MAL 7 LIBRARY Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED DECEMBER 31st 1943 Printed by J. B. Blackmore & Co. Ltd 85. Merton High Street, S.W.19 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.B.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 0. Scott, Assistant Rat Officer. Oliver Elliott, General Assistant and Mortuary Keeper. †Frebderick W. W. Mitchell, Clerk, t On Active Service. TEMPORARY. Ernest C. Challis, Casualty Staff Officer. Mrs. V. E. McClellan, Shorthand Typist. Borough of Malden and Coombe ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1943 Public Health Department, Municipal Offices, New Malden. June, 1944. 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 1943, which has been prepared in accordance with Ministry of Health Circular 2773. On the whole, in spite of having reached the fifth year of the war the health of the district has been well maintained, and in some respects improved. I wish to record my appreciation of the work of the staff of the department during the year, and to offer my thanks to those members of the Civil Defence Services who have assisted so much in Public Health work. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES PANNING, 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 1943) 37,750 VITAL STATISTICS. Total. M. F. Live births 685 347 338 Birth rate per 1,000 (legitimate) 325 327 of the estimated (illegitimate) 22 11 resident population 18.1 Stillbirths 23 9 14 Rate per 1,000 total (live and still) births 32.4 Deaths 381 192 189 Death rate per 1,000 of the estimated resident population 10.0 Deaths from puerperal pauses:— Deaths. Rate per 1,000 Total (Live & Still) Births. Puerperal sepsis Nil Nil Other Puerperal Causes Nil Nil Death rates of Infants under one year of age:— All Infants per 1,000 live births 35.0 Legitimate Infants per 1,000 legitimate live births 35.0 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 66 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 4 3 BIRTHS. During the year 685 live births were registered, an increase of 68 over last year's total. The rate per 1,000 was 18.1 compared with an average for England and Wales of 16.5. Of the total number 33, or 4.8 per cent., were illegitimate. This shows a fractional increase over the previous year. The birth rate is the highest recorded in the district since 1920. DEATHS. During the year 381 deaths were registered, being an increase of 65 over 1942, and exactly the same figure as for 1941. The death rate per 1,000 was 10.0 compared with an average of 12.1 for England and Wales. There was an increase in the mortality from respiratory diseases and influenza, and a considerable increase in that from heart disease. The increase over the previous year fell almost entirely among the age groups over 65 years. It is pleasing to record that the infantile mortality rate for illegitimate children was nil. CAUSES OF DEATH. M. F. Total. Typhoid and paratyphoid fevers — — — Cerebro-spinal fever 1 — l Scarlet fever — 1 l Whooping Cough — — — Diphtheria 1 — l Respiratory tuberculosis 7 8 15 Other forms of tuberculosis — — — Syphilitic diseases 3 — 3 Influenza 5 4 9 Measles 1 — 1 Acute polio-myelitis and polioencephalitis — — — Carried forward 18 13 31 4 Brought forward 18 13 31 Acute inf: encephalitis — — — Cancer 37 29 66 Diabetes 2 1 3 Intra-cranial vascular lesions 16 18 34 Heart disease 51 51 102 Other circulatory diseases 1 6 7 Bronchitis 13 9 22 Pneumonia 9 12 21 Other respiratory diseases 3 4 7 Ulcer of stomach and duodenum 2 2 4 Diarrhoea (under 2 years) 3 1 4 Appendicitis 2 — 2 Other digestive diseases 2 3 5 Nephritis 5 3 8 Puerperal or post-abortive sepsis — — — Other maternal causes — 1 1 Premature birth 3 2 5 Congenital malformations; birth injury; infant diseases 7 7 14 Suicide 1 1 2 Road traffic accidents 3 2 5 Other violent causes 4 3 7 All other causes 10 21 31 All causes 192 189 381 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 2 4 7 4 6 9 43 82 22 192 Females 10 4 2 9 5 12 20 20 65 42 189 Totals 23 6 6 16 9 18 29 63 147 64 381 5 statement showing where deaths occurred. In District. Surrey County Hospitals. London and other Hospitals. Other Districts. Total. 176 134 51 20 381 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of uge during the past five years:— 1939 12 Legitimate 12 Illegitimate 24 1940 21 " 3 „ 24 1941 18 " None „ 18 1942 21 " 1 „ 22 1943 23 " None „ 23 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 5 Congenital diseases, Malformations, Birth injury, Infant diseases 14 Other 4 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 1939 15.4 39.0 9.3 1940 14.5 43.7 12.6 1941 13.8 38.1 11.2 1942 16.6 35.6 9.0 1943 18.1 35.0 10.0 MORTUARY. Thirty bodies were brought to the Mortuary and a post mortem examination was made on each. 6 H.M. Coroner for the district held inquests in eight instances and the following verdicts were returned. Natural causes 3 Accidental 2 Suicide 1 Misadventure 2 RAINFALL, 1943. Table showing rainfall in the district during 1943, taken at the Sewage Disposal Works, California Road, New Maiden:— inches January 4.49 February 1.60 March 0.26 April 0.78 May 1.58 June 1.24 July 1.62 August 1.08 September 1.79 October 2.62 November 1.19 December 1.48 Total 19.73 Decrease on previous year 3.41 inches. Average for past 5 years 23.85 inches. Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1943. Provisional figures based on Weekly and Quarterly Returns. England and Wales 126 C.Bs. and Great Towns Including London 148 Smaller Towns Resident Pop. 25,000— 50,000 1931 Census London Adm. County England and Wales 126 C.Bs. and Great Towns including London 148 Smaller Towns Resident Pop. 25,000— 50,000 1931 Census London Adm. County *Rates per 1,000 Civilian Population. *Rates per 1,000 Live Births:— Live Births 16.5 † 18.6 19.4 15.8 Deaths under 1 year of age Deaths from Diarrhoea and Enteritis under 49 58 46 58 Still Births 0.51 † 0.63 0.61 0.45 Deaths:— All Causes 12.1 † 14.2 12.7 15.0 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 2 years of age 5.3 7.9 4.4 10.4 Scarlet Fever 0.00 0.00 0.00 0.00 *A dash (—) signifies that there were no deaths. Whooping Cough 0.0.3 0.03 0.03 0.03 Diphtheria 0.03 0.04 0.04 0.02 Rates per 1,000 Total Births (Live and Still). Influenza 0.37 0.36 0.37 0.27 Small-pox — — — — Maternal Mortality:— (Excluding Abortion) Measles 0.02 0.02 0.02 0.0i2 Notifications:— Typhoid Fever 0.01 0.01 0.02 0.01 Puerperal Infection (No. 147) Paratyphoid Fever 0.01 0.01 0.01 0.01 0.39 Not available. Cerebro Spinal Fever 0.08 0.10 0.06 0.09 Others 1.45 Total 1.84 Scarlet Fever 3.01 3.29 3.54 3.80 Whooping Cough 2.54 2.82 2.25 2.68 Notification:— Diphtheria 0.88 1.12 0.77 0.74 Puerperal Fever 3.05 Erysipelas 0.31 0.35 0.27 0.42 Small-pox — — — — Puerperal Pyrexia 11.68 15.11 9.26 i Measles 9.88 9.23 9.77 9.17 15.231 Pneumonia 1.34 1.62 1.16 1.27 † These rates are those published in the Quarterly Return. † Including Puerperal Fever. 8 NOTIFICATION OF INFECTIOUS DISEASES, 1943. DISEASES Totals Under 1-2 2-3 3-4 AGE GROUPS 15-20 20-35 35-45 45-65 Over 65 4-5 5-10 10-15 Diphtheria 1 Erysipelas 9 — — — — — — — — — 1 4 4 Pneumonia 46 3 1 2 5 2 4 2 3 4 5 7 8 Puerperal Pyrexia 7 — — — — — — — I 5 1 — — Scarlet Fever 185 — 4 10 9 25 98 24 7 5 2 1 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — Dysentery 1 — — — — — — 1 — — — — — Cerebrospinal Meningitis 2 — — — — — — 1 — — — 1 — Measles 221 7 13 14 29 56 81 10 — 10 1 — — Whooping Cough 143 7 28 17 16 32 41 — 1 — 1 — — Totals 616 18 46 43 59 115 224 39 12 24 11 13 12 DISEASES WARDS Totals Coombe Dickerage Mount Cambridge Norbiton Park Central Burlington Maiden St. James Diphtheria 1 — — 1 — — — — — — Erysipelas 9 — 1 1 4 1 — 1 — 1 Pneumonia 46 5 5 7 5 7 3 3 5 6 Puerperal Pyrexia 7 — 1 2 — 1 — — 3 — Scarlet Fever 185 13 28 13 8 20 16 21 34 32 Ophthalmia Neonatorum 1 — — — 1 — — — — — Dysentery 1 — 1 — — — — — — — Cerebro-spinal Meningitis 2 — — — — — — 2 — — Measles 221 27 14 10 10 13 18 40 37 52 Whooping Cough 143 19 25 10 7 18 7 12 20 25 Totals 616 64 75 44 35 60 44 79 99 116 9 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. There was a marked increase in the number of scarlet fever cases. One hundred and eighty-five cases were notified during the year, a rate of 4.89 per 1,000 population. One hundred and thirty cases were treated in hospital and fifty-five at home. A comparison of home treatment with hospital shows that where the home conditions are satisfactory there is no relative increase in the number of secondary cases in the former group, and in view of the prevailing mildness of the disease an extension of home treatment is to be encouraged. Mixed infection with resulting complications in crowded hospital wards is a particular danger which can be avoided by home isolation. The percentage of "infecting cases" (i.e., a case giving rise to another case within 28 days of discharge from hospital or release from isolation) was 5.2 per cent, in respect of hospital cases and nil in respect of home cases. Among these " infecting cases " infective conditions of the ear, nose or throat was evident in 85.5 per cent, after the normal period of isolation. Despite exhaustive inquiries as to the source of infection in each case, only some 14 per cent, could be linked with a definite preceding1 case from which the infection presumably originated. This suggests that in most cases infection is transmitted by carriers or by other types of streptococcal disease and accounts for the relative inefficiency of methods of control for this disease. DIPHTHERIA. Only one case of diphtheria was notified during the year, giving a rate of 0.02 per 1,000 population, the lowest ever recorded for the district. The single case occurred in a schoolboy, age 12, who had not been immunised, and unfortunately proved fatal. 10 There is little doubt that this remarkable low diphtheria rate is the direct result of the high proportion of immunised children in the district. The lowness of the rate, however, is a danger in itself because already there are signs that, with a relative absence of diphtheria, parents are beginning to get slack, and are not bringing their younger children forward for immunisation with the regularity which is desirable. No opportunity should be lost in urging parents that every child should be immunised as soon as possible after its first birthday as by this means it is within our power virtually to suppress diphtheria as a killing disease in children. At the end of the year it was estimated that of the children living in the district age 1-5, 68 per cent, have been immunised, and of children age 5-15, 75 per cent, have been immunised. As children are not immunised before their first birthday, 80 per cent, is the maximum possible in the earlier age group. The total number of children immunised during the year was 979. The following statistics refer to immunisation carried out during the year:— Number of eases completing treatment by M.O.H. during the year (pre-school children 577, school children 352) 929 Number of cases treated by private doctors under the Council's Scheme 50 Number of Schick tests 29 Total number of attendances at Clinic 1,272 CEREBROSPINAL FEVER. Only two cases of meningoccal meningitis were notified, the lowest number since 1939. Both cases recovered. An additional fatal case occurred in a child living temporarily outside the district. 11 MEASLES. The number of measles cases was rather less than in the previous year, 221 notifications being received. Cases were scattered through the first eight months of the year and were evenly distributed in the various wards of the district. The biennial beat, which was such a marked feature of measles incidence in pre-war years has not reappeared and a substantial number of cases has been notified annually for the past four years. The prevailing type of illness was not severe. Measles serum was requested and supplied in 14 cases. WHOOPING COUGH. One hundred and forty-three cases of whooping cough were notified, an increase over the previous year. Of these, twenty-three were treated in hospital. There were no deaths. In the near future it may be possible to suggest the introduction of an immunising measure for protection against whooping cough, but at the moment the evidence in favour of the materials at present available is too conflicting to justify its recommendation as a collective measure. SCABIES. There was still no abatement in the incidence of scabies, a disease which has become most troublesome since the war. In spite of the wide-spread publicity, which has been given to the disease, many cases still go unrecognised for a considerable time with multitudinous opportunities for spreading infection. Also, it is often difficult to impress upon people that the infection is a family one, and that it is essential that every member of the family should be treated whether suffering from an obvious eruption or not. Central cleansing stations have not been used, preference being given to the treatment of families in their homes. It is probably easier to ensure the treatment of the whole family by this method and the convenience of workers is better served. Treament is 12 carried out by the staff of the department and trained Civil Defence personnel with benzyl benzoate emulsion and the recurrence rate is very low. During 1943, 483 persons from 148 families received treatment. Of these 347 persons showed definite lesions, the remainder being contacts in the same families. SUSPECTED FOOD POISONING. No formal notifications of suspected food poisoning were received during the year. On two occasions a number of cases of diarrhoea came to notice in schools which were attributed to food consumed at school meals. An exhaustive investigation failed to disclose any cause. VERMINOUS CONDITIONS. As the result of information obtained through cooperation with the County Council Health Visitors and the Public Assistance Officer the services of Civil Defence Nurses have also been utilised in certain cases of severe infestation by the head louse. The preparation known as " lethane 384 special " has been used for treatment and, although slightly irritant in some cases, has proved very effective. Twenty-four cases from six families were cleansed in this manner. No case of body louse infestation came to notice during the year. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales. Borough of Maiden 6c Coombe. Scarlet Fever 3.01 4.89 Diphtheria 0.88 0.02 Typhoid Fever 0.01 Nil Paratyphoid Fever 0.01 Nil Cerebro-spinal Fever 0.08 0.05 Measles 9.88 5.85 Whooping Cough 2.54 3.78 *Puerperal pyrexia 11.68 9.88 *per 1,000 total births (i.e., live and stillbirths). 13 TUBERCULOSIS. Age Periods NEW CASES DEATHS Respiratory Non-Respiratorv Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 — — — — — — — — 1 — — — — — — — — 5 2 1 1 2 — — — — 15 5 4 1 2 3 4 — — 25 7 2 — 2 1 1 — — 35 1 4 — 1 1 2 — — 45 3 1 — — — — — — 55 4 — — — 2 1 — — 65 & upwards 1 — — — — — — — Totals 23 12 2 7 7 8 — — The rising incidence of tuberculosis since the beginning of the War was replaced by a definite fall in the number of new pulmonary cases notified, the reduction being mostly contributed to by a smaller number of cases in the female age group 15-25. There was also a considerable fall in the death rate from tuberculosis. The following table shows the variations of tuberculosis (all forms) during the past six years:— Year. Population. Cases notified. Rate per 1,000 population Deaths. Rate per 1,000 population. 1938 38,820 37 0.95 11 0.28 1939 39,630 38 0.95 14 0.35 1940 38,360 50 1.30 27 0.70 1941 33,920 53 1.56 36 1.05 1942 37,070 63 1.69 24 0.64 1943 37,750 44 1.43 15 0.39 Notification of tuberculosis was, on the whole, satisfactory. There were four cases during the year which did not come to light until after death. The facilities for chest X-ray examination offered by arrangement with the Kingston Victoria Hospital was made use of by seven cases. At the end of the year the following number of cases was shown to be suffering from the disease and living in 14 the district, an increase of twenty-three cases compared with the previous year:— Pulmonary. Non-Pulmonary. Males 102 18 Females 74 27 CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet Fever 130 Suspected Scarlet Fever 11 Diphtheria 1 Suspected Diphtheria 5 Cerebro-spinal Fever 2 Suspected Cerebro-spinal Fever 2 Measles and German Measles 14 Whooping Cough 23 Erysipelas 1 Chicken Pox 2 Impetigo 1 Pneumonia 5 197 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1938 1939 1940 1941 1942 1943 Scarlet Fever 68 96 46 23 48 185 Diphtheria 22 6 5 7 8 1 Enteric Fever (including Para-typhoid) 2 1 5 1 — — Erysipelas 6 11 2 6 4 9 Pneumonia 24 24 18 20 12 46 Encephalitis Lethargica — — — — — — Puerperal Pyrexia 12 9 2 1 5 7 Cerebro-spinal Fever 1 — 15 6 6 2 Acute Poliomyelitis 1 — — — — — Ophthalmia Neonatorum — 1 — — — 1 Dysentery 2 — — 2 28 1 Malaria — — — — — — *Measles — — 409 232 360 221 *Whooping Cough — — 13 133 28 143 Tuberculosis (all forms) 37 38 49 53 63 44 *Notifiable since November, 1939. 15 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. The following table shows the number of pathological examinations during the past year:— Disease. Positive Results. Negative. Totals. Tuberculosis Sputa 4 28 32 Scarlet Fever Swabs 0 7 9 Diphtheria Swabs 3 122 125 Dysentery Faeces 8 95 103 do. Blood 1 12 13 do. Urine — 1 1 Totals 18 265 283 A number of samples of milk were submitted for bacterial count for the presence of tuberculosis, details of which will be found in the report of the Sanitary Inspector. TREATMENT OP RHEUMATISM. The Council has been concerned for some time about the prevalence of the rheumatic diseases in the community and the inadequacy of facilities for treatment within the means of the average patient. A great deal of consideration was given to alternative methods for improving the position at the present time, and it was finally decided that an agreement with an existing clinic which could provide the necessary equipment for physio-therapy would be the best immediate solution. Fortunately, a suitable clinic of this type exists just outside the Borough boundary in the shape of the Red Cross Curative Post, Norbiton. The Committee of the Red Cross Post agreed to appoint a consultant in rheumatic diseases and to accept cases from the Borough as far as their capacity allowed at agreed rates per treatment. This arrangement has proved most successful, and during the year 86 patients received 2,830 16 treatments. No charges are made to bona-fide residents of the Borough. Cases are only accepted on the recommendation of their private doctor, and are seen in the first instance by the consultant, who prescribes the clinic treatment and advises the patient's doctor regarding home treatment. I am indebted to Dr. Francis Bach, consultant in rheumatic diseases to the Red Cross Post for the following note:— " Many and varied forms of ill-health are included in the term ' rheumatism.' It is only in recent years that the medical profession has made a serious and concerted effort to solve some of the major problems which they set the community. The war, by causing the mobilisation for industry of the less fit of the young people and middle aged and even the elderly, has shown how great is the pain caused to the individual and the hours of work lost to the community by the rheumatic diseases. Poverty, overcrowding, malnutrition, lack of sunshine, are important factors in the causation of rheumatism in childhood, and their elimination is followed by a marked reduction in the number of children crippled with rheumatic heart disease. Similar factors, with the addition of physical and psychological fatigue, play a big role in the rheumatoid type of arthritis, which so often is still recognised too late in its course when it has attacked and already crippled the young industrial worker. Other forms of rheumatism although they do not damage the heart, as in juvenile rheumatism, or cripple the joints, as in rheumatoid arthritis, cause long periods of disablement by their effect on the muscles and their fascial linings, such as fibrositis of the shoulder leading to brachial neuralgia, and the lumbago that if not treated leads to a prolonged and painful ' sciatica.' In middle age, especially at the 17 change of life in women, many different forms of rheumatism may first manifest themselves; some are serious, others fortunately cause only temporary disability. Innumerable rheumatic ' cures' are offered to the public. Drugs, vaccines, diets, special forms of physical treatment and manipulations all have a place in the treatment of the rheumatic person, but if treatment is to be successful and rapid, it is necessary to know from what form of rheumatism the patient is suffering and to apply that type of treatment which is appropriate for his form of rheumatism. In order to make a proper diagnosis, facilities for laboratory and X-ray investigations must be available. When a patient comes to the Norbiton Clinic he is examined, and, when indicated, such investigations must be carried out before the correct diagnosis can be made and the appropriate physical and drug treatment prescribed. Already we have treated many types of rheumatism and revealed other more serious conditions such as severe ansemia and new growths which have worn the mask of ' rheumatism ' and for months had failed to respond to the treatment given by the doctors, and once recognised, were returned to their doctors and responded rapidly to the correct treatment. The muscular rheumatism of the shoulder caused by the strain of carrying parcels will respond to a few treatments with heat and massage, the swollen knees and wrists of ' infective ' arthritis may only clear up with prolonged hospital treatment. The aim of the Clinic is to prevent certain forms of rheumatism from becoming serious by treating them in their early stages, to treat the simple forms of rheumatism rapidly and efficiently so that the individual may remain at work, and to relieve—if only temporarily—the painful and swollen joints of some of the elderly rheumatic people who come for help." 19 SANITARY ADMINISTRATION. ANNUAL REPORT of THE SANITARY INSPECTOR 1943 Public Health Department, Municipal Offices, New Malden. To the Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the pleasure to submit my twenty-fourth annual report of work accomplished and matters of interest concerning the Sanitary Department, which owing to the present exceptional circumstances will again be necessarily curtailed. 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 130 53 Complied 120 40 Remain outstanding 10 13 It was found necessary to apply to the Courts for Nuisance Orders in regard to six houses. Owing to the financial difficulties of the owners, repairs of a fairly extensive nature were carried out at a number of houses by a Contractor working under my supervision and paid by the Council. By agreement the owners are refunding the cost by monthly instalments. 20 Forty eight visits were made to houses prior to issuing letters to enable builders to obtain permits for wood from the Timber Control. SCABIES. Much time was again spent and many visits made in connection with the treatment of persons suffering from Scabies. Assistance was also given in dealing with a number of persons affected with head lice. The above entailed much work out of office hours. INFECTIOUS DISEASES. The following number of rooms were disinfected for the undermentioned causes :— Scarlet Fever 137 Diphtheria 1 Tuberculosis 35 Vermin— Houses 1 Booms 11 Puerperal Pyrexia 2 Cerebro-Spinal Fever 1 Other 16 One Public Elementary School was disinfected' throughout during the year. Two hundred and ninety-four books from the Public Library and Schools were disinfected for various reasons. Fourteen loads of bedding were removed for steam disinfection and two for destruction. In addition to the above, 24 blankets, 15 mattresses, 11 cushions and pillows from various posts and shelters have been disinfected or disinfested. 21 FOOD AND DRUGS ACT, 1938. During the year 124 samples were submitted to the Public Analyst for analysis. These comprised the following:— ARTICLES. ANALYSED. Adulterated or below standard. Formal. Informal. Total. Formal. Informal. Total. Milk 10 37 47 7 2 9 Flour, Self-raising 2 3 5 2 2 4 Flour, Plain — 4 4 — — — Butter — 3 3 — — — Lard — 3 3 — — — Cheese — 6 6 — — — Margarine — 2 2 — 2 2 Essence of Orange 1 — 1 — — — Essence of Lemon 1 — 1 — — — Tea — 8 8 — — — Fruit Sauce — 2 2 — — — Aspirin Tablets 1 — 1 — — — Bis. Mag. Tablets 1 — 1 — — — Sultanas — 4 4 — — — Coffee — 3 3 — — — Curry Powder — 3 3 — — — Baking Powder — 2 2 — 1 1 Forcemeat — 1 1 — — — Cocoa — 1 1 — — — Mustard Pickles — 1 1 — — — Vinegar — 2 2 — — — Semolina — 1 1 — — — Batter Flour — 1 1 — — — Saccharine Tablets — 1 1 — — — Piccalilli — 1 1 — — — Pudding Mixture — 1 1 — 1 1 Jam — 3 3 — — — Rice — 3 3 — — — Totals 16 96 112 9 8 17 Notes in regard Do samples shown as adulterated or below standard. Self-raising flour.—The samples contained fluorine in excessive quantities. It was decided not to prosecute in these cases. The flour was immediately withdrawn from sale by the vendors and the Ministry of Health communicated with. Margarine.—Each of these samples contained Boric Acid. The Public Health (Preservatives in Food) Regulations forbids the addition of preservatives in Margarine and for this reason the 22 Public Analyst returned them as being non-genuine. Under the Emergency Powers (Defence) Regulations, however, the addition of Borax is permitted under licence by the Ministry of Food. No action, therefore, was taken. Baking powder.—One informal sample contained less than eight per cent, of total carbon di-oxide. Milk.—In three instances (the same producer) proceedings were taken and fines of £5 with £1 Us. 6d. costs were made on each count. The four other milks were taken from another producer and although slightly deficient in milk solids other than milk fat, the freezing point of the samples did not indicate the presence of added water. " Appeal to the cow " samples were taken and these confirmed that the deficiency was due to the cows and not to tampering with the milk. A number of cases of overcrowding were reported or found in the course of visits. These had to be dealt with sympathetically, and it was not always possible to obtain an abatement of the conditions, although in several instances, with the help of the Housing Department, this was accomplished. Applications to be supplied with the permitted numbers for houses necessitated visits to and the measurement of 15 houses. 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 unfit foodstuffs were voluntarily surrendered and destroyed or handed over for salvage : — FOODSTUFFS VOLUNTARILY SURRENDERED. Beans 23 tins Meats (various) 60 „ Fish 146 „ Fruits and Vegetables ... 131 „ Milk 252 „ Soup 21 „ Eggs 102 „ Chocolate 246 bars OVERCROWDING. FOOD SUPPLY. 23 FOODSTUFFS VOLUNTARILY SURRENDERED—(contd.) Sweets 96 lbs. Dried Eggs 4 packets Beef 30 lbs. Meat trimmings 63 lbs. Rabbits 50 Bacon 17 lbs. Sausages 54 „ Sausage Meat 61 „ Margarine 6½ „ Butter 4 „ Cheese 98½ „ Fish (wet) 526 „ Liver 10 „ Biscuits 23½ „ Tea ½ „ Cocoa 8 „ Coffee 1 jar Flour 2 bags Split Peas 112 lbs. Sponge Mixture 168 packets Miscellaneous 51 tins Soup *158 „ Milk *844 „ Oxo Cubes *50 tins *Emergency Feeding Stocks. There are only two slaughter-houses in the district; one has been used on isolated occasions. 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 1 1 do. (rooms) 11 11 (b) Other houses 4 4 24 Every house becoming vacant on the Corporation's Estates is carefully inspected before re-letting. 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 with entirely satisfactory results. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders:— Dealers. Tuberculin tested 7 Pasteurised 7 Pasteurisers' licences 1 Supplementary. Tuberculin tested 3 Pasteurised 4 » Twenty samples of milk were submitted for examination and in five instances they were also examined for the presence of Tubercle bacilli by animal experiment with negative results. In three instances high counts were recorded and can mostly be accounted for by the prevailing abnormal conditions. Two samples reported upon unfavourably were bottled and produced outside the district and active investigations were made to find the cause of the trouble. Fifteen samples of pasteurised milk were submitted to the phosphatase test, and in fourteen a negative result was returned. SMOKE ABATEMENT. Prom time to time informal action had to be taken in regard to isolated smoke nuisances. It is not easy to deal with this problem, when so often it is caused by inferior fuel, with no possibility of getting better. 25 RATS AND MICE DESTRUCTION. Brevity on this subject is most difficult. So much has happened and so much work done during the year that I feel best to confine my remarks to brief generalities on the situation rather than to go into details. So far as urban rats and mice are concerned Ministerial responsibility under the Rats and Mice Destruction Act passed from the Ministry of Agriculture and Fisheries to the Ministry of Food in 1942. In May, 1943, the Infestation Order came into being. This does not supplant the Rats and Mice (Destruction) Act, but among other things gives the Ministry of Food powers to issue " Directions" to Local Authorities to perform certain functions. The first of these " Directions " was issued in June and called upon the Local Authorities to submit to the Minister a report with respect to the extent to which land (as defined) within the Area of the Council is subject to infestation by Rats and Mice and without prejudice to the foregoing a special report had to be made without delay as to any major infestations within the area. The report was duly forwarded after a careful survey. Following this a further " Direction " was issued to proceed with all necessary action for the remedying of all infestations on any land within the area of the Council. Appropriate steps have been taken to comply with this. In the meantime the Ministry of Food made an extensive publicity campaign to direct the attention of the public to the necessity of co-operating. As a result, for a short period, we were inundated with requests for assistance. Many of these, however, did not prove very helpful, and a great many thought that they would receive the services of operatives free of charge. Before the War, this district was to the forefront in this branch of work. For years past, publicity has been given to the subject, and the problem was undoubtedly kept 26 well in hand by obtaining the active co-operation of householders. Charges made for assistance were purposely kept at a minimum to encourage people to come forward and give information regarding infestations and not to frighten them with the possibility of heavy charges and penalties. The problem now has become more difficult. The fact that every other person keeps fowls or other live stock, the presence of Anderson shelters in back gardens and other war-time necessities has provided every encouragement to the rat population to breed and thrive. Towards the end of the year an additional man had, of necessity, to be appointed to assist in rodent destruction. Proceedings were instituted in one instance and a conviction obtained. MISCELLANEOUS. The nuisance at a factory to which I referred last year only recurred in very modified form. Energetic action reduced the number of rats to a minimum, whilst the fly and cricket menace was not in evidence. What trouble did occur arose from smell, and complaints were very few. I feel the Council will realise that the foregoing represents only a brief summary and by no means the whole of the activities of the Sanitary Department. Civil Defence claims a great deal of time both during and after office hours, but this has not been allowed to interfere with essential Public Health duties. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, HENRY TUNBRIDGE, Chief Sanitary Inspector. .