MAL 8 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED DECEMBER 31st 1944 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.8. (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.R.San.I., Sanitary Inspector. †A. H. Newport, M.S.I.A., Sanitary Inspector. Arthur O. Scott, Rodent Officer. *Oliver Elliott, General Assistant and Mortuary Keeper. †‡Frederick W. W. Mitchell, Clerk. *Died September, 1944. †On Active Service. ‡Returned to duty April, 1944. TEMPORARY. Ernest C. Challis, Casualty Staff Officer. Mrs. A. Savage, Shorthand Typist. A. Lovegrove, Assistant to Rodent Officer. Borough of Malden and Coombe ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1944 Public Health Department, Municipal Offices, New Malden. July, 1945. 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 1944, which has been prepared in accordance with Ministry of Health Circular 49/35. Vital statistics recorded in the text show that the year has been a uniformly good one. The high birth rate has been maintained and there have been reductions in the general death rate and in the infantile mortality rate. The incidence of infectious disease has been low and it is pleasant to record that no case of diphtheria was notified. I wish again to thank members of the staff of the department for their continued hard work and efficiency during a year when air attack made especially great demands on them. I am also grateful to those members of the Civil Defence Services who assisted in general public health work. The death during the year of Mr. O. Elliott, an old and trusted servant of the Council, was a sad loss to the Department. 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 1944) 35,480 VITAL STATISTICS. Total. M. F. Birth rate per 1,000 of the estimated resident population 18.0 Live births 639 322 317 (legitimate) 302 298 (illegitimate) 20 19 Stillbirths 14 9 5 Rate per 1,000 total (live and still) births 21.4 Deaths 326 167 159 Death rate per 1,000 of the estimated resident population 9.1 Deaths from puerperal causes:— Deaths. Rate per 1,000 Total (Live & Still) Birth*. Puerperal sepsis Nil Nil Other Maternal Causes 1 1.5 Death rates of Infants under one year of age:— All Infants per 1,000 live births 29.7 Legitimate Infants per 1,000 legitimate live births 30.0 Illegitimate Infants per 1,000 illegitimate live births 20.5 Deaths from Cancer (all ages) 52 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhœa (under 2 years of age) 1 3 BIRTHS. During the year 639 live births were registered, a decrease of 46 under last year's total. The rate per 1,000 population was 18.0 compared with an average for England and Wales of 17.6. Of the total number 39 or 6.1 per cent. were illegitimate. The birth rate is only fractionally less than the high recording of the previous year. DEATHS. During the year 326 deaths were registered, a decrease of 55 under those recorded in 1943. The death rate per 1,000 population was 9.1 compared with an average of 11.6 for England and Wales. There was no single outstanding cause of death calling for comment. The infantile mortality rate was very low at 29.7 per 1,000 live births and was even better for illegitimate infants than for legitimate. CAUSES OF DEATH. M. F. Total. Typhoid and paratyphoid fevers — — — Cerebro-spinal fever — — — Scarlet fever — — — Whooping cough — — — Diphtheria — — — Respiratory tuberculosis 10 5 15 Other forms of tuberculosis — — — Syphilitic diseases 2 — 2 Influenza 2 3 5 Measles — — — Acute poliomyelitis and polioencephalitis — — — Acute inf.: encephalitis — — — Cancer 31 21 52 Carried forward 45 29 74 4 Brought forward 45 29 74 Diabetes 1 — 1 Intra-cranial vascular lesions 12 23 35 Heart disease 43 36 79 Other circulatory diseases 4 3 7 Bronchitis 7 12 19 Pneumonia 14 7 21 Other respiratory diseases 3 2 5 Ulcer of stomach and duodenum 4 — 4 Diarrhœa (under 2 years) 1 — 1 Appendicitis 1 1 2 Other digestive diseases 1 6 7 Nephritis 3 7 10 Puerperal or post-abortive sepsis — — — Other maternal causes — 1 1 Premature birth 4 3 7 Congenital malformations; birth injury; infant diseases 3 3 6 Suicide — — — Road traffic accidents 1 1 2 Other violent causes 11 6 17 All other causes 9 19 28 All causes 167 159 326 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 9 4 1 2 4 9 21 32 64 21 167 Females 10 — — 2 4 3 13 19 66 42 159 Totals 19 4 1 4 8 12 34 51 130 63 326 5 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District. Surrey County Hospitals London and other Hospitals. Tolworth Hospital. Other Districts. Total. 156 91 54 1 24 326 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years:— 1940 (21 Legitimate 3 Illegitimate) 24 1941 (18 „ None „) 18 1942 (21„ 1 „) 22 1943 (23„ None „) 23 1944 (18„ 1 „) 19 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 7 Congenital diseases, Malformations, Birth injury, Infant diseases 6 Other 6 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 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 1944 18.0 29.7 9.1 MORTUARY. Twenty-one 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 seven instances and the following verdicts were returned:— Natural causes 3 Accidental 3 Misadventure 1 RAINFALL, 1944. Table showing rainfall in the district during 1944, taken at the Sewage Disposal Works, California Road, New Maiden:— inches January 1.32 February 0.65 March 0.05 April 1.56 May 0.90 June 2.01 July 2.18 August 2.30 September 2.11 October 2.61 November 3.49 December 1.28 20.46 Increase on previous year 0.73 inches. Average for past 5 years 22.75 inches. 7 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1944. 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 17.6 † 20.3 20.9 15.0 Deaths under 1 year of age 46 52 44 61 Still Births 0.50 † 0.64 0.61 0.42 Deaths:— Deaths from Diarrhœa and Enteritis under 2 years of age 4.8 7.3 4.4 10.1 All Causes 11.6 † 13.7 12.4 15.7 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 *A dash (—) signifies that there were no deaths. Whooping Cough 0.03 0.03 0.02 0.04 Diphtheria 0.02 0.03 0.03 0.01 Rates per 1,000 Total Births (Live and Still). Influenza 0.12 0.10 0.11 0.08 Small-pox 0.00 — — — Measles 0.01 0.01 0.01 0.00 Maternal Notifications:— Mortality:— (Excluding Abortion) Typhoid Fever 0.01 0.01 0.01 0.01 Puerperal Infection (No. 147) 0.28 Not available. Paratyphoid Fever 0.01 0.00 0.01 0.01 Cerebro Spinal Fever 0.05 0.06 0.04 0.06 Others 1.25 Total 1.53 Scarlet Fever 2.40 2.41 2.67 1.57 Notification:— Whooping Cough 2.49 2.49 2.29 2.90 Diphtheria 0.58 0.67 0.69 0.31 Puerperal Fever 10.34 13.13 9.25 3.61 Erysipelas 0.29 0.32 0.28 0.37 Small-pox 0.00 0.00 0.00 0.00 Puerperal Pyrexia †14.14 Measles 4.16 4.51 3.94 2.98 Pneumonia 0.97 1.13 0.82 0.93 † Bates per 1,000 Total Population. † Including Puerperal Fever. 8 NOTIFICATION OF INFECTIOUS DISEASES, 1944. 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 ... ... — — — — — — — — — — — — — Erysipelas ... ... 9 — — — — — 1 — 1 — 1 5 1 Pneumonia ... ... 12 — 1 — 1 — 3 — — 2 3 1 1 Puerperal pyrexia ... ... — — — — — — — — — — — — — Scarlet fever ... ... 98 — — 6 2 8 48 23 6 2 2 1 — Dysentery ... ... 9 1 1 2 — — 3 — — — — 1 1 Cerebro-spinal fever ... ... 2 — — — — — 1 — 1 — — — — Malaria ... ... 34 — — — — — — — — 29 5 — — Measles ... ... 22 2 1 2 — 4 5 2 1 5 — — — Whooping cough ... ... 44 1 13 10 4 4 12 — — — — — — Totals ... 230 4 16 20 7 16 73 25 9 38 11 8 3 DISEASES WARDS Totals Coombe Dickerage Mount Cambridge Norbiton Park Central Burlington Malden St. James Diphtheria ... ... — — — — — — — — — — Erysipelas ... ... 9 1 3 1 1 — 1 1 1 — Pneumonia ... ... 12 2 2 2 — 2 — 1 2 1 Puerperal pyrexia ... ... — — — — — — — — — — Scarlet fever ... ... 98 12 4 2 8 6 7 7 32 20 Dysentery ... ... 9 4 2 — — 1 — — 2 — Cerebro spinal fever ... ... 2 — 1 — — — — 1 — — Malaria ... ... 34 34 — — — — — — — — Measles ... ... 22 1 3 1 3 1 1 4 3 5 Whooping cough ... ... 44 9 4 1 2 4 3 — 16 5 Totals ... 230 63 19 7 14 14 12 14 56 31 9 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The epidemic incidence of scarlet fever continued during the first quarter of the year, after which the number of notifications rapidly diminished and there were only a few cases in the second half of the year. The total number of cases notified was 98 compared with 185 for the previous year. This gives a rate of 2.19 per 1,000 population. The proportion of cases treated at home was increased, a figure of 43 as against 55 removed to Hospital. Once again there was no evidence that retention at home resulted in an increased number of secondary cases and an advantage lay with the home treated cases inasmuch as they gave rise to no "return cases."A" return case" is a case which has presumably been infected by another case within 28 days of the latter's return from hospital or release from isolation. There were four "infecting cases" among hospital treated patients who gave rise to four "return cases" after discharge. In three out of the four there were residual infective conditions of the ear, nose or throat. There were only nine instances in which more than one ease occurred in a family. Scarlet fever commonly occurs as a single case in a family and the source of infection is, more often than not, untraceable. The type of disease, on the whole, remained mild and no deaths occurred. DIPHTHERIA. No ease of diphtheria was notified during the year, a unique circumstance for the district. Annual records going back for fifty years do not show a previous negative return within that period. While immunisation has, no doubt, played a part in producing this happy event good fortune has also been partly responsible, as the desirable goal of a completely immune child population has not yet 10 been reached. Indeed, mainly as a result of the disturbed conditions associated with evacuation and air attack, there was a considerable fall in the number of children treated. At the end of the year it was estimated that of the children living in the district age 0-5 years 40 per cent. have been immunised, and of the children age 5-15 years 81 per cent. have been immunised. As children are not immunised before their first birthday 80 per cent, is the maximum possible in the first age group. Steps are being taken to prepare a complete nominal roll of all the children in the district so that determined efforts can be made to persuade by personal approach the parents of unimmunised children to take advantage of the benefits offered to them. With movements of children in and out of the district and age changes the clerical task of keeping such a record up to date is likely to be great and only experience will show whether it is practicable or not, but the advantage to a community in being able to abolish such a serious disease as diphtheria is so important that it is worth a considerable expenditure of effort and money. The following statistics refer to immunisation carried out during the year:— Number of cases completing treatment by M.O.H. during the year (pre-school children 232, school children 35) 267 Number of cases treated by private doctors under the Council's scheme 34 Number of Schick tests 69 Number of children receiving reinforcing doses 129 Total attendances at Clinic 586 CEREBRO-SPINAL FEVER. The low incidence of cerebro-spinal fever was maintained, only two cases being notified. Both cases made good recoveries, 11 MEASLES. The incidence of measles was comparatively low. The 22 cases notified represent the smallest number since notification became general in 1939. The type of illness was not severe and no requests were received from practitioners for prophylactic serum. Four cases were treated in Hospital. There were no deaths. MALARIA. A new feature was the notification of 34 cases of malaria. These were notified from a military camp and were relapses in cases where the disease was contracted abroad. While the situation is being watched, it is not anticipated that any difficult problem is likely to arise by the infection of the ordinary civilian population in this country. SCABIES. The scheme for the treatment of scabies referred to in the Report for last year continued successfully. Towards the end of the year a number of new cases were imported as a result of the return of evacuees from various parts of the country. The total number of families affected was slightly less than during the previous year. During 1944, 483 persons from 139 families received treatment. Of these 330 persons showed definite lesions, the remainder being contacts in the same families. VERMINOUS CONDITIONS. Cases of infestation by the head louse were referred to the department from various sources from time to time and these were treated by Civil Defence nurses with Lethane. 22 eases from 9 families were cleansed in this manner. One case of body louse infestation came under notice and was treated. He was a workman temporarily resident in the district. Infestation by the body louse is very rare in this district and no previous case has been encountered for a number of years. 12 CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales. Borough of Maiden & Coomb. Scarlet fever 2.40 2.76 Diphtheria 0.58 Nil Typhoid fever 0.01 Nil Paratyphoid fever 0.01 Nil Cerebro-spinal fever 0.05 0.05 Measles 4.16 0.62 Whooping cough 2.49 1.24 *Puerperal pyrexia 10.34 Nil * per 1,000 total births (i.e., live and stillbirths). TUBERCULOSIS. Age Period NEW CASES DEATHS Respiratory Non-Respiratorv Respiratory Non-Respiratorv Male Female Male Female Male Female Male Female 0 — — — — — — — — 1 — — 1 — — — — — 5 — — 3 — — — — — 15 5 4 2 1 2 — — — 25 5 7 — — 4 2 — — 35 — 3 — — — 1 — — 45 1 1 — — 2 2 — — 55 — — 1 — 1 — — — 65 & upwards 1 — 1 — 1 — — — Totals 12 15 8 1 10 5 — — In 1943 the rise in the incidence of tuberculosis which marked the early war years was replaced by a fall which was repeated during the current year. The number of new cases notified has now almost reached the pre-war level again. The following table shows the variations of tuberculosis (all forms) from the years immediately preceding the war to the present year:— 13 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 1944 35,480 36 1.01 15 0.42 Notification of tuberculosis was, on the whole, satisfactory. There were 2 cases during the year which did not come to light until after death. The facilities for X-ray examination offered by arrangement with the Kingston Victoria Hospital was made use of by 10 cases. 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 two cases compared with the previous year:— Pulmonary. Non-Pulmonary. Males 97 23 Females 77 22 CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 54 do. (not confirmed) 3 Pneumonia 2 do. (not confirmed) 1 Diphtheria (not confirmed) 1 Measles 2 Whooping cough 10 Chicken pox 1 Tonsilitis 1 Cerebro-spinal fever 2 German measles 2 Typhoid fever (not confirmed) 1 Septic rash following scabies 4 Eczema 1 Erysipelas 2 Dysentery, diarrhœa, etc 12 99 14 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1939 1940 1941 1942 1943 1944 Scarlet fever 96 46 23 48 185 98 Diphtheria 6 5 7 8 1 — Typhoid Fever 1 3 — — — — Paratyphoid fever — 2 1 — — — Erysipelas 11 2 6 4 9 9 Pneumonia 24 18 20 12 46 12 Encephalitis Letliargica — — — — — — Puerperal pyrexia 9 2 1 5 7 — Cerebro spinal fever — 15 6 6 2 2 Acute Poliomyelitis — — — — — — Ophthalmia Neonatorum 1 — — — 1 — Dysentery — — 2 28 1 9 Malaria — — — — — 34 *Measles — 409 232 360 221 22 *Whooping cough — 13 133 28 143 44 Tuberculosis (all forms) 38 49 53 63 44 36 Suspected Food Poisoning 3 4 — — — — *Notifiable since November, 1939. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. The following table shows the number of pathological examinations during the past year:— Type of Specimen. Results. Totals. Positive. Negative. Tuberculosis Sputa 1 20 21 Hæmolytic Streptococci Swabs 7 39 46 Diphtheria Swabs — 40 40 Dysentery Faeces 1 18 19 do Blood — 2 2 Totals 9 119 128 A number of samples of milk were submitted for bacterial count or for the presence of tubercle bacilli, details of which will be found in the report of the Sanitary Inspector. TREATMENT OF RHEUMATISM. Details of the Council's scheme for the treatment of rheumatism were given in my report for last year. The arrangements with the Red Cross Curative Post continued and it was possible to do a great deal to alleviate the pains and disabilities of this crippling group of diseases, 15 One of the chief advantages of the scheme is that general practitioners are able to send their patients to a consultant in rheumatic diseases who advises the form of treatment most suitable for the individual and this saves much time and energy which might otherwise have been directed to unprofitable channels. Furthermore, apart from the physio-therapeutic treatment actually given at the clinic, the patient's doctor is advised regarding care and management at home, which is not the least important aspect of the problem. The cost of the scheme to the Council for 1944 was £938 and there is no doubt that this sum was well spent.. During the year 87 new patients attended, and a total of 5,324 treatments was given. I am indebted to Dr. Francis Bach, consultant in rheumatic diseases to the Red Cross Post, for the following note:— Routine work of the Rheumatism Clinic continues. The Doctors working in the Borough are referring more patients who are at work or who have been at work, until a few days prior to their first visit to the Clinic. In many of these people their work has been the trigger factor, if not the main causative factor of their disease. Some patients suffering from an advanced stage of rheumatoid arthritis have been sent to me. As they could not be adequately treated as out-patients and needed prolonged institutional treatment, we could offer them too little help and I had to write to the Doctors suggesting symptomatic medical treatment. Arrangements, however, were made for one young woman with early rheumatoid arthritis to be admitted for investigation and treatment to one of the Sector hospitals under my care. She benefited greatly from the period of mental and physical rest and is now back at work. Two patients have been admitted, under my care, to the Rheumatic unit at St. Stephen's, L.C.C. for observation and treatment, The number 16 of patients attending the Red Cross Curative Post is so great that, unfortunately, there is usually an interval between the first consultation and the time of the patient being taken on for physical treatment. This is unfortunate, as early treatment is so important. We have also had to decide to limit the length of time that we are able to treat those who are elderly and come for symptomatic relief. We now give them one or two courses of treatment and then stop, asking them to report again at the end of a stated period, usually two or three months. The X-ray and laboratory facilities have proved of great help., both in differential diagnosis and in following the progress of our patients. My own clinical research during the last year has shown that the " stress and strain of city life," the bombing and personal worries are important " trigger " and causative factors in both rheumatoid arthritis and fibrositis and play a much greater role than " infection." These are problems of what is now called " psycho-somatic disease " and it is along the lines of social medicine that they will be solved. We need an Almoner or Social worker who can help us to modify the environment such as the housing, finance, diet, hours and type of work of some of our rheumatic patients. She should both attend at the clinics and pay visits to the patients' homes. We need facilities to take some patients into Hospital for a few weeks for investigation and treatment, and we need an increase in both our technical staff and equipment, if we are going to give good treatment to our out-patients, relieve their pain and keep them at work, whether it is in the factory, the office or in their own homes. I should like to express my admiration of the way in which Miss Reed and her staff have helped to tackle the " rheumatic problem." 17 SANITARY ADMINISTRATION. ANNUAL REPORT of THE SANITARY INSPECTOR 1944 Public Health Department, Municipal Offices, New Malden. To the Mayor, Aldermen and Councillors, Ladies and Gentlemen, I have the pleasure to submit my twenty-fifth Annual Report of work accomplished and matters of interest concerning; the sanitary department. This again must, necessarily, be curtailed in view of the existing circumstances. The year will remain in my memory as the most difficult in my experience. Quite early on the Medical Officer of Health, my deputy and myself all had to go into hospital in succession to undergo operations. At the same time Mr. Elliott was away sick. His illness lasted for more than six months and, to my great regret, had a fatal termination. This meant that the department, already understaffed and with many extraordinary duties to perform had to carry on as best could be. The situation was eased somewhat by the release of Mr. Mitchell from the Royal Air Force and he returned to duty in April. I should also like to acknowledge the assistance he gave before his release whilst on leave. In June the flving-bomb attacks commenced and for the following three or four months work had to go on almost incessantly, day and night. Routine matters, to a large extent, had to be placed in abeyance. The extensive damage done to house property in the district by these attacks meant that war damage repairs necessarily took priority over others and, consequently, ordinary repairs had to be limited to those of an urgent character. 18 For the purpose of abating nuisances or executing repairs to houses the following notices were served:— Preliminary. Formal. Notices served 88 29 Completed 70 25 Remaining outstanding 18 4 Many visits were made to houses prior to the issue of letters to enable builders to obtain permits for wood for the repair of floors. These had to be subsequently revisited for the purpose of checking up whether the repairs had, in fact, been done. SCABIES. Scabies again accounted for a large amount of time spent on visits and treatments, a great deal of which was done after normal office hours or during week ends. Assistance was also given in dealing with a number of persons affected with lice. WATER SUPPLY. The whole of the area is supplied by the Metropolitan Water Board and the supply has been satisfactory both as regards quality and quantity. In view of the large number of bacteriological examinations known to be carried out by the Board it was not considered necessary to make any local tests. All dwelling-houses in the area are supplied by public water mains direct to the houses. INFECTIOUS DISEASES. The following number of rooms were disinfected for the undermentioned causes:— Scarlet fever 61 Tuberculosis 28 Vermin— Houses 3 Rooms 7 Dysentery 2 Others 11 19 Parts of several elementary schools were disinfected during the year. A number of books from the public library and schools were also disinfected for a variety of reasons. Seven loads of bedding were removed for steam disinfection and two for destruction. In addition to the above, clothing, mattresses, blankets and pillows from various posts and shelters were disinfected or disinfested. FOOD AND DRUGS ACT, 1938. During the year 110 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 22 43 65 12 7 19 Rice — 2 2 — — — Tea — 2 2 — — — Baking powder — 1 1 — — — Self-raising flour 1 3 4 — 1 1 Plain flour — 2 2 — — — Cake flour — 2 2 — — — Lard — 1 1 — — — Butter — 2 2 — — — Margarine — 1 1 — — — Cheese — 1 1 — — — Whiskey 1 4 5 — 1 1 Rum — 2 2 — — — Gin — 2 2 — — — Beer — 6 6 — — — Cocoa — 2 2 — — — Mustard — 1 1 — — — Coffee — 2 2 — — — Onion essence — 1 1 — — — Jam — 1 1 — — — Curry powder — 1 1 — — — Vinegar — 1 1 — — — Pickles — 1 1 — — — Sausage meat 1 — 1 — — — Stuffing — 1 1 — — — Totals 25 85 110 12 9 21 20 Notes in regard to samples shown as adulterated or below standard. Milk.—Proceedings were instituted in one case. The defendant's solicitor submitted he had no case to answer as the prosecution had not proven, in fact, that the milk had been sold to the Milk Marketing Board. The submission was upheld, the Court holding that the label attached to the churn purporting to be signed by the defendant was not evidence of a contract for sale. The case was therefore dismissed and a sum of £3 3s. 0d. awarded to defendant. Summonses were issued in five other instances (one defendant) but owing to the illness of witnesses, etc., two adjournments were granted. Subsequently, owing to the intervention of the flying bomb emergency, the summonses were withdrawn. The deficiencies in the remaining six samples were slight and in none was the presence of added water indicated. It will be noted that one informal sample of whiskey was returned as being below standard. A formal sample, taken at a later date, was certified to be genuine. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders Dealers.s Tuberculin tested 5 Pasteurised 5 Pasteuriser's licence 1 Supplementary. Tuberculin tested 5 Pasteurised 6 Twenty-three samples of milk were submitted for examination and in seven instances they were also examined for the presence of tubercle bacilli, by animal experiment, with negative results. In four instances high counts were recorded. Two samples reported upon unfavourably were bottled and produced outside the district. Forty-eight samples of pasteurised milk were submitted to the Phosphatase test and in seven instances the result indicated that the sample had not been sufficiently heat treated. 21 Early in the year a new Defence Regulation was made restricting the supply of milk by retail to certain permitted classes of milk in areas to be specified by the Ministry of Food. The permitted classes are given as follows (1) Tuberculin tested milk lawfully sold as such. (2) Accredited milk lawfully sold as such and provided that all such milk sold by the dairyman is derived from one herd, and (3) Heat treated, pasteurised or sterilised milk. The object of the Regulation is to improve the quality of milk supplied to consumers and is, I feel, of some importance. At the present time there is no restriction on the sale of raw milk provided it is not labelled as tuberculin tested, pasteurised, or accredited. As will be seen the effect of the Regulation will be to ensure that any milk sold by retail other than tuberculin tested or accredited will have to be heat treated, pasteurised or sterilised and will have to be labelled as such. Milk sold as pasteurised is already governed by the Milk (Special Designations) Orders, but milk sold as heat treated or sterilised will have to comply with the requirements of the new Regulation. At the close of the year this area had not been specified and the Order, consequently, had not been put into operation. I can only express the personal hope that it will be in the near future. FOOD SUPPLY. As far as possible, watch is kept on premises where foodstuffs are prepared or sold, which includes slaughterhouses, butchers' and fishmongers' shops, bakehouses, dairies, etc. 22 The following unfit foodstuffs were voluntarily surrendered and destroyed or handed over for salvage:— Beans 8 tins Meats (various) 40 „ Fish 129 „ Fruit or vegetables 18 „ Milk 67 „ Soup 6 „ Chocolate 41 bars Eggs 107 Self-raising flour 108 lbs. Sugar 2 „ Figs 110 „ Dates 81 „ Prunes 25 „ Rolled oats 28 „ Chicken 2 „ Bacon 20 „ Ham 13 „ Cheese 19 „ Fish (wet) 966 „ Tea 6 „ Gravy powder 24 packets Breakfast food 50 „ Jam 9 jars Rabbits 140 Miscellaneous 20 tins In addition to the above much time was spent in dealing with quantities of foodstuffs destroyed or damaged by enemy action during the fly bomb period. It would be impossible, even if desirable, to enumerate all the various commodities and the amounts as much was so damaged as to be unrecognisable. It was possible, however, in cooperation with the Salvage officers of the Ministry of Food, to save a very large quantity such as sugar, flour and meat and the expenditure of some considerable amount of time was amply justified. Inventories were made of damaged stocks to enable shopkeepers to claim compensation and refund of points 23 and although it was not possible always to give actual amounts I have not heard that my estimates were ever questioned. Twenty-one food shops were affected in seven incidents. SMOKE ABATEMENT. The problem of smoke abatement does exist although comparatively it is not a serious one. Probably the worst offenders are laundry chimneys, but war-time difficulties in getting replacements for boiler furnace parts and inferior fuel were found to be the causes of a small number of complaints received. In each case investigated I am satisfied that every effort had been made to avoid excessive smoke. SHOPS ACTS. The whole of these Acts are administered by my Department, and there appear to have been no instances 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) 5 5 (b) Other houses 3 3 Houses becoming vacant on the Council's estates are carefully inspected before re-letting. These were, however, very few during the year under review. I am frequently asked to advise house owners on this problem and several houses have been treated by outside contractors. HCN is known to have been used in several cases with entirely satisfactory results. 24 RATS AND MICE DESTRUCTION. Once again I have to report a very full year's activity in this branch of the public health department. Every endeavour has been made to co-operate with the Infestation Branch of the Ministry of Food and regular visits arcpaid to the district by an area inspector of the Ministry. In the Report for last year I gave fairly full details of the position in regard to administrative responsibilities and it is unnecessary for me to repeat these. I should like, however, to refer to one important point. The public tends, more and more, to think it is the duty of the Local Authority to destroy rats and mice wherever they may be. It is very necessary to point out that this is not the case, as the impression frequently leads to a negative attitude on the part of the householder concerned. The occupier, and in some cases the owner, of land (which includes buildings) is charged with a statutory responsibility for destroying rats and mice on such land and for preventing it from becoming infested. Thus it will be seen that a Local Authority is not compelled by law to do any work of actual rat destruction, except on land occupied by them. They may, however, order an occupier to do this work and summon him if the order is not obeyed. As in all other activities it should be the object of a Local Authority and certainly of its officers to see that the requirements laid down by various Acts of Parliament arc carried out without, if possible, resource to the Courts. To provoke hostility by the service of notice threatening penalties is a poor substitute to the fostering of a spirit of co-operation. The latter gets the work done and ends with both sides being satisfied with no ill feelings as an aftermath. Consequently I am happy to say that it has been the policy for a number of years to make the charges for the 25 services of the rodent officer as low as reasonably possible. In most cases a merely nominal charge is made and in some it is excused altogether. A few there are who will not co-operate initially but it is seldom, with tact, that this attitude lasts long. Advice is given free, and often no more is required with the exception of following up at a later date to record results. During the year sewer treatment was carried out in one part of the Borough. The results varied somewhat but did not seem to me to justify further expenditure of time unless the opportunity arises when other work slackens off. MISCELLANEOUS. I would like to refer to the loss the department has sustained by the death of Mr. Elliott. He was a faithful servant of the Council for 36 years, and ever since I was appointed 25 years ago he was a loyal colleague and a constant friend. I feel that the Council will realise that the foregoing represents only a brief summary and by no means the whole activities of the Sanitary Department. An exceptional year of Civil Defence activities claimed a considerable amount of time but this was not allowed to interfere with essential health duties although it did, nevertheless, make them more difficult to perform efficiently. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, HENRY TUNBRIDGE, Sanitary Inspector.