MAL10 Borough of Malden anb Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE Year Ended December 31st 1946 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. Medical Officer of Health. Henry Tunbridge, M.R.San.I. Chief Sanitary and Foods Inspector. Douglas J. Hughes, C.R.S.I., Sanitary Inspector. A. H. Newport, C.R.S.I., Sanitary Inspector. Bernard Ll. Prichard, Rodent Officer. Mrs. M. J. Butler, S.R.N., Public Health Nurse. Frederick W. W. Mitchell, Clerk. TEMPORARY. Mrs. A. Savage, Shorthand Typist. A. E. Wilson, Assistant to Rodent Officer. PUBLIC ANALYST: Daniel D. Moir, M.Sc., F.R.I.C. Borough of Malden and Coombe ANNUAL REPORT or THE MEDICAL OFFICER OF HEALTH 1946 Public Health Department, Municipal Offices, New Malden. July, 1947. 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 1946, which has been prepared in accordance with Ministry of Health circular 13/47. Vital statistics, which are dealt with in the text, are very satisfactory and show an advantage in almost every department over the average for the country as a whole. The population, as estimated by the Registrar-General, represents a big increase over that of the previous year which was probably under-estimated. The population of the district is now considerably higher than it has ever been in the past and it is almost superfluous to say that the most pressing problem of the moment is that of housing. I should like to record my appreciation of the work of the sanitary and clerical staff during the year, and to thank the other chief officers for the co-operation and help given by their departments. 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 population (mid-year, 1946) 43,160 VITAL STATISTICS. Total M. F. Live births 756 363 393 Birth rate per 1,000 of the estimated resident population 17.5 (Legitimate) 345 378 (Illegitimate) 18 15 Stillbirths 12 4 8 Rate per 1,000 total (live and still) births 15.6 Deaths 370 177 193 Death rate per 1,000 of the estimated resident population 8.5 Deaths from puerperal causes:— Deaths. Rate 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 19.8 Legitimate Infants per 1,000 legitimate live brths 19.3 Illegitimate Infants per 1,000 illegitimate live births 30.3 Deaths from Cancer (all ages) 57 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) Nil BIRTHS. During the year 756 live births were registered, an increase of 119 over last year's total. The rate per 1,000 population was 17.5 compared with an average for England and Wales of 19.1. Of the total number 33 or 4.3 per cent. were illegitimate. The birth rate is higher than that of last year but does not quite reach the high recordings of the two preceding years. 3 DEATHS. During the year 370 deaths were registered, an increase of 18 over those recorded in 1945. With the increase of population, however, the rate per 1,000 was lower, being 8.5 compared with an average of 11.5 for England and Wales. The infantile mortality rate was 19.8 per 1,000 live births, a remarkably low rate, comparing with a figure of 43 for England and Wales. For the second year in succession there was no deaths from maternal causes. CAUSES OF DEATH. M. F. Total Typhoid and paratyphoid fevers — — — Cerebro-spinal fever — — — Scarlet fever — — — Whooping cough — — — Diphtheria — 1 1 Respiratory tuberculosis 5 9 14 Other forms of tuberculosis — — — Syphilitic diseases 1 1 2 Influenza 1 3 4 Measles — — — Acute Poliomyelitis and polio encephalitis — — — Acute inf.: encephalitis — _ — Cancer 26 31 57 Diabetes — 1 1 Intra-cranial vascular lesions 15 36 51 Heart disease 61 45 106 Other circulatory diseases 6 7 13 Bronchitis 12 12 24 Pneumonia 5 7 12 Other respiratory diseases — 1 1 Ulcer of stomach and duodenum 5 1 6 Diarrhoea (under 2 years) — — — Appendicitis 1 1 2 Other digestive diseases 6 4 10 Nephritis 2 4 6 Carried forward 146 164 310 4  M. F. Total Brought forward 146 164 310 Puerperal and post abortive sepsis — — — Other maternal causes — — — Premature birth 1 2 3 Congenital malformations; birth injury; infant diseases 4 8 12 Suicide 2 — 2 Road traffic accidents 3 1 4 Other violent causes 5 6 11 All other causes 16 12 28 All causes 177 193 370 DEATHS. AGE GROUPS. Under 1 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-80 80 & over Totals Males 7 2 2 2 3 9 10 38 82 99 177 Females 8 1 3 5 3 12 10 28 76 47 193 15 3 5 7 6 21 20 66 158 69 370 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District Surrey County Hospitals. London and other Hospitals. Tolworth Hospital. Other Districts. Total. 204 85 52 1 28 370 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years:— 1942 (21 Legitimate 1 Illegitimate) 22 1943 (23 „ None „ ) 23 1944 (18 „ 1 „ ) 19 1945 (22 „ 4 „ ) 26 1946 (l4 „ 1 „ ) 15 5 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE Prematurity Atelectasis Birth injuries Congenital malformations Overlying Acute gastritis Toxæmia of pregnancy Broncho-pneumonia 3 1 hour; 5 hours; 9 hours. 3 4 days; 4 days; 12 days. 2 15 hours; 2 weeks. 3 4 hours; 1 day; 4 days. 1 1 month. 1 1 week. 1 8 hours. 1 4 months. SUMMARY OF BIRTHS, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 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 1946 17.5 19.8 8.5 MORTUARY. Twenty-three bodies were brought to the Mortuary and a post mortem examination was made on each. H.M. Coroner for the district held inquests in seven instances and the following verdicts were returned:— Accidental 2 Suicide 2 Natural Causes 1 Misadventure 1 Open Yerdict 1 RAINFALL, 1946. Table showing rainfall in the district during 1946 taken at the Sewage Disposal Works, California Road, New Maiden:— inches January 1.36 February 2.21 March 1.11 April 2.20 May 3.25 June 2.40 July 1.12 August 4.08 September 3.12 October 0.93 November 3.21 December 2.25 27.24 Increase on previous year 7.22 inches Average for past 5 years 22.06 inches Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1946. Provisional figures based on Weekly and Quarterly Returns. England and Wales Rates 126 C.Bs. and Great Towns Including London per 1,000 148 Smaller Towns Resident Pop. 25,000— 50.000 1931 Census Civilian Populaton 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 Live Births 19.1 † 22.2 21.3 21.5 Deaths under 1 year of age 43 45 37 41 Still Births 0.53† 0.67 0.59 0.54 Deaths:— Deaths from Diarrhoea and Enteritis under 2 Years of age 4.4 6.1 2.8 4.2 All Causes 11.5 † 12.7 11.7 12.7 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 Scarlet {'ever 0.00 0.00 0.00 0.00 *A dash (—) signifies that there were no deaths. Whooping Cough 0.02 0.02 0.02 0.02 Diphtheria 0.01 0.01 0.01 0.01 — Rates per 1,000 Total Births (Live and Still). Iufluenza 0.15 0.13 0.14 0.12 Small-pox 0.00 0.00 0.00 — Measles 0.00 0.01 0.00 0.01 Maternal Notifications:— Mortality: — (Excluding Abortion) Typhoid Fever 0.01 0.01 0.01 0.01 Puerperal Infection (No. 147) 0.18 Paratyphoid Fever 0.02 0.02 0.01 0.01 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 Others 1.06 Scarlet Fever 1.38 1.51 1.33 1.42 Total 1.34 Whooping Cough 2.28 2.48 2.05 2.22 Notification: — Diphtheria 0.28 0.32 0.31 0.24 Erysipelas 0.22 0.25 0.22 0.27 Puerperal Fever 8.50 10.35 7.63 9.68 Small-pox 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 Pneumonia 0.89 1.02 0.74 0.75 Puerperal Pyrexia t Rates per 1,000 Total Population. 6 7 NOTIFICATIONS OP INFECTIOUS DISEASES, 1946. DISEASES Totals Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 65 and over. Diphtheria 5 — — — — — — 3 1 1 — — — — Erysipelas 7 — — — — — — — 1 — — 1 3 2 Pneumonia 15 — — — 1 — 3 — — — — 3 5 3 Puerperal pyrexia 2 — — — — — — — 1 — 1 — — — Scarlet fever 44 — 1 5 1 3 18 8 2 2 4 — — — Dysentery 2 — — — — — — — — — 1 — 1 — Cerebrospinal fever 1 — — — — — 1 — — — — — — — Poliomyelitis — — — — — — 1 1 — — — — — — Measles 152 4 18 8 16 23 80 2 1 — — — — — Whooping cough 75 6 8 12 14 13 19 1 — — — 2 — — Totals 305 10 27 25 32 39 122 15 6 3 6 6 9 5 DISEASES Totals Coombe Dickerage Mount Cambridge WARDS Norbiton Park Burlington Malden Green St. James Maiden Manor Diphtheria 5 2 — — — 1 — ' — 1 1 Erysipelas 7 — 3 — 1 1 — — 2 — Pneumonia 15 1 4 2 — 3 1 — — 4 Puerperal pyrexia 2 — — 1 — 1 — — — — Scarlet fever 44 10 3 4 1 4 6 8 3 5 Dysentery 2 — — — — 1 — — 1 — Cerebro-spinal fever 1 — — 1 — — — — — — Poliomyelitis 2 — 1 — — — 1 — — — Measles 152 6 46 22 19 16 11 7 14 11 Whooping cough 75 3 16 5 3 10 3 16 14 5 Totals 305 22 73 35 24 37 22 31 35 26 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The number of cases of scarlet fever notified during the year was comparatively low, a total of 44 giving an incidence rate of 1.01 per 1,000 population. The majority of cases were mild, and no fatalities occurred. Twelve cases were treated at home, and thirty-two cases were removed to hospital. As is commonly the way in scarlet fever the great majority of patients did not infect other members of the family. DIPHTHERIA. Five cases of diphtheria occurred in residents of the district. Three of these cases were associated with an extensive outbreak at a private day school for girls. This outbreak raised many points of importance in connection with our knowledge of the behaviour of diphtheria in the immunised. One case occurred in a military camp in the district. The other case was that of a maid in a private house, who developed p severe attack of faucial diphtheria which was unfortunately not diagnosed. The illness proved fatal, and was the subject of inquest proceedings. This occurred about the same time as the school outbreak, but no connection between the two events was traceable. The outbreak of diphtheria referred to above was the subject of a special report to the Council and has been published in detail elsewhere (British Medical Journal, 22nd March, 1947). It is proposed therefore, to give only a short summary here. The school involved is a modern private day school for children of all ages and it is attended by over 300 pupils from this and surrounding districts. The proportion of children adequately immunised at some previous time was 94 per cent. and as many as 80 per cent. were negative to the Schick test at the time of the outbreak. In spite of this 18 children were taken ill with diphtheria over a period of 8 9 7 weeks, some of them being severely affected. It was found, however, that the case rate was considerably higher among the small group of children who had never been immunised and the severe cases occurred among children whose immunisation dated back longer than five years. The chief lessons to be learned from this occurrence are the limited value of the Schick test as a measure of immunity and the necessity for repeated re-inforcing doses of antigen until the end of school life. At the end of this year records in the Public Health Department s howed that of the children living in the district aged 0—5 years 47 per cent. have been immunised, and of the children 5—15 years 81 per cent. have been immunised. The figures for school children have improved, as recent visits to schools have shown that many children have been immunised in other districts. It is also probable that a number of children under five, for whom no records are available, have been immunised privately. The following statistics refer to immunisation carried out during the year:— Number of children completing treatment by M.O.H. during the year (pre-school 420, school 150) 570 Number of children treated by private doctors under the Council's scheme 22 Number of Schick tests 1,340 Number of children receiving re-inforcing doses 1,207 Total attendances at Clinic 1,806 CEREP.RO-SPINAL FEVER. Only one case of cerebro-spinal fever was reported. This was a girl of five, who made a good recovery. ACUTE POLIOMYELITIS. Two cases of acute poliomyelitis in children were reported. Neither had any connection with the other or apparently with any other case. Although they recovered from the acute attack, there was unfortunately a considerable degree of residual paralysis of the lower limbs in both cases, 10 MEASLES. After an epidemic prevalence in the previous year the incidence of measles was lower than the average for recent years; 152 cases were notified, and these were confined mainly to the summer months. The general type of illness was mild, and no requests for prophylactic serum were received. WHOOPING COUGH. The incidence of whooping cough was moderate, 75 cases being notified. Immunisation against this disease is carried out to a considerable extent in certain districts, but the evidence of its value is at present very conflicting. No recommendation has therefore been made to provide a public scheme in this district, as it is considered that there would be an extremely bad psychological effect in pressing a preventive measure which later might have to be withdrawn. A large scale experiment is now being carried out by the Medical Research Council on whooping cough immunisation, which it is hoped will have fruitful results. SCABIES. The scheme for the treatment of scabies referred to in recent reports continued successfully. During 1946, 525 persons from 132 families received treatment. Of these 297 persons showed definite lesions, the remainder being contacts in the same families. In one case it was necessary to institute a prosecution under the Scabies Order 1941. On an undertaking being given to accept treatment, no penalty was inflicted by the Court. 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 the Public Health nurse. 9 cases from 4 families were treated in this manner. A considerable improvement has been effected in the cleanliness of school children during recent years by the Public Health nurse, who, 11 working in co-operation with the school authorities, visits the homes of infested children and ensures the treatment of all members of the family at the same time. No case of body louse infestation came under notice. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England & Wales. Borough of Malden & Coombe. Scarlet fever 1.38 1.01 Diphtheria 0.28 0.11 Typhoid fever 0.01 Nil Paratyphoid fever 0.02 Nil Cerebro-spinal fever 0.05 0.02 Measles 3.92 3.52 Whooping cough 2.28 1.73 †Puerperal pyrexia 8.50 2.60 † per 1,000 total births (i.e., live and stillbirths). TUBERCULOSIS, 1946. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 — — — — — — — — 1 1 — — — — — — — 5 1 1 3 — — — 15 6 5 1 1 — 3 — — 25 6 3 2 2 1 2 — — 35 6 3 — — 2 2 — — 45 4 — — — 1 — — — 55 2 1 — 1 — 1 — — 65 & upwards 1 1 1 — 1 1 — — Totals 27 13 5 7 5 9 — — The mortality rate from pulmonary tuberculosis is now only one-third of the high peak rate registered in 1941 and shows a tendency to decline. The number of new cases notified annually is considerably below that of the early war years but has shown no tendency to diminish over the past four years. With the improvements in early diagnosis arising from 12 mass radiography and other modern methods of ascertainment it is not expected that in the near future notification rates are likely to fall quickly. The table shows the trend of tuberculosis in this district since 1938. Sympathetic consideration is given by the Housing Committee to special recommendations made by me for the housing of the tuberculous. TUBERCULOSIS, 1938—1946. NEW CASES. DEATHS. Year Estimated Population. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. No Rate per 1.000 Population No. Rate per 1,000 Population. No. Rate per 1.000 Population. No. Rate per 1.000 Population. 1938 38,800 29 0.74 8 0.20 10 0.25 1 0.02 1939 39,630 31 0.78 7 0.17 14 0.35 — — 1940 38,360 43 1.12 7 0.18 26 0.67 1 0.02 1941 33,920 45 1.32 8 0.23 31 0.91 5 0.14 1942 37,070 51 1.37 12 0.32 21 0.56 3 0.08 1943 37,750 35 0.92 9 0.23 15 0.39 — — 1944 35,840 27 0.75 9 0.25 15 0.41 — — 1945 38,080 37 0.97 7 0.18 13 0.34 4 0.10 1946 43,160 40 0.92 12 0.27 14 0.32 — . — Notification of tuberculosis was, on the whole, satisfactory. There were 3 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 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 21 compared with the previous year. Non- Pulmonary Pulmonary Males 126 25 Females 82 27 13 CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 32 Scarlet fever (not confirmed) 2 Pneumonia 3 Diphtheria 3 Diphtheria Carriers 3 Diphtheria (not confirmed) 7 Measles 6 Whooping Cough 1 Chicken Pox 2 Tonsillitis 1 Cerebro-spinal fever (not confirmed) 4 Typhoid fever (not confirmed) 1 Impetigo 1 Poliomyelitis 1 Erysipelas 3 Dysentery, Diarrhoea, etc. 5 Bronchitis and Scabies 1 Mumps 1 77 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1941 1942 1943 1944 1945 1946 Scarlet fever 23 48 185 98 25 44 Diphtheria 7 8 1 — 10 5 Typhoid fever — — — — — — Paratyphoid fever 1 — — — — — Erysipelas 6 4 9 9 5 7 Pneumonia 20 12 46 12 14 15 Encephalitis Lethargica — — — — — — Puerperal Pyrexia 1 5 7 — 4 2 Cerebro-spinal fever 6 6 2 2 2 1 Acute Poliomyelitis — — — — — 2 Ophthalmia Neonatorum — — 1 — — — Dysentery 2 28 1 9 53 2 Malaria — — — 34 28 — Measles 232 360 221 22 589 152 Whooping cough 133 28 143 44 43 75 Tuberculosis (all forms) 53 63 44 36 44 52 Suspected Food Poisoning — — — — — — 14 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 45 49 Haemolytic Streptococci Swabs 4 10 14 Diphtheria Swabs 10 1,466 1,476 Typhoid—Dysentery Group Rectal Swabs 1 18 19 Miscellaneous 4 3 7 Totals 23 1,542 1,565 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 £1,240. During the year 93 new patients attended, and a total of 7,107 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 last year, at the Rheumatic Clinic, 151 patients were seen by me. There were 442 consultations and 3,870 attendances were recorded. In a large number of these patients, X-ray investigations and blood tests were carried out. They were treated by various forms of physical treatment and, in 7 cases, a temporary plaster splint was made. 13 patients were treated for periods considerably longer than that covered by the routine two courses; of these 8 patients could well be considered as chronic cripples who, without the assistance of the Clinic, would have been bed-ridden. Three of them were taken into St. Stephen's Hospital Rheumatic Unit under my care 15 for short periods of time for splinting, manipulation, and in one instance for the removal of the thyroid gland. Five of these patients, although away from work for more than three years, are now back at either full or part-time work and, instead of being a financial liability to the community, are self-supporting people. The Clinic has at least three important functions to perform:— 1. The early diagnosis of rheumatic conditions so that adequate treatment can be provided and, if necessary, the patient can be treated out of working hours so that he can continue to lead his full, normal life. 2. The treatment, particularly of elderly people, of symptoms due to rheumatism which are causing them pain and suffering. In these cases, one or two courses of treatment may well relieve their symptoms and allow them to continue to lead a happy and reasonably full life. A year later, if their symptoms recur, it is reasonable to take them on again for a further course of treatment. 3. The treatment of the rheumatic cripple. Although not spectacular, in a way the most gratifying group. This consists of those patients who have been so badly crippled that, for a period of time, sometimes up to four or five years, they have been unable to do anything except be nursed in their own homes. With a period of in-patient treatment, followed by treatment as an out-patient at the Clinic, and a careful survey by the Social Service Department of the Council, and with the help of the Ministry of Labour, they can often be made happy and reasonably useful citizens once again. The success of this work is dependent on the close co-operation between the staff of the Clinic and the doctors by whom patients are referred for advice. The medical practitioners in the neighbourhood are giving us increasing help both in selecting the right type of patient and carrying out, under our guidance, that 16 part of the treatment—such as drugs, injections, modifying home conditions and so on—which is not dependent on the physical measures and technical skill which the Clinic alone can provide." WORK OF THE PUBLIC HEALTH NURSE. A good deal of useful work has been done by the nurse to the Public Health Department. Her duties include assistance with diphtheria immunisation, the treatment of scabies and other verminous conditions, routine infectious disease enquiries, the supervision of infectious diseases treated at home, the following up of cases discharged from the isolation hospital, and various other useful functions. She also attends the Rheumatism clinic and serves an indispensable function in regard to the social work which is so necessary in this disease. The following is a record of certain aspects of the work done by her during the year:— Home visits in connection with infectious diseases and other matters 1,796 Attendances at diphtheria immunisation sessions 40 Number of visits for scabies 1,489 Number of visits for head lice 46 17 SANITARY ADMINISTRATION. ANNUAL REPORT OF THE SANITARY INSPECTOR 1946 Public Health Department, Municipal Offices, New Maiden. To the Mayor, Aldermen and Councillors, Ladies and Gentlemen, I have the pleasure to submit my twenty-seventh Annual Report of work done and matters of interest concerning the sanitary department. The year under review is the first since 1938, which can be termed more or less normal, the department having been freed of duties in connection with civil defence and the aftermath of the war. Nevertheless, activities were restricted owing to the concentration of effort in building new houses and the necessary limitation of labour and supplies for ordinary repairs. Much essential repair work has, however, been done and in this respect close liaison with the licensing section of the Borough Engineer's Department has been maintained. Some of the work has been the repair of war damage and time has been occupied in assisting owners to make their claims. This has been due to the fact that notices requiring abatement of nuisances have often been in part to effect necessary repairs caused by enemy action and also for repairs due to ordinary wear and tear. Since war damage repairs have ceased to be carried out by the Council it has become obligatory for the owner to arrange for these to be done and a little help has assisted in obtaining more speedy compliance with notices. 18 For the purpose of abating nuisances or executing repairs to houses, the following notices were served:— Preliminary 228 Abatement 128 Informal (dustbin only) 227 Formal (dustbin only) 59 It was necessary to apply to the Court for Nuisance Orders in twenty instances. These referred to the following:— Public Health Act, 1936. Section 92 (a) Premises in such a state as to be a nuisance. Nuisance orders made 8 Applications withdrawn, work having been completed before hearing 1 Applications withdrawn after adjournment, work having been carried out in the meantime 10 Application adjourned and outstanding at end of year 1 Forty-seven dustbins were supplied to houses and charged to owners. These were mostly cases where owners had defaulted in complying with notices served under Section 75, Public Health Act, 1936. In one instance, at the request of the owner, the works necessary to be done under notice were carried out by a builder under my instructions and the cost recovered by monthly payments. A large number of visits to houses were made prior to the issue of letters to enable builders to obtain permits for timber to repair floors, etc. These had subsequently to be revisited for the purpose of checking whether the repairs had in fact been done. 19 In addition to the above, a number of complaints were received from occupiers of council houses or requisitioned properties and these were referred to appropriate departments. One Warrant to enter and examine premises where a nuisance was suspected was made to and granted by the County Magistrates. It is a matter of passing interest to note that within a few minutes of breaking into the premises, Scotland Yard had been notified and a flying squad car arrived in a very short time afterwards. Happily my papers were in order. This was the first time in my 39 years' experience that I had entered premises under a Warrant and I hope it will be my last. SCABIES. The continued prevalence of 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. 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 23 Tuberculosis 30 Vermin 4 Diphtheria 7 Puerperal Pyrexia 3 Dysentery 1 Others 6 20 A number of books from the public library and schools were also disinfected for a variety of reasons. Twenty-five loads of bedding were removed for steam disinfection or destruction. FOOD AND DRUGS ACT, 1938. During the year 111 samples were submitted to the Public Analyst for analysis. These comprised of the following:— ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Milk 10 14 24 — 1 1 Vinegar — 2 2 — — — Gravy powder — 2 2 — — — Baking powder 1 2 3 1 1 2 Tea — 1 1 — — — .Sausages — 2 2 - — — Egg substitute powder — 1 1 — — — Margarine — 2 2 — — — Butter — 3 3 — 1 1 Black pepper — 1 1 — — — Ground ginger — 2 2 — — — Ground cinnamon — 1 1 — — — Self-raising flour 3 4 7 — 1 1 Gelatine — 1 1 — — — Sauce — 2 2 — — — Ground nutmeg — 1 1 — — — Curry — 1 1 — 1 1 Pickles — 3 3 — — — Cocoa — 2 2 — — — Soup — 4 4 — 2 2 Horseradish cream — 2 2 — — — Glauber salts — 1 1 — 1 1 Semolina — 2 2 — — — Cake flour, etc. — 4 4 — — — Fish and meat paste — 2 2 — — — Liquid paraffin — 1 1 — — — Mixed herbs — 1 1 — 1 1 Mustard — 3 3 — — — Flour batter — 1 I — — — Jam and marmalade — 3 3 — — — Mushroom ketchup — 1 l — — — Coffee — 1 l — — — Saccharine — 4 4 — — — Sugar — 2 2 — — — Honey — 1 1 — — — Aspirin — 1 1 — — — Strawberry ouring — 1 1 — - — Stuffing — 1 1 — — — 21 ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Ice cream 3 — 3 — — — Household milk — 1 1 — — — Spice mixture — 1 1 — — — Cooking fat — 2 2 — — — Cough balsam — 1 1 — — — Ginger wine essence — 1 1 — — — Coffee mixture — 1 1 — — — Coffee and Chicory — 2 2 — — — Salad dressing powder — 1 1 — 1 1 Soup powder — 1 1 — — — Totals 17 94 111 1 10 11 Notes in regard to samples shown as adulterated or deteriorated. Butter.—The sample of butter was one in regard to which com plaints had been received. It was certified as being unfit for food owing to mould infection. The matter was referred to the Food Executive Officer who communicated the facts to the Ministry of Food. An explanation of the circumstances was furnished after which no further complaints were received. Curry Powder.—This sample contained 15 per cent. maize flour, the Public Analyst reported inter alia " Curry powder should be a mixture of spices with 110 other major ingredient although a few per cent., up to about 5, of common salt has frequently been added to prevent mould formation. Recently, however, Indian curry powders containing 10 per cent. or more of salt and anything up to 20 or 25 per cent.of pea or bean flour have been appearing on the market. Analysts have regarded this as an adulteration and a number of prosecutions have been taken but with little success." The firm concerned was written to and furnished an explanation and in view of the fact that there is no official definition of curry powder no further action was taken. Mixed herbs and salad dressing powder.—In these two instances no question of adulteration arose. The question at issue was that the carton or tin in each case did not bear a statement specifying the ingredients as required by the Labelling of Food No. 2 Order, 1944. A satisfactory explanation was received from each of the firms concerned and no further action was considered necessary. Glauber salts.—Although the Public Analyst had to make an adverse report in regard to this sample, it concerned a very minor matter and both he and the Medical Officer of Health recommended that no action was required. Milk.—One informal sample was found to be deficient in fat. The firm in question was written to and furnished a favourable explanation. Subsequent samples proved satisfactory. Soup.—One sample of meat soup was found to contain 11.5 per cent. of solids, whereas canned meat soup of ordinary commercial quality contains not less than 12 per cent. A repeat sample was found to contain 10 per cent, solids. The standard adopted was that of the 22 Meat Products Canned Soup and Canned Meat (Control and Maximum) Prices Order, 1946. It was questionable whether this standard would be held to apply for the purposes of the Food and Drugs Act and the matter was therefore referred to the Food Executive Officer. Self-raising flour and baking powder.—In both cases the samples yielded less available carbon dioxide than the minimum permitted, but formal samples taken later were found to be satisfactory. The news of the death of Mr. E. Hinks, Public Analyst, was received with real regret. He was always so helpful in dealing with problems under the Food & Drugs Act, that his loss was very keenly felt. The appointment of his deputy, Mr. D. D. Moir, M.Sc., F.R.I.C., to the post of Public Analyst did much to fill the gap and on many occasions I have been glad to obtain his advice on matters regarding foodstuffs apart from ordinary analyses. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders: — Dealers. Tuberculin tested 5 Pasteurised 7 Pasteurisers licence 1 Supplementary. Tuberculin tested 6 Pasteurised 6 Sixty-nine samples of milk were submitted for examination and in four instances were also examined for the presence of tubercle bacilli by animal experiment with negative results. During the year the plate count was discontinued as a prescribed test for pasteurised milk and the phosphatase test substituted therefor. As I pointed out in my last report the plate count was not reliable because of the fact that the test takes no account of heat resistant organisms whose presence is of no material significance for the safety or the keeping quality of the milk. The effectiveness of the phosphatase test is now well established as showing whether or not milk has been adequately heat treated, and thereby ensuring that all pathological organisms have been eliminated. 23 Heat treated milk must also satisfy the methylene blue test which discloses whether or not the milk is of satisfactory keeping quality. Of the sixty-nine samples examined by the phosphatase test, sixty-eight passed and only one failed. Sixty-five passed the methylene blue test, whilst four failed. Two methods of pasteurisation are now allowed:— (1) To retain the milk at a temperature of not less than 145° F. and not more than 150° F. for at least 30 minutes and immediately cooled to a temperature not exceeding 55° F., or (2) To retain the milk at a temperature of not less than 162° F. for at least 15 seconds and immediately cooled to a temperature of not more than 55° F. The trouble experienced in the two previous years was not repeated and only a few complaints were received. These related to stained or dirty bottles, alleged poor quality, portions of glass in bottles. Each case was carefully investigated and in some the complaints proved to be unfounded. What sometimes appeared dirt in bottles proved to be irremovable stains, but after passage through the bottle washing machine they are sterilized sufficiently to render them free from harmful bacteria. I have witnessed a number of instances where milk bottles have been returned to the dairy in a disgusting condition, obviously having been used for purposes completely foreign for which they were made. If bottles become stained or discoloured this has obviously been done when away from dairy control and if reasonable care was always taken by consumers there would be no dirty bottles, certainly not in the interiors. This does not, of course, excuse the dairyman for not detecting and eliminating such bottles from circulation, but with all possible care the human element allows for an occasional stained or dirty bottle to escape observation. 24 FOOD 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:— Condensed milk 88 tins Evaporated milk 419 tins Household milk 3 tins Vegetables and fruit 94 tins Beans 73 tins Meat and vegetables 9 tins Fish 95 tins Sausages 2 tins Eggs 577 Oranges 1,400 Stewed steak 19 tins Chopped ham 1 tin Spam or Prem 2 tins Lamb's tongue 1 tin Mixed beef loaf 1 tin Corned beef 1 tin Alarmalade 5 tins Jam 17 tins Wet fish 74 stones Cheese 26 lbs. Semolina 61 lbs. Beef 40 lbs. Raisins 2 lbs. Rolled Oats 4 lbs. Bacon 62| lbs. Biscuits 47* lbs. Flour 30 lbs. Barley Flakes 63 lbs. Meat or fish paste 3 jars Marmite 36 jars Pickles 2 jars Savourie 2 jars Spliced sprats 41 jars Shredded wheat 3 packets Date or Marmalade pudding 9 tins Soup 10 tins Syrup 2 tins Cocoa 2 tins Macaroni cheese 2 tins Malted Soya Cream 4 tins Butter 6 ozs. A number of interesting complaints regarding food were investigated during the year, one or two of which are worthy of recording. 25 (1) A householder had made some plum jam and noticed after emptying the iron pan in which it was boiled that a quantity of the galvanised interior was missing. A sample of the jam was sent to the Public Analyst who reported that it contained 0.12 per cent. of Zinc which is equivalent to 5.45 grains per lb. of Zinc or to 24 grains per lb. of Zinc Sulphate. The proportion of Zinc was grossly excessive and rendered the article unfit for human consumption. Galvanised containers are quite unsuitable for jam boilingowing to the ease with which Zinc is dissolved by the acids of the fruit. Particulars were sent to the Ministry of Health. (2) A tin of household milk was brought to me by a householder who complained that it smelt strongly of carbolic. This was easily confirmed and the specimen was forwarded to the Public Analyst for investigation. He found that through some mischance of manufacture there was an accumulation of blue lacquer at one spot near the upper rim of the tin. When the lid was placed in position some of this lacquer was squeezed up between the lid and the tin and gained entry to the inside, in this way being finally sealed by the white adhesive strip. The volatile solvent from the lacquer slowly evaporated and was absorbed by the dried milk giving rise to the contamination noted by the purchaser. The smell was undoubtedly one of cresol or " carbolic acid " and although the actual quantity absorbed by the milk was very small it rendered it unfit for food. This was a very rare and interesting occurrence and particulars were given to the Food Executive Officer for transmission to the appropriate department of the Ministry of Food. (3) A specimen of gorgqnzola cheese (about ½ lb.) thought to have caused stomach pains. I tested this by eating the cheese myself with no ill results. (4) Some trouble was experienced with one particular brand of sweetened machine skimmed condensed milk. When opened the contents of a number of these tins were found to be completely solid with rather unpleasant taste. It appears that the trouble was fairly widespread. Particulars were given to the Food Executive Officer who forwarded them to the London Divisional Food Officer. SMOKE ABATEMENT. Some time has been spent in regard to this problem which, at the present moment, owing to fuel difficulties, has not been an easy one to solve. Complaints were received regarding the emission of gritty particles from the chimneys at one large factory and although a considerable amount of money had been spent, both at the commencement of the war and since its termination, in the provision of grit extractors the trouble has still persisted. During the year the firm in question decided 26 to fit their main boilers to burn oil fuel and the installation of oil storage tanks and consequent constructional works was well in hand at the end of the year. When this is completed no nuisance should arise from the main shaft and as the boiler connected with the second chimney will only be used in case of emergency I hope this trouble may soon be finally abated. One laundry was the cause of a number of complaints. This has undoubtedly been due to the burning of sawdust and wood chips from an adjoining factory. The matter was under consideration at the end of the year and, although some improvement has been effected the nuisance then still remained. From time to time other laundry chimneys have been noted to be emitting quantities of black smoke. Fuel troubles have undoubtedly been responsible for much of this. SHOPS ACT. The whole of these Acts are administered by my Department and there appears to have been no instances of intentional evasion. One case of obvious unintentional contravention of the weekly half-day closing came to notice and was quickly remedied when attention was drawn to the matter. No question arose of the assistants being deprived of their half holiday. 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 — — (b) Other houses 4 4 Soon after being occupied by German prisoners of war some hutments were found to be badly infested. Fumigation was impracticable but vigorous treatment with liquid insecticide containing D.D.T. and D.D.T. powder quickly rid the places of these vermin. Valuable experience was thus gained which will prove very useful in dealing with any council houses found to be infested in the future. 27 RATS AND MICE DESTRUCTION. For the first three months of the year we were without a senior officer for this work, Mr. Prichard commencing duty on the 1st April. He immediately impressed me with his knowledge and energy, and I am glad to say that as time went on his ability became established and rapid leeway was made in outstanding arrears. More and more importance is given to this branch of Public Health activities and the haphazard methods of the past are giving way to scientific and methodical means in dealing with these destructive vermin. It is quite obvious that to deal with individual infestations without going thoroughly into the reasons, often results in re-invasion and the only effective way of ensuring success is to deal with the whole area in which the complaint has arisen, finding out and dealing with any other premises affected. This is termed " Block Control." Adopting a much broader outlook, if the whole of the Borough can be systematically dealt with in like manner within a certain given time, the destruction of rats will be far greater than the number that can be produced by their prolific breeding propensities and some lasting and visible results can be achieved. It was undoubtedly with this in mind that the Ministry of Food prepared a scheme set out in Circulars N.S. 11 and 12. Unfortunately the Circulars were not received until some time after the commencement of the financial year and for this and other reasons it was not adopted for the time being. I should like, however, to make a special reference to one part of the district in which the scheme was put into operation in a modified form. The area was taken as a whole and each householder was invited to co-operate by letting me know if any rats existed on their premises. In return I offered to do all necessary rat destruction during a specified period for a fee of two shillings. Some 450 householders were circularised and in 49 instances the replies indicated infestation to some degree or other. Consequent surveys found infestations at 46 further premises. 28 Rat destruction was carried out at all the places affected and by this means the whole area was systematically dealt with as one unit instead of in dribs and drabs. Whereas before this operation, complaints had been regularly received, by the end of the year only one revisit was requested. Just prior to the above the whole of the sewers in the area were test-baited, but except in one isolated spot where extensive war damage had occurred, negative results were obtained. Provided householders are now careful either to take efficient action themselves immediately any signs of reinfestation occur or will let me know, the area should now give little trouble for some time. 1 found occupiers generally eager to co-operate and this contributed greatly to the success of the campaign. During the year the area covered by the Refuse Destructor, Sewage Disposal Works, Pigstyes and Controlled tips received thorough attention and the results achieved were excellent. Constant liaison is maintained with officers of the Infestation Branch of the Ministry of Food. I have always found them most helpful, not only with practical advice, but in the loan of apparatus required for special problems. Regular meetings are held in the areas of different authorities at which difficulties are ironed out and explanations given by officers of the Ministry of Food. The damage done yearly to foodstuffs alone and the potential danger of the spread of the most serious diseases renders the subject of the greatest Public Health importance, and every penny and every bit of energy spent in their extermination is worth while provided it is expended in a planned and scientific manner. MISCELLANEOUS. A number of vacant plots in the district continued to be dumping places for all kinds of rubbish and this produced very untidy conditions. In the worst instances the rubbish was cleared and disposed of by the Council, but it was not long before similar conditions again prevailed. So long as these sites remain, certain householders will use them for dumping 29 garden and other rubbish. Fencing and warning notices have proved useless, and I am afraid that clearing the rubbish only encourages more to be dumped. Bombed sites have also had to be dealt with, but the progress in rebuilding demolished houses is resolving the problem in these instances. Samples of water from the Beverley Brook, taken early in the year, proved the fact that it was contaminated with sewage effluent of a poor quality. Later samples showed some improvement, but the water remained bad. The effluent however was stable and stood for five days without putrescence. The Sutton Council were informed and replied, " To deal with the situation the chlorinating plant has been put back into commission, the tank effluent is being chlorinated and preparations are being made to instal another chlorinating plant and to chlorinate the final effluent." No complaints were received of smell, but possibly the mild summer had something to do with this. The road embankment at the extreme southern end of the district was the subject of much attention. The County Council consolidated and covered this with earth, but at the close of the year the work had not been fully completed. Apart from matters not concerning my Department, certain work of soiling, seeding, and drainage, still required are to be completed by the County Council in the spring of 1947, and joint monthly inspections have been arranged by officers of the County Council and the Borough Council in regard to any infestation that might arise. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, HENRY TUNBRIDGE, Sanitary Inspector. .