AC 44 13 (1) Borough of Wimbledon. Public Health Department ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR ENDED 31st DECEMBER, 1959 PRINTED BY RAYNES PARK PRESS LTD., LAMBTON ROAD, LONDON, S.W.20. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1959 Public Health Department, Town Hall, Wimbledon, S.W.19. (WIMbledon 6262) August, 1960. 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 1959. This Report is compiled in accordance with the instructions contained in Circular 1/60 of the Ministry of Health and is on similar lines to previous years. Live births in Wimbledon in 1959 numbered 846, giving a birth rate, per thousand of the population, of 14.13, which compares with 794 births and a rate of 13.24 in 1958. This was the highest live birth rate recorded in the Borough for the past ten years. Six per cent of the total live births were illegitimate. The live birth rate for England and Wales for the year was 16.5. The death rate from all causes per thousand total population shewed an increase at 10.99 over the preceding year when it was 9.89. The excess of births over deaths was 94 compared with 124 in the previous year. The death rate for England and Wales in 1959 was 11.6. There were no maternal deaths. Deaths of infants under one year numbered 20 as against 15 last year, giving an infantile mortality rate of 23.64 per thousand live births. Some increase in this rate was to be expected in view of the higher birth rate in 1959. Counterbalancing this rate, however, was a fall in the number of stillbirths to 15 compared with 21 in 1958. The principal cause of death was as usual, heart disease, especially coronary disease, while cancer was the second greatest cause. Although deaths from heart disease were one fewer than last year, 255 as against 256, deaths from cancer shewed a further increase, numbering 150 compared with 129 in 1958. This increase was not confined to cancer 1 of the lung but included all other forms of cancer. In recent years attention has been drawn to the general increase in the number of deaths from lung cancer and its possible association with heavy cigarette smoking, and it will be seen in the analysis on page 9 that there are still nearly five times as many male deaths from lung cancer as females. There was an increase in deaths from influenza and pneumonia due, in part, to an epidemic of influenza which occurred in Wimbledon in the early part of the year and which was also fairly widespread throughout the country. The tuberculosis death rate was about average for recent years at 0.10 and compares with 0.08 for England and Wales. As was expected, the tuberculosis notification rate was higher than last year's record low figure, but was still well below the recent average. Five deaths were recorded from motor vehicle accidents, this being two less than last year. All other accidents accounted for 20 deaths, which was 10 more than in the previous year. Suicides totalled 7 cases, compared with 10 in 1958. Notifications of infectious disease amounted to 762 compared with 306 in 1958. The increase was due to the fact that 1959 was a "measles" year and this disease accounted for 627 of the total notifications. There were no deaths from infectious diseases. Notifications of whooping cough reached a new low level with only 5 cases being notified during the year. Once more, for the tenth year in succession, Wimbledon was completely free from diphtheria. There were, however, outbreaks of the disease in unimmunised children in some parts of London, which should serve to emphasise to parents the importance of keeping their children as highly immune as possible, and for the initial protection to be given in the first year of life. As I have stressed in previous Reports it is only by the maintenance of a high level of immunity that the population will be safeguarded from the return of this dreaded disease. Increased supplies of vaccine enabled the Poliomyelitis Vaccination programme to continue without interruption throughout the year. At the end of 1959 the very satisfactory total of 10,427 or 79% of children under the age of 15 years had been vaccinated with two or more injections. In the 15-26 years age group the acceptance rate was approximately 45%, a fairly satisfactory percentage having regard to the difficulties of contacting this age group, but one which still calls for improvement. As in 1958, only one case of poliomyelitis was notified, and in view of the climatic conditions it should be possible to afford some credit for this to the Poliomyelitis Campaign. From this brief summary it will be seen that, the health of the residents has remained good, and that further progress has been made. 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. 2 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. 3 LIST OF CONTENTS. Page Introduction 1-3 Health Committee Members and Health Sub-Committee Members 5 List of Staff 6 SECTION A: STATISTICS AND SOCIAL CONDITIONS: Statistics, etc 7-8 Population 9 Births 9 Illegitimacy 9 Deaths 9-10 Maternal Mortality 10-11 Infantile Mortality 11-13 Summary of Statistics 14 SECTION B: GENERAL PROVISION OF HEALTH SERVICES: Nursing Homes 15 Laboratory Facilities 15 Mass Radiography 16 National Assistance Act 1948 17 SECTION C: SANITARY CIRCUMSTANCES: Water Supply 18 Public Swimming Baths 18 Public Health Inspectors' Visits 19-20 Notices Served 20 Nuisances abated and defects remedied 21-22 Factories Act, 1937, Part I 23 Outworkers 24 SECTION D: HOUSING: Overcrowding 25 Rehousing 25 Rent Act, 1957 26 SECTION E: INSPECTION AND SUPERVISION OF FOOD: Milk - Licensing and Sampling 27 Ice-cream 27-28 Meat and other Foods 28 Food and Drugs Act, 1955 28 Unsound Food 28 Sampling of Food and Drugs 31-32 Legal Proceedings 32-34 SECTION F: RODENT CONTROL, PETROLEUM STORAGE, ETC. Prevention of Damage by Pests Act, 1949 35 Petroleum (Regulation) Act 1928 & 1936 36 Pet Animals Act, 1951 36 Heating Appliances (Fireguards) Act, 1952 36 Clean Air Act 1956 36-38 Shops Act, 1950 38 Diseases of Animals Acts 38 SECTION G: PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES: Notifiable Infectious Diseases, etc. 39-42, 45-46 Vaccination and Immunisation 42-43 Tuberculosis 47-48 4 BOROUGH OF WIMBLEDON HEALTH COMMITTEE December, 1959 Alderman T. H. Metcalf. (Chairman). Alderman N. S. Clarke, J.P., (Mayor). Councillor A. E. Ayres, (Vice-Chairman). Alderman Sir Cyril Black, J.P., D.L., 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, 1959 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. 5 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 F. R. Brackfield, M.A.P.H.I. (Resigned 5/7/59). R. G. Ayling, M.A.P.H.I. (Appointed 28/9/59). J. E. Stacey, M.A.P.H.I. (Appointed 23/11/59). Pupil Public Health Inspector: R. A. White. (Resigned 11/7/59) J. T. Thompson. (Appointed 1/9/59) 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. Egerton Swann †Miss I. Maidment. (Resigned 15/3/59). †Miss I Moss. (Appointed 6/4/59) *R. P. Stanton. (Resigned 27/9/59). G. Matthews *Miss M. A. Fawdry. (Appointed 1/12/59). † 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. 6 SECTION A. — STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres—Census, 1951) 3,212 Population (Census, 1951) 58.141 Home Population (mid-1959) 57,450 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:— £1,283,086. Sum represented by penny rate:— £5,170. Extracts from Vital Statistics of the Year 1959. (Registrar-General's Figures.) Live Births Total M. F. Legitimate 795 408 387 Illegitimate 51 29 22 Total 846 437 409 Stillbirths Total M. F. Legitimate 14 6 8 Illegitimate 1 – 1 Total 15 6 9 Live birth rate per 1,000 of the estimated home population 14.72 Corrected live birth rate per 1,000 of the estimated home population 14.13 Still-birth Rate per 1,000 total (live and still) births 17.42 Total M. F. Deaths 752 317 435 Crude Death Rate per 1,000 of the estimated home population 13.09 Corrected Death Rate per 1,000 of the estimated home population 10.99 Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births. Puerperal and post-abortive sepsis – – Other maternal causes – – Total – – Death Rate of infants under one year of age:— All infants per 1,000 live births 23.64 Legitimate infants per 1,000 legitimate live births 22.63 Illegitimate infants per 1,000 illegitimate live births 39.21 Deaths from cancer 150 „ „ diphtheria Nil „ „ poliomyelitis Nil measles Nil whooping cough Nil Births:— Live Births 14.13 16.5 Still Births 0.26 0.30 17.42* 21.0 * Deaths:— All Causes 10.99 11.6 Coronary and arteriosclerotic heart disease 2.21 1.87 Whooping Cough 0.00 Diphtheria – – Tuberculosis . all forms 0.10 0.08 Influenza 0.22 0.17 Smallpox – — Acute Poliomyelitis (including Polioencephalitis) – 0.00 Pneumonia 0.69 1.60 Malignant Neoplasm . Lung, Bronchus 0.59 0.46 Maternal Mortality — 0.38* Notifications:— (Corrected) Scarlet Fever 1.28 1.05 Whooping Cough 0.08 0.73 Typhoid and Paratyphoid Fever 0.03 0.01 Meningococcal Infection . 0.01 Acute Encephalitis 0.06 0.00 Diphtheria . 0.00 Erysipelas 0.01 0.07 Smallpox . . Measles 10.91 11.83 Pneumonia 0.31 0.59 Acute Poliomyelitis — Paralytic — 0.01 Non.paralytic 0.01 0.00 Food Poisoning 0.13 0.22 Dysentery 0.19 0.78 Tuberculosis— Pulmonary 0.45 0.53 Non.pulmonary 0.08 0.06 Puerperal Pyrexia 12.72* 13.19* Deaths:— Rates per 1,000 Live Births Infant Deaths (all causes under 1 year) 23.64 22.2 Diarrhoea and Enteritis (under 2 years) – 0.45 * Per 1,000 total (live and still) births. 8 VITAL STATISTICS. POPULATION. The Registrar-General's mid-year estimate of the civilian population, 57,450 shews an estimated decrease of 70 on the previous year, although the natural increase by excess of births over deaths was 94. 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 1959, the total number of registered live births belonging to Wimbledon was 846. Of this number, 437 were males and 409 females. This gives a birth-rate of 14.72 per thousand of the population as compared with a rate of 13.80 per thousand in 1958, and an average of 13.92 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 1959 was 14.13 per thousand of the population, whilst the rate for England and Wales was 16.5 and has averaged 15-9 over the past five years. Stillbirths - The number of stillbirths registered during the year was 15 (6 males and 9 females), this being 6 fewer than last year. The stillbirth rate for Wimbledon was 0.26 per thousand of the population, whilst that for England and Wales was 0.30. Illegitimacy - Of the live births registered in 1959, 51 (29 males and 22 females) were illegitimate, this being 10 more than in the preceding year. One of the 15 stillbirths registered was illegitimate. DEATHS. The total number of Wimbledon residents who died during 1959 was 752 (317 males and 435 females), giving a death-rate of 13.09 per thousand of the population as compared with 11.64 per thousand for 1958. The corrected death-rate for 1959 was 10.99 per thousand as compared with a rate of 11.6 per thousand for England and Wales. The number of Wimbledon residents who died outside the Borough was 326, whilst 425 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 255 33% Cancer 150 20% Vascular lesions of nervous system 106 14% Diseases of the respiratory system 96 12% Totals 607 79% 9 The following is an analysis of the causes of death : — Cause Males Females Total 1. Respiratory tuberculosis 2 2 4 2. Other tuberculosis 1 1 2 3. Syphilitic disease 3 1 4 4. Diphtheria – – – 5. Whooping cough – – – 6. Meningococcal infections – – – 7. Acute poliomyelitis – – – 8. Measles – – – 9. Other infective and parasitic diseases 2 – 2 10. Malignant neoplasm, stomach 15 8 23 11. Malignant neoplasm, lung, bronchus 28 6 34 12. Malignant neoplasm, breast – 21 21 13. Malignant neoplasm, uterus . – 6 6 14. Other malignant and lymphatic neoplasms ... 23 39 62 15. Leukaemia – 4 4 16. Diabetes 1 2 3 17. Vascular lesions of nervous system 35 71 106 18. Coronary disease, angina 68 59 127 19. Hypertension with heart disease 7 7 14 20. Other heart disease 19 61 80 21. Other circulatory disease 11 23 34 22. Influenza 5 8 13 23. Pneumonia 17 23 40 24. Bronchitis 24 13 37 25. Other diseases of respiratory system 2 4 6 26. Ulcer of stomach and duodenum 8 3 11 27. Gastritis, enteritis and diarrhoea 2 5 7 28. Nephritis and nephrosis - 2 2 29. Hyperplasia of prostate 6 - 6 30. Pregnancy, childbirth, abortion - - - 31. Congenital malformations 2 - 2 32. Other defined and ill-defined diseases 23 47 70 33. Motor vehicle accidents 1 4 5 34. All other accidents 8 12 20 35. Suicide 4 3 7 36. Homicide and operations of war – – – Totals 317 435 752 MATERNAL MORTALITY. No deaths in childbirth, either from puerperal sepsis or other maternal causes, were recorded during the year. Only three maternal deaths have occurred in the Borough in the last ten years. The maternal mortality rate for England and Wales per thousand live and still births was 0.38. 10 The following table sets out the number of deaths and death rates per thousand total live and stillbirths for 1959:— Number of Deaths Rate England and Wales Maternal causes, excluding abortion 244 0.32 Due to abortion 47 0.06 Total maternal mortality 291 0.38 The estimated mid-1959 female population for England and Wales age 15.44 was 9,022,000. As stated overleaf there were no maternal deaths in Wimbledon during 1959. INFANTILE MORTALITY. During 1959 there were 20 deaths among infants under one year of age, compared with 15 in 1958 and an average of 13 in the last ten years. Two of the deaths were in respect of illegitimate children. The resultant infant mortality rate for Wimbledon per thousand live births was 23.64. The infant mortality rate for England and Wales in 1959 was the low record of 22.2, the lowest previously recorded being 22.6 in 1958. The number of neo-natal deaths (i.e. those occurring during the first four weeks of life) was 18, giving a neo-natal death rate of 21.2 per thousand live births, as compared with a rate of 15.8 for England and Wales. As is usual, the commonest cause of death (14 out of 20 deaths) was from prematurity. While fluctuations are likely to occur in dealing with relatively small numbers, it should be mentioned that whether a death in early life occurs as a stillbirth or a neo-natal death is something of a chance. It is not surprising therefore that the increase in the number of infant deaths in Wimbledon in 1959 was accompanied by a decline in the number of stillbirths notified. The following table shows the cause of the 20 deaths which occurred during 1959, together with the age at death. 11 12 Infantile Mortality During 1959. 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 — 1 4 — — — — 4 Prematurity and atelectasis 13 1 — — 14 — — — — 14 Pneumonia — — — — — — 1 — — 1 Bilateral pneumothorax — — — — — — 1 — — 1 Totals 15 2 — 1 18 — 2 — — 20 13 Infantile Mortality during the last 10 years. Cause of death 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 Prematurity and atelectasis 5 3 3 5 5 2 1 3 7 14 Congenital defects or birth injuries 2 9 6 4 5 5 5 3 6 4 Diseases of the newborn 1 2 — — — — — — 1 — Gastro-enteritis 2 — — 1 — — — — — — Pneumonia — 1 1 1 1 2 2 1 1 1 Bronchitis 2 — — — — — — 1 — — Septicasmia 1 1 — — — — 1 — — — Asphyxia (un-known cause) — — — — — — — 1 — — Accidental death 1 1 — 1 1 2 — — — — Inattention at birth — — — — — — 1 — — — Bilateral pneumothorax — — — — — — — — — 1 14 17 10 12 12 11 10 9 15 20 Total neo-natal deaths included above 8 14 6 9 11 1 8 7 8 12 18 14 Summary of Statistics. The following table shows the birth.rates and death.rates for Wimbledon as compared with England and Wales since 1940. 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. 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 1959 14.13 16.5 0.26 0.30 10.99 11.6 — 0.38 23.64 22.2 *From 1940 to 1948 the local death-rate could not be corrected as the publication of an area comparability factor was suspended. Consequently it is not strictly possible to compare the death-rate for Wimbledon with that for England and Wales for those years. SECTION B. - GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. PUBLIC HEALTH ACT, 1936, PART IV. — NURSING HOMES. The Wimbledon Borough Council is responsible for the registration and supervision of Nursing Homes in the Borough. Eight visits of inspection were made during 1959. No new Nursing Homes were registered during the year. One Maternity Hospital and one Nursing Home were exempted, on an annual basis, from registration under Section 192 of the Public Health Act 1936. One existing Home closed down. The position at the end of 1959 was as follows :— Number of Homes on the register Maternity Nil Others 5 Number of beds provided 85 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. LABORATORY FACILITIES. The Corporation's arrangements for the examination of pathological material continued on similar lines to previous years. Bacteriological examinations of milk, ice-cream, water, swabs, sputum and other pathological specimens are undertaken by the Ministry of Health Laboratory at Epsom. The Laboratory at the Nelson Hospital, Merton is also utilised for the examination of pathological specimens. Reports on examinations carried out at both these Laboratories are available to the Corporation free of cost. The following is a summary of the examinations made during the year:— Nose and throat swabs 94 Faeces for the typhoid and dysentery groups 387 Ice-cream samples 64 Milk samples 113 Water samples 47 Miscellaneous 11 Total 716 Samples of milk and water requiring chemical analysis, and also Food and Drug samples are sent by the Corporation to the Public Analyst, D. D. Moir, M.Sc., F.R.I.C., Southwark Street, S.E.l. Biological examinations of milk are carried out at the Royal Institute of Public Health and Hygiene Laboratory, Queen Square, W.C.l. 15 MASS RADIOGRAPHY. The Mass Radiography Unit of the South West Metropolitan Regional Hospital Board visited Wimbledon during the year, being stationed at the A.T.C. Centre, Merton Road, South Wimbledon, from 6th to 22nd October. This X-ray Unit offered facilities for free x-ray of the chest of all persons over the age of 15 years. The examination is of value in the early diagnosis and treatment of pulmonary tuberculosis and other nontuberculous diseases and abnormalities. 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 1,631 Females 1,507 3,138 A bnormalities discovered: (i) Pulmonary tuberculosis requiring treatment or close clinic supervision: Males 2 Females 2 4 (ii) Pulmonary tuberculosis requiring occasional clinic supervision : Males 4 Females 2 6 (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. A mobile Chest Radiography Unit also visits Wimbledon and Raynes Park each week. This service, which was set up in December 1958, primarily for the use of general practitioners' patients, is now available to all members of the public, as follows:— Wimbledon - Car Park, Grove Hotel (opposite South Wimbledon Tube Station) Mondays 7.30 - 8.30 p.m. Raynes Park - Raynes Park Station, Grand Drive Entrance Thursdays, 7.30 - 8.30 p.m. 16 NATIONAL ASSISTANCE ACT 1948 - 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. At the beginning of 1959 there was one patient already in hospital as the result of an Order made by the Wimbledon Court under Section 47 of the 1948 Act. This Order, which had been extended during 1958, was further extended on four occasions during 1959, and the patient was still in hospital at the end of the year. Although a number of cases were brought to the notice of the Public Health Department for investigation during the year, it was possible to find a solution to each particular problem without resorting to compulsory powers. The problem of dealing with the aged and chronic sick will always be a difficult one. Apart from the difficulties encountered in regard to the shortage of places in Old People's Homes, and of hospital beds, problems are often caused by the patients refusal to co-operate. It is understandable that most of them prefer to stay in their own homes and retain their independence despite difficulties and hardships. Every effort is made to meet each problem and in this regard the effective work done by the District Nurses and Home Helps in keeping many old people in reasonable comfort in their own homes should be mentioned. The close liaison which has been established between the Geriatric Department of St. Helier Hospital, the Guild of Social Welfare, the General Practitioners and your Medical Officer of Health, continues. 17 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 five exceptions all the dwelling houses in Wimbledon are supplied from public water mains direct to the houses. During the year 1959, samples of water were taken for bacteriological and/or chemical analysis, as follows:— Bacteriological. Public Swimming Baths 30 Dwelling houses Metropolitan Water Board supply 5 Well water 9 — 14 Spring outlet near Caesar's Well 2 Artesian Well 1 47 All these samples of water proved bacteriologically satisfactory. Chemical. Public Swimming Baths 2 Dwelling houses Metropolitan Water Board supply 1 Well water 2 — 3 Artesian well 1 6 All samples of water proved chemically satisfactory. Public Swimming Baths. I am indebted to the Baths Superintendent and Engineer for the following information regarding the Public Swimming Baths, which has been included in accordance with Ministry of Health Circular 1/60 (Annual Report 1959). The Wimbledon Swimming Baths include three Pools within one establishment. All the Pools are open throughout the year with the exception of one Pool which is closed during the winter season and used as a Public Hall. 18 Pool No. 1 is 100' x 40' with a depth of 6' 6" to 3'. Filtration is by a rapid sand bed system and the 130,000 gallons of water are turned over every five hours. The water is sterilised by break-point chlorination. Pool No. 2 is 100' x 40' with a depth of 6' 6" to 3'. Filtration is by a rapid sand bed system and the 125,000 gallons of water are turned over every eight hours. The water is sterilised by break-point chlorination. The Teaching Pool is 26' x 18' with a depth of 2'3" to 2'9". Filtration is by a Diatomateous Earth filtration plant and the 6,500 gallons of water are turned over in 1½ hours. The water is sterilised by marginal chlorination. All the Pools are heated to an average temperature of 72oF., and the water supply is from the Metropolitan Water Board's mains. Inspection of the District The following is a summary of the complaints received and the visits made during the year 1959 :— Complaints received. General disrepair and insanitary conditions 206 Dampness 89 Overcrowding 31 Defective drainage systems 31 Blocked drainage systems 115 Defective drainage fittings 20 Defective W.C. pans and/or flushing apparatus 22 Defective service water pipes 11 Absence of or defective dustbins 40 Accumulations of refuse, etc 39 Rats and mice 278 Insect pests, etc 269 Smoke nuisances 49 Unsound food 104 Miscellaneous 157 1,461 Visits made. Infectious diseases. Inquiries re cases of infectious disease 248 Visits re disinfection 69 Miscellaneous 103 Housing. Dwelling houses (Housing Act) 175 Dwelling houses (Public Health Act) 1,298 Rent Act, 1957 178 House Purchase and Housing Act 1959 65 Overcrowding 59 Underground rooms 30 Houses let in lodgings 6 Miscellaneous 324 19 Food and Food premises. Dairies and milk distributors 20 Ice-cream premises 31 Bakehouses 25 Butchers' shops 37 Meat preparation premises 13 Fish shops 17 Fried fish shops 7 Restaurant kitchens 69 Other food premises 234 Visits re unsound food 159 Sampling: food and drugs 129 Sampling: milk 142 Sampling: ice-cream 74 Sampling: water 52 Miscellaneous 239 General. Drainage and plumbing work 748 Stables and piggeries 3 Smoke observations and Clean Air Act, 1956 344 Pet Animals Act, 1951 9 Factories (P.) 23 Factories (N.P.) 2 Factories (Building sites) 20 Outworkers' premises 1 Shops Act, 1950 (Vent. temp, etc.) 12 Shops Act, 1950 (Shop hours) 79 Petroleum (Consol.) Act, 1928 153 Heating Appliances (Fireguards) Act, 1952 4 Watercourses 4 Rodent control 4,348 Insect infestations 181 Refuse storage 108 Accumulations 153 Diseases of Animals Act 4 Employment Agencies, etc 6 Fairgrounds 5 Miscellaneous 361 10,371 Notices Served. Preliminary notices or intimations 344 Statutory Notices 58 Other letters 1,770 Result of Service of Notices. (1) Legal Proceedings Legal proceedings were instituted against the owner of a dwelling house for failing to comply with two Abatement Notices, and for failing to supply information as to the nature of his interest in the premises concerned. 20 The first hearing of the case was adjourned for fourteen days. At the resumed hearing all the offences were proved, and fines totalling £11. were imposed, together with £6.6.0. costs. In addition, an Abatement Order was made requiring the nuisances to be abated within twenty-eight days. The Defendant subsequently appealed to Quarter Sessions against the Abatement Order. The appeal was dismissed and a further Order for costs amounting to £12.12.0d. was made against the appellant. (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 162 Reconstructed 86 Cleansed 93 Soil pipes and ventilation shafts repaired or renewed 10 Inspection chamber covers renewed 8 Fresh air inlets repaired or renewed 4 New W.C. pans provided 31 Water waste preventors repaired or renewed 13 Gutters and rainwater pipes repaired or renewed 78 New lavatory basins provided 11 New baths provided 5 New glazed sinks provided 3 Waste pipes trapped, repaired or renewed 15 Gully surrounds repaired 15 Miscellaneous 36 General Housing repairs. Roofs repaired 96 Yards paved or repaired 6 Dampness remedied 102 Damp-proof courses provided 4 Sub-floor ventilation provided 5 Walls and ceilings repaired 172 New ceilings constructed 2 Walls cleansed 123 Ceilings cleansed 30 Floors repaired or renewed 44 Windows repaired or renewed 180 Doors repaired or renewed 28 Fireplaces repaired or renewed 16 Service water mains repaired 5 Miscellaneous 199 Food premises. Walls repaired or redecorated 42 Ceilings repaired or redecorated 29 Floors renewed or repaired 3 Woodwork repaired or repainted 13 21 Lighting provided or improved 14 Ventilation provided or improved 6 Fresh air inlets removed and drain inlets trapped 4 Infestation risks removed 3 Sinks provided 9 Hot water provided to sink 14 Detergent provided 7 Clean cloths provided 7 Overall clothing provided 1 First aid kit provided or improved 24 Water supply provided 31 Cold Storage facilities provided 1 Risks of contamination removed 45 Outdoor clothing store provided 21 Refuse storage improved 4 Wash-hand basins provided 25 Hot water provided to wash-hand basins 35 Soap provided 26 Nailbrush provided 32 Clean towels provided 27 Sanitary accommodation provided/repaired/cleansed 6 Lighting in sanitary accommodation provided 18 Ventilation in sanitary accommodation provided 1 Hand washing notices fixed 30 Miscellaneous 1 Rodent Control. Defects remedied in connection with ratproofing work are included in foregoing lists. Miscellaneous. Accumulations removed 13 New dustbins provided 20 Smoke nuisances abated 3 22 FACTORIES ACTS, 1937 to 1959. 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 . 93 2 — — Factories with mechanical power 264 23 3 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 26 20 1 — Totals 383 45 4 — 2. Defects Found. Particulars Number of Defects Prosecutions Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of Cleanliness (S.1) — — — — — 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 4 1 4 — Unsuitable or Defective 2 — — 2 — Not Separate for Sexes — — — — — Other Offences (Excluding offences relating to outwork) 2 — — 2 — Totals 8 1 — 8 — 23 PART VIII. OUTWORK - SECTIONS 110 & 111. Nature of work Section 110 Section 111 No. of outworkers in Auggust list required by Sec. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole some premises Notices served Prosecutions Wearing Apparel — Making etc. 18 — — — — — Others 2 — — — — — Total 20 — — — — — Number of addresses received from other Councils 54 Number of addresses forwarded to other Councils 26 Number of premises where outwork was carried on at the end of 1959 105 Inspections of outworkers' premises 1 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 24 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 72 (ii) Number of families dwelling therein 81 (iii) Number of persons dwelling therein 388 (b) Number of new cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding known to have been relieved during the year 4 (ii) Number of persons concerned in such cases 16 (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, 1959 :— Number of houses requisitioned since the beginning of the war and still held under requisition 45 Number of prefabricated bungalows provided since the end of the war 71 (At the end of 1959 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 2,256 Number of live applications on the housing list for:— (a) accommodation in Wimbledon 493 (b) accommodation in Frimley and Camberley 205 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 1959 : Private enterprise 95 Local authority 29 Number of flats created by conversion in 1959 : Private enterprise 35 Local authority Nil 25 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, 1959 :— Applications for Certificates of Disrepair (Form I) 231 Applications withdrawn by applicants 13 Forms J sent to landlords 206 Undertakings given by landlords (Form K) 113 Certificates of Disrepair issued (Form L) 88 Applications for Cancellation of Certificates of Disrepair (Form M) 64 Certificates of Disrepair cancelled 45 Number of visits made during 1959 in connection with applications for Certificates of Disrepair — 178. 26 SECTION E. — INSPECTION AND SUPERVISION OF FOOD. Milk. In accordance with the provisions of the Milk and Dairies (General) Regulations 1959, 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 Dealers' Licences— Nil Tuberculin Tested Milk 25 Pasteurised Milk 26 Sterilised Milk 32 Supplementary Licences— Tuberculin Tested Milk 12 Pasteurised Milk 12 Sterilised Milk 11 118 During the year 113 samples of designated milk were submitted for bacteriological examination. The results were as follows:— Designation Satisfactory. Unsatisfactory. Pasteurised 100 Nil Tuberculin Tested (Pasteurised) 4 Nil Sterilised 8 Nil Tuberculin Tested (Farm bottled) 1 Nil No samples of Tuberculin Tested (Farm bottled) milk were sent to the Royal Institute of Public Health and Hygiene Laboratory for animal inoculation. Ice-Cream. During the year 64 samples were submitted for bacteriological examination. The results were as follows :— Grade 1 64 Grade 2 Nil Grade 3 Nil Grade 4 Nil 27 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, and no slaughtermen's licences were issued under the provisions of the Slaughter of Animals Act 1958, during the year 1959. Food and Drugs Act, 1955. The inspection of food premises has formed an important part of the work of the Public Health Inspectors during the past year. 1,248 visits were made to premises in which foodstuffs, intended for human consumption, were prepared, stored or sold. All food premises, whether or not they are registered, must comply with the Food Hygiene Regulations 1955, and a considerable amount of work has been done under these Regulations during the year. 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. Greengrocers 70 Confectioners 132 Ice-cream premises 213 Bakers 36 Grocers 130 Provision dealers 90 Butchers 44 Fishmongers 25 Milk distributors 36 Chemists 25 Licensed premises 73 Clubs 30 Restaurants and Cafes 81 Works canteens 11 School canteens 47 Kitchens (Hospital and Central Kitchens) 5 Food stalls/vehicles 13 1,061 28 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 144 Registered for the manufacture and sale of icecream 2 Registered for the preparation or manufacture of sausages 46 Registered for the preparation or manufacture of potted, pressed, pickled or preserved food ... 34 The number of inspections of registered food premises during 1959 was 108. 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 1959 CWlS. qrs. lbs. Canned soups 5 Canned meat 6 0 3 Canned fish 10 Canned vegetables 2 25 Canned fruit 4 3 0 Canned milk or cream 27 Meat, bacon, poultry, etc. 4 2 2 Fish 2 10 Cheese 1 Sugar, jam and syrup 15 Flour and cereals 2 10 Salt 8 Potatoes 2 2 0 Spaghetti 1 12 Frozen egg 1 0 Confectionery 1 3 21 Beverages 10 22 3 19 The number of complaints received during the year regarding unsound food was 104. These included references to extraneous matter in food and a detailed investigation was made in each case. Informal action was successful in the majority of cases, but in two instances it was necessary to institute legal proceedings. 29 The complaints of extraneous matter in food above referred to included the following :•— Foreign body in orange squash. Bitter taste in bread. Rat droppings in butter beans.* Glass in loaf of bread. Dirty milk bottles. Odour in lemonade. Rusted cans of food. Bitter taste in brewed tea. Mould growth on wrapped bread. Maggots in chocolate cakes. Maggots in chocolates. Foreign material in bottles of milk. Ants in wrapped swiss roll. Discoloured creamed rice milk pudding.* Discoloured loaf of bread. Foreign matter in bread. * Denotes legal proceedings taken. 30 Sampling of Food and Drugs. The following samples were submitted to the Public Analyst during 1959, with the results shown :— Articles Total Formal Informal Genuine NonGenuine or Irregular Bananas, dried 1 1 1 Bilberries, dried 1 1 — 1 - Biscuits 3 1 2 3 - Blancmange Powder 1 — 1 1 - Bouillon cubes 1 — 1 1 - Brawn 1 1 — 1 - Bread and butter 1 1 — 1 - Cheese 2 2 — 2 - Cheese spread 1 — 1 1 - Chicklettes 1 — 1 1 - Christmas pudding 1 1 — 1 - Cod, frozen 1 1 — 1 - Confectionery, flour 2 2 — 2 - Confectionery, sugar 4 2 2 4 - Cordial 1 1 — 1 - Cream 1 — 1 1 - Custard powder 1 1 — 1 - Dates 1 1 — 1 - Dessert, table 1 — 1 1 - Flour, plain 1 1 — 1 - Fruit, cocktail 1 1 — 1 - Fruit salad 1 1 — 1 - Ginger cordial 1 1 — 1 - Hamburgers 1 1 — — 1 Horseradish sauce 1 — 1 1 - Icing sugar 1 1 — 1 - Jelly, decorating 1 — 1 1 - Jelly, table 1 1 — 1 - Lemonade 1 1 — 1 - Lolly, frozen 2 2 — 2 - Luncheon meat, pork 1 1 — — 1 Milk 46 46 — 46 - Mock salmon cutlets 1 1 — 1 - Mushrooms 1 1 — 1 - Mustard and cress 1 1 1 - Oats 1 1 1 - Orange drink 1 1 1 - Oranges in syrup 1 1 — 1 - Peanuts, salted 1 1 — 1 - Peas, canned 1 1 1 - Pease pudding 1 — 1 1 - Pickle 3 2 1 3 - Pickled onions 1 1 1 - Pineapple, canned 1 1 — 1 - Prunes 1 1 1 - Ravioli in sauce 1 - 1 1 - Rennet, essence of 2 1 1 2 - Rhubarb, canned 1 1 1 - Roes, cod 1 1 1 - Roes, herring 1 1 — 1 - Sage, dried 1 1 1 - Salmon 1 1 1 - Sauce 2 2 2 - Sausage rolls 1 1 - 1 - Shrimps 1 1 — 1 - C/Fwd. 112 93 19 110 2 31 Articles Total Formal Informal Genuine NonGenuine or Irregular B/Fwd. 112 93 19 110 2 Soda bread mix 1 1 1 Sponge mixture 1 1 — 1 — Steak, stewed 1 1 — 1 — Strawberries in syrup 1 1 — 1 — Suet, beef 1 1 — 1 — Sultanas 1 1 — 1 — Tea 1 1 — 1 — Tea, instant 1 1 — 1 — Till seed 1 1 1 Tomatoes, canned 1 1 1 Tuna, canned 1 1 1 Veal, jellied 1 1 — 1 — Whisky 4 4 — 4 — Wine 1 — 1 1 — Wine, green ginger 1 — 1 1 — Yorkshire pudding mixture 1 — 1 1 — Totals 131 109 22 129 2 The following samples were submitted for special examination: — Articles Total Formal Informal Genuine NonGenuine or ular Bread roll with cheese 1 1 l Butter beans 1 — 1 — l Buttered bread 1 — 1 1 — Chicken, roasted 1 — 1 1 — Creamed rice milk pudding 4 — 4 2 2 Hamburgers 3 — 3 2 1 Lemonade 1 — 1 — 1 Soft drink 1 — 1 1 — White bread 1 — 1 1 — Totals 14 — 14 8 6 It will be seen that adverse reports were received upon eight samples and the following is an account of the action taken in respect thereof. Hamburgers. A formal sample of hamburger was purchased from a local shop and was submitted to the Public Analyst for examination. In the Analyst's opinion the sample was of the nature of a meat rissole containing not more than 35% meat, together with a large proportion of cereal filler. In his opinion a hamburger should consist essentially of minced beef and should contain at least 80% of meat. Subsequently, further informal samples of different types of hamburger were obtained and submitted to the Public Analyst. Two of these informal samples were found to be satisfactory, but the third contained only 53% meat. The opinions of the National College of Food Technology and of the 32 Food Standards Division of the Ministry of Agriculture, Fisheries and Food were obtained, but it appears that no standard exists for either the definition or composition of hamburgers for the purposes of the Food and Drugs Act 1955. The facts were reported to the Health Committee, and warning letters were sent to the manufacturers concerned. Pork luncheon meat. A formal sample of pork luncheon meat was submitted to the Public Analyst for examination. The sample was found to contain 70% meat including fat, and in his opinion this meat content was not sufficient to justify the use of the description 'pork luncheon meat' for this article. The Danish manufacturers of the meat were informed of the result of the examination. During the course of correspondence with the Ministry of Agriculture, Fisheries and Food, it was stated that the question of the possible need for statutory standards for canned meat had been referred to the Food Standards Committee, which would make recommendations in due course. Butter beans. A quantity of butter beans, which had been delivered to the Central Kitchen, Queens Road, were found to contain foreign matter, which proved to be rat droppings. Legal proceedings were instituted against the suppliers of the beans under the provisions of the Food and Drugs Act 1955 for selling butter beans which were not of the quality demanded by the purchaser. The case was adjourned sine die at the first Hearing, and was dismissed after the adjourned Hearing. Bread roll with cheese. A bread roll with cheese, purchased by a workman on a building site, from a shop within the Borough, was submitted to the Public Analyst for examination to identify the foreign matter present. The substance proved to consist of a mass of carbonaceous particles from burned or partly burned organic matter, mixed with numerous vegetable fibres. Investigation disclosed a defect in the bakehouse machinery which was immediately rectified, and it was deemed unnecessary to take further proceedings. Creamed rice milk pudding. As the result of a complaint, a can of creamed rice milk pudding was examined and found to be discoloured and of unpleasant taste. A check can was purchased from the same stock, and both specimens were sent to the Public Analyst for examination. He confirmed that the contents of both the cans were discoloured, and that a taste foreign to this article was present. Analysis showed the specimens to contain about 2% of sodium citrate in addition to the ingredients declared on the label. It appeared that the amount of sodium citrate was grossly excessive, and that it adversely affected the quality of the food. The manufacturer was summoned under the provisions of the Food and Drugs Act 1955 for selling a creamed rice milk pudding which was not of the 33 quality demanded, and also for an offence under the Labelling of Food Order 1953. The Defendant pleaded guilty to both charges and was fined £10. and ordered to pay £20.18.0d. costs. Lemonade. A partially filled bottle of lemonade was sent to the Public Analyst for examination. The lemonade, which was the subject of a complaint, was alleged to possess an unpleasant odour. The Public Analyst reported that this odour was attributed to the action of the acid mineral water on the ebonite stopper which produced sulphuretted hydrogen. This gas is soluble in water and possesses an objectionable smell even in very minute quantities, although the lemonade was not rendered harmful. Correspondence with the manufacturers resulted in the replacement of ebonite stoppers by a newly designed bottle fitted with an external screw and plastic screw cap. 34 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 1959. Type of Property Number of Properties inspected as a result of: Number of Properties found to be infested by: Number of Treatments carried out including retreatments Number of inspections made including reinspections Notifica tion Survey under Act Total Rats Mice Local Authority 1 13 14 4 1 14 96 Dwellings 224 391 615 137 45 188 3,013 All other, including Business Premises 81 309 390 22 24 59 1,239 Totals 306 713 1,019 163 70 261 4,348 The inspection and treatment of sewers, and of the Corporation's Depots, etc., was undertaken in collaboration 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 1959 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. PEST CONTROL. During the year 1959, 269 complaints were received concerning insect pests, and the following is a list of the major infestations dealt with :— White mite 3 Woodworm 6 Furniture beetles 2 Cockroaches 9 Bed bugs 14 Ants 8 Maggots 8 Silver fish 2 Fleas 4 Bees 2 Flies 14 Mosquitoes 2 Crickets 1 Weevils 1 Wasps 138 35 The incidence of wasps was generalised during 1959, and it is considered that the service provided by the Department in the destruction of wasps nests plays a great part in the Council's Food Hygiene policy. In addition, 11 complaints were received regarding squirrels, pigeons and rabbits, and these were referred to the Pests Officer of the Ministry of Agriculture, Fisheries and Food at Guildford. PETROLEUM (REGULATION) ACTS 1928 & 1936. 58 licences were issued by the Department to store petroleum spirit during 1959, and the total quantity of petroleum spirit stored was 95,995 gallons. In addition, 25 licences were issued to store petroleum mixtures involving a total of 9,390 gallons, and 3 licences were issued in respect of the storage of a total of 42 cwts. of calcium carbide. 153 visits were made to premises under the provisions of Petroleum legislation. During 1959 the Conditions attached to licences were revised to conform to the Model Code of Licensing Conditions issued by the Home Office. These new Conditions were attached to the licences issued on the 1st January, 1960. PET ANIMALS ACT 1951. 6 licences to keep pet shops were issued by the Department during 1959. 9 visits were made to these premises and various infringements of the conditions of licence were rectified. HEATING APPLIANCES (FIREGUARDS) ACT 1952. During 1959, 4 visits were made in connection with the Act and 2 appliances were examined and the prescribed tests applied. Both 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 1959, 49 complaints were received with regard to smoke or grit emission, and the necessary observations were made and remedial action taken. 344 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 co-operation of the firms concerned. Conversion from solid fuel to oil burning has taken place in several premises. "Prior approval" was given to two installations during the year — (1) a new installation of oil fired furnace plant, and (2) the conversion of an existing solid fuel fired furnace to oil burning. 36 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 488 Local Authorities and other Organisations. The following tables give the results of recording up to December 1959 :— 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 January 3.4 6.1 9.5 2.9 February 2.6 4.3 6.9 2.5 March 3.0 6.4 9.4 1.4 April 4.9 4.2 9.1 1.1 May 6.8 3.5 10.3 1.3 June 5.1 3.3 8.4 0.7 July 4.6 5.0 9.6 0.6 August 6.1 5.6 11.7 0.7 September 5.9 3.4 9.3 1.3 October 7.5 4.0 11.5 0.9 November 11.4 11.4 22.8 1.6 December 2.0 5.1 7.1 1.6 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 January 5.3 6.9 12.2 3.7 February 3.9 3.3 7.2 3.4 March 5.2 6.8 12.0 2.1 April 3.6 5.0 8.6 1.7 May 7.1 4.7 11.8 1.8 June 5.9 4.0 9.9 1.2 July 5.3 2.9 8.2 0.9 August 4.2 6.0 10.2 1.1 September 6.3 4.0 10.3 1.8 October 4.5 5.7 10.2 1.2 November 4.2 13.7 17.9 2.1 December 2.4 6.2 8.6 1.8 37 The Council has 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. This Conference met twice during the year. The Council continued to give consideration to a Clean Air Programme, and during 1959 a scheme was approved to enable the making of Smoke Control Orders covering the whole of the Borough during the next twenty years. The scheme provides for the division of the Borough into fifteen Areas, the first four of which would be dealt with within the first five years. It was hoped that by obtaining additional staff the preliminary work on the first Smoke Control Area would be put in hand on January the 1st, 1960, but up to the time of writing this has not been possible. SHOPS ACT 1950. The total number of Shops Act inspections during 1959 was 91. Sanitary accommodation and heating and ventilation of shops has been kept under observation, and any necessary action has been taken in respect of general closing hours, half-day closing and Sunday Trading. DISEASES OF ANIMALS ACTS. No outbreaks of disease occurred within the Borough during 1959. 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. In November a consignment of horse flesh, which was suspected of having been in contact with an outbreak of anthrax in Scotland, was delivered to a shop in Wimbledon. Precautions were taken to keep the consignment of meat under control, and eventually the meat was destroyed under the supervision of the Senior Public Health Inspector, upon the instructions of the Ministry. The shop premises, including the refrigerator and all the equipment liable to contamination, were cleansed and disinfected. Four visits were made during the year to a piggery which is licensed by the Council under the Diseases of Animals (Waste Foods) Order 1957 for the boiling of foodstuffs for the feeding of animals. One other licence was surrendered during the year following the closing down of the premises. 38 SECTION G. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. During the year there were 762 cases of infectious disease notified compared with 306 in 1958, and 898 in 1957. The increase over 1958 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, nor were we required to undertake surveillance of any contacts. From time to time notice is received of persons arriving in this country from abroad who have been in contact with smallpox. All such contacts are kept under observation until the possibility of developing the disease has disappeared. SCARLET FEVER. There were 74 cases of scarlet fever notified during 1959 compared with 80 in 1958, 59 in 1957, and 110 in 1956. Twelve of the cases were 39 admitted to hospital for treatment. The infection continued to be mild in character and as is usual was most common in children of school age. Forty-two of the notifications related to children in the 5-9 years age group. MEASLES. Six hundred and twenty seven cases of measles were notified during the year compared with 134 in 1958. There was no mortality from the disease. The number of cases notified in 1956 and 1957 was 64 and 660 respectively, and this series of figures illustrates how this disease is more prevalent in alternate years. ACUTE ENCEPHALITIS. Of four cases reported two were diagnosed as Acute Infective Encephalitis and two as Post Infectious Encephalitis. Of the latter two cases one became infected following an attack of chicken pox and the other following influenza. All recovered. DIPHTHERIA. Although for the tenth year running there were no cases of Diphtheria in Wimbledon, it cannot be emphasised too strongly that Diphtheria is still about and could return unless a high level of immunisation is maintained in the community. Notifications of Diptheria in England and Wales in 1959 amounted to 103 which is the highest number of cases notified since 1956 and included outbreaks of the disease in unimmunised children in some parts of London. This increase in notified cases of Diphtheria serves to emphasize to parents the importance of keeping their children as highly immune as possible by early immunisation and periodical reinforcing doses. TYPHOID FEVER. One case was notified. This was a girl of 17 years who was admitted to hospital in January suffering from a Pyrexia of unknown origin and was diagnosed, after bacteriological examination, as suffering from typhoid fever type E.l. This girl had returned from boarding school in Switzerland for the Christmas holidays and it seems probable that she may have picked up the infection in Switzerland although on enquiry of the Principal of the Boarding School no evidence was obtained of any other similar cases among the students, teachers or staff. Investigations carried out in respect of all known contacts failed to reveal any further cases of typhoid fever. The patient responded to treatment and soon became free from infection. PARATYPHOID FEVER One case occurred in a young man of 18 years who was removed to hospital following fever and sickness. Bacteriological examination of other members of the family and known contacts proved to be negative. The patient made an uneventful recovery. 40 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 11 notifications were received, all but one of the cases occurring in hospital. Of the 11 notifications, 9 of the patients had addresses outside the Borough. In 1958 19 cases were notified. PNEUMONIA. Eighteen cases of acute primary or influenzal pneumonia were notified during the year, compared with 25 in 1958 and 24 in 1957. The total number of deaths from all forms of the disease during the year was 40 compared with 26 in 1958. DYSENTERY. Eleven cases of dysentery were notified compared with 24 in 1958, 9 in 1957 and 15 in 1956. There was one incident involving four school children, all pupils of the same school, the mother and younger brother of one of these pupils and the two younger sisters of another pupil. In this incident the causative organism was the mild but very infectious Sonne type. In addition a number of other children in the school who had symptoms of dysentery were examined bacteriologically but no pathological organism was isolated. Another notified case was due to an organism known as Shigella Flexner and concerned a boy of 4 years who was admitted to hospital for treatment. The remaining cases were all of the Sonne type and occurred singly in various parts of the Borough. The illness caused by the Sonne organism is generally mild but is highly infectious and once it appears in a school or nursery it is difficult to check and causes great inconvenience to those concerned. All cases reported to the Public Health Department are systematically followed up and stool specimens obtained for bacteriological examination where necessary. In dealing with cases of dysentery attention to personal hygiene is always stressed as an important mean's of preventing the spread of infection. WHOOPING COUGH. Only five cases of whooping cough were notified in 1959 compared with 10, 108, 82, 139 and 74 in the last five years. This is the lowest number of notifications received since whooping cough became notifiable in 1940 and is even better than last year's figure of 10 notifications which was the previous lowest. POLIOMYELITIS. As was the case in 1958 there was only 1 confirmed case of Poliomyelitis in 1959. This was a young soldier of 20 years, serving in the 41 R.A.S.C. in Dorset who was admitted to hospital on 25th May with suspected Poliomyelitis whilst home on leave. This was a rather obscure case and was only finally diagnosed as non-paralytic poliomyelitis on 19th June. As this young man had only been home on leave a few days before his admission to hospital, and had in fact been ill whilst at his camp, there is no doubt that he contracted the disease in Dorset. The patient had not been vaccinated against Poliomyelitis. FOOD POISONING. Eight cases were notified. Two children in one household were infected with Salmonella typhi-murium and in four other cases the organism responsible was also Salmonella typhi-murium. In another case in a child of 6 years who was admitted to Hospital the causative organism was Salmonella Chester. Another case reported was a family of three who had symptoms of food poisoning after eating a chicken pie prepared and cooked at home. The organism Clostridum Welchi was isolated from both the chicken pie and faecal specimens. A number of other cases investigated failed to reveal any specific Food Poisoning organism. WINTER EPIDEMICS An epidemic of influenza started in Wimbledon about the 1st February and was fairly widespread throughout the Country. At its peak in the week ending 17th February the percentage of new sickness benefit claims of the insured population was 495% of the average weekly figure but as from the week ending 24th February, there was a steady decline in new sickness benefit claims and the epidemic had subsided by early March. In general the influenza was of a mild type, although in some cases, particularly in regard to the elderly, there were serious complications. Foggy weather helped to increase the severity of the disease. The average school attendance for the Council Schools in Wimbledon at the peak period was 20% below normal and in one school the attendance was nearly 40% below normal although in addition to influenza and colds the schools were at this time affected by a high incidence of measles. 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. 42 During the year 573 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 vaccination of 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 56% and there is every need to raise this figure to at least 75%. The following shews the number of vaccinations carried out during the yea:— Primary vaccinations 564 Re-vaccinations Ill 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 553 Number of children boosted 83 DIPHTHERIA IMMUNISATION. The following table gives details of the number of children who were immunised for the first time during the year 1959:— Under 5 years 616 Between 5 and 15 years 88 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 2,124 Between 5 and 15 years 6,675 Number of children given reinforcing doses during 1959 1,355 TETANUS IMMUNISATION. Active immunisation against tetanus is available for those who desire it in the same way as other immunising procedures. During the year 265 children received protection. 43 POLIOMYELITIS VACCINATION. Following an improvement in vaccine supplies, Poliomyelitis vaccination continued unabated throughout 1959. In order to encourage those in the 15-26 years age group to be vaccinated, Open Clinics, both in the evening and on Saturday mornings were started towards the end of 1958, where vaccination could be carried out without prior appointment. The response from this age group was disappointingly low as it was throughout the Country. In May, in an effort to improve the acceptance rate among these young adults, an intensive campaign of one week's duration was launched in Wimbledon combined with Merton and Morden. During this Polio Week, evening clinics were set up at the Town Hall and at Amity Grove Clinic, Raynes Park, and a total of 1,333 persons turned up to receive their first injections. Arising from this campaign and the associated publicity there was a renewed interest shown in poliomyelitis vaccination and at the end of the year the acceptance rate in this age group had risen to nearly 45%. The following table shews the position with regard to poliomyelitis vaccination at 31/12/59 :— Class Number vaccinated with 2 injections since the beginning of the scheme Children born in the years 1943 to 1959 10.427 Young persons born in the years 1933 to 1942 3.589 Expectant mothers 569 General practitioners and families 47 Ambulance staff and families 17 Total 14,649 Number of persons given reinforcing doses under the extended Scheme - 9,394. 44 Notifiable diseases during 1959. DISEASE Number of Cases Notified in Various Age Groups 25 and over 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 Scarlet Fever - - 5 3 6 42 18 — — 74 12 - Measles 10 32 73 69 85 324 28 2 4 627 — - Whooping Cough 1 - 1 1 1 1 — — — 5 — - Acute Poliomyelitis (Non-Paralytic) - - - — — — — 1 — 1 1 - Puerperal Pyrexia - - - — — — — 4 7 11 10* - Dysentery - - - — 1 6 — 1 2 11 1 - Paratyphoid Fever - - =- — — — — 1 — 1 1 - Erysipelas - - =- — — — — — 1 1 — - Typhoid Fever - - - — — — — 1 - 1 1 - Pneumonia (Acute Primary or Influenza) - 1 - — — 1 — — 15 18 4 - Food Poisoning - 1 - 2 — 2 1 — 1 8 2 - Acute Encephalitis - - - - - - - - Infective - - - — 1 — 1 -— — 2 2 - Post-infectious - - - - - - - 1 1 2 2 - TOTALS 11 35 81 75 94 376 48 11 31 762 36 — * These 10 patients were already in hospital Notifications of infectious Disease during the last 10 years. DISEASE 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 Dysentery 7 53 36 19 14 2 15 9 24 11 Encephalitis acute — — — — — — 1 1 — 4 Enteric Fever (Typhoid) ... — — — — — — — — — 1 Paratyphoid Fever 3 — 1 1 — — — 1 1 1 Erysipelas 1 5 3 3 3 2 6 1 3 1 Food Poisoning 4 6 13 2 11 1 8 8 Malaria — 1 — — 1 — — — Measles 364 758 337 896 18 813 64 660 134 627 Meningococcal Infection 3 -> 1 1 2 1 1 1 — Ophthalmia Neonatorum 1 — 1 — — Pneumonia 20 27 24 29 18 21 34 24 25 18 Poliomyelitis 12 4 2 11 4 11 7 10 1 1 Puerperal Pyrexia 1 2 5 22 4 7 12 25 19 11 Scarlet Fever 68 136 128 96 49 77 110 59 80 74 Whooping-cough 181 166 112 183 74 139 82 108 10 5 661 1.158 649 1,267 200 1,074 344 900 306 762 Tuberculosis:— Pulmonary 82 56 56 65 40 36 44 50 25 26 Non-Pulmonary 10 4 3 1 7 4 6 2 1 5 TUBERCULOSIS. During the year 70 new cases were added to the register of tuberculous persons compared with 80 in 1958 and 89 in 1957. Of the 70 additions 31 were primary notifications, 34 were transferred from other areas, and 5 were restored cases. An analysis of the notifications received is given overleaf. One hundred cases were removed from the register for the following reasons:— Pulmonary N on-Pulmonary M. F. M. F. Deaths from tuberculosis 2 2 1 1 Deaths of patients suffering from - - tuberculosis through other - - causes4 1 - - Recovered cases 20 14 - 1 Removals from district 32 19 1 2 58 36 2 4 At the end of the year, after taking into account all the additions and deletions, there were five hundred and six cases remaining on the tuberculosis register, four hundred and fifty being cases of pulmonary tuberculosis and fifty six cases of non-pulmonary tuberculosis. New notifications of pulmonary tuberculosis amounted to only 26 compared with an average of 36 in the last five years. This represents a notification rate of 0.45 per thousand of the population, which, apart from last year's record figure, is the lowest the Borough has known, and is most encouraging having regard to the use now made of Mass Radiography and other means of early detection of the disease. Deaths from pulmonary tuberculosis amounted to 4 compared with 1 last year, when the Borough's lowest figure was recorded. While there are bound to be fluctuations in dealing with relatively small numbers, on the average the local death rate from pulmonary tuberculosis has steadily declined, as it has nationally. 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. is offered to all children between the ages of 13 and 14 years and is carried out in the secondary schools and County Council's Clinics normally in the autumn term. This scheme is operated through the County School Health Service. Public Health (Prevention of Tuberculosis) Regulations 1925 — No action was necessary in regard to tuberculosis employees in the milk trade. Public Health Act 136 (Section 172) — No action was required under this Section of the Public Health Act 1936. 47 TUBERCULOSIS 1959. AGE GROUPS CASES ADDED TO THE REGISTER DEATHS Cases Discovered Primary Notifications otherwise than by Total Cases (Form A) Notification 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 — — - - — - - — — - - - - - 5—9 2 — - - — - - 2 — - - - - - 10—14 1 1 - 1 — — - - 1 1 - 1 - - - - 15—19 — 2 1 1 1 — - 1 1 2 1 2 - - - - 20 — 24 4 — - 1 3 3 - 7 3 1 - - - - 25 — 29 1 2 - - 4 2 - 5 4 - - - - - 30 — 34 1 1 - 3 3 - 4 4 - - 35 — 44 2 2 - - 6 2 - 8 4 - - - - 1 45 — 54 „ 3 3 - 6 - 1 1 - 55 — 64 1 — - 1 2 - 3 1 1 - - 65 and Over . 2 1 - - 4 1 - 6 2 - 5 2 - Age not known - - - - 1 — - - 1 — - — - - - - 17 9 1 4 27 11 1 44 20 1 5 6 3 1 1 26 * 5 38 1 64 6 9 2 31 39 70 11