MAL5 Borough of Malden and Coombe. Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED DECEMBER 31st 1941 Printed by J. B. Blackmore & Co. Ltd.. 85. Merton High Street, S.W.l9. 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. Henry Tunbridge, M.R.San.I. Chief Sanitary and Foods Inspector. Douglas J. Hughes, C.E.San.I., Sanitary Inspector. †A. H. Newport, M.S.I.A., Sanitary Inspector. Arthur O. Scott, Assistant Rat Officer. Oliver Elliott, General Assistant and Mortuary Keeper. Frederick W. W. Mitchell, Clerk. † On Active Service. TEMPORARY. Ernest C. Challis, Casualty Staff Officer. Doris Cole, Clerk. Borough of Malden and Coombe. ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1941 Public Health Department, Municipal Offices, New Malden. July, 1942. To the Mayor, Aldermen and Councillors of the Borough of Malden and Coombe. Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1941, which has been prepared in accordance with Ministry of Health Circular 2604. In view of the expressed wish of the Minister that only interim reports should be made, and that they should be confined to essential and urgent matters which have affected the public health during the year, the report has been abbreviated as much as possible. Vital statistics on the whole remain very good, the only disturbing feature being an increase in the tuberculosis death and notification rates, which is shared by the country as a whole and may be attributed to war conditions. I should like to record my appreciation of the work of the sanitary and clerical staff of the department who have always given me their willing help. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FANNING, Medical Officer of Health. 2 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area 3,162 acres. Registrar General's estimate of resident population (mid-year 1941) 33,970 VITAL STATISTICS. Total. M. F. Live births 472 249 223 Birth rate per 1,000 of the estimated resident population 13.8 (legitimate) 234 212 (illegitimate) 15 11 Stillbirths 15 9 6 Rate per 1,000 total (live and still) births 30.8 Deaths 381 188 193 Death rate per 1,000 of the estimated resident population 11.2 Deaths from puerperal causes:— Deaths. Rate per 1,000 Total (Live & Still) Births. Puerperal Sepsis 1 2.0 Death rates of Infants under one year of age:— All Infants per 1,000 live births 38.1 Legitimate Infants per 1,000 legitimate live births 38.1 Illegitimate Infants per 1,000 illegitimate live births Nil 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 3 CAUSES OF DEATH. M. F. Total. Typhoid and paratyphoid fevers - - - Cerebro-spinal fever 1 - l Scarlet Fever - - - Whooping cough - - — Diphtheria - 1 l Respiratory tuberculosis 17 14 31 Other forms of tuberculosis 2 3 5 Syphilitic diseases — 2 2 Influenza 2 1 3 Measles — — — Acute polio-myelitis and polioencephalitis - - - Acute inf: encephalitis — — — Cancer 37 25 62 Diabetes — 4 4 Intra-cranial vascular lesions 11 21 32 Heart disease 40 43 83 Other circulatory diseases 3 6 9 Bronchitis 8 8 16 Pneumonia 10 9 19 Other respiratory diseases 2 6 8 Ulcer of stomach and duodenum 5 1 6 Diarrhoea (under 2 years) 1 1 2 Appendicitis 1 — 1 Other digestive diseases 3 4 7 Nephritis 6 5 11 Puerperal or post-abortive sepsis — 1 1 Other maternal causes — 2 2 Premature birth — 4 4 Congenital malformations; birth injury; infant diseases 3 1 4 Suicide 2 2 4 Road traffic accidents 8 — 8 Other violent causes 12 10 22 All other causes 14 19 33 All causes 188 193 381 4 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 8 — 3 8 10 14 28 29 72 16 188 Females 10 4 1 8 16 9 18 29 64 34 193 Totals 18 4 4 16 26 23 46 58 136 50 381 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District. Kingston County Hospital. Kingston Victoria Hospital. Tolworth Isolation Hospital. London & other Hospitals. Wimbledon Hospital. Other Districts. Total. 182 81 10 3 46 1 58 381 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years:— 1937 (21 Legitimate None Illegitimate) 21 1938 (18 „ 2 „ ) 20 1939 (12 „ 12 „ ) 24 1940 (21 „ 3 „ ) 24 1941 (18 „ None „ ) 18 Average for past five years—21. CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 4 Congenital diseases, Malformations, Birth injury 4 Gasto-Enteritis 2 Broncho pneumonia 6 Other 2 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 1937 15.1 37.1 9.2 1938 16.7 30.8 8.2 1939 15.4 39.0 9.3 1940 14.5 43.7 12.6 1941 13.8 38.1 11.2 (uncorrected) Average for past 5 years 15.1 37.7 10.1 5 MORTUARY. Thirty-one bodies were brought to the Mortuary and a post mortem examination was made on thirty. H.M. Coroner for the district held inquests in twelve instances and the following verdicts were returned:— Natural causes 4 Accidental 3 Suicide 3 Misadventure 1 Open verdict 1 RAINFALL, 1941. January 2.30 inches. February 1.78 „ March 3.35 „ April 1.33 „ May 1.59 „ June 2.29 „ July 3.55 „ August 4.53 „ September 0.33 „ October 0.75 „ November 2.50 „ December 1.66 „ Total 25.96 „ Increase on previous year 1.50 inches. Average for past 5 years 24.48 inches. 6 NOTIFICATIONS OF INFECTIOUS DISEASES, 1941. DISEASES AGE GROUPS Totals Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 5-45 45-65 Over 65 Diphtheria 7 — — 2 — 1 1 — 2 1 — — — Erysipelas 6 1 — — — — — — — — 1 4 — Pneumonia 20 2 1 2 — — 3 2 — 1 3 4 2 Puerperal Pyrexia 1 — — — — — — — — 1 — — — Scarlet Fever 23 — — — — 1 14 3 3 2 — — — Ophthalmia Neonatorum — — — — — — — — — — — — — Paratyphoid "B" 1 - - - - - - - - - - 1 — Dysentery 2 — — — — 1 1 - - - - - - Cerebro-spinal Meningitis 6 1 — — — — — — 2 2 1 — — Measles 232 7 7 19 21 27 120 16 3 12 — — — Whooping Cough 133 11 18 7 17 22 55 1 — 2 — — — Totals 431 22 26 30 38 52 194 22 10 21 5 9 2 DISEASE WARDS Totals Coombe Kickerage Mount Cambridge Norbiton Park Central Burlington Malden St. James Diphtheria 7 4 2 — 1 — — — — — Erysipelas 6 — 1 — — — — 1 2 2 Pneumonia 20 1 2 3 3 2 1 2 3 3 Puerperal Pyrexia 1 — — — — — 1 — — — Scarlet Fever 23 5 — — 1 2 1 6 5 3 Ophthalmia Neonatorum — — — — — — — — — — Paratyphoid "B" 1 — 1 — — — — — — — Dysentery 2 — — — — — — — — 2 Cerebro-spinal Meningitis 6 2 — — 1 1 — 1 — 1 Measles 232 54 29 7 8 22 5 12 53 42 Whooping Cough 133 11 23 11 11 7 2 3 44 21 Totals 431 77 58 21 25 34 10 25 107 74 7 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The incidence of scarlet fever was unusually low, only twenty-three cases being notified, a rate of 0.67 per 1,000 population. Fifteen cases were treated in hospital and eight at home. Only one instance of "return case" infection occurred. DIPHTHERIA. The diphtheria incidence remained on a low level, seven cases being notified, a rate of 0.20 per 1,000 population. Of these three were military cases. No case occurred in a child who had been previously immunised. One child did not recover. As a result of increased publicity given to diphtheria through the Press, cinema, and by broadcasting, there was a considerably increased public demand for immunisation. In the beginning of the year by co-operation with the County Council Medical Staff all the schools were visited and a large number of children were immunised. In addition the numbers attending the fixed clinics were considerably increased, and this popularity continued, although diminishing somewhat, throughout the year. This is a good example of the value of the radio in putting over health propaganda on a national scale. One talk can produce better results than years of local effort. I believe that the most important if not the only worth while approaches to health teaching are through the schools, the public cinemas, and the radio. The following statistics refer to immunisation carried out during the year:— Number of eases completing treatment during the year (pre-school children 449, school children 888) 1,337 Number of cases treated by private doctors under the Council's scheme 100 8 Number of Schick tests 19 Total number of attendances at Clinic 1,854 CEREBROSPINAL MENINGITIS. Although not so high as in the previous year the incidence of meningococcal meningitis was greater than normal, six cases being notified. One case proved fatal. Two were military cases and the remainder civilians. ENTERIC FEVER. There was only one case of enteric group infection. This was a mild case of paratyphoid B in a middle-aged woman. There was no evidence as to the origin of the infection. MEASLES. Measles behaved in a peculiar fashion. It has previously appeared regularly in biennial cycles, and in view of the sharp outbreak last year the present year should have been comparatively clear. A minor epidemic appeared in the first months of the year, however, died down in the summer, and showed a slight recrudescence at the end of December. In all, two hundred and thirtytwo cases were notified. Most of these were mild, although eleven were treated in hospital. Owing to war conditions it has not been possible to provide the adult measles serum which has proved so useful in previous years, although a substitute is now available commercially, and is being used with promising results. WHOOPING COUGH. Whooping cough was more prevalent than usual and a total of 133 cases was notified during the year. Twelve cases were treated in hospital. SCABIES. In common with most other districts a tiresome problem which developed during the year was the prevalence of scabies. As there is no cleansing and disinfecting station in the district, and admission to 9 hospital was impracticable in the great majority of cases the best means possible for treating the disease in the home had to be devised. One of the most important points in the treatment of the disease is that the family should be treated as a whole, and in order to attain that end the Public Health Department assumed complete responsibility in most eases for investigation, treatment and following up in the home. Local doctors co-operated very helpfully in this scheme. Reliance was placed mainly in the use of a proprietary preparation which, when properly applied, effects a cure in 36 hours. Hitherto, a great deal of labour and expense has been incurred in the disinfestation of clothing and bedding after scabies. If done for a large number of cases this burden becomes immense. In the light of the recent experiments of K. Mellanby, in which he found great difficulty in transferring infection experimentally except by personal contact, it was decided to try the effect of omitting routine disinfestation altogether. The results to date show a complete justification of this method. In the cases in which the treatment has been correctly applied and an immediate cure obtained there has been no evidence of re-infection from clothing or bedding. During 1941 90 infested persons from 41 families received treatment. This number does not include those who received the treatment as contacts only. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales. Borough of Maiden & Coombe. Smallpox 0.00 0.00 Scarlet fever 1.47 0.67 Diphtheria 1.25 0.20 Paratyphoid fever 0.09 0.03 Erysipelas 0.30 0.18 *Puerperal pyrexia 11.91 2.0 * 1,000 total births (i.e., live and stillbirths). 10 TUBERCULOSIS. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 - - - - - - - - 1 - - - - - - - - 5 - - - - - - - - 15 — — 2 1 1 — 1 - 25 5 7 2 — 2 3 — - 35 12 2 1 1 5 4 1 1 45 3 1 — — 4 2 — 1 55 6 1 — 1 1 2 — 65 & upwards 5 3 - - 4 3 - - Totals 31 14 5 3 17 14 2 3 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 three such cases during the year. The facilities for chest X-ray examination offered by arrangement with the Kingston Victoria Hospital was made use of in one case. At the end of the year the following number of cases were shown to be suffering from the disease and living in the district, a decrease of thirteen cases compared with the previous year:— Pulmonary. Non-Pulmonary. Males 86 19 Females 60 20 CASES OF INFECTIOUS DISEASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 15 Suspected scarlet fever 1 Diphtheria 6 Diphtheria "carrier" 1 Suspected diphtheria 1 Measles 11 Whooping cough 12 11 Cerebro-spinal-meningitis 4 Suspected cerebro-spinal-meningitis 3 Pneumonia 3 Erysipelas 2 Suspected erysipelas 2 Paratyphoid fever 1 Suspected typhoid fever 2 Chicken pox 1 Otitis media 1 Infective jaundice 1 Impetigo 1 Bronchitis 1 Total 69 In addition to the above, one ease of Diphtheria was removed to Wimbledon Isolation Hospital. NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1936 1937 1938 1939 1940 1941 Scarlet Fever 45 39 68 96 46 23 Diphtheria 21 22 22 6 5 7 Enteric Fever (including Para-typhoid) - 4 2 1 5 1 Erysipelas 6 4 6 11 2 6 Pneumonia 16 19 24 24 18 20 Encephalitis Lethargica — — — — — — Puerperal Fever - - - - - - Puerperal Pyrexia 6 3 12 9 2 1 Cerebro-Spinal Fever — — 1 — 15 6 Acute Poliomyelitis — 1 1 — — — Ophthalmia Neonatorum — 2 — 1 — — Dysentery — 12 2 — — 2 Malaria - - - - - — *Measles — — — — 409 232 *Whooping Cough — — — — 13 133 Tuberculosis (all forms) 36 46 37 38 49 53 *Notifiable since November, 1939. 12 GENERAL PROVISION OP HEALTH SERVICES IN THE AREA. Laboratory Facilities. The following table shows the number of pathological examinations during the past year:— Disease. Positive. Results. Negative. Totals. Tuberculosis Sputa 4 47 51 do. Urine - 3 3 Diphtheria Swabs 2 71 73 Cerebro-Spinal Meningitis Swabs — 3 3 Typhoid and Paratyphoid Faeces — 2 2 do. Urine — 1 1 Totals 6 127 133 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. 13 SANITARY ADMINISTRATION. ANNUAL REPORT of THE SANITARY INSPECTOR 1941 Public Health Department, Municipal Offices, New Malden. To The Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the pleasure to submit my twenty-second annual report of work accomplished and matters of interest concerning the Sanitary Department. Once again, in view of the exceptional circumstances, this will necessarily be greatly curtailed. Many items which usually appear are omitted altogether. For the purpose of abating nuisances, and executing repairs to render houses fit for human habitation, the following notices were served:— Preliminary. Formal. Notices served 85 15 Complied 70 12 Remaining outstanding 15 3 It was not necessary to institute legal proceedings for the abatement of nuisances or other sanitary matters. SCABIES. A good deal of time has been spent and many visits paid in connection with the treatment of persons suffering from scabies. 14 INFECTIOUS DISEASES. The following number of rooms were disinfected for the under-mentioned causes:— Scarlet Fever 19 Diphtheria 3 Tuberculosis 39 Vermin— Houses 8 Booms 8 Typhoid or Paratyphoid 4 Puerperal Pyrexia 2 Cerebrospinal Fever 4 Other 15 102 All the Public Elementary Schools were disinfected throughout during the year. Two hundred and fifty-six books from the Public Library and Schools were disinfected for various reasons. Eleven loads of bedding were removed for steam disinfection and four for destruction. In addition to the above, 106 Blankets, 105 mattresses, 7 straw beds, 30 canvas beds, 25 cushions and pillows and 6 bedcovers from various posts and shelters have been disinfected or disinfested. 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. Some complaints were received of "taste" but in every instance this was found to be due to extra precautions being taken, due either to abnormal weather or to conditions produced as a consequence of the War. 15 POOD AND DRUGS ACT, 1938. During the year 136 samples were submitted to the Public Analyst for analysis. These comprised the following:— Articles. Analysed. Adulterated or below standard. Prosecutions. Convictions. Formal. Informal Total. Formal Informal. Total. Milk 67. — 67. 8. — 8. — — Sausages — 3. 3. Jam — 3. 3. — 1 1 — — Margarine — 4. 4. — 4. 4. — — Flour — 3. 3. - - - - - Tapioca — 1. 1. - - - - - Rice — 4. 4. - - - - - Egg powder — 1. 1. — 1 1 — — Pepper — 3. 3. - - - - - Lard — 4. 4. - - - - - Butter — 4. 4. - - - - - Cocoa — 6. 6. - - - - - Tea — 4. 4. — — — — — Coffee — 3. 3. - - - - - Vinegar — 4. 4. - - - - - Sugar — 2. 2. - - - - - Pickles — 3. 3. - - - - - Honey — 1. 1. - - - - - Cheese — 6. 6. - - - - - Essences and food substitutes 7. 3. 10. 3. 3. 6. 1. 1. 74. 62. 136. 11. 9. 20. 1. 1. Notes in regard to samples shown as adulterated or deteriorated. Milk.—The eight samples of milk were all taken in course of delivery The deficiencies in five instances were small and further samples taken from churns in the same consignments disclosed satisfactory results. It was felt, therefore, that prosecutions could not be sustained and warnings were issued. The remaining three were all from one producer. A prosecution was authorised in regard to one of these samples but, unfortunately, the third (retained) portion burst before the hearing and the case had to be abandoned. Jam.—The Analyst's comments in regard to this sample were:— "This is not of full fruit standard as regards soluble solids (i.e., sugar mostly) but in view of the very high proportion of fruit present I do not think any action need be taken." Margarine.—Each of these samples contained Boric acid. The Public Health (Preservatives in Food) Regulations forbids the 16 addition of preservatives in Margarine and for this reason the Public Analyst returned them as being non-genuine. Under Emergency Powers (Defence) Regulations, however, the addition of Borax is permitted, under licence by the Minister of Food. No action, therefore, was taken. Egg powder.—This sample contained a small amount of sugar introduced apparently to overcome a bitter taste. Fruit and Vegetable essences or substitutes.—Four commodities were affected. In two the wording on the packets was such that it was considered inadvisable to proceed further. A prosecution was undertaken in one case with the result that a fine of £20 was inflicted and the Corporation was awarded 20 guineas costs. The remaining sample was a vegetable essence which contained a preservative contrary to the Regulations. This was not of a serious nature and a warning was issued. During the year Regulations were made by the Minister of Food making it necessary for all manufacturers of Food Substitutes to be licensed by the Minister. OVERCROWDING. There is nothing to report in regard to overcrowding during the past year. Applications to be supplied with the permitted numbers for houses continued to be received and this necessitated visits to and the measurement of 18 houses. 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:— Veal 24 lbs. Eggs 555 Butter 109 lbs. Beef 4 „ Bacon 10 „ Meat Roll 3 „ Luncheon meat 6 „ Ducks 4 In addition various quantities of food were dealt with consequent on damage by enemy action. There now remain only two slaughterhouses in the district These were not used during the year. 17 SHOPS ACTS. The whole of these Acts are administered by my Department. 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:— Infested. Disinfested. (a) Council houses 8 8 do. (rooms) 8 8 (b) Other houses 6 6 Every house becoming vacant on the Corporation Estates is carefully inspected before reletting. 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. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders:— Dealers. Tuberculin tested 8 Pasteurised 7 Pasteurisers licences 1 Supplementary. Tuberculin tested 5 Pasteurised 3 Ten samples of milk were submitted for examination and in all instances they were also examined for the presence of tubercle bacilli (animal experiment). In one instance a count slightly higher than the permitted was recorded. This was immediately followed up. In the tests for the presence of tubercle bacilli negative results were returned in each case. 18 The phosphatase test was made on 13 samples of pasteurised milk, and satisfactory results were obtained in 12. SMOKE ABATEMENT. For the first time for many years there were no complaints in regard to smoke nuisance. Several visits, however, had to be made where black smoke was observed for unreasonable periods. The trouble appeared mostly to be due to inferior fuel. RATS AND MICE DESTRUCTION. The observations I made in my previous report apply equally well for this. I think possibly, however, it might be worth recording that the amount of work done during the year undoubtedly exceeded, by far, anything in previous years. AIR RAID PRECAUTIONS. In addition to many other activities I attended a week's revision course at Falfield during the year. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, HENRY TUNBRIDGE, Sanitary Inspector.