LIBRARY MAL11 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED DECEMBER 31st 1947 Printed by Raynes Park Press, Lambton Road, London, S.W.20. OFFICERS AND STAFF OF THE PUBLIC HEALTH DEPARTMENT James Fanning, M.D., B.S. (Lond.), M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. Henry Tunbridoe, F.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, Chief Clerk. A. H. Hadlow, Clerk. Alan Sharman, Junior. TEMPORARY. Mrs. A. Savage, Shorthand Typist. A. E Wilson, Assistant to Rodent Officer. T. Clarkson, Assistant to Rodent Officer. PUBLIC ANALYST : Daniel D. Moir, M.Sc., F.R.I.C. Borough of Malden and Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1947 Public Health Department, Muncipal 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 1947 which has been prepared in accordance with Ministry of Health circular 170/47. 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. As this is my last report to the Council on leaving their service I may, perhaps, be permitted to end on a personal note. During my seventeen years in the district, the population has doubled and many changes have taken place. The most outstanding event was, of course, the world war during which time the Council had to take on many unusual duties and developed an organisation which seems remarkable in retrospect. I have seen many changes as regards members of the Council and I should like to thank them all, past and present, for the many kindnesses I have received from them. I have also been fortunate with my working colleagues and a happy atmosphere has always existed within the Public Health Department and in its relation with other departments. 1 cannot end without paying tribute to Mr. Tunbridge, who has been my colleague and friend for so many years. There is no one who knows as well as I do just how much the district owes to his ability and energy. 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, 1947) 44,450 VITAL STATISTICS. Total M. F. Live births 765 407 358 (Legitimate) 395 348 (Illegitimate) 12 10 Stillbirths 16 9 7 Deaths ... 452 221 231 Birth rate per 1,000 of the estimated resident population 17.2 Rate per 1,000 total (live and still) births 20.5 Death rate per 1,000 of the estimated resident population 10.1 Deaths from puerperal causes :— Rate per 1,000 Deaths. 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 24.8 Legitimate Infants per 1,000 legitimate live births 24.8 Illegitimate Infants per 1,000 illegitimate live births Deaths from Cancer (all ages) 75 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 765 live births were registered, an increase of 9 over last year's total. The rate per 1,000 population was 17.2 compared with an average for England and Wales of 20.5. Of the total number 22 or 2.8 per cent. were illegitimate. The birth rate is slightly lower than that of last year. 3 DEATHS. During the year 452 deaths were registered, an increase of 82 over those recorded in 1946, the rate per 1,000 being 10.1 compared with an average of 12.0 for England and Wales. The infantile mortality was 24.8 per 1,000 live births, a low rate, comparing with the figure of 41 for England and Wales. For the third year in succession there were no deaths from maternal causes. CAUSES OF DEATH. M. F. Total Typhoid and paratyphoid fevers 2 — 2 Cerebro-spinal fever — 1 1 Scarlet fever — — — Whooping Cough — 1 1 Diphtheria — — — Respiratory tuberculosis 5 9 14 Other forms of tuberculosis — 4 4 Syphilitic diseases 2 1 3 Influenza 3 — 3 Measles 1 — I Acute poliomyelitis and polio-encephalitis — — — Acute infective encephalitis — 1 1 Cancer 41 34 75 Diabetes — 1 1 Intra-cranial vascular lesions 23 29 52 Heart diseases 69 61 130 Other circulatory diseases 6 10 16 Bronchitis 5 11 16 Pneumonia 10 11 21 Other respiratory diseases 1 3 4 Ulcer of stomach or duodenum 3 1 4 Diarrhoea (under 2 years) — 1 1 Appendicitis — 1 1 Other digestive diseases 8 5 13 Nephritis 3 9 12 Puerperal and post-abortive sepsis — — — Other maternal causes — — -- Premature birth 4 4 8 Congenital malformations; birth injuries; infant diseases 5 4 9 Suicide 1 — 1 Road traffic accidents 5 — 5 Other violent causes 6 2 8 All other causes 18 27 45 221 231 452 4 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 3 2 5 3 7 19 40 9C 45 221 Females 12 3 2 7 3 18 15 29 80 60 231 Totals 19 6 4 12 6 25 34 69 170 105 452 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District. Surrey County Hospitals. London and other Hospitals. Tolworth Hospital. Other Districts. Total. 281 89 60 2 20 452 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years :— 1943 (23 Legitimate. None Illegitimate) 23 1944 (18 1 „ ) 19 1945 (22 4 „ ) 26 1946 (14 1 „ ) 15 1947 (19 None „ ) 19 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF ACE. Prematurity 8 2 hours; 3 hours; 1 day; 1 day; 2 days; 2 days; 5 days; 2 weeks. Birth injury 1 2 days. Congenital malformation 1 1 week. Gastro enteritis 1 7 months. Other diseases of infancy 6 2 hours; 1 day; 3 days; 4 days; 1 month; 6 months. Acute inf. encephalitis 1 2 months. Cerebro-spinal fever 1 11 months. 5 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST FIVE YEARS. Year. Births. Infantile Mortality. Deaths. 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 1947 17.2 24.8 10.1 MORTUARY. Thirty-two bodies were brought to the Mortuary and thirty-one post-mortems made. H.M. Coroner for the district held inquests in eight instances and the following verdicts were returned : Accidental 5 Suicide 1 Open Verdict 2 RAINFALL, 1947. Table showing rainfall in the district during 1947, taken at the Sewage Disposal Works, California Road, New Maiden :— Inches January 1.46 February 1.35 March 4.54 April 1.69 May 1.52 June 2.10 July 1.27 August 0.35 September 1.23 October 0.11 November 1.12 December 2.31 19.05 Decrease on previous year 8.19 inches Average for past 5 years 21.30 inches 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the Year 1947. Provisional figures based on Weekly and Quarterly Returns. England and Wales 126 C.Bs.1 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 41 47 36 37 Live Births 20.5 t 23.3 22.2 22.7 Still Births 0.50t 0.62 "6^54 0.49 Deaths :— Deaths from Diarrhoea and F.nteritis under 2 years of age i 5.8 8.0 3.7 4.8 All Causes 12.0 t 13.0 11.9 12.8 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 Cough 0.02 0.03 0.02 0.02 Diphtheria 0.01 0.01 0.01 0.01 Rates per 1,000 Total Births (Live and Still). Influenza 0.09 0.09 0.08 0.08 Small-pox 0.00 0.00 0.00 — Measles 0.01 0.02 0.02 0.01 Notification :— Notifications :— Typhoid Fever 0.01 0.01 0.00 0.01 Puerperal Fever 7.16 8.99 6.27 6.94 Paratyphoid Fever 0.01 0.01 0.01 0.01 Cerebro Spinal Fever 0.05 0.06 0.05 0.05 Puerperal Pyrexia Scarlet Fever 1.37 1.54 1.37 1.31 Maternal Mortality in England and Wales Whooping Cough 2.22 2.41 2.02 2.80 Diphtheria 0.13 0.15 0.14 0.14 Erysipelas 0.19 0.21 0.18 0.22 Abortion with Sepsis 0.10 Small-pox 0.00 0.00 0.01 0.00 Measles 9.41 9.13 9.58 5.29 Abortion without Sepsis 0.06 Pneumonia 0.79 0.89 0.68 0.64 Puerperal Infections 0.16 † Rates per 1,000 total Population Other Maternal Causes 0.85 7 NOTIFICATIONS OF INFECTIOUS DISEASES, 1947 DISEASES Totals Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 45-6 55 and 5 over. Diphtheria 3 - - - - - - - 1 1 1 — — — Erysipelas 8 - - - - - - - - - 1 4 3 — Pneumonia 18 2 3 1 — 1 1 1 — — 1 2 5 1 Puerperal Pyrexia 4 — — — — — — — — 2 2 — — — Scarlet Fever 49 — 4 8 4 4 18 6 4 — — 1 — — Typhoid 2 - - - 1 - - - 1 - - - - - Cerebro-spinal fever 2 1 - - - 1 - - - - - - - — Poliomyelitis 5 — — — 1 1 — — — 1 — 1 1 — Measles 240 6 16 24 25 30 120 10 4 1 2 1 — 1 Whooping Cough 39 6 6 5 3 8 10 — — 1 — — — — Totals 370 15 29 38 34 45 149 17 10 6 7 9 9 2 DISEASES Totals Coombe Dickerage Mount Cambridge WARDS Norbitor Park Burlington Maiden Green St. James Maiden Manor Diphtheria 3 — 1 1 — 1 — — — — Erysipelas 8 1 1 — 2 — — 2 1 1 Pneumonia 18 1 4 2 1 1 3 3 1 2 Puerperal Pyrexia 4 —• — 1 — 2 — — — 1 Scarlet Fever 49 20 2 — 1 — 6 12 3 5 Typhoid 2 — — — 1 1 — — — — Cerebro-spinal fever 2 1 — — 1 — — — — — Poliomyelitis 5 1 — 2 — 1 1 — — — Measles 240 6 47 9 14 28 39 15 51 31 Whooping Cough 39 1 12 3 1 3 2 5 8 4 Totals 370 31 67 18 21 37 51 37 64 44 8 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The number of cases of scarlet fever notified during the year remained comparatively low, a total of 49 giving an incidence rate of 1.10 per 1,000 population. The majority of cases were mild and no fatalities occurred. Eleven cases were treated at home and thirty-eight cases were removed to hospital. A large proportion of the cases resulted from an outbreak in a residential children's nursery where there were 26 children and 9 resident staff. There were also 6 additional members of the staff who were non-resident. The outbreak began with 3 children falling ill at approximately the same time and, over a period of eleven days, a total of 16 children was affected. Seven days later one more child developed scarlet fever and this was the end of the incident. Several interesting features emerged from this small outbreak — the unusually high morbidity rate, 17 children out of 26 having been affected; the fact that no member of the staff contracted the illness; and the relative immunity of children aged one year or under. Only one out of seven infants of this age was affected. In spite of exhaustive enquiries and investigations there was no clue as to the origin of the infection. DIPHTHERIA. Three cases of diphtheria occurred in residents ot the district, all of them young adults without any history of previous immunisation. No deaths occurred. The scheme for immunisation progresses satisfactorily, and parents are beginning to accept immunisation as a matter of course. We are now recommending it at the age of seven months in order to prevent the occasional unfortunate case under one year. When done so early it is probably advisable to give a third dose twelve months later. Under the present scheme children arc given the opportunity of receiving a re-inforcing dose at intervals of 3—5 years up to school leaving age. At the end of the year records in the Public Health Department showed that of the children living in the district aged 0—5 years 46% have been immunised, and of the children 5—15 years 87% have been immunised. The figures for school children have improved, as recent visits to schools have 9 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 during the year (pre-school 485, school 109) 594 Number of children receiving re-inforcing doses 924 Total attendances at Clinic , 912 An extract, quoted below, from a recent circular of the Ministry of Health will be of interest to members showing, as it does, the rapid decline in the number of notifications and deaths from diphtheria in England and Wales since the immunisation campaign got under way in 1941. Incidentally, it may be mentioned that every facility for immunisation was available in this district in 1934. "The provisional figure for deaths from diphtheria in 1947 was 245, compared with an average of about 2,800 deaths annually in the ten-year period 1931-40. For the sixth successive year therefore, the number of deaths was the lowest yet recorded Totals of deaths and original notifications during the past eight years are as follows :— Year. Deaths. Cases. 1940 2,480 46,281 1941 2,641 50,797 1942 1,827 41,404 1943 1,371 34,662 1944 934 29,949 1945 722 25,246 1946 472 18,283 1947 245* 10,469* * Provisional. The number of cases in 1947 is also the lowest ever recorded. For the ten-year period 1931-40, the average number of original notifications was about 55.300. The total for 1947 will therefore, be about 45,000 below that average. This decrease has resulted in very substantial savings to public funds. In addition, the strain on medical and nursing personnel has been relieved; it is estimated that about 2,500 nurses are freed for other work ” 10 CEREBRO-SPINAL FEVER. Two cases of cerebrospinal fever were reported. One was a very acute case in an infant who died shortly after admission to hospital. The other case made a good recovery. ACUTE POLIOMYELITIS. A widespread epidemic of poliomyelitis affected the whole country during the second half of the year, and in this district five cases were confirmed. In two other cases residents of the district were taken ill while temporarily absent although infection had probably taken place before leaving. Of these seven cases, five made a complete recovery. Of the remaining two — one, a young adult woman was left with rather severe paralysis of both lower limbs; and the other, a child, had some residual paralysis of one leg. MEASLES. Two hundred and forty cases of measles were notified, an average number. Four of these were removed to hospital with complications, but all made a good recovery. Prophylactic serum for contacts was supplied in four cases. WHOOPING COUGH. The number of cases of whooping cough notified was 39, a figure much below the average. Six of these were removed to hospital, but all did well. One child, age 3, died at home. TYPHOID FEVER. Two cases of typhoid fever were reported. One was the case of a soldier who had obviously contracted his infection while abroad. He made a good recovery. The other was a child of three who was taken suddenly ill and died a few hours after admission to hospital. The diagnosis was based on the post mortem appearance of a section of the intestine and there was no bacteriological confirmation. The second death classified as Typhoid fever and shown in the causes of death on page 3 occurred in the person of a man aged 73 years who suffered from the disease more than 30 years ago. The heart disease which caused death was apparently attributed to his previous illness. SCABIES. The scheme for the treatment of scabies referred to in recent reports continued successfully. During 1947 131 persons from 30 families received treatment. Of these 78 persons showed definite lesions, the remainder being contacts in the same family. These numbers show a considerable reduction on recent years. 11 VERMINOUS CONDITIONS. The standard of cleanliness in regard to infestation by the head louse is high in the district and has been improved during recent years by close co-operation between the Public Health nurse and the school authorities. The nurse made 24 visits in this connection during the year and dealt with 4 cases from 3 families. No case of body louse infestation came under notice. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England & Wales. Borough of Maiden & Coombe. Scarlet fever 1.37 1.10 Diphtheria 0.13 0.06 Typhoid fever 0.01 0.04 Paratyphoid fever 0.01 — Cerebro-spinal fever 0.05 0.04 Measles 9.41 5.39 Whooping cough 2.22 0.89 †Puerperal pyrexia 7.16 5.12 † per 1,000 total births (i.e. live and stillbirths). CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 38 Scarlet fever (not confirmed) 3 Pneumonia 4 Diphtheria 2 Measles 4 Measles (not confirmed) 1 Whooping Cough 6 Chicken Pox 2 Tonsillitis Cerebro-spinal fever 1 Cerebro-spinal fever (not confirmed) 4 Poliomyelitis 4 Poliomyelitis (not confirmed) 2 Erysipelas 2 Dysentery, Diarrhoea, etc. 4 78 Readmissions — Scarlet fever 3 12 CASES ADMITTED TO HOSPITALS OTHER THAN TOLWORTH. Diphtheria 1 Typhoid 2 Poliomyelitis 1 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1942 1943 1944 1945 1946 1947 Scarlet Fever 48 185 98 25 44 49 Diphtheria 8 1 — 10 5 3 Typhoid fever - - - - - 2 Paratyphoid fever — — — — — — Erysipelas 4 9 9 5 7 8 Pneumonia 12 46 12 14 15 18 Encephalitis Lethargica - - - - - - Puerperal Pyrexia 5 7 — 4 2 4 Cerebro-spinal fever 6 2 2 2 1 2 Acute Poliomyelitis — — — — 2 5 Ophthalmia Neonatorum — 1 — — — — Dysentery 28 1 9 53 2 — Malaria — — 34 28 — — Measles 360 221 22 589 152 240 Whooping cough 28 143 44 43 75 39 Tuberculosis (all forms) 63 44 36 44 52 42 Suspected Food Poisoning - - - - - - TUBERCULOSIS, 1947 Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 - - - - - - - - 1 - — 1 1 1 — — — 5 l l l 1 — — — 1 15 6 4 — 3 — 2 — — 25 2 2 l 1 2 2 — — 35 3 3 — 2 — 4 — 2 45 3 1 — — 1 1 — — 55 3 1 — — 1 — — — 65 & upwards - 1 - - - - - 1 Totals 18 13 3 8 5 9 — 4 The mortality rate from pulmonary tuberculosis is again only one-third of the high peak rate registered in 1941 and still shows a tendency to decline. The following table shows the trend of tuberculosis since 1938. 13 TUBERCULOSIS 1938 - 1947. NEW CASES DEATHS Year Estimated Population No. Pulmonary Rate per 1,000 Population No. Non-Pulmonary Rate per 1,000 Population No. Pulmonary Rate per 1,000 Population No Jon-Pulmonary Rate per 1,000 Population 1938 38,820 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 — — 1947 44,450 31 0.69 11 0.24 14 0.31 4 0.09 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 were 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 2 compared with the previous year. Non- Pulmonary Pulmonary Males 130 23 Females 82 27 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 7 46 53 Hemolytic Streptococci Swabs 9 46 55 Diphtheria Swabs 1 97 98 Typhoid — Dysentery Group Rectal Swabs — 26 26 Miscellaneous 1 8 9 Totals 18 223 241 14 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 £1,097. During the year 90 new patients attended, and a total of 6,049 treatments was given. 1 am indebted to Dr. Francis Bach, consultant in rheumatic diseases to the Red Cross Curative Post for the following note :— " During the year 140 patients have been under my care. It is difficult to have any more than a clinical impression of the number of people living in the Borough who are suffering from rheumatic diseases. In addition to those who have attended the clinic under the Council scheme, there have been several who have been referred as ' private patient'There must be many who have not, for various reasons, been referred to the clinic by their doctors and many who have not been able to because either they are confined to their homes or are going elsewhere for treatment. The problem of rheumatism is a big one and the facilities at our disposal must still be considered as inadequate. The social service side is of very great importance and, during the year, we have been made to realise that the link between the patient, his home conditions, his work, his own doctor and the clinic should be still closer. We have also realised that the more detailed the investigations from the clinical, x-ray and pathological aspect, the more often we are able to recognise or rule out other serious conditions and to give the best treatment that is at our disposal. Some patients have been referred to St. Thomas's or elsewhere for x-ray treatment, others have needed general treatment for which we have been able to make suggestions to their own doctors. Some of those who were considered as chronic cripples have been able to remain reasonably active throughout the year and. in consequence, as well as being less strain on the time of their relatives have been able to lead a reasonably happy life. The physiotherapists at the clinic have worked hard and enthusiastically. There is no doubt that, in general, the rheumatic patient who wants to get better usually does get better under the line of management we are employing. There are many rheumatic people in Maiden who need treatment and, unfortunately, many more will need treatment in the immediate future. 15 My work at Maiden has made me realise even more clearly, that this is a social problem in which other forms of social service must play a part. It has also brought vividly to mind how important are housing conditions, proper help in the home, and proper links with the local industries, both in the treatment of those people in the early stages of their disease and in making life easier for those who are already partially crippled with arthritis. On the introduction of the new Health Service 1 do hope that this social service will not only allow us to continue, but will be extended so as to improve the present services for those who live in the Borough and also provide facilities for people, although not in the Borough itself, who are living in the same part of the County. It has been a great pleasure to me to be associated with the Medical Officer of Health and the Social services of the Borough and, once again, I should like to express my appreciation for work that has been done, in spite of their limited facilities, by the physiotherapists and the staff of the clinic. I do feel that the general practitioners in the area have made use of the scheme in the treatment of their patients and 1 only wish that we could have done more for some of the patients that have been referred to us WORK OF PUBLIC HEALTH NURSE. The following is a record of certain aspects of the work done by the nurse to the public health department during the year:— Home visits in connection with infectious diseases 390 Home visits in connection with rheumatic clinic 917 Home visits in connection with other matters 16 Attendances at diphtheria immunisation clinics 18 Number of visits for scabies 120 Number of visits for head lice 24 16 SANITARY ADMINISTRATION. ANNUAL REPORT of THE SANITARY INSPECTOR 1947 Public Health Department, Municipal Offices, New Malden. To the Mayor, Alderman and Councillors of the Borough of Maiden and Coombe, Ladies and Gentlemen, I have the pleasure to submit my twenty-eighth Annual Report of work done and matters of interest concerning the Sanitary department. Although activities were restricted somewhat owing to the concentration of effort in building new houses and the necessary limitation of labour and supplies for ordinary repairs much essential work has, however, been done and, in this respect, close liaison with the licensing section of the Borough Engineer's department has been maintained. As Dr. Fanning your Medical officer of health will be terminating his appointment early in the new year to take up the position of deputy county medical officer of health for the County of Surrey I may, perhaps, be permitted to record my very happy association with him during the past seventeen years. This took us through the trying period of the last world war when extraordinary matters and services had to be attended to and maintained and it has indeed been a privilege for me to serve under his leadership. For the purpose of abating nuisances or executing repairs to houses, the following notices were served :— Preliminary 289 Abatement 146 Informal (dustbin only) 179 Formal (dustbin only) 58 17 It was necessary to apply to the Court for Nuisance Orders in ten instances. These referred to the following:— Public Health Act, 1936. Section 92 (1) (a). Premises in such a state as to be a nuisance. Nuisance Orders made 7 Applications withdrawn, work having been completed before hearing 2 Section 92 (1) (d). Effluvia from factory causing nuisance. Application adjourned and outstanding at end of year 1 In one instance the Owner failed to comply with a Nuisance Order and was fined £1 Os. Od. with £2 2s. Od. costs. Twenty-two dustbins were supplied to houses and the costs charged to Owners. These were cases where Owners had defaulted in complying with notices served under section 75. In one case action was successfully taken in the County Court to recover the cost of a dustbin so supplied. A number of complaints were received from occupiers of council houses and requisitioned properties and in regard to bombed sites. After investigation these were referred to appropriate departments for attention. SCABIES. Although tending to decrease towards the end of the year the prevalence of Scabies again accounted for a large amount of time spent on visits and treatments, much 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 re gards quality and quantity. In view of the large number of bacteriological and chemical examinations 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. 18 INFECTIOUS DISEASES. The following number of rooms were disinfected for the undermentioned causes :— Scarlet fever 12 Tuberculosis 34 Vermin 20 Diphtheria 2 Typhoid fever 1 Erysipelas 1 Others 12 A number of books from the public library and schools were also disinfected as far as practicable for a variety of reasons. Seven loads of bedding were removed for steam disinfection or destruction. FOOD AND DRUGS ACT, 1938. During the year 125 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 8 27 35 — — — Vinegar 4 2 6 3 — 3 Gravy salt — 1 1 — 1 1 Baking powder — 2 2 — 1 1 Tea 1 5 6 1 — 1 Beef sausage meat 3 2 5 1 — 1 Beef sausages 2 — 2 1 — 1 Margarine — 5 5 — — — Butter — 4 4 — — — Pepper ... — 2 2 — — — Self raising flour — 4 4 — — — Horseradish sauce - 1 1 - — — Pickles — 1 1 — — — Sultana chutney 1 — 1 — — — Cocoa — 3 3 — 1 1 Soup and soup powder - 3 3 - - - Cake pudding mixture - 1 1 - - - Fish and meat paste - 2 2 - - - Liquid paraffin - 1 1 1 — — Mustard - 1 1 - — — Jam and Marmalade - 5 5 - — — Saccharin — 2 2 - — — Flavouring essences - 3 3 - - — Sage and onion stuffing - 2 2 - — — 19 It is satisfactory to note that all the samples of milk proved to be genuine. Notes in regard to samples shown as adulterated or deteriorated. Beef Sausages and Beef Sausage Meat.—One sample of beef sausages and one of beef sausage meat were certified to contain 28 per cent. and 43 per cent. of meat respectively, whereas the Meat Products and Canned Meat (Control and Maximum Prices) Order, 1947 specifies that the meat content shall not be less than 50 per cent. As the infringements were against the Order and thereby constituted offences against the Defence (General) Regulations, 1939 the whole circumstances were re ferred to the Food Executive Officer for consideration and action, if considered necessary by the Food Control Committee. N.B.—The first case came before the Justices in April, 1948. when a fine of £10 was imposed and £3 3s. 0d. costs awarded. In the second instances a warning was issued. Vinegar.—One sample of wood vinegar was certified to contain 3 per cent. acetic acid, whereas wood or artificial vinegar should contain not less than 4 per cent. This minimum of 4 per cent, is not, however, a legal standard but has been recognised and accepted in the Courts for many years. A warning was given in this case. Two samples of malt vinegar contained added salt to the extent of 0.7 per cent, and 0.9 per cent. respectively. Salt is not a natural ingredient of malt vinegar and the analyst had, therefore, no alternative but to report adversely in regard to these samples. In view of the fact that the Ministry of Food gave certain manufacturers of malt vinegar a special temporary dispensation to add, without declaration, a small quantity of salt to help preserve the vinegar, no further action was taken. Gravy Salt.—In this case the label on the tin containing the grav. salt stated that the powder contained about 14 per cent. protein. It was found, however, that the sample contained 11.9 per cent, protein ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Spices — 3 3 — — — Cooking fat — 2 2 — — — Glycerine, Lemon and Ipecacuanha mixture - 1 1 - - - Magnesia tablets — 2 2 — — — Cheese - 1 1 — — — Plain flour - 1 1 — — — Coffee - 1 1 — — — Browning - 1 1 — — — Lard - 1 1 — — — Ground nutmeg - 1 1 — — — Caraway seeds - 1 1 — — — Pate dc Foie - 1 1 — — — Jelly - 2 2 — — — Paste of dates - 1 1 — 1 1 Beef extract - 1 1 — — — Gin 3 — 3 — — — Rum 1 — 1 — — - Aspirin — 3 3 — — — Totals 23 102 125 6 4 10 20 or only 85 per cent. of the amount stated. An explanation from the manufacturers was considered reasonable and no further action was taken. Cocoa.—The label on the packet containing this sample did not state that it contained salt to the extent of 2.2 per cent., otherwise the cocoa was entirely satisfactory. This was purely a question of labelling and the manufacturers were able to satisfy the Committee that it was old stock and that at the time the cocoa was being retailed in new packets and did not, in fact, contain salt. Salt is often added to cocoa powders but when it is done it must be stated on the label. No further action was considered necessary. Tea.—I was asked by the Food Enforcement Officer to go with him to a shop where " tea off the ration" was advertised on a board outside. 1 purchased a sample and it was certified to be mate tea. If any offence had occurred it was against Regulation 1 (2) of the Defence (Sale of Food) Regulations, tea probably being a false description for mate lea or at any rate a description calculatcd to mislead. The analyst pointed out that mate tea, although prepared from leaves ot an entirely different plant, is in many respects similar to ordinary tea. Moreover, the practice of mixing mate with ordinary tea is not uncommon. The offending board was immediately removed and any further action, if thought necessary, was left to the Food Enforcement Officer. Paste of Dates.—An informal sample of this commodity contained 0.01 per cent. cork, 0.3 per cent. crushed date stones and 1.2 per cent. of sand and siliceous matter. The analyst's observations were as follows :— "This article is of very poor quality. The presence of several pieces ot extraneous cork and of crushed date stones denotes lack of care in preparation and in my opinion this article is not suitable for sale for human consumption in its present condition". The full details were given to the Food Executive Officer for transmission tc the appropriate department of the Ministry of Food. Golden Raising Powder.—This informal sample gave a yield of available carbon dioxide less than that permitted by the Food Standards (Baking and Golden Raising Powders) Order, 1946. A formal sample, however, taken at a later date proved satisfactory. The irregularity was no doubt due to it having been kept in stock for too long a period. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders :— Dealers. Tuberculin tested 4 Pasteurised 6 Pasteuriser's licence 1 Supplementary. Tuberculin tested 6 Pasteurised 6 Seventy-six samples of milk were submitted for examination by the phosphatase and methylene blue tests. I have given 21 details of the significance of these tests in previous reports, but it may be helpful for me to remind members that the phosphatase test determines whether or not the milk has been adequately heat treated and failure to pass the methylene blue test indicates that the milk may not be of good keeping quality. The greater importance must be attached to the phosphatase test as correct heat treatment or pasteurisation reasonably ensures that all pathological organisms have been eliminated. Only one failure to pass this test was recorded out of the 76 examined. Seven samples failed to pass the methylene blue test. Most of these occurred during very hot weather when it is recognised that milk kept at an atmospheric shade temperature of above 65°F. will not remain sweet for any lengthy period. The interpretation of Article 2(b) 7(3) of the Milk (Special Designations) Order 1946 has been open to much discussion, and, if what appears to be the true definition is established, the test should not be applied when the atmospheric shade temperature at the laboratory at any time exceeds 65°F. This renders the methylene blue test futile at a time when it is most needed. To me it indicates that the Authorities recognise the fact that even with efficient pasteurisation and correct handling, milk may be expected to sour fairly quickly if kept at an atmospheric shade temperature exceeding 65°F., the rapidity of the deterioration increasing rapidly with increase of temperature. Consequently this necessitates additional precautions being adopted by the householder such as scalding as soon as the milk is delivered. This is confirmed by the fact that the Minister of Food thought fit to publish details of methods of keeping milk fresh during the hot weather which included scalding. I have noticed that milk is often left on the front doorstep of houses for long periods during the heat of a summer day, which, of course, just invites trouble of this character. 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 33 tins Evaporated milk 884 tins Household milk 2 tins Vegetables and fruit 273 tins Beans 119 tins Meat and vegetables 33 tins Fish 166 tins 22 Wet fish 201¾ stones Tinned sausage 46 tins Sausages 38 lbs. Eggs 2,822 Dried eggs 2 tins Sauce 4 bottles Soup 46 tins Soup powder 35 lbs. Biscuits 150 lbs. Butter 8 ozs. Soya cream 12 tins Cheese 87 lbs. Prunes 75 lbs. Puddings 4 tins Junket powder 1 packet Egg savoury 69 jars Pearl barley 6 lbs. Barley flakes 30 lbs. Sweets 44 lbs. Mars bars 24 bars Chocolate 38 lbs. Fynnons salts 2 tins Devonshire pies 2 large Meat pies 12 small Flour and batter mixture 63 lbs. Macaroni 10 lbs. Olives 1 jar Pudding mixture 1 packet Potatoes 11 cwt. Beef cubes 168 cubes Essences 6 bottles Betox 3 jars Custard and baking powder 9 packets Dried peas 86 ibs. Bengers food 1 tin Meat 701½ lbs. Tea 3 lbs. Spaghetti 6 tins Stewed steak 81 tins Spam, prem and tongue 5 tins Minced beef loaf 14 tins Corned beef 6 tins Jam and Marmalade 88 tins Chocolate cup 21 packets Bacon 78½ lbs. Porridge 1 packet Dates 72 packets Pickles 31 jars Meat or fish paste 128 tins Mincemeat 1 jar Potted meat 1 tin A number of interesting complaints regarding food were investigated during the year, one or two of which are worthy of recording. (1) A tin of unsweetened evaporated milk was brought to me by a householder who complained that when used to make a cup of tea the resultant mixture turned a purple colour. The tea had been saved and inspection confirmed the peculiarity. The inside 23 of the tin disclosed obvious deterioration and both this and the tea was sent to the Public Analyst for examination. His report was as follows :— " The interior tinning of the tin was very faulty, there being large and extensive patches where the tin coating was practically non-existent and the iron underneath exposed. Whether this was a result of corrosion of the plating by the milk during storage or an original fault 1 cannot say. The tea contained approximately 30 parts per million of iron and 30 parts per million of tin. The effect of this proportion of iron would be to cause the discolouration observed by a reaction between the iron and the tannin in the tea infusion, whereby a bluish-black compound is formed. The proportion of iron in the tea would not be harmful, but that of the tin is such that I should consider it very inadvisable to drink such a fluid. Assuming the whole of the tin to have come from the milk used, the latter must have contained much in excess of 2 grains per pound This was an unusual instance of an individual defective tin and is the only complaint of this nature I have received. Full particulars were given to the Food Executive Officer for forwarding to the appropriate department of the Ministry of Food. (2) A complaint came to me via the Food Standards Division of the Ministry of Food in regard to a jar of sultana chutney which was stated to be unpalatable and to produce a feeling of sickness after a small portion had been eaten. The Public Analyst, however, reported that it was pure and wholesome, free from poisonous metals or other substance likely to cause sickness. (3) A piece of cloth 7½" x 1" was found firmly embedded in the centre of the meat in a tin of corned beef. This was obviously introduced during packing abroad. Details were given to the Food Executive Officer. (4) Several other specimens were brought to me such as Cheese alleged to taste and smell bad and which neither the complainant or his wife could eat. This proved to be some French Gruyere of normal taste and satisfactory quality. Margarine alleged to have a "funny taste". In one instance it was found to be normal in composition with no evidence of developed rancidity, but in a second instance the taste was confirmed and the shop-keeper obtained a fresh supply in lieu of the affected consignment. Soup having a "soapy" taste. Found to be due to addition of Margarine. More serious were complaints of the discovery of a dead mouse in a packet of breakfast cereals; of a hairpin embedded in a sausage, and a black beetle embedded in the crust of a loaf of bread. In these cases warnings were given to the firms in question after the fullest consideration had been given to the circumstances by the Public Health Committee. 24 ICE CREAM. The Ice Cream (Heat Treatment) etc. Regulations came into force on the 1st May, 1947. These broadly require that the ingredients of ice cream shall be heat treated after being mixed and that the mixture shall be cooled until the freezing process is begun. After freezing the ice cream must not be sold unless it has been kept at a temperature not more than 28°F. or, if its temperature has risen above 28°F„ unless it has again been heat treated and then kept at not more than 28°F. after having been frozen. An exception is made in regard to a complete cold-mix. A cold-mix is a product which, among other things, is capable of being manufactured into ice-cream with no addition except that of water, being in this respect, analogous to dried or evaporated milk. If a complete cold-mix is used the product, when reconstituted for manufacture, must be converted into ice cream within one hour of reconstitution. Regulation 3(b) (iv) prescribes that certain thermometers shall be used for indicating and recording the temperature to or at which the ice cream is raised, kept or reduced. This regulation, however, has not yet come into force. The date when it will, is to be fixed by the Minister of Health. There is no statutory standard prescribed to govern the minimum fat content or other ingredients nor does any bacteriological standard of cleanliness exist. At the moment there is no test available the reliability of which is considered sufficiently established to justify its use as a statutory test, non-compliance with which would constitute an offence. A form of methylene blue test, however, has been devised for ice-cream. This does not provide a guarantee of safety, but it does serve as a simple and practical method for grading ice cream according to its degree of bacterial cleanliness. Briefly four grades have been laid down, dependent on the time taken to reduce methylene blue and it is suggested that ice cream which consistently fails to reach grades 1 and II gives reasonable grounds to indicate defects in manufacture or of handling calling for further investigation. Twenty-nine samples were tested by this method during the year and only thirteen reached Grades I and II. Thirteen reached Grade III and three were placed in Grade IV. Whilst these figures do not appear, on first sight, to be entirely satisfactory the testing served a useful purpose. Moreover the results do not appear to compare unfavourably with figures given of more extensive testing in other areas. It has been my firm opinion, held for a number of years, that the greatest safeguard against bacterial contamination of 25 this important commodity would be for it to be manufactured and prepacked by machinery, untouched by hand from start to finish. It would be possible for me to write extensively on this subject, but with the whole matter being so indefinite at the present time it would, perhaps, not be appropriate to do so. I do feel, however, that some amendment is required to section 14 of the Food and Drugs Act, 1938. Under this only premises where ice cream is sold, manufactured or stored are required to be registered. Consequently a person retailing ice-cream from a barrow need not be registered in the district where he is selling the commodity so long as he does not manufacture or store it on premises situated in that area. In my opinion this is wrong. Any person selling ice cream should be required to register in whichever area he is so doing. SMOKE ABATEMENT. Much as 1 should like to report improvement in conditions under this heading, I am unable to do so. Some factory and laundry chimneys have given a good deal of trouble and have been responsible for complaints and many visits. It is not that the managements or the boiler staff have been unaware of the trouble.1 am satisfied that in most cases genuine attempts have been made to grapple with the problem. Two reasons stand out as being the primary causes of the deterioration in the position. One has been the inferior or unsuitable fuel available and the second is that, owing to the increased output demanded from factories in order to cope with the export drive, the boilers have had to be unduly forced in order to maintain the head of steam required for this purpose. Placed in the first category one laundry chimney gave much trouble through grit emission and to overcome this and at some considerable expense, a new grit catcher was being installed at the end of the year. The trouble here was that inferior fuel made it impossible for the stoker to maintain a head of steam anything like sufficient to keep work going and to remedy this, abnormal forced draught was employed resulting in much of the fuel dust being blown up the chimney unburnt. This eventually found its way on and into surrounding houses, much to the annoyance of the occupiers. 1 am able to say that since the grit catcher was installed (during January 1947) very great improvement has resulted and 1 hope, therefore, that this problem has been solved. The work of installing oil burning apparatus to the main boilers at one factory (referred to in my last report) was com- 20 pletcd during the year. The results were somewhat disappointing. Although, no doubt, it had the effect of reducing grit emission, periods of black smoke still remained a problem. Developments at this factory, however, give me every reason to hope that lasting improvement will soon materialise. SHOPS ACT. The whole of these Acts are administered by my Department and there appears to have been no instances of intentional evasion. In one or two instances hairdressers premises were found Jo be closing on days other than those laid down in the order made by the Council some years ago and remaining open on both of the alternative days when they should have been closed. On attention, however, being drawn to the matter, in each case it was quickly rectified. 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 2 2 Council houses (rooms) 4 4 (b) Other houses 8 8 The methods adopted, which appear to have been very successful, have been to fumigate with D.D.T. generators followed by spraying with D.D.T. liquid combined with dusting (especially behind picture rails and mouldings) with D.D.T. or Gammexane powder. RATS AND MICE DESTRUCTION. The year has been an important one in regard to action taken for the purpose of destroying rats and mice. At the beginning of the year a scheme of the Ministry of Food was adopted by the Council and commencing on the 1st April a comprehensive survey was made throughout the Borough to discover anv premises that were rat infested. In other words instead of waiting for complaints or requests for assistance, the whole district was taken section by section, the occupiers of dwelling houses being circularised to find out where infestations existed and to deal with them. This was done free of charge for occupiers of private dwelling houses, but owners of business premises were required to pay for services rendered. As the operations do not end until 31st March, 1948, a full statement will be made in my next annual report and I do not, therefore, propose to enlarge upon the matter at the moment. 27 Suffice to state that at the end of the year excellent progress and results had been achieved. At the same time all the soil sewers in the Borough were test baited and certain sections, which proved to show infestation received subsequent maintenance treatments. The refuse destructor, piggeries, sewage disposal works and controlled tip all received thorough treatment as part of the scheme. MISCELLANEOUS. A fairly considerable amount of time is occupied in clearing blockages in public sewers. The emptying and cleansing of these by the Local Authority is made obligatory by the Public Health Act, 1936. The cost of repairs of such sewers, however, is recoverable from the Owners of houses served. Many of what were previously termed combined drains in this area are now public sewers within the meaning of The Act and, as the great majority of houses are drained by means of public sewers it will be realised that stoppages, even if occurring in a small percentage of such public sewers, makes the actual number dealt with fairly high. It is not always possible, also, to ensure that repeat blockages do not occur. Occasionally something is introduced into the sewer which continues to give trouble until it is finally recovered or pushed into the main sewer in the roadway. When complaints are received it is necessary first for an inspector to make an investigation. Whilst doing so and in order to save valuable time and expense a few rods are taken and the matter generally attended to there and then. Occasionally however, the blockage is one requiring calling on the Borough Engineer to allow the sewermen to take the matter in hand. I have thought fit to mention these facts as it may be considered that actual clearing of drains are not matters for inspectors to do themselves. As I have said, however, the time and the expense saved and the satisfaction derived by householders by prompt action taken to remove conditions possibly prejudicial to health or at least objectionable and inconvenient, makes the practice well worth while. Trouble was experienced during the summer in the neighbourhood of the California Road depot due to the prevalence of crickets and flies. Nearby houses suffered an invasion and it became necessary to take more than routine measures to get the matter under control. The presence of refuse tips, piggeries etc., in close proximity to the houses no doubt influenced the trouble. Extensive areas were treated with Gammexane powder 28 and an allowance has been made in the estimates for the current year to repeat the operations at the appropriate time should a recurrence of the infestation become apparent. Bomb demolished houses having been rebuilt on the majority of sites this has assisted in reducing the problems due to the dumping of rubbish, etc. Attention was given to the Plough pond which instead of being a pleasing feature had become an eyesore. The stagnant water was pumped out, a quantity of old iron, etc., removed and the pond afterwards refilled with mains water. The hot dry summer contributed to the trouble. For this pond to remain without yearly becoming a nuisance, I am of opinion— (i) The mud should be removed and the bottom cemented, to facilitate cleansing. (ii) More surface water should be directed into it, and (iii) periodically attention should be given to remove debris which is thrown into it. Close liaison with the housing and rehousing officers has been maintained in supplying particulars regarding families living in overcrowded and other adverse conditions and by supplying the permitted numbers for many houses, to enable accurate records to be kept. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, HENRY TUNBRIDGE, Sanitary Inspector. 29 FACTORIES ACT, 1937 Prescribed particulars required by section 128 (3) in respect of matters under Part 1 and Part VIII of the Act which are administered by the District Council. PART 1 OF THE ACT. 1. INSPECTIONS. Number on Register Number of Inspections Written Notices Occupiers prosecuted Fatcories in which sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities. 71 32 3 — Factories not included in (i) in which section 7 is enforced by Local Authorities. 18 22 1 - Other premises in which section 7 is enforced by the Local Authority. — — — — Total 89 54 4 — 30 2. CASES IN WHICH DEFECTS WERE FOUND. Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.m. Inspector By H.m. Inspector Want of cleanliness — — — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences : (a) Insufficient 3 3 — 2 — (b) Unsuitable or defective 2 1 l — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 3 — 3 — — Total 8 4 4 2 — 31 PART VIII OF THE ACT. OUTWORK. No. ot out-workers in August list req'd. by Sect. 11O(l) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions The making of boxes or other receptacles or parts thereof made wholly or partially of paper ... 6 — ' — — — — Brush making 26 — — — - — Stuffed toys 5 — — — — — Total 37 — — — — —