MALI library Borough of malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED DECEMBER 31st 1937 Printed by J. B. Blackmore & Co. Ltd., 86, Merton High Street, 8.W.19. Borough of Malden and Coombe ANNUAL REPORT of the Health and Sanitary Conditions for the Year 1937 JAMES FANNING, M.D.. B.S. (Lond), M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. HENRY TUNBRIDGE, M.R.San.I., Sanitary Inspector. 2 BOROUGH OF MALDEN AND COOMBE PUBLIC HEALTH COMMITTEE 1937. Chairman : Alderman E. E. W. Manning. ViceChairman : Alderman Major G. Petit, M.C., L.R.C.P. The Mayor: C. W. Speirs, Esq., .T.P., C.C. The Deputy Mayor: Alderman A. D. Young, A.C.A. Aldermen A. Dicker and Mrs. D. M. Porter. Councillors H. J. Gorer, Mrs. A. M. Harder, J. W. Harper. Major F. J. Johnson, Mrs. •T. Marshall, J. L. Mobsby, and G. G. N. Taylor. OFFICERS AN!) STAFF OF THE PUBLIC HEALTH James Fanning, M.D., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health (part time). Assistant Medical, Officer, Surrey County Council. Henry Tunbridge, M.R.San.I. Chief Sanitary and Foods Inspector. Certificates of the Royal Sanitary Institute as Sanitary Inspector and Inspector of Meat and Other Foods. Certificates in Building Construction and Drawing. Douglas J. Hughes, C.R.San.I., Sanitary Inspector. •Clement S. T. Dancer, M.S.I.A., Sanitary Inspector. Certificates of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. Certificates of Royal Sanitary Institute as Inspectors of Meat and Other Foods. t Arthur O. Scott, Assistant Rat Officer. Oliver Elliott, General Assistant and Mortuary Keeper. DEPARTM ENT. Frederick W. W. Mitchell, Clerk. *Appointed April, 1937. †Appcinted October, 1937. 3 Borough of malden & Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1937 Public Health Department, Municipal Offices, New Malden. May, 1938. To the Mayor, Aldermen and Councillors of the Borough of Malden and Coombe. Ladies and Gentlemen, I have the honour to present to you niv Annual Report on the health and sanitary conditions of the Borough of Maiden and Coombe for the year ended 31st December, 1937. it has been prepared in accordance with Ministry of Health circular 1650. The Registrar General's estimate of population for midyear 1937 of 37,270 showed an increase of 2,790 over the previous year. This is greater than the average annual increase which has been taking place for a number of years. The corrected death rate was 9.2 per 1,000 population compared with 12.4 for England and Wales. This figure approximates to the average for the past five years. The birth rate of 15.1 per 1,000 population compares with 14.9 for England and Wales and represents the highest figure since 1930. There were again no deaths of mothers in childbirth. The infantile mortality rate was 37 per 1,000 live births, the figure for the country as a whole being 58. 4 This is a very favourable figure and is considerably below the average rate for the district. An important event in Public Health legislation during the year was the coming into force of the Public Health Act, 1936, on October 1st. This comprehensive Act is mainly a consolidating measure, although a number of amendments to the law have been introduced. Work in connection with the relief of overcrowding under the Housing Act of 1936 developed during the year, and plans for 52 houses were passed. Details will be found in the report of the Chief Sanitary Inspector. Two additions were made to the staff of the Public Health Department during the year. Mr. C. S. T. Dancer was appointed third Sanitary Inspector and Mr. A. O Scott was appointed Assistant Rat Officer. The latter appointment is of a temporary nature at present. I am again grateful to the Chairman and Members of the Public Health Committee for their kind cooperation and sympathetic reception of suggestions. I am glad to be able to record that the staff of the department have, in every respect, carried out their work with vigour and ability, and my thanks are especially due to Mr. Tunbridge, the Chief Sanitary Inspector, for his boundless energy and loyal support. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FANNING, Medical Officer of Health. GENERAL INFORMATION. Situation.—About ten miles south of Charing Cross, in the County of Surrey, bounded by Richmond Park, Wimbledon Common, Merton, Worcester Park, Surbiton and KingstonuponThames, the greater part of the District lying between the Hogsmill River and Beverley Brook. 5 Much of the District lies on London clay, the exceptions being the higher parts of Coombe, a broad strip of land adjoining the Hogsmill River, and portions of New Maiden. The subsoil of Coombe is chiefly gravel. New Maiden and Maiden are approximately 4050 feet above sea level, whilst the ground rises to Coombe, the highest parts being 175 feet above sea level. Social Conditions.—The District is chiefly residential, the majority of the inhabitants being employed in London or surrounding districts. There is no industry of a staple character in the area. Two or three large and several smaller factories exist, but there are none which, in my opinion, have any particular effect on public health. There is a considerable number of sports grounds in the district maintained mostly by London firms for the recreation of their staffs. Whilst these, of course, are private, the general public is allowed access in some cases on the occasion of the . various athletic meetings, either on payment of a small fee or free. The district is now remarkably well provided ir. respect of open spaces. In the Coombe district the preservation of the large and beautiful tracks of land (187 acres) comprising Coombe Hill and Coombe Wood Golf Courses was ensured by purchase in 1933 and, later, a further 15 acres were acquired in this neighbourhood between Coombe Hill Golf Course and Robin Hood Way, together with part of Coombe Wood (5 acres) adjoining Robin Hood Way. Kingston Vale is well provided with open spaces being situate immediately adjoining Richmond Park and Wimbledon Common. Six acres of land called the Coombe Vale Sports Ground have also been acquired by the Council and laid out in this area. 6 In the New Maiden area (Burlington Ward) the Council own the Beverley Park of 20 acres and (Dicker age Ward) the Kingston Road Recreation Ground of 8 acres, where cricket, tennis, golf putting, etc. are played. Further open spaces have been laid out in the Mount Ward (4 acres) and Norbiton Park Ward (12 acres). Two acres of land in the Burlington Ward were presented to the Council during 1936 by a private donor, as a permanent open space. The Maiden Golf Course (114 acres) was purchased by the Council in 1933 and, at present, is leased to the Maiden Golf Club. In the Maiden area there is a large sports and recreation ground (18 acres) which was purchased by the Council a few years ago, and a further open space of 36 acres was acquired during 1936 but has not yet been laid out for organised games. Several smaller open spaces, public walks and pleasure grounds also exist in various parts of the district. The advantages of these amenities are becoming more and more pronounced as the district advances to its complete urbanisation. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area 3,162 acres. Registrar General's estimate of resident population (midyear 1937) 37,270 Number of inhabited houses according to rate books (end of 1937) 11,058 Rateable value £399,937 Sum represented by a penny rate £1,615 During 1931 the Census was taken and the population of the district was returned at 23,405. 7 The following table illustrates the growth of the district, and the distribution of the increase during the past 35 years. Year. Census Pop. of whole District. Coombe. New Maiden. Maiden. 1901 6.233 875 4,850 508 1911 12,137 1,224 10,368 545 1921 14,495 1,351 12,642 502 1931 23,405 1,962 20,120 1,323 1937 (Est.) 37,270 4,870 22,649 9.751 N.B.—For purposes of comparison with census figures the terms Coombe, New Maiden, and Maiden, have been retained in this table. In 1933 New Maiden was subdivided into six wards, and during 1936 Maiden was subdivided into two wards. VITAL STATISTICIS. Total. M. F. Live births 565 264 301 Birth rate per 1,000 of the estimated resident population 15.1 (legitimate) 259 295 (illegitimate 5 6 Stillbirths 16 7 9 Hate per 1,000 total (live and still) births 27.5 Deaths 325 167 158 Death rate per 1,000 of the estimated resident population Crude 8.7 Corrected 9.2 Deaths from puerperal causes Nil Death rates of Infants under one year of age:— All Infants per 1,000 live births 37.1 Legitimate Infants per 1,000 legitimate live births 37.9 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 49 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 2 8 BIRTHS. During the year 565 live births were registered, this being 61 above last year's total. The rate per 1,000 was 15.1 compared with the average of 14.9 for England and Wales. Of the total number 11, or 1.9 per cent, were illegitimate. DEATHS. During the year 325 deaths were registered, being 12 more than in 1936. One hundred and fiftytwo deaths were registered in the district and one hundred and seventythree in Institutions and other districts. The death rate per 1,000 population was 9.2 compared with the average of 12.4 for England and Wales. Heart disease and cancer were again the most prominent separate causes of death. The infantile mortality rate was 37.1 per 1,000 live births and compares with 58.0 for the average of England and Wales. No death occurred in an illegitimate child under one year of age. CAUSES OF DEATH. M. F. Total. Measles 1 - l Scarlet fever 1 - i Whooping cough 3 - 3 Diphtheria 1 - 1 Influenza 3 3 6 Respiratory tuberculosis 9 5 14 Other tuberculosis — 1 1 General paralysis of Insane Tabes, etc. 1 1 Cancer 24 25 49 Diabetes 6 3 9 Cerebral hainorrhafje, etc, 8 - 10 Heart disease 34 43 77 Other circulatory diseases 4 10 14 9  M. F. Total Bronchitis 2 5 7 Pneumonia (all forms) 13 11 24 Other respiratory diseases 2 1 3 Peptic ulcer 3 1 4 Diarrhoea (under 2 years) 1 1 2 Appendicitis 2 3 5 Cirrhosis of liver — 1 1 Other liver diseases — 1 1 Other digestive diseases 4 5 9 Acute and chronic nephritis 6 6 12 Congenital debility, mature birth, etc. 8 8 16 Senility 5 4 9 Suicide 5 4 9 Other violence 10 8 18 Other defined diseases 11 7 18 167 158 325 DEATHS. AGE GROUPS. Under 1 15 515 1525 2535 3545 4555 5565 6580 80 & over Total Males 13 O 6 4 10 7 20 34 50 20 167 Females 8 4 13 3 10 17 23 58 26 158 21 7 7 7 18 17 37 57 108 46 325 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of ag& during the past five years: — 1933 (19 Legitimate. 3 Illegitimate) 22 1934 (20 None „ 20 1935 (14 „ 1 „ 15 1936 (22 „ None „ 22 1937 (21 „ None „ 21 Average for the past five years—20. STATEMENT SHOWING WHERE DEATHS OCCURRED. Total. In District. Surrey County Hospital. Kingston Victoria Hospital. Tolworth Isolation Hospital. London & other Hospitals. Wimbledon Hospital. Other Districts. 325 152 65 13 4 31 3 57 10 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. infantile Mortality. Deaths. 1933 13.0 60.4 9.6 1SI34 12. 2 53.2 8.9 1935 14.1 32.8 7.9 1936 14.6 43.6 9.6 1937 15.1 37.1 9.2 Average for past 5 years 13.8 45.4 9.0 WARDS STATISTIC TABLE. Wards. Acres. Est. Inhab. Houses MidYear 1937. Est. Pop. MidYear 1937. Deaths. Infantile Deaths. Coombe 1,312 1,457 4,870 42 o Dickerage 225 875 4,395 33 6 Mount 113 965 3,995 35 3 Cambridge 212 850 3,045 30 3 Norbiton Park 207 890 2,985 25 2 Central 112 755 2,935 31 1 Burlington 172 1,400 5,294 56 2 Maiden Manor St. James 446 363 3,284 9,751 136 1 37 2 3,162 10,476 37,270 325 21 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 2 3 minutes ; 3 hours. Congenital Diseases, Malformations, etc. 12 1 hour; 17 hours; 1 day; 2 weeks; 1 month; 1 month; 1 month; 5 weeks; 2 months; 2 months; 6 months; 7 months. Birth Injuries 2 i8 hours; 2 days. Whooping Cough 3 1 month; 2 months; 8 months. Gastroenteritis 2 2 months; 1 week. 11 MORTUARY. Twenty bodies were brought to the Mortuary and a post mortem examination was made 011 each. H.M. Coroner for the district held inquests in thirteen instances and the following verdicts were returned:— Natural Causes 3 Accidental 2 Suicide 5 In accordance with medical evidence 2 Manslaughter 1 RAINFALL. Compared with the figures for the previous year this is an increase of 5.33 inches. Average yearly rainfall (for past five years) 23.82 inches. SANITARY CIRCUMSTANCES OF THE AREA. Details as to water supply, rivers and streams, drainage and sewerage, closet accommodation, etc., will be found in the accompanying report of the Sanitary Inspector. Table showing rainfall in the district during 1937. taken at the Sewage Disposal Works, California Road, New Maiden. January 3.72 inches. February 3.81 „ March 2.53 „ April 1.75 „ May 2.22 „ June 1.94 „ July 0.56 „ August 3.20 „ September 1.56 „ October 2.29 „ November 1.28 „ December 3.95 „ Total 28.81 „ 12 SCHOOLS. The children attending the Public Elementary Schools in the district at the beginning of the year (1938) numbered:— Boys 1,988 Girls 1,851 3,839 The numbers attending each school were as follows:— COOMBE. Kingston Vale— Girls. Boys. Total Junior Mixed 22 12 60 Infants 8 18 MALDEN. Parochial— Junior Mixed 46 49 140 Infants 20 25 Sheepiiouse Lane— Junior Mixed 123 122 433 Infants 77 111 Beverley Central — 310 310 NEW MALDEN. New Malden East— Central 346 - Junior Mixed 164 185 997 Infants 147 155 New Malden West— Central 232 207 1,394 Junior Mixed 250 296 Infants 176 233 Elji Boad Junior — 195 195 Lime Grove— Junior 164 — 310 Infants 76 70 1,851 1,988 3,839 This shows an increase of 126 scholars compared with last year's total. 13 NOTIFICATIONS OF INFECTIOUS DISEASES, 1937. Totals AGE GROUPS DISEASES Under 1 12 23 34 45 510 1015 1520 2035 3545 4565 Over 65[] Diphtheria 22 — — 2 2 1 13 4 ] Erysipelas 4 — — — — — — — — 1 1 1 1 Pneumonia 19 1 1 — — 1 — — — 2 1 8 5 Puerperal Pyrexia 3 — — — — — — — — 2 1 — — Poliomyelitis 1 — — 1 — — — — — — — — — Scarlet fever 39 — 1 2 2 1 18 10 1 3 1 — — Ophthalmia Neonatorum 2 2 — — — — — — — — — — — Enteric fever 4 1 1 2 — — — — Dysentery 12 — 3 1 1 3 1 1 2 Totals 106 3 2 5 7 3 33 15 4 11 5 10 8 WARDS DISEASES Coombe Dickerage Mount Cambridge Norbiton Park Central Burlington Maiden St. James Diphtheria — 11 2 1 — 2 3 o 1 Erysipelas — 1 — — — 2 1 — — Pneumonia 2 3 1 2 3 3 4 — 1 Puerperal Pyrexia — 1 — — — — — 2 — Poliomyelitis — — 1 — — — — — — Scarlet fever 2 3 5 3 4 6 5 5 6 Ophthalmia Neonatorum — 1 — — — — — — 1 Enteric fever 1 — 1 — — — 1 1 Dysentery 1 — 1 1 1 1 2 5 — Totals 6 20 11 7 8 14 16 15 9 14 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SMALLPOX. No case of smallpox occurred during the year. There were, however, three ship contacts who came to live in the district. Routine visits were paid to each of these. It was not found necessary to perforin any vaccinations under the Public Health (Smallpox Prevention) Regulations of 1917. SCARLET FEVER. The incidence of scarlet fever was again comparatively low, thirtynine cases being notified, an incidence rate of 1.04 per 1,000 population. One death occurred in a child who developed surgical scarlet fever after an operation for tonsillectomy. Thirtyone cases were treated in hospital and eight cases at home. In addition six suspected cases were admitted to hospital where it was later decided that the illness was not scarlet fever. Groups of four and six cases respectively occurred as outbreaks at two private schools. Apart from these outbreaks the majority were single cases in a family, with the exception of three instances in which two members of the family were involved. Two of the latter were examples of " return case " infection, i.e. a second case occurring in a house within twentyeight days of the return of a scarlet fever patient from hospital. DIPHTHERIA. The diphtheria incidence was 0.59 per 1,000 population. This figure has remained approximately the same for the past three years. Twentytwo cases were notified, all of which were treated in Tolworth Hospital. 15 Two of these cases had received adequate doses of immunising material and in each of them the attack was very mild. It is estimated that approximately '24% of children of school age and under living in the I5orough have now been immunised. Experience of immunisation in this district since the scheme was instituted three years ago all goes to confirm the value of the procedure. The majority of children so treated are likely to be fully protected, while the few who contract the disease suffer a trivial complaint instead of the serious illness usually caused by diphtheria. Six suspected cases were sent to hospital and were afterwards discharged as not so suffering. It is always a wise precaution to send doubtful cases for immediate treatment even though a proportion afterwards prove not to be diphtheria. Five carriers were treated in hospital, all with nasal lesions. The distinction between a simple carrier and a very mild case of the disease is not always easy to draw. It is probable that the majority of persistent carriers have some pathological state in the nose or throat and these are the chief means of spreading the disease. One such case gave rise to seven clinical cases of diphtheria in a small group of houses. One death from diphtheria occurred during the year. The following statistics refer to the immunisation scheme adopted by the Council in 1934. Details of the scheme were given in my Annual Report for 1935. Number of cases completing treatment during year 378 Number of cases in course of treatment at end of year 19 Number of cases failing to attend for complete course 8 16 Number of Schick tests performed 246 Total number of attendances at Clinic 1,528 Number of cases treated by private doctors under Council's scheme 43 Total number of cases treated under Council's scheme to end of 1937 1,240 MEASLES. Measles has appeared biennially with such regularity for so long that the sharp burst which appeared in the months of February and March was rather unexpected. The number of cases was not large and the outbreak was confined to the eastern side of the district. There was one death in a boy aged seven. The usual biennial epidemic had not begun at the end of the year, but preparations were made to repeat the scheme described in my Report for 1936. ACUTE POLIOMYELITIS. Only one case of acute poliomyelitis was reported during the year. This was a child of 2 years who made a good recovery without paralysis. Although the child was a member of a large family no spread of the disease occurred. ENTERIC FEVER. An unusual feature was the occurrence of four cases of paratyphoid fever during the year. Two were notified in April, one in .July, and one in August. All were females, the ages being 6, 13, 18 and 19 respectively. Exhaustive enquiries failed to elicit any connection between the various cases and also failed to find any relationship with other cases outside the district. The illness was of a mild type in all cases. Sporadic cases of paratyphoid fever are known to occur fairly 17 quently and it is common knowledge that the disease has been more prevalent than usual in this country during the past few years. There must undoubtedly be a large number of unknown carriers in existence and as the paratyphoid type of organism is known to be spread frequently by food contamination it becomes of the utmost importance that all persons who come into contact with food intended for others should observe the strictest rules of personal cleanliness, always bearing in mind that the hands in particular can be a ready medium for the transfer of infection. DYSENTERY. The subject of dysentery was dealt with in some detail in my Annual Report for 1935. It was there indicated that there was a strong probability that many of the mild diarrhoeas were in fact an infectious disease caused by the Sonne dysentery bacillus. Cases of this nature began to come to light in November of the present year, and it soon became evident that the disease was widespread throughout the country. The attention of all the local doctors was again drawn by letter to the prevalence of the disease and leaflets of advice for the prevention of spread were prepared. Twelve notifications were received, but there is little doubt that there was a much greater prevalence than this indicates. The responsible organism is excreted from the intestine of those suffering for a variable period, and in the case of a disease which is widespread, sometimes mild, and often unrecognized, it is easy to understand that infection may be readily conveyed by the person or clothing of the sufferer either directly to others or to food which they may consume. It is important, therefore, that the simple precautions mentioned under the heading of enteric fever should be carried out by all, whether suffering from obvious intestinal disease or not. 18 TUBERCULOSIS. Age Periods NEW CASES DEATHS Respiratory Male Female NonRespiratory Male Female Respiratory Male Female NonRespiratory Male Female 0 - - - - - - - - 1 — — — 1 - — — — 5 1 — 2 2 — — — — 15 4 5 — 2 — 1 — — 25 11 3 — — 8 2 — — 35 6 — — 2 1 1 — 1 45 3 55 2 1 — — — 1 — — 65 1 - - - - - - - & upwards Totals 28 9 2 7 9 5 — 1 Under the Public Health (Tuberculosis) Regulations, a register of all notified cases is kept in the Public Health Department. Weekly returns of new cases are sent to the County Medical Officer, and at the end of each quarter a numerical return is made showing the cases added to or removed from the Register, together with the number remaining at the end of the quarter. The continual movement of patients to and from the district entails constant supervision in order that the register may present a true record. Careful watch is kept on the home conditions of patients in the register in order that any defects in their mode of living which might tend to spread the disease can be amended. The following table shows the case rate and the death rate from tuberculosis during the past 17 years:— Year. Population. Cases Notified. Rate per 1,000 population. Deaths. Rate per 1,000 population. 1921 14,503 21 1.44 8 0.55 1922 15,000 18 1.20 10 0.66 1923 15,366 11 0.71 12 0.78 1924 15,600 21 1.34 16 1.02 1925 15,850 26 1.64 12 0.75 1926 17,130 20 1.16 10 0.58 1927 17,450 26 1.48 10 0.57 19 Year. Population. Cases Notified. Rate per 1,000 population. Deaths. Rate per 1,000 population. 1928 18,310 18 0.98 11 0.60 1929 19,800 21 1.06 4 0.20 1930 21,290 26 1.22 10 0.46 1931 23,500 21 0.89 14 0.59 1932 25,370 21 0.83 15 0.59 1933 27,830 32 1.15 20 0.71 1934 30,720 36 1.17 14 0.45 1935 32,380 42 1.30 14 0.43 1936 34,480 36 1.04 20 0.58 1937 37.270 46 1.23 15 0.40 There was an increase in the number of new notifications due to a larger number of male pulmonary cases. There was 110 evidence of any local cause at work to account for this. On the other hand there was a fall in the death rate from tuberculosis. As early ascertainment and notification is of great importance in the prevention and cure of tuberculosis, the number of cases dying unnotified is an important index of the extent of our awareness of the disease. A certain number of cases will always defy diagnosis before death and in the present year there were only three such eases. In none of these could a diagnosis have reasonably been expected before death and there was no instance of failure on the part of the doctor to notify. The facilities for chest Xray examination offered by arrangement with the Kingston Victoria Hospital were made use of in four cases. At the end of the year the following number of cases was shown to be suffering from the disease and living in the district, an increase of four cases compared with the previous year:— Pulmonary. NonPulmonary. Males 75 14 Females 50 26 Old standing cases moving into the district are, of course, added to the register in the same way as new cases. 20 THE PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. THE PUBLIC HEALTH ACT, 1925, SECTION 62. THE PUBLIC HEALTH ACT, 1936, SECTION 172. It has not been found necessary to take any formal action under the above Regulations or Acts. The first relates to tuberculous employees in the milk trade, and the latter give power to a Council to apply for an order for the compulsory removal to Hospital of a person suffering from pulmonary tuberculosis, if certain conditions obtain so that serious risk of infection is thereby caused to other persons. No action has been taken during the year under section 66 of the Public Health Act, 1925, or section 176 of the Public Health Act, 1936, for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. The puerperal pyrexia rate was again low and without fatality. All conditions of notifiable pyrexia following childbirth are now returnable under this heading and the term " puerperal fever " disappears. An extensive epidemic of mumps prevailed in April and May. Whooping cough was prevalent in the Spring and gave rise to three deaths, all in children under one year. Good use was made of the facilities offered by Tolworth Hospital for the treatment of complicated cases. PREVENTION OF BLINDNESS. GENERAL. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales. Administrative County of Surrey. Borough of Maiden & Coombe. Smallpox 0.00 0.00 0.00 Scarlet fever 2.33 1.81 1.04 Diphtheria 1.49 0.58 0.59 21  England and Wales. Administrative County of Surrey. Borough of Maiden & Coombe. Enteric fever 0.05 0.066 0.10 Erysipelas 0.37 0.25 0.10 *Puerperal pyrexia 13.93 10.33 5.15 *Per 1,000 total births (i.e., live and stillbirths). CASES OF INFECTIOUS DISEASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever *32 Suspected Scarlet fever 6 Diphtheria 22 Diphtheria "Carriers" 5 Suspected diphtheria 6 Whooping cough and complications Measles and complications 2 Erysipelas 1 Enteric fever 1 Suspected Enteric fever 1 Mumps 1 Suspected Meningitis 1 84 CASES OF INFECTIOUS DISEASES REMOVED TO THE LONDON FEVER HOSPITAL. Scarlet fever 2 *Includes 3 readmissions. THE FOLLOWING TABLE SHOWS THE NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1932 1933 1934 1935 1936 1937 Scarlet Fever 52 113 87 35 45 39 Diphtheria 9 11 7 22 21 22 Enteric Fever (including Paratyphoid) 1 4 Erysipelas 6 4 8 4 6 4 Pneumonia 49 31 31 10 16 19 22  1932 1933 1934 1935 1936 1937 Encephalitis Lethargica 1 1 - — — — Puerperal Fever — 1 5 1 — — Puerperal Pyrexia 0 0 4 2 6 3 Cerebro Spinal Fever — — 1 — — — Acute Poliomyelitis — 3 — 3 — 1 Ophthalmia Neonatorum 0 3 0 — — 2 Dysentery — — — 10 — 12 Malaria 1 Tuberculosis (all forms) 21 32 36 42 36 46 GENERAL PROVISION OP HEALTH SERVICES IN THE AREA. Laboratory Facilities. The bacteriological examinations for the Council are carried out by the Clinical Research Association, Watergate House, London. Each medical practitioner has, or can obtain the apparatus for bacteriological examinations, and the cost of such examinations in suspected cases of diphtheria, enteric fever, tuberculosis, and certain other special cases is defrayed by the Council. The following table shows the number of examinations during the past year:— Disease. Positive. Results. Negative. Totals. Tuberculosis Sputa 8 65 73 Scarlet Fever Swabs 7 3 10 Diphtheria Swabs 16 295 311 Dysentery Faeces 8 7 15 Paratyphoid Faeces 1 17 18 do. Blood — 14 14 do. Urine — 7 7 Cerebro spinal Meningitis Swabs — 3 3 Totals . 40 411 451 In addition some specimens were examined at the Ministry of Health Laboratory in connection with the cases of dysentery. A number of samples of milk were submitted for bacterial count or the presence of tuberculosis, details of which will be found in the report of the Sanitary Inspector. 23 Other Public Health Officers. Tuberculosis Officers, Public Vaccinators, Veterinary Surgeons, Vaccination Officers and Health Visitors are appointed and controlled by the County Council. Nursing in the Home. (a) General: Nursing Institute in District has staff of Trained Nurses for attending cases in the home (including maternity). (b) Infectious Diseases: No permanent ments, cases having to be dealt with as they arise. HOSPITALS. The following Hospitals are available for residents of the district for the purpose indicated, but there are no Hospitals, voluntary or otherwise within the district. Purpose. Name. Situation. Management. Infectious diseases e.g., Scarlet Fever, Diphtheria, Typhoid and severe or complicated cases of Measles and Whooping Cough. Tolworth Isolation Hospital. Tolworth, Surbiton. Tolworth Joint Hospital Board (this district being a constituent authority). Smallpox. Smallpox Hospital. Clandon, Surrey. Surrey County Council. Tuberculosis. County Sanatorium. Milford, Surrey. Surrey County Council. Venereal diseases. The Principal London Hospitals. The Surrey County Council are responsible for the operation of the Venereal Diseases Regulations through whom arrangements are made for treatment of cases under the London and Home Counties Scheme. General Medical and Surgical (including Chronic Sick & Maternity). Surrey County Hospital. Kingston onThames, Surrey. Surrey County Council (Public Assistance Committee). 24 Purpose. Xante. Situation. Management Mental, etc. Surrey County Hospital. Brookwood and Netherne Mental Hospitals. Kingston onThames, Surrey. Brookwood and Netherne, Surrey. Surrey County Council. Surrey County Council. Puerperal Fever and Pyrexia. Arrangements are made for the hospital treatment of these diseases by the County Council generally at the Queen Charlottes Hospital, Isolation Block, Hammersmith. General Medical and Surgical. Medical practitioners are able, by arrangement, to obtain admission of general medical and surgical cases into The Kingston Victoria, Wimbledon, Nelson and St. Anthony's Hospitals and most of the large London Hospitals or other Hospitals in the vicinity. Maternity and Nursing Homes. Controlled by the County Council. Maternal Mortality. Enquiries into maternal deaths are conducted by public health officers of the County Council. AMBULANCE FACILITIES. (a) For Infectious cases Tolworth Hospital Motor Ambulance. (b) For NonInfectious Motor Ambulance provided by the cases and Accidents Council. (c) Maternity do. (where required). Cases for admission to the Kingston and District Hospital are removed by Ambulance attached to that Hospital. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare.—8, Westbury Road, New Maiden. (Wednesday and Friday afternoons in each week). Antenatal Clinic.—8, Westbury Road, New Maiden. (Every Thursday afternoon). School Clinic.—8, Westbury Road, New Maiden. Dental—(Mondays—whole day—and Tuesday afternoons in each week). Speech—(Tuesday and Friday mornings in each week). General Medical—(Monday and Thursday mornings in each week). Diphtheria Immunisation Clinic.—8, Westbury Road, New Maiden. (Every Wednesday, 10 a.m.). Orthopajdic Clinic.—Kingston Red Cross Curative Post, Coombe Lane, KingstonuponThames. (By appointment). Tuberculosis Dispensary.—South Place, Surbiton Hill. (Wednesdays at 5.30 p.m. and Fridays at 1.30 p.m.). Venereal Diseases.—Sec Hospitals. Day Nursery.—Rear of Municipal Offices, New Maiden. 25 The Maternity and Child Welfare Centre, School and Antenatal Clinics and Tuberculosis Dispensary are provided and controlled by the Surrey County Council. The Day Nursery is provided by the Council. DAY NURSERY. The Day Nursery is situated at the rear of the Council Offices and is administered by the Borough Council. Under the Public Health Act, 1936, which came into force on 1st October, 1937, the Surrey County Council became responsible for all Maternity and Child Welfare Services in the Borough and at the end of the year the future of the Nursery was still in doubt. The use of the Nursery is confined to mothers who, by force of circumstances, are compelled to go to work and leave their children. It has thus fulfilled a very useful social service in the district for many years. In addition to general care, good feeding and medical supervision, the development of the older children is assisted by training on nursery school lines. The work of the Nursery since its inception has been carried out under difficult conditions in a wooden hut which is nearing the end of its existence and which cannot be expected to serve its purpose much longer. A site for a new nursery was purchased in 1935, but the scheme is held in abeyance pending the resolution of present uncertainties. The normal staff consists of a Matron, a senior nurse and two probationers. The Nursery is open from 8 a.m. to 6 p.m. except on Saturdays and Sundays. Mothers pay tenpence daily per child or sixpence per half a day with a graduated scale for more than one child. During the year the Nursery was open on 236 days arid there were 2,956 attendances. HEALTH EDUCATION. A national drive for education in health matters and for the better use of the health services was instituted in the autumn by the Minister of Health. In Surrey a special scheme was organized by the Central Council for 26 Health Education in conjunction with the Surrey County Council and the sixteen largest centres of population in the County. Under this scheme, in which this Borough took part, a monthly "Health Day" was to be organized in each district for five months. The general plan for each day comprised a morning visit by school children to the cinema in order to see special health films, an afternoon meeting intended particularly for mothers, and an evening public meeting addressed by a well known speaker. The first two of these special days were carried through before the end of the year. Another new development in health education this year has been the publication of a local edition of "Better Health." This is a bright little magazine which is distributed free from the Public Health Department, the Public Library and Welfare Clinic, and presents information on health and other matters in an interesting and readable form. OTHER MATTERS. I am indebted to the Manager of the Kingston-uponThames Employment Exchange for information regarding the degree of unemployment in this area. A rise in the unemployment figures began at the end of the summer and by December conditions were somewhat abnormal and compared unfavourably with 1936. The increase was almost entirely confined to the building trade and certain types of women factory workers. A troublesome plague of flies arose in August in a localized area, the origin of which was traced eventually to a heap of clinker from the refuse destructor. A proportion of organic matter had been coming through the destructor without complete disintegration and offered a favourable breeding ground for flies. On the removal of this accumulation the trouble was overcome. 27 SANITARY ADMINISTRATION. ANNUAL REPORT OF THE SANITARY INSPECTOR 1937 Public Health Department, Municipal Offices, New Malden. To The Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the pleasure to submit my eighteenth annual report of work accomplished and matters of interest concerning the Sanitary Department. I am glad to state that, in April, a second additional sanitary inspector was appointed and this has assisted considerably in allowing more time to be given to routine work. House to house inspections were carried out in a number of streets. For the purpose of abating nuisances and executing repairs to render houses fit for human habitation, the following notices were served under the Public Health, Housing and other Acts and Regulations affecting public health. Preliminary. Formal. Notices served 312 83 Complied 297 48 Remaining outstanding ... 15 35 It was not necessary to institute legal proceedings for the abatement of nuisances or other sanitary matters. Good relations have again been maintained with property owners and much work has been done and inspected without notice. 28 No houses were constructed by the Corporation during the year, but building by private enterprise has again made very rapid progress. NUISANCES AND HOUSING DEFECTS DEALT WITH DURING THE YEAR. Dampness (other than defective roofs) 51 Guttering or downspouts 48 Rooms requiring cleansing, re-papering or distempering 184 Ceilings requiring cleansing and distempering 160 Defective ceilings 22 Defective cooking ranges and firegrates 33 Defective roofs 61 Defective pointing or rendering of walls 22 Defective sinks 16 Defective W.C. basins ; seats ; flushing cisterns ; and flush pipes 32 Houses without sufficient dustbins 105 Absence of or defective yard pavings 37 Defective front approaches 10 Defective floors 31 Defective scullery floors 10 Defective or dirty water storage cisterns, etc. 3 Defects in water supply system 3 Defects in drains (including inspection chambers) 25 Blocked drains 42 Defects in vent pipes 9 Staircases 4 Defective coppers 12 Accumulation of rubbish, etc. 26 From keeping animals 3 Broken window frames, cords, etc. 00 Gas Stove in Bathroom 1 Defects in sink and bath wastes 9 Rat nuisances 65 Ponds, ditches 2 Vacant land 4 Empty premises 4 Overcrowding (Statutory) 1 Absence of or unventilated foodstores 33 Drinking water taps and pipes 8 Structures (Settlements) 7 Public House urinals 4 Miscellaneous 68 Failure to enter permitted number in rent book 45 29 INFECTIOUS DISEASES. The premises where cases of infectious diseases occur are promptly visited, and in some cases drains are tested. The principals of the various schools where patients or contacts attend are immediately notified. Seventy-three of these notices were sent in respect of one hundred and four children. Detailed enquiries are made after each of the principal infectious diseases with the object of endeavouring to prevent an extension. To ascertain quickly the origin of one or two cases often prevents a small outbreak assuming larger proportions. Routine swabbing of contacts in the case of Diphtheria is generally adopted to discover " carriers." In this I work in closc co-operation with the Medical Officer of Health The following number of rooms were disinfected for the under-mentioned causes:— Scarlet fever 46 Diphtheria 21 Tuberculosis 23 Vermin— Houses 12 Booms 15 Enteric Fever 4 Puerperal Pyrexia 2 Other 16 139 The Public Elementary Schools, with the exception of the Beverley Centra}, were sprayed throughout with formalin during the summer holidays. It was found necessary also to disinfect a private school and the New Maiden West Central, Junior Mixed and Infants' Departments. One hundred and thirty-eight books from the Public Library and Schools were disinfected for various reasons. 30 There are no arrangements available in the area for cleansing and disinfestation of verminous persons and their belongings. Articles and rooms that have been exposed to infection are disinfected by means of the formalin spray, formalin vapour, or both. In many cases, in addition to the above, a bottle of disinfectant is left at the house to enable the occupier to wipe down woodwork, floors, chairs, bedsteads, etc., and also, especially in the case of Diphtheria, to disinfect eating and drinking utensils. Twenty-one loads of bedding were removed for steam disinfection and four for destruction. One hundred and forty-seven visits were made in investigating cases of infectious diseases. AMBULANCE SERVICE. During the year 503 cases were dealt with as follows:— To Hospital (Medical aud Surgical cases) 218 From Hospital 40 Accidents and Street Casualties (involving 243 persons) ... 217 Other Cases 28 503 This shows a slight decrease (12 cases) over the figure for the previous year. Since the Ambulance Service was first established 12½ years ago, 4,493 cases have been dealt with. No hitch has occurred in the working of the service and co-operation with neighbouring authorities has been fully maintained. 31 Towards the end of the year I was compelled, very reluctantly, to request the Council to relieve me of these voluntary duties, but owing to certain difficulties I agreed to carry on temporarily until these could be surmounted. SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. The drinking water for the district is supplied by the Metropolitan Water Board and consists of Thames derived stored water, filtered and terminally chlorinated. On every working day the raw water, general well and main waters leaving the works are subjected to full chemical and bacteriological tests by the Board's Director of Water Examinations and the results of such tests have shown the last-mentioned waters to be invariably of first class quality. In addition each individual filter is tested bacteriologically in daily sequence, and appropriate biological, chemical and bacteriological tests are regularly made on all reservoir waters. BEVERLEY BROOK, PYL BROOK AND HOGSMILL RIVER. No complaints were received during the year regarding these streams. Improvement works have been carried out on the Beverley and Coombe Brooks and negotiations are proceeding for the improvement of the Hogsmill River. Engineering details have already been agreed in connection with the Hogsmill River improvement. CLOSET ACCOMMODATION. Practically all the houses in the district have water closets connected with the main sewerage system. Only in a few isolated instances are earth closets known to be in use. 32 PUBLIC CLEANSING. House refuse is collected weekly from houses in mechanically driven freighters and disposed of by burning at the Council's destructor at California Road. Owing to the growth of the district the present destructor has to be used to its limit and a proportion of the house refuse is now disposed of by controlled tipping on land adjoining the sewage disposal works. The very few cesspools are emptied and cleansed by owners as and when required. Movable ashbins, with few exceptions, are general throughout the district. As earth closets and privies are practically nonexistent, no special arrangements exist for the disposal of the contents thereof. SEWAGE DISPOSAL. Proposed Joint Sewerage Scheme. This scheme is to centralise the sewage disposal works of a number of districts, namely, Kingston-uponThames, Surbiton, Epsom and Ewell, and this district. The proposed site of the new works is on the western boundary of this district, near the present works. During the year various conferences were held between the constituent authorities and finally a Public Enquiry was called for 5th January, 1938. This was, however, postponed as it was considered that its object would be defeated due to disagreements on the financial aspect of the scheme. At present it has been agreed that each Authority should prepare estimates for extending their respective works to 1950, based on the same rates as the Consulting Engineer's rates for his estimate' of the joint scheme. This will result in a fair comparison of costs between the Authorities and facilitate an early agreement on financial matters. 33 Sewage Disposal Works. The report by your Engineer and Surveyor, Mr. A. R. Goldthorp, B.Sc., A.M.Inst.O.E.. M.Inst.M. & Cy.E., on the method of treatment of sewage at the Sewage Disposal Works remains unaltered from last year with the exception of the total dry weather flow of sewage treated at the works which has increased to 1,425,000 gallons per day of 24 hours. Future Works. The Sewage Disposal Works is of insufficient capacity to deal with the present flow and the estimate of a scheme for carrying out the following additional works was passed by the Council in June. This will increase the works capacity to deal with the flow up to 1940, after which any additional increase of sewage will be dealt with by the Joint Board's works :— The construction of a screening chamber with detritus grab and gantry. The installation of a 10" diameter centrifugal pump, diesel engine operated. The installation of a diesel engine to take the place of the existing steam engine. The construction of two flumes with flow measurement apparatus for 3 x D.W.F., and above 3 x D.W.F. respectively. Erection of three storm tanks and two circular humus tanks, six rotary filters, larger effluent carrier, additional pipe lines, valves, etc., and an increased sludge drying bed area. The storm, settling and humus tanks will be sludged with mechanical sludging apparatus. The Council accepted Messrs. George Bell and Son's tender of £35,341 7s. 10d. on 13th September for this work, 34 and loan sanction for same was received from the Ministry of Health during November. (The work was commenced early in February, 1938.) Pumping Station, Kingston Vale. This pumping station has to deal with very heavy contributions during storm periods due to infiltration and, the surrounding district having been developed considerably of late, the pumping station is unable to deal with the flow. The existing sumps are of insufficient size, while the pumps are obsolete. A scheme and estimate of £7,020 covering the works of constructing a new pumping station with much larger sump capacity, the sewage being raised by 4" centrifugal pumps (vertical spindle type) operated by 26 B.H.P. electric motors, in duplicate with float operated switch gear was approved by the Council on 30th December. Sanction for loan is, at present, awaited. The above scheme has been held up pending the approval of the Ministry of Transport on the lay-out of a traffic roundabout adjacent to the site of the pumping station. Houses draining to Sutton. Sewage from 444 houses on the Station Estate, Worcester Park, is pumped to the Borough of Sutton and Cheam Sewage Disposal Works for treatment. Houses draining to the Wandle Valley Works. Sewage from 49 houses on the Kingston By-Pass Road drain to the works of the Wandle Valley Joint Drainage Board. REFUSE DUMP ADJOINING HOGSMILL RIVER. House refuse, tipped by an adjoining Authority, near the western boundary of the district, appears to have caused 35 no nuisance and no complaints were received. Periodical inspections were made (20 in number) during the year. SMOKE ABATEMENT. Although there are few factories in the district, the problem of smoke, mostly in the form of grit, has been given constant attention. This is a most difficult problem and further advice was sought in one instance. As the matter was still under review at the end of the year, I feel it would be better not to comment further in this report. RATS AND MICE DESTRUCTION. In the latter half of the year, the Council decided that this section of public health administration was of sufficient importance to justify a whole-time rat officer and a man was appointed to act under my supervision as assistant rat officer. He is employed in investigating complaints, advising as to the best methods to adopt to rid premises of these vermin and to prevent re-infestation. He also carries out actual rat destruction for which householders pay a small fee for his services. He was engaged, in the first instance, for a period of six months. Up to the end of the year his services had fully justified the appointment and many old-standing cases were soon cleared up. This has been mostly achieved by obtaining the co-operation of a number of householders in the vicinity where trouble occurs. This combined action, which has been constantly emphasised by me in the past, is vital if a successful attack is to be made on these vermin. Action during rat week followed the same lines as in previous years. Red squill rat biscuits are kept in stock and sold to ratepayers at cost price (half price during rat week). 36 I now make it a practice to send the assistant rat officer to all premises where the occupiers have purchased rat biscuits and almost invariably his advice has been welcomed and acted upon with successful results. Five hundred and seventy-five visits were paid to premises and gassing was carried out on nine occasions. SPECIAL REPORTS. During the year, in addition to my usual Monthly reports, I prepared and submitted the following special reports as under:— 1.— (Two) Giving particulars regarding overcrowding in district. 2.—On sanitary conveniences, etc., at the Public Elementary Schools. 3.—On existing public conveniences in the district with suggested sites for additional conveniences. 4.—On grit emission from a factory chimney. 5.—Tabulated particulars of families occupying Council flats. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS. There is little of interest to report regarding the administration of these Acts, except that enquiries for information, both from tenants and landlords, have been far more numerous. Quite a lot of time has been occupied in interviewing persons and a number of visits were paid to houses to check information received regarding the rents paid, where it was alleged that they exceeded the amounts laid down by Statute. SALE OF FOOD AND DRUGS ACT The Acts are administered by the County Council and by the courtesy of the County Medical Officer of Health a return of samples analysed during the year is given herewith. 37 Articles. Analysed Adulterated or Deteriorated. Prosecutions. Convictions. Milk 30 3 1* — Meat 1 — — — Sausago o — — — Wine 1 — — — Other Articles 9 — — — Total 43 3 1 — •Dismissed with £3 3s. Od. costs. RAG FLOCK ACT, 1911 AND 1928. There are no known premises in the district where Rag Flock is manufactured or sold. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE LAWS OR REGULATIONS. There appear to be no premises or occupations in the District which necessitate Byelaw control or regulations operated by the District Council with the exception of eight fish frying businesses (scheduled as offensive trades), two slaughterhouses and the dairies and cowsheds. The consents given by the Council to the establishment of fish frying businesses in four instances are limited to periods of twelve months and for such extension thereof as may from time to time be granted, whilst the other four are not subject to any limitation of time FACTORY AND WORKSHOPS ACTS. There is little to report regarding the administration of these Acts as most of the provisions are enforced by Inspectors of the Home Office. Several matters were dealt with, in most cases by verbal request. During the year H.M. Inspector of Factories had only on one occasion to refer a matter to the Council under Section 5. 38 FOOD SUPPLY. As far as possible, watch is kept on premises where food-stuffs are prepared or sold, which includes slaughterhouses, butchers' and fishmongers' shops, bakehouses, dairies, cowsheds, etc. This entailed 205 visits. Places where ice-cream is prepared are visited, but these are very few, the great proportion of the ice-cream sold in the District being manufactured by large firms outside and distributed to shops for sale or retailed in the street from carrier cycles. The Public Health (Meat) Regulations have worked smoothly. The number of animals slaughtered in the District continues to decrease year by year. This is reflected in the small amount of foodstuffs found to be unfit. Notice of slaughter has always been given, so that it can be safely said that all animals slaughtered locally are inspected before being exhibited for sale. Most of other meat sold has been previously inspected at Smithfield or elsewhere. Stalls or vehicles from which food is retailed have been non-existent. The following foodstuffs were found to be unfit for food and destroyed :— 5 Stones Haddocks Decomposed. 1 Box Kippers There now remain only two slaughterhouses in the district—one registered and one licensed. Only the latter has been used during the year. HOUSING ACT, 1936. Overcrowding. As I indicated in my Annual Report for 1936, a compulsory order for the purchase of land at the rear of Franks Avenue was confirmed by the Minister of Health early in the year. Later arbitration proceedings were held to fix the purchase price. 39 Meanwhile plans were prepared for the erection of 50 houses (together with an additional two in South Park Grove) and tenders were accepted by the Council in October. The construction of these houses will be commenced early in the year. The scheme provides for the following tvpes:— Type. Number of Houses. Accommodation. A. 8. 3 bedroom, non-parlour for 5 persons. B. 3. 3 bedroom, non-parlour for 6 persons. c. 11. 4 bedroom, non-parlour for 7 persons. D. 11. 4 bedroom, parlour for 8 persons. E. 7. 4 bedroom, parlour for 9 persons. P. 10. 5 bedroom, parlour for 10-14 persons. It is probable tnat not more than 4U will be required for rehousing overcrowded families and the rest will be used for general housing needs. During the year visits were made, from time to time, to check the records relating to overcrowding and, at the close, the following result was revealed:— Families overcrowded at the end of the year, 1936 45 Added during year 6 51 Abated during year 13 Leaving 38 Of the 13 eases abated during the year, 5 were granted houses or flats on the Council's own estates whilst, in the rest abatement was secured either by members of the family leaving home (often sons or daughters being married) or complete removals elsewhere. A tabulated statement regarding overcrowding, as required by the Ministry of Health is included at the end of this report. One case of statutory overcrowding came to light, due to lodgers. This was immediately abated on notice. 40 The temporary assistance for measuring houses was discontinued early in the year but applications for permitted numbers continued to be received (87 in all), and these were dealt with by the permanent staff. In a number of cases, also, inspection of rent books revealed failures to enter the summary and permitted numbers. With the progress of the new housing scheme I hope to be able to state, in my next Annual Report, the abatement of all known cases of overcrowding. In addition to the time occupied in measuring houses, seventy-seven special visits were paid to verify particulars relating to overcrowded families and other matters in this connection. SHOPS ACTS. A large amount of work, chiefly occasioned by the Shops Act, 1934, and the Shops (Sunday Trading Restrictions) Act, 1936, was carried out during the year. The whole of the Acts are administered by my Department, which include the hours of closing, weekly half-holidays, time worked, the provisions relating to sanitary conveniences, lighting, heating, etc., Sunday trading, etc. There appears to have been no instance of intentional evasion but the explanation of the very complicated nature of these Acts takes up much time. A visit lasting more than an hour is not unusual in these cases. Supervision of hours worked by young persons (i.e., those under 18 years of age) has called for a great proportion of the work. All this has been done as tactfully as possible and visits made so as least to affect the operations of the shopkeeper concerned. Two hundred and eighty-one visits were made which, in many instances, entailed a complete inspection of the shop and records. Twenty-two cases of failure to keep the requisite forms were noted. 41 Co-operation is maintained with the Building Department to see that plans of new shops comply with the provisions of the Acts. ERADICATION OF BED BUGS. During the year the following number of houses were found to be infested with bed bugs:— (a) Council houses Infested. 12 Disinfested. 12 do. (rooms) 10 10 (b) Other houses 3 3 do. (rooms) 5 5 The methods employed for freeing infested Council houses are completely to remove all picture rails, skirtings and mouldings which are first thoroughly sprayed with insecticide (Zaldecide). "Wallpaper is stripped where loose and a floorboard taken up in each room. The place is then sealed up and left for 24 or 48 hours under gas (Cimex). On opening, the walls are cleansed and any defects repaired. Before reinstating, the woodwork is cleansed and the back thoroughly soaked with creosote. The place is then redecorated and the walls distempered, not papered. There is no routine action employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses, but where infestation is known to exist the furniture is fumigated before removal. This matter is engaging the attention of the Housing Committee and some special action may be decided upon when overcrowded families are rehoused. The work of disinfestation at Council houses is carried out by Council employees under my supervision and not by outside contractors. HCN has not been used. Except in the case of rooms, the three private houses were done by private firms. Where disinfestation is carried out at occupied Council houses detailed advice is given to prevent reinfestation. Every encouragement is given by supplying disinfectant to cleanse bedsteads, pictures, etc. In most of these cases it 42 was the tenant who sought advice and there was no difficulty in seeing that it was carried out. Every house becoming vacant on the Corporation housing estates is carefully inspected before reletting and in this way a number are found to be affected, to a varying degree, and dealt with. Advice has also been given to a number of house owners, and several houses are known to have been treated by outside contractors without notice from my department. So far as I am aware HCN has not been employed at any of these. DAIRIES, COWSHEDS AND MILKSHOPS. Only two cowsheds are now in use in the district. One of these is in a poor condition structurally but there is every reason to think that this will not remain much longer. The cleanliness of the cows, milkers and utensils (which is by far the most important factor in the production of clean milk) has been well maintained. Delivery of milk, otherwise than in bottles is negligible. The cows are periodically inspected by the veterinary staff of the County Council. The great proportion of milk sold is produced and bottled elsewhere and delivered to depots in the district for distribution. There is quite a number of shops from which milk is sold in sealed containers. The occupiers of such shops are not required to register the premises as dairies. Nearly all the milk is pasteurised before delivery to the consumer but not all is sold labelled as such. During the year the following licences were issued under the Milk (Special Designations) Order, 1936:— Dealers. Tuberculin tested 7 Pasteurised 7 Accredited 2 Pasteurisers licences 2 43 Supplementary. Tuberculin tested 4 Pasteurised 2 Twenty-one samples of milk were submitted for examination and in twelve instances they were also examined for the presence of tubercle bacilli (animal experiment). In two instances B. Coli were detected and high counts were recorded in two other cases, one of which was unpasteurised. These were immediately followed up and, in one case, the trouble was traced to the cooling section of the pasteurising apparatus, whilst in the other the inspections and explanations given indicated that it was an isolated instance. Improvement resulted and later samples gave satisfactory results. In the tests for the presence of tubercle bacilli negative results were returned in each case. All the milk delivered to schools was included in these examinations and in each ease a satisfactory result was recorded. SWIMMING BATHS AND POOLS. There are no swimming baths or pools, publicly owned or privately owned and open to the public, within the district. SANITARY CONVENIENCES. The sanitary conveniences attached to licensed premises in the district are periodically visited and generally found to be kept in a satisfactory condition. With the rebuilding of several of these premises improvement has resulted in the conveniences attached thereto. 44 OTHER MATTERS. I continued to act as Hon. Organising Officer for Air Raid Precautions until the appointment of a permanent Officer in March. By permission of the Council I attended the Conference of the Sanitary Inspectors' Association at Brighton. A number of complaints were again received regarding weeds and were passed on to the County Agricultural Department. Advice was given in a number of instances regarding extermination of crickets, earwigs and moles and once again the Natural History Museum provided useful suggestions. Vacant plots of land become dumping places for garden rubbish and besides producing untidy conditions provide good harbourage for rats. The rubbish is cleared as occasion demands, but unfortunately, the fact of it being removed appears often to provide an incentive to dump more. Fencing off or notices have proved useless. Although two years ago the district was circularised regarding empty milk bottles being placed overnight on the public footpaths, this practice has not altogether ceased. In conclusion may I express my thanks to the Council, especially the Chairman and Members of the Public Health Committee for their support and for the interest taken in the work of the Department. The co-operation and help given at all times by the Medical Officer of Health, other officers of the Corporation and the loyal support of the staff of the Department is also gratefully acknowledged. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, HENRY TUNBRIDGE, Sanitary Inspector. 45 HOUSING. STATISTICS. 1.—Inspection of Dwelling-Houses During the Year. (1) (a) Total Dumber of dwelling-houses inspected for housing defects (under the Public Health or Housfng Acts) 367 (b) Number of Inspections made for the purpose 367 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 208 (b) Number of Inspections made for the purpose 212 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 188 2.—Remedy of Defects During the Year Without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 162 3.—Action Under Statutory Powers During the Year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) by owners 2 (b) by Local Authority in default of owners ... Nil (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 80 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) by owners 46 (b) by Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (d) Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil 46 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4.-—Housing Act, 1936. Part IV. Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 38 (ii) Number of families dwelling therein 38 (iii) Number of persons dwelling therein 316 (b) Number of neu cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding relieved during the year 13 (ii) Number of persons concerned in such cases 106 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (e) Any other particulars See page 38 FACTORIES, WORKSHOPS AND WORK-PLACES. 1.—INSPECTIONS. Premises. Inspections Number of Written Notices Occupiers. Prosecuted Factories (including Factory Laundries) 9 1 - Workshops (including Workshop Laundries) 33 2 - Workplaces (other than Outworkers' premises) 16 1 — Total 60 4 - 2.—DEFECTS. Particulars Number of Defects Found Remedied Referred to H.M. Inspector Prosecutions Want of cleanliness 5 5 — — Sanitary accommodation— Insufficient — — — — Unsuitable or defective 1 1 — — Not separate for sexes — — — — Total 6 6 - - OUTWORK IN UNWHOLESOME PREMISES. Nil.