Borough of Malden and Coombe. Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOB THE YEAR ENDED DECEMBER 31st 1939 Printed by J. B. Blackmore & Co. Ltd., 85. Merton High Street, S.W.19. Borough of Malden and Coombe ANNUAL REPORT of the Health and Sanitary Conditions for the Year 1939 JAMES FANNING, M.D., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. HENRY TUNBRIDCE, M.R.San.I., Sanitary Inspector. 2 BOROUGH OF MALDEN AND COOMBE PUBLIC HEALTH COMMITTEE 1939. Chairman: The Deputy Mayor: Alderman E. E. W. Manning. Alderman D. Emmanuel, B.A. Vice-Chairman: Alderman A. Dicker. Aldermen Major G. Petit, M.C., L.R.C.P., Mrs. D.M. Porter, and A. D. Young, A.C.A. The Mayor: Alderman F. S. Wagner, J.P. Councillors Mrs. A. M. Harder, Mrs. J. Marshall, C. W. Bunker, H. J. Gouer, F.C.S., J. W. Harper, A. N. Hookway, and G. G. N. Taylor. OFFICERS AND STAFF OF THE PUBLIC HEALTH DEPARTMENT. James Panning, M.D., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. 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. *( lemi-.nt S. T. Dancer, M.S.I.A., Sanitary Inspector. +A. H. Newport, M.S.I.A., Sanitary Inspector. Certificates of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. Certificates of Eoyal 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. * Besigned. † Appointed December, 1939. 3 Borough of Malden and Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1939 Public Health Department, Municipal Offices, New Malden. October, 1940. 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 Malden and Coombe for the year ended 31st December, 1939. It has been prepared in accordance with the Ministry of Health Circular 2067, in which it is advised that many items which usually appear may be omitted entirely, and that those which are retained should be dealt with as briefly as possible. Although the activities of the Public Health Department have been encroached upon and over-shadowed by Civil Defence, every matter affecting the health of the district has received the same attention it would have had in normal times. I should like to record my appreciation of the hard work and long hours put in by the whole of the staff in achieving this aim. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FANNING, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area 3,162 acres. Registrar General's estimate of resident population (mid-year 1939):— For calculation of birth rates 39,930. For calculation of death rates or the incidence of infectious diseases 39,630 VITAL STATISTICS. Total. M. F. Live births 615 292 323 Birth rate per 1,000 (legitimate) 286 312 of the estimated (illegitimate) 6 11 resident population 15.4 Stillbirths 15 9 6 Rate per 1,000 total (live and still) births 23.9 Deaths 352 179 173 Death rate per 1,000 of the estimated resident population Crude 8.8 Corrected 9.3 Deaths from puerperal causes Nil Death rates of Infants under one year of age:— All Infants per 1,000 live births 39.0 Legitimate Infants per 1,000 legitimate live births 20.0 Illegitimate Infants per 1,000 illegitimate live births 705.8 Deaths from Cancer (all ages) 62 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 2 5 BIRTHS. During the year 615 live births were registered, this being 34 less than last year's total. The rate per 1,000 was 15.4 compared with an average of 15.0 for England and Wales. Of the total number 17 or 2.7 per cent. were illegitimate. DEATHS. During the year 352 deaths were registered, being 51 more than in 1938. One hundred and ninety-two deaths were registered in the district and one hundred and sixty in institutions and other districts. The death rate per 1,000 population was 9.3 compared with the average of 12.1 for England and Wales. Heart disease and cancer were again the most prominent separate causes of death. The infantile mortality rate was 39.0 per 1,000 live births and compares with 50.0 for the average of England and Wales. Twelve deaths occurred in illegitimate children under one year of age. The infantile mortality figures were strongly weighted by this exceptional mortality among illegitimate infants. CAUSES OF DEATH. M. F. Total. Influenza 5 2 7 Respiratory tuberculosis 11 3 14 Other tuberculosis — — — Syphilis 2 — 2 G.P.I., tabes, etc 1 — 1 Cancer 29 33 62 Diabetes — 1 1 Cerebral haemorrhage, etc. 6 15 21 Heart disease 49 41 90 Aneurysm 1 1 2 Other circulatory diseases 4 9 13 6  M. F. Total. Bronchitis 2 6 8 Pneumonia (all forms) 8 7 15 Other respiratory diseases — 2 2 Peptic ulcer 4 1 5 Diarrhoea (under 2 years) — 2 Diarrhoea (2 years and over) 1 2 3 Appendicitis 1 — 1 Cirrhosis of liver — — — Other liver diseases 1 — 1 Other digestive diseases 4 2 6 Acute and Chronic nephritis 7 3 10 Puerperal sepsis — — — Other puerperal diseases — — — Congenital debility, premature birth, etc. 9 7 16 Senility 1 10 11 Suicide 5 1 6 Other violence 11 9 20 Other defined diseases 17 15 32 111 defined — 1 1 179 173 352 Poliomyelitis (included under —other defined diseases) 1 - 1 DEATHS. AGE GROUPS. Under 1 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-80 80 & over Total Males 13 1 2 4 9 7 25 44 57 17 179 Females 11 1 3 5 6 6 18 19 68 36 173 Totals 24 2 5 9 15 13 43 63 125 53 352 STATEMENT SHOWING WHERE DEATHS OCCURRED. ]District. Kingston County Hospital. Kingston Victoria Hospital. Tolworth Isolation Hospital. London & other Hospitals Wimbledon . Hospital. Other Districts. Total. 192 77 5 4 34 2 38 352 7 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years: — 1935 (14 Legitimate 1 Illegitimate) 15 1936 (22 None „ ) 22 1937 (21 None „ ) 21 1938 (18 2 „ ) 20 1939 (12 12 „ ) 24 Average for the past five years—20. CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 4 Congenital diseases, Malformations, etc. 12 Poliomyelitis 1 Gastro-enteritis 2 Laryngeal spasm 1 Convulsions, Broncho-pneumonia 1 Toxaemia, Acute bronchitis 1 Influenza, Infantile eczema 1 Marasimus 1 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 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 1939 15.4 39.0 9.3 Average for past 5 year 15.2 36.6 8.8 MORTUARY. Twenty-nine bodies were brought to the Mortuary and a post mortem examination was made on twenty-eight. H.M. Coroner for the district held inquests in eight instances and the following verdicts were returned. Natural causes 3 Accidental 2 Suicide 2 Misadventure 1 8 RAINFALL. Table showing rainfall in the district during 1939, taken at the Sewage Disposal Works, California Road, New Malden:— January 3.68 inches. February 0.85 „ March 0.88 „ April 2.18 „ May 1.47 „ June 1.11 „ July 2.07 „ August 3.10 „ September 0.99 „ October 5.65 „ November 3.18 „ December 0.80 „ Total 25.96 „ Compared with the figures for the previous year this is an increase of 8.75 inches. Average yearly rainfall (for past five years) 24.80. 9 NOTIFICATIONS OF INFECTIOUS DISEASES, 1939. AGE GROUPS diseases 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 6 — 1 — — — 4 — — 1 — — — Erysipelas 11 - - - - - 1 — 1 - 2 4 1 Pneumonia 24 1 1 — 1 — 2 3 1 - 2 8 3 Puerperal Pyrexia 9 — — — — — — — — 8 1 — — Scarlet Fever 96 — 3 — 7 7 46 25 1 4 2 1 — Ophthalmia Neonatorum 1 1 — — — — — — -— — — — — Typhoid (Enteric) 1 - - - - - - - - - 1 Measles 2 1 — 1 - - - - - - - - - Whooping Cough 3 — — 2 1 - - - - - - - - Totals 153 3 5 3 9 7 53 28 3 17 7 13 5 DISEASES Totals Coombe Dickerage Mount WARDS Cambridge Norbiton Park Central Burlington Malden St. James Diphtheria 6 1 1 2 — — 1 — 1 — Erysipelas 11 2 1 — — — — 2 1 5 Pneumonia 24 2 2 2 3 3 3 4 1 4 Puerperal Pyrexia 9 1 — 1 — — — 2 5 — Scarlet Fever 96 3 21 12 4 7 8 14 6 11 Ophthalmia Neonatorum 1 — 1 — — — — — — — Typhoid (Enteric) 1 1 — — — — — — — — Measles 2 1 — — 1 — — — — — Whooping Cough 3 — 1 — — — — 2 — — Totals 153 11 27 17 8 20 12 24 14 20 10 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. There was an increase in the incidence of scarlet fever, ninety-six cases being notified, a rate of 2.42 per 1,000 population. Eighty-eight cases were treated in hospital, and seven cases at home. In addition eight suspected cases were admitted to hospital where it was later decided that the illness was not scarlet fever. During the early summer months there was an abnormal incidence of cases (twenty-three in all) at the Burlington Road Infants' and Junior Schools. Throat swabs taken at the time showed a high proportion of hemolytic streptococcal carriers among the scholars. Seventy-six of the total number of cases occurred as single cases in a house. There was only one example of " return case " infection. DIPHTHERIA. The diphtheria incidence was 0.15 per 1,000 population. This is very much lower than that of the past few years. Six cases were notified, and all except one were treated in hospital. None of the cases had been immunised. In addition, three " carriers" received hospital treatment. The following statistics refer to immunisation carried out during the year. No change has been made in the scheme as previously reported. Number of cases completing treatment during the year (pre-school children 89, school children 31) 120 Number of cases treated by private doctors under Council's scheme 20 Number of Schick tests performed 415 Total number of attendances at Clinic 655 11 GENERAL. One case of enteric fever was reported. The infection in this case was contracted on a cruise. One case of acute poliomyelitis and one of pneumococcal meningitis occurred. Both were fatal. Facilities are available for the typing of pneumococci. FOOD POISONING. The law requiring the compulsory notification of cases of food poisoning or suspected food poisoning came into operation on 3rd October, 1939. Only one case was reported, and this was probably one of sensitiveness or allergy and not true food poisoning. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales. Borough of Malden & Coombe. Smallpox 0.00 0.00 Scarlet fever 1.89 2.42 Diphtheria 1.14 0.15 Enteric fever 0.04 0.02 *Prysipelas 0.34 0.27 *Puerperal pyrexia 14.35 14.65 *Per 1,000 total births (i.e., live and stillbirths). TUBERCULOSIS. Age Periods NEW CASES DEATHS Respiratory Male Female Non-Respiratory Male Female Respiratory Male Female Non-Respiratory Male Female 0 - - - - - - - - 1 - - - - - - 5 2 1 15 2 6 - - - - - - 25 1 4 — 1 2 3 — — 35 2 4 — 1 2 — — — 45 5 1 — 1 3 — — — 55 3 — — — 1 — — — 65 & upwards 3 — — 1 3 — — — Totals 16 15 2 5 11 3 — — 12 Notification of tuberculosis was, on the whole, satisfactory. Cases which die unnotified are usually those of an obscure character where ante-mortem diagnosis is difficult or impossible. There were two such cases during the year. The facilities for chest X-ray examination offered by arrangement with the Kingston Victoria Hospital were made use of in five 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 ten cases compared with The previous year:— Pulmonary. Non-Pulmonary. Males 80 20 Females 67 27 CASES OF INFECTIOUS DISEASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet Fever 88 Suspected Scarlet Fever 8 Diphtheria 5 Diphtheria " carriers " 3 Suspected Diphtheria 2 Measles 1 „ German 4 Whooping Cough 11 Pneumococcal Meningitis 1 Poliomyelitis 1 Suspected Poliomyelitis 1 Pneumonia 4 Suspected Pneumonia 5 Suspected Typhoid 1 Suspected Dysentery 1 Erysipelas 3 Scabies 1 140 13 THE FOLLOWING TABLE SHOWS THE NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1934 1935 1936 1937 1938 1939 Scarlet Fever 87 35 45 39 68 96 Diphtheria 7 22 21 22 22 6 Enteric Fever (including Paratyphoid) 1 4 2 1 Erysipelas 8 4 6 4 6 11 Pneumonia 31 10 16 19 24 24 Encephalitis Lethargica - - - - - - Puerperal Fever 5 1 — — — — Puerperal Pyrexia 4 2 6 3 12 9 Cerebro-Spinal Fever 1 — — — 1 — Acute Poliomyelitis — 3 — 1 1 — Ophthalmia Neonatorum o — — 9 — 1 Dysentery — 10 — 12 2 — Malaria - - - - - - Tuberculosis (all forms) 36 42 36 46 37 38 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Laboratory Facilities. The cost of bacteriological investigations required by medical practioners in diphtheria, enteric fever, tuberculosis and certain other special cases is defrayed by the Council. The bulk of this work is carried out by the Pathologist at Kingston Victoria Hospital. The following table shows the number of examinations during the past year:— Disease. Results. Positive. Negative. Totals. Tuberculosis Sputa 15 63 78 Scarlet Fever Swabs 15 22 37 Diphtheria Swabs 13 187 200 Diphtheria Pus — 1 1 Typhoid and Paratyphoid Faeces — 12 12 do. Blood — 2 2 do. Urine — 3 3 do. Sputum — 1 1 Puerperal Pyrexia Swabs 1 12 13 Totals 44 303 347 14 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. There has been no change in the general provision of health services as recorded in my annual report for 1938. SANITARY ADMINISTRATION. ANNUAL REPORT OF THE SANITARY INSPECTOR 1939 Public Health Department, Municipal Offices, New Malden. To The Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the pleasure to submit my twentieth annual report of work accomplished and matters of interest concerning the Sanitary Department. In view of the exceptional circumstances this will, necessarily be greatly curtailed. Many items which usually appear will be omitted altogether. 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 197 22 Complied 176 18 Remaining outstanding 21 4 15 One cottage was dealt with under Section 11 of the Housing Act, 1936, and the Council accepted an undertaking from the owner in accordance with sub-section 3 that it would not be used for human habitation. It was not necessary to institute legal proceedings for the abatement of nuisances or other sanitary matters. INFECTIOUS DISEASES. The following number of rooms were disinfected for the under-mentioned causes:— Scarlet Fever 104 Diphtheria 8 Tuberculosis 33 Vermin— Houses 13 Booms 22 Enteric Fever 1 Puerperal Pyrexia 7 Other 10 198 All the Public Elementary Schools were sprayed throughout with formalin during the summer holidays. Two hundred and forty-seven books from the Public Library and Schools were disinfected for various reasons. Ten loads of bedding were removed for steam disinfection and nine for destruction. 287 visits were made in investigating cases of infectious disease. AMBULANCE SERVICE. Up to July 3rd, 235 cases were dealt with as follows:— To Hospitals (Medical and Surgical cases) 112 From Hospitals 16 Accidents and Street Casualties (Involving 112 persons) 103 Other cases 4 235 16 At the commencement of July I handed over the control of the Ambulance to the Chief Officer of the Fire Brigade and the figures given above are only for the period up to that date. I should have liked, on relinquishing the control of the Ambulance service, to have reported rather more fully on the sixteen years since the service was inaugurated, but I am afraid this wish will have to remain unfulfilled. 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. 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 water has the composition of a neat sewage effluent. Suspended solids and rate of absorbed dissolved oxygen are both much in excess of the respective maxima of the Royal Commission's general standard for a sewage effluent. The water did just withstand anaerobic incubation for 5 days at 26.7°C without putrescence, but only just." The report on the sample from Hogsmill River stated:— " The rate of absorption of dissolved oxygen places this water in the bad class of river water: the water is of the character of a good sewage effluent." CLOSET ACCOMMODATION. Practically all the houses in the district have water closets connected with the main sewage system. Only in a few isolated instances are earth closets known to exist. 17 PUBLIC CLEANSING. House refuse is collected from houses in mechanically driven freighters and disposed of by burning at the Council's destructor at California Road, or by controlled tipping on adjacent land. 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. SMOKE ABATEMENT. The management of the factory, mentioned in my last annual report where trouble has been experienced owing to the emission of grit from the boiler chimney, was actively engaged during the year in trying to provide a remedy. Unfortunately the outbreak of war had the effect temporarily of delaying the installation of apparatus which it was confidently expected would overcome the trouble. RATS AND MICE DESTRUCTION. This good work has gone on unabated. Indeed the war has tended it to increase, and the Assistant Rat Officer has had his time fully occupied in dealing with complaints, requests for assistance, giving advice and carrying out actual work of destruction. FOOD AND DRUGS ACT, 1938. The Food and Drugs Acts were administered by the County Council up to the 1st October and by courtesy of the County Medical Officer of Health a return of samples analysed during the nine months is given herewith. 18 Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convictions. Milk 20 1 — — Lard 1 — — — Confectionery and Jam 2 — — — Meat 1 — — — Sausages 2 — — — Apple Jelly 1 — — — Orange Squash 1 — — — Total 28 1 — — Since the 1st October, 1939, this Council took over the administration of the new Act and during the 3 months to the end of the year following samples were analysed:— Articles. Analysed. Adulterated or Deteriorated Prosecutions. Convictions. Butter 1 — — — Chutney 1 — — — Flour 1 — — — Jam 2 — — — Margarine 6 — — — Milk 8 — — — Pepper 1 — — — Eice 1 — — — Sausages 7 — — — Sultanas 2 — — — Tapioca 2 — — — Vinegar 2 - - - Total 34 - — — HOUSING ACT, 1936. OVERCROWDING. The fifty houses in Potters Grove erected primarily for the abatement of overcrowding were completed at the beginning of the year, seven of these having been occupied at the end of the year (1938). 19 It is gratifying to be able to record that the Council were thus enabled to deal with all known cases of overcrowding so that at the year under review all had been abated. Families were removed by contractors. The furniture and other effects being subjected to a process of fumigation in order to ensure that no vermin were transferred to the premises. The following table gives details of the cases dealt with :— Families overcrowded at the end of the year 1938 29 Added during the year 5 34 Abated during the year 34 Leaving Nil Of the 34 cases abated, 27 were allotted houses on the new estate at Potters Grove, 2 themselves obtained larger accommodation whilst the remainder (5) abatement was secured by some member or members of the families leaving home (generally sons or daughters getting married). Two cases of overcrowding which constituted an offence came to light and were both soon afterwards abated on notice being given. In two instances applications were received for licences to permit more than the permitted number to sleep in the premises. Both were granted for periods of six months at the end of which the overcrowding was found to be abated. In the cases of overcrowded families who were removed to Potters Grove the Council adopted a scheme of rent rebates. Each case was carefully considered by a Rents tribunal and in a number, where the family income fell below a certain figure based on what is known as the Cambridge formula, rebates were granted. A review is made at intervals of three months when adjustments are 20 made according to a rise or fall in the income of the families affected. Non-overcrowded families who were granted the occupation of those houses which were surplus to requirements were charged the economic rent. Applications to be supplied with the permitted numbers for houses continued to be received and this necessitated visits to and the measurement of 187 houses. In addition much time was spent in visits made in regard to various matters connected with overcrowded families and with the removal of families to the new Estate. FOOD SUPPLY. As far as possible, watch is kept on premises where foodstuffs are prepared or sold, which includes slaughterhouses, butchers' and fishmongers' shops, bake-houses, dairies, cowsheds, etc. The following foodstuffs were found to be unfit for food and destroyed:— 14 lbs. Haddocks Roes 4 stone Sprats Unwholesome 255 Eggs 2 Sheep's Lungs 1 Sheep's Liver There now remain only two slaughterhouses in the district. One only has been used and that to a very limited extent. 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. ERADICATION OF BED BUGS. During the year the following number of houses were found to be infested with bed bugs:- 21 Infested. Disinfested (a) Council houses 13 13 do. (rooms) 15 15 (b) Other houses (rooms) 7 7 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. The work of disintestation 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 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. Advice has also been given to a number of house owners, and several houses have been treated by outside contractors without notice from my department. HCN is known to have been used in two or three cases. DAIRIES, COWSHEDS AND MILKSHOPS. Only one cowshed is now in use in the district. This is in a very poor condition structurally, but is not, however, used for cows in milk. 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:— 22 Dealers. Tuberculin tested 7 Pasteurised 8 Tuberculin tested (pasteurised) 2 Tuberculin tested (certified) 1 Pasteurisers licences 1 Supplementary. Tuberculin tested 5 Pasteurised 3 Fourteen samples of milk were submitted for examination and in eight instances they were also examined for the presence of tubercle bacilli (animal experiment). In two instances B. Coli were detected and high counts recorded. They were immediately followed up. In the tests for the presence of tubercle bacilli negative results were returned in each case. Eight samples were submitted of milk pasteurised locally and in each case a satisfactory result was obtained. All the milk delivered to the schools was included in these examinations and in one ease an unsatisfactory result was recorded. In this instance it was found that a new bottling machine was being installed and it was during this time that unsatisfactory results were being obtained. AIR RAID PRECAUTIONS. A considerable amount of time was occupied in this direction. In July I attended a further course in the control of incendiary bombs and elementary methods in the protection against high explosive bombs at the Home Office School, Reading. In November I attended the special course of training prescribed for (las Identification Officers by the Ministry of Home Security. Details of the number of lectures given need not, perhaps, be summarised. It will suffice to note that these amounted to a great number and occupied much time. I 23 have been very ably assisted in this direction by Mr. I). Hughes, Deputy Senior Sanitary Inspector, and Mr. G. Smallpiece of the A.R.P. Department. With the outbreak of War the whole Department was mobilised to deal with the problems arising therefrom, and for some time little other work could be done except that of assisting and co-operating with the Medical Officer of Health in the organisation of the casualty services for the Borough. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, HENRY TUNBRIDGE, Chief Sanitary Inspector. 24 FACTORIES. INSPECTIONS. Premises. Number of Inspections Written Notices Occupiers. Prosecuted (1) (2) (3) (4) Factories with mechanical power 36 13 Factories without mechanical power 24 2 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 6 1 Total 66 16 — DEFECTS FOUND. Particulars Number of Defects Number of Defects 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 1 1 — — Sanitary Conveniences (S. 7)— Insufficient 1 — — — Dirty 2 2 — — Unsuitable or defective 1 1 — — Insufficient artificial lighting 6 6 — — Not separate for sexes — — — — No intervening ventilated space — — — — Other offences 9 9 — — Total 20 19 — —