AC 4413(1) WIM 30 Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1957 OF THE MEDICAL OFFICER OF HEALTH 1957 Public Health Department, Town Hall, Wimbledon, S.W.19. August, 1958. To The Mayor, Aldermen and Councillors of the Borough of Wimbledon. Mr. Mayor, Ladies and Gentlemen, 1 have the honour to submit the Annual Report on the work of the Public Health Department for the year 1957. This Report is compiled in accordance with the instructions contained in Circular 1/58 of the Ministry of Health and is on similar lines to previous years. The Report shows that the health of the residents has been good during the year and that progress has been made in many directions. The corrected live birth rate for Wimbledon in 1957 was 13.16 per thousand of the population compared with a rate of 13.94 for 1956. The rate for England and Wales for the year was 161. The corrected death rate for the Borough during the period was 9.61 compared with 9.88 in 1956 and 11.5 for England and Wales. This is one of the lowest death rates recorded in Wimbledon. The excess of births over deaths was 138 compared with 134 in the previous year. There were no maternal deaths. The infantile mortality rate for 1957 was the lowest yet recorded for Wimbledon. A total of nine children under the age of one year died during the year giving an infantile mortality rate of 11.40 per thousand live births compared with a rate of 23.1 for England and Wales. A low infantile mortality rate is generally regarded as a fairly accurate pointer to the state of the public health of a community, and this low figure is an indication of improved public health and social standards of the people and is a tribute to the medical services of this community. It is unlikely that these rates will be very much improved in the future. Once again, the principal cause of death was heart disease, especially coronary disease, while cancer was the second greatest cause. 1 In recent years public attention has been drawn to the increasing death rate due to cancer of the lung and during the year the Minister of Health addressed a circular to Local Authorities drawing attention to the Medical Research Council's conclusion that the most reasonable interpretation of the very great increase in deaths from lung cancer in males during the past twenty-five years was that a major part of it was caused by smoking tobacco, particularly heavy cigarette smoking. The Council point to the evidence derived from investigations in many countries in support of this conclusion, in particular to identification of several carcinogenic substances in tobacco smoke. In Wimbledon deaths from cancer of the lung were higher than last year, as was the case for the country as a whole. Deaths from influenza in Wimbledon were only slightly higher than last year, despite the epidemic of "Asian flu" which occurred in the autumn. The tuberculosis death rate shewed another sharp decline and at 0.05 was the lowest on record. The figure for England and Wales was 0.11. Notifications of infectious disease amounted to 898 compared with 344 in 1956. The increase was accounted for almost entirely by the prevalence of measles in the first half of the year. For the eighth successive year no cases of diphtheria occurred in Wimbledon. Freedom from diphtheria can create the impression among many young people, who have never heard of a case of diphtheria, that the danger from this dreaded disease has disappeared. This is not so, diphtheria could return in its old killing epidemic form and it is only by maintaining a high level of immunity that the population will be safeguarded from the return of this disease. There were ten confirmed cases of poliomyelitis, seven of them being associated with paralysis. There were two deaths from this disease, these being the only deaths from infectious diseases during the year. Vaccination against poliomyelitis proceeded throughout the year and although the supplies of vaccine were limited it was possible to vaccinate with two injections over 2,000 registered children. At the end of the year the scheme was extended to take in more age groups but work on these did not commence until early in 1958. I should like to take this opportunity of expressing to the Chairman and Members of the Health Committee my appreciation for the consideration and courtesy which they have shewn to me during the year. I should also like to express my thanks to all those associated with the local Health and social services, both official and voluntary, for their continued co-operation during the year. In particular I would like to thank Mr. Cockell, the Senior Public Health Inspector, and Mr. Richardson, my Chief Clerk, for their contribution towards the production of this Report. I am much indebted to my colleagues in other Departments for their ready help on all occasions. 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: Laboratory Facilities 14 Nursing Homes 14 Mass Radiography 15 National Assistance Act 1948 16 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 17 Public Health Inspectors' Visits 17-19 Notices Served 19-20 Nuisances abated and defects remedied 20-21 Factories Act, 1937, Part I 22 Outworkers 23 SECTION D: HOUSING: Overcrowding 24 Rehousing 24 Housing Repairs and Rents Act, 1954 25 Rent Act, 1957 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 27-28 Unsound Food 28 Sampling of Food and Drugs 29-32 Legal Proceedings 31-32 SECTION F: RODENT CONTROL, PETROLEUM STORAGE, ETC. Prevention of Damage by Pests Act, 1949 33 Petroleum (Regulation) Act 1928 & 1936 33 Pet Animals Act, 1951 33 Heating Appliances (Fireguards) Act, 1952 34 Clean Air Act 1956 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, 39-42 Epidemic Influenza 38 Vaccination and Immunisation 39-40 Tuberculosis 43-44 3 BOROUGH OF WIMBLEDON HEALTH COMMITTEE December, 1957 Councillor T. H. Metcalf, (Chairman). Councillor D. L. Reid, J.P., (Mayor). Councillor A. E. Ayres, (Vice-Chairman). Alderman C. W. Black, D.L., 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, 1957 Councillor T. H. Metcalf, (Chairman). Councillor J. E. V. Campbell. Councillor Miss D. M. Lord. Councillor Miss M. K. Paterson. Councillor Miss E. A. Weldon. 4 STAFF Medical Officer of Health: Harold Ellis, M B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H. (Retired 3/1/57) P. J. Doody, M.B.. B.Ch.. B.A.O., D.P.H. (Appointed 4/1/57) Senior Public Health Inspector: G. H. Cockell, M.R.S.H., M.A.P.H.I. Deputy Senior Public Health Inspector: L. R. Godfrey, M.A.P.H.I. Public Health Inspectors: C. L. Hunt G. M. McFall. F. R. Brackfield, M.A.P.H.I., (Appointed 1/9/57). Assistant Rodent Officer: F. J. Reddington. Chief Clerk: t J. R. Richardson, A.R.I.P.H.H. Clerks: *Mrs. D. Wilson, S.R.N. *Mrs. V. Waters. F. R. Brackfield. (Resigned 31/8/57). J. R. Gill. (Appointed 11/2/57). *Mrs. F. D. Ayres. ,tMrs. C. B. Brett, (Resigned 23/3/57). fMiss I. Maidment. (Appointed 25/3/57). P. B. Stannett. (H.M. Forces). R. P. Stanton. (H.M. Forces 1/1/57). *Miss M. J. Perry. 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. 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-1957) 57,630 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 :—£1,219,516. Sum represented by penny rate :— £4,908. 0 0. Extracts from Vital Statistics of the Year 1957. (Registrar-General's Figures.) Live Births Total M. F. r Legitimate 757 402 355 Illegitimate 33 22 11 Total 790 424 366 Total M. F. Stillbirths Legitimate 17 11 6 Illegitimate 1 1 - Total 18 12 6 Live birth rate per 1,000 of the estimated home population 13.71 Corrected live birth rate per 1,000 of the estimated home population 13.16 Still-birth Rate per 1.000 total (live and still) births 22.27 Total M. F. Deaths 652 306 346 Crude Death Rate per 1,000 of the estimated home population 11.31 Corrected Death Rate per 1,000 of the estimated home population 9.61 Deaths trom 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 11.0 Legitimate infants per 1,000 legitimate live births 10.57 Illegitimate infants per 1,000 illegitimate live births 30.30 Deaths from cancer 121 diphtheria Nil „ poliomyelitis 2 „ 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 1957. Provisional Figures Based on Quarterly Returns of Registrar-General. Wimbledon England and Wales Rates per 1,000 Home Population Births:— Live Births 13.16 16.1 Still Births 0.31 0.37 22.27* 22.5* Deaths:— All Causes 9.61 11.5 Coronary and artetiosclerotic heart disease 2.04 1.70 Whooping Cough - 0.00 Diphtheria - 0.00 Tuberculosis - all forms 0.05 0.11 Influenza 0.08 0.15 Smallpox - 0.00 Acute Poliomyelitis (including Polioencephalitis) 0.03 0.01 Pneumonia 0.52 0.52 Malignant Neoplasm - Lung, Bronchus 0.50 0.43 Maternal Mortality - 0.47* Notifications:— (Corrected) Scarlet Fever 1.02 0.65 Whooping Cough 1.87 1.89 Typhoid and Paratyphoid Fever 0.02 0.01 Meningococcal Infection 0.02 0.02 Acute Encephalitis 0.02 0.00 Diphtheria - 0.00 Erysipelas 0.02 0.07 Smallpox - 0.00 Measles 11.45 14.10 Pneumonia 0.41 0.72 Acute Poliomyelitis — Paralytic 0.10 0.07 Non-paralytic 0.03 0.03 Food Poisoning 0.02 0.20 Dysentery 0.15 0.62 Tuberculosis — Pulmonary 0.88 0.65 Non-pulmonary 0.03 0.08 Puerperal Pyrexia 6.06 15.9 Rates per 1,000 Live Births Deaths:— Infant Deaths (all causes under 1 year) 11.40 23.1 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, 57,630, shews an estimated decrease of 190 on the previous year, although the natural increase by excess of births over deaths was 138. All rates used in this report are based on the Registrar-General's figures. The statistics supplied by the Registrar-General show that during the year 1957, the total number of registered live births belonging to Wimbledon was 790. Of this number, 424 were males and 366 females. This gives a birth-rate of 13.71 per thousand of the population as compared with a rate of 13.94 per thousand in 1956, and an average of 13.45 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 1957 was 13.16 per thousand of the population, whilst the rate for England and Wales was 16.1 and has averaged 15.5 over the past five years. Stillbirths- The number of stillbirths registered during the year was 18 (12 males and 6 females), this being 2 more than last year. The stillbirth rate for Wimbledon was 0.31 per thousand of the population, while that for England and Wales was 0.37. Illegitimacy -Of the live births registered in 1957, 33 (22 males and 11 females) were illegitimate, this being 11 fewer than in the preceding year. One of the 18 stillbirths registered was illegitimate. The total number of Wimbledon residents who died during 1957 was 652 (306 males and 346 females), giving a death-rate of 11.31 per thousand of the population as compared with 11.62 per thousand for 1956. The corrected death-rate for 1957 was 9.61 per thousand as compared with a rate of 11.5 per thousand for England and Wales. The number of Wimbledon residents who died outside the Borough was 256, whilst 393 persons not normally resident in Wimbledon died in institutions, etc., in the Borough. BIRTHS. DEATHS. The four principal causes of death were as follows:— Number of deaths Percentage of total deaths Disease of the heart and circulatory system 247 38% Cancer 121 19% Vascular lesions of nervous system 106 16% Diseases of the respiratory system 75 11% Totals. 549 84% 8 The following is an analysis of the causes of death :— Cause Malts Femalts Total 1. Respiratory tuberculosis 3 - 3 2. Other tuberculosis - - - 3. Syphilitic disease 1 - 1 4. Diphtheria - - - 5. Whooping cough - - - 6. Meningococcal infections - - - 7. Acute poliomyelitis 1 1 2 8. Measles - - — 9. Other infective and parasitic diseases 4 - 4 10. Malignant neoplasm, stomach 8 7 15 11. Malignant neoplasm, lung, bronchus 24 5 29 12. Malignant neoplasm, breast - 15 15 13. Malignant neoplasm, uterus - 4 4 14. Other malignant and lymphatic neoplasms 26 26 52 15. Leukaemia 4 2 6 16. Diabetes 1 4 5 17. Vascular lesions of nervous system 33 73 106 18. Coronary disease, angina 63 55 118 19. Hypertension with heart disease 6 9 15 20. Other heart disease 26 53 79 21. Other circulatory disease 16 19 35 22. Influenza 2 3 5 23. Pneumonia 12 18 30 24. Bronchitis 26 6 32 25. Other diseases of respiratory system 6 2 8 26. Ulcer of stomach and duodenum 5 2 7 27. Gastritis, enteritis and diarrhoea 2 - 2 28. Nephritis and nephrosis 2 1 3 29. Hyperplasia of prostate 5 - 5 30. Pregnancy, childbirth, abortion - - - 31. Congenital malformations - 1 1 32. Other defined and ill-defined diseases 16 26 42 33. Motor vehicle accidents 5 1 6 34. All other accidents 5 11 16 35. Suicide 4 2 6 36. Homicide and operations of war - - - Totals 306 346 652 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 nine years. The maternal mortality rate for England and Wales per thousand live and still births was 0.47. 9 MATERNAL MORTALITY - ENGLAND AND WALES. Rates per 1,000 live and still births. Number of Deaths Rate Maternal causes, excluding abortion 288 0.39 Due to abortion 61 0.08 Total maternal mortality 349 0.47 The estimated nud-1957 female population for England and Wales age 15-44 was 9,040,000. As stated overleaf there were no maternal deaths in Wimbledon during 1957. INFANTILE MORTALITY. During 1957 there were 9 deaths among infants under one year, compared with 10 in 1956 and an average of 14 in the last ten years. On no occasion previously has the low figure of 9 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 11.40, the lowest rates previously recorded being 12.40 in 1956 and 13.60 in 1952. The figure for England and Wales, 23.1, was also the lowest on record, being 0.6 per thousand below that for 1956, the previous lowest. Three of the deaths were due to prematurity and three due to congenital malformations or birth injuries. One child died from pneumonia, one from asphyxia (unknown cause) and the remaining death was due to bronchitis. The number of neo-natal deaths (i.e. those occurring during the first four weeks of life) was 8, giving a neo-natal death rate of 10.1 per thousand live births, as compared with a rate of 16.5 for England and Wales. The following table shows the causes of the 9 deaths which occurred during 1957, together with the age at death. 10 11 Infantile Mortality during 1957. 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 2 - 1 - 3 - - - - 3 Prematurity 3 — — — 3 — — — — 3 Pneumonia — 1 — — 1 — — — — 1 Bronchitis — — — — — — 1 — — 1 Asphyxia (unknown cause) 1 — — — 1 — — — — 1 Totals 6 1 1 — 8 — 1 — — 9 Infantile Mortality during the last 10 years. Cause of death 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Prematurity 8 5 5 3 3 5 5 2 1 3 Congenital defects or birth injuries 5 12 2 9 6 4 5 5 5 3 Diseases of the newborn — — 1 2 — — — — — Gastro-enteritis — 1 2 — — 1 — — — Pneumonia 1 1 — 1 1 1 1 2 2 1 Bronchitis - - 2 - - - - - - 1 Whooping cough — 1 - - - - - - - - Pneumococcal Meningitis 1 - - - - - - - - - Septicaemia — — 1 1 — — — — 1 — Asphyxia (unknown cause) - - - - - - - - - 1 Accidental death 3 2 1 1 — 1 1 2 — — Inattention at birth - - - - - - - - 1 — 18 22 14 17 10 12 12 11 10 9 Total neo-natal deaths included above 14 14 8 14 6 9 11 8 7 8 12 13 The following table shows the birth-rates and death-rates for Wimbledon as compared with England and Wales since 1939. Year Live-Birth Rale (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 9.88 11.7 — 0.56 12.40 23-8 1957 13.16 16.1 0.31 0.37 9.61 11.5 — 0.47 11.40 23-1 * 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. LABORATORY FACILITIES Almost all specimens requiring bacteriological examination in the interests of public health are sent to the Ministry of Health Public Health Laboratory at Epsom. In addition the staff is always available to assist the Medical Officer of Health in field investigations in the case of epidemics or outbreaks of food poisoning. The Laboratory at the Nelson Hospital, Merton, is also available for the examination of pathological material. Te following is a summary ot tne examinations made during tne year:— Nose and throat swabs 42 Faeces for the typhoid and dysentery groups 384 Ice-cream samples 98 Milk samples 170 Water samples 61 Miscellaneous 24 Total 779 Samples of milk and water requiring chemical analysis, and also Food and Drug samples, are sent by the Corporation to the Public Analyst. Biological examinations of milk are carried out at the Royal Institute of Public Health and Hygiene Laboratory. 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. At the end of the year there were six registered nursing homes providing a total of 92 beds. One maternity hospital and one nursing home were exempted, on an annual basis, from registration under Section 192 of the Public Health Act 1936. Two certificates of registration were issued by the Council during 1957. One was in respect of a new Home for chronic medical cases and the second was in respect of an existing nursing home which required to be re-registered owing to a change occurring in the constitution of the body carrying on the Home. The nursing homes were periodically inspected and supervised. Fourteen visits of inspection were made. Three were in connection with applications for registration, seven were routine visits and four special visits. 14 The nursing homes in Wimbledon were again found to be maintained and run in a satisfactory manner. Close supervision was paid during the visits to the way in which the records of the homes were kept, that proper attention was being paid to fire precautions, and the Council's byelaws were being complied with. MASS RADIOGRAPHY. The Mass Radiography Unit of the South West Metropolitan Regional Hospital Board paid its annual visit to Wimbledon during the year, being stationed at the T.A. Centre, St. George's Road, from 23rd to 25th April and at the A.T.C. Centre, Merton Road, from 29th April to 14th May. 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 3,082 Females 3,087 6,169 A bnormalities discovered: (i) Active pulmonary tuberculosis: Males 9 Females 6 15 (ii) Inactive pulmonary tuberculosis: Males 124 Females '103 227 (iii) Non-tuberculous conditions: Males 121 Females 90 211 15 NATIONAL ASSISTANCE ACT —CARE OF THE AGED. Under Section 47 of the above 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 National Assistance (Amendment) Act enables Local Authorities to deal more expeditiously with very urgent cases by initial removal, for a period not exceeding three weeks. The care of the aged, infirm and chronic sick continues as one of the major problems of the present day. The problems are considerable and unusual, and the solution to many of them is complicated by the personalities of the patients themselves. Many of these old people become dirty and neglected, not necessarily because of poverty, but often due to the fact that they have outlived their relatives and friends, have become unable to help themselves, and strongly resent any approach that is made to them. Many are not ill but being unable adequately to care for themselves can become completely incapacitated through quite trivial illnesses. There are those who will not accept the domiciliary services which are available and those who resolutely refuse to lose their independence and enter a Home or hospital. Generally these problems are resolved by perseverance and persuasion, and it is pleasing to report that it was not necessary to resort to any statutory action under the above Acts during 1957. Although it cannot yet be said that the problems associated with the care of the aged are diminishing, there are encouraging signs that there is a far greater awareness among the general public of the difficulties involved, and statutory and voluntary bodies are now tackling the problem in earnest. In Wimbledon we are most fortunate in having a number of excellent voluntary organisations including the Guild of Social Welfare with its own Geriatric Social Worker, and there is the closest co-operation between these organisations, the Geriatrician and Geriatric Social Worker of St. Helier Hospital, the Divisional Welfare Officer, local doctors, and your Medical Officer of Health. Every effort is made to ensure that any old person in need of care and attention is visited regularly and receives the benefit of the services which are available. 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 1957 samples of water were taken for bacteriological and/or chemical examination, as follows:— Bacteriological. Wimbledon Corporation Swimming Baths 37 Dwelling houses Well water 12 Metropolitan Water Board supply 2 — 14 Other premises Metropolitan Water Board supply 5 Spring outlet near Caesar's Well 4 Artesian well 1 61 All the samples proved bacteriologically satisfactory. Chemical. Wimbledon Corporation Swimming Baths 1 Dwelling houses Well water 1 Artesian well 1 3 All the samples proved chemically satisfactory. Inspection of the District. The following is a summary of the complaints received and the visits made during the year 1957:— Complaints received. General disrepair and insanitary conditions 145 Dampness 86 Overcrowding 26 17 Defective drainage systems 13 Blocked drainage systems 102 Defective drainage fittings 13 Defective W.C. pans and/or flushing apparatus 26 Defective service water pipes 6 Absence of or defective dustbins 58 Accumulations of refuse, etc 28 Rats and mice 247 Insect pests, etc 82 Smoke nuisances 26 Unsound food 120 Miscellaneous 131 1,109 Visits made. Infectious diseases. Inquiries re cases of infectious disease 390 Visits re disinfection 102 Miscellaneous 150 Housing. Dwelling houses (Housing Act) 310 Dwelling houses (Public Health Act) 1,635 Housing Repairs & Rents Act, 1954 23 Houses let in lodgings 3 Overcrowding 109 Underground rooms 51 Tents, vans, etc 8 Flooding 29 Rent Act, 1957 210 Miscellaneous 356 Food and Food premises. Dairies and milk distributors 49 Ice-cream premises 220 Bakehouses 16 Butchers' shops 18 Meat preparation premises 5 Fish shops 10 Fried fish shops 4 Restaurant kitchens 42 Other food premises 251 Visits re unsound food 194 Sampling: food and drugs 176 Sampling: milk 205 Sampling: ice-cream 113 Sampling: water 68 Miscellaneous 188 General. Drainage and plumbing work 871 Stables and piggeries 6 Smoke observations 140 Pet Animals Act, 1951 19 Factories (P.) 121 Factories (N.P.) 28 Factories (Building sites) 10 Workplaces 15 Outworkers' premises 41 Shops Act, 1950 (Vent. temp, etc.) 48 Shops Act, 1950 (Shop hours) 83 Hairdressers and barbers 5 Diseases of Animals Acts 7 Petroleum (Consol.) Act, 1928 170 Heating Appliances (Fireguards) Act, 1952 2 Watercourses 16 Rodent control 5,154 Insect infestations 126 Nursing Homes 1 Refuse storage 147 Accumulations 87 Miscellaneous 393 12,425 Notices Served. Preliminary notices or intimations 401 Statutory Notices 65 Other letters .. 2,252 Result of Service of Notices. (1) Legal Proceedings Public Health Act, 1936. (a) Legal proceedings were instituted against an owner for failing to comply with an Abatement Notice and for failing to supply information as to the nature of his interest in the premises concerned. At the first hearing the case was adjourned for seven days, and in the meantime the nuisance was abated. The summons was withdrawn after the Defendant had offered to pay the costs of the proceedings. (b) An owner appealed to the Magistrates' Court against the service of a Notice to provide a dustbin. The appeal was dismissed and costs amounting to 7/6d. were awarded against the Appellant. (c) Legal proceedings were instituted against the joint owners of a dwelling house for failing to comply with an Abatement Notice. At the first hearing the case was adjourned for seven days. The nuisance was abated in the meantime, and at the resumed hearing costs amounting to £5. 5s. 0d. were awarded against the Defendants. (d) Legal proceedings were instituted against the owner of a dwelling house for non-compliance with two Abatement Notices. Both cases were proved and a fine of £5, together with £2. 2s. 0d. costs was imposed in each case. In addition, an Abatement Order to be complied with within twenty-eight days was made in respect of the nuisances. 19 The Defendant appealed to the Quarter Sessions against the amount of fines imposed. The appeal was dismissed and further costs amounting to £5. 5s. Od. were awarded against the Appellant. (2) Work carried out in default. In one instance it was necessary to carry out work in default after the service of a Notice under the Wimbledon Corporation Act, 1933, Section 53, in connection with a blocked soil drainage system. The cost of the work was recovered from the owner concerned. (3) 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. Examined and tested 125 Reconstructed 49 Cleansed 91 Soil pipes and ventilation shafts repaired or renewed 9 Inspection chamber covers renewed 22 Fresh air inlets repaired or renewed 39 New W.C. pans 37 Water waste preventors repaired or renewed 16 Gutters and rainwater pipes repaired or renewed 56 New lavatory basins 3 New baths 2 Waste pipes trapped, repaired or renewed 16 Gully surrounds repaired 6 Urinals cleansed 2 Miscellaneous 90 General Housing repairs. Roofs repaired 87 Yards paved or repaired 5 Dampness remedied 127 Damp-proof courses provided 4 Sub-floor ventilation provided 2 Walls and ceilings repaired 182 New ceilings constructed 1 Walls cleansed 146 Ceilings cleansed 74 Floors repaired or renewed 44 Additional light and ventilation provided 11 Windows repaired or renewed 94 Doors repaired or renewed 15 Fireplaces repaired or renewed 29 Coppers repaired or renewed 1 Service water mains repaired 8 Additional light and ventilation provided to W.C. apartments 5 W.C. apartments cleansed 2 Miscellaneous 201 20 Food premises. Food shops reconstructed 1 Walls and ceilings cleansed and repaired 3 Hot water supply provided 10 New wash-hand basins 6 New glazed sinks 3 Waste pipes repaired 2 Staff sanitary accommodation repaired 1 Staff sanitary accommodation cleansed 1 Staff sanitary accommodation provided 2 Floors repaired or renewed 1 Food stores provided 3 Ventilation provided to food rooms 5 Windows repaired 2 Miscellaneous 43 Rodent Control. Rat proofing work carried out 6 Miscellaneous. Accumulations removed 16 New dustbins provided 21 21 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 92 28 1 — Factories with mechanical power 261 121 12 — Other premises under the Act (including works of building and engineering construction but not including outworkers* premises) 6 10 1 - Totals 359 159 14 — 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) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate v e n t i 1 a tion (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7):— Insufficient - - - - Unsuitable or Defective 13 14 — 3 — Not Separate for Sexes — — — — — Other Offences (Excluding offences relating to outwork) 2 1 Totals 15 15 — 3 — 22 PART VIII. OUTWORK — SECTIONS 110 & 111. Nature of work Section 110 Section 111 No. of outworkers in Auggust list required by Sec. 110 (/) (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. 25 — — — — — Others 4 — — — — — Total 29 — — — — — Number of addresses received from other Councils 76 Number of addresses forwarded to other Councils 22 Number of premises where outwork was carried on at the end of 1957 64 Inspections of outworkers' premises 41 Outwork in infected premises (Section 153, Public Health Act, 1936) 1 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. The following information is given in connection with overcrowding, rehousing and new houses erected:— Housing Act, 1936, Part IV; Housing Act, 1957, Part IV—Overcrowding. (a) (i) Number of dwellings known to the Department to be overcrowded at the end of the year 59 (ii) Number of families dwelling therein 64 (iii) Number of persons dwelling therein 306 (b) Number of new cases of overcrowding reported during the year 14 (c) (i) Number of cases of overcrowding known to have been relieved during the year 12 (ii) Number of persons concerned in such cases 58 (d) Number of cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 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, 1957:— Number of houses requisitioned since the beginning of the war and still held under requisition 232 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 2,206 Number of live applications on the housing waiting list 957 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 1957 : Private enterprise 44 Local authority 38 Number of flats created by conversion in 1957: Private enterprise 25 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 5th July, 1957:— Number of applications for Certificates of Disrepair 81 Number of applications withdrawn 3 Number of Certificates not recommended 1 Number of Certificates of Disrepair issued 77 Number of applications for Certificates of Revocation 49 Number of Certificates of Revocation issued 47 Rent Act, 1957. This Act came into force on the 6th July, 1957, and in certain respects modified the powers and duties of Local Authorities under the Rent Acts and other enactments. Those Sections of the Housing Repairs and Rents Act 1954 relating to Certificates of Disrepair were repealed by the new Act which provided for an entirely new procedure in connection with applications by tenants for Certificates of Disrepair. This necessitated a complete revision of inspection and recording procedure, and the technical and clerical staff are to be commended upon the manner in which this somewhat complicated additional work was absorbed. The following is a summary of the position on the 31st December, 1957:— Applications for Certificates of Disrepair (Form I) ... 89 Applications withdrawn by applicants 6 Forms J sent to landlords 45 Undertakings given by landlords (Form K) 16 Certificates of Disrepair issued (Form L) 10 Applications for Cancellation of Certificates of Disrepair (Form M) 4 Certificates of Disrepair cancelled 2 Total number of visits made in connection with applications for Certificates of Disrepair—233. 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 36. 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 26 Pasteurised Milk 27 Sterilised Milk 35 Supplementary Licences— Tuberculin Tested Milk 11 Pasteurised Milk 11 Sterilised Milk 10 120 During the year 170 samples of designated milk were submitted for bacteriological examination. The results were as follows:— Designation Satisfactory. Unsatisfactory. Pasteurised 141 Nil Tuberculin Tested (Pasteurised) 17 Nil Sterilised 10 Nil Tuberculin Tested (Farm bottled) 2 Nil Five samples of Tuberculin Tested (Farm bottled) milk were sent to the Royal Institute of Public Health and Hygiene Laboratory for animal innoculation. These samples were found to be negative for tubercle bacilli. Ice-Cream. During the year 98 samples were submitted for bacteriological examination. The results were as follows:— Grade 1 91 Grade 2 3 Grade 3 3 Grade 4 1 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 case of the Grade 4 sample, 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 1957. 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 during the past year. A register of all such premises includes the following:— Greengrocers 68 Confectioners 128 Ice-cream premises 211 Bakers 37 Grocers 126 Provision dealers 89 Butchers 45 Fishmongers 24 Milk distributors 36 Chemists 25 Licensed premises 72 Clubs 30 Restaurants and Cafes 85 Works canteens 9 School canteens 47 Kitchens (Hospital and Central Kitchens) 5 Food stalls 11 1,048 The initial inspection of these premises has been proceeded with during the year 1957, but the work was not completed by the end of the year. By the application of informal measures and by discussions with owners and occupiers of food premises, no particular difficulty has been experienced in obtaining compliance with the requirements of the Regulations. In general, it has been found that food traders within the Borough are co-operative, and I have reason to believe that the assistance and advice given by the Department is appreciated. 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 123 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 1957 was 296. 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 is still operating satisfactorily. The following is a list of unsound food surrendered during 1957:— cwts. qrs. 1bs. Canned soups 1 18 Canned meat 15 2 11 Canned fish 1 2 Canned vegetables 1 3 14 Canned fruits 5 1 9 Canned milk or cream 3 13 Frozen food 2 3 19 Meat, bacon, poultry, etc. 3 1 25 Fish 2 2 10 Meat and fish pastes 18 Butter, fats and cheese 1 2 Sugar, jam, etc. 17 Flour, bread, cereals and biscuits 21 Pickles and sauces 10 Fruit and vegetables 1 20 Spaghetti, macaroni, etc. 2 25 Desiccated coconut 3 16 Cocoa 22 Sugar confectionery 32 0 10 Miscellaneous 10 68 2 12 28 Sampling of Food and Drugs. The following samples were submitted to the Public Analyst during 1957, with the results shown:— Articles Total Formal Informal Genuine NonGenuine or Irregular Ale 2 2 – 2 – Alka Seltzer tablets 1 1 – 1 – Aspirin tablets 1 1 — 1 — Beer, bitter 1 1 — 1 — Biscuits 2 1 1 2 — Biscuits, chocolate 3 3 — 3 — Black pudding sausage 2 2 — 2 — Bread and butter 1 1 — 1 — Butter 2 2 — 2 — Butter beans 1 1 — 1 — Cake mixture 2 2 — 2 — Carrots, canned 1 1 — 1 — Cereals, breakfast 1 1 — 1 — Cheese, processed 1 — 1 1 — Cheese spread 1 1 — 1 — Chutney, fruit 1 — 1 1 — Cloves 1 — 1 1 — Cocoa 1 1 — 1 — Cochineal colouring 1 — 1 1 — Coconut, desiccated 2 2 — 2 — Codeine tablets 1 1 — 1 — Coffee, ground 2 2 — 2 — Coffee, powder 1 1 — 1 — Confectionery, flour 3 2 1 3 — Confectionery, sugar 5 5 — 5 — Cordials 6 6 — — Corned beef 1 1 – 1 — Crab fish paste 1 — 1 1 — Crab paste 1 — 1 1 — Cream, double 1 1 — 1 — Curry powder 1 — 1 1 — Custard powder 1 1 — 1 — Dripping 1 1 — 1 — Faggots 1 1 — 1 — Fat, cooking 1 1 — 1 — Flour 1 1 – 1 — Gin 1 1 – 1 — Grapes 1 1 — 1 — Groats 1 1 — 1 — Ground nut oil 1 – 1 1 — Jam, strawberry 1 – 1 1 — Jelly 1 – 1 1 — Junket tablets 1 – 1 1 — Lard 3 3 – 3 — Lemon juice 1 – 1 1 — Lentils 1 1 — 1 — Luncheon meat 1 1 — 1 — Macaroni 1 1 — 1 — Macaroni milk pudding 1 1 — 1 — Margarine 4 4 — 4 — Milk 61 61 — 61 — Milk beverage 2 1 1 1 1 Mincemeat 1 1 — 1 — Mineral water 5 3 2 5 — Mustard 2 1 1 2 — C/Fwd. 146 128 18 145 1 29 Articles Total Formal Informal Genuine NonGenuine or Irregular B/Fwd. 146 128 18 145 1 Mustard sauce 1 1 — 1 – Oxo cubes 1 1 — 1 — Peas, canned 1 1 — 1 — Peas, dried 1 1 — 1 — Pickle 1 1 — 1 — Pilchards in tomato sauce 1 — 1 1 — Pork pie 1 1 — 1 — Raising powder 1 1 — 1 — Raspberry drink 1 1 — 1 — Rice 2 2 — 2 — Rice, flaked 1 1 — 1 — Rum 1 1 — 1 — Rusks 1 1 — 1 — Salad cream 1 1 — 1 — Sandwich spread 1 1 — — 1 Sausages, pork 1 1 — 1 – Soup, vegetable 1 1 — 1 — Spaghetti in tomato sauce 1 1 — 1 — Suet, shredded, beef 2 2 — 2 — Sweet corn 1 1 — 1 — Tapioca 1 1 — 1 — Tea 3 3 — 3 — Tomatoes, canned 2 2 — 2 — Vinegar, malt 2 1 1 2 — Whisky 3 3 — 3 — Yeast tablets 1 – 1 1 – Totals 180 159 21 178 2 The following samples were submitted for special examination:— Articles Total Formal Informal Genuine NonGenuine or Irregular Brown bread 1 – 1 1 – Butter 1 — 1 1 — Desiccated coconut 1 — 1 — 1 Tuna fish 1 — 1 1 — Steak and kidney pudding, canned 1 – 1 – 1 White bread 3 — 3 2 1 Totals 8 — 8 5 3 It will be seen that adverse reports were received upon five samples and the following is an account of the action taken in respect thereof. Milk beverage. An informal sample of milk beverage in powder form was submitted to the Public Analyst, who reported that in his opinion one ingredient specified on the label was not in accordance with the Labelling 30 of Food Order 1953. It was ascertained that action had already been taken in respect of a similar sample by the Sampling Officer of another Local Authority. As a result of correspondence with him it was found that the manufacturers had already made arrangements to re-label the product. No further action, therefore, was taken in the matter. Sandwich spread. This formal sample consisted of a jar of sandwich spread which the Public Analyst reported upon as being "Stale and rancid through long storage and is now unfit for human consumption." Upon receipt of this report the remaining stock of this food (12 jars) was examined at the place of purchase, and was voluntarily surrendered for destruction. Desiccated coconut. As the result of a complaint, a box of desiccated coconut deposited in a bakehouse store-room was examined, and it was found to contain small dark objects. Specimens were submitted to the Public Analyst who expressed the opinion that the objects did in fact consist of rodent excreta. The box of desiccated coconut (100 lbs.) was surrendered for destruction, and rodent treatment work was carried out upon the premises. Steak and kidney pudding. An opened tin of steak and kidney pudding was submitted to the Senior Public Health Inspector for examination by a resident of the Borough. Embedded in the contents of the tin was a used cigarette end. The cigarette paper was intact and one end was stained with a red substance resembling lipstick. The complaint alleged that the cigarette end was found in the tin when it was opened. The tin and its contents were submitted to the Public Analyst, and his report confirmed the presence of the cigarette end. As a result of discussions with the Public Analyst and with the manufacturers of the pudding, experiments were carried out in an endeavour to prove whether or not both cigarettes and lipstick could in fact survive the normal production procedure. The Health Committee considered reports upon the action which had been taken, and resolved that a warning letter be sent to the manufacturers concerned. White bread. As the result of a complaint a portion of a loaf of white bread containing foreign matter was submitted to the Public Analyst for examination. It was found that the foreign matter consisted of a piece of white fabric of irregular shape folded several times throughout the bread. There was no evidence that the fabric had been in a dirty condition or was contaminated, and it was suggested that it could have been torn from an overall or possibly from a dough cloth. The Health Committee resolved that a warning letter be sent to the Baker concerned. Legal Proceedings. (a) A retailer was summoned under the provisions of the Food and Drugs Act 1955 for selling a pork pie which was not of the quality 31 demanded by the purchaser. The pie was affected by a mould growth. The defendant pleaded guilty and was fined £5, and was ordered to pay £1. 1s. 0d. costs. (b) An assistant employed by a fruiterer was summoned under the provisions of the Food Hygiene Regulations 1955 for using tobacco whilst he was handling open food. The Defendant pleaded guilty and was fined £2, and was ordered to pay £1. 1s. 0d. costs. 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 1957. 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 2 12 14 3 — 3 — 5154 Private Premises 217 565 782 129 33 100 13 All other including Business Premises 36 285 321 28 20 24 16 Totals 255 862 1117 160 53 127 29 5154 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 deal with rodent treatment and disinfestation work in Surrey County Council owned property within the Borough, including schools, school canteens and river banks, on a contract basis. During 1957 no legal action was required to be taken under the provisions of the Act, and this is an indication of the co-operation rereceived from householders and business people. PETROLEUM (REGULATION) ACTS 1928 & 1936. 60 licences were issued by the Department to store petroleum spirit during 1957, and the total quantity of petroleum spirit stored was 102,605 gallons. In addition, 22 licences were issued to store petroleum mixtures involving a total of 9,255 gallons, and 3 licences were issued in respect of the storage of a total of 42 cwts. of calcium carbide. 170 visits were made to premises under the provisions of Petroleum Legislation. PET ANIMALS ACT, 1951. 9 licences to keep pet shops were issued by the Department during 1957. 19 visits were made to these premises and various infringements of the conditions of licence were rectified. 33 HEATING APPLIANCES (FIREGUARDS) ACT, 1952. During 1957, 2 visits were made in connection with the Act and 5 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. CLEAN AIR ACT, 1956. During the year 1957, 26 complaints were received with regard to smoke or grit emission, and the necessary observations were taken. A total of 140 visits was made to boiler installations situated in industrial premises. There was during the year a progressive improvement with regard to the emission of smoke from the industrial installations in the town. This, I think, is due to the coming into force of the Clean Air Act, 1956, and to the co-operation of the firms concerned. Conversion from solid fuel to oil burning has taken place in several premises which had previously been a source of nuisance from smoke and grit. During the year a Report was submitted to the Health Committee regarding instruments to record atmospheric pollution within the Borough, and the purchase and installation of two standard deposit gauges and two lead peroxide instruments was approved. The location sites for these instruments were approved by the Department of Scientific and Industrial Research after consultation, but the instruments had not been sited by the end of the year. It is hoped that they will be installed, and recordings commenced, early in 1958. 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 1957 was 131. DISEASES OF ANIMALS ACTS. No outbreaks of disease occurred within the Borough during 1957. Copies of Orders made by the Ministry of Agriculture, Fisheries and Food in respect of outbreaks of foot and mouth disease, anthrax and fowl pest, were received, but these did not give rise to any enquiries within the Borough. 34 SECTION G.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 898 cases of infectious disease notified compared with 344 in 1956 and 1,074 in 1955. The increase over 1956 was almost entirely due to the high incidence of measles. The following infectious diseases are notifiable to the Medical Officer of Health of the Borough:— Smallpox Cholera Diphtheria (including Membranous Croup) Erysipelas Scarlet Fever Typhus Enteric or Typhoid Fever Relapsing Fever Tuberculosis (all forms) Ophthalmia Neonatorum Malaria Dysentery Acute Primary Pneumonia Acute Influenzal Pneumonia Puerperal Pyrexia Measles Whooping Cough Meningococcal Infection Acute Poliomyelitis-Paralytic Acute Poliomyelitis-Non-Paralytic Acute Encephalitis-Infective Acute Encephalitis-Post Infectious Food Poisoning Plague Para-typhoid Fevers Leprosy is notifiable direct to the Chief Medical Officer of the Ministry of Health. SMALLPOX. No case of smallpox was notified in the Borough during the year but all Health Authorities were warned by the Minister of Health in June to be on the alert as the result of three cases of smallpox occurring in the Borough of Tottenham. This information was transmitted to the general medical practitioners in the district to assist them in cases of illness in which a diagnosis of smallpox was suspected. In the Ministry of Health's memorandum on vaccination against smallpox it is recommended that all Public Health Officers likely to deal at short notice with cases of smallpox should be regularly re-vaccinated at not more than yearly intervals. During the year thirteen members of the Public Health Department staff, including clerical staff, were vaccinated or re-vaccinated. 35 SCARLET FEVER. There were 59 cases of scarlet fever notified during 1957 compared with 110 in 1956, 77 in 1955 and 49 in 1954. Eleven of the cases were treated in hospital. The disease for a number of years has been mild in character. ACUTE ENCEPHALITIS. One case occurred in a boy of 7 years who was admitted to hospital and was diagnosed as suffering from acute encephalitis following an attack of measles. The boy made a good recovery. DYSENTERY. Nine cases of dysentery were notified compared with 15 in 1956, 2 in 1955, 14 in 1954, and 19 in 1953. Two of the cases were children in a residential nursery run by an outside Authority. Bacteriological investigations were carried out in the case of all the children and staff involving a total of 146 specimens being examined, and as a result 20 symptomless excreters were discovered. Arrangements were made for these to be isolated in hospital, or in the nursery, or in the case of staff, excluded from work, until such time as they were considered to be free from infection. The presence of dysentery in a nursery can be a serious matter and urgent action is necessary to prevent the rapid spread of infection. Another case occurred in a Wimbledon Maternity Hospital and concerned a woman belonging to another district. This woman was discharged from hospital apparently quite fit, following confinement, but was re-admitted three days later and subsequently diagnosed as suffering from Sonne dysentery. Stringent precautions were taken to prevent the spread of infection, the probable source of which was from the woman's home. No further cases were reported from the hospital. The 6 remaining cases occurred singly in various parts of the Borough and were unrelated to each other. POLIOMYELITIS. There were 10 confirmed cases of poliomyelitis during the year. The first 3 cases notified occurred in the latter part of June and concerned two boys aged 11 and 9 years and a girl of 6 years, all members of one family. The two boys were admitted to hospital on 26th June and the girl on 28th June. On 29th June the boy of 9 years died of the Bulbar type of poliomyelitis. The other two children recovered. It is clear that the infection in each case was contracted from a family living outside the Borough who visited the Wimbledon family early in June before proceeding to France on holiday. This family had been ill when they visited the Wimbledon family, but as they thought they had all recovered they went on holiday to France where the baby died of poliomyelitis. 36 The next case notified was an expectant mother aged 31 years who was admitted to hospital on 25th July. She was a paralytic case. On 7th August she died from paralytic poliomyelitis. On 14th August a youth of 18 years, was admitted to hospital suffering from non-paralytic poliomyelitis. The five remaining cases occurred in October, November and December, four of the five being removed to hospital. No case of poliomyelitis occurred in a vaccinated person. In view of the virulent form of the disease certain precautions were advised during the summer months. The measures advised included the temporary suspension of immunisation against diphtheria and whooping cough and the postponement of swimming galas at the Public Baths. Frequent samples of water were taken from the Public Baths to ensure that the chlorinating plant was working efficiently and that the water was chlorinated up to the requisite strength. In 1956 there were 7 confirmed cases. PUERPERAL PYREXIA. 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. During the year 25 notifications were received, all cases occurring in hospital. Of the 25 notifications, 20 of the patients had addresses outside the Borough. In 1956 10 cases were notified. MEASLES. There were 660 cases notified during the year compared with 64 in 1956. Measles is usually prevalent in alternate years and the high incidence of the disease during 1957 was not unexpected. A case of measles occurred in one of the Wimbledon Day Nurseries during the early part of the year, and in view of the prevalence of the disease in the district at the time, arrangements were made for susceptible children to have an injection of Gamma Globulin in order to prevent them from developing measles in a severe form. Fifteen susceptible children were injected, and it is gratifying to note that a number of these children who did eventually develop measles did so in a very modified form, with little constitutional upset. PARATYPHOID FEVER. There was one confirmed case. This was a man who had returned to this country from the Persian Gulf on 19th October. On 6th November he was admitted to hospital where he was diagnosed as a case of Paratyphoid Fever. Bacteriological investigations were carried out in respect of the remainder of the family but these proved negative. 37 DIPHTHERIA. There were no cases. The present level of immunisation is still below what is aimed at, and every effort is made through propaganda and other means to remind the public of the need for immunisation. Only if an adequate level of immunisation is maintained can diphtheria be driven altogether from this country. FOOD POISONING. There was one confirmed case in an old lady of 76 years who became ill after returning from holiday. Stool examination revealed that she was suffering from a form of food poisoning due to Salmonella typhi-murium. Specimens taken from other members of the household were negative, except in the case of a school-girl of 5 years, who was found to be excreting Salmonella organisms, and was excluded from school. This child subsequently became negative but the old lady remained a temporary carrier for some months. In four other cases investigated the diagnosis of food poisoning was not sustained. MENINGOCOCCAL INFECTION. This was a case of a girl of 10 years who was admitted to hospital with suspected poliomyelitis but was subsequently diagnosed as a case of meningococcal meningitis. She made a good and uneventful recovery. PNEUMONIA. Twenty-four cases of acute primary or influenzal pneumonia were notified during the year, compared with 34 in 1956 and 21 in 1955. The total number of deaths from all forms of the disease during the year was 30 compared with 23 in 1956. WHOOPING COUGH. One hundred and eight cases were notified during the year compared with 82, 139, 74, and 183 in the last four years. Two of the patients were treated in hospital. There were no deaths. EPIDEMIC INFLUENZA ("ASIAN FLU"). A letter was received from the Chief Medical Officer of the Ministry of Health in June, 1957 warning of the likelihood of outbreaks of influenza in this country, following outbreaks which had occurred in several Far Eastern countries during April, May and June. These outbreaks had been explosive in character but the epidemic passed quickly. The usual symptoms were reported to be severe headache, generalised pains and fever (101° -103° F.) lasting 2 or 3 days, and followed by four days disability. Sporadic outbreaks of Asian type influenza were first reported in the North of England about the end of July. The epidemic started in Wimbledon on or about 21st September. At its peak, school attendances at some schools in Wimbledon were between 40% and 50% below 38 normal. The percentage of new sickness benefit claims of the insured population during the week ending 15th October was 500% above the average weekly figure, but as from the week ending 22nd October there was a steady decline in new sickness benefit claims and the epidemic had subsided by early November. The Ministry of Health made available a supply of vaccine for protection against Asian influenza to Doctors and others who, by virtue of their employment, came in contact with the sick. 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, 568 requests were received from residents for certificates of vaccination or inoculation to be authenticated for the purpose of travel abroad. SMALLPOX VACCINATION. Vaccination is voluntary and every effort is made to maintain the high level of protection from smallpox which the population had at the time of compulsory vaccination. The view of the Ministry of Health is that for adequate protection 75% of infants should be vaccinated. During the year the following vaccinations were carried out in the district:— Primary vaccinations 577 Re-vaccinations 86 WHOOPING COUGH IMMUNISATION. The following figures show the number of children immunised and those who received reinforcing doses during the year (this includes those children who received the combined diphtheria and whooping cough prophylaxis). Number of children immunised 528 Number of children boosted 93 DIPHTHERIA IMMUNISATION. The following table gives details of the number of children who were immunised during 1957:— Number who completed course of immunisation 566 Number of "Booster" doses given 1,494 39 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 2,068 Between 5 and 15 years 7,210 TETANUS IMMUNISATION. In view of the fact that a boy of 11 years died of tetanus following a wound the facilities for tetanus immunisation were expanded. It is very desirable that parents should have their children immunised against tetanus. It is also advisable for all those engaged in agricultural and horticultural pursuits and also people engaged in handling horses to have this form of immunisation. POLIOMYELITIS VACCINATION. Further limited supplies of British type vaccine became available from time to time during the year. This made possible the vaccination with two injections of all the 2,017 children in the original age groups (2-9 years) who had registered for poliomyelitis vaccination by 4th April, 1956. The vaccinations were carried out at the County Council's Clinics. Towards the end of the year an extension of the scheme was announced to include (a) all children between 6 months and 15 years, (b) expectant mothers, (c) general practitioners and their families, (d) ambulance staffs and their families. The extension of the scheme was made possible by the importation of Salk vaccine from U.S.A. and Canada but the extended scheme did not commence until the early part of 1958 and does not therefore belong to this Report. 40 Notifiable diseases during 1957. 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 – 2 2 3 2 44 6 – – 59 11 – Measles 11 50 62 80 83 349 17 3 5 660 6 — Whooping Cough 7 7 7 11 13 57 5 — 1 108 2 – Acute Poliomyelitis (Paralytic) — — — — 1 2 — — 3 6i 5 2 ,, „ (Non-paralytic) — — — — — — 1 1 — 2‡ 2 — Meningococcal Infection — — — — — 1 — — — 1 1 — Puerperal Pyrexia — — — — — — — 11 14 25 25† — Dysentery 1 — 1 — 2 — — 1 4 9 4 — Paratyphoid Fever — — — — — — — — 1 1 1 — Erysipelas — — — — — — — — 1 1 — — Pneumonia (Acute Primary or Influenzal) – 1 – – 1 – 2 – 20 24 6 30* Food Poisoning — — — — — — — — 1 1 — — Acute Encephalitis — — — — — 1 — — — 1 1 — TOTALS 19 60 72 94 102 454 31 16 50 898 64 32 * All Forms. t These 25 patients were already in hospital. ‡ Two further cases were notified to Lambeth Borough Council. 41 Notifications of Infectious Disease daring the last 10 years. DISEASE 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 Diphtheria 4 6 — — — — — — — — Dysentery — 2 7 53 36 19 14 2 15 9 Encephalitis acute 1 — — — — — — — 1 1 Enteric Fever (including Paratyphoid) 1 — 3 — 1 1 — — — 1 Erysipelas 2 7 1 5 3 3 3 2 6 1 Food Poisoning 5 2 — 4 — 6 13 2 11 1 Malaria — — — 1 — — — — 1 — Measles 481 707 364 758 337 896 18 813 64 660 Meningococcal Infection 3 2 3 2 1 1 2 — 1 1 Ophthalmia Neonatorum 2 2 1 — — — 1 — — — Pneumonia 15 19 20 27 24 29 18 21 34 24 Poliomyelitis 4 10 12 4 2 11 4 11 7 8‡ Puerperal Pyrexia 5 8 1 2 5 22 4 7 12 25 Scarlet Fever 95 55 68 136 128 96 49 77 110 59 Whooping-cough 231 149 181 166 112 183 74 139 82 108 849 969 668 1,158 649 1,267 200 1,074 344 898 Tuberculosis:— Pulmonary 60* 79* 82* 56* 56* 65* 40* 36* 44 50 Non-Pulmonary 4 6 10 4 3 1 7 4 6 2 * In previous years these figures have included transfers from other areas. ‡ Two further cases were notified to Lambeth Borough Council. 42 TUBERCULOSIS. During the year 89 new cases were added to the register of tuberculous persons compared with 91 in 1956, and 84 in 1955. Of the 89 additions 52 were primary notifications and 37 were transferred from other areas. An analysis of the notifications received is given overleaf. Ninety-eight cases were removed from the register for the following reasons:— Pulmonary Non-Pulmonary M. F. M. F. Deaths from tuberculosis 3 – – – Deaths of patients suffering from tuberculosis through other causes 8 – – – Recovered cases 12 12 2 2 Removals from district 36 19 1 3 59 31 3 5 The figure of 3 deaths from all forms of tuberculosis represents a death rate per 1,000 of population of 0 05. This is the lowest tuberculosis death rate ever recorded in Wimbledon and compares with 0.14 for 1956 when there were 8 deaths. The rate for England and Wales for 1957 was 0.11. The number of deaths from tuberculosis has continued to fall for a number of years due to the use of new drugs and modern methods of treatment. The notification rate also is beginning to show a steady decline, though the number of cases notified still remains high, no doubt due to the better aids to diagnosis. Treatment for cases of tuberculosis is the responsibility of the Regional Hospital Board who provide both sanatorium and dispensary treatment. Vaccination against tuberculosis with B.C.G. (Bacille CalmetteGuerin) 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 1957 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. 43 TUBERCULOSIS 1957. AGE GROUPS CASES ADDED TO THE REGISTER DEA THS Primary Notifications (Form A) Cases Discovered otherwise than by Notification Total Cases added to the Register Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary Non- Pulmonary Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females Under 1 Year — — — — — — — — — — — — — — — — 1 — 4 Years 1 — — — — — — — — — — — — — — — 5—9 ,, — — — — — — — — — — — — — — — — 10—14 ,, 1 1 — — — — — — 1 1 — — — — — — 15 — 19 ,, 2 — — — 1 — — — 3 — — — — — — — 20 — 24 ,, 3 2 1 1 4 1 — — 7 3 1 1 — — — — 25 — 29 ,, 4 5 — — 6 3 — 1 10 8 — 1 — — — — 30 — 34 ,, 4 2 — — 4 2 — — 8 4 — — — — — — 35 — 44 „ 5 2 — — 3 3 — — 8 5 — — — — — — 45 — 54 ,, 5 1 — — 4 — — — 9 1 — — 1 — — — 55 — 64 ,, 6 2 — — 1 1 — — 7 3 — — 3 — — — 65 and Over 4 — — — 3 — — — 7 — — — 7 — — — 35 * 15 1 1 26 10 — 1 61 25 1 2 11 — — — 50 2 36 1 86 3 11 — 52 37 89 11 44