WIM 29 Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1956 Printed by Raynes Park Press, Lambton Road, London, S.W.ao. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1956 Health Department, Town Hall, Wimbledon, S.W.19. August, 1957. 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 1956, having been appointed your Medical Officer of Health following the retirement of Dr. Ellis. During the whole of the period to which all sections of the Report refer, Dr. Harold Ellis was your Medical Officer of Health, and I should first of all like to pay tribute to his work as Medical Officer to the Borough from his appointment on 4th February, 1929, until his retirement on 3rd January, 1957. I was closely associated with Dr. Ellis in his work since I was first appointed as Deputy Medical Officer of Health to the Borough in January 1939. Dr. Ellis was most conscientious and devoted to his work, which he carried out with great thoroughness and ability. He set himself a high standard. Matters great and small, were dealt with in a clear-sighted manner and with unruffled courtesy. His sense of fairness, tact, and consideration to all, made him well liked by his staff, his colleagues in other Departments and his fellow Medical Officers of Health of the County districts of Surrey. I am pleased to report that the health of the Borough during 1956 was good and there were no special outbreaks of infectious disease. 1 The corrected live birth rate for Wimbledon in 1956 was 13.94 per thousand of the population compared with a rate of 12.91 for 1955. The rate for England and Wales for the year was 15.7. The corrected death rate for the Borough during the period was 9.88 compared with 8.29 in 1955 and 11.7 for England and Wales. This is one of the lowest death rates recorded in Wimbledon. There were no maternal deaths in the Borough. The infantile mortality rate for 1956 in Wimbledon was the lowest on record. Ten Wimbledon children under the age of one year died during the year, giving an infantile mortality rate of 12.40 per thousand live births compared with a rate of 23.8 for England and Wales. The stillbirth rate per thousand live and stillbirths was 19.46. This is higher than the record low figure of 10.14 in 1955 but better than the rate for England and Wales which is recorded as 23.0. The death rate from all forms of cancer was higher than in 1955, although deaths from cancer of the lung in Wimbledon shewed a decrease over the figures for the previous year. Nationally, the trend continues upward, and in 1956 deaths from cancer of the lung in England and Wales were the highest on record. The tuberculosis death rate was the same as for the previous year at 0.14, this being slightly above the figure for England and Wales which was 0.12 Notifications of infectious disease amounted to only 344 compared with 1,074 in 1955. The decrease was largely attributable to the low incidence of measles. There were no deaths from infectious diseases. For the seventh successive year there were no cases of diphtheria in Wimbledon. There were seven confirmed cases of poliomyelitis, four of them being associated with paralysis. This disease does not now appear to be so markedly seasonal as in the past, and during 1956 notifications were received sporadically throughout the year, although the period of greatest risk is still in the summer months. In the field of preventive medicine, 1956 will be remembered for the introduction, for the first time, of a vaccine to fight poliomyelitis. Due to the stringent tests to which the vaccine is subjected before release to Local Health Authorities, only small supplies became available during the year and these were given to certain registered children between the ages of 2 and 9 years. It is to be hoped that increased supplies will become available in the near future to assist in stamping out this disease. I would like to thank Mr. Cockell, the Senior Public Health Inspector, and Mr. Richardson, my Chief Clerk, for their contribution in connection with the preparation of this Report. I have the honour to be, Your obedient Servant, P. J. DOODY, Medical Officer of Health. 2 LIST OF CONTENTS. Page Introduction 1-2 Health Committee Members and Health Sub-Committee Members 4 List of Staff 5 SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc 6-7 Population 8 Births 8 Illegitimacy 8 Deaths 8-10 Maternal Mortality 9-10 Infantile Mortality 10-12 Summary of Statistics 13 SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Nursing Homes 14 National Assistance Act 1948 14 Laboratory Facilities 15 Mass Radiography 15-16 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 17 Public Health Inspectors' Visits 17-18 Notices Served 19 Nuisances abated and defects remedied 20-21 Factories Act, 1937, Part I 20-22 Outworkers 23 SECTION D. HOUSING: Overcrowding 24 Rehousing 24 Housing Repairs and Rents Act, 1954 25 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk - Licensing and Sampling 26 Ice-cream 26-27 Meat and other Foods 27 Food and Drugs Act, 1955 27 Food Hygiene Regulations, 1955 27-28 Classification of Food Premises 28 Unsound Food 28 Sampling of Food and Drugs 29-32 Legal Proceedings 32 SECTION F: RODENT CONTROL, PETROLEUM STORAGE, ETC. Prevention of Damage by Pests Act, 1949 33 Petroleum (Consolidation) Act, 1928 33 Pet Animals Act, 1951 33 Heating Appliances (Fireguards) Act, 1952 34 Shops Act, 1950 34 Diseases of Animals Acts 34 SECTION G: PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc. 35-37, 39-40 Diphtheria and Whooping Cough Immunisation 37-38 Tuberculosis 41-42 3 BOROUGH OF WIMBLEDON HEALTH COMMITTEE December, 1956 Councillor T. H. Metcalf, (Chairman). Councillor D. L. Reid, J.P., (Mayor). Councillor A. E. Ayres, (Vice-Chairman). Alderman C. W. Black, J.P., M.P. Councillor W. J. M. Fisher, B.Sc. Councillor Miss D. M. Lord. Councillor P. MacHugh. Councillor W. Reay. Councillor A. J. Stringer. Councillor A. Styles. Councillor J. A. Watson. Councillor Miss E. A. Weldon. NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE WIMBLEDON REPRESENTATIVES December, 1956 Councillor T. H. Metcalf, (Chairman). Councillor J. E. V. Campbell. Councillor N. S. Clarke. Councillor L. C. Grant. Councillor Miss D. M. Lord. 4 STAFF Medical Officer of Health: Harold Ellis, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H. Senior Public Health Inspector: G. H. Cockell, (a) b) Deputy Senior Public Health Inspector: L. R. Godfrey, (a), (b). Public Health Inspectors: P. W. Smith, (a), (ft).(Resigned 22/2/56) P. W. Jolly, (a), (b). (Resigned 29/2/56) E. Killby, (a), (b). (Resigned 9/5/56) J. Bamford, (a), (b). (Resigned 19/8/56) C. L. Hunt, (a). (Appointed 1/8/56) G. M. McFall (a) (b). (Appointed 29/10/56) Assistant Rodent Officer: F. J. Reddington. Chief Clerk: t J. R. Richardson. Clerks: *S. C. Nottingham. (Resigned 17/6/56) *Mrs. D. Wilson. (Appointed 23/1/56) *Mrs. V. Waters. Mr. F. R. Brackfield. *Mrs. F. D. Ayres. fMrs. C. B. Brett. (Appointed 23/7/56) P. B. Stannett. (H.M. Forces 16/1/56) R. P. Stanton. ♦Miss J. Plumtree, Appointed 9/4/56 - Resigned 10/11/56) *Miss M. J. Perry. (Appointed 3/12/56) f Officer of the Surrey County Council. In part-time employment of 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 Meat and other Foods. 5 SECTION A. — STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres—Census, 1951) 3,212 Population (Census, 1951) 58,141 Home Population (mid-1956) 57,820 Number of occupied dwellings:— 1921 (Census) 11,926 1931 (Census) 13,325 1951 (Census) 16,047 Number of private households:— 1921 (Census) 13,998 1931 (Census) 15,883 1951 (Census) 19,185 Rateable Value :— £1,301,972. Sum represented by penny rate :— £5,235. 0. 0. Extracts from Vital Statistics of the Year 1956. (Registrar-General's Figures.) Total M. F. Live Births Legitimate 762 393 369 Illegitimate 44 22 22 Total 806 415 391 Total M. F. Stillbirths Legitimate 15 6 9 Illegitimate 1 — 1 Total 16 6 10 Live birth rate per 1,000 of the estimated home population 13.94 Corrected live birth rate per 1,000 of the estimated home population 13.38 Still-birth Rate per 1,000 total (live and still) births 19.46 Deaths Total 672 M. 325 F. 347 Crude Death Rate per 1,000 of the estimated home population 11.62 Corrected Death Rate per 1,000 of the estimated home population 9.88 Deaths from puerperal causes— Rate per 1,000 total (live and Deaths. 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 12.40 Legitimate infants per 1,000 legitimate live births 11.81 Illegitimate infants per 1,000 illegitimate live births 22.72 Deaths from cancer 126 diphtheria Nil „ poliomyelitis Nil measles Nil whooping cough Nil 6 Birth Rates, Death Rates, Analysis of Mortality, Maternal Mortality and Case Rates for Certain Infectious Diseases in the Year 1956. Provisional Figures Based on Quarterly Returns of Registrar.General. Wimbledon England and Wales Rates per 1,000 Home Population Births:— Live Births 13.38 15.6 Still Birthsj 0.28 0.37 19.46* 22.9* Deaths:— All Causes 9.88 11.7 Coronary and arteriosclerotic heart disease 1.87 1.67 Whooping Cough — 0.00 Diphtheria 0.00 Tuberculosis . all forms 0.14 0.12 Influenza 0.05 0.06 Smallpox _ . Acute Poliomyelitis (including Polioencephalitis) 0.00* Pneumonia 0.39 0.52 Malignant Neoplasm . Lung, Bronchus 0.36 0.41 Maternal Mortality 0.56* Notifications:— (Corrected) Scarlet Fever 1.90 0.74 Whooping Cough 1.45 2.07 Typhoid and Paratyphoid Fever 0.01 Meningococcal Infection 0.02 0.02 Acute Encephalitis 0.02 0.00 Diphtheria . 0.00 Erysipelas 0.10 0.09 Smallpox _ — Measles l.io 3.59 Pneumonia 0.59 0.57 Acute Poliomyelitis — Paralytic 0.07 004 Non.paralytic 0.09 0.03 Food Poisoning 0.19 0.25 Dysentery 0.24 1.09 Tuberculosis — Pulmonary 0.76 0.78 Non.pulmonary 0.10 0.09 Puerperal Pyrexia 14.60* 16.33* Rates per 1,000 Live Births Deaths:— Infant Deaths (all causes under 1 year) 12.40 23.8 Diarrhoea and Enteritis (under 2 years) 0.5 * Per 1,000 total (live and still) births. 7 VITAL STATISTICS. POPULATION The Registrar.General's mid.year estimate of the civilian population, 57,820 shews an estimated decrease of 250 on the previous year, although the natural increase by excess of births over deaths was 134. All rates used in this report are based on the Registrar.General's figures. BIRTHS. The statistics supplied by the Registrar.General show that during the year 1956, the total number of registered live births belonging to Wimbledon was 806. Of this number, 415 were males and 391 females. This gives a birth.rate of 13.94 per thousand of the population as compared with a rate of 13.45 per thousand in 1955, and an average of 13.22 in the last five years. A comparability factor has been supplied by the Registrar.General which enables the birth.rate for Wimbledon to be compared with that for England and Wales. The corrected birth.rate for Wimbledon for 1956 was 13.38 per thousand of the population, whilst the rate for England and Wales was 15.7 and has averaged 15.3 over the past five years. Stillbirths . The number of stillbirths registered during the year was 16 (6 males and 10 females), this being 8 more than last year. The stillbirth rate for Wimbledon was 0.28 per thousand of the population, while that for England and Wales was 0.37. Illegitimacy . Of the live births registered in 1956, 44 (22 males and 22 females) were illegitimate, this being 10 more than in the preceding year. One of the 16 stillbirths registered was illegitimate. DEATHS. The total number of Wimbledon residents who died during 1956 was 672 (325 males and 347 females), giving a death.rate of 11.62 per thousand of the population as compared with 10.37 per thousand for 1955. The corrected death.rate for 1956 was 9.88 per thousand as compared with a rate of 11.7 per thousand for England and Wales. The number of Wimbledon residents who died outside the Borough was 247, whilst 354 persons not normally resident in Wimbledon died in institutions, etc., in the Borough. The four principal causes of death were as follows:— Number of deaths Percentage of total deaths Disease of the heart and circulatory system 263 39% Cancer 126 19% Vascular lesions of nervous system 99 15% Diseases of the respiratory system 76 11% Totals 564 84% 8 The following is an analysis of the causes of death :— Cause Males Females Total 1. Respiratory tuberculosis 5 3 8 2. Other tuberculosis - - - 3. Syphilitic disease 1 1 2 4. Diphtheria - - — 5. Whooping cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis - — — 8. Measles — — — 9. Other infective and parasitic diseases 1 - 1 10. Malignant neoplasm, stomach 10 5 15 11. Malignant neoplasm, lung, bronchus 18 3 21 12. Malignant neoplasm, breast 1 11 12 13. Malignant neoplasm, uterus — 1 1 14. Other malignant and lymphatic neoplasms 30 43 73 15. Leukaemia 2 2 4 16. Diabetes 1 2 3 17. Vascular lesions of nervous system 39 60 99 18. Coronary disease, angina 66 42 108 19. Hypertension with heart disease 13 12 25 20. Other heart disease 36 61 97 21. Other circulatory disease 19 14 33 22. Influenza 2 1 3 23. Pneumonia 9 14 23 24. Bronchitis 26 15 41 25. Other diseases of respiratory system 4 5 9 26. Ulcer of stomach and duodenum 5 2 7 27. Gastritis, enteritis and diarrhoea 1 4 5 28. Nephritis and nephrosis — 1 1 29. Hyperplasia of prostate 5 — 5 30. Pregnancy, childbirth, abortion - — — 31. Congenital malformations 2 5 7 32. Other defined and ill-defined diseases 19 28 47 33. Motor vehicle accidents 3 2 5 34. All other accidents 9 10 19 35. Suicide 3 - 3 36. Homicide and operations of war — — — Totals 325 347 672 MATERNAL MORTALITY No deaths in childbirth, either from puerperal sepsis or other maternal causes, were recorded during the year. Only two maternal deaths have occurred in the Borough in the last eight years. The maternal mortality rate for England and Wales per thousand live and still births was 0.56. 9 MATERNAL MORTALITY . ENGLAND AND WALES. Rates per 1,000 live and still births. Number of Deaths Rate Maternal causes, excluding abortion 330 0.46 Due to abortion 71 0.10 Total maternal mortality 401 0.56 The estimated mid. 1956 female population for England and Wales age 15.44 was 9,094,000. As stated overleaf there were no maternal deaths in Wimbledon during 1956. INFANTILE MORTALITY. During 1956 there were 10 deaths among infants under one year, compared with 11 in 1955 and an average of 15 in the last ten years. On only one occasion previously has the low figure of 10 infant deaths been recorded in the Borough. One of the deaths was in respect of an illegitimate child. The resultant infant mortality rate for Wimbledon, per thousand live births, was the lowest on record at 12.40, the lowest rate previously recorded being 13.60 in 1952. The figure for England and Wales, 23.8, was also the lowest on record, being IT per thousand below that for 1955, the previous lowest. Five of the deaths were due to congenital malformations or birth injuries and one was due to prematurity. Two children died from pneumonia and one from staphylococcal septicaemia. The remaining death was due to lack of attention at birth, and may therefore have been preventable. The total number of neo.natal deaths (i.e. occurring during the first four weeks of life) was 7, giving a neo.natal death rate of 8.68 per thousand live births, as compared with a rate of 16.9 for England and Wales. The following table shows the causes of the 10 deaths which occurred during 1956, together with the age at death. 10 11 Infantile Mortality during 1956. 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 Congenital defect or birth injury 3 — — — 3 I — 1 — 5 Prematurity — 1 — — 1 — — — — 1 Pneumonia 1 1 — — 2 — — — — 2 Staphylococcal septicaemia — — — — — 1 — — — 1 Inattention at birth 1 — — — ' 1 — — — 1 Totals 5 2 — — 7 2 — 1 — 10 Infantile Mortality during the last 10 years. Cause of death 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Prematurity 6 8 5 5 3 3 5 5 2 1 Congenital defects or birth injuries 10 5 12 2 9 6 4 5 5 5 Diseases of the newborn — — — 1 2 — — — — — Gastro-enteritis — — 1 2 — — 1 — — — Pneumonia 2 1 1 — 1 1 1 1 2 2 Bronchitis — — — — — — — — — — Whooping cough — — — — — — — — — — Meningococcal Meningitis — — — — — — — — — — T.B. Meningitis ... — — — — — — — — — — Pneumococcal Meningitis — 1 — — — — — — — — Septicaemia — — — 1 1 — — — — 1 Encephalomyelitis — — — — — — — — — — Pyelonephritis ... — — — — — — — — — — Asphyxia (unknown cause) ... 1 — — — — — — — — — Accidental death 1 3 2 1 1 — 1 1 2 — Inattention at birth — — — — — — — — — 1 Infanticide — — — — — — — — — — Other causes — — — — — — — — — — 20 18 22 14 17 10 12 12 11 10 Total neo-natal deaths included above 13 14 14 8 14 6 9 11 8 7 12 13 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 (per thousand home population) Still-birth Rate (per thousand home population) Death-Rate (per thousand home population) Maternal Mortality Rate (per thousand total (live and still) births) Infantile Mortality Rate (per thousand live births) 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 1952 11.67 15.3 0.29 0.35 10.63 11.3 — 0.72 13.60 27.6 1953 12.17 15.5 0.26 0.35 10.05 11.4 1.33 0.76 16.24 26.8 1954 12.94 15.2 0.30 0.36 8.51 11.3 — 0.69 15.30 25.5 1955 12.91 15.0 0.14 0.35 8.29 11.7 1.27 0.64 14.08 24.9 1956 13-38 15-7 0-28 0-37 9-87 11-7 — 0-56 12-40 23-8 * 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 IV. — NURSING HOMES. The Wimbledon Borough Council is responsible for the registration and supervision of nursing homes in the Borough. No additional homes were registered during the year. One maternity hospital and one nursing home were exempted, on an annual basis, from registration under Section 192 of the Public Health Act, 1936. There was one application for the registration of an new nursing home to take 15 chronic medical cases. At the end of the year registration had not been granted pending compliance with fire precautions and certain structural alterations. The position at the end of 1956 was as follows :— Number of homes on the register :— Maternity Nil Others 5 Number of beds provided 73 Number of visits of inspection to registered and exempted homes during the year 7 NATIONAL ASSISTANCE ACT, 1948. NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951. Under Section 47 of the 1948 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. The 1951 Act enables Local Authorities to deal more expeditiously with very urgent cases by initial removal, for a period not exceeding three weeks. A number of border line cases were brought to the notice of the Public Health Department for investigation during the year, and it is gratifying to report that a satisfactory solution was found to each particular problem without resorting to compulsory powers. The problems associated with aged persons do not diminish. Their needs are many and diverse and it is understandable that most of them 14 prefer to stay in their own homes and retain their independence despite difficulties and hardships. The close co-operation between the Hospital Authorities, local doctors, the Divisional Welfare Officer and the several excellent voluntary organisations in Wimbledon, who are of great assistance to the Medical Officer of Health in dealing with this difficult problem, continues. LABORATORY FACILITIES. The Ministry of Health, Public Health Laboratory at Epsom is available for the bacteriological examination of samples of milk, icecream and water, swabs, sputum and other pathological specimens. In addition the staff is always available to assist the Medical Officer of Health in the investigation of any important outbreaks of disease. The Laboratory at the Nelson Hospital, Merton, is also available for the examination of pathological material, but in general, almost all specimens submitted for examination from this Department are sent to the Public Health Laboratory at Epsom. The following is a summary of the examinations made during the year:— Nose and throat swabs 244 Faeces for the typhoid and dysentery groups 187 Ice-cream samples Ill Milk samples 202 Water samples 46 Miscellaneous 16 Total 806 Samples of milk and water requiring chemical analysis are sent by the Corporation to the Public Analyst. MASS RADIOGRAPHY. The Mass X-Ray Unit of the South West Metropolitan Regional Hospital Board was stationed in South Wimbledon from 6th - 20th March, 1956, and as in previous years, facilities were offered to all persons over the age of 15 years for x-ray examination of the chest. This examination is of great value in the early diagnosis and treatment of pulmonary tuberculosis and other non-tuberculous abnormalities. I am indebted to the Medical Director of the Mass Radiography Unit for the following details of persons who attended for examination. As the facilities were available to all, and were used by persons coming from a wide area, the statistics do not necessarily relate to Wimbledon residents only. Number of persons examined: Males 3,163 Females 3,836 6,999 15 Abnormalities discovered'. (i) Active pulmonary tuberculosis : Males 1 Females 5 6 (ii) Inactive pulmonary tuberculosis: Males 166 Females 163 329 (iii) Non-tuberculous conditions : Males 125 Females 51 176 16 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 periodic examinations are made by that Authority. With three exceptions all the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. During the year 1956 samples of water were taken for bacteriological and/or chemical examination, as follows:'— Bacteriological. Wimbledon Corporation Swimming Baths 18 Dwelling houses 31 Spring outlet near Caesar's Well 2 Schools 15 66 A sample obtained from a drinking fountain in a school playground was reported upon as being bacteriologically unsatisfactory. Subsequent samples from the same source proved satisfactory. All the remaining samples proved bacteriologically satisfactory. Chemical. Wimbledon Corporation Swimming Baths 5 Dwelling houses 5 Schools 2 12 All these samples proved chemically satisfactory. Inspection of the District. The following is a summary of the complaints received and the visits made during the year 1956:— Complaints received. General disrepair and insanitary conditions 229 Dampness 94 Overcrowding 18 Defective drainage systems 12 Blocked drainage systems 58 Defective drainage fittings 21 Defective W.C. pans and/or flushing apparatus 50 Defective service water pipes 30 17 Absence of or defective dustbins 11 Accumulations of refuse, etc 27 Rats and mice 282 Keeping of animals 3 Insect pests, etc 69 Smoke nuisances 26 Unsound food 112 Miscellaneous 114 1,156 Visits made. Infectious diseases. Inquiries re cases of infectious disease 702 Visits re disinfection 79 Miscellaneous infectious disease visits 142 Housing. Dwelling houses (Housing Act) 516 Dwelling houses (Public Health Act) 2,259 Housing Repairs & Rents Act, 1954 87 Houses let in lodgings 8 Overcrowding 82 Underground rooms 8 Caravans 2 Refuse storage 123 Disinfestation 44 Miscellaneous 542 Food and Food premises. Dairies and milk distributors 17 Ice-cream premises 49 Bakehouses 24 Butchers' shops 34 Meat preparation premises 7 Fish shops 7 Fried fish shops 4 Restaurant kitchens 91 Other food premises 245 Visits re unsound food 159 Sampling: food and drugs 177 Sampling: milk 238 Sampling: ice-cream 128 Sampling: water 98 Utensil swabbing 6 Miscellaneous 140 General. Places of public entertainment 11 Drainage and plumbing work 705 Stables and piggeries 10 Atmospheric pollution 106 Pet Animals Act, 1951 15 Factories (P.) 102 18 Factories (N.P.) 61 Factories (Building sites) 2 Workplaces 8 Outworkers' premises 3 Shops Act, 1950 (Vent. temp, etc.) 48 Shops Act, 1950 (Shop hours) 60 Hairdressers and barbers 17 Diseases of Animals Acts 4 Petroleum (Consol.) Act, 1928 220 Heating Appliances (Fireguards) Act, 1952 9 Watercourses 27 Rodent control 4,823 Public conveniences 6 Nursing Homes 3 Swimming Baths 8 Miscellaneous 432 12,698 Notices Served. Preliminary notices or intimations 477 Statutory Notices 33 Other letters 2,458 Result of Service of Notices. (a) Legal proceedings. (1) Public Health Act, 1936. Legal proceedings were instituted against an owner for failing to comply with an Abatement Notice. At the first hearing the case was adjourned at the request of the Bench so that further evidence could be obtained. As the result of a further inspection in order to obtain the additional evidence, it was found that the work which had been executed was such that the case could not be proceeded with. The summons was therefore withdrawn. (2) Housing Act 1936. Notices were served under Section 9 of the Housing Act, 1936 upon the owner of seven dwelling houses requiring him to make them in all respects fit for human habitation. The owner appealed under Section 15(1) (a) of the Act on the grounds that:— (i) The houses were unfit for human habitation on account of age and inconvenience and inadequate accommodation by modern standards. (ii) They were incapable at reasonable expense of being rendered fit, and (iii) The carrying out of the repairs required by the Notices would still leave them unfit. The case was heard at Kingston County Court and during the course of the hearing the Judge was taken to see the dwelling houses. 19 The appellants withdrew the first ground of appeal, and the case proceeded upon the remaining two. The Judge allowed the appeals, with costs, and quashed the Notices. (b) Work carried out in default. In two instances during the year it was necessary to carry out work in default after the service of Notices under the Wimbledon Corporation Act, 1933, Section 53, in connection with blocked soil drainage systems. The cost of the works was recovered from the owners concerned. Nuisances abated and defects remedied. The following is a summary of nuisances abated and defects remedied under the supervision of the Public Health Inspectors:— Drainage and Sanitary fittings. Reconstructed 30 Cleansed 67 Soil pipes and ventilation shafts repaired or renewed 18 Inspection chamber covers renewed 10 Fresh air inlets repaired or renewed 24 New W.C. pans 29 Water waste preventors repaired or renewed 34 Gutters and rainwater pipes repaired or renewed 81 New lavatory basins 4 New baths 5 New glazed sinks 11 Waste pipes trapped, repaired or renewed 20 Gully surrounds repaired 17 Urinals cleansed 2 Miscellaneous 79 General Housing repairs. Roofs repaired 97 Yards paved or repaired 24 Dampness remedied 74 Damp-proof courses provided 8 Sub-floor ventilation provided 8 Walls and ceilings repaired 241 New ceilings constructed 5 Walls cleansed 83 Ceilings cleansed 43 Floors repaired or renewed 85 Additional light and ventilation provided 2 Windows repaired or renewed 162 Doors repaired or renewed 52 Fireplaces repaired or renewed 47 Coppers renewed or repaired I Service water mains repaired 14 Additional light and ventilation provided to W.C. apartments 14 W.C. apartments cleansed 10 New dustbins provided 48 Miscellaneous 511 20 Food premises. Walls and ceilings cleansed and repaired 32 Hot water provided to staff ablutions 10 New lavatory basins 4 New glazed sinks 1 Waste pipes repaired 2 Staff sanitary accommodation repaired 1 Staff sanitary accommodation cleansed 2 Staff sanitary accommodation provided 4 Floors repaired or renewed 4 Food stores provided 1 Yards paved or repaired 3 Roofs repaired 1 Miscellaneous 32 Rodent Control. Rat proofing work carried out 5 Miscellaneous. Accumulations removed 11 Smoke nuisances abated 1 21 FACTORIES ACT, 1937. PART I. 1. Inspections for Purposes of Provisions as to Health. Premises Number Number of on Register Inspections Written Notices Prosecutions Factories without mechanical power .. 95 61 3 — Factories with mechanical power 244 102 14 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 8 2 — — Totals 347 165 17 — 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) — 1 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — 1 — — — Inadequate v e n t i 1 a tion (S.4) — — — — — Ineffective drainage of floors (S.6) -- — — — — Sanitary Conveniences (S.7):— Insufficient 1 4 — 1 Unsuitable or Defective 14 14 — 3 — Not Separate for Sexes — — — — — Other Offences (Excluding offences relating to outwork) — — — — — Totals 15 20 — 4 22 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. 1 — — — — — Others — — - — — — Total 1 — - — — — Number of addresses received from other Councils 65 Number of addresses forwarded to other Councils 10 Number of premises where outwork was carried on at the end of 1956 63 Inspections of outworkers' premises 3 Outwork in infected premises (Section 153, Public Health Act, 1936) 2 OTHER MATTERS. Failure to affix Abstracts of Act notified to H.M. Inspector of Factories Nil Underground bakehouses in use at the end of the year 1 23 SECTION D. — HOUSING. In accordance with Ministry of Health Circular 17/55, details on housing matters are omitted, but the following information is given in connection with overcrowding, rehousing and new houses erected:— Housing Act, 1936, Part IV — Overcrowding. (a) (i) Number of dwellings known to the Department to be overcrowded at the end of the year 60 (ii) Number of families dwelling therein 63 (iii) Number of persons dwelling therein 312 (b) Number of new cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding known to have been relieved during the year 7 (ii) Number of persons concerned in such cases 39 (d) Number of cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding 1 Rehousing. I am indebted to the Housing Manager for the following information regarding rehousing in Wimbledon. These figures relate to the position at 31st December, 1956:— Number of houses requisitioned since the beginning of the war and still held under requisition 336 Number of prefabricated bungalows provided since the end of the war 71 Number of families rehoused by the Council or by private owners at the Council's instigation since the beginning of the war 2,156 Number of live applications on the housing waiting list 998 New houses erected, etc. I am indebted to the Borough Engineer and Surveyor for the following information:— Number of new houses and flats erected in Wimbledon in 1956: Private enterprise 42 Local authority 18 Number of flats created by conversion in 1956: Private enterprise 29 Local authority Nil 24 Housing Repairs and Rents Act, 1954. This Act came into force on 30th August, 1954, and applications from tenants for Certificates of Disrepair and from landlords for Certificates of Revocation have been received and dealt with. The following is a summary of the position on the 31st December, 1956:— Number of applications for Certificates of Disrepair 80 Number of applications withdrawn 3 Number of Certificates not recommended 1 Number of Certificates of Disrepair issued 76 Number of applications for Certificates of Revocation 47 Number of Certificates of Revocation issued 43 25 SECTION E. — INSPECTION AND SUPERVISION OF FOOD. Milk. In accordance with the provisions of the Milk and Dairies Regulations, 1949 to 1954, the handling, distribution and sale of milk continued to receive the necessary attention. The number of distributors of milk in the Borough, as shown by the register kept in accordance with the Regulations, is 35. The following licences were granted by the Council under the provisions of the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949 to 1953 and the Milk (Special Designation) (Raw Milk) Regulations 1949 to 1954:— Pasteurisers' Licences Nil Dealers' Licences— Tuberculin Tested Milk 25 Pasteurised Milk 26 Sterilised Milk 34 Supplementary Licences— Tuberculin Tested Milk 9 Pasteurised Milk 10 Sterilised Milk 8 112 During the year 202 samples of designated milk were submitted for bacteriological examination. The results were as follows:— Designation Satisfactory. Unsatisfactory. Pasteurised 147 Nil Tuberculin Tested (Pasteurised) 28 Nil Sterilised 27 Nil Two samples of Tuberculin Tested (Farm bottled) milk were sent to the Royal Institute of Public Health and Hygiene Laboratory for animal inoculation. These samples were found to be negative for tubercle bacilli. Ice-Cream. During the year 111 samples were submitted for bacteriological examination. The results were as follows:— Grade 1 102 Grade 2 7 Grade 3 Nil Grade 4 2 26 Grade 1 and 2 samples can be considered satisfactory; only 20% of the samples taken from any one vendor should be of Grade 3 quality, and none of Grade 4. Investigations were made into the handling of the ice-cream from manufacturer to consumer in the cases of Grade 4 results mentioned above, and subsequent samples proved satisfactory. Meat and Other Foods. There are no slaughterhouses within the Borough. Three slaughtermen's licences were issued under the provisions of the Slaughter of Animals (Amendment) Act 1954, during the year 1956. Food and Drugs Act, 1955. The inspection of food premises under the provisions of the Food Hygiene Regulations 1955 has formed an important part of the work of the Public Health Inspectors. A register of all such premises includes the following:— Greengrocers 63 Confectioners 128 Ice-cream premises 214 Bakers 35 Grocers 125 Provision dealers 89 Butchers 45 Fishmongers 24 Milk distributors 35 Chemists 25 Licensed premises 72 Clubs 30 Restaurants and Cafes 84 Works canteens 9 School canteens 47 Kitchens (Hospital and Central Kitchens) 5 Food stalls 9 1,039 As the result of new legislation, a new system of inspection records and registers was devised and put into operation. The systematic inspection of food premises was commenced during 1956, but progress has been considerably curtailed owing to the shortage of Inspectorial staff. With the coming into force of the Food Hygiene Regulations 1955 on 1st January, 1956, all food traders within the Borough were circularised and were sent a printed copy of the Abstract of the provisions of the Regulations. In addition, public notices were inserted in the local press drawing the attention of traders and others to the coming into force of the Regulations, and giving a summary of the extended powers possessed by the Council. The Wimbledon Clean Food Advisory Committee, which had been in existence since 1951, held a meeting in March 1956, and expressed the opinion that recent legislation had caused the Committee to become redundant, and that the re-appointment of the Committee after the expiration of the current Municipal year in May 1956, was unnecessary. 27 The number of food premises registered in accordance with Section 16 of the Act is as follows :— Registered for the storage and sale of ice-cream 118 Registered for the manufacture and sale of icecream 2 Registered for the preparation or manufacture of sausages 43 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food 28 The number of inspections of registered food premises during 1956 was 111. Unsound Food. Following the closing down of the Corporation's refuse disposal works at the end of 1955, arrangements were made with Merton and Morden U.D.C. for the reception of unsound food surrendered to the Health Department. This system operated until December, 1955, when arrangements were made for this procedure to continue for a further period of two years. The following is a list of unsound food surrendered during 1956: Cwts. qrs. lbs. Canned soups 2 0 18 Canned meat 9 0 4½ Canned fish 3 0¾ Canned vegetables 3 0 26 ¾ Canned fruits 8 2 11 Canned milk or cream 1 0 16½ Canned puddings 3 6¾ Meat, bacon, poultry, etc. 18 0 2 Fish 4 2 0 Meat and fish pastes 13 Butter, fats and cheese 3¼ Sugar, jam, etc. 3 20¼ Flour, bread, cereals and biscuits 3 1¼ Pickles and sauces 21½ Fruit and vegetables 5½ Spaghetti, macaroni, etc 9 Coffee 2¼ Ginger 4 0 0 Miscellaneous 27¼ 54 2 21½ 28 Sampling of Food and Drugs. The following samples were submitted to the Public Analyst during 1956, with the results shown:— Articles Total Formal Informal Genuine NonGenuine or Irregular Ale 3 3 — 3 — Almonds, ground 1 1 — 1 — Baby food 1 1 — 1 — Baking powder 1 1 — 1 — Beans in tomato sauce 1 1 — 1 — Biscuits 3 3 — 3 — Bitter beer 1 1 — 1 — Brandy snaps 1 — 1 1 — Bread 2 2 — 2 — Bread and butter 1 1 — 1 — Cake, fruit 1 1 — 1 — Cakes, spiced 1 1 — 1 — Chicken broth with rice 1 1 — 1 — Chicken and ham cutlets 1 1 — 1 — Chicken pie 1 1 — 1 — Chicken spread 1 — 1 1 — Cochineal extract 1 — 1 1 — Coffee, ground 1 1 — 1 — Confectionery 10 8 2 8 2 Corn flakes 1 1 — 1 — Crab, dressed 1 1 — 1 — Cream, double 1 1 — 1 — Cream, sterilised 1 — 1 1 — Cream, canned 1 1 — 1 — Fat, cooking 1 1 — 1 — Fish fingers, frozen 1 1 — 1 — Fish, frozen 1 1 — 1 — Flavouring, brandy 1 — 1 1 — Forcemeat, thyme and parsley 1 1 — 1 Fruit, dried, mixed — 1 1 2 — Gravy powder 1 1 — 1 — Jam, strawberry 1 1 — 1 — Lemon curd tarts 1 1 — 1 — Lemon juice 1 1 — 1 — Lollies, frozen 2 1 1 2 — Luncheon roll 1 1 — 1 — Margarine (10% butter) 1 1 — 1 — Marmalade 1 — 1 1 — Marzipan 1 1 — 1 — Meat paste — — 2 2 — Milk 51 51 — 51 — Milk, condensed 1 1 1 — Milk chocolate beverage 2 1 1 2 — Mincement 1 1 1 — Mincemeat pie 1 1 1 — Mustard pickle 1 1 1 — Onions, pickled 1 1 1 — Pain relieving tablets 1 1 1 — Pastry 1 1 1 — Pie filling, lemon flavoured 2 1 1 2 — Pineapple chunks 1 1 1 — Puddings 1 1 — 1 — Rejuvenating capsules 1 1 — — 1 Rheumatic tablets 1 1 — 1 — Salt 1 1 — 1 — C/Fwd. 124 107 17 121 3 29 Articles Total Formal Informal Genuine NonGenuine or Irregular B/Fwd. 124 107 17 121 3 Salted peanuts 1 1 — 1 — Sauce 1 — 1 1 — Sausages, pork 5 5 — — Sleep tablets 1 1 — 1 — Soda water 1 — 1 1 — Soup, desiccated, brown 1 1 — 1 — Soup, mushroom 1 1 — 1 — Soup powder, tomato 1 1 — 1 — Suet 1 1 — 1 — Sugar (pieces) 1 1 — 1 — Tea 1 1 — 1 — Tomato juice 1 1 — 2 Travel sickness tablets 1 1 — 1 — Vitamin capsules 1 1 — 1 — Vinegar, apple 1 1 — 1 — Vinegar malt 1 1 — 1 — Wheat germ, stabilized 1 1 — 1 — Whisky 3 3 - 3 — Wine, white 1 1 1 ~ Totals 150 130 20 145 5 The following samples were submitted for special examination Articles Total Formal Informal Genuine NonGenuine or Irregular Tablet in milk bottle 1 — 1 — 1 Chocolate fruit bar 1 — 1 — 1 Chocolate peppermint creams 1 — 1 — 1 Jumbo sucker 1 — 1 — 1 Cream, single 1 — 1 1 — Cream, double 1 — 1 1 — French ice 2 — 2 1 1 Totals 8 — 8 3 5 It will be seen that adverse reports were received upon 10 samples and the following is an account of the action taken in respect thereof:- Confectionery. (1) As the result of a complaint, an article of sherbet confectionery (Jumbo sucker) was submitted to the Public Analyst for examination. At the same time, a further sample was purchased informally from the same retailer's shop. The Analyst reported that, apart from the ingredients in each case not being correctly specified on the label, the amount of tartaric acid was in excess of the amount normally contained in this type of confectionery. As a result of correspondence, the manufacturers agreed to reduce the amount of tartaric acid, and the 30 Sampling Officer of the Local Authority in whose area the confectionery was manufactured, obtained samples of the newly constituted article, and these proved satisfactory. (2) A box of chocolate peppermint creams was the subject also of a complaint, and these, together with a further sample purchased informally from the same retailer, were submitted to the Public Analyst for examination. This confectionery was alleged to have an unpleasant smell and taste. The Analyst reported that the confectionery had become stale through long storage, and as a result the taste and smell of both the chocolate and the cream had become unpleasant. Following correspondence with the firm concerned, the remaining stock was withdrawn from sale. Rejuvenating capsules. This formal sample consisted of a packet of rejuvenating capsules. The Public Analyst reported that the sample was non-genuine in that the ingredient Lecithin did not conform to the amount indicated upon the label. In addition, other terms used in the label were not, in his opinion, descriptive of the true nature of the constituents or ingredients used. Communications were sent to the manufacturers and to the retailers, but the matter had not been resolved by the end of 1956. Tomato juice. An informal sample consisting of a bottle of tomato juice was submitted to the Public Analyst, who reported that in his opinion the sample consisted of lemon flavoured tomato drink, and that the vitamin C content was nil. The manufacturers were informed of the contents of this report, but they were unwilling to change the wording of the label. A formal sample was therefore obtained, and the Public Analyst's report was similar to that upon the previous informal sample. Legal proceedings were contemplated, but whilst evidence was being prepared, it was found that the manufacturers had withdrawn the bottles of tomato juice and had substituted tins with amended labels. No further action was therefore taken in the matter. Tablet in milk bottle. A complaint was received from a Secondary Boys' School that a tablet of unknown origin had been found in the bottom of a one-third pint bottle of milk served to one of the scholars. The Public Analyst reported that the tablet was a medicinal tablet containing phenacetin and caffein. The milk bottling firm carried out a very searching enquiry into the matter, but at no stage of their process was it found possible for the tablet to have been introduced. Following a communication to the Headmaster, it was deemed unnecessary to take further action in the matter. Chocolate fruit bar. This confectionery was submitted to the Public Analyst as the result of a complaint. He reported that the chocolate possessed an objectionable rancid smell and an unpleasant taste, which appeared to have developed as the result of long storage. The retailer's remaining stock was examined and was voluntarily surrendered and destroyed. 31 French ice. A bar of French ice confectionery which was manufactured in Wimbledon, was the subject of a complaint from an outside district. The Public Analyst reported that one of the ingredients (coconut) possessed a slightly rancid taste and smell, although the chemical analysis did not indicate that any significant decomposition had occurred. As the result of negotiations steps were taken by the manufacturers to insert a warranty slip in each packet of confectionery. By this means it was hoped that the confectionery would be sold and consumed within a certain date after leaving the factory. A further sample taken at a later date proved satisfactory. Legal Proceedings. A retailer was summoned under the provisions of the Food and Drugs Act, 1955 for selling a loaf of bread in which was embedded a strip of metal. The defendant pleaded guilty and was fined £5. Costs awarded amounted to £5. 32 SECTION F. — RODENT CONTROL, PETROLEUM STORAGE, ETC. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The following table gives a statement indicating the action taken during 1956. Type of Property Number of Properties inspected as a result of: Number of Properties found to be infested by: Treatment carried out by Department Total Number of Inspections made Notification Otherwise Total Rats Mice Rats Mice Local Authority 3 17 20 5 - 5 - 4823 Private Premises 222 520 742 132 32 97 12 All other including Business Premises 37 240 277 35 20 34 17 Totals 262 777 1039 172 52 136 29 4823 The inspection and treatment of sewers, and of the Corporation's Depots, etc., was undertaken in conjunction with the Borough Surveyor's Department, and details are not included in the figures given above. The Public Health Department continued to undertake the routine disinfestation of schools and school canteens administered by the County Council within the Borough, as and when necessary, on a contract basis. During 1956 no legal action was required to be taken under the provisions of the Act, and this is an indication of the co-operation received from householders and business people. PETROLEUM (CONSOLIDATION) ACT, 1928. 62 licences were issued by the Department to store petroleum spirit during 1956, and the total quantity of petroleum spirit stored was 106,633 gallons. In addition, 17 licences were issued to store petroleum mixtures involving a total of 550 gallons, and 3 licences were issued in respect of the storage of a total of 4,692 lbs. of calcium carbide. 220 visits were made to premises under the provisions of the Petroleum (Consolidation) Act 1928. PET ANIMALS ACT, 1951. 9 licences to keep pet shops were issued by the Department during 1956. 15 visits were made to these premises and various infringements of the conditions of licence were rectified. 33 HEATING APPLIANCES (FIREGUARDS) ACT, 1952. During 1956, 9 visits were made in connection with the Act and 4 appliances were examined and the prescribed tests applied. All these appliances were found not to conform to the standards laid down and were either modified or withdrawn from sale. SHOPS ACT, 1950. As far as possible inspections have been made of the sanitary accommodation, and heating and ventilation of shops, and improvements have been effected as circumstances have permitted. Surveys are carried out regularly to observe compliance in respect of general closing hours, half day closing and Sunday Trading. The total number of inspections made for the purposes of this Act during 1956 was 108. DISEASES OF ANIMALS ACTS. No outbreaks of disease occurred within the Borough during 1956. In consequence of Orders made by the Ministry of Agriculture, Fisheries and Food, particularly with regard to foot and mouth disease and fowl pest, a number of enquiries were dealt with. 34 SECTION G. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 344 cases of infectious disease notified compared with 1,074 cases in 1955 and 200 in 1954. Of the total notifications, 110 were in respect of scarlet fever and 82 in respect of whooping cough. SMALLPOX. No case occurred in the Borough during the year, nor were we required to undertake surveillance of any contacts. SCARLET FEVER. There were 110 cases of scarlet fever notified during 1956 compared with 77 in 1955, 49 in 1954, and 96 in 1953. Forty-eight of the cases were treated in hospital. This disease for a number of years has been mild in character. ERYSIPELAS. Six cases were notified, four of which were removed to hospital. All recovered. DIPHTHERIA. There were no confirmed cases during the year. Deaths from this disease are now greatly outnumbered every year by deaths from whooping cough and measles, and many young parents believe that, because they have never seen or heard of a case of diphtheria, the danger from this dreaded disease has disappeared. This is not so - diphtheria could return in its old killing epidemic form, and it is important, therefore, that there should be no relaxation in the campaign for diphtheria immunisation. It is only by maintaining a high level of immunity that the population will be safeguarded from the return of this disease. DYSENTERY. Fifteen cases of dysentery were notified compared with 2 in 1955, 14 in 1954, 19 in 1953 and 36 in 1952. Ten of the notifications were in respect of two separate outbreaks in the same family. The onset in the first outbreak occurred when two boys of the family, aged 8 and 14 years, were sent home from school suffering from diarrhoea and sickness. Subsequently, two other children of the family, aged 5 and 9 years, and the mother and father, developed symptoms, and following bacteriological investigation, were all found to be positive for shigella sonnei. The four children were admitted to hospital and the parents treated at home, until specimens were completely negative. Later in the year the four children of this family again developed sonne dysentery and were admitted to hospital. The 5 remaining cases occurred singly in various parts of the Borough and were unrelated to each other. 35 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 for bacteriological investigation. ACUTE POLIOMYELITIS Seven cases of poliomyelitis occurred during 1956, all of which were removed to hospital. Four of the cases were of the paralytic type and 3 non-paralytic. There were no deaths. Ten other persons were admitted to hospital as suspected cases of poliomyelitis, but the diagnosis was not sustained. In 1955 there were 11 confirmed cases. ACUTE ENCEPHALITIS. One case occurred in a woman of 32 years who was admitted to hospital. The source of the infection was not discovered. PUERPERAL PYREXIA. During the year 10 notifications were received, 8 of which occurred in hospital and 2 at home. Of the hospital notifications 7 of the patients had addresses outside the Borough. The Pueperal Pyrexia Regulations 1951 define this illness as any febrile condition occurring in a woman in whom a temperature of 100.4°F. or more has occurred within fourteen days after childbirth or miscarriage. In 1955 7 cases were notified. MEASLES. There were 64 cases notified during the year compared with 813 in 1955. The comparatively low incidence of this disease was not unexpected as measles tends to be epidemic in alternate years. The disease generally remained mild in character and none of the patients was removed to hospital. FOOD POISONING. Eleven cases were notified involving one outbreak and 8 isolated cases. The single outbreak concerned three members of one family the mother, a baby of 6 months and a boy of 9 years. The baby became very ill and was removed to hospital for treatment. After admission, notification was received that the child was infected with salmonella typhi-murium. Other members of the household were investigated bacteriologically and salmonella typhi-murium was isolated in the mother and boy of 9 years. The baby and the boy responded well to treatment, but the mother remained a carrier for some considerable time. The source of the infection was not discovered. In another case, a girl of 24 years suffered symptoms of food poisoning after eating pork sausages. The causative agent was believed to 36 have been staphylococcus aureus as this organism was found, on examination, in a similar packet of sausages to those eaten by the patient, but this diagnosis could not be definitely confirmed because the patient was not prepared to submit to bacteriological investigation. A further case concerned a girl of 13 years who was admitted to hospital with symptoms of food poisoning and was found to be suffering from an infection due to salmonella typhi-murium. The remainder of the family submitted specimens of faeces for examination but were all found to be quite negative. The origin of the infection was not discovered. The majority of the remaining 6 single cases were only slightly affected and in no case where bacteriological investigation was carried out was it possible to identify specific organisms likely to have caused the illness. PNEUMONIA. Thirty-four cases of acute primary or influenzal pneumonia were notified during the year, compared with 21 in 1955 and 18 in 1954. The total number of deaths from all forms of the disease during the year was 23 compared with 18 in 1955. WHOOPING COUGH. Eighty-two cases were notified during the year compared with 139, 74, 183 and 112 in the last four years. There were no deaths. CERTIFICATES OF VACCINATION AND INOCULATION. In order to prevent the spread of infectious diseases, certain countries require that visitors should be vaccinated or inoculated against specified diseases. International certificates have been prescribed for smallpox, yellow fever and cholera. When completed by the medical practitioner, the certificate must be authenticated by the Medical Officer of Health. During the year, 452 requests were received from residents for certificates of vaccination or inoculation to be authenticated for the purpose of travel abroad. VACCINATION. Vaccination against smallpox is no longer compulsory. The vaccination Acts, 1867 to 1907 were repealed by the National Health Service Act, 1946. During the year the following vaccinations were carried out in the district:— Primary vaccinations 446 Re-vaccinations 43 WHOOPING COUGH IMMUNISATION. The following figures show the number of children immunised and those who received reinforcing doses during the year (this includes those 37 children who received the combined diphtheria and whooping cough prophylaxis). Number of children immunised 481 Number of children boosted 78 DIPHTHERIA IMMUNISATION. The following table gives details of the number of children who were immunised during 1956:— Number who completed course of immunisation 572 Number of "Booster" doses given 797 The following table shows the total number of children in Wimbledon under the age of 15 years who had received immunising treatment by the end of the year. Under 5 years 1,890 Between 5 and 15 years 6,620 38 39 Notifiable diseases during 1956. DISEASE Number of Cases Notified in Various Age Groups Total Cases Notified Total Cases removed to Hospital Total Deaths Under 1 1-2 2-3 3-4 4-5 5-9 10-14 15-24 25 and over Scarlet Fever — 3 4 15 17 59 10 1 1 110 48 — Measles 2 1 7 3 6 31 11 2 1 64 — — Whooping Cough 5 2 9 6 6 47 4 — 3 82 — — Acute Poliomyelitis (Paralytic) — — — — — — 1 — 3 4 4 — „ (Non-paralytic) — — 1 — — 2 — — — 3 3 — Meningococcal Infection — — — — — 1 — — — 1 1 — Puerperal Pyrexia — — — — — — — 9 3 12 10† — Dysentery — — 1 1 — 6 2 — 5 15 9 — Paratyphoid Fever — — — — — — — — — — — — Erysipelas — — — — — — — — 6 6 4 — Pneumonia (Acute Primary or Influenzal) 1 — 1 — — 2 — 1 28 34 2 23* Food Poisoning 1 1 — — — — 3 2 4 11 2 — Ophthalmia Neonatorum — — — — — — — — — — — — Malaria — — — — — — — — 1 1 — — Acute Encephalitis — — — — — — — — 1 1 1 — TOTALS 9 7 23 26 29 148 31 15 56 344 84 23 * All Forms. † These 10 patients were already in hospital. 40 Notifications of Infections Disease during the last 10 years. DISEASE 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Diphtheria 4 4 6 — —' - - — Dysentery 2 — 2 7 53 36 19 14 2 15 Encephalitis Lethargica, acute - 1 - - - - - - - 1 Enteric Fever (including Paratyphoid) - 1 — 3 - 1 1 - - — Erysipelas 5 2 7 1 5 3 3 3 2 6 Food Poisoning — 5 2 — 4 — 6 13 2 11 Malaria — — — — 1 — — — — 1 Measles 253 481 707 364 758 337 896 18 813 64 Meningococcal Infection 5 3 2 3 2 1 1 2 — 1 Ophthalmia Neonatorum. 4 2 2 1 — — — 1 — Pneumonia 32 15 19 20 27 24 29 18 21 34 Poliomyelitis 25 4 10 12 4 2 11 4 11 7 Puerperal Pyrexia 3 5 8 1 2 5 22 4 7 12 Scarlet Fever 51 95 55 68 136 128 96 49 77 110 Whooping-cough 157 231 149 181 166 112 183 74 139 82 541 849 969 668 1,158 649 1,267 200 1,074 344 Tuberculosis:— Pulmonary 87 87 96 102 93 84 104 66 78 44 Non-Pulmonary 8 6 10 13 6 5 2 8 6 6 TUBERCULOSIS. During the year 91 new cases were added to the register of tuberculous persons compared with 84 in 1955, and 74 in 1954. Of the 91 additions, 50 were primary notifications and 41 were transfered from other areas. An analysis of the notifications received is given overleaf. Eighty-five cases were removed from the register for the following reasons:— Pulmonary Non-Pulmonary. M. F. M. F. Deaths from tuberculosis 5 3 — — Deaths of patients suffering from tuberculosis through other causes 1 1 1 - Recovered cases 17 7 1 2 Removals from district 24 23 - - 47 34 2 2 The figure of 8 deaths from all forms of tuberculosis represents a death rate per 1,000 of population of 0.14, this being the same rate as for 1955 when there were also 8 deaths. The rate for England and Wales for 1956 was 0.12. The number of deaths from tuberculosis has continued to fall over a number of years, both locally and nationally, and it is gratifying to note that the number of new notifications in the Country is showing a decline. The Mass Radiography Units continue to carry out their surveys and it is in this way that many new cases are detected. The earlier detection of the disease makes it easier to deal with and the chances of complete recovery are much greater. Modern methods of treatment by thoracic surgery and the use of new drugs are proving increasingly successful, and have brought about a dramatic decrease in deaths from tuberculosis in recent years. Another important measure aimed at combatting this disease is rehousing and a degree of medical priority is given by the Council to tuberculous patients with regard to rehousing. Vaccination against tuberculosis with B.C.G. is offered to all children between the ages of 13 and 14 years who attend the County Council's schools. The scheme is operated through the County School Health Service. During 1956 it did not become necessary to use the powers given under the Public Health (Prevention of Tuberculosis) Regulations 1925, or Section 172 of the Public Health Act 1936. These powers prohibit persons suffering from pulmonary tuberculosis from entering upon employment involving the handling of milk, and the compulsory removal and detention in hospital in certain circumstances, of persons suffering from tuberculosis. 41 42 TUBERCULOSIS 1956. 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 j Males Females Males Females Males Females Males Females Males Females Males Females Males Females Under 1 Year — — — — — — — — — — — — — — — — 1 — 4 Years 2 — — — 1 — — — 3 — — — — — — — 5—9 „ 2 — — — 2 — — — 4 — — — — — — — 10—14 „ — 1 1 — — — — — — 1 1 — — — — 15—19 „ 3 2 — 1 — — — — 3 1 — 2 — — — — 20 — 24 „ — 2 — — 3 — — — 3 2 — — — — 1 — 25 — 29 „ 2 1 — — 5 6 — — 7 7 — — — — — — 30 — 34 „ 7 3 — 1 4 6 — 1 11 9 — 2 — — — — 35 — 44 „ 1 3 1 1 6 3 — — 7 6 1 1 1 1 — — 45 — 54 „ 6 1 1 — — — — — 6 1 1 — — 1 — — 55 — 64 „ 6 — — — 1 — — — 7 — — — 1 — — 65 and Over 1 1 — — 3 — — — 4 1 — — 4 2 — — 30 14 3 3 25 15 — 1 55 V 28 3 5 6 4 1 \ — 44 6 40 1 83 8 10 1 50 41 91 11