mal 2 Borough of Malden anb Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOB THE YEAR ENDED DECEMBER 31st 1938 Printed by J. B. Blackmore & Co. Ltd., 86. Merton High Street, S.W.19. Borough of Maiden and Coombe ANNUAL REPORT of the Health and Sanitary Conditions for the Year 1938 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 1938. Chairman: Alderman E. E. W. Manning. Vice-Chairman: Councillor Mrs. J. Marshall. The Mayor: Alderman F. S. Wagner, J.P The Deputy Mayor: Councillor Major F. J. Johnson, C.C. Aldermen A. Dicker, Major G. Petit, M.C., L.R.C.P., Mrs. D. M. Porter, and A. D. Young, A.C.A. Councillors Mrs. A. M. Harder, J. W. Harper, A. N. Hookway, F. L. McGhee, J. L. Mobsby, and G. G. N. Taylor. OFFICERS AND STAFF OF THE PUBLIC HEALTH DEPARTMENT. *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.E.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.E.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. Arthur O. Scott, Assistant Rat Officer. Oliver Elliott, General Assistant and Mortuary Keeper. Frederick W. W. Mitchell, Clerk. *Appointed whole time Medical Officer of Health (with Urban District Council of Esher) as from. 1st -January, 1939. 3 Borough of Malden and Coombe. ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1938 Public Health Department, Municipal Offices, New Malden. June, 1939. To the Mayor, Aldermen and Councillors of the Borough of Malden and Coombe. Ladies and Gentlemen, I have the honour to present to you my Annual Report on the health and sanitary conditions of the Borough of Maiden and Coombe for the year ended 31st December, 1938. It has been prepared in accordance with the Ministry of Health Circular 1728. The Registrar General's estimate of population for mid-year 1938 of 38,820 showed an increase of 1,550 over the previous year. This is rather below the average annual increase which has been taking place for a number of years. The corrected death rate was 8.2 per 1,000 population compared with 11.6 for England and Wales. This figure is below the average for the past five years. The birth rate of 16.7 per 1,000 population compares with 15.1 for England and Wales. This rate is the highest recorded for many years. The infantile mortality rate was 30.8 per 1,000 live births, the figure for the country as a whole being 53.0. Such favourable figures for births and infantile mortality have not been recorded 4 since 1925, when the population was much lower and therefore, more subject to chance fluctuation. Infectious diseases presented no outstanding feature with the exception of a rise in the puerperal pyrexia rate. No changes were made in the staff of the Public Health Department during the year. I wish to offer my thanks to the Chairman and Members of the Public Health Committee for their helpful co-operation and I have again to record my appreciation of the energy and ability with which the staff have carried out their work. My thanks are especially due to Mr. Tunbridge, your Chief Sanitary Inspector, in this connection. 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 Kingston-upon-Thames, the greater part of the District lying between the Hogsmill River and Beverley Brook. 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 sub-soil of Coombe is chiefly gravel. New Maiden and Maiden are approximately 40-50 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 5 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 in 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. In the New Maiden area (Burlington Ward) the Council own the Beverley Park of 20 acres and (Dickerage 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. 6 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. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area 3,162 acres. Registrar General's estimate of resident population (mid-year 1938) 38,820 Number of inhabited houses according to rate books (end of 1938) 11,870 Rateable value £430,954 Sum represented by a penny rate £1,725 The last Census was taken in 1931, when the population was returned at 23,405. The following table illustrates the growth of the district, and the distribution of the increase during the past 37 years. Year. Census Pop. of whole District. Coombe. New Maldein 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 1938 (Est.) 38,820 5,470 22,890 10,451 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 sub-divided into two wards. 7 VITAL STATISTICS. Total. M. F. Birth rate per 1,000 of the estimated resident population 16.7 Live births 649 320 329 (legitimate) 311 322 (illegitimate) 9 7 Stillbirths 22 9 13 Rate per 1,000 total (live and still) births 32.8 Deaths 301 147 154 Death rate per 1,000 of the estimated resident population Crude 7.7 Corrected 8.2 Deaths from nuerueral causes: ] Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis l 1.4 Other puerperal causes l 1.4 Total 2 2.9 Death rates of Infants under one year of age All Infants per 1,000 live births 30.8 Legitimate Infants per 1,000 legitimate live births 28.4 Illegitimate Infants per 1,000 illegitimate live births 125.0 Deaths from Cancer (all ages) 55 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 3 BIRTHS. During the year 649 live births were registered, this being 84 above last year's total. The rate per 1,000 was 16.7 compared with an average of 15.1 for England and Wales. Of the total number 16 or 2.4 per cent., were illegitimate. The comparatively high birth rate is probably due, 8 to some extent to a favourable age distribution in the present population. It is, however, a measure of local contribution to the future welfare of the nation. It is difficult to understand the complacency with which the fall in the national birth rate is regarded in some quarters. DEATHS. During the year 301 deaths were registered, being 24 less than in 1937. One hundred and sixty-five deaths were registered in the district and one hundred and thirty-six in institutions and other districts. The death rate per 1,000 population was 8.2 compared with the average of 11.6 for England and Wales. Heart disease and cancer were again the most prominent separate causes of death. The infantile mortality rate was 30.8 per 1,000 live births and compares with 53.0 for the average of England and Wales. Two deaths occurred in illegitimate children under one year of age. CAUSES OF DEATH. M. F. Total. Diphtheria — 1 l Influenza — 2 2 Encephalitis lethargica 1 — 1 Cerebro-spinal fever 1 — 1 Respiratory tuberculosis 6 4 10 Other tuberculosis 1 — 1 Cancer 26 29 55 Diabetes 2 2 4 Cerebral hasmorrhage, etc. 3 11 14 Heart disease 33 37 70 Aneurysm 1 1 2 Other circulatory diseases 11 6 17 Bronchitis 1 5 6 Pneumonia (all forms) 6 8 14 Other respiratory diseases 1 4 5 9  M. F. Total. Peptic ulcer 3 2 5 Diarrhcea (under 2 years) 3 — 3 Appendicitis — 1 1 Cirrhosis of liver — 1 1 Other liver diseases 2 1 3 Other digestive diseases 3 2 5 Acute and chronic nephritis 8 7 15 Puerperal sepsis — 1 1 Other puerperal diseases — 1 1 Congenital debility, premature birth, etc. 7 6 13 Senility 2 3 5 Suicide 2 — 2 Other violence 9 6 15 Other defined diseases 15 13 28 147 154 301 DEATHS. AGE GROUPS. Under 1 1-5 5-15 15-25 25-35 35-45 i 45-55 55-65 65-80 80 & over Total Males 13 2 4 7 7 9 19 26 41 19 147 Females 1 2 — 4 2 12 10 26 53 38 154 Totals 20 4 4 11 9 21 29 52 94 57 301 STATEMENT SHOWING WHERE DEATHS OCCUR RED. In District. Kingston County Hospital. Kingston Victoria Hospital. Tolworth Isolation Hospital. London & other 1 Hospitals. Wimbledon Hospital. Other Districts. Total. 165 62 8 1 23 1 41 301 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years:— 1934 (20 Legitimate None Illegitimate) 20 1935 (14 „ 1 ) 15 1936 (22 „ None „ ) 22 1937 (21 „ None „ ) 21 1938 (18 „ 2 ) 20 Average for the past five years 20 10 CAUSES OF DEATH OP INFANTS UNDEK ONE YEAE OF AGE. Prematurity 9 3 hours; 4 hours; 4 hours; 5 hours; 13 hours; 1 day; 1 day; 2 days ; 2 months. Congenital Diseases, Malformations, etc. 4 1 hour; 2 days; 2 days ; 1 month. Cerebro-spinal Fever 1 6 months. Miliary Tuberculosis 1 5 months. Gastro-enteritis 3 3 months; 3 months; 4 months. Broncho-pneumonia 1 7 months. Renal neoplasm 1 8 months. SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 1934 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 1938 16.7 30.8 8.2 Average for past 5 years 14.5 39.5 8.5 WARDS STATISTIC TABLE. Wards. Acres. Est. Inhab. Houses Mid-Year 1938. Est. Pop. Mid-Year 1933. Deaths. Infantile Deaths. Coombe 1,312 1,857 5,470 30 1 Dickerage 225 915 4,445 30 4 Mount 113 970 4,045 20 — Cambridge 212 870 3,095 44 1 Norbiton Park 207 910 3,010 35 2 Central 112 760 2,960 24 2 Burlington 172 1,420 5,345 40 1 Maiden Manor 446 3,762 10,450 35 4 St. James 363 43 5 3,162 11,464 38,820 301 20 11 Nineteen bodies were brought to the Mortuary and a post mortem examination was made 011 sixteen. H.M. Coroner for the district held inquests in twelve instances and the following verdicts were returned:— Natural Causes 7 Accidental 3 Suicide 1 In accordance with medical evidence 1 RAINFALL. Table showing rainfall in the district during 1938, taken at the Sewage Disposal Works, California Road, New Maiden. January 1.96 inches. February 0.33 „ March 0.26 „ April 0.07 „ May 1.17 „ June 0.32 „ July 1.04 „ August 1.95 „ September 2.35 „ October 1.92 ,, November 3.22 ,, December 2.62 „ Total 17.21 „ Compared with the figures for the previous year this is a decrease of 11.60 inches. Average yearly rainfall (for past five years) 23.65 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. 12 SCHOOLS. The children attending the Public Elementary Schools in the district at the beginning of the year (1939) numbered:— Boys 2,008 Girls 1,881 3,889 The numbers attending each school were as follows:— COOMBE. Kingston Vale— Girls. Boys. Total Junior Mixed 17 67 Infants 12 17 MALDEN. Parochial— Junior Mixed 44 51 139 Infants 18 26 Sheephouse Lane— Junior Mixed 116 133 495 Infants 101 145 Beverley Central — 288 288 NEW MALDEN. New Malden East— Central 356 — 1,020 Junior Mixed 166 184 Infants 162 152 | New Malden West— Central 210 230 1,384 Junior Mixed 267 283 Infants 170 224 185 Elm Boad Junior — 185 Lime Grove— Junior 165 - 311 Infants 73 73 1,881 2,008 3,889 This shows an increase of 50 scholars compared with last year's total. 13 NOTIFICATIONS OF INFECTIOUS DISEASES, 1938. DISEASES AGE GROUPS Totals Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 Over 65 Diphtheria 22 — — — 2 3 12 2 2 1 — — — Erysipelas 6 — — — — — — — — — 1 4 1 Pneumonia 24 1 2 1 1 1 — — 1 4 8 4 1 Puerperal Pyrexia 12 - - - - - - - - 11 1 — — Poliomyelitis 1 — 1 — — — — — — — — — — Scarlet fever 68 — 2 1 2 7 41 12 2 1 — — — Cerebro Spinal Meningitis 1 1 — — — — — — — — — — — Dysentery 2 - - - 1 - - - 1 - - - - Enteric Fever, Typhoid or Paratyphoid 2 - - - - - - - - 2 - - - Totals 138 2 5 2 6 11 53 14 6 19 10 8 2 DISEASES Coombe Dickerage Mount Cambridge WARDS Norbiton Park Central Burlington Maiden St. Jamei Diphtheria — 6 5 — 1 5 1 — 4 Erysipelas 1 — — 2 1 — — 2 — Pneumonia — 7 4 — 2 3 3 2 3 Puerperal Pyrexia — 2 — — 2 — — 6 2 Poliomyelitis — — 1 — — — — — — Scarlet fever 10 13 5 7 7 3 11 3 9 Cerebro Spinal Meningitis — 1 — — — — — — — Dysentery — 1 — — — 1 — — — Enteric Fever, Typhoid or Paratyphoid 1 — — — — — — 1 — Totals 12 30 15 9 13 12 15 14 18 14 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SMALLPOX. No case of smallpox occurred during the year. It was not found necessary to perform any vaccinations under the Public Health (Smallpox Prevention) Regulations of 1917. SCARLET FEVER. There was a distinct increase in the incidence of scarlet fever, sixty-eight cases being notified, a rate of 1.75 per 1,000 population. The numbers of notifications of scarlet fever have shown a tendency to fluctuate widely over many years, a feature which is perhaps only to be expected in an infection which shows itself under varied guises. The type of illness remained mild on the whole and there were no deaths. Fifty-nine cases were treated in hospital and nine cases at home. In addition seven suspected cases were admitted to hospital where it was later decided that the illness was not scarlet fever. A striking feature was that in the majority of instances the notified case was the only member of the family to suffer. In only two instances was there an exception, one other member of the family being affected in each case. All cases were fairly evenly distributed as regards time and place. The highest proportion (over 50%) occurred amongst school children aged 5-10, and in certain cases some grouping in schools was noticeable. There was only one example 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 0.56 per 1,000 population. This figure has remained approximately the same for the past four years. Twenty-two cases were notified and, with the exception of one, all were treated in 15 Tolworth Hospital. One case was rapidly fatal, the child dying before she could be removed to hospital. None of the cases had been immunised. Six suspected cases were sent to hospital and were afterwards discharged as not so suffering. There was a considerably greater tendency for multiple cases to occur in the same household than with scarlet fever. Groups of four, three, three, and two, respectively, occurred, the remainder being single cases. Fifteen carriers were treated in hospital. These were contacts who, on routine investigations being made after the notification of a case of diphtheria, were discovered to be harbouring diphtheria bacilli in the nose or throat. The majority of them, although apparently in satisfactory general health, showed an unhealthy condition of the nose which was very evident on inspection. This type of carrier is, in my view, the most dangerous and is capable of giving rise to infinite trouble. This was well exemplified on two occasions. On one occasion the notification of a case of diphtheria led to the examination of the child's class contacts at school. A carrier of this type was discovered and she was immediately removed, but she had already infected three other children. In the other example, an outbreak arose as the result of the introduction of a nasal carrier into a Home for young children. This child gave rise to three clinical cases and a widespread carrier condition among the children who remained healthy. The following statistics refer to immunisation carried out during the year. The scheme is still carried out on the lines described in my Annual Report for 1935, but toxoid antitoxin floccules in three doses of 1 cc. have now been substituted for toxoid antitoxin mixture, and, in the case of children under eight years of age, alum precipitated toxoid in two doses of .2 cc. and .5cc. respectively are given. 16 Number of eases completing treatment during the year (pre-school children 141, school children 296) 437 Number of cases failing to attend for the complete course 43 Number of cases treated by private doctors under Council's scheme 14 Number of Schick tests performed 383 Total number of attendances at Clinic 1,196 SURVEY OF THE FIRST THOUSAND CASES TREATED UNDER THE DIPHTHERIA IMMUNISATION SCHEME. Sufficient time has now elapsed to make it possible to review in some detail the results obtained from the immunisation of the first group of children. For convenience the first 1,000 cases have been taken. The following table shows their record in age groups up to the date of their post-Schick test. Age last Birthday Number completing injections . T.A.M. Number Schick tested only. Number failing to complete injections. Number tailing final Schick test. Number Schick POSITIVE after six months. Per cent. Schick Negative after six months. 1 64 — — 10 3 94.4 2 62 — 4 10 2 96.2 3 90 — — 11 4 95.0 4 94 — 3 20 1 98.7 5 142 — 5 21 4 96.7 6 134 — 8 8 2 98.4 7 84 — 1 6 3 96.0 8 79 — — 9 1 98.6 9 59 2 2 7 6 88.5 10 46 3 1 6 — 100.0 11 45 — — 2 1 97.7 12 32 — — 4 — 100.0 13 23 1 2 7 2 87.5 14 & over 13 — 1 2 3 72.7 967 6 27 123 32 96.2 17 It is very satisfactory to note from this table the high Schick negative rate after six months. Preliminary Schick testing was soon discarded owing to the very high percentage of positives (90%). After a period of three years had elapsed since the original injections a further Schick test was offered. Of the 58 acceptances three gave a slight positive Schick reaction which became negative after one further injection. This means that 94.8% had retained their immunity as evidenced by the Schick test after three years, and the others had probably sustained a partial loss only. The number who failed to complete the full course of injections was remarkably low and in view of the numerous possible reasons for failure to complete, is a testimonial to the negligible discomfort suffered by the children on the first injection. One of the group who had completed the course and had been found Schick negative developed a mild diphtheria. This is, of course, much below the expected rate in immunised children. MEASLES. The year under review was a measles epidemic year and the scheme instituted in 1936 was repeated on the same lines as described in my Annual Report for that year. The scheme in brief provides for the distribution of adult measles serum, domiciliary nursing, and the admission of complicated cases to hospital. The Use of Adult Measles Serum. No change was made in the general administration of the scheme for serum distribution. The object of the injection was attenuation in the majority of cases, and the dose recommended was 10 cc. given approximately six days after exposure to infection. The following is a statement of the results obtained as compiled from the returns made by medical practitioners:— 18 Number of children receiving prophylactic injections 41 Number developing measles 28 Classification of results. Moderately severe 2 Mild or very mild 26 Number not developing measles 13 The general impression gained was that the epidemic was of average or even more than average severity. There were no fatal cases. Domiciliary Nursing. The services of a trained nurse were obtained for home visiting during the main period of the epidemic. She began duty on the 13th March and finished on the 23rd April. The total number of cases dealt with was 208 and the number of visits paid was 645. I am much impressed with the value of such work during a measles epidemic, although in a few instances there was a tendency to make use of the nurse's services for cases which could have been more efficiently treated in hospital. Hospital Accommodation. Accommodation which was amply sufficient for the needs of the district was available at Tolworth Hospital. Seventeen cases were admitted from this area. ACUTE POLIOMYELITIS. One case of acute poliomyelitis was notified during the year. This occurred in September at a time when this infection was causing concern in several parts of the country. The patient was an infant of one year who was removed to Tolworth Hospital and made a good recovery. The family in which the case occurred was a large one, but routine precautions were instituted and no further ease arose. Information was also received about the same time of a mild case in a young adult, who was diagnosed and notified at a late stage of the disease in another district although the onset apparently took place in this district. 19 ENTERIC FEVER. Two eases of the enteric group were notified, one of paratyphoid B and one of typhoid. The case of paratyphoid was a mild one and was nursed at home with adequate precautions against the spread of infection. As is usual with sporadic cases, the origin of the infection was uncertain, but there was a history of contact with a possible carrier in a neighbouring district. The case of typhoid was removed to Tolworth Hospital and although his illness was of a more serious type, he eventually made a good recovery. Here again the source of the infection could not be definitely fixed, although some suspicion was attached to a batch of oysters of which he had partaken. Anti-typhoid serum supplied by the Lister Institute was administered to other members of his family as a prophylactic measure. DYSENTERY. I have referred to dysentery at some length in recent Annual Reports and there is little further to add at the moment. The epidemic which began in the autumn of 1937 died out in the first two months of the current year. There was no evidence of a recurrence during the autumn of 1938. CEREBRO-SPINAL FEVER. One case of Cerebro-spinal fever occurred in a baby aged six months. The child died in hospital. PUERPERAL PYREXIA. Under this heading all rises of temperature occurring within twenty-one days following childbirth are notifiable when the temperature is above 100.4°F for 24 hours or recurs within that time. Many assorted conditions are thus included in the group, and some may be entirely incidental. The number of notifications received during the year was unusually high. Six of the twelve cases 20 were patients in nursing homes situated within the district and three of these were women not usually resident in the district. There is a statutory duty to inform the County Medical Officer of Health of all puerperal pyrexia notifications within twenty-four hours and the circumstances are then investigated by him if a nursing home or midwife is involved. There were two maternal deaths during the year, one following abortion and one following ectopic gestation. 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 Scarlet fever 2.41 1.75 Diphtheria 1.58 0.56 Enteric fever 0.03 0.05 Erysipelas 0.40 0.15 *Puerperal pyrexia 14.42 17.88 *Per 1,000 total births (i.e., live and stillbirths). TUBERCULOSIS. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 1 - - - - - 1 1 — — 1 - - - - - 5 — 2 1 4 — — — — 15 3 7 - — 1 3 — — 25 4 2 1 1 — — — — 35 3 1 — — 3 1 — — 45 3 - - - - - - 55 2 - — — 1 — — — 65 & upwards 1 — — - 1 - - - Totals 14 15 3 5 6 4 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 21 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. Where it is considered that the prevention of spread of the disease would be assisted by an improvement in the housing conditions of the affected family a special recommendation is made to the Housing Committee to that effect. Four recommendations of this nature were made during the year, and all these families were rehoused. The following table shows the case rate and the death rate from tuberculosis during the past 18 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 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 1938 38.820 37 0.95 11 0.28 22 There was a decrease in the number of new notifications and there was also a fall in the death rate from tuberculosis. These figures fluctuate a good deal from year to year, but there has been no significant change during the past ten years. As early ascertainment and notification is of great importance in the prevention and cure of tuberculosis, the number of cases dying un-notified 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 two such cases. There was no instance of failure on the part of the doctor to notify. The facilities for chest X-ray examination offered by arrangement with the Kingston Victoria Hospital were made use of in nine 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 twenty-three cases compared with the previous year:— Pulmonary. Non-Pulmonary. Males 78 18 Females 62 26 Old standing cases moving into the district are, of course, added to the register in the same way as new cases. THE PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. THE PUBLIC HEALTH ACT, 1936, SECTION 172. It has not been found necessary to take any formal action under the above Regulations or Act. The first relates to persons suffering from pulmonary tuberculosis employed in the milk trade, and the latter gives 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. 23 PREVENTION OF BLINDNESS. No action has been taken during the year under 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. CASES OP INFECTIOUS DISEASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 59 Suspected Scarlet fever 7 Diphtheria 21 Diphtheria "carriers" 15 Suspected Diphtheria 6 Measles 17 Pneumonia 6 Suspected Pneumonia 4 Typhoid fever 1 Suspected Dysentery 3 Pyrexia for observation 1 Suspected otitis media 1 (Measles contact) Suspected Meningitis 2 Erysipelas 2 Chicken pox 1 Poliomyelitis 1 Laryngeal croup 1 Suspected Whooping cough 1 149 The total number of admissions to Tolworth Hospital from this district increased considerably. 24 THE FOLLOWING TABLE SHOWS THE NUMBER OP NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1933 1934 1935 1936 1937 1938 Scarlet Fever 113 87 35 45 39 68 Diphtheria 11 7 22 21 22 22 Enteric Fever (including Paratyphoid) - 1 - - 4 2 Erysipelas 4 8 4 6 4 6 Pneumonia 31 31 10 16 19 24 Encephalitis Lethargica 1 — — — — — Puerperal Fever 1 5 1 — — — Puerperal Pyrexia 2 4 2 6 3 12 Cerebro Spinal Fever — 1 — — — 1 Acute Poliomyelitis 3 — 3 — 1 1 Ophthalmia Neonatorum 3 2 — — 2 — Dysentery — — 10 — 12 2 Malaria — — — — — — Tuberculosis (all forms) 32 36 42 36 46 37 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Laboratory Facilities. New arrangements were made for carrying out bacteriological examinations for the Council. The opening of a laboratory and the appointment of a pathologist at Kingston Victoria Hospital now makes it possible to have these examinations carried out locally and thus the inconvenience and delay occasioned by sending specimens to London is avoided. The cost of bacteriological investigations required by medical practitioners in diphtheria, enteric fever, tuberculosis and certain other special eases is defrayed by the Council. 25 The following table shows the number of examinations during the past year:— Disease. Totals. Positive. Negative. Tuberculosis Sputa . 7 62 69 Scarlet Fever ... Swabs . 5 10 15 Diphtheria Swabs . . 35 400 435 Dysentery Faeces . . — 7 7 Paratyphoid Faeces . . — 3 3 do. Blood . . — 1 1 do. Urine .. . — 2 o Puerperal Pyrexia Urine .. . — 1 1 Totals . 47 486 533 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. 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. llie tollowing Hospitals arc available for residents of the district for the purpose indicated, but there are no Hospitals, voluntary or otherwise within the district. 26 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). Mental, etc. Kingston County Hospital. Kingston- on-Thames, Surrey. Surrey Council (Public County Assistance Committee). Kingston County Hospital. Brookwood and Netherne Mental Hospitals. Kingston- on-Thames, 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. 27 AMBULANCE FACILITIES. (a) For Infectious cases Tolworth Hospital Motor Ambulance. (b) For Non-Infectious Motor Ambulance provided by the cases and Accidents Council. (c) Maternity do. (where required). Cases for admission to the Kingston County 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). Ante-natal 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.). Orthopaedic Clinic.—Kingston Red Cross Curative Post, Coombe Lane, Kingston-upon-Thames. (By appointment). Tuberculosis Dispensary.—South Place, Surbiton Hill. (Wednesdays at 5.30 p.m. and Fridays at 1.30 p.m.). Venereal Diseases.—See Hospitals. Day Nursery.—Wellington Crescent, New Maiden. The Maternity and Child Welfare Centre, School and Antenatal Clinics and Tuberculosis Dispensary are provided and controlled by the Surrey County Council. DAY NURSERY. The coming into force of the Public Health Act, 1936, was responsible for radical changes in the administration of the Day Nursery. Under this Act the Surrey County Council became responsible for all Maternity and Child Welfare services in the Borough, and it was indicated that it would be no longer possible to carry on the Day Nursery as a municipal service. After many negotiations the Nursery was successfully re-organised on a voluntary basis with the assistance of a grant from the County Council and donations from others interested in its welfare. The old building closed at the end of July and was removed to form part of the new building on the site which was originally bought for that purpose in 1935. 28 During the portion of the year the nursery was under the control of the Council it was open on 146 days and there were 1,956 attendances. HEALTH EDUCATION. The campaign for health education inaugurated in the autumn of 1937 by the Ministry of Health was carried through to completion in the early months of the present year. As mentioned in my report for last year a special scheme was organised in Surrey by the Central Council for Health Education in conjunction with the Surrey County Council and the sixteen largest centres of population in the County. Under this scheme a monthly "Health Day" was organized in each district for five months. The last three of these special days were carried through in the present year. 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 following is a statement regarding the afternoon and evening meetings. Evening Lecture. ATTENDANCES Afternoon. Evening. 1st Day. Graham Spieer Institute. Opening address by Lady Benn. 70 150 2nd Day. Stoneleigh Hall. Dr. Stuart Cowell on " Diet & Health." 80 80 3rd Day. Baptist Hall. Dr. Millar on " Infectious Disease." 25 150 4th Day. Maiden & Coombe Sports Pavilion. Film and Gymnastic Display. 4 20 5th Day. Kingston Vale Village Hall. Dr. Saleeby on " Sunlight." 15 70 The experience gained from this and previous efforts convinces me that this type of propaganda is not worth the energy and money put into it. Health cannot be advertised and sold like a commercial commodity and those who come for instruction are not those who are in 29 most need of it. The instruction which carries the most weight is that given in the daily contact of health departments with the public through the media of health visitors, sanitary inspectors, welfare centres, schools, etc. Lectures given on request to organised bodies have a certain value. Instruction to senior children by qualified persons on healthy living should receive more attention in schools. There is no doubt that the most successful part of the campaign as carried out was the display of cinema films to children. OTHER MATTERS. I am indebted to the Manager of the Kingston-uponThames Employment Exchange for information regarding the degree of unemployment in this area. At the end of the year it was noticed that the incidence of unemployment was lighter than in adjoining areas, the figures being approximately—men 250, women 80, and juveniles 20. Most of the unemployed men were of the clerical or light labouring type and it has been found that very few Maiden men capable of heavy labour are out of work. In June the water supply of the district became affected by an unpleasant musty taste and several complaints were received. On communication with the Metropolitan Water Board officials it was stated that the taste was caused by a vegetable growth in the filters due to abnormal climatic conditions and that the potability of the Water was unaffected. The inconvenience proved to be a very temporary one. 30 SANITARY ADMINISTRATION. ANNUAL REPORT OF THE SANITARY INSPECTOR 1938 Public Health Department, Municipal Offices, New Malden. To The Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the pleasure to submit my nineteenth annual report of work accomplished and matters of interest concerning the Sanitary Department. House to house inspections have been carried out in a number of streets. For the purpose of abating nuisances, destruction of rats, and executing repairs to render houses fit for human habitation, the following notices were served:— Preliminary. Formal. Notices served 261 33 Complied 247 30 Remaining outstanding 14 3 It was not necessary to institute legal proceedings for the abatement of nuisances or other sanitary matters. Good relations have been maintained with property owners and much work has been done and supervised without notice or on verbal request. Fifty-two houses were under construction by the Corporation during the year. Building by private enterprise has not made such rapid progress as in the previous few years. Thirty-eight working-class houses were constructed by the Kingston Corporation in Stafford and Lincoln Roads. 31 NUISANCES AND HOUSING DEFECTS DEALT WITH DURING THE YEAR. Dampness (other than defective roofs) 38 Guttering or downspouts 34 Rooms requiring cleansing, re-papering or distempering 142 Ceilings requiring' cleansing and distempering 118 Defective ceilings 8 Defective cooking ranges and firegrates 42 Defective roofs 35 Defective pointing or rendering of walls 19 Defective sinks 13 Defective W.C. basins; seats; flushing cisterns; and flush pipes 41 Houses without sufficient dustbins 78 Absence of or defective yard pavings 32 Defective front approaches 14 Defective floors 22 Defective scullery floors 7 Defective or dirty water storage cisterns, etc. 7 Defects in water supply system 1 Defects in drains (including inspection chambers) 33 Blocked drains 39 Defects in vent pipes 5 Defective coppers 4 Accumulations of rubbish, etc. (not including those dealt with under Eats, etc. Act). 17 From keeping animals 6 Broken window frames, cords, etc. 65 Defects in sink and bath wastes 11 Ponds, ditches 1 Vacant land 4 Overcrowding (Statutory) 1 Absence of or unventilated foodstores 13 Drinking water taps and pipes 23 Structures (Settlements) 1 Public House urinals 2 Temporary Builders Latrines 2 Miscellaneous 53 Failure to enter permitted number in rent book 27 32 INFECTIOUS DISEASES. The premises where eases of infectious diseases occur are promptly visited, and in some eases drains are tested. The principals of the various schools where patients or contacts attend are immediately notified. One hundred and seventeen of these notices were sent in respect of one hundred and sixty-two 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 close co-operation with the Medical Officer of Health. The following number of rooms were disinfected for the under-mentioned causes:— Scarlet fever 77 Diphtheria 30 Tuberculosis 29 Vermin— Houses 17 Booms 1 Enteric Fever 7 Puerperal Pyrexia 19 Other 34 214 The Public Elementary Schools, with the exception of the Maiden Parochial, which were being reconditioned at the time, were sprayed throughout with formalin during the summer holidays. One hundred and seventy-six books from the Public Library and Schools were disinfected for various reasons. There are no arrangements available in the area for cleansing and disinfestation of verminous persons and their belongings. 33 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-three loads of bedding were removed for steam disinfection and nine for destruction. Three hundred and twenty-nine visits were made in investigating cases of infectious diseases. AMBULANCE SERVICE. During the year 465 cases were dealt with as follows:— To Hospital (medical and Surgical cases) 200 From Hospital 26 Accidents and Street Casualties (involving 239 persons) 219 Other cases 20 465 This shows a decrease of thirty-nine cases compared with the figure for the previous year. Since the Ambulance service was first started (during 1924) 4,958 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. During the year the Council considered the question of charges and it was decided to institute a free service for ratepayers of the district, except in the case of persons who are members of the Hospital Saving Association. In these instances the fees are collected from the Association direct, by an arrangement which was made some years ago. 34 As I indicated in my last report, pressure of other work which, during the past year, has become more and more severe, has compelled me reluctantly to ask to be relieved of these voluntary duties. Certain difficulties, however, have arisen which prevented the transfer and I agreed to carry on 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 AND HOGSMILL RIVER. During the year samples of water were taken from Beverley Brook and Hogsmill River and submitted for analysis. The Analyst's report on the sample from the Beverley Brook stated:— "This, judged as a stream water, is very bad indeed. Suspended solids and rate of absorbtion of dissolved oxygen are very largely in excess of the Royal Commission's general standard for neat sewage effluent." Representations were made hereon to a neighbouring authority and the reply indicated that the matter was being treated as one of urgency and that the utmost expedition was being used in the preparations of plans for 35 proposed extensions at the sewage disposal works in question with a view to overcoming the difficulty complained of. The works of improvement to the Beverley Brook and Coombe Brook, noted last year, have been steadily progressing throughout the year. The samples taken from the Hogsmill River also indicated bad river water. If and when the proposed joint sewage scheme materialises great improvement must result. This scheme is to centralise the sewage disposal works of a number of districts, namely Kingston-uponThames; Surbiton; Epsom and Ewell and this district, and to convey the effluent direct into the Thames instead of, as at present, from the various works into the Ilogsmill. At the close of the year the position in regard to this proposal had altered little from that reported in my last Annual Report, but it is hoped that during 1939 the existing differences would be cleared up so that the scheme could progress. 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 exist. 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. During the year the combustion chambers and flues of the Refuse Destructor were remodelled in order to increase the capacity. 36 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 WORKS. In my last report I included a section written by Mr. Goldthorp, Borough Engineer and Surveyor, regarding the above, which included details of the proposed extensions at the main works and of the new pumping station at Kingston Vale. The extensions at the main works were commenced in February and were progressing satisfactorily at the end of the year and the new pumping station at Kingston Vale was commenced at the end of December. Full details of these works will be given in my next report. 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 89 houses on the Kingston By-Pass Road drain to the works of the Wandle Valley Joint Drainage Board. REFUSE TIPPING. House refuse, tipped by an adjoining Authority, near the western boundary of the district, appears to have caused no nuisance and no complaints were received. Periodical inspections were made during the year. I anticipate that by the end of the current year the tipping of refuse within this area, by an outside authority, will cease. 37 SMOKE ABATEMENT. Throughout the year constant attention has been directed to this problem. Whilst it is true that few factories exist in the area trouble has been experienced, particularly in two instances. At one factory, however, I am very gratified to state that the nuisance appears to have been abated. In this case serious trouble had extended over a number of years causing endless complaints. The problem, emission of damped particles of clay dust from a brick making plant, was of a peculiar nature, and appeared well nigh insoluble. The Engineer at the works, however, persevered in his efforts and at last devised a means, which, if kept and maintained in good working order, has provided a remedy. At the second factory the trouble is grit emission from a boiler chimney and, in an endeavour to discover the cause and thereby to provide a remedy the Council decided to engage an expert—Dr. R. Lessing, Queen Anne's Gate— and his investigations were proceeding at the end of the year. RATS AND MICE DESTRUCTION. The year under review has seen much good work accomplished in the destruction of rats and the removal of conditions conducive to infestation. The whole time rat officer who was appointed during 1937, acts under my supervision and is employed in investigating complaints and advising as to the best methods of ridding premises of these vermin and preventing re-infestation. He also carries out actual rat destruction for which householders pay a small fee. Much of his success is achieved by obtaining the co-operation of as many householders as possible in the vicinity of where trouble occurs. The time spent in doing this is amply rewarded as combined action is a vital necessity if a successful attack is to be made. One hundred and sixty-nine complaints were investigated and these entailed 608 primary visits together with 38 1,614 subsequent revisits. Gassing with HCN was carried out on 63 occasions and other methods of destruction were employed in 56 further cases. Seven houses were ratproofed, 46 sheds taken down or made rat-proof and 41 rubbish dumps which were harbouring rats were removed. Action during rat week followed the same line as in previous years. It is now becoming established that the only way successfully to keep the rat menace under control is to have an officer devoting the whole of his time to the work, as the district sanitary inspectors, with all their other duties, cannot devote the ncessary attention to this section of health administration. SPECIAL REPORTS. With the exception of a number of additional reports to various Committees only one report of a special nature was submitted during the year. This dealt with the question of disinfestation of the furniture of overcrowded families prior to their removal to the new houses in Potters Grove. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS. Up to the year under review the administration of these Acts had been carried out by the Public Health Department. With the passing of the new Act of 1938, I suggested that it would be a convenient time for these duties to be transferred to the Town Clerk's Department and this was agreed to. By the new Act the Rent and Mortgage Interest Restrictions Acts are continued in operation until 24th June, 1942, but a number of changes in the law relating to rent control are made. I have little of interest to report regarding the administration of these Acts whilst under my control, except that quite a lot of time was spent in interviewing tenants and landlords seeking information on various points. 39 SALE OP FOOD AND DRUGS ACTS. By the courtesy of the County Medical Officer of Health a return of samples analysed during the year is given herewith. Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convictions. Milk 28 — — — Tea 2 — — — Confectionery and Jam 1 — — — Total 31 — — — A new Act entitled the Food and Drugs Act, 1938, was passed into law in July and will come into operation on 1st October, 1939. By this the law relating to Food and Drugs (including Milk and Dairies), slaughterhouses, etc., is consolidated and amended and, in some respects, simplified. This Act will be more fully reported upon next year, but some note might be made now of those sections designed to secure that food and drugs are sold only in a pure and genuine condition. The present Food and Drugs Acts are administered by the County Council, but under the new Act, among other Authorities all non-county boroughs and urban districts which, according to the last published census for the time being have a population of forty thousand or upwards will become Food and Drugs Authorities. The Local Authority of any non-county borough or urban district with a population of twenty thousand or upwards but less than forty thousand can make application to the Minister of Health, who may direct that the Local Authority in lieu of the County Council shall be the Food and Drugs Authority as respects their district. As, shortly, when the next census is taken, the population of this district will exceed forty thousand, the Council decided to make application to the Minister of 40 Health for a direction to be made the Food and Drugs Authority and the necessary action was being taken to that end at the close of the year. CAMPING SITES. Section 43 of The Maiden and Coombe Urban District Council Act, 1933, enables the Council, with certain limitations, to prohibit tents, vans, sheds or similar structures used or intended to be used for human habitation, being placed or kept on any land without their previous consent. In consequence section 269 of the Public Health Act, 1936, does not operate within this area. The limitations to which I have referred rather seriously impair the efficacy of these powers. For instance the tent or similar structure must have been used or intended for use for an unbroken period of at least three months before control can operate. It would appear that section 269, offers more scope for the control of camping sites and although the necessity does not appear to have arisen up to now, the Medical Officer of Health and myself have under consideration the question of advising the Council to make application to the Minister of Health to declare that section 269 of the Public Health Act, 1936, shall be in force and that the corresponding section in the local act be repealed. During the summer a number of persons camp on land between the Beverley Brook and Robin Hood Way. Public lavatories and drinking water are conveniently near. It was found, however, that a danger existed from persons obtaining water from the Beverley Brook, and on the instructions of the Medical Officer notices were placed in the vicinity giving warning against this. I should estimate that not more than 50 persons are ever encamped on this land at the same time, and that this number is only approached during week-ends. The site has never been found otherwise than satisfactory. 41 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 BYELAWS 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 five 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. FACTORIES ACT. The Factories Act, 1937, came into operation on 1st July, 1938. This Act consolidates, with amendments, the Factory and Workshops Acts, 1901 to 1929, and other enactments relating to factories. Several administrative changes have thus been brought about. The old distinction between a factory and a workshop is abolished and the expression "workshop" disappears, only one term, "factory," being employed. For certain purposes, however, a distinction is drawn between factories where mechanical power is used and factories where mechanical power is not used. The Local Authority is now required to keep a register of all factories within its district with respect to which it is responsible for the enforcement of any of the provisions of Part I of the Act. These may be summarised as follow:— 42 Factories where mechanical power is used.—The provision, lighting and maintaining of proper and sufficient sanitary conveniences. Factories where mechanical power is not used.—The provision, lighting and maintaining of proper and sufficient sanitary conveniences; cleanliness; overcrowding; temperature; ventilation and drainage of floors. Soon after the Act came into force I visited the offices of the District Inspector of Factories and extracted from his Register a list of factories within this area and a commencement has been made in compiling the Register. Eighty-five inspections were made and in twenty-one instances the District Inspector was notified of cases where proper abstract was not exhibited, or where the factory did not appear on the list. A table is included at the end of the report giving details of the administration of the Act as required by the Home Office. 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 165 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 Food and Drugs Act, 1938, provides for the registration of premises used in connection with the manufacture or sale of ice cream, and thus will give a larger measure of control over this popular commodity. The Public Health (Meat) Regulations have worked smoothly. The number of animals slaughtered in the District continues to decrease year by year. This is 43 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 3 Boxes of Kippers 1 Box of Cod Unwholesome. Sheeps plucks weighing 3 stone I 7 pounds Parasitic. There now remain only two slaughterhouses in the district—one registered and one licensed. Only the latter has been used during the year, and that to a very limited extent. Verbal notices were given in seven instances to cleanse or Hmewash premises where food was prepared or sold, and written notices were sent on five other occasions to remedy matters, chiefly in restaurants or hotels. HOUSING ACT, 1936. Overcrowding. As indicated in my last report the construction of 50 houses in Potters Grove and two in South Park Grove were commenced early in the year. These were nearing completion at the end of the year. I expressed the hope last year that, in this report, I might have been able to report the abatement of all known cases of overcrowding. This, however, has not quite materialised. A complete check was made into known cases of overcrowding and, at the close of the year the following result was revealed:— 44 Families overcrowded at the end of the year 1937 38 Added during the year 15 53 Abated during the year 24 Leaving 29 Of the 24 cases abated, 7 were allotted houses on the new estate in Potters Grove, 1 was allotted a flat on the Council's estate, 6 themselves obtained fresh accommodation whilst in the rest (10) abatement was secured by some member or members of the family leaving home (often sons or daughters being married). A tabulated statement regarding overcrowding, as required by the Minister of Health is included at the end of this report. One case of overcrowding which constituted an offence came to light, and was immediately abated on notice. Applications to be supplied with the permitted numbers for houses continued to be received, and this necessitated visits to and the measurement of 136 houses. In addition to these sixty-nine visits were made regarding various matters connected with overcrowded families. SHOPS ACTS. The whole of these Acts are administered by my Department, which include the hours of closing, weekly half-holidays, time worked, Sunday trading, and the provisions relating to sanitary conveniences, lighting, heating, etc. There appears to have been no instance of intentional evasion One hundred and three visits were made which, in many instances, entailed a complete inspection of the shop and records. 45 Six cases of failure to keep the requisite forms were noted. In seven instances informal notices were served to remedy various matters connected with the health provisions and a number of verbal requests were made for minor matters to receive attention. During the year the Young Persons (Employment) Act was passed and comes into operation on 1st January, 1939. This Act is in two parts. Part One contains provisions regulating the employment of young persons under the age of 18 employed in certain occupations which have hitherto been unregulated. Part Two contains certain amendments of the Shops Acts. 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:— Infested. Disinfeated. (a) Council houses 17 17 do. 1 1 (b) Other houses 6 6 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. During the year the Council considered the question of routine action for ensuring that the furniture and belongings of tenants are free from vermin before being 46 removed to the new houses in Potters Grove and South Park Grove. It was decided that the effects of all these new tenants should be removed and treated en route and a contract was accordingly entered into with a firm undertaking this class of work. The question of applying this rule to new tenancies of all Council houses was held in abeyance until the removals to the Potters Farm estate was sufficiently advanced to enable a decision to be made on the experience so gained. The work of disinfestation at Council houses is carried out by our own staff under my supervision and not by outside contractors. HCN has not been used. When these houses are occupied detailed advice is given to prevent reinfestation. Every encouragement is given by supplying disinfectant to cleanse bedsteads, pictures, etc. Every house becoming vacant on the Corporation Estates is carefully inspected before reletting. In this way a number were found to be affected, to a varying degree and dealt with. Thirty-seven inspections were carried out. 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. HCN is known to have been used in two cases. The Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938, will come into operation on 1st February 1939. These Regulations have been made to safeguard the use of Hydrogen Cyanide, owing to its extremely dangerous nature. Among other matters it is required that notice be given to the Medical Officer of Health of any forthcoming fumigation with HCN. 47 DAIRIES, COWSHEDS AND MILKSHOPS. Only one cowshed is now in use in the district. This is in a very poor condition structurally, but there is reason to think that it will not continue much longer. It is not, however, used for cows in milk. The great proportion of milk sold is produced and bottled elsewhere and only delivered to depots in the district for distribution. A number of shops sell milk 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 is not sold labelled as such. During the year the following licences were issued under the Milk (Special Designations) Orders:— Dealers. Tuberculin tested 6 Pasteurised 7 Tuberculin tested (pasteurised) 2 Pasteurised licences 2 Supplementary. Tuberculin tested 5 Pasteurised 3 Nineteen samples of milk were submitted for examination and in eleven instances they were also examined for the presence of tubercle bacilli (animal experiment). In two instances B. Coli were detected and high counts recorded, one of which was tuberculin tested milk. Both of these milks came from outside the district. They were immediately followed up 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 the schools was included in these examinations and in each case a satisfactory result was recorded. 48 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. AIR RAID PRECAUTIONS. So much has been done in the Department during the year in this direction that I feel it deserves some comment. At the beginning of the year I spent a fortnight at the Home Office Civilian anti-gas school, Falfield, and was successful in qualifying as a first-class instructor (special certificate). Since then a very considerable amount of my time has been occupied in giving lectures to the various sections of air raid precautions personnel. The details of these lectures can be summarised as follows:— Lectures. Voluntary Aid personnel 43 Decontamination and Rescue Parties 30 Wardens 13 Councillors and Chemists 5 91 Instructors Course. L.A.G.C. 6 (Each occupying one whole day) 6 Examinations. Instructors. L.A.G.C.— Artington 2 Surbiton 1 British Bed Cross Society, Fire Brigade and others. Local 10 13 49 Demonstrations. First Aid (Dr. J. Fanning, Instructor) 9 9 During the Crisis the whole department was engaged in various matters connected with A.R.P. A tent had previously been erected at the front of the Council Offices and for a week many hundreds of the general public received instruction in the proper methods of fitting, etc. Immediately on receipt of instruction the assembly of the Civilian respirators was commenced and with the very willing assistance of members of the public health department, councillors and volunteers 32,500 were assembled in under 24 hours and distributed to various centres, from whence the Wardens delivered them to houses in their respective areas. OTHER MATTERS. By permission of the Council I attended the conference of the Sanitary Inspectors' Association at Edinburgh. During the summer a number of allotment holders were circularised asking for certain steps to be taken to prevent the breeding of flies in heaps of manure. On a number of occasions advice was given as to methods of extermination of earwigs, ants, crickets, cockroaches, etc. As the district is becoming more and more built up the trouble due to vacant plots of land becoming dumping heaps for rubbish tends to diminish. Nevertheless a good deal of time has been spent in this direction. A few years ago the partition walls of the men's conveniences in Dukes Avenue were reconstructed and faced with glazed tiles to prevent them being defaced with objectionable writing. During the year I was forced to ask for the ladies' compartments to be dealt with in a similar manner and this was done. 50 Improvements were carried out to the sanitary conveniences of certain elementary schools during the year, more particularly at the Maiden Parochial and New Maiden East Council schools. At the former the conveniences were reconstructed and improved in addition to which improvements were carried out to the class rooms, cloakrooms, etc. It is hoped that improvements will be carried out during the year at the Lime Grove and Kingston Vale schools where the accommodation falls below modernday standards. In conclusion may I express my thanks to the Council, especially the Chairman and Members of the Public Health Committee for their support and 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. 51 HOUSING. STATISTICS. 1.—Inspection of Dwelling-Houses During the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 383 (b) Number of Inspections made for the purpose 383 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Eegulations, 1925 172 (b) Number of Inspections made for the purpose 172 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 150 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 136 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 ... ... Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) by owners Nil (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 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) by owners 22 (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 Nil (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 52 (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 29 (ii) Number of families dwelling therein 29 (iii) Number of persons dwelling therein 250 (b) Number of new cases of overcrowding reported during the year 15 (c) (i) Number of cases of overcrowding relieved during the year 24 (ii) Number of persons concerned in such cases ... 178 (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 43 FACTORIES INSPECTIONS. Premises. Number of Inspections Written Notices Occupiers. Prosecuted (1) (2) (3) (4) Factories with mechanical power 48 30 - Factories without mechanical power 30 6 - Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 7 - - Total 85 36 — 53 DEFECTS FOUND. Particulars Number of Defects Number of Dcfects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Lack of Thermometer in Workroom 4 4 — — Sanitary Conveniences (S. 7)— Insufficient 2 2 — — Dirty 4 4 — — Unsuitable or defective 3 3 — — Insufficient artificial lighting 28 28 — — Not separate for sexes 4 4 — — No intervening ventilated space 1 1 - — Other offences — — — — Total 46 46 — —