MAL 9 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE Year Ended December 31st 1945 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. (Loud.), 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. *Mrs. M. J. Butler, Public Health Nurse. Frederick W. W. Mitchell, Clerk. †On Active Service. *Commenced duties June, 1945. TEMPORARY. Ernest C. Challis, Casualty Staff Officer. Mrs. A. Savage, Shorthand Typist. A. E. Wilson, Assistant to Rodent Officer. Borough of Malden and Coombe ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1945 Public Health Department, Municipal Offices, New Malden. July, 1946. 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 1945, which has been prepared in accordance with Ministry of Health Circular 28/46. Vital statistics for the year have been satisfactory on the whole, and, as a result of more settled conditions, there has been a considerable increase in the resident population. This has, of course, tended to aggravate the most pressing problem of the moment—that of housing. I should like to record my appreciation of the work of the sanitary and clerical staff of the department during the year. The Public Health staff was.strengthened by the appointment of Mrs. M. Butler as nurse, but otherwise remained unchanged. The burden of Civil Defence was laid down without reluctance, although this necessitated parting with the services of Mr. E. C. Challis, Casualty Staff Officer, to whom I am very grateful for the sterling work he has put in since 1939. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FANNING, Medical Officer of Health. 2 STATISTICAL AND SOCIAL CONDITIONS OF THE AREA. Area 3,162 acres. Registrar-General's estimate of resident poula- tion (mid-year, 1945) 38,090 VITAL STATISTICS. Trotal M. F. Live births 637 322 315 Birth rate per 1,000 of the estimated resident population 16.7 (legitimate) 305 292 (Illegitimate) 17 23 Stillbirths 8 3 5 Rate per 1,000 total (live and still) births 12.4 Deaths 352 \ 169 183 Death rate per 1,000 of the estimated resident population 9.2 Deaths from puerperal causes:— Deaths. Bate per 1,000 Total (Live & Still) Births. Puerperal sepsis Nil Nil Other Maternal Causes Nil Nil Death rates of Infants under one year of age:— All Infants per 1,000 live births 40.8 Legitimate Infants per 1,000 legitimate live births 36.8 Illegitimate Infants per 1,000 illegitimate live births 100.0 Deaths from Cancer (all ages) 69 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 1 BIRTHS. During the year 637 live births were registered, a decrease of 2 under last year's total. The rate per 1,000 population was 16.7 compared with an average for England and Wales of 16.1. Of the total number 40 or 6.2 per cent, were illegitimate. The birth rate is less than the high recording of the previous two years. 3 DEATHS. During the year 352 deaths were registered, an increase of 26 over those recorded in 1944. The death rate per 1,000 population was 9.2 compared with an average of 11.4 for England and Wales. There was no single outstanding cause of death calling for comment. The infantile mortality rate was 40.8 per 1,000 live births. No deaths occurred from maternal causes. CAUSES OF DEATH. M. F. Total Typhoid and paratyphoid fevers — — — Cerebro-spinal fever — — — Scarlet fever — — — Whooping cough — 1 1 Diphtheria — — — Respiratory tuberculosis 5 8 13 Other forms of tuberculosis 2 2 4 Syphilitic diseases 1 — 1 Influenza 1 — 1 Measles — 1 1 Acute poliomyelitis and polioencephalitis — — — Acute inf.: encephalitis — — — Cancer 42 27 69 Diabetes — 2 2 Intra-cranial vascular lesions 12 19 31 Heart disease 34 55 89 Other circulatory diseases 1 4 5 Bronchitis 12 6 18 Pneumonia 9 6 15 Other respiratory diseases 3 2 5 Ulcer of stomach and duodenum 3 1 4 Diarrhoea (under 2 years) 1 — 1 Appendicitis — 1 1 Other digestive diseases 4 5 9 Nephritis 7 3 10 Puerperal and post abortive sepsis — — — Carried forward 137 143 280 4 Brought forward 137 143 280 Other maternal causes — — — Premature birth 3 5 8 Congenital malformations; birth injury; infant diseases 12 4 16 Suicide 2 1 3 Road traffic accidents 1 2 3 Other violent causes 2 3 5 All other causes 12 25 37 All causes 169 183 352 DEATHS. AGE GROUPS. Under 1 1-5 5-15 15-25 25-35 i 35-45 45-55 55-65 65-80 80 & over Totals Males 15 3 1 7 2 8 15 33 64 21 169 Females 11 2 2 3 5 9 10 24 80 37 183 26 5 3 10 7 17 25 57 144 58 352 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District Surrey County Hospitals. London and other Hospitals. Tolworth Hospital. Other Districts. Total. 167 101 52 2 30 352 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years: — 1941 (18 Legitimate None Illegitimate) 18 1942 (21 „ 1 ,, ) 22 1943 (23 „ None „ ) 23 1944 (18 „ 1 „ ') 19 1945 (22 ,, 4 ,, ) 26 5 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE Prematurity 8 Congenital diseases, Malformations, Birth injury, Infant diseases 16 Other 2 SUMMARY OF BIRTHS, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 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 1945 16.7 40.8 9.2 MORTUARY. Twenty-one bodies were brought to the Mortuary and a post mortem examination was made on each. H.M. Coroner for the district held inquests in four instances and the following verdicts were returned:— Accidental 1 Suicide 2 Manslaughter 1 RAINFALL. 1945. Table showing rainfall in the district during 1945 taken at the Sewage Disposal Works, California Road, New Maiden :— inches January 1.62 February 1.31 March 0.96 April 1.19 May 2.32 June 1.41 July 3.32 August 1.22 September 1.54 October 2.20 November 0.25 December 2.68 20.02 Decrease on previous year 0.44 inches. Average for past 5 years 21.86 inches. 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1945. 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. Deaths under 1 year of age 46 54 43 53 Live Births 16.1† 19.1 19.2 15.7 Still Births 0.46† 0.58 0.53 0.40 Deaths:— Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 7.8 4.5 7,6 All Causes 11.4 † 13.5 12.3 13.8 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 Coug 0.02 0.02 0.01 0.02 Diphtheria 0.02 0.02 0.02 0.01 Rates per 1,000 Total Births (Live and Still). Influenza 0.08 0.07 0.07 0.07 Small-pox - - - - Maternal Measles 0.02 0.02 0.02 0.01 Mortality:— (Excluding Abortion) Notifications: — Puerperal Typhoid Fever 0.01 0.01 0.01 0.01 Infection Paratyphoid (No. 147) 0.24 Not available. Fever 0.01 0.00 0.01 0.00 Others 1.22 Cerebro Spinal Fever 0.05 0.05 0.05 0.06 Total 1.46 Scarlet Fever 1.89 2.02 2.03 1.57 Notification: — Whooping Coug] 1.64 1.65 1.47 1.25 Diphtheria 0.46 0.52 0.56 0.31 Puerperal 9.93 12.65 8.81 3.60 Erysipelas 0.25 0.28 0.24 0.31 Fever Small-pox 0.00 0.00 — 0.00 Puerperal 115.87 Measles 11.67 10.89 11.19 9.08 Pyrexia Pneumonia 0.87 1.03 0.72 0.78 † Including Puerperal Fever. † Rates per 1,000 Total Population. 7 NOTIFICATIONS OF INFECTIOUS DISEASES, 1945. DISEASES Totals Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-56 65 and over. Diphtheria 10 — 1 3 3 2 1 _ Erysipelas 5 — — — — — — — — — 1 2 2 Pneumonia 14 1 1 — 1 — 2 — — — 2 4 3 Puerperal pyrexia 4 — — — — — — — — 1 2 1 — — Scarlet fever 25 — — — 1 1 6 12 2 2 — 1 — Dysentery 53 2 12 5 3 — — — 2 1 4 1 8 15 Cerebro spinal fever 2 — — — 1 — 1 — Malaria ... 28 — — — — — 5 22 1 Measles ... 589 15 28 54 44 50 365 17 9 4 2 1 Whooping cough 43 1 11 10 4 5 12 — — — — — — — Totals ... 773 19 52 69 53 57 389 32 15 13 32 10 14 18 DISEASES Totals Coombe Dickerage Mount Cambridge WARDS Norbiton Park Burlington Maiden Green St. James Maiden Manor Diphtheria 10 2 5 2 1 — Erysipelas 5 2 2 — 1 Pneumonia 14 — 2 2 2 1 1 3 1 2 Puerperal pyrexia 4 — — — 1 3 Scarlet fever 25 4 3 2 5 3 5 3 Dysentery 52 27 22 2 1 1 — Cerebrospinal fever 2 1 1 Malaria 28 28 _ Measles 589 36 99 84 53 43 60 63 51 100 Whooping cough 43 2 19 1 3 — 1 4 7 6 Totals 773 102 149 92 60 47 69 74 65 115 8 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. There was a considerable falling off in the number of scarlet fever cases notified during the year. The total number of cases notified was 25 compared with 98 for the previous year. This gives a rate of 0.65 per 1,000 population. • The majority of cases were treated in hospital, only five being kept at home. Among the hospital treated cases there was one " infecting case," i.e., a case which is presumed to have given rise to another case in the home within twenty-eight days of its release from isolation. With the exception of this one case there was no instance of multiple infection in the same household. DIPHTHERIA. Ten cases of definite diphtheria occurred, while eight other cases of suspected diphtheria were diagnosed as not so suffering after observation in hospital. All of the cases were mild or moderate, and no serious complications occurred. Five of them had been previously immunised at some time. Experience has not shaken belief in the value of immunisation, but it has shown that the protection afforded is of limited duration in a certain proportion of cases. Regular Schick testing is of value in assessing a child's resistance to diphtheria, but even the Schick test is not an absolute criterion of immunity. Probably the best method of ensuring the retention of a high degree of immuity is a combination of reinforcing doses during the earlier years with Schick testing repeated every few years later on. There are still a number of children in the district, however, who have not yet had their first immunisation. At the end of the year records in the Public Health Department showed 9 that of the children living in the district aged 0-5 years 46 per cent, have been immunised, and of the children 5-15 years 7i per cent, have been immunised. As a number of children have certainly been immunised privately and in other districts it is probable that this is an under estimate. The following statistics refer to immunisation carried out during the year :— Number of cases completing treatment by M.O.TI. during the year (pre-school children 467, school children 103) 570 Number of cases treated by private doctors under the Council's scheme 56 Number of Schick tests 1,551 Number of children receiving reinforcing doses 334 Total attendances at Clinic 1,247 CEREBROSPINAL FEVER. Only two cases of cerebro-spinal fever were notified, both ot' whom made good recoveries. MEASLES. The incidence of measles was very high. The 589 cases notified represent the largest number since notification became general in 1939. The general type of illness was very mild, however, and only six cases were removed to hospital. Prophylactic serum for contacts was supplied for 40 cases to medical practitioners. One death occurred in an old lady aged 84 who was temporarily living outside the district. DYSENTERY. Of the 53 cases of Sonne dysentery notified, the greater number occurred in connection with two separate outbreaks. The first occurred at a Public Assistance residential children's nursery and affected eighteen children and three of the staff. The infection was introduced by one of the children and spread from case to case. All the cases .were mild, but the children were removed to hospital for isolation. 10 The second outbreak occurred at a large mental institution for old ladies. Here again the infection was from case to case, and in view of the favourable conditions for the spread of infection, it is fortunate that the number of cases was limited to 22. These were dealt with by isolation in a special ward. MALARIA. I drew attention in my report for last year to a new feature in the notification of a number of cases of malaria in soldiers contracted while serving abroad, and mentioned that it was not anticipated that any difficult problem was likely to arise by infection of the ordinary civilian population. A further twentyeight similar cases among the military were notified during the year. SCABIES. The scheme for the treatment of scabies referred to in recent reports continued successfully. The total number of families affected was slightly more than during the previous year. During 1945, 545 persons from 150 families received treatment. Of these 298 persons showed definite lesions, the remainder being contacts in the same families. In addition 34 children in a residential institution, of whom 27 showed lesions, received treatment. VERMINOUS CONDITIONS. Cases of infestation by the head louse were referred to the department from various sources from time to time, and Ihese were treated by the Public Health nurse. 32 cases from 13 families were treated in this manner. There is still great scope for improvement in the cleanliness of the population in this respect. The supervision of children in school only is not sufficient, as they are frequently re-infested by younger children or older women in the home. The Public Health nurse works in close co-operation with the school authorities by visiting the homes of infested children, and treating the relatives where necessary as well as the school children. No ease of body louse infestation came under notice. 11 CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England & Wales. Borough of Maiden & Coombe. Scarlet fever 1.89 0.65 Diphtheria 0.46 0.26 Typhoid fever 0.01 Nil Paratyphoid fever 0.01 Nil Cerebro-spinal fever 0.05 0.05 Measles 11.67 15.43 Whooping cough 1.64 1.12 † Puerperal pyrexia 9.93 6.20 †per 1,000 total births (i.e., live and stillbirths). TUBERCULOSIS. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 — — — — — — — — 1 3 — — — 2 — — — 5 2 1 2 — — — — 1 15 6 4 1 — 1 — 1 1 25 4 5 — 4 — 2 1 — 35 3 — — — 1 4 — — 45 3 1 — 55 1 1 — — — 1 — — 65 & upwards 2 1 — — 1 1 — — Totals 24 13 3 4 5 8 2 2 The fall in the number of new cases of tuberculosis experienced in 1944 was not maintained, and the notifications approximated to the 1943 level. These are, however, still well below the figures for the early war years. With improvements in early diagnosis it is not expected that in the near future notification rates are likely to fall quickly. The following table shows the variations of tuberculosis (all forms) from the years immediately preceding the war to the present year 12 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 1945 38,080 44 1.15 17 0.44 Notification of tuberculosis was, on the whole, satisfactory. There were 6 cases during the year which did not come to light until after death. The mass radiography unit of the Surrey County Council was set up in an annex to the Council Offices for three weeks, and an opportunity was given to factory workers and other organised bodies to undergo X-ray examinations. The facilities for X-ray examination offered by arrangement with the Kingston Victoria Hospital was made use of by 8 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, an increase of 20 compared with the previous year. Pulmonary Non. pulmonary Males 113 24 Females 80 22 CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 20 Scarlet fever (not confirmed) 3 Pneumonia 3 Diphtheria 10 Diphtheria Carriers 5 Diphtheria (not confirmed) 8 Measles 6 Whooping Cough 3 13 Chicken Pox 1 Tonsillitis 3 Cerebro-spinal fever (not confirmed) 3 Vincents agina 2 Impetigo 1 Poliomyelitis (not confirmed) 1 Erysipelas 3 Dysentery, diarrhoea, etc. 26 Quinsy 1 99 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1940 1941 1942 1943 1944 1945 Scarlet fever 46 23 48 185 98 25 Diphtheria 5 7 8 1 — 10 Typhoid fever 3 — — — — — Paratyphoid fever 2 1 — — — — Erysipelas 2 6 4 9 9 5 Pneumonia 18 20 12 46 12 14 Encephalitis Lethargica — — — — — — Puerperal pyrexia 2 1 5 7 — 4 Cerebro-spinal fever 15 6 6 2 2 2 Acute Poliomyelitis — — — — — — Ophthalmia Neonatorum — — — 1 — — Dysentery — 2 28 1 9 53 Malaria — — — — 34 28 Measles 409 232 360 221 22 589 Whooping cough 13 133 28 143 44 43 Tuberculosis (all forms) 49 53 63 44 36 44 Suspected Food Poisoning 4 — — — — — GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. The following table shows the number of pathological examinations during the past year:— Types of Specimen Results Positive Negative Totals Tuberculosis Sputa 4 32 36 Haemolytic Streptococci Swabs 4 13 17 Diphtheria Swabs 9 115 124 Dysentery Faeces 6 41 47 Miscellaneous — 3 3 Totals 23 204 227 14 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 1943. The general arrangements continued successfully during the year, the cost of the scheme to the Council being £968. During the year 80 new patients attended, and a total of 5,570 treatments was given. I am indebted to Dr. Francis Bach, consultant in rheumatic diseases to the Red Cross Curative Post for the following note :— " During the past year the Rheumatic Clinic has continued its routine activities. There have been 3,314 attendances in the Physical Medicine Department. As before, a considerable number of patients have been referred for X-ray and pathological investigations, and two patients have been admitted under my care into the Rheumatic Unit at St. Stephen's Hospital, L.C.C. Research into rheumatic diseases is progressing along several lines. We have known for a long time that constitutional factors are important. Certain forms of rheumatism, such as gout and spondylitis ankylopoetica are seen much more frequently in men than in women, whereas rheumatoid arthritis and Heberden's nodes are much more common in women. . We are now finding that persons of one sex who get a form of rheumatism which is common in the other sex may have many of the physical characteristics of that sex. An example of that in the Arts is Motley's picture of Margaret of Parma, with " her imperious temper, her masculine appearance, her moustache and her gout." We have shown the importance of psychological upsets as trigger factors in the causation of rheumatoid arthritis and fibrositis. Also, we are convinced of the importance of 15 sociological studies and the modification in the patient's environment that should be carried out. We have introduced new pharmacological methods as the use of prostigmine for the relief of pain and muscle spasm in rheumatoid arthritis. We have learnt that the numbness, tingling, and uselessness of the hands and fingers which we meet so commonly in the middle-aged women who come to the Rheumatic Clinic are often just one sign of their chronic fatigue. This is the result of excessively heavy duties and household work necessitated by the war. Their muscles are atonic, their shoulder girdles have fallen, and some branches of the brachial plexus are caught between the arms of a vice formed by the clavicle and the upper chest wall. A period of rest from all domestic work is of more value than intensive physical treatment in the relief of these symptoms. Rheumatic people can do a great deal to help themselves by using simple physical remedies in their own homes. We have started to give our patients some instruction along these lines. Mrs. Butler has visited several of our patients in their own homes, and has been able to give them appreciable help both in their domestic troubles and in their dietetic and housing difficulties. Sister Reed, in spite of the smallness of her staff, has run the clinic most efficiently and has somehow managed to find time, space and staff for the physical treatment of our rheumatic patients. During the year we have tended to concentrate our physical treatments rather more on the younger patients who are referred to us, and we have limited the length of treatment which we have given to our older patients. We give them one or two courses of treatment, and then keep in touch with them and they report to be seen by me at stated intervals." 16 WORK OP THE PUBLIC HEALTH NURSE. The Council decided to make an appointment of a State registered nurse to the Public Health Department from June, 1945. The duties of this officer included assistance with diphtheria immunisation, the treatment of scabies and other verminous conditions, routine infectious disease enquiries, the supervision of infectious eases treated at home, the following up of cases discharged from the isolation hospital, and various other useful functions. The following is a record of certain aspects of the work done during the period of the year she was on duty:— Home visits in connection with infectious diseases and other matters 559 Attendances at diphtheria immunisation sessions 19 Number of visits for scabies 371 Number of visits for head lice 224 17 SANITARY ADMINISTRATION. ANNUAL REPORT OF THE SANITARY INSPECTOR 1945 Public Health Department, Municipal Offices, New Malden. To the Mayor, Aldermen and Councillors, Ladies and Gentlemen, I have the pleasure to submit my twenty-sixth Annual Report of work done and matters of interest concerning the sanitary department. The end of the war in Europe gave some relief chiefly in regard to civil defence duties but, although these services were disbanded in June, a large amount of work remained to be cleared up so that it was not until towards the end of the year that any appreciable effect could be felt. I do feel that, at some time or other when the opportunity occurs, a record of the tremendous amount of these war-time activities should be placed on record. The whole of the administration in connection with First Aid Posts, Ambulances, Heavy and Light Rescue, Oas Identification, Mortuary and Food Decontamination Services was done in the department under extremely difficult and trying circumstances. Looking back I feel a sense of satisfaction that, with the loyal backing of the staff of the department under the leadership of the Medical Officer of Health, this work which commenced long before the outbreak of war was so successfully accomplished. The carrying out of ordinary house repairs was again handicapped by the large amount of war damage repairs occasioned by the flying bomb attacks, but nevertheless a good deal of urgent house repairs were done. 18 For the purpose of abating nuisances or executing repairs to houses, the following notices were served:— Preliminary 138 Abatement 68 Informal (dustbin only) 259 Formal (dustbin only) 32 It was necessary to apply to the Court for Nuisance Orders in nine instances. These referred to the following:— Public Health Act, 1936. Section 92 (d) Effluvia caused by trade or business.—Nuisance order made. Section 92 (b) Animals so kept as to be a nuisance.—Nuisance order made. Section 92 (a) Premises in such a state as to be a nuisance. Nuisance orders made 2 Applications withdrawn, work having been completed before hearing 3 Applications withdrawn after adjournment, work having been carried out in the meantime 2 In a number of instances after inspection, the bulk of the work required was found to be due to war damage and in these cases the matters were referred to the War Damage Department. • In two instances, at the request of owners, owing to their inability to pay the cost in one sum, the work was done by builders under my instructions and the costs recovered by monthly payments. In addition to visits made to check house repairs being carried out after service of notices, many visits were also made prior to the issue of letters to enable builders to obtain permits for wood for the repair of floors. These had subsequently to be revisited for the purpose of checking up whether the repairs had, in fact, been done. SCABIES. The continued prevalence of Scabies again accounted for a large amount of time spent on visits and treatments, a great 19 deal of which was done after normal office hours or during week-ends. 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 16 Tuberculosis 27 Vermin 6 Diphtheria 8 Puerperal Pyrexia 4 Others 20 One elementary school was disinfected during the year. A number of books from the public library and schools were also disinfected for a variety of reasons. Twenty loads of bedding were removed for steam disinfection or destruction, and three loads were dealt with otherwise. In addition to the above, clothing, mattresses, blankets and pillows from various posts, shelters, or emergency services were disinfected or disinfested. FOOD AND DRUGS ACT, 1938. During the year 110 samples were submitted to the Publie Analyst for analysis. These comprised of the following:— 20 ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Milk — 29 29 — — — Vinegar — 3 3 — — — Pea flour — 2 2 — 1 1 Baking powder — 2 2 — — — Tea — 1 1 — — — Pork Sausages — 8 8 — — — Beef Sausages 2 1 3 — 1 1 Margarine — 4 4 — 1 1 Butter 1 3 4 — — — Black pepper — 2 2 — — — Ground ginger — 2 2 — — — Ground cinnamon — 1 1 — — — Self-raising flour 3 9 12 2 2 4 Plain flour — 2 2 — — — Sauce — 3 3 — — — Ground nutmeg — 1 1 — — — Curry — 1 1 — — — Pickles — 2 2 — — — Cocoa — 3 3 — — — Lard — 2 2 — — — Steam pudding Mixture - 1 1 - - - Malted soyacream - 1 1 — — — Semolina - 2 2 — — — Cake flour - 2 2 — — — Fish & meat paste - 2 2 — — — Chocolate spread - 1 1 — — — Mixed Herbs - 1 1 — — Mustard - 2 2 — — — Yorkshire pudding mixture - 1 1 - - - Jam - 2 2 — — — Custard powder - 1 1 — — — Coffee - 1 1 — — — Saccharine - 2 2 — '— — Aspirin - 2 2 — — — Honey - 1 1 — — — Chutney - 1 1 — 1 1 Totals 6 104 110 2 6 8 Notes in regard to samples shown as adulterated or below standard. Self-raising flour.—The deficiencies in these samples were in regard to the yield of carbon-dioxide which, at the time of taking the samples, was prescribed by the Food Standards (Self-raising flour) Order, 1944, to be not less than 0.45 per cent. The two formal samples yielded 0.35 and 0.40 per cent. respectively. The vendors were written to in each ease. N.B.—The minimum has since been lowered to 0.40 per cent. In December a letter was circulated to all shopkeepers selling selfraising flour drawing attention to these deficiencies. 21 Chutney.—This sample contained 150 parts per million sulphur dioxide as a preservative. Public Analyst's comments:— I have reported the presence of sulphur dioxide in this sample, but do not consider it worth while to follow the matter up. Dried fruit and now dehydrated vegetables manufactured under licence are allowed relatively large amounts of sulphur dioxide and as such fruit and vegetables are, or at any rate may be the basis of chutney (this sample if fruit and vegetable basis) the sulphur dioxide would be allowable under the "necessarily introduced" proviso of the Preservatives Regulations. Pea Soup Flour.—In this case the sample was infested with mites and grubs and was thereby unfit for food. On visiting the shop it was established to be very old stock, the shopkeeper having only two or three packets' left. These were destroyed. Margarine.—This sample contained a small amount of excess water. It was really submitted on account of complaints in regard to taste and in regard to this the Analyst reported: — As to taste the article is alkaline in reaction due, I suggest, to some error in refining of the oils used, this would result in some soap formation and give an unpleasant flavour. I confirm that the taste is unpleasant but could not say the article is unfit for food, though complaint is justified and probably to be expected. The matter was taken up with the Ministry of Food and no more complaints were received. Beef Sausages.—Instead of containing 37½ per cent. meat and 7½ per cent. low fat Soya, the sample had 40 per cent. meat and no Soya. A formal sample taken later was found to be correct. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders / Dealers. Tuberculin tested 5 Pasteurised 5 Pasteuriser's licence 1 Supplementary. Tuberculin tested 6 Pasteurised 6 One hundred and sixty-three samples of milk were submitted for examination and in five instances were also examined 22 for the presence of tubercle bacilli by animal experiment with negative results. Of the above 150 were examined by plate count to see if they exceeded the limit of 100,000 per ml. prescribed by the Milk (Special Designations) Order. Ninety-six samples were below the limit whilst fifty-four were above. Of 152 samples submitted to the Phosphatase test, 137 passed and 15 failed. Those on which the Methylene Blue test was made numbered 148. 114 passed the test whilst 34 failed. The large number of samples examined were occasioned by trouble which occurred in respect of the milk from one firm. Many complaints were received that the milk did not keep fresh for a reasonable time after delivery. I have found some difficulty in presenting figures which correctly indicate the position and perhaps a few remarks on this subject will prove informative. I attach the greatest importance to the phosphatase test which indicates whether or not milk has been properly pasteurised. Correct pasteurisation reasonably ensures that all pathological organisms have been eliminated. As can be seen 137 samples passed this test and 15 failed. On some occasions, however, three samples were taken on the same day of the milk from the same firm, at different points in the district. Often these would represent the same bulk milk and two or three failures (as did so happen) would really represent only one. Similarly those that passed may represent fewer actual bulk samples. The importance, however, is reflected in the failures which might be reduced to half the number shown. I feel, therefore, that so far as actual pasteurisation is concerned the results are not unsatisfactory, as the percentage of failures would be of reasonable proportions. 23 The methylene blue tests, which indicate whether or not the milk is of good keeping quality, were not so satisfactory. 34 samples failed this test and although these could be reduced for the same reasons as given for the phosphatase tests, nevertheless the percentage of failures was too high and confirmed the complaints. As this has been the subject of special reports to the Council, I feel that nothing more need be said here. The plate counts showed even a higher percentage of failures, and to a certain extent confirmed the methylene blue results, but on occasions a satisfactory methylene blue test was obtained with high plate counts. The plate count is not reliable because of the fact that non-pathological organisms will often increase the count without necessarily affecting the keeping qualities or actual purity. Some valuable information, however, was gained with all these samples and allowed me to indicate to the firm in question many points where improvement in the distribution could be effected. Lack of cold storage accommodation (since remedied), lengths of rounds, etc., all entered into the causes of the trouble and I hope during the next spell of hot weather that the keeping qualities of this firm's milk will at least equal that of other milk purveyors. Nothing further transpired during the year in regard to the restrictions of sale of raw milk by retail to certain permitted clases of milk in areas to be specified by the Ministry of Food. POOD SUPPLY. As far as possible, watch is kept on premises where foodstuffs are prepared or sold, which includes slaughter-houses, butchers' and fishmongers' shops, bakehouses, dairies, etc. The following unfit foodstuffs were voluntarily surrendered and destroyed or handed over for salvage:— 24 Chopped ham, 61b. tins 1 tin Chopped ham, 2½1b. tins 15 tins Luncheon meat or chopped ham, 71b. tins ... 2 tins Luncheon meat or stewed steak, 12oz. tins ... 56 tins Pork-sausage meat 4 tins Beans 102 tine Pish 157 tins Vegetable or Fruit 32 tins Milk 399 tins Oranges 3,714 lbs. Soup 5 tins Jam and Marmalade 131 jars Boiled Sweets 11 lbs. Mars bars and raisin choco-milk 72 bars Butterscotch 3 pkts. Eggs 1,775 Dates, currants and sultanas 30 lbs. Fish (wet) 75 stone Beef 360 lbs. Sugar 95 lbs. Self-raising flour (31b. bags) 31 bags Potatoes 1 cwt. Butter, margarine and lard 7¼ lbs. Cheese 21¼ lbs. Poultry 58 lbs. Babbits 60 Crabs 24 lbs. Cocoa and coffee 7¼ lbs. Bacon and ham 30¼ lbs. Tea 13¼ lb. pkts. 90 1 oz. pkts. Pudding or cake mixture 93 pkts. or tins Meat paste 7 jars Prunes and dates 70 lbs. Sauces 28 bote or tins Pickles 2 jars Cooking fat 10 ozs. Orange juice 30 bots. Dried eggs 2 pkts. Marmite or Bovril 2 jars Stewed steak 12 tins Lemon Curd 1 jar Lamb's tongue 1 tin During the year quite a number of specimens of food were brought to the office by householders with some complaint or other in regard to them. It was often, however, quite impossible to deal with them owing to the period which had elapsed between the time of purchase and my seeing the offending commodity. Meat was the most frequent subject, but quality and not condition was more often than not the reasons of complaint. 25 One specimen was alleged to have caused illness, but analysis proved that this could not have been so. A certain number of specimens are brought with a request that they should be analysed. No complaint is made, but apparently the person would like to know what the constituents are. Requests of this nature have to be refused as it is not the Council's business to act in the capacity of advisors in this respect. Section 69 of the Food and Drugs Act, 1938, seems to provide for this. Under sub-section (2) any person, other than a sampling officer, who has purchased any food or drug may submit a sample of it to be analysed by the public analyst for the area in which the purchase is made. The public analyst may demand in advance a fee from such person for conducting the analysis. SMOKE ABATEMENT. This problem, although not comparatively a serious one, has been in evidence during the year and householders in certain parts of the district have been inconvenienced thereby. Undoubtedly war-time difficulties have been contributory factors, but with the gradual return to more normal conditions the problem should soon become of negligible proportions. 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 — — do (rooms) 6 6 (b) Other houses 2 2 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 36 lem and several houses have been treated by outside contractors. HCN is known to have been used in one or two cases with entirely satisfactory results. The advent of the new D.D.T. preparation should prove extremely useful in dealing with problems of this nature. RATS AND MICE DESTRUCTION. This work has gone on without interruption. I am sorry to say that Mr. Scott resigned his position in December after being with this council for eight years. He was the first operative to be employed and did excellent work whilst here. He left to take up an appointment as Rodent Officer at Great Yarmouth. In my last Annual Report I made fairly full reference to the administration of this work, but I feel that the Council's policy of making only small charges to occupiers of dwelling houses has again been fully justified. I am certain that nearly all cases of infestation become known quickly by reason of the fact that occupiers of houses are not deterred from reporting them by the thought that it will mean heavy costs and possibly official action. I cannot emphasise the fact enough, and I hope anyone reading this report will gain and spread the knowledge that we are out to assist and not harrass householders in getting rid of rats. This does not mean, of course, that householders should do nothing. Active co-operation is essential and most assistance in this respect can be made by carrying out the suggestions of the Rodent Officer on rat prevention measures so far as possible, to avoid re-infestation. One large operation was undertaken. This was in the Lower Marsh Lane area where the Kingston Corporation tips, small holdings, etc., are situated. A survey of this area revealed major infestation. I called for the co-operation of the Rodent Officer of the Surrey County Council and the Sanitary Inspectors of Kingston and Surbiton to deal with this. A week's combined drive was made with excellent results. Representatives of the Infestation Branch of the Ministry of Pood attended whilst this was being done. 27 No work on sewers was undertaken during the year. I am sure that there is no serious problem in this district from this cause. There are a number of factors which tend to make it so, but plans have been made to treat some more sections during the year 1946. MISCELLANEOUS. In September I felt obliged, owing to the pressure of other work, to ask to be relieved of duties in connection with the Borough Ambulance Service. During the year the County Council deposited a quantity of brick rubble, etc., on the estate at the extreme southern end of the district to form the embankment for a new road. Houses in the neighbourhood later became infested with crickets and there was little doubt that the heap was providing an excellent harbourage and breeding place for these insects. The heap was treated with insecticides by the Pest Destruction Officer of the County Council which had a beneficial effect. Insect killing powder and distributors were obtained and given to householders affected. Blockages in drains have provided a good deal of work. Simple blockages occurring in the interceptors were most frequently met with, and in most cases were due to something abnormal getting into the drain. In a few cases the trouble was more difficult to overcome and the Engineer's Department had to be asked to open the ground and deal with the cause. Once again 1 would like to state that the foregoing represents only a brief summary and by no means the whole activities of the Sanitary Department. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, HENRY TUNBRIDGE, Sanitary Inspector. , .1 ■... ■ a , ... V..