AC 4413(1) Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1958 PRINTED BY RAYNES PARK PRESS LTD., LAMBTON ROAD, LONDON, S.W.20. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1958 Public Health Department, Town Hall, Wimbledon, S.W.19. (WIMbledon 6262) August, 1959. 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 1958. This Report is compiled in accordance with the instructions contained in Circular 22/58 of the Ministry of Health and is on similar lines to previous years. I am pleased to report that the health of the Borough during 1958 was good and there were no special outbreaks of infectious disease. The live birth rate for Wimbledon in 1958 shewed a slight increase at 13.24 per thousand of the population compared with 13.16 in 1957. The rate for England and Wales for the year was 16.4. Five per cent. of the total live births were illegitimate. The death rate from all causes per thousand total population increased slightly at 9.89 compared with 9.61 in 1957. Although higher than for the preceding year, this is one of the lowest death rates yet recorded in Wimbledon. The excess of births over deaths was 124 compared with 138 in the previous year. One maternal death occurred, giving a maternal mortality rate of 1.29 per thousand live and still births. Deaths of infants under one year numbered fifteen, giving an infantile mortality rate of 18.89 per thousand live births. This compares with a rate of 22.6 for England and Wales. The principal cause of death was once again heart disease, especially coronary disease which again shewed an increase, there being 130 deaths from this cause compared with 118 in 1957. The total number of deaths from cancer also shewed an increase over last year and was the second greatest cause of death. The number of deaths from cancer of the lung was the same as for 1957 but the proportion of male cancer deaths attributed to cancer of the lung shewed an increase. 1 The tuberculosis death rate fell again last year, and at 0.03 was the lowest on record. There was also a spectacular fall in the tuberculosis notification rate, there being only 26 new cases of tuberculosis notified, compared with 52 in 1957. While fluctuations are likely to occur in dealing with relatively small numbers, this sharp decline in the notification rate is most encouraging, and it is hoped that this improved rate will be maintained in the future. Seven deaths were recorded from motor vehicle accidents, this being one more than in 1957. All other accidents accounted for 10 deaths, as compared with 16 in 1957. Suicides totalled 10 cases, compared with 6 in 1957. Notifications of infectious disease amounted to only 306 compared with 898 in 1957. The decrease was largely due to the low incidence of measles. There were no deaths from infectious diseases. Of special mention is the decrease in the number of notifications of whooping cough. Ten cases only were notified, the lowest figure since the disease became notifiable, and compares with 108 in 1957. Immunisation against whooping cough was commenced in 1952 and the average incidence of the disease has fallen since then. Although Wimbledon was completely free from diphtheria for another year, the ninth in succession, I would draw special attention to the importance of maintaining a high level of immunisation in the community. Any relaxation of the immunisation campaign could have serious results, the disease is still about and it could return in its old killing epidemic form. Only if an adequate level of immunisation is maintained can diphtheria be driven altogether from the country. Only one case of poliomyelitis was notified in the Borough during 1958, this being the lowest figure recorded in Wimbledon for the past fourteen years. Increased supplies of poliomyelitis vaccine became available during the year which enabled further progress to be made in the active immunisation of the child population against poliomyelitis. The scheme was also extended to include further groups of persons and also for a third reinforcing injection to be given seven months after the second injection. At the end of the year, 8,248 or 69% of children under the age of 15 years had been vaccinated with two or more injections. 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. May I also express my thanks to all those associated with the local Health and social services, both statutory and voluntary, for their continued co-operation during the year. In particular I would like to mention the contributions of the Senior Public Health Inspector, and my Chief Clerk, in the production of this Report, and the co-operation and loyalty of all members of the Public Health Department staff. 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 18-19 Notices Served 19 Nuisances abated and defects remedied 20-21 Factories Act, 1937, Part I 22 Outworkers 23 SECTION D: HOUSING: Overcrowding 24 Rehousing 24 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 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 33-34 Heating Appliances (Fireguards) Act, 1952 34 Clean Air Act 1956 34-35 Shops Act, 1950 36 Diseases of Animals Acts 36 SECTION G. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc. 37-40, 43-44 Vaccination and Immunisation 41-42 Tuberculosis 45-46 3 BOROUGH OF WIMBLEDON HEALTH COMMITTEE December, 1958 Alderman T. H. Metcalf, (Chairman). Alderman N. S. Clarke, 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 Mrs. M. L. Seys-Phillips. Councillor A. J. Stringer. Councillor J. A. Watson. Councillor Miss E. A. Weldon. NORTH-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE WIMBLEDON REPRESENTATIVES December, 1958 Alderman 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: P. J. Doody, M B., B.Ch., B.A.O., D.P.H. 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. (Resigned 7/12/58). F. R. Brackfield, M.A.P.H.I. Pupil Public Health Inspector: R. A. White. (Appointed 9/6/58). Assistant Rodent Officer: F. J. Reddington Chief Clerk: † j. R. Richardson, A.R.I.P.H.H. Clerks: *Mrs. D. Wilson, S.R.N. *Mrs. V. Waters. J. R. Gill. *Mrs. F. D. Ayres. † Miss I. Maidment. P. B. Stannett. (Resigned 22/6/58). *R. P. Stanton. *Miss M. J. Perry. (Resigned 28/12/58). G. Matthews. (Appointed 14/7/58). † 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-1958) 57,520 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 :—£1,222,679. Sum represented by penny rate:— £4,864. Extracts from Vital Statistics of the Year 1958. (Registrar-General's Figures.) Total M. F. Live Births Legitimate 753 398 355 Illegitimate 41 23 18 Total 794 421 373 Total M. F. Stillbirths Legitimate 19 10 9 Illegitimate 2 2 — Total 21 12 9 Live birth rate per 1,000 of the estimated home population 13.80 Corrected live birth rate per 1,000 of the estimated home population 13.24 Still-birth Rate per 1,000 total (live and still) births 25.76 Total M. F. Deaths 670 317 353 Crude Death Rate per 1,000 of the estimated home population 11.64 Corrected Death Rate per 1,000 of the estimated home population 9.89 Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births. Puerperal and post-abortive sepsis l 1.29 Other maternal causes Total 1 1.29 Death Rate of infants under one year of age:— All infants per 1,000 live births 18.89 Legitimate infants per 1,000 legitimate live births 21.20 Illegitimate infants per 1,000 illegitimate live births — Deaths from cancer 129 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 1958. Provisional Figures Based on Quarterly Returns of Registrar-General. Wimbledon England and Wales Rates per 1,000 Home Population Births:— Live Births 13.24 16.4 Still Births 0.36 0.36 25.76* 21.52* Deaths:— All Causes 9.89 11.7 Coronary and arteriosclerotic heart disease 2.26 1.86 Whooping Cough — 0.00 Diphtheria — 0.00 Tuberculosis - all forms 0.03 0.10 Influenza — 0.05 Smallpox — 0.03 Acute Poliomyelitis (including Polioencephalitis) — 0.00 Pneumonia 0.45 0.54 Malignant Neoplasm - Lung, Bronchus 0.50 0.44 Maternal Mortality 1.29* 0.43* Notifications:— (Corrected) Scarlet Fever 1.39 0.86 Whooping Cough 0.17 0.74 Typhoid and Paratyphoid Fever 0.02 0.00 Meningococcal Infection — 0.01 Acute Encephalitis — 0.00 Diphtheria _ 0.00 Erysipelas 0.52 0.07 Smallpox _ 0.00 Measles 2.33 5.74 Pneumonia 0.43 0.49 Acute Poliomyelitis — Paralytic 0.02 0.03 Non-paralytic _ 0.13 Food Poisoning 0.14 0.19 Dysentery 0.42 0.84 Tuberculosis — Pulmonary 0.43 0.58 Non-pulmonary 0.02 0.77 Puerperal Pyrexia 23.31* 14.26* Rates per 1,000 Live Births Deaths:— Infant Deaths (all causes under 1 year) 18 89 22.6 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, 57,520 shews an estimated decrease of 110 on the previous year, although the natural increase by excess of births over deaths was 124. 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 1958, the total number of registered live births belonging to Wimbledon was 794. Of this number, 421 were males and 373 females. This gives a birth-rate of 13.80 per thousand of the population as compared with a rate of 13.71 per thousand in 1957, and an average of 13.12 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 1958 was 13.24 per thousand of the population, whilst the rate for England and Wales was 16.4 and has averaged 16.0 over the past five years. Stillbirths - The number of stillbirths registered during the year was 21 (12 males and 9 females), this being 3 more than last year. The stillbirth rate for Wimbledon was 0.36 per thousand of the population, whilst that for England and Wales was also 0.36. Illegitimacy - Of the live births registered in 1958, 41 (23 males and 18 females) were illegitimate, this being 8 more than in the preceding year. Two of the 21 stillbirths registered were illegitimate. DEATHS. The total number of Wimbledon residents who died during 1958 was 670 (317 males and 353 females), giving a death-rate of 11.64 per thousand of the population as compared with 11.31 per thousand for 1957. The corrected death-rate for 1958 was 9.89 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 257, whilst 418 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 256 38% Cancer 129 19% Vascular lesions of nervous system 107 16% Diseases of the respiratory system 76 11% Totals 568 84% 8 The following is an analysis of the causes of death :— Cause Mala Females Total 1. Respiratory tuberculosis 1 - 1 2. Other tuberculosis 1 - 1 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 13 9 22 11. Malignant neoplasm, lung, bronchus 25 4 29 12. Malignant neoplasm, breast - 11 11 13. Malignant neoplasm, uterus - 1 1 14. Other malignant and lymphatic neoplasms 37 26 63 15. Leukaemia - 3 3 16. Diabetes 1 2 3 17. Vascular lesions of nervous system 31 73 104 18. Coronary disease, angina 63 67 130 19. Hypertension with heart disease 8 8 16 20. Other heart disease 22 52 74 21. Other circulatory disease 15 21 36 22. Influenza - - - 23. Pneumonia 11 15 26 24. Bronchitis 25 13 38 25. Other diseases of respiratory system 8 4 12 26. Ulcer of stomach and duodenum 4 1 5 27. Gastritis, enteritis and diarrhoea 1 3 4 28. Nephritis and nephrosis - 1 1 29. Hyperplasia of prostate 8 - 8 30. Pregnancy, childbirth, abortion - 1 1 31. Congenital malformations 3 3 6 32. Other defined and ill-defined diseases 22 23 45 33. Motor vehicle accidents 7 - 7 34. All other accidents 3 7 10 35. Suicide 6 4 10 36. Homicide and operations of war - - - Totals 317 353 670 MATERNAL MORTALITY There was one death associated with childbirth during 1958 compared with a nil return for the preceding year. The cause of death in this case was acute puerperal metritis following a live delivery in an institution situated outside the Borough. This maternal death was only the third which has occurred in the Borough during the past ten years. 9 The following table sets out the number of deaths and death rates per thousand total live and stillbirths for 1958:— ] Number of Deaths Rate England and Wales Maternal causes, excluding abortion 263 0.35 Due to abortion 63 0.08 Total maternal mortality 326 0.43 Wimbledon Maternal causes, excluding abortion 1 1.29 Due to abortion Nil Nil Total maternal mortality 1 1.29 The estimated mid-1958 female population for England and Wales age 15-44 was 9,016,000. INFANTILE MORTALITY. During 1958 there were 15 deaths among infants under one year, compared with 9 in 1957 and an average of 14 in the last ten years. None of the deaths was in respect of an illegitimate child. The resultant infant mortality rate for Wimbledon per thousand live births was 18.89. The infant mortality rate for England and Wales in 1958 was the low record of 22.6, the lowest previously recorded being 23.1 in 1957. Six of the deaths were due to congenital defects or birth injuries and four due to prematurity. Three children died from atelectasis (that is failure of lungs to expand at birth) and there was one death from pneumonia. The cause of death in the remaining case was certified as haemolytic disease of the newborn. The number of neo-natal deaths (i.e. those occurring during the first four weeks of life) was 12, giving a neo-natal death rate of 15.1 per thousand live births, as compared with a rate of 16.2 for England and Wales. The following table shows the causes of the 15 deaths which occurred during 1958, together with the age at death. 10 11 Infantile Mortality During 1958. 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 4 — — — 4 2 — — — 6 Prematurity 4 — — — 4 — — — — 4 Pneumonia — — — — 1 — — — 1 Atelectasis 3 — — — 3 — — — — 3 Diseases of the newborn 1 — — — 1 — — — — 1 Totals 12 — — — 12 3 — — — 15 Infantile Mortality during the last 10 years. Cause of death 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Prematurity 5 5 3 3 5 5 2 1 3 4 Congenital defects or birth injuries 12 2 9 6 4 5 5 5 3 6 Diseases of the newborn — 1 2 — — — — — — 1 Gastro-enteritis 1 2 1 Pneumonia 1 — 1 1 1 1 2 2 1 1 Bronchitis — 2 — — — — — — 1 — Whooping cough 1 — — — — — — — — — Septicaemia — 1 1 — — — — 1 — — Asphyxia (unknown cause) — — — — — — — — 1 — Accidental death 2 1 1 — 1 1 2 — — — Inattention at birth — — — — — — — — — — Atelectasis — — — — — — — — — 3 22 14 17 10 12 12 11 10 9 15 Total neo-natal deaths included above 14 8 14 6 9 11 8 7 8 12 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 9.88 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 1958 13.24 16.4 0.36 0.36 9.89 11.7 1.29 0.43 18.89 22.6 * From 1940 to 1948 the local death-rate could not be corrected as the publication of an area comparability factor was suspended. Consequently it is not strictly possible to compare the death-rate for Wimbledon with that for England and Wales for those years. SECTION B. — GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 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 50 Faeces for the typhoid and dysentery groups 406 Ice-cream samples 96 Milk samples 167 Water samples 73 Miscellaneous 12 Total 804 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 90 beds. No new homes were registered. One maternity hospital and one nursing home were exempted, on an annual basis, from registration under Section 192 of the Public Health, 1936. The nursing homes were periodically inspected and supervised. Eight routine visits were made during the year. 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. 14 MASS RADIOGRAPHY. The Mass Radiography Unit of the South West Metropolitan Regional Hospital Board has made a practice of visiting Wimbledon for two weeks every year, when facilities are made available for the free x-ray of the chest for all persons over the age of 15 years. During 1958 in an effort to get a larger response from the public a more intensive survey was organised than in previous years. A static unit was stationed at the South Wimbledon Methodist Church Hall for four weeks from 27th May until 17th June, and other units were stationed at the T.A. Centre, St. Georges Road, from 27th 30th May and at Wimbledon Park Hall, Arthur Road, from 2nd - 6th June. I am indebted to the Medical Director of the Mass Radiography Service for the following details of the findings of the survey. Number of persons examined: Males 2,999 Females 3,085 6,084 A bnormalities discovered: (i) Pulmonary tuberculosis requiring treatment or close clinic supervision : Males 5 Females 3 8 (ii) Pulmonary tuberculosis requiring occasional clinic supervision : Males 1 Females 6 7 (iii) Primary lung cancer : Males 2 Females - 2 As the facilities were available to all, whether they resided in the Borough or not, the figures do not necessarily relate to Wimbledon residents only. The examination is of value in the early diagnosis and treatment of pulmonary tuberculosis and other non-tuberculous abnormalities. 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. In one case during 1958 it was found necessary for the Council to apply to the Court for an Order under Section 47 of the 1948 Act. Every effort had been made to get this old lady, who was partially blind, to accept help from the domiciliary services but she resolutely refused every offer of help, and in September an Order was granted by the Court for the old lady to be removed to hospital. The Court later granted an extension of the Order, and at the end of the year the patient was still in hospital. During 1958 a number of other cases were brought to the notice of the Public Health Department for investigation where it was felt that action under Section 47 might be necessary and it is gratifying to be able to report that a satisfactory solution was found to each particular problem without resorting to compulsory powers. The care of the aged will continue to be an evergrowing preoccupation for many sections of the Health service, and in this regard the effective work done by District Nurses and Home Helps in keeping many old people in reasonable comfort in their own homes should be mentioned. The close liaison between the local doctors, the Geriatric Department of St. Helier Hospital, the Divisional Welfare Officer, the voluntary organisations in Wimbledon dealing with the aged, and your Medical Officer of Health, continues. 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 four exceptions all the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. During the year 1958 samples of water were taken for bacterological and/or chemical examination, as follows: — Bacteriological. Wimbledon Corporation Swimming Baths 50 Dwelling houses :Well water 13 Metropolitan Water Board supply 4 17 Other premises :- Metropolitan Water Board supply 2 Spring outlet near Caesar's Well 4 73 Four of the reports upon samples of Swimming Bath water indicated that chlorination appeared to be inadequate to maintain the purity of the water. Immediate action resulted in subsequent samples proving satisfactory. The Bacteriologist reported that one sample of water from the spring outlet near Caesar's Well should be regarded with suspicion. As the result of correspondence, action was taken by the Chief Ranger, and subsequent samples proved satisfactory. All other samples of water proved bacteriologically satisfactory. Chemical. Wimbledon Corporation Swimming Baths 2 Dwelling houses :Well water 6 8 A sample of well water taken from a pump line in a house owned by the Corporation was found to contain lead. As the result of discussions on the site, the pipe line from the well was taken up and re- 17 laid in alkathene tubing. Samples taken after completion of this work indicated that no lead was present. Subsequent samples have proved satisfactory. All other samples of water proved chemically satisfactory. inspection of the District. The following is a summary of the complaints received and the visits made during the year 1958 :— Complaints received. General disrepair and insanitary conditions 262 Dampness 157 Overcrowding 25 Defective drainage systems 32 Blocked drainage systems 111 Defective drainage fittings 29 Defective W.C. pans and/or flushing apparatus 40 Defective service water pipes 15 Absence of or defective dustbins 57 Accumulations of refuse, etc 43 Rats and mice 247 Insect pests, etc 95 Smoke nuisances 40 Unsound food 131 Miscellaneous 120 1,404 Visits made. Infectious diseases. Inquiries re cases of infectious disease 228 Visits re disinfection 44 Miscellaneous 137 Housing. Dwelling houses (Housing Act) 243 Dwelling houses (Public Health Act) 1,652 Rent Act, 1957 342 Overcrowding 79 Underground rooms 95 Tents, vans, etc 8 Miscellaneous 327 Food and Food premises. Dairies and milk distributors 21 Ice-cream premises 85 Bakehouses 24 Butchers' shops 92 Meat preparation premises 22 Fish shops 36 Fried fish shops 6 Restaurant kitchens 121 18 Other food premises 289 Visits re unsound food 212 Sampling: food and drugs 160 Sampling: milk 181 Sampling: ice-cream 96 Sampling: water 80 Miscellaneous 325 General. Places of public entertainment 2 Drainage and plumbing work 625 Stables and piggeries 3 Smoke observations and Clean Air Act, 1956 286 Riding Establishments Act 1939 1 Pet Animals Act, 1951 27 Factories (P.) 41 Factories (N.P.) 5 Factories (Building sites) 3 Outworkers' premises 1 Shops Act, 1950 (Vent. temp, etc.) 1 Shops Act, 1950 (Shop hours) 40 Hairdressers and barbers 4 Petroleum (Consol.) Act, 1928 133 Heating Appliances (Fireguards) Act, 1952 12 Watercourses 17 Rodent control 4,547 Insect infestations 150 Refuse storage 107 Accumulations 169 National Assistance Act 1948 2 Massage, etc. establishments 2 Miscellaneous 370 11,453 Notices Served. Preliminary notices or intimations 473 Statutory Notices 81 Other letters 2,514 Result of Service of Notices. (1) Legal Proceedings Legal proceedings were instituted against an owner/occupier of a dwelling house to recover the cost of works carried out by the Council to the soil drainage system. The owner/occupier had failed to comply with a Notice served under Section 53 of the Wimbledon Corporation Act 1933. The case was dismissed. 19 (2) 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 175 Reconstructed 94 Cleansed 64 Soil pipes and ventilation shafts repaired or renewed 18 Inspection chamber covers renewed 11 Fresh air inlets repaired or renewed 12 New W.C. pans provided 41 Water waste preventors repaired or renewed 14 Gutters and rainwater pipes repaired or renewed 60 New lavatory basins provided 4 New baths provided 4 Waste pipes trapped, repaired or renewed 13 Gully surrounds repaired 18 Miscellaneous 34 General Housing repairs. Roofs repaired 103 Yards paved or repaired 12 Dampness remedied 125 Damp-proof courses provided 9 Sub-floor ventilation provided 5 Walls and ceilings repaired 213 New ceilings constructed 3 Walls cleansed 142 Ceilings cleansed 80 Floors repaired or renewed 57 Additional light and ventilation provided 3 Windows repaired or renewed 171 Doors repaired or renewed 45 Fireplaces repaired or renewed 25 Service water mains repaired 4 Additional light and ventilation provided to W. C. apartments 4 Miscellaneous 259 Food premises. Food shops reconstructed 1 Walls repaired or redecorated 16 Ceilings repaired or redecorated 13 Floors renewed or repaired 6 Woodwork repaired or repainted 4 Lighting provided or improved 4 Ventilation provided or improved 9 Fresh air inlets removed and drain inlets trapped 13 Infestation risks removed 3 Sinks provided 4 Hot water provided to sink 7 20 Detergent provided 4 Clean cloths provided 2 Overall clothing provided 4 First aid kit provided or improved 15 Water supply provided 17 Cold Storage facilities provided 1 Risks of contamination removed 28 Outdoor clothing store provided 7 Refuse storage improved 4 Wash-hand basins provided 19 Hot water provided to wash-hand basin 24 Soap provided 19 Nailbrush provided 21 Clean towels provided 18 Sanitary accommodation provided/repaired 5 Intervening ventilated space provided 4 Lighting in sanitary accommodation provided 9 Ventilation in sanitary accommodation provided 2 Hand washing notices fixed 17 Rodent Control. Defects remedied in connection with ratproofing work are included in foregoing lists. Miscellaneous. Accumulations removed 3 New dustbins provided 19 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 95 5 — Factories with mechanical power 261 41 3 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 9 3 — — Totals 365 49 3 — 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 3 6 — 3 — Not Separate for Sexes — — — — — Other Offences (Excluding offences relating to outwork) — Totals 3 6 — 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. 29 — — — — — Others 4 — — — — — Total 33 — — — — — Number of addresses received from other Councils 63 Number of addresses forwarded to other Councils 39 Number of premises where outwork was carried on at the end of 1958 73 Inspections of outworkers' premises 1 Outwork in infected premises (Section 153, Public Health Act, 1936) Nil OTHER MATTERS. Failure to affix Abstracts of Act notified to H.M. Inspector of Factories 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 1957, Part IV — Overcrowding. (a) (i) Number of dwellings known to the Department to be overcrowded at the end of the year 69 (ii) Number of families dwelling therein 79 (iii) Number of persons dwelling therein 361 (b) Number of new cases of overcrowding reported during the year 16 (c) (i) Number of cases of overcrowding known to have been relieved during the year 4 (ii) Number of persons concerned in such cases 20 (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, 1958 :— Number of houses requisitioned since the beginning of the war and still held under requisition 199 Number of prefabricated bungalows provided since the end of the war 71 (At the end of 1958 4 had been demolished). Number of families rehoused by the Council or by private owners at the Council's instigation since the beginning of the war 2,232 Number of live applications on the housing fist for:— (a) accommodation in Wimbledon 517 (b) accommodation in Frimley and Camberley 227 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 1958 : Private enterprise 74 Local authority 1O Number of flats created by conversion in 1958 : Private enterprise 62 Local authority Nil 24 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. The following is a summary of the position on the 31st December, 1958:— Applications for Certificates of Disrepair (Form I) 195 Applications withdrawn by applicants 8 Forms J sent to landlords 170 Undertakings given by landlords (Form K) 95 Certificates of Disrepair issued (Form L) 73 Applications for Cancellation of Certificates of Disrepair (Form M) 35 Certificates of Disrepair cancelled 22 Number of visits made in connection with applications for Certificates of Disrepair — 342. Legal proceedings. Application was made to the County Court by a tenant, for direction that a Certificate of Disrepair should have been issued in respect of certain defects. The application was dismissed, and costs were awarded against the Applicant. 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 25 Pasteurised Milk 26 Sterilised Milk 33 Supplementary Licences— Tuberculin Tested Milk 11 Pasteurised Milk 11 Sterilised Milk 10 116 During the year 167 samples of designated milk were submitted for bacteriological examination. The results were as follows:— Designation Satisfactory. Unsatisfactory. Pasteurised 142 Nil Tuberculin Tested (Pasteurised) 12 Nil Sterilised 11 Nil Tuberculin Tested (Farm bottled) 2 Nil Four 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 96 samples were submitted for bacteriological examination. The results were as follows:— Grade 1 94 Grade 2 Nil Grade 3 2 Grade 4 Nil 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. 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 Acts 1933 to 1954, during the year 1958. 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 70 Confectioners 133 Ice-cream premises 214 Bakers 38 Grocers 132 Provision dealers 91 Butchers 46 Fishmongers 25 Milk distributors 36 Chemists 25 Licensed premises 73 Clubs 30 Restaurants and Cafes 83 Works canteens 10 School canteens 47 Kitchens (Hospital and Central Kitchens) 5 Food stalls 11 1,069 The initial inspection of these premises has been continued during the year 1958, but the work was still not completed by the end of the year due to the time spent in the administration of other recent legislation. 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 136 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 31 The number of inspections of registered food premises during 1958 was 226. 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 1958:— cwts. qrs. lbs. Canned soups 2 25 Canned meat 11 0 6 Canned fish 1 0 Canned vegetables 2 1 26 Canned fruit 4 3 1 Canned milk or cream 1 3 23 Meat, bacon, poultry, etc. 21 3 14 Fish 4 3 23 Butter, fats and cheese 1 0 14 Sugar, jam, etc. 2 Flour, bread, cereals and biscuits 5 Pickles and sauces 1 Dried fruit 2 4 Spaghetti, macaroni, etc. 2 Pearl barley 1 0 7 Split peas, haricot beans 2 13 51 1 26 28 Sampling of Food and Drugs. The following samples were submitted to the Public Analyst during 1958, with the results shown:— Articles Total Formal Informal Genuine NonGenuine or Irregular Ammoniated tincture of Quinine 1 1 — 1 — Apples 1 1 — 1 — Apricots in syrup 1 1 — 1 — Barley 1 1 — 1 — Bicarbonate of Soda 1 1 — 1 — Bread, wholemeal 1 1 — 1 — Breadcrumbs 2 1 1 2 — Caterpillars, roasted 1 1 — 1 — Cheese spread 1 — 1 1 — Chicken fillets, canned 1 — 1 1 — Chocolate spread 1 — 1 1 — Chocolate wafer biscuit 1 — 1 1 — Cinnamon, ground 1 — 1 1 — Cocoa 1 1 — 1 — Coffee powder 1 1 — 1 — Coffee & chicory essence 1 1 — 1 — Confectionery, sugar 10 9 1 10 — Confectionery, flour 3 3 — 3 — Corned beef 1 1 — 1 — Cordials 8 7 1 8 — Curry powder 1 1 — 1 — Currants 1 1 — 1 — Dates 2 1 1 2 — Dragees, tinted 1 1 — 1 — Figs 1 1 — 1 — Fish cakes 1 1 — 1 — Flavouring, almond 1 1 — 1 — Flavouring, lemon 1 1 — 1 — Fruit pie 1 1 — 1 — Fruit salad 1 — 1 1 — Game pate 1 1 — 1 — Gelatine 1 1 — 1 — Ginger beverage 1 1 — 1 — Glace cherries 1 1 — 1 — Glucose 1 1 — 1 — Gravy powder 2 2 — 2 — Grapes 1 1 — 1 — Haricot beans 1 — 1 1 — Icing sugar 2 — 2 2 — Jellies 2 1 1 2 — Lemonade powder 1 1 — 1 — Luncheon meat 1 1 — 1 — Meringue powder 1 — 1 — 1 Milk 60 60 — 60 — Milk, evaporated 1 1 — 1 — Milk, sweetened condensed 1 1 — 1 — Milk beverage 2 2 — 2 — Mincemeat 1 1 — 1 — Mineral water 3 3 — 3 — Mushroom soup 1 1 — 1 — Mustard, ready mixed 1 1 — 1 — Oatmeal 1 1 — 1 — Olive oil 1 1 — 1 — Onions, dried 1 1 — 1 — C/Fwd. 139 124 15 138 1 29 Articles Total Formal Informal Genuine NonGenuine or Irregular B/Fwd. 139 124 15 138 1 Peanut butter 1 1 — 1 — Peanuts, salted 1 — 1 1 — Peas, split 1 1 — 1 — Peas, dried 2 2 — 2 — Peal, mixed 3 1 2 3 — Pepper, white, ground 1 — 1 1 — Pork pie 1 1 — 1 — Port flavoured beverage 1 — 1 1 — Potato crisps 1 1 — 1 — Potato, instant 1 1 — 1 — Puff pastry, frozen — — 1 1 — Raisins — 1 — 1 — Rice 1 1 — 1 — Sage and onion stuffing 2 2 — 2 — Salmon, canned 1 1 — 1 — Sauce 1 1 — 1 — Sausages, beef 1 1 — 1 — Sausages, pork 4 4 — 3 1 Savoury straws 1 — 1 1 — Sherbet 1 1 — 1 — Soup powder 1 — 1 1 — Strawberry mousse 1 1 — 1 — Sugar corn 1 1 — 1 — Sultanas 1 1 — 1 — Tea 3 3 — 3 — Tomatoes, canned 1 1 — 1 — Vinegar, malt 2 2 — 2 — Whisky 4 4 — 4 — Totals 180 157 23 178 2 The following samples were submitted for special examination: — Articles Total Formal Informal Genuine NonGenuine or Irregular Brown bread 1 — 1 — 1 Fat-sugar mixture 1 — 1 1 — Iced cake 1 — 1 — 1 Lemon curd 1 — 1 — l Malt extract with cod liver oil 1 — 1 1 – Peanut butter 1 — 1 — 1 Sage and onion stuffing 1 — 1 — 1 Steak and kidney pie 1 — 1 — 1 White bread 3 — 3 1 2 Totals 11 — 11 3 8 It will be seen that adverse reports were received upon ten samples and the following is an account of the action taken in respect thereof. 30 Meringue powder. The Public Analyst, in reporting upon an informal sample of meringue powder, observed that it contained no milk solids although the label on the packe stated that milk solids were included in the ingredients. The article contained skimmed milk powder and he considered that "milk solids" was not an appropriate designation of skimmed milk powder. Following correspondence, the manufacturers stated that this matter had been brought to their attention previously by another Local Authority, and in consequence the product was now being marketed in printed packets upon which the words "skimmed milk powder" had been substituted for "milk solids". The vendor withdrew his existing stock from sale. Pork sausages. The Public Analyst reported that this formal sample of pork sausages contained 55% meat, including fat, and that in his opinion pork sausages of ordinary commercial quality should contain not less than 65% meat, including fat. The manufacturer of these sausages was discussed with the butcher concerned, and it appeared that the deficiency of meat in the sample was due to the improper making of ingredients. The butcher undertook to ensure that greater care would be exercised in the future manufacture of sausages and pending the taking of further samples, no action was taken against the butcher. Brown bread. A loaf of brown bread sold to the Surrey County Council and delivered to a Children's Day Nursery in Wimbledon, was found to contain shreds of tobacco. Legal proceedings were instituted against the bakers under the provisions of the Food and Drugs Act 1955 for selling a loaf which was not of the substance demanded by the purchaser. The Defendants pleaded guilty and were fined £10 and ordered to pay £2. 2s. 0d. costs. Iced cake. The remains of an iced cake were submitted to the Public Analyst for examination following a complaint that the cake had an unpleasant taste. Examination of the synthetic cream filling, which consisted of fat, sugar and other ingredients, revealed an unpleasant taste, and the fat was found to be rancid. Investigation of the materials used in the manufacture of these cakes and of the methods used in marketing, has prevented a recurrence of this complaint. Lemon curd. A 1 lb. jar of lemon curd, in the top of which were found strands of fibrous matter, was submitted to the Public Analyst for examination. The fibrous matter was found to consist of a piece of coarse string, some 11 ins. in length. No other foreign matter was detected. The manufacturers of the lemon curd were interviewed and informal steps were taken to prevent a recurrence. Peanut butter As the result of a complaint, a partly filled screw capped glass jar of peanut butter was submitted to the Public Analyst for examination, and was found to contain a large fragment of glass. The characteristics of the glass fragment were similar to those of the jar, which was itself 31 intact. No other fragments, splinters or powdered glass were detected in the remaining peanut butter. The Health Committee considered the observations of the manufacturers, together with reports by the Public Analyst and the Senior Public Health Inspector, and Resolved that a warning letter be sent to the manufacturers. Sage and onion stuffing. A complaint was received from the purchaser of a packet of sage and onion stuffing that upon the day of purchase a small maggot was seen beneath the outer cellophane wrapping. The packet was submitted to the Public Analyst intact, and he reported that there were signs of an insect infestation on the surface of the inside wrapper, but that no larvae or pupae were found in the contents of the packet. The retailer withdrew his remaining stock of this article from sale, for destruction. Steak and kidney pie. As the result of a complaint, a steak and kidney pie, purchased at a local shop by a Wimbledon resident, was submitted to the Public Analyst for further examination. The presence of mould growths on the pie crust was confirmed. The retailer was summoned under the provisions of the Food and Drugs Act 1955 for selling a steak and kidney pie which was not of the quality demanded by the purchaser. The Defendant pleaded guilty and was fined £10 and was ordered to pay £4. 4s. Od. costs. White bread (1). Seven slices from a white sliced, wrapped loaf of bread, four of which contained foreign matter in the form of dark coloured streaks and patches, were submitted to the Public Analyst for examination. He reported that the foreign matter consisted of cooked dough contaminated with mineral oil or grease. As the result of investigations at a local bakery, the offending material was found to be lubricating oil used on the bread making machinery. A warning letter was sent to the firm concerned, and immediate remedial action was taken. White bread (2). Several slices from a white sliced, wrapped loaf of bread, were found upon examination to be contaminated with a pink mould growth of the species monila sitophila, a mould which grows rapidly and which can quickly cover the surface of infected bread. It is probable that the bread was infected at the time of slicing and packing. Upon investigation there appeared to be no reason to suppose that the mould growth was apparent at the time of the sale of the bread. Probably the spore growth was present at that time and that ideal conditions existed afterwards for its further development. Immediate remedial action was taken by the local bakery firm concerned, and no further complaints were received. Other Legal Proceedings. The joint proprietors of a food stall were summoned under the provisions of the Food and Drugs Act 1955 for using tobacco whilst they were handling open food. Both the Defendants pleaded guilty and were each fined £2 and 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 1958. 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 1 11 12 3 — 7 — 4547 Private Premises 217 602 819 139 63 150 59 All other including Business Premises 49 290 339 30 11 48 10 Totals 267 903 1170 172 74 205 69 4547 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 1958 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. 61 licences were issued by the Department to store petroleum spirit during 1958, and the total quantity of petroleum spirit stored was 101,732 gallons. In addition, 23 licences were issued to store petroleum mixtures involving a total of 9,320 gallons, and 3 licences were issued in respect of the storage of a total of 42 cwts. of calcium carbide. 133 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 1958. 27 visits were made to these premises and various infringements of the conditions of licence were rectified. 33 Legal Proceedings. An application was received for a licence to keep a Pet Shop at premises within the Borough. The premises were inspected, and the Health Committee, after considering a report thereon, refused to grant a licence. The applicant appealed to the Court against the Council's decision, and the Court dismissed the appeal. HEATING APPLIANCES (FIREGUARDS) ACT, 1952. During 1958, 12 visits were made in connection with the Act and 34 appliances were examined and the prescribed tests applied. 28 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 1958 40 complaints were received with regard to smoke or grit emission, and the necessary observations were made and remedial action taken. 286 visits of inspection were made in connection with these complaints, and to boiler houses situated in industrial premises. There was during the year a continued improvement with regard to the emission of smoke from industrial installations in the town. This, I think, is due to the provisions of the Clean Air Act 1956, and to the cooperation of the firms concerned. Conversion from solid fuel to oil burning has taken place in several premises, and the operation of solid fuel furnaces at a Power Station ceased during the year. "Prior approval" was given to the installation of a new oil fired boiler installation at industrial premises, and to the conversion of two existing coal fired boilers to oil burning. The work was in progress at the end of the year, and it is anticipated that when completed the new plant will efficiently replace equipment which has from time to time caused a nuisance from smoke and grit. During 1958 two standard deposit gauges and two lead peroxide instruments were sited, one of each at Wimbledon Cemetery and at Cannizaro Nursery. These two sites were approved by the Department of Scientific and Industrial Research and recordings were commenced on the 1st April, 1958. After exposure for one month, the collecting jars and lead peroxide candles are sent to the Public Analyst for examination. When the results are received, a copy of each is sent to the Department of Scientific and Industrial Research for publication in the Atmospheric Pollution Bulletin, together with the results of observations by 415 Local Authorities and other Organisations. 34 The following tables give the results of recordings up to December, 1958:— Cannizaro Nursery Site. Month Deposit per month (in tons per sq. mile) SO2 per day (in milligrams per 100 sq. centimetres of candle) Insoluble Solids Soluble Solids Total Solids April 5.3 4.5 9.8 1.3 May 3.7 5.1 8.8 0.45 June 2.5 10.9 13.4 0.6 July 3.5 5.5 90 0.6 August 2.0 3.6 5.6 0.3 September 11.7 15.6 27.3 0.6 October 2.4 4.3 6.7 0.8 November 4.2 6.5 10.7 3.2 December 5.2 4.9 10.1 1.8 Wimbledon Cemetery Site. Month Deposit per month (in tons per sq. mile) SO2 per day (in milligrams per 100 sq. centimetres of candle) Insoluble Solids Soluble Solids Total Solids April 6.1 5.5 11.6 2.0 May 4.6 5.7 10.3 0.7 June 4.2 10.6 14.8 0.7 July 8.0 5.9 13.9 0.45 August 3.0 6.2 9.2 0.5 September 4.7 7.2 11.9 0.9 October 3.0 5.1 8.1 1.3 November 6.1 8.0 14.1 1.9 December 3.1 8.6 11.7 2.6 During the year the Council appointed the Chairman of the Health Committee and the Senior Public Health Inspector as their representatives on the Standing Conference convened by the Department of Scientific and Industrial Research and comprising all the co-operating bodies involved in the investigation of atmospheric pollution. At the time of writing consideration is being given to a Clean Air Programme to enable the whole of the Borough to be eventually declared a Smoke Control Area. 35 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 have been carried out to ensure 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 1958 was 41. DISEASES OF ANIMALS ACTS. No outbreaks of disease occurred within the Borough during 1958. 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. Two premises, which are licensed by the Council under the Diseases of Animals (Waste Foods) Order 1957 for the boiling of foodstuffs for the feeding of animals, were inspected and found to be satisfactory. 36 SECTION G. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 306 cases of infectious disease notified compared with 898 in 1957 and 344 in 1956. The decrease was due mainly to a drop in the number of notifications 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. There were no cases notified in Wimbledon during 1958, but this disease is still prevalent in some parts of the world and constant vigilance has to be maintained. From time to time notice is received of persons arriving in this country who have been in contact with smallpox. All such contacts are kept under surveillance until the possibility of developing the disease has disappeared. Vaccination against smallpox is voluntary and every effort is made to maintain the high level of protection 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. 37 SCARLET FEVER. There were 80 cases of scarlet fever notified during 1958 compared with 59 in 1957, 110 in 1956 and 77 in 1955. Nineteen of the cases, all children, were treated in hospital. There was no mortality from the disease, which continued to be of a mild type. PARATYPHOID FEVER. One case was notified. This was a girl of 9 years who was admitted to hospital at the beginning of October for investigation and was found to be infected with Salmonella paratyphosus B. Faecal specimens from other members of the family were sent for examination but these proved to be negative. The water supply was also tested with negative results. Towards the end of November the child was taken home from hospital by her parents although she was still excreting paratyphoid organisms in her faeces and urine. The Ministry of Health were informed but it was felt that there was no action that could be taken to prevent discharge. Shortly after the girl had returned home her sister, aged 6 years, although having no clinical symptoms, was also found to be excreting paratyphoid organisms. Special precautions as regards personal hygiene were advised for the two sisters, with the full co-operation of the parents. After six consecutive negative specimens had been obtained from each sister they were both allowed to return to school. ERYSIPELAS. Of three cases notified, two were removed to hospital. All recovered. DIPHTHERIA. There were no cases. Freedom from diphtheria can create the impression that the danger from this dreaded disease has disappeared, and this can result in apathy towards immunisation. Diphtheria is still about, in fact during 1958 in England and Wales, 78 cases of diphtheria were notified and there were eight deaths. By comparison in 1948, 3,575 cases of diphtheria were notified and there were 156 deaths. These figures clearly indicate the value of immunisation. It is still very important that parents should ensure that their children are kept as highly immune as possible against diphtheria by early immunisation and periodical reinforcing doses. FOOD POISONING. Eight cases were notified. In one of these the patient suffered intermittent diarrhoea during her pregnancy and after the birth of her baby in hospital Salmonella typhi-murium was isolated from faecal specimens. On discharge from hospital the mother remained a carrier and later the three children of the family were also found to be excreting Salmonella organisms, although clinically free from symptoms. The father was at all times negative. At the end of the year negative reports were obtained from all the carriers but supervision of the family was still being continued. 38 In another case the patient, a man of 46 years, was admitted to hospital suffering from diarrhoea, sickness and abdominal pain, and while there Salmonella typhi-murium was isolated from a specimen of faeces. Bacteriological investigation of the patient's family was carried out but the results proved negative. As the patient was a grocery and provision merchant, faecal specimens were also obtained from six members of the staff of his shop, but these again proved to be negative. In two other cases of food poisoning which were investigated, the organism responsible was also Salmonella typhi-murium, and in a third case the organism isolated was Salmonella newport. Another incident concerned a husband and wife who suffered diarrhoea and sickness within a few hours of one another. Bacteriological examination of faecal specimens and remnants of the food consumed did not reveal any specific food poisoning organism. In the remaining single isolated case bacteriological examination again failed to establish the nature of the causal organism. MEASLES. One hundred and thirty-four cases of measles were notified during the year compared with 660 in 1957. No death from the disease was recorded. Generally speaking, the disease was mild in character and all the cases notified were nursed at home. PUERPERAL PYREXIA. The Puerperal 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 19 notifications were received, all but one of the cases occurring in hospital. Of the 19 notifications, 16 of the patients had addresses outside the Borough. In 1957 25 cases were notified. PNEUMONIA. Twenty-five cases of acute primary or influenzal pneumonia were notified during the year, compared with 24 in 1957 and 34 in 1956. The total number of deaths from all forms of the disease during the year was 26 compared with 30 in 1957. POLIOMYELITIS. Only one case occurred. This was a schoolboy of 9 years who was admitted to hospital in the early part of December with weakness of the left leg, and was later diagnosed as suffering from paralytic poliomyelitis. The usual precautions with regard to the exclusion and supervision of contacts was carried out. The patient had not been vaccinated against poliomyelitis. 39 This single notification represents the lowest figure for this disease recorded in Wimbledon since 1944. In 1957 there were 10 confirmed cases. DYSENTERY. Twenty-four cases of dysentery were notified compared with 9 in 1957, 15 in 1956, 2 in 1955 and 14 in 1954. There were two outbreaks, in the first of these a boy of 7 years, one of a family of eight, developed diarrhoea and within a matter of days, the father, and the other six children of the family, and a Home Help who was employed daily in the home, also developed mild symptoms of dysentery. Following bacteriological investigation of the whole family and the Home Help, four of the children and the Home Help were found to be positive for Shigella Sonnei. All the patients responded well to treatment and made good recoveries. In the second outbreak three children, all belonging to one family, were sent home from school suffering from diarrhoea. A younger brother, aged 3 years, was also ill with diarrhoea. Three weeks before the children became ill the father had also had an attack of diarrhoea. Stool specimens taken from all the members of the household and sent for examination, confirmed the presence of Shigella Sonnei in the case of the father and three children of the family. The patients all responded quickly to treatment. The remaining cases occurred either singly or among not more than two persons in individual families in various parts of the Borough, and were unrelated to each other. In 9 of these cases, although having definite dysentery symptoms, no causative agent was identified on examination. Every case of dysentery is followed up very closely and the importance of personal hygiene in preventing the spread of infection is stressed at all times. Dysentery is generally a mild illness, but will spread rapidly in nurseries and schools unless quickly checked. WHOOPING COUGH. During 1958 only 10 notifications of whooping cough were received, compared with 108, 82, 139 and 74 in the last four years. This is the lowest number of notifications received since 1940 when the disease first became notifiable. The immunisation of all children against whooping cough is strongly recommended and this treatment should be commenced at 3 months of age. 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. 40 During the year, 560 requests were received for certificates of vaccination or inoculation to be authenticated for the purpose of travel abroad. SMALLPOX VACCINATION. Every effort is made to maintain a high level of immunity to smallpox by vaccinating infants in their early months. This is carried out by general practitioners or at Surrey County Council Clinics. The percentage of infants under one year vaccinated in this Borough during the year was 60% and there is every need to raise this figure. The following shews the number of vaccinations carried out during the year:— Primary vaccinations 552 Re-vaccinations 104 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). As with smallpox vaccination, whooping cough and diphtheria immunisation is carried out either by general practitioners or at Surrey County Council Clinics. Number of children immunised 673 Number of children boosted 49 DIPHTHERIA IMMUNISATION. The following table gives details of the number of children who were immunised for the first time during the year 1958 Under 5 years 516 Between 5 and 15 years 83 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 2,031 Between 5 and 15 years 7,179 Number of children given reinforcing doses during 1958 187 TETANUS IMMUNISATION. Active immunisation against tetanus is available for those who desire it in the same way as other immunising procedures. During the year 125 children received protection. 41 POLIOMYELITIS VACCINATION. Towards the end of 1957 an extension of the poliomyelitis vaccination 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 staff and their families. The extension of the scheme was made possible by the importation of Salk vaccine from America and Canada and a start on the vaccination of the new groups was commenced early in 1958. Consent forms were distributed to all schools in Wimbledon, including the independent schools, and were also available at the County Council's Clinics, private doctors surgeries, Welfare Food Distribution Centres, and the Town Hall. The initial response was very good, so much so that in the first six months, temporary shortages of vaccine occurred, this being due primarily to the fact that the imported Salk vaccine had to go through tests in this country before use. This double testing was later discontinued on the advice of the Medical Research Council and supplies of vaccine became plentiful. In October the scheme was further extended to young persons from 15-25 years and by the inclusion of a third reinforcing injection to be given not less than seven months after the second injection. Despite the very good response from the children in the under 15 years age group (over 69% were vaccinated during the year) applications for vaccination from those over 15 years was, initially, very disappointing. In an effort to encourage those over 15 years to be vaccinated, open Clinics were started, both in the evening and on Saturday mornings, where vaccination could be carried out without prior appointment, but most of the work on these older age groups was done in 1959 and does not therefore belong to this Renort. The following table shews the position with regard to poliomyelitis vaccination at 31/12/58:— Class Number vaccinated with 2 injections since the beginning of the schemey Children born in the years 1943 to 1957 8,248 Young persons born in the years 1933 to 1942 101 Expectant mothers 216 General practitioners and families 46 Ambulance staff and families 17 Total 8,628 Number of persons given reinforcing doses during 1958 - 3,550 42 43 Notifiable diseases during 1958. 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 1 3 6 7 44 18 1 — 80 19 — Measles 3 5 14 13 11 76 9 2 1 134 — — Whooping Cough — 4 — — 2 4 — — — 10 — — Acute Poliomyelitis (Paralytic) — — — — — 1 — — — 1 1 — Puerperal Pyrexia — — — — — — — 12 7 19 18† — Dysentery — 2 1 5 1 10 — 1 4 24 — — Paratyphoid Fever — — — — — 1 — — — 1 1 — Erysipelas — — — — — — — — 3 3 2 — Pneumonia (Acute Primary or Influenzal) — — — — — 1 1 3 20 25 2 — Food Poisoning — — — — — 1 — 1 6 8 3 — TOTALS 3 12 18 24 21 138 28 20 41 305 46 — * All Forms. † These 18 patients were already in hospital. Notifications of infectious Disease during the last 10 years. DISEASE 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Diphtheria 6 — — — — — — — — — Dysentery 2 7 53 36 19 14 2 15 9 24 Encephalitis acute — — — — — — — 1 1 — Enteric Fever (including Paratyphoid) — 3 — 1 1 — — — 1 1 Erysipelas 7 1 5 3 3 3 2 6 1 3 Food Poisoning 2 — 4 — 6 13 2 11 1 8 Malaria — — 1 — — — — 1 — — Measles 707 364 758 337 896 18 813 64 660 134 Meningococcal Infection 2 3 2 1 1 2 — 1 1 1 Ophthalmia Neonatorum 2 1 — — — 1 — — — — Pneumonia 19 20 27 24 29 18 21 34 24 25 Poliomyelitis 10 12 4 2 11 4 11 7 10 1 Puerperal Pyrexia 8 1 2 5 22 4 7 12 25 19 Scarlet Fever 55 68 136 128 96 49 77 110 59 80 Whooping-cough 149 181 166 112 183 74 139 82 108 10 969 661 1,158 649 1,267 200 1,074 344 900 306 Tuberculosis: Pulmonary 79 82 56 56 65 40 36 44 50 25 Non-Pulmonary 6 10 4 3 1 7 4 6 2 1 44 TUBERCULOSIS. During the year 80 new cases were added to the register of tuberculous persons compared with 89 in 1957 and 91 in 1956. Of the 80 additions 26 were primary notifications and 54 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 1 – 1 – Deaths of patients suffering from tuberculosis through other causes – 6 – – Recovered cases 11 18 1 – Removals from district 24 25 1 1 42 44 3 1 The figure of 26 new notifications of tuberculosis for the year compares with 52 in 1957 and an average of 43 in the last five years. This represents a notification rate of 0.45 per thousand of the population, which is the lowest the Borough has known, and is particularly satisfactory in view of the extensive use of mass radiography and other means of early detection of the disease. The number of notifications of new cases of tuberculosis in Wimbledon has shewn a steady decline since 1950 apart from temporary increases in 1953, 1956 and 1957. While these fluctuations are likely to occur in dealing with relatively small numbers, the fall in the number of new cases notified last year (a reduction of 50% on the previous year) is a most encouraging sign, and it is hoped that this downward trend will be maintained in the future. The number of deaths from all forms of tuberculosis also fell again last year. Only 2 deaths from tuberculosis occurred among residents, giving a death rate per thousand of the population of 0.03, which was the lowest tuberculosis death rate ever recorded in Wimbledon, the previous lowest was in 1957 when the rate was 0.05. The rate for England and Wales in 1958 was 0.10. B.C.G. vaccination against tuberculosis is available to contacts in tuberculous families if preliminary testing shows that they have not already been infected. It is also offered to all children between the ages of 13 and 14 years. The scheme is operated through the County School Health Service. During 1958 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. 45 46 TUBERCULOSIS 1958. AGE GROUPS CASES ADDED TO THE REGISTER DEATHS Primary Notifications (Form A) Cases Discovered otherwise than by Notification Total Cases added to the Register Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females. Under 1 Year – – – – – – – – – – – – – – – – 1— 4 Years 1 – – – – – – – 1 – – – – – – – 5 — 9 „ — 2 – – – – – – – 2 – – – – – – 10—14 „ – – – – – – – – – – – – – – – – 15—19 „ 2 1 – – 1 – – – 3 1 – – – – – – 20 — 24 „ 1 — — – 1 4 – – 2 4 – – – – – – 25—29 „ — 3 – – 5 10 – – 5 13 – – – – – – 30 — 34 „ 1 1 – – 6 2 – 1 7 3 – 1 – – – – 35 — 44 „ 2 1 1 – 7 5 – – 9 6 1 – 1 – – – 45 — 54 „ 2 – – – 5 1 – – 7 1 – – 1 – – – 55 — 64 „ 3 1 – – 2 2 – 1 5 3 – 1 3 – – – 65 and Over 4 – – – – – 1 – 4 – – – 2 1 1 – 16 9 1 — 27 24 1 2 43 33 2 2 7 1 1 – 25 1 51 3 76 4 8 1 26 54 80 9