cream 3 12 15 — 1 1 Jam — 1 1 — — — Jellied veal — 1 1 — — — Jelly, table — 1 1 — — — Lemon curd — 3 3 — 1 1 Macaroni in sauce — 1 1 — — — Milk 20 26 46 1 3 4 Olive Oil — 2 2 — — — Onion powder (dehydrated) — 1 1 — — — Oxo cubes — 1 1 — — — Orange Squash — 1 1 — — — Paste, beef — 1 1 — — — Paste, fish — 2 2 — — — Pea flour — 1 1 — — — Pepper — 1 1 — — — Pepper flavouring compound — 2 2 — — — Pickling spice — 1 1 — — — Pineapple, dried — 1 1 — — — Potato crisps — 3 3 — — — Rennet, essence of — i 1 — — — Rice creamola — 2 2 — — — Salad cream — 2 2 — — — Sage — 1 1 — — — Sausage, beef — 3 3 — — — Sausage, liver — 1 1 — — — Suet, beef 2 1 3 — 1 1 Soup, dessicated . 1 1 — — — Soup, flavouring — 1 1 — — — Sponge mixture — 2 1 — — — Tapioca — 1 1 — — — Tea — 1 1 — — — Vinegar — 3 3 — — — Totals 25 110 135 1 7 8 25 SECTION F. - PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifications of Infectious Disease. During the year there were 1,158 cases of infectious disease notified, as compared with 668 cases during 1950. This increase was largely due to an outbreak of measles, of which 758 cases were notified. Diphtheria. There were no cases of diphtheria in Wimbledon during 1951. One child suspected to be suffering from diphtheria was found, after admission to hospital, to be suffering from follicular tonsillitis. Immunisation against Diphtheria. The authority responsible for immunisation in this area is the Surrey County Council. The following table shows the state of immunisation in Wimbledon in relation to the child population. Age at 31/12/51 No. immunised Total child population Under 1 30 1 year 454 2 years 588 3 years 676 4 years 870 Total under 5 years 2,618 4,595 5-9 years 3,353 10-14 years 2,255 Total 5-14 years 5,608 6,440 Percentage of children immunised Under 5 years 57% 5 to 14 years 87% Scarlet Fever. During 1951 there were 136 cases of scarlet fever notified, as compared with 68 during 1950. The majority of these cases occurred during November and December, when in all 70 cases were notified, including 54 children attending infant or junior schools in the area. 26 Repeated visits were paid by the medical staff and health visitors to the schools mainly affected for the purpose of inspecting the children. All those with suspicious symptoms were excluded and followed up, and a large number of swabs was sent for bacteriological examination. The illness was almost invariably reported to be of a mild character. Measles. Seven hundred and fifty-eight cases of measles were notified during 1951. There was one death — a child aged 19 months who died in hospital where he had been an inpatient for some time owing to a congenital deformity. Measles is now a milder illness than it used to be, and this, combined with the introduction of sulphonamides and antibiotics, has very materially reduced the death-rate. Acute Poliomyelitis. Four cases of poliomyelitis occurred during 1951, three of them associated with moderate or severe paralysis. One of these patients — a woman aged 34 years — died shortly after being admitted to hospital. Dysentery. During 1951 52 cases of Sonne dysentery, and one of Flexner dysentery, were notified to the Department. Thirty-five of the cases of Sonne dysentery were connected with the outbreak which commenced at one of the day nurseries in Wimbledon in December, 1950. Seven of the remaining cases occurred amongst children, or contacts of children, attending one of the junior schools in Wimbledon. There is reason to think that the incidence of Sonne dysentery amongst the general public is much higher than the notified figures would appear to indicate, as cases of slight diarrhoea are often not submitted to bacteriological investigation. One patient found to be suffering from Flexner dysentery was removed to hospital for treatment. Food Poisoning. In three of the four cases of food poisoning notified during 1951 it was not possible to trace the source of infection. The remaining case occurred in a man aged 57 who died two days after being admitted to hospital. The organism isolated in this case was salmonella enteritidis, and the illness was attributed to the consumption of a duckegg. It was not possible to trace the supplier of the infected egg. Public Health (Leprosy) Regulations 1951. These Regulations came into operation on 22nd June, 1951. The Regulations make leprosy a notifiable disease. Notification is sent in direct to the Chief Medical Officer of the Ministry of Health. 27 Puerperal Pyrexia Regulations 1951. These Regulations came into operation on 1st August, 1951, and replaced existing Regulations with certain modifications including a revised definition of puerperal pyrexia. The present condition requiring to be notified is "any febrile condition occurring in a woman in whom a temperature of 100.4° Fahrenheit (38° Centigrade) or more has occurred within fourteen days after childbirth or miscarriage". Two notifications of puerperal pyrexia were received during the year. 28 29 Notifiable Diseases during 1951. DISEASE Number of Cases Notified in Various Age Groups Total Cases Notified Total Cases removed to Hospital Total Deaths Under 1 1-2 3-4 5-9 10-14 15-24 25-44 45-64 65 and over Scarlet Fever - 12 33 83 2 5 1 - - 136 63 - Measles 23 157 263 275 12 14 12 2 — 758 12 1 Whooping Cough 10 47 52 45 6 2 4 — — 166 1 — Acute Poliomyelitis (Paralytic) — — — — 1 — 2 — — 3 3 1 „ „ (Non-paralytic) — — — — — 1 — — — 1 1 — Meningococcal Infection — — — 2 — — — — — 2 2 — Puerperal Pyrexia — — — — — 1 1 — — 2 2 — Dysentery 2 10 19 7 2 6 6 1 — 53 1 — Malariat — — — — — — — 1 — 1 — — Food Poisoning — — — — — 1 2 1 — 4 1 1 Erysipelas — — — — — — 2 2 1 5 3 — Pneumonia (Acute Primary or Influenzal) — — 2 2 1 — 8 5 9 27 1 35* TOTALS 35 226 369 414 24 30 38 12 10 1,158 90 38 †Believed contracted abroad. *A11 forms. 30 Notifications of Infectious Disease during the last 10 years. DISEASE 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 Diphtheria 10 20 24 8 7 4 4 6 — — Dysentery 3 — 89 18 4 2 — 2 7 53 Encephalitis Lethargica, acute — — — — — — 1 — — — Enteric Fever (including Paratyphoid) 6 — — — — — 1 — 3 — Erysipelas 12 11 11 11 12 5 2 7 1 5 Food Poisoning — — — 1 — — 5 2 — 4 Malaria 1 — 1 1 7 — — — — 1 Measles 556 272 57 586 339 253 481 707 364 758 Meningococcal Infection 7 10 3 6 5 5 3 2 3 2 Ophthalmia Neonatorum 8 6 9 10 8 4 2 2 1 — Pneumonia 20 30 25 27 26 32 15 19 20 27 Poliomyelitis — — 1 4 2 25 4 10 12 4 Puerperal Pyrexia 6 9 6 8 10 3 5 8 1 2 Scarlet Fever 100 186 77 46 37 51 95 55 68 136 Whooping-cough 34 115 117 54 114 157 231 149 181 166 763 659 420 780 571 541 849 969 668 1,158 Tuberculosis:— Pulmonary 64 59 66 76 84 87 87 96 102 93 Non-Pulmonary 16 12 10 16 12 8 6 10 13 6 TUBERCULOSIS. During the year, 99 cases of tuberculosis were added to the Register, as compared with 115 in 1950. Of these, 62 were new cases and 37 were transfers from other areas. An analysis of the notifications received is given overleaf. The following cases were removed from the Register:— Pulmonary Non-Pulmonary. M. F. M. F. Deaths from tuberculosis 9 5 1 1 Deaths from other causes 1 3 2 — Recovered cases 5 2 1 1 Patients found to be nontuberculous 2 1 1 1 Removals from district 19 22 — 2 36 33 5 5 Notifications were received of 38 admissions to hospitals or sanatoria in 1951. During the year investigations were carried out in connection with a Youth Club in Wimbledon, four members of the Club having developed pulmonary tuberculosis within six months. To assist in the investigations arrangements were made for the Mass Radiography Unit to visit the area. Facilities were then offered for all senior officials and members of the Club to undergo an x-ray examination of the chest. No abnormality was discovered to indicate the source of infection. 31 32 TUBERCULOSIS — 1951. 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—4 Years — 2 — — — — — — — 2 — — — — — — 5—9 „ 1 1 — — — — — — 1 1 — — — — — — 10—14 „ — 2 — — — — — — — 2 — — — — — — 15—19 „ 1 5 — — — 1 — — 1 6 — — — — — — 20—24 „ 5 11 — — 1 5 — — 6 16 — — — — — — 25—29 „ 5 3 — 1 3 7 — — 8 10 — 1 — 2 — — 30—34 „ 1 3 — — 2 4 — — 3 7 — — 1 1 — — 35—44 „ 1 2 2 1 1 6 1 — 2 8 3 1 — 1 1 — 45—54 „ 6 1 — — 3 1 — 1 9 2 — 1 3 — — 1 55—64 „ 4 — —. — 1 — — — 5 — — — 2 — — — 65 and Over 1 1 — — 2 — — — 3 1 — — 3 1 — — 25 31 2 2 13 24 1 1 38 55 3 3 9 5 1 1 56 4 37 2 93 6 14 2 60 39 99 16