Cou 12 LIBRARY THE HEALTH REPORT OF COULSDON AND PURLEY FOR 1944. INTERIM REPORT. Ladies and Gentlemen, In accordance with the instructions-of the Ministry Health I have prepared an interim report on the state of the Public Health in this District during 1944, which I beg to present to you. This is my 13th Annual Report as your Medical Officer of Health and it is hoped that this will be the last of a series of 5 such abbreviated reports as also that it will be permissible and practicable, either to prepare the 1945 Report as a summary of conditions during the war years, or for such a summary to be published in addition to the 1945 Report. The matter required for a comprehensive report of this nature has been prepared and preserved year by year. Looking back, the year 1944 will stand out from the other war years on account of the nature of the enemy attack following the invasion of the Continent. It is well known that there were two phases, the first from 15th June to 31st October, was marked by the use of "Flying Bombs" which chiefly affected the south-eastern Counties south of the Thames; the second, in which rockets predominated, was more severe northeast of the capital. During the first phase at least 70 Flying Bombs fell in, or on the boundary of, this District, damaging the vast majority of houses. Occasional night bombing raids had occurred in the first half of the year, one particularly heavy one being on 25th March while the rockets, one of which fell in the District on the 17th September, frequently sounded unpleasantly close, but it was the Flying-bomb period which caused locally the greatest upheaval of the war period. Unofficial evacuation, in a similar mariner to the ??? in 1939 and 1940, commenced soon after these bombs started to arrive, followed, however, this time by the official evacuation of mothers and children from mid-July onwards. By contrast troops and large numbers of workmen wore drafted into the District to deal with the bomb damage. With the overrunning of the French and Belgian coasts the unofficial return of evacuees commenced, but their official return was delayed until 1945. This social upheaval might have been expected to have an adverse effect upon the public health of the District, but fortunately there is but little statistical evidence of this. It "appeared to some that the 1944 attacks had a more profound effect on the nervous system than earlier attacks, as might be expected after 5 years of War, but the effects of the prolonged strain have greatly diminished since, and are, in any case incapable of statistical presentation. The following are the essential facts which can be presented relating to the health of the District in 1944. Infectious disease was at a lower level than in either of the preceding war years. The Infant Mortality Rate was the lowest for the last 10 years and the Birth Rate remained high, though slightly less than in 1943. While it is true that the crude 2 death rate increased, had it not been for 50 Deaths among residents due to enemy action the increase would only have been slight and probably accounted for by the ageing population. Against a background of 5 years of war, culminating in a period of social upheaval, these facts give ground for much satisfaction. On the other hand, proportionately almost twice as many new cases of Pulmonary Tuberculosis were notified, as compared with 1939. While this increase is probably partly due to better means of detection and partly to fluctuations in the rate which inevitably occur, particularly when dealing with small numbers of people, the increase in this disease which has been noted throughout the country emphasises that we have not been able to avoid all the deleterious effects of war. Obviously housing, the dietary and working conditions, including hours of work, of the average adult have deteriorated and will need early attention now that the war is over. When one considers the factors which have minimised deterioration in the public health during the period of the war one remembers the Diphtheria Immunisation campaign, the use of the sulphonamides and later penicillin and in the Forces, the use of D.D.T. These have all been outstanding successes in their own spheres and presage well for the future. Is it not. however, probably correct to assume that the degree of success achieved in the maintenance of health was very largely attributable to a wise use of the national food resources, to an absence of acute poverty and to some extent to a simplification of life? One might also ask whether it is not within the power of man to retain and even develop further these beneficial environmental factors in time of peace? While giving credit to these major influences it is undoubtedly true that this satisfactory report on the health of the District in 1941 was also due in part to local effort, and here I would pay tribute to the loyalty ami. perseverence, not only of my colleagues in the Public Health Services, but to my friends in the wider health service, the Doctors, Nurses and Midwives of the District, the Civil Defence personnel and many other voluntary helpers. Above all may I humbly record my admiration of the cheerful doggedness of the average resident and the splendid spirit of neighbourly helpfulness which saw us through those darker days and made our record one of which we need not be ashamed. May this spirit of cheerful and indefatigable service also persist and flourish, making our District a still more desirable locality. I hope I may, in conclusion, again thank all my colleagues and staff for the help they gave during the year. Particularly would I thank the Senior Health Visitor, the Senior Sanitary Inspector and my Chief Clerk, not only for their assistance in preparing this report but for their unfailing and cheerful co-operation which, especially in the darker days of 1944, was an inspiration and constant source of encouragement. I am, Ladies and Gentlemen, Your obedient servant, F.R.Edbrooke. Medical Officer of Health. THE HEALTH REPORT OF COULSDON & PURLEY for 1944. INTERIM R E P O R T STATISTICS. Area (in acres) 11,142 Registrar-General's estimate of population, 1944 50,240 Population, Census 1931 37,666 Number of occupied houses, December 1944 15,872 Number of occupied houses, December 1931 9,533 Rateable value, December 1944 £744,493 Sum represented by a penny rate £2,940 Birth Rate per 1,000 of the estimated resident population 16.9 Still Birth Rate per 1,000 (live and. still) births 24.0 Death Rate per 1,000 of the estimated resident population 2.9 Death Rate from Puerperal causes per 1,000 (live and still) births:Puerperal and post abortive sepsis Nil. Other maternal causes 2.29 Death Rates of Infants under 1 year of age:- All infants per 1,000 live births 33 Legitimate infants per 1,000 legitimate births 33 Illegitimate infants per 1,000 illegitimate births 26 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2. years) 2 AREA AND POPULATION. The District has an area of 11,182 acres, this being 2,547 more than before the last revision of boundaries in 1933. The fluctuations in the population are most clearly shown by the following figures:- 1915 Registrar-General's estimate 17,920 1921 Census 1,493 1931 Census 73,666 1938 Registrar-General's estimate 55,070 1939 -do- -do- -do- 55,060 - 56,400 1940 -do- -do- -do- 50,920 1941 -do- -do- -do- 46,820 1942 -do- -do- -do- 49,760 1943 -do- -do- -do- 51,660 1944 -do- -do- -do- 50,240 It is considerod locally the population in September 1938 was just under 59,000 and in mid 1939 was at least 60,000. At the time of the preparation of the National Register the number of residents (including the residents in the local institutions) was only 50,415 chiefly owing to unofficial evacuation, and about 45,000 in December 1940. A rise to 46,820 in mid 1941 was followed by a fall to 43,350 in December 1941. Thereafter the figures in the above table are the most reliable to hand at the time of the preparation of this report. In 1915 there were 4,141 occupied houses, in December 1938 there were 15,431 occupied houses and in December 1944 there were 15,872, in spite of the fact that during the war nearly 300 houses have been destroyed by enemy action. 2 VITAL STATISTICS. BIRTHS. During the year 853 Births were registered as belonging to the Districts of which 4.28 were males and 425 were females, as compared with 901 in 1943. This is equal to an Annual Birth Rate of 16.9 per thousand of population, as compared with 17.4 last year and 17.1, 12.6 and 12.3 in the preceding 3 years. The average Birth Rate for this District has been between 11.6 and 13.9. It suddenly increased in 1942, coinciding with the biggest recruitment of women for National Service. The National Birth Rate followed the same trend, though much less abruptly, being 17.6 in 1944, 15.6 in 1943 and 15.8, 14.2 and 15.1 in the preceding 3 years. It is interesting to surmise whether this year's slight local tendency to decrease will continue in future years and whether the National rate will also have reached its peak. There were 39 illegitimate births (21 males and 18 females) registered, this being 12 less than in the preceding year. Expressed as a percentage of total births, 4.6 were illegitimate compared with 5.7, 4.8, 5.7 and 3.0 in the preceding 4 years. In 1944 there were 21 still births registered (9 males and 12 females), all occurring in legitimate children. The local stillbirth Rate was thus 0.42 per thousand of population, as compared with 0.66 last year and 0,56, 0.42 and 0.35 in the preceding 3 years. This Rate for England and Vales was 0.50 in 1944. DEATHS. The number of Deaths registered during the year as belonging to this District was 651, (302 males and 439 females), as,compared with 570 in 1943. The crude Death Rate' for the year was equal to 12.9 per thousand of population, as compared with 10,5 last year and 10.7, 11.6 and 11.5 in the preceding 3 years. The crude Death Rates in England and Vales were 11.6 in 1944, and 12.1, 11.6, 12.9 and 14.3 in the preceding 4 years. The chief causes of death in the District were Heart and other circulatory diseases (including Cerebral Haemorrhage) 254, Cancer 96, followed by Violence (including Suicide) 68, Bronchitis 34, Pulmonary Tuberculosis 31 and Pneumonia 30. Heart Disease etc. The percentage of deaths due to heart and other circulatory diseases was slightly less than last year, altogether constituting about two-fifths of the total deaths. As has been previously stated, insofar as this group includes deaths in elderly people from what is really old age, it is hoped that the proportion of deaths coming under this heading will increase. This year 78 per cent. were over 65 years of age at the time of death, while 48 per cent. were over 75 years of age, being slightly less than the corresponding figures for last year. Once again about a quarter of this group of deaths was in respect of persons under 65 years of age in whom the postponement of death might reasonably have been expected had undue strain or stress been avoided. Cancer. During 1944 there were 96 deaths from cancer, with the Cancer Death Rate 1.91 per thousand of population, compared with 1.51, 1.74, 1.92 and 1.45 in the preceding 4 years. with the age of the population at risk rising and the rate fluctuating annually it is unwise to make any deductions 3 from these figures. It is obvious, however, that there is still a need for earlier diagnosis and the reference to the family Doctor of any suspicious symptoms, this being the only way to a cure if the diagnosis is confirmed} or to peace of mind if false alarm has been caused. Violence. Violence, including Suicide, was the third highest cause of death in the District during 1944, with no less than 68 deaths so classified. The Death Rate from this cause was 135 per 100,000 of population, compared with 42, 40, 75, 118 and 49 in the preceding war years. The chief cause of death was, of course, enemy action, 50 local residents being killed in this way in 1944. Of these 3 died indirectly through enemy action, 9 from ordinary bombing, 36 from V.l attack and 2 owing to a V.2. Only 4 deaths resulted from road accidents (3 pedestrian and 1 cyclist), compared with 4, 2, 4, 4 and 8 in the preceding war years. The Death Rate from Suicide continued to decline, the rate from 4 deaths attributed to this cause being 8 per 100,000 compared with 9, 10, 17, 11 and 14 in the 5 preceding years. Maternal Mortality. There were 2 deaths associated with childbirth during 1944, the Maternal Mortality Rate being 2.21 per thousand total births as compared with 1.07, 1.10 and 1.68 in the preceding 3 years. The corresponding rates for England and Wales were 1.93, 2.29, 2.01 and 2.23. After several years during which the local Rate was below the average it is not surprising that a rise should occur, especially when one extra death can affect the percentage so greatly. It is no less regrettable that these Deaths should have occurred, particularly as it could reasonably have been hoped. that both deaths would have been avoided, considering the actual causes. Infantile Mortality. The number of deaths occurring in children under one year of age was 28, as compared with 32 last year. Only 5 of these deaths occurred among female babies. One of the deaths was in an illegitimate child. The Infantile Mortality Rate was thus 33 per thousand registered births, which is the lowest rate experienced in this District for 10 years. Last year it was 36, while in the three preceding years it was 45, 52 and 37. The low rate is all the more commendable after 5 years of war. The Infantile Mortality Rate for England and wales in 1938 was the lowest experienced to date, viz. 46 compared with 49, 49 and 59 for the preceding 3 years. The neo-natal mortality rate (i.e. deaths in the first month per thousand live births) was only 18, this being the lowest rate noted locally and a tribute to the midwifery ??? and care of very young babies in the District. In the last 3 years this rate was 23, 31 and 36. There was a welcome reduction in the number of deaths from all the chief causes except Whooping Cough, which caused the deaths of two children. This and other infections caused one third of the deaths under 1 year, hence there is good hope of improvement by greater care being taken to avoid infection at an early age, especially from the commoner diseases, including the "common cold". 4 INFECTIOUS DISEASE. Contrary to what might have been expected in the fifth complete year of war, infectious disease was less prevalent in the District than in either of the 4 preceding years. In comparing the years it is desirable to exclude Measles and whooping Cough, which only became notifiable again in 1939, although 1944 was quite a good year in respect of both diseases. Tuberculosis is also considered separately later in this Report, Apart from these diseases, only 176 cases of infectious disease were notified and of these no less than 64 were associated with the mental hospitals in outbreaks which did not affect the remainder of the District, Scarlet Fever diminished most markedly and it is hoped that it will still further decrease. From the following table it would appear that Diphtheria, Enteric and Dysentery had increased but this is due to the influence of the mental hospitals. Actually there were in the District as a whole only 2 cases of Diphtheria, 4 of Dysentery and no Enteric, Poliomyelitis, Encephalitis Lethargica or Ophthalmia Neonatorum, Even including the cases at the mental hospitals, the incidence of infectious disease per thousand of population was about the average for the period 1925-36 and was only surpassed during the very good years immediately preceding the war. Disease. Number notified. Number removed to Isolation Hospital. Total number of Deaths. Diphtheria 19 10 - Typhoid Fever 1 - 1 Paratyphoid Fever 5 1 - Scarlet Fever 88 51 - Erysipelas 9 1 - Puerperal Pyrexia 1 1 - Pneumonia 9 -- 30 Dysentery 42 2 - Cerebro-spinal fever 2 1 — Measles 52 - - Whooping Cough 51 8 2 Totals 279 75 33 Includes deaths from all forms of Pneumonia. Diphtheria. At the first glance it would appear that the incidence of Diphtheria increased during 1944 as a total of 19 notifications were received. Of these, however, no less than 15 occurred at one of the mental hospitals among the adult patients and staff. The use of passive, followed by active, immunisation stopped this outbreak. From the District as a whole only 4 notifications were received and 2 of these were not confirmed, being only cases of tonsilitis with negative swabs. The two isolated and bacteriologically positive cases occurred in children who had previously been immunised with P. A. F. One of these, being only 3 years old and having been immunised at the age of 1 year, had not been Schick tested subsequently. His was a fairly severe attack from which, however, he recovered. The other child returned from Leeds late in the year, where she had had recent tonsilitis. This recurred and the swab showed a scanty growth of diphtheria germs (mitis) together with haemolytic streptococci (Group A), Interestingly enough she caused no secondary cases either at school or among the numerous members of her family with whom she was in intimate contact. She recovered after a prolonged spell in hospital. 5 In addition to the above, 2 or 3 children from this District developed Diphtheria when evacuated, presumably having come into contact with a new and virulent strain of the germ. They all recovered. Apart from the mental hospital outbreak, which can be considered as distinct from infection among the general population of the District, the position .locally during 1944 with regard to Diphtheria can be considered very satisfactory. The relatively high state of immunity, especially of the younger members of the population, combined with good social conditions, give grounds for hope that this satisfactory state will continue, providing a good majority of babies are immunised each year and their immunity enhanced by occasional additional doses during school life. Scarlet Fever. There was a considerable reduction in the number of cases of Scarlet Fever notified during 1944, viz 88, compared with 184 in 1943. In three of the cases the diagnosis was not confirmed. The disease remained very mild in type and there is nothing of note to report with regard to it. After the very wide spread wave of this infection in 1943 it is probable that a period of diminished incidence can be anticipated. Enteric Fever. Typhoid. There was only 1 case of Typhoid Fever notified and this occured at one of the mental hospitals, where death unfortunately occurred. Paratyphoid. Similarly all 5 of the cases of Paratyphoid Fever notified occurred in the mental hospitals. No deaths occured from this disease. Erysipelas. There were 9 notifications of Erysipelas received during the year and of these 5 occurred at one of the mental hospitals. The remaining 4 were isolated cases occurring during the first 3 months of the year. Only 1 of these was admitted to the Isolation Hospital, but all recovered. Puerperal Pyrexia. There was only 1 case of Puerperal Pyrexia notified, fortunately a mild case, and she recovered at the Isolation Hospital. Pneumonia. The number of cases of Acute Primary or Influenzal Pneumonia notified during the year was 9, this being 18 less than in 1943, and still less than in the two preceding years. Five of the cases were notified by Redhill County Hospital and one by one of the mental hospitals. Dysentery. There was again a slight increase in the number of cases of Dysentery notified, viz. 42 compared with 21 in 1943, but this was much less than the 85, 224 and 121 in the three preceding years. As on previous occasions almost all the eases have arisen in one or other of the mental hospitals. In 1944, 37 cases were cases of Flexner Dysentery occurring in one of these hospitals and one in the other. None of these cases died from the disease. The remaining four cases, which were notified from the District as a whole, were scattered over the District during the first five months of the year. All were comparatively mild cases of Sonne Dysentery, two of whichwere treated in general hospitals. 6 Cerebro-spinal Fever. Only two cases of Cerebro-spinal fever were notified as occurring among the civilian population of the District One which occurred in March was treated in a County Hospital, and the other, a male nurse who contracted the disease in December, was treated at the Isolation Hospital. Both recovered. Measles This disease, which with Whooping Cough again became notifiable in 1940, was much less prevalent than in the preceding year, when 275 cases were notified. Only 52 cases were reported in 1944 and of these 33 occurred in December. Measles usually occurs in epidemic form in alternate years and the increased number of cases at the end of the year presaged the widespread outbreak since experienced,, No deaths occurred from this disease. Reference is made in the Section on Infectious Disease Prevention to the use of placental serum, which was first encouraged by the Council during 1943/44-but not used until 1945. Whooping Cough. The number of notifications of cases of Whooping Cough during the year was almost the same as in 1943, i.e. 51 compared with 55. (In the two previous years this number was 36 and 136.) Unfortunately 2 deaths occurred from this disease in very young babies. As in the case of Measles, it is only a proportion of the cases which are seen by a Doctor and not all of these which are notified. This tendency, which is partly due to the fact that these two diseases have only been notifiable during the two war periods and which partly reflects the more casual, though unjustified attitude to them, as compared with other notifiable diseases, is unfortunate insofar as it limits the possibility of preventive measures referred to later in this report. THE CONTROL OF INFECTIOUS DISEASE The usual measures to restrict outbreaks and spread of infectious disease were employed during 1944, including the following: 1. Diphtheria Immunisation. This was continually encouraged during the year but in the second half of the year enemy air attack and evacuation had a very disturbing effect. It was partly to meet the difficulty of assembling mothers and children during the period of the Flying Bomb attacks that use was first made of Alum Precipitated Toxoid (A.P.T.) at the clinics. Previously Toxoid Anti-Floccules (T.A.F.) had been used, but this necessitated three visits at intervals of approximately a fortnight, whereas A.P.T. only requires 2 visits about 4 weeks apart. Unfortunately A.P.T. is more likely to cause local irritation in the child, but on the other hand it probably has a more rapid and profound influence on the development of immunity. Furthermore the child only experiences the more or less distrubing effect of injections on two occasions instead of three. In time it is hoped that an efficient product will be obtainable which will only necessitate one injection, but meanwhile it is proposed to continue with the use of A.P.T. as being, on the whole, the most desirable material for the immunisation of young children. During 1944 it has also appeared desirable to introduce the routine use of an enhancing or "boosting" dose as the child enters school or shortly afterwards, according to the age at the time of the original course, gather than following in all cases the previous practice of routine Schick testing, coupled with additional doses when indicated. Where circumstances 7 permit, however, it, is hoped to. follow the more ideal practice of both testing arid .enhancing immunity in all cases. Since the end of the year the free issue of A.P.T. to General Practitioners has been introduced, T.A.F. being still issued at cost price when required. The following are the figures showing the number of children treated at the clinics end schools during 1944: Clinics. Number of sessions held during 1944 71 Number of children who commenced treatment 433 Number of children who completed treatment 326 Number of Schick tests made 62 Total number of attendances 1,199 Schools. Number of visits 5 Number commencing treatment 1 Number completed treatment 17 Number of Schick tests made 4 2. Measles and Whooping Cough. In July 1943 the, Council authorised the supply of Placental serum for the prevention of Measles to the General. Practitioners, at cost price, except in respect of children under three years of age where the family income was below a specified and very low level. No advantage was taken of this not veryattractive offer, however, until early in 1945 and it has now been decided to issue for a trial period ofr6 months this material free of charge in respect of any child under 3 years of age. Unfortunately the usefulness of this serum is very limited as it has to be given within a few days of exposure to infection, the interval and dosage being varied according to whether it is desirable to prevent the disease absolutely, but only for a few weeks, or to produce a modified attack with a resultant immunity of much longer and possibly life long duration. It will be appreciated that The Doctor does not always see the case at the right time and even if he does there is always the doubt whether the child has or has not been infected by exposure. If, to this uncertainty is added the probability of an appreciable percentage of failures and of local or general reactions it can be realised why the attempt to prevent measles by this method is likely to be confined to special cases until a mora reliable material is made available. . . Similarly the present vaccines used to prevent Whooping Cough have not reached that degree of ???, either as to their effectiveness in preventing the disease or in the durability of any immunity they may provoke, as to encourage official recognition, although they are being quite widely used in general practice. Tuberculosis. The case rate for new cases of Pulmonary Tuberculosis which had steadily increased from 56 per 100,000 of population in 1939 to 6l, 68 and 90 in. 1942, dropped to 75 in 1943? but in 1944 the Upward tendency was again continued, rising to 101, The average case rate from 1915 to 1924 was as high as 115 but from 1925 to 1938 it had fallen to 80 and even as low on average as 58 for the 5 years preceding the war. In other words there were relatively nearly twice as many new cases of Pulmontery Tuberculosis during 1944 as in the years immediately preceding the war. On the other hand the non-pulmonary Tuberculosis case rate fell from an average of about 17 per 100,000 for the last 7 years to 14. 8 The Death Rate from Pulmonary Tuberculosis during 1944 was 65 per 100,000 population, compared with 38 in 1943 and 40, 55, 43, 21 and 27 in the preceding 5 years. Thus not only did nearly twice as many contract the disease during 1944 as in the pre-war years, but relatively three times as many died as in the year war broke out. The Date Rate from non-Pulmonary Tuberculosis was only 2 per 100,000 compared with 7, 8, 11, 6 and 9 in the preceding 5 years. hile all the methods previously employed in an attempt to prevent the spread of the disease which are still practicable were continued throughout the year it is obvious that with the return to peace it will be most desirable to raise the standard of life of the nation as soon as possible to pre-war levels. It is well recognised that good housing, good food and reasonable conditions of employment are the fundamental essentials to a reduction in the ravages of this disease, and these must be achieved as speedily as possible. NON-NOTIFIABLE INFECTIOUS DISUSE. The chief sources of information on the prevalence of the group of non-notifiable infectious diseases are the death returns and notifications from Head Teachers of the Public Elementary Schools. From the former it is noted that 5 deaths from Influenza occurred, this disease being less prevalent than in 1943, and 2 from diarrhoea in children less than 2 years of age. From the school returns it would also appear that the incidence of non-notifiable infectious diseases was low, the most prevalent being German Measles with a total of 103 notifications chiefly affecting Kenley and Old Coulsdon from March to June. There were a very few cases of Mumps, chiefly in November and December, while Chicken Pox was also mild, the notifications coming mostly from Purley (22) and Chipstead Valley (15) between January and April, and Old Coulsdon (17) in November and December. Only 2 cases of Infective Jaundice were notified. OTHER DISEASES. Diabetes. Only two cases of diabetes were assisted financially by the Council to get the insulin which they needed but were unable to obtain through other agencies under existing legislation. One of these died during the year. As so very few cases have been found to need insulin who are not able to obtain it advantageously through other bodies the Council has decided to treat more generously those few cases which are discovered to need assistance in this way. Scabies. Until the end of the year the treatment of Scabies with benzyl benzoate was given at the Coulsdon First Aid Post, where the Civil Defence staff continued voluntarily to give their services until the Post was closed. Since then the Council has employed half-time two ex-members of the Post, assisted by several part-time volunteers. During 1944 a total of 399 persons were treated as suffering from or being in contact with the disease, a total of 905 baths being given. The corresponding figures for 1943 were 326 treated and a total of 1217 baths, while from May 1942, when the Centre was established, until the end of that year 237 cases were treated. Judged by the above and the number of attendances in 1945 to the time of completing this Report it appears that the incidence of this disease is diminishing but that there is still a need for treatment to be provided at a special centre. Consideration is being given, however, to the possibilities of economically reducing the service. 9 Vermin. The number of cases of infestation with body vermin discovered during the year continued to be very small and almost all were cases of head lice found by the Health Visitors attached to the School Medical Service. Apart from casual infestations there are just a families in which it has been found difficult permanently to eradicate head lice, the position being complicated in most cases by physical or mental defects, usually of the mother. Since the war the Council has supplied Sacker's Combs to persons found to have been infested, usually at full cost though repayable by instalments, and in recent years Lethane Special has also been given free of cost, together with advice on the measures to be taken,, Where necessary the Medical Officer of Health has visited personally and encouraged the treatment of the whole family as a unite. AMBULANCE. For Infectious Disease Cases. The arrangements made for the conveyance of cases of infectious disease remained unchanged during the year. Accident and General Cases. Similarly no alteration was made until the end of the year in the Civil Ambulance Service, which since August 1941 has been under the control of the Medical Officer of Health and was staffed very ably by members of the First Aid and Light Rescue Service. In December the 40% cut in the whole-time First Aid and Light Rescue personnel necessitated the appointment of male drivers and attendants specifically for the Civil Ambulance Service. Unfortunately, owing to the absence of a decision on the future status of the Fire Service, the future of the Ambulance Service has also remained uncertain 3 an interim measure 6 drivers and 6 attendants, all recruited from the Civil Defence Service, were appointed for a period of 6 months, terminating on 30th June, 1945, but until that date the Service remained closely linked to the First Aid and Light Rescue Service, which continued to provide garages, deputies in cases of absence of the whole-time ambulance staff, and female attendantS. The services of the local Report and Control Centre were also again utilised in dispatching the ambulances until 30th June, 1945, and their co-operation was much appreciated. For practically 5 years the Civil Ambulance Service has been one of the primary interests of the First Aid and Light Rescue Service, the members of which have taken a keen interest in its efficiency, which has been enhanced, while the calls it has attended annually have been nearly de ■^ In determining its future it is hoped that the interest, enthusiasm and careers of the personnel at present serving it will not be forgotten, although it is obviously desirable to link it with another form of Service, e.g. the Fire and/or Hospital Services, if it is to be economically developed. HOSPITALS No major alteration was made during the year in the hospitals providing for the needs of the district. The shortage of general hospital beds was again acute, particularly during the period of fly-bomb attack which seriously curtailed the available accommodation. 10 LABORATORY FACILITIES AND DISINFECTION. All the bacteriological examinations of samples of milk and water, and of swabs for the grouping of streptococci were again made by the staff of the Emergency Medical Service Laboratory at Epsom College, whose assistance and valuable cooperation were greatly appreciated, It is hoped that this or a similar arrangement will be practicable after the war. Examinations of swabs for Diphtheria and sputa for Tuberculosis were carried out as usual by the Medical Staff of the Wandle Valley Isolation Hospital., In addition an arrangement exists whereby other specimens, the examination of which is important to public healths are examined by the Bacteriologist at Croydon General Hospital, No alteration was made in the arrangements for disinfection. HEALTH PROPAGANDA. This was continued chiefly through the Health Visitors and by the use of selected posters-, pamphlets, etc., published by the Central Council for Health Education, including Anti-V.D. propaganda. MATERNITY AND CHILD WELFARE. MATE RNITY CLINICS. The usual three maternity clinics were held throughout the year, additional sessions and medical staff being necessary as in the two previous years. The only effect of evacuation on this branch of the service was to remove the need for two Doctors attending the Kenley Maternity Clinic sessions after the middle of the year. The total number of new Ante-natal cases who attended the clinics was 359 compared with 413 in 1943, 431 and 438 in the two preceding years and 248 in 1938. The number of sessions held was 118, this being 3 more than in 1943 and 10 more than in 1942, while the total number of ante-natal visits was 2,146 compared with 2,401, 2,603 and 2,078 in the three preceding years. Undoubtedly the reduction in total attendances was only caused by the phase of the war through which we were passing, and the temporary lessening of work in the clinics was compensated for by the additional work entailed in evacuation. Special arrangements were made for the evacuation of expectant mothers with their children, care being taken to see that each ante-natal mother was examined by a Doctor at the clinic to certify her fitness to travel and to pass her antenatal notes to the Doctor at her destination. Parties, including a few mothers from this District, were sent off at regular intervals and the arrangements worked extremely smoothly. The co-operation of the London County Council and the assistance of the Volunteer Car Pool in conveying the patients to London were greatly appreciated. In the circumstances it is not surprising that the number of post-natal visits dropped from 225 last year to 148. It is hoped that this most necessary section of the work will receive greater support from mothers in the post-war period. If only they will realise that much inconvenience and suffering in after life can be avoided by attendance for post-natal examination and advice, an increase in this form of service will undoubtedly occur. Normally the majority of cases who attend the Clinics are subsequently confined by Midwives in the patient's own home or at Purley Hospital, or they are admitted to the County Hospital Redhill. During the second half of 1944 the cases were scattered all over the Country for their confinements. 11 Dental treatment for ante-natal mothers continued to be arranged where necessary and sterilised dressings provided, while appliances were supplied to post-natal cases when circumstances justified this assistance. emergency unit. The Emergency Obstetrical Unit based on Mayday Hospital was again called upon once during the year and proved of great value. OBSTETRIC SPECIALISTS. The only one of the Obstetric Specialists normally available in the District was unfortunately incapacitated or absent from the District during a great deal of the year and temporary alternative arrangements had to be made at times. Fortunately the position has now improved. MATERNITY CASES. During 1944 the number of maternity cases admitted to Purley Hospital under the Council's scheme was 58, compared with 73, 69 and 55 in the three preceding years. 'The maternity section of this hospital was almost empty during the summer months, 12 bookings being cancelled. Similarly the number of maternity cases admitted to Redhill County Hospital was only 107, compared with 150 in 1943, and 203 and 170 in the two preceding years, but even so it was 9 more than in 1939 and 1940 and 43 more than in 1938. Only mothers expecting their first babies, or with physical or social complications could' be admitted, owing to lack of accommodation. On the other hand 14 cases were evacuated through the official Evacuation Scheme but arrangements were made for more than this number, some having to cancel before being evacuated. Numbers of other mothers made their own private arrangements to leave the Districts some being assisted and many advised by the Public Health Department. A uniform charge of 5/- per case is made for the conveyance of maternity cases by ambulance to any hospital approved by the Medical Officer of Health, while a similar charge is made if, in order to avoid infection, undue strain on the mother, etc.,the mother and baby subsequently return home by ambulance. MIDWIFERY SERVICE. With the evacuation of mothers first one and then the other Council's Midwife escorted mothers to Broomshiels Hall Emergency Maternity Home, Satley, Tow Law, County Durham, where they remained in residence, helping to confine and attend to evacuated mothers sent to this institution, Altogether one or other was absent from this District for four months. During their time in this District the Purley Midwife attended 50 cases (33 midwifery and 17 maternity) and the Selsdon Midwife 49 cases (20 midwifery and 29 maternity) a total of 99 cases, compared with 103, 96, 76, 96, 87 and 87 in the preceding 6 years. Neither Midwife wished to leave the District during the period of flying bomb attack and only did so on request when they realised the greater need of the evacuated. CARE OF PREMATURE BABIES. At the end of the year special consideration was given to the particular problems attaching to the care of premature infants, and the following measures were instituted. 12 Doctors and Midwives were requested to include information when notifying the births of premature babies, and the hospitals asked to inform the Department before such babies are discharged. Arrangements were made for the ambulances to carry special equipment and for a Health Visitor or Midwife to accompany them in special cases; also for the services of the Paediatrician at St. Helier Hospital to be available for consultation when required. Two special cots with thermostatically controlled electric cradles and two sots of the special equipment required for nursing premature babies were purchased by the Council and made available for the use of residents, all Doctors and Midwives being informed of these and other provisions made. It was not until 1945 that all these facilities were available. Care of Illegitimate Infants and their Mothers. Special consideration was also given to the problems of this group of babies and mothers, but with no really satisfactory results, as the position is a much more difficult one. For one thing the Public Health Department receives no information regarding at least half of these cases until the Registrar-General's returns are received. Birth notifications do not mention the question of legitimacy, while an appreciable proportion of these mothers do not make known to the Health Visitors their ante-natal condition, making their own arrangements for their confinements, etc., frequently outside the District,to which they often do not return. Conferences have been held with the County Council and adjoining authorities at which it has been recognised that there has been a deficiency in the accommodation for the short term residence of the increased number of these mothers arising during the war and an almost complete absence of long-stay accommodation. An attempt has been made to increase the short stay accommodation but without success to date. The Health Visitors are all very alive to the peculiar needs of these cases and give special attention to such as they encounter, as a result of which it has not been thought necessary or desirable to make any special appointment for this work. The whole question will continue to receive attention, however. HOME HELPS. Since 194-2 the Council has employed two wholetime Home Helps and in addition has employed a number of temporary Home Helps as and when required. During the Winters 1943/4 and 1,944/5 voluntary assistance was also organised to assist residents during time of sickness. Paid assistance was provided during the year 1944 in 73 cases and 9 other bookings were cancelled owing to evacuation. These numbers show an increase over 1943, when 56 cases were assisted, compared with 25 in 1942 and a previous maximum of 35 in 1937. During the Autumn of 1944 a number of part-time paid Home Helps were introduced to needy residents but no financial assistance could be given in these cases, unless they could be classified as Maternity or Child Welfare cases. The demand was always far greater than the supply of Home Helps who were not attracted by the irregular work and rate of pay, apart from the arduous nature of the work. The encouragement given by the issue of Ministry of Health Circular No.179/44, dated 14th December, 1944, came as a tonic and renewed efforts have been made tc develop a useful and successful service. 13 The Annual Report for 1945 will show a considerable increase in this service and it is hoped that, with a more reasonable rate of pay, ls.6d. per hour instead of the basic 1s.3d. per hour, even more Home Helps will be enrolled, with a narrowing of the gap between supply and demand. Only cases in which ill health or old age is a factor can be assisted through this service. FAMILY GUIDANCE. The Council continued its financial support of the Croydon Mothers' and Infants' welfare Association during 1944, as a result of which many cases were referred from the Centres and Clinics for advice which they obtained on financially advantageous terms compared with the residents of other localities which did not give official support to the association. HEALTH VISITATION. During the early part of 1944 the Council continued to employ four Health Visitors but in February 1944 decided to appoint a fifth Health Visitor to meet the demands occasioned by the increased Birth Rate of the last few years. The Health Visitors continued to work under the supervision of the Medical Officer of Health and during the year paid a total of 10,309 visits, compared with 8,341 and 7,924 in the two previous years. The number of primary visits to babies remained high, 788 such visits being paid, compared with 836, 777 and 487 in the three preceding years, but the more satisfactory point is to be able to record that an average of 3 visits was paid to each child under 1 year of age, compared with an average of only 2 visits in 1942 and 1943. Altogether 91% of the Births registered in the District were visited. It was also practicable to increase the number of visits to children from 1 to 5 years of age, 6,449 such visits being paid, compared with 4,685 4,387 and 4,774 in the three preceding years, while an increased number of ante-natal and other health visits were carried out. INFANT WELFARE CENTRES. The only alteration made in the Infant Welfare sessions held at the six Centres established by the Council was that at Old Coulsdon the Centre was held weekly towards the end of the year, the Doctor, however, only attending twice a month, as at Sanderstead. The total number of sessions held was thus increased from 261 in 1943 to 277 in 1944. As might be expected, evacuation and enemy air attack produced a reduction in the number of attendances, the total number being 10,811 compared with 13,904 and 12,328 in the two previous years and the new cases 681, compared with 811 and 848. The decreases affected all Centres with the exception of Old Coulsdon, where the number of new cases, the total attendances and number of consultations increased. There was also a decrease in the number of cases referred to hospital for minor operative or other treatment, via. 21 compared with 38, 59 and 68 in the three preceding years* Arrangements were made for one child to be admitted to a convalescent home. TODDLERS CLINICS. The year under review was the fifth complete year in which special sessions were held at which the Doctors confined their attention to children from 2-5 years of age. The actual number of sessions was 1 more than in 1943 and 4 more than in 1942, but probably owing to war conditions there was a drop in the number of examinations made, viz. only 165 primary examinations compared with 241 and 198, and 289 re-examinations, compared with 323 and 26l in the two 14 preceding years. The biggest decreases were at Brighton Road, Coulsdon, and at Kenley, with only a slight fall at Selsdon, where in fact the number of re-examinations increased. It is hoped that this important branch of the service will improve considerably with the return to normal conditions. DISTRIBUTION OF MILK, ETC. With the Government issue of dried milk and the almost total absence of acute poverty, the granting of special dried milks, cod liver oil and malt, etc., free or at reduced cost, has assumed negligible proportions. There is still, however, a large sale of these commodities at cost price. DENTAL TREATMENT. The scheme for the provision of dental treatment for ante-natal and nursing mothers and children under 5 years of age continued throughout the year, but only 47 cases were treated, compared with 97, 100, 85 and 67 in the four preceding years and 90 in 1938. A much more generous income scale has been adopted since 1944 with a view to discouraging the postponement of dental treatment in the case of children until they are of school age, which was one of the causes of the diminished use of this service. DAY NURSERIES, The two Voluntary Nurseries continued to perform useful service, but owing to war conditions had a very difficult time during the second half of the year. As a result the Council increased considerably its already substantial annual grant to each. During the early part of the year these Nurseries were accommodating their normal total of about 60 children. The three wartime Nurseries established at Purley in 1942 and at Selsdon and Old Coulsdon in 1943 continued to render good service. Normally the Purley Nursery accommodates a maximum of 40 children, while the Selsdon and Old Coulsdon Nurseries can each take 60 children. During the first half of the year Purley and Old Coulsdon were kept full except during times of epidemic, but the demand at Selsdon was never as great ae the accommodation. By transferring up to 24 children daily by Civil Defence ambulances the total attendance had increased to over 50, however, when the flying bomb attack started. All the Nurseries experienced a very trying time during this phase, a large part of the time having to be spent in or going to and from the shelters. The Selsdon Nursery was twice damaged considerably by nearby bombs and the Purley Nursery to a lesser extent, fortunately in each case when the Nurseries were empty. Evacuation produced a considerable reduction in the number of attendances and, to a smaller extent, in the number of staff. On the whole the health of the children remained good and there is nothing of note in this respect to report. CHILD LIFE PROTECTION. During the year 18 foster mothers were under supervision, 23 children being distributed among them, this being 6 fewer foster mothers and 18 fewer children than in the preceding year. 15 SANITARY CONDITIONS. HOUSING Undoubtedly the housing position in this District became worse during the year. Preceding years had seen graduallyaccumulating arrears of repairs, the requisitioning of a very appreciable proportion of the houses and their deterioration during military or other occupancy, and above all increasing congestion owing to the diminishing number of tenable houses in the London area. Added to all this were the effects of the flying bombs, chiefly during the third quarter of 1944, when a further 9,000 houses in this District were damaged and over 100 demolished. Altogether nearly 300 houses had to be or were demolished as a result of enemy action during the war. With all the demands on manpower and materials it has become progressively less possible to obtain the necessary reconditioning of property and rehousing. By the end of 1944, thanks to the importation and mobilisation of labour, most houses were weather proof but the majority needed further extensive repairs, etc. Years of hard work lie ahead to make good these arrears. Meanwhile the following are the official statistics required by the Ministry of Health for 1944:- The total number cf houses inspected during the year under the Public Health or Housing Acts was 317, the number of inspections for this purpose being 342. No houses were found by the Public Health Department to be in a state so dangerous or injurious to health as to be unfit for human habitation but 259 were found not to be in all respects reasonably fit for human habitation. As a result of informal action 206 were rendered fit. Proceedings under Sections 9, 10 and 16 of the Housing Act 1936 led to the service of 3 notices and as a result of such notices 5 houses v/ere rendered fit by the owners during the year. A further 14 notices served under the Public Health Acts resulted in 26 houses having their defects remedied by the owners and 1 by the Local authority in default of the owners. No proceedings under Sections 11, 12 or 13 of the Housing Act, 1936, were taken. Three new cases of overcrowding were reported during the year and three cases were relieved, 22 persons being involved. At the end of the year 2 dwellings remained overcrowded, as judged by the standard of the Housing Act, 2 families and 14 persons being concerned. There is in addition, of course, a considerable amount of undesirable crowding in some parts of the District owing to the migration of families due to war conditions, while it is anticipated that representation under the Housing Act 1936, Section 11, will have to be made in respect of some 50 houses as soon as the housing situation makes this course advisable. WATER SUPPLY. No alteration in the water supply was made during the year. The East Surrey Water supply and that of the Sutton Water Company were each examined chemically three times and bacteriologically four times as a routine measure, and three times bacteriologically on account of damage to mains through enemy action. All the samples were taken in course of delivery and there Was no evidence of contamination to justify examination by the Local Authority of the raw water. All the reports on routine samples v/ere satisfactory and only one repeat sample after bomb damage was required. Pour samples from the reserve supplies in storage tanks in the Emergency Feeding Centres were also submitted for bacteriological examination and these showed this 0water to be fit for human consumption. Both Companies continued their practice of maintaining a fairly high percentage of free chlorine and very careful measured were taken to prevent infection resulting from injury to mains. 16 The year was notable for the great fluctuation in the rainfall which affected the water supply during the first half of the year. By the end of April or the beginning of May, each Water Company issued advertisements in the local newspapers and/or circularised consumers giving warnings of a water shortage. The watering of gardens was checked. The greatest care had to be taken in the use of hose pipes and encouragement was given to report immediately waste from leaking taps and fittings. The public evidently responded to these appeals, and it was not necessary to impose further restrictions, but it was not until later in the year that the restrictions were withdrawn. Complaints of insufficient or limited supplies were not received. In one instances however, for a short time water had to be distributed by water cart, owing to damage to a main by enemy action. The supply is constant to all parts of the area and there are no private wells in use. All houses are served by public water mains and as each house has its own supply within the house there are no stand pipes for common use. The statutory maximum limit for hardness in the water supplied by the East Surrey and Sutton District Water Companies is 9 degrees and 28 samples were examined by the Department during 1944 to ascertain that this was not exceeded. In no case was this found to occur. RAINFAIL. The rainfall registered at the Refuse Destructor was 26.94 inches, compared with 25.01 inches in 1943 and 28.93 in 1942. CLOSET ACCOMMODATION. Nearly the whole district is on the water carriage system. Owing to the war very little alteration of other forms of sanitation has been made during recent years. The approximate numbers using the following methods of disposal at the end of the year were Premises with water closets drained to sewers 15,202 Premises with pail closets excluding temporary buildings 216 The total number of cesspools throughout the district is approximately 164 The contents of almost all pail closets are collected by the Council's gully emptiers and disposed of in the public sewers, as are the contents of such cesspools as are emptied by the Council. In a few inaccessible premises the occupiers dispose of the contents in their gardens. PUBLIC CLEANSING. There was no alteration in the system of house and trade refuse collection daring the year. The fortnightly system of collection instituted in 1941 was continued with special drives for waste paper, books, rubber and non-ferrous metals. There was also no alteration in the charges for the removal of trade refuse or for cesspool emptying. SMOKE ABATEMENT. No action was taken in connection with any factory chimney, but a number of complaints were received of nuisance from smoke arising from the chimneys of workmen's temporary billets erected by the Home Office on sites of buildings destroyed by enemy action. These one storey buildings with their low chimneys caused considerable trouble, both to residents and to the Department, and no remedy had been effected by the end of the year. 17 RIVERS AND STREAMS, DRAINAGE AND SEWER. GS, FACTORIES AND WORKSHOPS, SCHOOLS AND SHOPS presented no special problems during the year. SWIMMING POOLS. One swimming pool was in use by the Public for a short while but no bacteriological examinations of the water were made, as the pool was closed when evacuation of the school children occurred. SANITARY INSPECTIONS, ETC. The number of complaints received during the year (453) was slightly less than in 1943 and two-fifths related to rats and mice. On the other hand nearly eight times as many inspections were made, chiefly owing to the Rat Campaign. There was a marked decrease in the number of infectious disease investigations and disinfections, but this was compensated for by an increase in the number of drains requiring attentions of visits to public shelters and for the preparation of war damage schedules of dilapidations. ERADICATION OF BED BUGS. The methods of dealing with this pest found most satisfactory during previous years were continued during 1944. The number of houses dealt with was as follows:- Council Houses infested 3 Other houses infested 8 Council houses disinfested 3 Other houses disinfected 8 This shows a decrease of two private houses compared with the previous year's figures, whilst the number of council houses infested and treated remained the same. RATS AND MICE DESTRUCTION. The nation wide campaign against rodents was continued throughout the year. The public were again offered the opportunity to report the presence of rats to the Council through the wardens' Service, but without success: the public preferred to refer their complaints direct to the Public Health Department. The total number of complaints received was 180, a decrease on the number received during the preceding year. The number of inspections was 721 and re-inspections 1,421. The chief causes of complaints were premises where poultry were kept in small numbers and where food was prepared in canteens. The building of sheds at ground level with wooden, concrete or brick floors on or a few inches above the ground provides excellent harbourage for rats, and the remedying of this kind of defect has been most difficult, owing to labour shortage and the impossibility of obtaining adequate rat-proofing material. The methods adopted for extermination in these cases has been the laying of prebait and poison bait in baiting boxes, and the use of cymag gas. Re infestations have occurred in several cases. During the year, a wide examination of sewers was undertaken, but only in a few cases were there signs of small infestations in the manholes. Of 200 streets inspected, only 6 were affected. These were short streets in congested areas, or where the sewers ended. Poisoned baits were laid in these areas and since the completion of the initial baiting the results of subsequent baiting has proved that few rats infest the areas. in fact, for the amount of time, labour and baiting expended in these areas the results were 18 disappointing. Altogether 559 visits were paid for this purpose. The base and poison used on the first occasion were bread mash and barium carbonate,, Subsequently, sausage rusk was used with 5% zinc phosphide. The routine followed for each manhole was (i) Inspection and baiting with prepared base. (ii) Examination following day and prebaiting again, if necessary. (iii) Examination on third day with further prebaiting. (iv) laying of poisoned baits. (v) Examination of 'take' on fifth or sixth day. (vi) Further examination of 'take' several days later. This routine took up much of the time of the Inspectors with a consequent curtailment of other routine inspections usually undertaken. The results of the poisonings and gassings are difficult to assess, but the bodies of dead rats have been found in many cases and a conservative estimate would not be lower than 1,000 rats. LEGAL PROCEEDINGS. Proceedings were taken on two occasions, viz. (l) under the Public Health Act 1936, Section 92, when an Order of the Court was obtained, and (2) under the Rats and Mice (Destruction) Act 1929, when a fine of £5. 0. and costs was imposed. REGULATED TRADES, COWSHEDS AND DAIRIES. As in the previous year 7 dairy farms were functioning in the District and two of the farms were licenced by the Surrey County Council to produce ''Accredited" milk. In addition one of the farms was licenced to produce "Tuberculin Tested" milk. At the end of the year there were 11 registered dairies, as in 1943? and 13 registered retailers (1 less than in 1943) of whom 6 live out of the District. There has been a reduction of 17 registered retailers, (3 from outside the District), compared with 1941. Two of the registered dairies retail heat treated milk, treated on their own premises and authorised by the Ministry of Food. SLAUGHTER HOUSES. There are two slaughter houses within the district but neither was licenced during the year. Two licences to slaughter -animals were issued to slaughtermen under the Slaughter of Animals Act 1935. These men are employed at private slaughter houses belonging to Public Institutions in the District. BAKEHOUSES. There were seven bakehouses engaged chiefly in the manufacture of bread and confectionery, and 28 other places at which confectionery was produced for sale or consumption on the premises. There are also bakehouses at private institutions hotels, schools, etc., all of which are inspected from time to time. 19 OTHER FOOD PREMISES. Fish frying is carried on at four premises, one each in Selsdon, Purley, Coulsdon and Old Coulsdon. Fish frying is not scheduled as an offensive trade in this district but registration of such premises under Section 14 of the Food and Drugs Act, 1938, is required. The canteens set up for supplying food to the various civil defence services and factory workers were also inspected periodically. FACTQRIES AND WORKPLACES. There were 163 factories and 16 workplaces within the District. INSPECTION AND SUPERVISION OF FOOD. MILK During the year 54 samples of milk were submitted for bacteriological and microscopical examination, 45 being satisfactory as judged by the total bacterial count, and 35 judging by the presence of coliform organisms. Eight biological examinations were made, none of which was positive. Thirty samples of pasteurised milk were submitted to the phosphatase test, all but two being satisfactory. MILK (SPECIAL DESIGNATIONS) ORDER, 1936. During the year the Council granted the following licences to sell milk under the above Orders- Principal. Supplementary. Tuberculin tested 5 3 Accredited 1 - Pasteurised 10 3 ICE CREAM. No samples of ice cream were taken during the year. The Government restriction on the making of icecream was withdrawn from 10th December, 1944, and as most stocks of ingredients had been sold or deteriorated, no ice cream was manufactured in the district so far as is known. MEAT. As slaughtering ceased at the two licenced slaughterhouses in January 1940 no carcases of meat were inspected except those of animals which were privately owned and slaughtered partly for their owners' consumption on the authority of the Local Food Office. Only 16 pigs were thus killed and inspected. UNSOUND FOODS. The following unsound foods were surrendered during the years:- 20  lbs. ozs. Meat, bacon and poultry 310. 0½ Canned meat 228 15½ Evaporated or condensed milk 108 10 Fish 1028 12 Canned fish 137 14½ Sugar, jam, etc. 309 15 Canned beans, peas and vegetables 192 8 Flour, bread, cereals, fishcakes, pastries, etc. 1163 4 Canned fruit 42 14 Lemon squash, etc. 16 0 Eggs 21 8 Coffee and cocoa 4 2 Fruit 186 12 Vegetables 1150 1 Soup 29 0 Pickles 11 4 Butter and fats 12 4 Sauce 5 0 Flavourings (Oxo etc.) 5 6 Miscellaneous 19 2 Total 4983 lbs. 4¼ozs. This is an increase of 60% on last year's figures and almost double that surrendered in 1942. The whole of these goods were disposed of as animal or poultry food, largely through the Ministry of Pood Salvage Organisation. FOOD AND DRUGS ACT, 1938. SAMPLES TAKEN DURING 1944. Articles. Analysed. Adulterated or deteriorated. Prosecutions. Convic- tions Formal Informal Total Formal In- formal Total Ale 1 - 1 - - - -- - Baking Powder 3 - 3 - - - - - Barley & barley powder 2 - 2 - - - - — Beans in Sauce 2 - 2 - - - — - Beer 7 - 7 1 - 1 - — Bread 4 - 4 - - - - - Broth 1 - 1 - - - - 7 Butter 1 - 1 - - - - — pake & cake flour 2 - 2 - - - - — Cake Mixture 2 — 2 1 — 1 — — Chocolate Cup 1 - 1 - - - - - Chocolate Powder 1 - 1 - - - - - Coffee & coffee extract 3 - 3 - - - - — Coffee & chicory 1 - 1 - - - - - Cordial Ginger 1 - 1 - - - - - Cooking Pat 1 - 1 - — - - - Cream of Tartar l - 1 - - - — — Culinary Herbs 1 - 1 - - - - Curry Powder 1 - 1 - - - - — Drinking Chocolate 1 - 1 - - - - — Egg Substitute l - 1 1 - 1 — — Fishcake Roll 1 - 1 - - - - — Fish Galantine l - 1 - - - - - Fish Paste 4 — 4 — — - - - Carried forward 44 - 44 3 - 3 - - 21 Article. Analysed. Adulterated or Deteriorated. Prosecutions. Convic tions. Formal In- formal Total Formal Informal Total Brought forward 44 - 44 3 - 3 - - Glycerine & Gelatine 2 - 2 - - - - — Grapefruit Squash 1 — 1 - - - - - Gravy Salt 1 - 1 - — - - - Ground Nutmeg 1 - 1 - - - - - Jam 7 - 7 - - - - — Lard 1 - 1 - - - - - Lemonade Powder 1 - 1 - - - - - Lemon Curd 1 - 1 - - - - - Liver Pills 1 — 1 - - - - - Liver Sausage 1 - 1 - - - - - Malt Cocoa spread 1 - 1 - - - - - Malt, Milk & egg powder 1 - 1 - - - - - Malted Soyacream. 1 - 1 - - - - - Margarine 2 - 2 - - - - - Marmalade 2 - 2 - - - - - Meat paste, pies and roll 4 - 4 - - - - - Milk 33 - 33 2 - 2 - - Mince & Beans 1 - 1 - - - - - Mixed Spice 1 - 1 - - - - - Mustard Mixture 1 - 1 - - - - - Mustard Sauce 1 — 1 - - - - - Pickles & 1 - 1 - - - - - Pudding Mixture 1 - 1 - - - - - Pudding Sauce Powder 1 - 1 - - - - - Raising Powder 1 - 1 - - - - - Rolled Oats 1 - 1 - - - - - Rosehip Syrup 1 - 1 - - - - - Salad Dressing Powder 2 - 2 - - - - - Sardines 2 - 2 - - - - - Sauce 3 - 3 - - - - - Sausages 9 - 9 1 - 1 1 1 Semolina 3 - 3 - - - - - Soup 4 - 4 - - - - - Soup Powder 1 - 1 - - - - - Soya Flour 1 - 1 - - - - - Sponge Mixture 1 - 1 - - - - - Stewed Steak 2 - 2 - - - - - Stuffing 1 - 1 - - - - - Syrup of Figs 1 - 1 - — - - - Tea 1 - 1 - - - - - Whisky 4 " 4 - - - - - Total 150 - 150 6 - 6 1 1