LIbrary wan 89 Metropolitan Borough of Mandsworth ANNUAL REPORT of the Medical Officer of Health for the Year 1952 by J. TUDOR LEWIS, M.D., D.P.H. together with the Report of the Public Analyst REPORT of the Medical Officer of Health for the year 1952 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Wandsworth Mr. Mayor, Ladies and Gentlemen, I beg herewith to present to you the Annual Report on the health and sanitary conditions of the Metropolitan Borough of Wandsworth for the year 1952. The Report, which in form follows closely that adopted by my predecessor, deals with many matters touching the health of the people of Wandsworth, and here all I need do is to indicate generally some of the more interesting and important details. Before doing this, however, I should like to refer to the long and distinguished service to the Borough Council of my predecessor, Dr. F. G. Caley. Dr. Caley retired from the service of the Council on the 6th of January, 1952, when I had the privilege of taking over responsibility for the Public Health Department. His retirement terminated an active career in the public health service which had been spent almost entirely with the Wandsworth Metropolitan Borough Council. He was first appointed by the Council in 1913 as Tuberculosis Officer and Deputy Medical Officer of Health. On the outbreak of war in 1914 he joined the R.A.M.C. and served with that Corps until he returned to civilian duties in 1919. In 1923, when the late Dr. Caldwell Smith died suddenly, Dr. Caley was appointed in his place and held the position of Medical Officer of Health with marked distinction until his retirement in 1952. Dr. Caley, therefore, had upwards of 40 years' service in the Public Health Department of Wandsworth, and during this period was intimately associated with the great expansion of the health and social services of the borough. In the earlier years of his service his interest was particularly in the field of tuberculosis, its prevention and cure, and later on he extended his interests very greatly, giving attention particularly to the development of the maternity and child welfare services, and playing an active part in connection with slum clearance. In 1938, through his appointment as Training Officer, he became responsible for the training of civil defence personnel in first aid and anti-gas precautions, and when in 1939 war was again declared, Dr. Caley was made responsible for the first aid posts and the light rescue parties, which in a borough of the size of Wandsworth, forming part of the vulnerable metropolitan area, involved a heavy weight of responsibility. I should like to say how easy it was for me to take over from Dr. Caley, and this can be attributed in no small measure to the 2 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 high state of efficiency in which he left the Department. I am sure it is the wish of everyone that Dr. Caley will enjoy many years of happy and fruitful retirement. The year under consideration was not one of any particular note from the health point of view. The population of the borough fell slightly as compared with the previous year. There was a slight reduction in the death rate and also in the birth rate as compared with 1951, while the infant mortality rate, that is to say, the number of deaths of infants of under one year of age per 1,000 live births, remained at 23, the figure for 1951. The number of deaths from causes associated with childbirth was three, and the still-birth rate was 16.6. There was a decrease in the number of infectious disease notifications, due mainly to a large reduction in the incidence of measles and whooping cough compared with the previous year. The number of cases of scarlet fever showed a slight increase, while there were 39 cases of infantile paralysis. Of these, 16 fortunately were of the non-paralytic type. Two hundred and thirty cases of dysentery were notified as compared with 117 in the previous year, a high proportion of these being in various mental hospitals situated within the borough. Special attention was paid by the Department to the investigation and control of cases of dysentery occurring at home. The number of deaths from tuberculosis dropped from 107 to 95. Of the many duties with which the Department has been concerned, either directly or indirectly, perhaps I should make special mention of one of the most important problems in public health and sociology of to-day, namely, the welfare of old people. We have tried to give particular attention to this very important subject, over and above our statutory obligations, by assisting and co-ordinating the many voluntary associations in the borough, which are doing such excellent work themselves in this sphere. We hope thus to weld together both voluntary and official bodies into one cohesive service whose one aim is the welfare of old people. A good deal of attention has been paid to the supervision of catering establishments, which involves a considerable amount of work in a borough of the size of Wandsworth. Towards the end of the year the new By-Laws for the Protection of Food made by the London County Council came into force, and the opportunity was taken by the Food Inspectors of visiting the traders concerned to give them every help and guidance in complying with the by-laws. 1952 was the first complete year in which the new and somewhat unusual system of public health administration in Wandsworth was in operation. I refer, of course, to the arrangement by which the Medical Officer of Health of Wandsworth is also Medical Officer of Health of the adjoining Metropolitan Borough of Battersea and Divisional Medical Officer for the London County Council Health Division 9, while the Deputy Medical Officer of Health for Wandsworth is also Assistant Divisional Medical Officer. I do not wish to make more than a brief reference to this important subject in this 3 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Report, since at the time of writing the system has been operating for barely 18 months. I think, however, that the members of the Council should have a short interim statement about a method of public health administration which has given rise to a good deal of interest and comment. In order that the new arrangements may be seen in their proper perspective, it is important that the principles on which they are based should be recognized. Everyone is agreed that one of the major problems in the administration of the health services is to effect the closest liaison between the various branches of the health and medical services, responsibility for which was divided amongst a number of statutory bodies by the National Health Service Act, 1946. The main branches resulting from that Act are the local health and preventive medical services, the responsibility of various types of local authorities; the hospital and specialist services, the responsibility of the Regional Hospital Boards, Boards of Governors and the Hospital Management Committees; and the general medical or general practitioner services, the responsibility of the Local Executive Councils. There is no difference of opinion on the need for the closest co-ordination of the work of these three statutory bodies and of the officers of all grades who serve under them. It is harder to achieve this object, however, where there is dual responsibility within the local authority health services, and the difficulty is probably most acute within the County of London. The reason for this is that many of the metropolitan boroughs (Wandsworth, of course, is an example), which are responsible only for the environmental health services, are larger in population and acreage than many important provincial cities and counties, some of which are all-purpose authorities, whereas the London County Council (the largest public health authority in the country), is responsible for the personal health services and also for other services closely linked with them, namely, the education and welfare services. It is, I think, a testimony to the efficiency of the officers engaged in the local public health service in London that the standard of public health practice and administration under these conditions is so high, both in the environmental and the personal health spheres. Nevertheless, it must be obvious that this dual responsibility is a serious weakness in the administration and that great advantage would result from effecting a blending of the two sections of the preventive health service. There are a number of ways, no doubt of varying degrees of practicability, by which this can be attempted, and one is the method which has been adopted in this area, where the Medical Officer of Health for two adjoining metropolitan boroughs and the Divisional Medical Officer is the one person ultimately responsible to the three committees concerned with the administration of the two sections of the public health services. It should be possible by this means for the two branches of the public health and preventive medical services to be very closely combined and co-ordinated. 4 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 I am happy to be able to state that up to the present time no difficulty whatsoever has been experienced and I am unaware that any commitment or responsibility has gone undischarged. Apart from the practicability of the arrangement as a purely administrative measure, there are many other advantages. For instance, the two boroughs comprising Health Division 9 are such that they form a convenient and economic unit for the purpose of planning the public health services, and this means that over a fairly large area unified methods of sanitary administration and of the practice of public health and preventive medicine can be applied. This, in itself, tends to eliminate problems which might arise if there were three separate departments with three separate heads, and local difficulties can be the more easily ironed out; and this in turn greatly helps all sections of the work. Perhaps the most obvious advantages, however, are those which involve branches of the work which are partly the responsibility of the Wandsworth Borough Council and partly of the London County Council. To take the control of infectious disease as an example, if an outbreak occurs in a school or day nursery, the Borough Council is certainly responsible, as the authority charged with the prevention of infectious disease, for dealing with the epidemic, but the London County Council is also intimately concerned in that the infectious disease occurs in one of their institutions. By having one person responsible for both sides of the work there is only one guiding hand and the officers of both authorities can be employed in conjunction or separately to the best effect. We have had instances during the year of the great benefit which is derived from this arrangement. Another example is the care of old people. Their needs come to light in a variety of ways, and the borough Sanitary Inspectors, whose duties afford them entry into the homes of the people, are frequently the first to uncover the special problems of an old man or an old lady. On the other hand many of the health and social services from which the aged derive special benefit are the responsibility of the London County Council, although, under certain conditions, the responsibility for removing an old person to hospital rests with the Borough Council. Here again, with one person in charge it has been possible to secure the close co-operation of both authorities' officers, and the deployment at the right time and in the right way of the service most suited to the individual. Yet again, both authorities have important responsibilities in the matter of housing, particularly where priority recommendations on medical or health grounds are made, and undoubtedly this work is much facilitated by the new procedure. These are but a few instances of how the two separate services can be closely brought together under the system. An efficient public health and preventive medical service is essentially a team service, and it is likely that the team spirit is more vital in the system operating in Wandsworth than in any other. There 5 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 is no doubt that the greatest single factor making for success in this form of administration is an abundance of good will and a determination by all persons, both at Committee and officer level, to make the system work through a community of effort. It is most gratifying to be able to report that everybody concerned has shown the greatest keenness to ensure the success of this venture. I should like to record the great help and encouragement I have personally received from the members of the Wandsworth Borough Council, especially the members of the Wandsworth Public Health Committee, and in particular from the two Health Committee chairmen under whom I have served, namely, Alderman Mrs. C. E. F. Callingham and Councillor T. V. Rowlands. I have greatly appreciated and valued the help, encouragement and kindly advice which has always been forthcoming at member level. In like measure the Chief Officers of Wandsworth have done everything in their power to make my first year in the borough a happy and successful one, and if I mention Major R. H. Jerman, O.B.E., M.C., M.A., the Town Clerk, separately, it is because inevitably I have been most closely in touch with him. All the staff of the Health Department in all sections and grades have rendered me yeoman service and every member has played his or her part in the work as a whole. I should like particularly to mention my deputy, Dr. W. G. Harding, who, like myself, was new to the borough. Dr. Harding has been untiring in giving me every support and I am most grateful to him for the loyal and efficient way in which he has done so, and for ensuring that our contacts with other Departments and outside bodies related to our work have been close and harmonious. The Chief Sanitary Inspector, Mr. A. E. Vickers, has been most assiduous in his efforts to make available to me his extensive experience of sanitary work in general and of problems connected with the borough in particular, and I am most appreciative of the great help he has given me. To everyone concerned, therefore, I would like to express my warmest thanks for making my first year's work in Wandsworth as much a pleasure as it has been a privilege. Eighteen months is not a very long time and I have been deliberately cautious in making this statement. My feeling at the moment, however, is that the foundations of a permanent success have certainly been laid, and if the very happy spirit which has so far permeated the whole of our efforts at all levels can be continued, I see no reason why this method of public health administration should not, in this area, prove to be highly successful. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, J. TUDOR LEWIS, Medical Officer of Health. 6 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 STAFF The following changes occurred during the year. Resignations, etc. Mr. C. Nargang, General Division Officer (service, three years), and Miss E. Douglass, shorthand-typist (service, nine months), resigned on obtaining appointments elsewhere. Mr. K. Winton, Sanitary Inspector (service, three years), resigned on obtaining an appointment as Meat Inspector under the City of London Corporation. Mr. W. G. Pearce, Sanitary Inspector (service, 23 years), retired in October on attaining the age of 65 years. On the 26th December, the death occurred by accident of Mr. A. Batten, age 43, the Assistant Supervisor at the Disinfecting Station, after 14 years' service with the Council. Appointments Mr. J. Miles, Sanitary Inspector, commenced duty with the Council in February. STATISTICS AND SOCIAL CONDITIONS Area 9,199 acres Resident population in 1952 331,700 Wandsworth is the largest of the Metropolitan Boroughs. It has an area of 9,199 acres which includes a number of open spaces, with an approximate combined area of 1,200 acres. The population is a varied one, as the Borough contains residential neighbourhoods in addition to several working-class districts. The chief industries carried on are the manufacture of gas, electricity and motor accessories, laundries and general engineering. There is no trade which has any particular effect on the health of the workers or residents. 7 8 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Extracts from Vital Statistics Number of Live Births:— Males Females Total Legitimate 2,176 1,961 4,137 Illegitimate 109 128 237 Total live births 2,285 2,089 4,374 Males Females Total Number of stillbirths 44 31 75 Number of deaths 2,036 2,129 4,165 Birth-rate 13.18 Death-rate 12.55 Rate per 1,000 (Live and Still) Births Deaths from puerperal and post-abortive sepsis – – Deaths from other puerperal causes 3 0.67 Total 3 0.67 Infantile mortality per 1,000 live births:— All infants 23 Legitimate infants 19 Illegitimate infants 38 Deaths from Cancer 805 Diphtheria 0 Scarlet Fever 1 Measles 2 Whooping Cough 1 Tuberculosis 95 Tuberculosis death-rate 0.28 There has been no unusual or excessive mortality during the year. VITAL STATISTICS Population The civilian population at the middle of the year was estimated by the Registrar-General to be 331,700, and all the rates used in this Report are based on this.figure. Table I shows the approximate population of each Parliamentary Division, based on the above estimation. TABLE I. Population estimated to middle of 1952 Putney 88,420 Central 96,902 Clapham 75,399 Streatham 70,979 Whole Borough 331,700 Births The total number of births belonging to the Borough registered during 1952 was 4,374, consisting of 2,285 males and 2,089 females. The number for 1951 was 4,553. The birth-rate was 13.18 per 1,000 persons living, compared with 13.70 for 1951. The rate for the whole of London during 1952 was 17.6 and for England and Wales 15.3. Two hundred and thirty seven illegitimate births took place in the Borough compared with 276 in 1951. 9 10 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Deaths The number of registered deaths which took place in the Borough during the year was 3,527 but 1,220 of these did not belong to the Borough, while 1,858 Borough residents died outside the Borough. The corrected number of deaths for the Borough, after allowing for these factors, was 4,165 of whom 2,036 were males and 2,129 females. The death-rate for the year was 12.55 per 1,000 persons living, compared with 12.85 in 1951. The death-rate for the whole of London for 1952 was 12.6 and for England and Wales 11.3. Table II shows the total number of registered deaths and the death-rates for each division and for the whole Borough. TABLE II. Corrected Deaths Death Rate Males Females Total Putney 545 547 1,092 12.35 Central 547 551 1,098 11.33 Clapham 536 552 1,088 14.43 Streatham 408 479 887 12.49 Whole Borough 2,036 2,129 4,165 12.55 11 VITAL STATISTICS Table III is the general mortality Table for the whole Borough and shows the number of deaths from each cause divided into sexes, age groups and sub-districts. TABLE III. CAUSES OF, AND AGES AT DEATH, DURING THE YEAR 1952 DEATHS IN OR BELONGING TO LOCALITIES (ALL AGES) Streatham 12 3 3 — — — — — 3 156 3 6 103 281 52 7 28 87 7 15 3 15 7 — 10 71 3 7 5 — 887 Clapham 25 3 5 — — 1 2 2 1 207 7 5 112 311 67 12 58 95 7 13 3 13 8 1 12 86 5 16 11 — 1,088 Central 20 5 3 — 1 - 2 - 2 216 8 9 119 331 57 3 49 104 8 11 2 10 16 2 7 82 2 20 8 1 1,098 Putney 25 1 4 — — — 1 - 2 226 4 10 112 347 58 4 45 79 10 13 4 12 13 — 10 76 6 20 10 — 1,092 DEATHS IN OR BELONGING TO WHOLE DISTRICT AT SUBJOINED AGES 65 and upwards 20 3 12 — - — — - 3 486 10 23 352 1,049 186 20 125 282 16 32 5 30 40 — 4 165 7 27 14 1 2,912 45 and under 65 36 4 2 — — — 1 — 1 273 8 6 86 196 43 5 33 75 9 18 4 12 4 — 1 73 2 16 15 — 923 15 and under 45 26 1 1 — — — 3 — — 41 2 1 7 25 5 1 8 3 5 2 2 7 — 3 5 23 6 11 5 — 193 5 and under 15 — — - — — - 1 2 1 3 2 - 1 - - - 1 — 1 — — 1 — — 3 5 1 2 — — 24 1 and under 5 — 3 — — — — — — 2 2 — — — — — — 4 2 1 — — — — — 3 4 — 3 — 24 Under 1 year — 1 — — 1 1 — - 1 - — — — — — — 9 3 — — 1 — — — 23 45 — 4 — 89 Females 26 7 7 — 1 1 — 2 4 391 14 21 276 675 124 13 97 141 15 22 7 31 - 3 25 177 7 28 14 — 2,129 Males 56 5 8 — - — 5 — 4 414 8 9 170 595 110 13 83 224 17 30 5 19 44 - 14 138 9 35 20 1 2,036 All Ages 82 12 15 — 1 1 5 2 8 805 22 30 446 1,270 234 26 180 365 32 52 12 50 44 3 39 315 16 63 34 1 4,165 CAUSES OF DEATH Tuberculosis, Respiratory Tuberculosis, Other Syphilitic Disease Diphtheria Whooping Cough Meningococcal Infections Acute Poliomyelitis Measles Other Infective and Parasitic Diseases Malignant Neoplasms Leukaemia, Aleukaemia Diabetes Vascular Lesions of Nervous System Diseases of Heart Other Circulatory Disease Influenza Pneumonia Bronchitis Other Diseases of Respiratory System Ulcer of Stomach and Duodenum Gastritis, Enteritis, Diarrhoea Nephritis and Nephrosis Hyperplasia of Prostrate Pregnancy, Childbirth, Abortion Congenital Malformations Other Defined and Ill-defined Disease Motor Vehicle Accidents All other Accidents Suicide Homicide and Operations of War All Causes 12 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Infantile Mortality The number of deaths under one year was 89, the infantile mortality rate being 23 per 1,000 births. This compares with a rate of 23 for 1951 and 22 for 1950. For the ten years ending 1942 the average infantile mortality rate was 50 while for the ten years ending 1952 the average rate was 31. Maternal Mortality Three deaths occurred from accidents and diseases of pregnancy. This is equivalent to a rate of 0.67 for 1,000 live and still births, compared with 0.64 in 1951. INFECTIVE DISEASES The number of deaths from notifiable infectious diseases, including all forms of tuberculosis, was 171. From all notifiable infective diseases the death-rate was 0.52 per 1,000. Table IV shows the number of cases of the notifiable diseases reported, arranged in age groups, and Table V shows the same figures arranged in the sub-districts in which they occurred. Smallpox No case occurred in the Borough during the year. Notification is frequently received from Port and Local Authorities of persons coming into the Borough who may have been in contact with Smallpox. Observation for the necessary period is kept on these persons by members of the Public Health Department. Diphtheria There were no confirmed cases during the year. Twenty-two cases were reported, but after admission to hospital were found to be incorrectly diagnosed. Scarlet Fever Five hundred and sixty-three cases of Scarlet Fever were notified or reported compared with 414 in 1951, 584 in 1950, and 495 in 1949. The diagnosis was not confirmed in 28 cases. One death was attributed to Scarlet Fever during the year. Whooping Cough Four hundred cases were notified during the year. There was one death. 13 14 TABLE IV. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 NOTIFIABLE DISEASES NO. OF CASES OF INFECTIVE DISEASES GROUPED IN AGE PERIOD Total Under 1 1-3 3-5 5-10 10-15 15-25 25-45 45-65 65 and upwards Smallpox – – – – – – – – – – Diphtheria – – – – – – – – – – Scarlet Fever 535 1 33 133 301 38 16 12 1 – Measles.. 2,290 68 487 561 1,112 32 18 11 1 – Whooping Cough 400 30 85 108 151 9 7 9 1 – Enteric Fever and Paratyphoid Fever 3 – – – – – 1 1 – 1 Malaria – – – – – – – – – – Dysentery 230 5 30 43 61 12 18 32 15 14 Erysipelas 68 – – – – 1 2 22 25 18 Scabies 30 – – 1 2 1 6 11 7 2 Puerperal Pyrexia 156 – – – – – 53 103 – – Ophthalmia Neonatorum 6 6 – – – – – – – – Meningococcal Infection 7 2 1 – 1 1 – 1 1 – Acute Poliomyelitis 39 1 – 3 9 9 10 6 1 – Acute Encephalitis 2 – – 1 – – – – – 1 Anthrax – – – – – – – – – – Pneumonia:— Acute Influenzal 52 2 5 4 1 2 10 12 8 8 Acute Primary 184 8 3 7 11 8 6 39 44 58 Tuberculosis—All forms 666 4 4 16 20 20 167 281 119 35 Food Poisoning 123 2 5 9 10 7 20 38 25 7 Continued Fever 1 – – – – – – – – 1 Total 4,792 129 653 886 1,679 140 334 578 248 145 15 TABLE V. INFECTIVE DISEASES NOTIFIABLE DISEASES TOTAL CASES OF INFECTIVE DISEASES OCCURRING IN EACH WARD Whole Borough Deaths PUTNEY CENTRAL CLAPHAM STREATHAM Putney Thamesfield Fairfield West Hill Southfield Earlsfield Springfield Tooting Graveney Bedford Larkhall Clapham North Clapham Park Thornton Balham Streatham Hill St. Leonards Streatham Common Streatham South Furzedown Smallpox – – – – – – – – – – – – – – – – – – – – – – Diphtheria – – – – – – – – – – – – – – – – – – – – – – Scarlet Fever 30 28 21 25 38 27 21 38 28 29 38 22 25 20 23 11 20 30 78 33 535 1 Measles 69 70 198 76 205 253 139 141 97 135 158 135 84 49 89 1 10 66 74 59 83 2,290 2 Whooping Cough 10 17 77 17 14 28 38 86 26 14 10 12 5 5 15 7 1 8 3 7 400 1 Enteric Fever and Paratyphoid Fever – – – – – – – – 1 1 – – 1 – – – – – – 3 – Malaria – – – – – – – – – – – – – – – – – – – – – – Dysentery 3 1 14 2 2 4 7 118 21 5 8 17 1 4 4 4 2 10 1 2 230 1 Erysipelas 1 1 3 2 2 3 5 8 8 5 2 4 3 – 5 3 2 3 2 6 68 Scabies – 1 4 1 2 2 1 2 4 1 2 5 – 2 – – 1 2 30 Puerperal Pyrexia 2 2 8 3 4 3 6 15 7 7 2 12 28 12 7 9 3 11 5 10 156 — Ophthalmia Neonatorum – – – 1 – 1 1 1 – – – – – 1 – – – – 1 – 6 Meningococcal Infection – – 1 – – 1 – 1 – – 1 1 1 1 – – – – – 7 1 Acute Poliomyelitis 4 2 2 1 3 1 1 1 4 3 1 2 3 2 4 1 1 – 1 2 39 5 Acute Encephalitis – 1 – – – – – – – – – – – – – 1 2 1 Anthrax – – – – – – – – – – – – – – – – – – – – – – Pneumonia:— Acute Influenzal 3 6 6 1 – 3 1 1 3 6 4 4 2 4 2 2 1 – 2 1 52 14 Acute Primary 5 7 12 11 6 14 14 10 6 9 12 12 9 10 5 10 8 9 6 9 184 50 Tuberculosis—All forms 50 24 35 31 32 46 26 47 28 29 33 45 36 46 43 34 22 13 18 28 666 95 Food Poisoning 3 3 20 2 5 35 2 6 19 4 2 2 2 – 5 4 – 4 2 3 123 – Continued Fever 1 – – – – – – – – – – – – – – – – – – – 1 – Total 181 162 401 173 313 422 262 475 252 248 273 268 204 155 204 195 176 163 128 187 4,792 171 16 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Measles The number of cases notified during the year was 2,290, compared with 4,299 in 1951, 1,720 in 1950, and 2,969 in 1949. Puerperal Pyrexia During the year 156 cases of puerperal pyrexia were notified. Acute Poliomyelitis Seventy-three cases of this disease were notified or reported during the year, of which 34 were subsequently not confirmed. Of the remaining 39 confirmed cases, 23 were of the paralytic type and 16 non-paralytic. Five of the paralytic cases died. In 1951, 11 cases were confirmed with no deaths. Acute Encephalitis Two deaths were attributed to Acute Encephalitis. Ten other cases investigated were subsequently not confirmed. Meningococcal Infection Seven confirmed cases were notified. There was one death. Twenty-one other cases were investigated, but were subsequently not confirmed. In the previous year there were two cases with no deaths. Dysentery Two hundred and forty-two cases were notified or reported during the year, 101 being from institutions. Twelve cases were subsequently held not to be dysentery. There was one death. Typhoid and Paratyphoid Fever Of four cases reported during the year, two were subsequently confirmed as typhoid and one as paratyphoid. Diagnosis was not confirmed in the remaining case. There were no deaths. 17 INFECTIVE DISEASES Influenza The number of deaths from Influenza was 26 compared with 122 in 1951, 35 in 1950, and 45 in 1949. Influenzal Pneumonia and Acute Primary Pneumonia These are the notifiable forms of pneumonia. Fifty-two cases of acute influenzal pneumonia and 184 cases of acute primary pneumonia were notified. Fourteen of the former, and 50 of the latter died. The total number of deaths credited to all forms of pneumonia during the year was 180, compared with 161 in 1951. Malaria One recurrent case was reported. Erysipelas Sixty-eight cases were notified. No deaths occurred. Other Infective Diseases Fifteen deaths occurred from syphilis. Scabies Thirty cases were notified. Eighty-eight cases of scabies were treated at the Council's Cleansing Station under the supervision of the two bathing attendants. The majority of the cases were treated by two applications of benzyl benzoate and received a course of two baths each. Sixty-three other persons received cleansing treatment for various conditions. Food Poisoning One hundred and twenty-three cases were notified during the year. Ninety-four were individual cases, and 10 were outbreaks involving two or more persons and comprising 29 cases in all. The majority of the cases were only slightly affected and by the time notification was received and investigation carried out it was impossible to confirm the notified diagnosis. In most cases, too, the suspected foods were not available for examination and in four cases only was it possible to submit any food remains for examination. In all of these cases the examination revealed no organisms likely to be responsible for food poisoning. 18 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Diseases Reported from Schools A total of 5,078 infective diseases was reported from schools in the Borough throughout the year. The numbers of each disease were:— Scarlet Fever 261 Diphtheria 1 Measles 941 German Measles 2,018 Poliomyelitis 6 Chicken Pox 1,383 Whooping Cough 155 Mumps 224 Ringworm 9 Scabies 2 Other Diseases 78 Disinfection During the year 1,463 rooms were disinfected after infectious disease and 517 rooms disinfested for vermin. Bacteriological Examinations All these examinations are carried out by the Camberwell Research Laboratory which, in October, 1948, became a Public Health Service Laboratory directed by the Medical Research Council for the Ministry of Health. The following is a summary of examinations made during the year:— Nose and throat swabs 537 Faeces for the typhoid and dysentery groups 751 Miscellaneous specimens 11 Total 1,299 NON-INFECTIVE DISEASES The total number of deaths from cancer and malignant disease was 805 the number of males being 414 and females 391. The deathrate was 2.43 per 1,000. The number of deaths in 1952 was 91 more than in 1951. Deaths from disease of the heart and circulatory system were 1,504, compared with 1,564 in 1951. Of these deaths 1,235 were of persons of 65 years of age and above. There were 577 deaths from diseases of the respiratory system compared with 572 in 1951. The number from bronchitis was 365 compared with 375 in 1951, and from pneumonia (all forms), 180 compared with 161 in 1951. Further particulars relative to pneumonia are given on page 17. One hundred and fourteen deaths were due to violence, 16 of them being due to motor accidents, 34 to suicide and 64 to other forms of violence. INVESTIGATION INTO DEATHS DUE TO FOG One hundred and sixty-seven inhabitants of the Borough of Wandsworth died during the week ending 13th December, 1952. The figure for the corresponding week in the previous year was 39. Of the 167 deaths, 86 were attributed to lung disease and 52 to heart disease; bronchitis caused the largest number of deaths, that is 56, 17 more than the total number of deaths from all causes during the corresponding week in the preceding year. I arranged for a detailed investigation to be carried out into the causes of deaths, a home visit being paid by two Sanitary Inspectors in all cases in which a post-mortem had been ordered by the Coroner, and the findings being reviewed in detail by the Deputy Medical Officer of Health. The results of this enquiry were referred to the medical officers of the Ministry of Health. This Council has been a member of the London and Home Counties Smoke Abatement Advisory Council since 1939, when the Chairman of the Public Health Committee was appointed to be its representative. The question of membership of this body and also of the National Smoke Abatement Society, of which the Council was a member between 1937 and 1950, is at present under consideration by the Public Health Committee, as are also other means of investigating and combating atmospheric pollution. CERTIFICATES OF VACCINATION AND INOCULATION Three hundred and forty requests were received from residents in the Borough for a certificate of vaccination or inoculation to be authenticated for the purpose of travel abroad. The signature of the person issuing the certificate was verified in each case as that of a registered medical practitioner practising in Wandsworth and the certificate was endorsed accordingly. 19 20 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 STAFF MEDICAL EXAMINATIONS At the request of the Committees and Chief Officers concerned, arrangements were made during the year for 17 members of the Council's staff to undergo special medical examinations. In the majority of cases the purpose of the examination was to determine the employee's future fitness for his occupation, following serious illness, and in eight cases it was found necessary to recommend superannuation. Thirty-seven shorter reports on members of the staff who were sick were obtained from doctors and hospitals at the request of the departments concerned. TUBERCULOSIS Notifications The total number of new cases which came to the notice of the Department during 1952 was 666 compared with 716 in 1951. The sources of information regarding the 666 new cases were as follows:— Primary notifications on Form A 423 Notifications from H.M. Forces 6 Unnotified at death 22 Transfers from other sanitary authorities 215 Total 666 Deaths The number of deaths certified as due to diseases of a tuberculous nature was 95. Particulars of the new cases and deaths during the year, classified by sexes and age groups are given in the following table:— TABLE VI. ###]Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year 3 – 1 – – – 1 – 1-2 3 1 – – – – 1 – 2-5 5 5 3 3 – – – 1 5-10 5 6 5 4 – – – – 10-15 3 9 6 2 – – – – 15-25 70 86 5 6 – 1 1 – 25-45 128 139 6 8 15 15 – – 45-65 76 36 5 2 28 7 1 1 65 and upwards 24 7 2 2 15 6 – 2 Totals 317 289 33 27 58 29 4 4 SANITARY INSPECTION OF THE BOROUGH Work of the Sanitary Inspectors A Summary of the inspections carried out by the Inspectors is given in Table VII:— TABLE VII Inspections Re- Inspections Total To investigate complaints 8,613 33,611 42,224 Housing Reports 1,673 530 2,203 Notifiable diseases 1,221 313 1,534 Piggeries 15 – 15 Factories, Workplaces, etc. (including Outworkers) 1,805 138 1,943 Sanitary conveniences 57 – 57 Mews and stables 239 – 239 Other inspections 5,283 1,297 6,580 Totals 18,906 35,889 54,795 Smoke observations 51 Legal proceedings, attendances at court 51 Table VIII gives details of the sanitary operations carried out in the Borough during the year. The number of drains which were tested was 735 and 1,229 were cleansed or repaired. The drains of 36 houses were reconstructed. Damp conditions have been remedied in 2,221 premises, and in 53 of these damp courses were inserted. 21 22 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 TABLE VIII. Putney Central Clapham Streatham Whole Borough 1. Premises cleansed and repaired 692 505 588 316 2,101 2. Drains tested 222 145 167 201 735 3. Drains cleansed or repaired 368 290 306 265 1,229 4. Water closets cleansed or repaired 188 169 173 152 682 5. Soil pipes repaired 29 31 30 15 105 6. Waste pipes altered or repaired 65 53 81 47 246 7. Rainwater pipes repaired 56 44 69 34 203 8. Roofs and gutters repaired 386 436 362 187 1,371 9. Damp courses inserted 26 4 8 15 53 10. Damp conditions otherwise remedied 392 342 353 217 1,304 11. Yards drained or paved 46 9 17 9 81 12. Dustbins provided or repaired 52 63 76 59 250 13. Water cisterns cleansed, covered or repaired 22 19 19 13 73 14. Water supply reinstated 45 13 36 13 107 15. Defective fireplaces remedied 163 128 83 52 426 16. Defective coppers remedied 2 1 – – 3 17. Accumulations of rubbish, etc., removed 10 12 19 11 52 18. Urinals cleansed or repaired – 1 1 – 2 19. Animals improperly kept 4 1 4 4 13 20. Smoke nuisances 1 – – – 1 21. Other nuisances 71 59 96 56 282 Total 2,840 2,325 2,488 1,666 9,319 Number of Preliminary Notices served 988 986 921 543 3,438 Number of Preliminary Notices complied with 1,129 1,131 997 618 3,875 Number of Nuisance Notices served 306 286 297 152 1,041 Number of Nuisance Notices complied with 338 342 334 173 1,187 23 SANITARY INSPECTION OF THE BOROUGH Water Supply—Cutting-off Notices During the year, notices with respect to 108 premises were received from the Metropolitan Water Board stating that the supply had been withdrawn. In 42 premises the water supply was cut off for non-payment of rates, and in 66 premises because of defects in the service. Dustbin Accommodation—Section 105, Public Health (London) Act, 1936 During the year action was taken under Section 105 of the Public Health (London) Act, 1936, in respect of 236 premises, and 224 dustbins were provided. Dustbins were also provided at 26 premises without the necessity of action being taken under the Act. Rodent Control Energetic measures for rodent control continued throughout the year, the system followed being that of prebaiting laid down by the Ministry of Agriculture and Fisheries. Rat and mice complaints received during the year totalled 2,219. Following is a summary of the work of the rodent operatives. Number of operatives' visits to premises 14,906 „ „ premises prebaited and treated with poison 1,300 „ „ premises prebaited and found not troubled 319 „ „ premises investigated and found not troubled 3,341 „ „ prebaits laid 28,732 „ „ poison baits laid 7,220 „ „ drains tested by Sanitary Inspector 476 „ „ drains found defective 279 „ „ rats estimated killed 8,407 There were seven rodent operatives and one clerk engaged on rodent control duties during the year under the supervision of a Sanitary Inspector. 24 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Swimming Baths and Bathing Pools There are four public swimming bath establishments and one open air swimming pool belonging to the Council, one open air swimming bath owned by the London County Council, one public swimming pool privately owned, and a number of private bathing pools in the Borough. The Queensmere pond on Wimbledon Common has also for many years past been a recognized bathing pond. In four of the Borough Council's swimming baths, the water is purified by a process of continuous circulation through a filtration plant whereby the whole of the water is dealt with every three to four hours and chlorinated automatically during its circulation from the filtration plant to the bath. In the other bath belonging to the Council, each bath is emptied of water as often as necessary and refilled with fresh water which is continuously circulated and chlorinated automatically the whole time the bath is in use. Disinfection and Fumigation of Clothing and Rags for Export Disinfection in bulk of clothing intended for export was carried out at the Disinfecting Station. A charge is made for this service and by the end of the year £26 had been received by the Council. Fumigation of clothing intended for export was also carried out by the Council at a warehouse in this Borough. The amount collected for this service during the year was £8. At one factory in the Borough rags are washed and disinfected prior to export under the supervision of the Council's Inspector, and certificates are issued for which a charge is made. During 1952, 154 certificates were issued and the amount collected was £46. Removal to suitable premises of persons in need of care and attention— National Assistance Act, 1948, Section 47 In dealing with the problems of the many aged and infirm persons in the Borough, much advantage has been derived from the close liaison maintained between the Public Health staff and those members of the London County Council divisional staff who are concerned with the care of the aged. This co-operation with the County Council has meant that in many cases of aged persons of chronic infirmity and incapacity to look after themselves adequately, it has been possible to make satisfactory arrangements for their care and attention without the necessity of having to take action under Section 47 of the National Assistance Act, 1948. 25 SANITARY INSPECTION OF THE BOROUGH During the year under review it was not found necessary to take action except in one case only, which was that of an old lady, aged 74 years, who was living alone in a flat under insanitary conditions and was physically incapacitated and unable to devote to herself proper care and attention. Action had been initiated in December, 1951, by my predecessor, Dr. F. G. Caley, and at the court hearing of this case in the following January Dr. Caley himself attended. A court order was granted for a period of three months and the old lady was removed to a home under the control of the London County Council. Eradication of Bed Bugs The methods employed for freeing infested houses include the stripping of all paper from the walls, the removal of wooden mouldings and skirtings and application of a blow lamp to the room surfaces. Candles are often used by house owners and the spraying of rooms by the disinfecting staff of the Council is carried out, proprietory insecticides being used. Infested bedding is removed to the Disinfecting Station and treated by steam. During the year 322 houses were found to be infested with bed bugs and disinfestation was carried out in all cases. Special steps are taken to ensure that the furniture and clothing of families about to be accommodated in the Council's houses or flats are freed from vermin. Hydrogen cyanide gas is used for the disinfestation of the furniture, which is placed in special vans constructed for the purpose, the process being carried out by a contractor. Bedding is not subjected to hydrogen cyanide but is disinfested by steam at the Council's Disinfecting Station. Mortuary and Crematorium The Mortuary at Wandsworth was used throughout the year and 445 bodies were received there. Under the Crematorium Regulations, 1930, 1,239 cremations were authorised during 1952 as compared with 1,243 in 1951. Burial of the Dead Under Section 50 of the National Assistance Act, 1948, it is the responsibility of the Council to arrange for the burial or cremation of persons who die or are found dead in the Borough, and for whom no suitable burial arrangements are made or are being made. The number of persons buried or cremated under the provisions of the Act during 1952 was 26. 26 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 HOUSING Statistics Relating to Housing Public Health Act Number of houses inspected on account of complaints or illness 9,834 Re-inspections 33,924 Number of statutory notices served:— Intimation notices 3,438 Nuisance notices 1,041 Number of houses repaired or nuisances remedied 3,875 The number of cases referred to the Solicitor for legal action during 1952 was 218 The following is a summary of Police Court proceedings:— Number of summonses served 57 „ „ „ withdrawn 15 „ „ „ adjourned 26 „ „ Orders made for abatement of nuisances 16 Costs awarded in respect of three cases .. £4 4s. Od. Housing Act, 1936 Number of houses inspected—house to house (Housing Consolidated Regulations., 1925) Nil (a) Number of houses included by representations by the Borough Medical Officer under Section 25 of Housing Act, 1936 Nil (b) Number of houses demolished following representation by Borough Medical Officer under Section 25 of Housing Act, 1936 Nil Number of houses repaired under Sections 9 and 10 of Housing Act, 1936:— (a) By owners Nil (b) By Local Authority in default of owners Nil Number of houses demolished:— (a) In pursuance of Orders under Section XI of the Housing Act, 1936 Nil (b) Voluntarily Nil Number of rooms on which Closing Orders were made (excluding underground rooms) Nil Number of Closing Orders determined Nil 27 HOUSING Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 146 Number of overcrowded families who have obtained alternative accommodation 100 Number of dwellings erected by the Borough Council for working classes during the year 343 Underground Rooms Number occupied but unfit 29 Number closed or modified occupation approved 15 Number of Closing Orders determined Nil Houses Let in Lodgings Number in Borough (registered since 1946) 3 Number of inspections 2 Number of prosecutions Nil Number of complaints remedied under the By-laws (not included under any other heading) Nil Rent and Mortgage Interest Restrictions Acts, 1920-39 During the year two applications were received from occupiers that their houses were not in a reasonable state of repair, and after consideration by the Committee it was decided not to grant certificates. Housing Accommodation Applications—Points Scheme During the year 112 of the applications made to the Council for rehousing were referred to me for the award of points under the medical category of the Council's Points Scheme. 28 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Unfit Houses 39 Victoria Rise.—The basement flat at these premises had been represented by my predecessor. Proposals to render the rooms fit for habitation were made by the owner, and specifications were approved by the Council on 29th January. 7 Hyacinth Road.—The basement premises had also been represented by my predecessor. The owner applied for the Council's consent to use the rooms for storage purposes, and this was duly granted on the 29th January. 30 St. Anne's Crescent.—A closing order was made on the basement premises on 17th June. Proposals from the owners with a view to rendering the premises habitable had previously been invited, but none were submitted. 8a Zennor Road.—A closing order was made on the basement premises on 18th November. As before, proposals were invited from the owners, but none was forthcoming. 199a Bedford Hill.—I represented the basement premises, and proposals were invited from the owners on the 18th November. 24b Old Devonshire Road.—I represented the basement premises, and proposals were invited from the owners on the 16th December. 73 Hendham Road.—A closing order was made on three rooms of the premises on the 16th July, 1935. A request from the owner to use the rooms for storage purposes was approved by the Council on the 16th December. Matrimony Place and Putney Bridge Road.—I submitted to the Council official representations under Part II of the Housing Act, 1936, upon the condition of the properties 1, 2 and 9 to 12 (consecutive), Matrimony Place, Clapham, and Nos. 1 and 3 Frogmore, and 52-58, and 66-80 (even), Putney Bridge Road. At its meeting of the 16th December, the Council gave instructions for the London County Council to be formally notified, in accordance with proviso (a) to Section 33 of the Act, that it was the Council's intention to take into consideration a proposal that the areas comprising these properties should be declared Clearance Areas. FOOD AND FOOD PREMISES There are four Inspectors engaged in the supervision of the food supply. One of them is the Food and Drugs Inspector of the Borough who is occupied in procuring samples of food and drugs for analysis by the Public Analyst and the Public Health Laboratory and the supervision of dairy premises. The other three Inspectors are designated Food Inspectors and supervise all other premises where food is sold, stored, manufactured, or prepared for sale. One-third of the Borough is allocated to each Inspector. The three Inspectors also carry out the duties required under the Pharmacy and Poisons Act, 1933, and the Pharmacy and Medicines Act, 1941. With the object of ensuring that all food businesses are supervised systematically, a register of all premises where a food business is carried on has been compiled and is kept up-to-date. This Register includes not only those premises which are subject to some form of legal control, but also all other premises in which a food business of any description is carried on. The total number of food premises on the register in the Borough is 2,705 and during 1952 they were visited on 40,965 occasions. Table IX has been drawn up to show the number of visits to various food premises in different parts of the Borough. Milk Supply The Milk and Dairies Regulations, 1949 These Regulations came into force on 1st October, 1949, and require local authorities to keep a register of all persons carrying on the trade of distributor in their district and of all premises within their district which are used as dairies, not being dairy farms. During the year 26 applications have been received from persons to be registered as distributors of milk. In each case the certificate of registration was granted. Twenty-two notices of cancellation of registration have been received. At the end of the year there were 198 persons on the register, including 17 persons with premises outside the Borough. There were 31 dairies on the register at the end of the year. The bulk of the milk sold by retail within the Borough is sent out in bottles filled in properly constructed dairies and its quality is good. 29 30 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 TABLE IX. SUMMARY OF VISITS BY FOOD INSPECTORS Putney Thamesfield Fairfield West Hill Southfield Earlsfield Springfield Tooting Graveney Bedford Larkhall Clapham North Clapham Park Thornton Balham Streatham Hill St. Leonards Streatham Common Streatham South Furzedown Whole Borough Dairies and Shops distributing Milk 21 146 70 36 80 68 32 83 106 18 111 101 129 95 128 72 43 139 17 49 1,544 Restaurant Kitchens 47 86 97 37 44 57 12 95 64 31 67 126 65 74 129 40 192 51 13 25 1,352 Ice Cream Premises 56 117 60 27 66 42 39 92 176 25 99 128 64 109 101 49 200 43 31 87 1,611 Butchers' Shops 252 245 285 63 181 197 36 129 286 55 168 164 90 248 189 91 345 23 51 133 3,231 Greengrocers' Shops 41 63 52 33 42 37 30 60 264 42 97 126 34 164 197 50 75 17 50 67 1,541 Fishmongers' Shops 23 37 30 14 22 36 22 93 90 8 52 66 37 94 102 27 114 10 25 45 947 Fried Fish Shops 3 16 30 4 17 17 15 20 64 5 82 56 — 21 10 7 4 6 9 48 434 Market Stalls 263 839 294 389 442 198 722 1,688 8,267 — 76 560 91 6,849 605 — 1,100 — — 187 22,570 Other Premises 308 477 841 199 407 330 187 370 596 100 446 544 239 682 422 313 542 136 175 374 7,688 Slaughterhouses — 7 — — — — — — — — 40 — — — — — — — — — 47 Total Inspections 1,014 2,033 1,759 802 1,301 982 1,095 2,630 9,913 284 1,238 1,871 749 8,336 1.883 649 2,615 425 371 1,015 40,965 31 FOOD AND FOOD PREMISES Food and Drugs Act, 1938 Three hundred and eighty-three samples of milk were submitted for analysis. Of these 381 were reported as genuine; 12 of which were samples of Channel Island and South Devon milks with an average fat content of 4.33 per cent. The remaining 369 genuine samples had an average fat content of 3.61 per cent. The Milk (Special Designation) (Raw Milk) Regulations, 1949 50, and the Milk (Special Designation) (Pasteurised and Sterilized Milk) Regulations, 1949-50 These regulations, which came into force on 1st October, 1949, provide for the issue of licences to persons who sell milk under any of the following designations:— "Accredited" "Pasteurized" "Sterilized" "Tuberculin Tested" The following licences for the sale of milk under these designations were granted during the year:— Dealers' Dealers' Supplementary Total Accredited Nil Nil Nil Pasteurized 164 28 192 Sterilized 226 29 255 Tuberculin Tested 115 26 141 Total 505 83 588 Three dealers' (pasteurizers') licences were granted during the year and are included in the above figures. A person who holds a "Tuberculin Tested" licence and a "Pasteurized" or "Sterilized" licence may use the designations "Tuberculin Tested (Pasteurized)" or "Tuberculin Tested (Sterilized)" as the case may be. Four hundred and forty-nine samples of milk were procured as follows:— 372 from distributors 44 from schools 33 from hospitals and institutions Total 449 32 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 These samples were sent to the Public Health Laboratory, Camberwell, and were submitted to the following examinations:— 221 by the Methylene Blue Test 204 by the Phosphatase Test 24 by the turbidity test Total 449 Four of these samples failed to comply with the prescribed tests. In addition, 16 samples of milk were examined for the presence of brucella abortus and tubercle bacilli. In each case negative results were obtained. Meat There are 217 butchers' shops in the Borough. The majority are registered under Section 14(l)(b) of the Food and Drugs Act, 1938, for the preparation or manufacture of sausages or potted, preserved, pickled or pressed foods. There were 3,231 visits made to these shops during the year. Slaughter of Animals There are three private slaughter-houses in the Borough and they were visited on 47 occasions during the year. Six carcases of pigs were inspected after slaughter. Slaughter of Animals Act, 1933-51 Section 3 of this Act provides that no animal shall be slaughtered or stunned in a slaughterhouse or knacker's yard by any person who is not the holder of a licence granted by a local authority and in force under this section. During the year one application from a person desirous of acting as a slaughterman was submitted to the Council and granted. War Time Piggeries There are now seven war time piggeries in this Borough and they were inspected on 14 occasions. Unsound Food One hundred and forty-six varieties of foodstuff suspected to be unsound were examined at the request of the owners and afterwards either destroyed or released for animal feeding. The owners were granted a certificate to this effect. 33 FOOD AND FOOD PREMISES Pharmacy and Poisons Act, 1933, and Pharmacy and Medicines Act, 1941 These Acts provide for the listing with the Local Authority of all persons dealing in poisons included in Part II of the Poisons List. The number of persons on the Council's list at the end of 1952 was 392, and 771 visits were made to the premises of the listed persons by the Food Inspectors. The principal business conducted on the premises of these applicants is shown in Table X. The majority of the listed sellers are also purveyors of food. TABLE X. PART II OF POISONS LIST. Principal Business Number of Premises Number of Visits Confectioners 3 5 Domestic stores, ironmongers, etc. 105 218 Drug stores 26 53 Grocers 235 443 Hairdressers 18 42 Nurserymen and florists 5 10 Total 392 771 Bakehouses There are 82 bakehouses in the Borough, of which 20 are in basements and subject to the provisions of Section 54 of the Factories Act, 1937. Two hundred and fifteen visits were made to these premises by Food Inspectors during the year. 34 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Water Supply The bulk of the water supply in the Borough is provided by the Metropolitan Water Board and this has been satisfactory, both in quality and quantity. There are 13 artesian wells in the Borough. The water from six of these wells is used for drinking and in the manufacture of food. Eleven samples of water were examined for contamination, and were found to be free from pollution. Three of these 13 wells were not in use pending repairs. The Food and Drugs Act, 1938 Registration of Premises Section 14(1) of this Act requires that any premises used or proposed to be used for:— (a) the sale, or the manufacture for the purpose of sale, of icecream, or the storage of ice-cream intended for sale; or (b) the preparation or manufacture of sausages or potted, pressed, pickled or preserved food; shall be registered by the owner or the occupier thereof with the local authority. During the year 100 applications for registration under the provisions of Section 14(l)(a) and 25 applications for registration under the provisions of Section 14(l)(b) were submitted to the Council. In all cases the premises were found to be satisfactory and the registration granted. 35 FOOD AND FOOD PREMISES Section 57(l)(a) of this Act requires that it shall not be lawful:— for the occupier of any premises to use them as a slaughterhouse or knacker's yard or permit them to be so used, unless he holds a licence granted under this section by the local authority authorizing him to keep those premises as a slaughter-house, or as the case may be, as a knacker's yard. During the year three applications for the renewal of licences to use premises as slaughter-houses were submitted to the Council and granted. Bacteriological Analysis of Ice-Cream During the year 80 samples of ice-cream were tested in accordance with the technique suggested by the Ministry of Health and Public Health Laboratory Service. These samples were examined at the Public Health Laboratory, Camberwell. The following table gives a summary of the results:— TABLE XI. Methylene Blue Test Coliform Test Provisional Grade Number of Samples Coliform in l/10th ml. (non-faecal) Number of Samples 1 27 Bacillus coli—absent 28 2 8 „ „ —present 12 3 4 4 1 Faecal coli—present — Total 40 Total 40 In addition, three samples of ice-lollies were submitted to the coliform test. Bacillus coli was not found in any of these samples. 36 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Analysis of Food and Drugs During the year 1,099 samples of foods and drugs were procured for analysis. Three hundred and eighty-three samples of milk, 626 other foodstuffs and 90 drugs. Of these 346 were submitted as formal samples while 753 were purchased informally. Three, or 0.9 per . of the formal samples, and 21, or 2.8 per cent. of the informal samples, were found to be adulterated or not up to standard. The total adulterations reported were 24, or 2.4 per cent., of the samples submitted. The 24 samples found to be adulterated were:— six samples of ice-cream, three each of pork sausages and sal volatile; two of milk; one each of anchovy paste, herring roes, meat extract, non-brewed condiment, peas, scone flour, senna pods, sherbet, soup and tincture of iodine. It was not necessary to take Police Court proceedings in any of the above cases of adulterated samples. 37 FOOD AND FOOD PREMISES SPECIAL ANALYSIS One sample of tinned crab paste was submitted for examination following a question as to its fitness for sale. All cultures remained sterile. The product was found to be fit for sale. Three tins of luncheon meat were submitted to a bacteriological examination following a question as to their fitness for sale. In each case the Analyst was of the opinion that the cooking process was not sufficient to kill organisms in the unprepared meat and other ingredients. The product was quite unsuitable for human consumption. A total of 1,592 tins of luncheon meat was surrendered by shopkeepers and destroyed. Two samples of synthetic cream and one sample of cream sandwich were taken from a bakery in this Borough. An organism was isolated in the sample of cream sandwich which did not conform to any known pathogen. Faecal bacillus coli was found in one of the samples of synthetic cream. The other sample was found to be free of pathogenic organisms. One sample of synthetic cream was obtained from a manufacturer of synthetic cream in this Borough. No pathogenic organisms were isolated from this sample. Fourteen samples of synthetic cream were obtained from a firm packing the cream for sale by retail. In one case the number of organisms found was less than ten. In all 14 cases bacillus coli was not found and no pathogenic organisms were isolated. Eighteen samples of synthetic cream were purchased from retail shops in this Borough. In seven cases the number of organisms were more than 100 and in another seven cases the number was 100 or less. But in all 18 cases bacillus coli was not found and no pathogenic organisms were isolated. One sample of synthetic cream powder was purchased from a retail shop in this Borough. A number of organisms were found but bacillus coli was not found and no pathogenic organisms were isolated. FACTORIES ACT, 1937 Prescribed particulars required by Section 128 PART I. (1) INSPECTIONS. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) Factories in which Sections 1, 2, 3, 4 and 6 of the Act are to be enforced by Local Authorities 613 304 5 — (2) Factories not included above in which Section 7 of the Act is enforced by the Local Authority 1,097 834 12 — (3) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 7 3 1 — Total 1,717 1,141 18 — (2) DEFECTS. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 6 5 4 Overcrowding — — — — — Unreasonable temperature 1 1 1 — — Inadequate ventilation 3 2 — 1 — Ineffective drainage of floors — — — — — Sanitary Conveniences (a) insufficient 3 3 — 2 — (b) unsuitable or defective 90 64 — 28 — (c) not separate for sexes 2 1 — — — Other offences against the Act (not including offences relating to outwork) 21 15 5 — — Total 126 91 6 35 — 38 39 FACTORIES ACT 1937 PART VIII. SECTION 110. OUTWORK. Nature of work Number of outworkers in August list Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Wearing apparel—making, etc. 553 — — cleaning and washing 3 — — Fur pulling 3 — — Furniture and upholstery 5 — — Umbrellas, etc. 2 Artificial flowers 5 Household linen 5 Paper bags 8 — — Boxes or other receptacles made wholly or partially of paper 24 — — Brush making 1 — — Feather sorting 1 — — Carding, etc., of buttons, etc. 1 — — Stuffed toys 1 — — Cosaques, Christmas crackers, etc. 25 — — Lampshades 37 — — Total 674 — — REPORT OF THE PUBLIC ANALYST FOR 1952 I have pleasure in presenting my report on the work performed in the laboratory for your Council during the year ended 31st December, 1952. I was appointed Deputy Public Analyst by the Council in 1941, and I have continued to act in this capacity during the year under review. By virtue of the requirements of the Food and Drugs Act, 1938, I have to report that 1,099 samples were examined under the Act during the year ended 31st December, 1952: 1,009 articles of food and 90 drugs. All were submitted by your Council's Food Inspector, 346 having been taken with the formalities required by the Act and 753 informally. Samples of the following substances were analysed:—Beverages (cocoa, coffee, etc.), 24 samples; biscuits, 24; butter, 4; cake and pudding mixtures, 12; cereal preparations, 33; cheese, 21; cooking fat and lard, 4; fish, canned, 24; fruit, canned, 22; ice-cream, 37; margarine, 4; meat products (other than sausages), 22; milk, 383; pickles and sauces, 51; preserves (jam, marmalade, etc.), 37; sausages, 14; soup, canned, 32; spices and condiments, 37; sugar, 4; suet, 4; tea, 9; vegetables, 52; aspirin tablets, 7; iodine solutions, 11; laxative oils, 23; ointments, 18; sal volatile, 5. 40 41 REPORT OF THE PUBLIC ANALYST FOR 1952 Adulterated Samples Particulars of the samples reported as adulterated or not up to standard are given in the following table:— Case No. Nature of sample Nature of report Formal 715 Pork sausages 5 % deficient in meat content 766 Milk 2 ½ % extraneous water 775 Milk 1 % extraneous water Informal 347 Pork sausages 8% deficient in meat content. See also complaint samples 426 Senna pods 0.23% of foreign matter 469 Pork sausages 12% deficient in meat content 496 Tincture of iodine 30% deficient in iodine and 40% deficient in potassium iodide 548 Scone flour Infested with mites 621 Tinned onion soup Unfit for human consumption 639 Canned herring roes Unfit for consumption 652 Ice-cream 60% deficient in fat 653 Ice-cream 20% deficient in solids-not-fat 691 Ice-cream 25% deficient in sugar 694 Ice-cream 15% deficient in solids-not-fat 696 Ice-cream 10% deficient in solids-not-fat 723 Canned anchovy paste Unfit for consumption 752 Ice-cream 18% deficient in solids-not-fat 764 Non-brewed condiment 7% deficient in acetic acid 799 Canned meat extract Unfit for consumption. See also complaint samples 833 Sal volatile 20% deficient in ammonia 837 Sal volatile 18% deficient in ammonia 900 Canned processed peas Unfit for consumption 940 Sherbet, "Kiddies' Gave an alkaline mixture with Fountain" water. Taste unpleasant. See also complaint samples 1042 Sal volatile 55% deficient in ammonia Adulteration The amount of adulteration detected during the year was:— For formal samples 0.9 per cent. For informal samples 2.8 per cent. For all samples 2.4 per cent. 42 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 Complaint Samples Case No. 346. Milk. On examination the milk was found to be sour with an acid value of 2.4. The complaint was of an indefinite nature. Whether the complaint was justified or not depends on how long the complainant had had the bottle of milk. Case No. 347. Pork Sausages. The complainant alleged that the sausages were deficient in meat. The meat content was 57 per cent. and the sample was therefore 8 per cent. deficient in meat. The complaint was considered justified. Case No. 544. Canned Crab Paste. This sample was found to be quite satisfactory and was passed as genuine. The complaint that it was unfit for consumption was considered not justified. Case No. 799. Canned Meat Extract. This sample was found to be quite unfit for consumption. The complaint was considered justified. Case No. 924. "Pep" Sweets. The complainant alleged that the "sweets" caused sickness. They were intended as, and sold as, a practical joke. An analysis of the "sweets" was not carried out and the sample has not been included in the total number of samples examined. Case No. 940. Sherbet. "Kiddies' Fountain". This sample was submitted as a possible cause of food poisoning. Nothing of a deleterious nature could be found. The preparation gave an alkaline mixture with water, the taste being decidedly unpleasant. The amount of tartaric acid was less than that required to neutralize the bicarbonate of soda. Case No. 1035. Canned crab paste. The complaint that the sample was unfit for consumption was considered not justified. Cases Nos. 1072, 1073, and 1074. Christmas puddings. The puddings were examined for the presence of mites and other infestations. They were found to be free from any sign of infestation and were in excellent condition. The complaint was not justified. • 43 REPORT OF THE PUBLIC ANALYST FOR 1952 Milk The average composition of the samples of milk submitted during each month of the year and returned as genuine was as under:— Month Number Total solids Milk fat Non.fatty solids January 37 % % % 12.50 3.73 8.77 February 18 12.31 3.57 8.74 March 44 12.11 3.46 8.65 April 14 1207 3.43 8.64 May 24 1204 3.32 8.72 June 36 12.20 3.42 8.78 July 29 12.19 3.51 8.68 August 22 12.09 3.48 8.61 September 36 12.51 3.65 8.86 October 12 12.69 3.74 8.95 November 33 12.73 3.82 8.91 December 64 12.74 3.85 8.89 The average composition of the 369 samples of milk received during the year and returned as genuine was as under:— Total milk solids 12.39 per cent. Milk fat 3.61 per cent. Non.fatty solids 8.78 per cent. 44 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 The average composition of the 12 samples of Channel Island and South Devon milks was as under:— Total milk solids 13.34 per cent. Milk fat 4.33 per cent. Non-fatty solids 9.01 per cent. I have the honour to be, Mr. Mayor, Ladies, and Gentlemen, Your obedient servant, J. E. WOODHEAD, B.Sc., F.R.I.C., Ph.C. Deputy Public Analyst. INDEX PAGE Accidents, Deaths from 19 Acute Encephalitis 16 Analyst, Report of 40 Bacteriological Examinations of Milk 32 „ „ of Ice-cream 35 Bathing Pools and Swimming Pools 24 Bed Bugs, Eradication of 25 Births, Birth Rates 9 Butchers' Shops 30 Cancer 19 Childbirth, Deaths from 12 Circulatory diseases 19 Closing Orders 28 Crematorium 25 Cutting-off Notices—Water Supply 23 Deaths, Causes of 11 Death Rates 10 Death Rate from Infective Diseases 13 Death Rate, Infantile 12 Deaths, Number of 11 Diphtheria 13 Diseased or Infirm Persons, Removal of 24 Disinfection 18 Dysentery 16 Enteric Fever 16 Erysipelas 17 Factories Act, 1937 38 Factories and Workshops 38 Food and Drugs Act, 1938 31 Food Poisoning 17 Food, Supervision of 29 Food Places, Inspection of 30 Food Places, Number on Register 29 Houses and Premises Inspected 21 Houses Let in Lodgings 27 Housing Act, 1936 27 Housing Statistics 26 Hydrogen Cyanide Disinfection 25 Illegitimate Children, Births of 8 Infant Mortality 12 Infective Diseases 13 Infective Diseases, Cases of 14 Infective Diseases, Death Rate from 13 Infirm or Diseased Persons, Removal of 24 Influenza, Deaths and Death Rates 17 Influenzal Pneumonia and Acute Primary Pneumonia 17 Influenzal Pneumonia, Cases Notified 17 Insanitary Areas 28 Inspections, Details of 21 45 46 INDEX PAGE Malaria 17 Maternal Mortality 12 Meat 32 Meningococcal Infection 16 Milk Analysis 32 Milk, Bacteriological Examination of 32 Milk and Dairies Regulations, 1949 29 Milk Premises, etc., on Register 29 Milk (Special Designations) Regulations, 1949-50 31 Mortuary 25 Non-infective Diseases, Deaths from 19 Notification of Infective Diseases 14 Outworkers 39 Overcrowding 27 Pharmacy and Poisons Act, 1933 33 Pharmacy and Medicines Act, 1941 33 Piggeries 32 Poliomyelitis 16 Population 9 Pregnancy, Deaths from Accident and Diseases of 12 Preserved Meat, etc. Manufacture of 34 Public Analyst, Report 40 Puerperal Pyrexia 16 Pulmonary Tuberculosis, Notification of cases of 20 Ragwashing and Sterilization, Certificates 24 Rent and Mortgage Interest (Restriction) Acts, 1920-39 27 Rodent Control 23 Samples, Formal and Informal, Number of 41 Sanitary, Inspection of Borough 21 Sanitary Operations, Table of 22 Scabies 17 Scarlet Fever 13 Slaughter-houses 32 Slaughter of Animals Acts, 1933 32 Smallpox 13 Statistics for the Borough 8 Suicide, Deaths from 19 Swimming Baths and Bathing Pools 24 Syphilis, Deaths from 17 Tuberculosis 20 Unsound Food 32 Water Supply 23 Water Supply, Cutting-off Notices 23 Whooping Cough 12 Printed by Geo. Gibbons Ltd., Leicester