LIBRARY MAL 12 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED DECEMBER 31st 1948 Printed by Raynts Park Press, Lambton Road, London, S.W.2o. OFFICERS AND STAFF OF THE PUBLIC HEALTH DEPARTMENT "James B. Morwood, M.B., F.R.C.S.I., D.P.H. Medical Officer of Health. Henry Tunbridge, 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. Thomas Arnell, 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. * Commenced duties 1st March, 1948. Borough of malden and Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1948 Public Health Department, Municipal Offices, New Malden. July, 1949. 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 1948 which has been prepared in accordance with Ministry of Health circular 3/49. 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 year has seen a number of changes in public health administration due to the coming into operation of the National Health Service and the National Assistance Acts, some new duties being added and others transferred to the County Council. One duty that has been added relates to applications which may now be made to a Court of Summary Jurisdiction for the compulsory removal to hospital of any person who is suffering from grave chronic disease and is unable to devote to him or herself and does not receive from other persons proper care and attention. Naturally the operation of this power must necessarily be restricted to cases where the interference with the liberty of the subject is of vital necessity and although several instances occurred where application to the Court was at first indicated it eventually only became necessary to make this in one case. This has been my first year as your Medical Officer of Health and I would like to take this opportunity of thanking you for your friendly welcome. My thanks are due also to the chief officers and their staffs for the co-operation and assistance they have so readily given me. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, J. B. MORWOOD, 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, 1948) 44,490 VITAL STATISTICS. Total M. F. Birth rate per 1,000 of the estimated resident population 14.2 Live Births 636 314 322 (Legitimate) 305 308 (Illegitimate) 9 14 Stillbirths 13 6 7 Rate per 1,000 total (live and still) births 20.0 Deaths 404 182 222 Death rate per 1,000 of the estimated resident population 9.0 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 25.1 Legitimate Infants per 1,000 legitimate live births 24.4 Illegitimate Infants per 1,000 illegitimate live births 43.4 Deaths from Cancer (all ages) 76 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) I BIRTHS. During the year 636 live births were registered, a decrease of 129 on last year's total. The rate per 1,000 population was 14.2 compared with an average for England and Wales of 17.9. Of the total number 23 or 3.6 per cent. were illegitimate. The birth rate is much lower than that of last year. 3 DEATHS. During the year 404 deaths were registered, a decrease of 48 compared with those recorded in 1947, the rate per 1,000 being 9.0 compared with an average of 10.8 for England and Wales. The infantile mortality was 25.1 per 1,000 live births, a low rate, comparing with the figure for 34 for England and Wales. For the fourth year in succession there were no deaths from maternal causes. CAUSES OF DEATH. M. F. Total Typhoid and paratyphoid fevers — — — Cerebro-spinal fever — — •— Scarlet fever — — — Whooping Cough 1 1 2 Diphtheria — — — Respiratory tuberculosis 8 5 13 Other forms of tuberculosis — 1 1 Syphilitic diseases 4 2 6 Influenza 2 1 3 Measles — — — Acute poliomyelitis and polio-encephalitis — — — Acute infective encephalitis — 1 1 Cancer 31 45 76 Diabetes — 3 3 Intra-cranial vascular lesions 15 27 42 Heart diseases 54 58 112 Other circulatory diseases 12 13 25 Bronchitis 5 3 8 Pneumonia 4 4 8 Other respiratory diseases 4 1 5 Ulcer of stomach or duodenum 1 — 1 Diarrhoea (under 2 years) — 1 1 Appendicitis 2 — 2 Other digestive diseases 5 5 10 Nephritis 4 6 10 Puerperal and post-abortive sepsis — — — Other maternal causes — — — Premature birth 3 3 6 Congenital malformations; birth injuries; infant diseases 3 6 9 Suicide 2 5 7 Road traffic accidents 5 1 6 Other violent causes 1 3 4 All other causes 16 27 43 182 222 404 4 DEATHS INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years :— 1944 (18 Legitimate. 1 Illegitimate) 19 1945 (22 „ 4 „ ) 26 1946 (14 „ 1 „ ) 15 1947 (19 „ None „ ) 19 1948 (15 „ 1 „ ) 16 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 6 30 minutes; 1 hour; 2 hours; 12 hours: 2 days; 2 days. Birth injury 1 3 hours. Congenital malformation 3 3 days; 4 days; 2 months. Gastro enteritis 1 10 months. Other diseases of infancy 5 3 days; 2 weeks; 1 month; 5 months; 7 months. 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 9 8 16 38 73 27 182 Females 9 1 2 2 3 8 29 27 90 51 222 Totals 16 1 4 4 12 16 45 65 163 78 404 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District. Surrey Hospitals. London and other Hospitals. Tolworth Hospital. Other Districts. Total. 230 126 27 1 20 404 5 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST SIX 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 1948 14.2 25.1 9.0 MORTUARY. Thirty-one bodies were brought to the Mortuary and thirty-one post-mortems made. H.M. Coroner for the district held inquests in five instances and the following verdicts were returned :— Accidental 1 Suicide 4 RAINFALL, 1948. Table showing rainfall in the district during 1948, taken at the Sewage Disposal Works, California Road, New Maiden:— Inches January 3.00 February 1.21 March 0.57 April 1.26 May 1.93 June 1.93 July 0.83 August 3.09 September 0.93 October 2.00 November 1.41 December 2.82 20.98 Increase on previous year 1.93 inches Average for past 5 years 21.55 inches 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the year 1948. Provisional figures based on Weekly and Quarterly Returns. England and Wales 126 C.Bs. and Great Towns Including London 148 Smaller Towns Resident Pop. 25,000— 50,000 1931 Census London Adm. County 1 England and Wales 126 C.Bs. and Great R Towns Including London 1 [48 Smaller Towns esident Pop. 25,000— 50,000 931 Census London Adm. County Rates per 1,000 Civilian Population. Deaths under 1 year of age 34 39 32 31 Live Births 17.9 t 20.0 19.2 20.1 Still Births 0.42f 0.52 0.43 0.39 Deaths :— Deaths from Diarrhoea and Enteritis under 2 years of age 3.3 4.5 4- tUara urar 2.1 a n A 2.4 All Causes 10.8 t 11.6 10.7 11.6 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 Pneumonia 0.41 0.38 0.36 0.54 rv uciau v ) iiiai mtit. vvtit ii*-» utaiiu. Whooping Cough 0.02 0.02 0.02 0.01 Diphtheria 0.00 0.00 0.00 0.01 Influenza 0.03 0.03 0.04 0.02 Rates per 1,000 Total Births (Live and Still). Small-pox — — — — Tuberculosis 0.51 0.59 0.46 0.63 Notification :— Notifications :— Puerperal \ Fever f and I Pyrexia / 6.89 8.90 4.71 7.34 Typhoid Fever 0.01 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 Cerebro Spinal Fever 0.03 0.03 0.02 0.03 Scarlet Fever 1.73 1.90 1.82 1.37 Whooping Cough Diphtheria 3.42 0.08 3.51 0.10 3.31 0.09 3.13 0.10 Maternal Mortality in England and Wales Erysipelas 0.21 0.23 0.21 0.22 L . , _ n 11 Small-pox — — — — Abortion with ISepsis u. 11 n fK Measles 9.34 9.75 8.84 9.17 Abortion without Sepsis U.U3 Pneumonia 0.73 0.84 0.60 0.57 Puerperal Infections 0.13 t Rate s per 1,0 00 Total Popi ilation. Other Maternal Causes 0.73 7 NOTIFICATION OF INFECTIOUS DISEASES. 1948 DISEASES Totals Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-25 25-35 35-45 65 and 45-65 over. Measles 386 18 41 45 55 55 158 8 2 1 2 1 — Whooping Cough 267 26 34 35 33 32 92 4 2 1 3 3 2 Scarlet Fever 33 _ 1 1 19 9 1 1 1 — Pneumonia . . 22 3 1 1 2 1 4 2 2 3 3 Erysipelas 3 — — — — — 3 — Paratyphoid 1 — — — — — — 1 Puerperal Pyrexia *1 — — — — — — — , 1 Malaria 1 — — — — — — — — — 1 — — — Totals 714 47 76 81 91 89 273 21 8 1 6 5 11 5 WARDS DISEASES Totals Coombe Dickerag Mount C Dambridgf Norbiton Park Burlington Maiden Green St. James Maiden Manor Measles 386 34 46 40 36 75 53 31 38 33 Whooping Cough 267 40 25 28 19 40 44 10 43 18 Scarlet Fever 33 1 4 1 4 5 2 7 3 6 Pneumonia 22 — 3 7 2 — 2 2 3 3 Erysipelas 3 — — 1 1 1 — — — — Paratyphoid 1 1 — — — — — — — — Puerperal Pyrexia 1 — — — — — — — — 1 Malaria 1 — — — — — — — 1 — Totals 714 76 78 77 62 121 101 50 88 61 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 thirty-three, giving an incidence rate of 0.74 per thousand population. This compares with a rate of 1.73 for England and Wales. The majority of cases were very mild and no fatalities occurred. Nine cases were treated at home and twenty-four were removed to hospital. There were no 'return' cases. DIPHTHERIA. No case of diphtheria occurred in the district during the year, this being the second occasion only during the past fifty years of complete freedom from this disease. The scheme for immunisation progresses smoothly and the great majority of parents are now accepting immunisation as a matter of course. We are now recommending it at the age of seven months. When done so early it is probably advisable to give a third dose twelve months later. Under the present scheme children are given the opportunity of receiving a reinforcing dose at intervals of 3-5 years up to school leaving age. Under the new National Health Service Act all medical practitioners providing general medical services in the area have been given an opportunity to provide services in the scheme of diphtheria immunisation. This has resulted in a number of children being done otherwise than at schools or clinics. The following statistics refer to immunisation carried out during the year:— Number of children completing treatment during the year (pre-school, 559; school, 101) 660 Number of children receiving reinforcing doses 954 Total attendances at clinic 940 During the latter part of the year a special effort was made to encourage mothers to bring their babies for immunisation in cases where persuasion by the health visitor had failed. A note was made of every child aged ten months and older who had not been immunised and the parents of these babies were circularised in regard to the importance of immunisation against 9 diphtheria. In many cases this personally addressed circular succeeded where other methods of encouragement had failed and it is hoped there will be, in consequence, a rise in the percentage of immunised children next year. In his report for 1947 Dr. Fanning quoted an extract from a circular of the Ministry of Health, showing 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. The facts shown are so remarkable that I cannot do otherwise than include the following latest information which is extracted from a recent circular of the Ministry. "The provisional total of deaths from diphtheria in England and Wales in 1948 was 150, compared with an average of about 2,800 deaths annually in the ten year period 1931/40. For the seventh consecutive year, therefore, since the immunisation campaign was launched, the number of deaths was the lowest ever recorded. Totals of deaths and original notifications during the past nine years have been as follows:— Year Diphtheria deaths Case s 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 244* 10,465* 1948 150* 8,034* * Provisional. The number of cases in 1948 was also the lowest ever recorded, being 47,000 below the average of 55,000 in the ten year period 1931/40. Apart from the avoidance of unnecessary suffering, this has resulted in substantial savings in hospital costs and has freed medical and nursing personnel for other work." VACCINATIONS. The National Health Service Act, 1946 repealed the Vaccination Acts, 1867 to 1907 and in consequence vaccinations against smallpox are not now compulsory. As with diphtheria immunisation all medical practitioners providing general medical services in the area are given an opportunity to provide service for carrying out vaccinations. 10 From the 5th July until the end of the year the numbers performed by myself as Medical Officer of Health or by medical practitioners were as follows:— Vaccinations 105 Revaccinations 32 Total 137 Ninety-five of the persons vaccinated were under 1 year of age. CEREBRO-SPINAL FEVER AND ACUTE POLIOMYELITIS. No cases of cerebro-spinal fever or acute poliomyelitis were notified during the year. MEASLES. In the past Measles was epidemic every second year but this seems recently to have changed so that epidemics are now occurring, more or less, every year. Three hundred and eighty six cases were notified, being one hundred and forty-six more than the previous year. Nineteen cases were removed to hospital but no deaths occurred. Prophylactic serum for contacts was supplied to doctors in all cases where application was made. WHOOPING COUGH. The number of cases of whooping cough notified was two hundred and sixty-seven, which is well above the average. Twenty-seven cases were removed to hospital. Two cases died at home. PARATYPHOID FEVER. One case of paratyphoid fever was reported. This was a young Spanish Olympic boxer who arrived ill at Richmond Park Camp and who, obviously, contracted the disease out of this country. He only remained at the camp for a few hours before being removed to hospital where the actual diagnosis was made. SCABIES. The scheme for the treatment of scabies referred to in previous reports continued successfully. During 1948, 95 persons received treatment. Of these, 60 showed definite lesions, the remainder being contacts in the same family. II VERMINOUS CONDITIONS. Sixty-five persons, mostly school children, were treated for headlice during the year. No case of body louse infestation came under notice. FOOD POISONING. There were no outbreaks of food poisoning during the year. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales Borough of Maiden and Coombe Scarlet fever 1.73 0.74 Diphtheria 0.08 — Typhoid fever 0.01 — Paratyphoid fever 0.01 0.02 Cerebro-spinal fever 0.03 — Measles 9.34 8.67 Whooping cough 3.42 6.00 *Puerperal pyrexia 6.89 1.54 * per 1,000 total births (i.e. live and stillbirths). CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 23 Scarlet fever (not confirmed) 5 Pneumonia 4 Pneumonia (not confirmed) 4 Diphtheria (not confirmed) 2 Measles 19 Whooping cough 27 Chicken pox 8 Laryngitis 1 Cerebro-spinal fever (not confirmed) 1 Mumps 8 Meningitis 1 Erysipelas 1 Dysentery, Diarrhoea, etc 1 105 12 CASES ADMITTED TO HOSPITALS OTHER THAN TOLWORTH. Scarlet fever 1 Chicken pox 6 Paratyphoid 1 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1943 1944 1945 1946 1947 1948 Scarlet fever 185 98 25 44 49 33 Diphtheria 1 — 10 5 3 — Typhoid fever — — — — 2 — Paratyphoid fever — — — — — 1 Erysipelas 9 9 5 7 8 3 Pneumonia 46 12 14 15 18 22 Encephalitis lethargica Puerperal pyrexia 7 — 4 2 4 1 Cerebro-spinal fever 2 2 2 1 2 — Acute Poliomyelitis — — — 2 5 — Ophthalmia Neonatorum 1 — — — — — Dysentery 1 9 53 2 — — Malaria — 34 28 — — 1 Measles 221 22 589 152 240 386 Whooping cough 143 44 43 75 39 267 Tuberculosis (all forms) 44 36 44 52 42 63 Suspected food poisoning TUBERCULOSIS, 1948. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Females Male Female Male Females 0 2 - - - - - - - l 1 - - - - - - - 5 1 l - - - - - - 15 7 8 — 1 — l — — : 25 4 7 1 1 3 l — — ,i 35 12 4 — — 1 l — — 45 5 1 — 1 2 l — i 55 5 1 — — 2 l — — 65 - - - - - - - - & upwards Totals 37 22 1 3 8 5 10 13 A sharp rise is shown in the number of notifications of new cases of pulmonary tuberculosis but the mortality rate is again only one-third of the high peak registered in 1941 and still shows a tendency to decline. The following table shows the trend of tuberculosis since 1938. TUBERCULOSIS 1938 - 1948. Year NEW CASES DEATHS Estimated Population No. Pulmonary Rate per 1,000 Population N No. on-Pulmonary Rate per 1,000 Population No. Pulmonary Rate per 1,000 Population No No. n-Pulmonary Rate per 1,ooo 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 1948 44,490 59 1.32 4 0.09 13 0.29 1 0.02 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 2 cases. At the end of the year the following numbers of cases were shown to be suffering from the disease and living in the district, an increase of 31 compared with the previous year. Non- Pulmonary Pulmonary Males 150 22 Females 93 28 TREATMENT OF RHEUMATISM. The Council's scheme for the treatment of Rheumatism came to an end on 4th July, 1948, due to the operation of the National Health Service Act. Details of the scheme were given in the Medical Officer's report for 1943. 14 In order that all patients on the waiting list, numbering nineteen, should receive some treatment new cases were not accepted from 1st January. The actual number who received treatment during the six months was eighty-two and a total of 2,882 treatments were given during that period, the cost to the Council being £522. This scheme undoubtedly proved of great benefit to ratepayers suffering from rheumatic diseases and during the five years it was in operation nearly five hundred persons affected with this distressing complaint received free treatment. WORK OF PUBLIC 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 (measles. whooping cough, etc.) 689 Home visits in connection with rheumatic clinic 32 Attendances at diphtheria immunisation sessions 33 Number of visits for treatment of scabies 213 Number of visits for treatment of head lice 243 Visits in connection with other matters, (home helps, old people, etc.) 308 15 SANITARY ADMINISTRATION. ANNUAL REPORT of THE SANITARY INSPECTOR 1948 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 pleasure to submit my twenty-ninth Annual Report of work done and matters of interest concerning the Sanitary Department. The raising of the 'free' limit to £100 has been of great assistance in obtaining more prompt compliance with notices, whether informal or abatement and much leeway has been made up. The separation of war damage repairs, however, as apart from those of ordinary maintenance has, at times, caused some delay, owners naturally desiring to carry out both together. In fact quite often the two have been inseparable and abatement notices have had to include repairs under both categories. In those instances where there was failure to obtain early settlement with the war damage commission delay in the work being put in hand was a consequence. Generally speaking, however, the year under review has seen far greater activity in this respert, certainly since 1938. For the purpose of abating nuisances or executing repairs to houses, the following notices were served:— Preliminary 278 Abatement 190 Informal (dustbin only) 15 Formal (dustbin only) 19 16 It was necessary to apply to the Court for Nuisance Orders in twenty-nine 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 25 Applications withdrawn, work having been completed before hearing 4 Twelve dustbins were supplied to houses and the cost charged to owners. These were cases where Owners had defaulted in complying with notices served under section 75. It will be noted that the notices served on owners to supply dustbins and the number of dustbins supplied in default are greatly reduced when compared with the previous two or three years. This has been due to the fact that the pre-war routine was re-introduced during the year. Instead of all cases where dustbins are required being referred to me in the first place, a card drawing attention to the absence of or defective condition of the existing bin is placed in the letter box of the house in question. This is effective in the great majority of cases, and only those failing to respond are referred to me. There have been few instances where the owner has objected to supplying a bin and no appeals were made pursuant to section 75. SCABIES. I am glad to say the continued decrease in the incidence of Scabies has given me far less work in this direction, so that I have only given my personal attention to a few cases during the year. WATER SUPPLY. The whole of the Area is supplied by the Metropolitan Water Board and the supply has been satisfactory both as regards quantity and quality. 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. 17 INFECTIOUS DISEASES. The following number of rooms were disinfected for the undermentioned causes:— Scarlet fever 23 Tuberculosis 40 Vermin 14 Suspected Diphtheria 2 Chicken Pox 3 Whooping Cough 1 Puerperal Pyrexia 10 A number of books from the public library and schools were also disinfected as far as practicable for a variety of reasons. Seventeen loads of bedding were removed for steam disinfection or destruction. Routine disinfection after Scarlet Fever is not now carried out and is only done in those cases where a request is made. Instead a bottle of disinfectant is left and advice given as to the best method to be employed in dealing with the bedroom used by the patient. It is now well known that the incidence of this disease is not affected by failure to do ordinary fumigation. Efforts are made, however, to ensure that disinfection is carried out after death and where patients suffering from Pulmonary Tuberculosis move. There are, however, difficulties in ensuring that this is always done. Disinfection is sometimes declined but in these cases it is generally found that adequate measures have already been taken. FOOD AND DRUGS ACT, 1938. During the year 142 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 Barley crystals — 1 1 — — — Beef cubes — 1 1 — — — Beef jelly — 1 1 — — — Butter — 5 5 — — — Cascara Sagrada Tablets - 1 1 - - - Coffee and Chicory — 2 2 - — — Coffee and Chicory Essence - 2 2 - - - Cooking fat - 3 3 - — — 18 ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Epsom Salts — 1 1 — — — Almond flavouring — 1 1 — — — Fruit Laxative Tablets - 1 1 - - - Gelatine - 1 1 - - — Gravy powder - 2 2 - - — Hydrogen peroxide - 1 1 - - — Lemonade crystals - 1 1 - - — Magnesia tablets - 1 1 - - — Marmalade - 1 1 - - — Milk 14 22 36 1 - 1 Liquid paraffin — 2 2 - - — Meat paste — 3 3 - - — Pepper — 3 3 - - — Ammoniated tincture of Quinine - 1 1 - - - Saccharin tablets 2 2 4 - - 1 Sage — 1 1 - - — Sauce — 3 3 - - — Sausages and sausage meat 21 - 21 2 - 2 Sherbert — 1 1 — - — Hare soup — 1 1 — 1 1 Sulphur tablets — 1 1 — - — Table desert — 2 2 — 1 1 Tomato sauce — 1 1 — 1 1 Baking powder — 2 2 — - — Bicarbonate of soda - 1 1 - - - Plain flour — 1 1 — - — Self raising flour 2 1 3 — - — Jam — 3 3 — - — Oatmeal — 1 1 — - — Salad cream — 2 2 — - — Mixed spice — 3 3 — - — Tea — 2 2 — - — Cocoa — 1 1 — - — Cream of tartar — 1 1 — - — Fish paste — 2 2 — - — Margarine — 4 4 — - — Mustard — 2 2 — - — Tomato soup — 1 1 — - — Ground ginger — 1 1 — - — Sponge mixture — 1 1 — - — Vinegar 2 — 2 — - — Vinegar (wood) 1 — 1 1 - 1 Whisky 2 — 2 — - — Totals 44 98 142 4 4 8 Notes in regard to samples shown as adulterated or below standard. Milk. It is satisfactory to note that, with the exception of one, all the samples purchased proved genuine. The one case shown to be below standard was deficient in milk solids other than milk fat to the extent of 1 % only. The milk fat content was up to standard and the freezing point of the sample did not indicate the presence of 19 added water. Except that the firm retailing the milk was informed, no action was taken in this case. Saccharin Tablets. Twenty tablets selected at random from this informal sampling weighed from 0.98 to 1.10 of a grain and contained between 0.146 and 0.181 of a grain of saccharin per tablet. Only one tablet or 5% of the total number selected contained 0.18 of a grain or more of saccharin. A standard saccharin tablet should contain not less than 0.18 of a grain and not more than 0.22 of a grain of saccharin. A formal sample of the same brand taken shortly afterwards was found to be up to standard. Correspondence with the makers took place and in view of the explanations and assurances given, no further action was taken. Sausage Meat. The meat content in these two instances was found to be 45% and 40% respectively instead of 50%. Both cases were referred to the Food Executive Officer who subsequently gave a warning to each vendor. Hare Soup. In this case the ingredients were not specified on the label as required by the Labelling of Food Order, 1946. It had also undergone some deterioration owing to absorption of moisture and there was evidence of the previous existence in the article of one or more grubs. The soup powder was found obviously to be old stock and the remaining 12 packets were withdrawn from sale and destroyed. Table Dessert. This was another instance in which the label on the container did not bear a statement specifying the name and address of the packer or labeller of the food, nor the ingredients of the food as required by the Labelling of Food Order. The makers of the commodity were able to satisfy me that the label was issued prior to September, 1944 and that the new labels used since then complied with the Regulations. Tomato Sauce. This sample contained 200 parts per million of sulphur dioxide which is an added preservative. Sulphur dioxide may be introduced into sauce by the use of fruit pulp preserved with sulphur dioxide and permitted by the Regulations, but the bulk of it, so introduced, is normally removed during manufacture. An explanation given by the manufacturers was considered satisfactory and accepted, and in view of other peculiar circumstances no further action was deemed necessary. Wood Vinegar. This sample contained 3.85% acetic acid instead of the minimum of 4%. A warning was issued. MILK. During the year the following licences were issued under the Milk (Special Designations) Orders:— Dealers Tuberculin tested 6 Pasteurised 5 Pasteuriser's licence 1 Supplementary. Tuberculin tested 8 Pasteurised 7 20 Seventy-nine samples of milk were submitted for examination by the phosphatase and methylene blue tests. 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 79 examined. Seven samples failed to pass the methylene blue test. Most of these occurred during 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. Even with efficient pasteurisation and correct handling, milk may be expected to sour quickly if kept at a shade temperature exceeding 65 °F, the rapidity of the deterioration increasing quickly with a rise of temperature. Consequently this necessitates additional precautions being adopted by the householder, such as scalding, as soon as the milk is delivered. 1 have noticed that milk is still often left on the front doorsteps of some houses for long periods exposed to the sun which, of course, just invited trouble of this character. With the exception of tuberculin tested milk, all milk sold in this district is, so far as I am aware, pasteurised. In some cases tuberculin tested milk also is pasteurised. FOOD SUPPLY. As far as possible, watch is kept on premises where foodstuffs are prepared or sold, which includes slaughterhouses, butchers' and fishmongers' shops, bakehouses, dairies, etc. No animals were killed for sale in local slaughter-houses during the year. The following unfit foodstuffs were voluntarily surrendered and destroyed or handed over for salvage:— Chicken 50 lbs. Fish 174 tins Wet fish 149 stone Salt 12 packets Flour 88½ lbs- Pickles 13 jars Sauce 46 bottles 21 Evaporated or Condensed Milk 336 tins Jam and Marmalade 69 tins Tomato Juice 6 tins Grape Fruit Juice 6 tins Coffee 6 bottles Beans 69 tins Prem 13 tins Strained Foods 10 tins Minced Beef or Veal Loaf 26 tins Meat or Fish Paste 122 jars Vegetables and Fruit 459 tins Soup 177 tins Spaghetti 13 tins Puddings 6 tins Mutton Hash 2 tins Meat Lunch 3 tins Eggs 1,462 Potted Meat 1 tin Bacon 4 tins Pork Sausages 1 tin Beef 206½ lbs. Lamb 131 lbs. Offal 4 lbs. Carcase of Pig 12 stone Oatmeal and Porridge Oats 54 packets Dried Egg 5 tins Cream Chocolate Blocks 23 bars M & V Ration 2 tins Stewed Steak 5 tins Syrup 9 tins Semolina 4 packets Malted Food 81 tins Cheese 25 lbs. Baking Powder 3 packets A number of complaints regarding foodstuffs were received during the year, some of which are worth recording. (1) A piece of bread was brought to my office in which was a small beetle. A visit to the bakery and an examination of the flour disclosed one infested sack. A sample was submitted to the Public Analyst and the beetles were identified as triboleum castaneum or red rust flour beetles. These are a common form of flour beetle which frequently develop in flour during storage. The affected flour was immediately withdrawn from use and no further action was considered necessary. (2) Another complaint was received regarding the presence of some fibres in flour. The complainant was unwilling to press the matter and preferred to take it up privately with the seller. I did, however, send a sample to the Public Analyst who found that it contained a number of jute fibres which might have been removed accidentally from a typical flour sack. This was considered a purely adventitious occurrence. (3) The presence of two pieces of foreign matter in a piece of bread formed the basis of another complaint, it being thought that these were rat 'dirts'. The Public Analyst, however, found that this was not so and the trouble was found to be due to a little grease which had gained access from the arm of the dough mixing machine. Occasional accidental contamination of this character is difficult to avoid. 22 (4) A more serious complaint concerning bread was the discovery by the purchaser of a double edged safety razor blade embedded in a loaf. The circumstances as to how this got there were very thoroughly investigated and it was in fact established that the blade was one used in the bakery in making loaves. It had been missed and, although search was made, it was not found and the conclusion was reached that it had been swept up. What undoubtedly happened was that it had fallen from a shelf into a baking tin and later was discovered in the customer's loaf. The manager of the bakery was asked to attend before the Public Health Committee when a strong verbal warning was given, followed later in writing. Immediate steps were taken by the firm to avoid a repetition. (5) A somewhat similar occurrence was demonstrated in the case of a cake which contained a bent metal can opener. How this actually got into the cake was never established as no can openers of this type were used in the bakery. The manager of this bakery was also interviewed by the Public Health Committee and a warning was given. Several other specimens were brought to my office. In one or two the complaints proved groundless and in others, investigations proved the troubles to be of minor character. It is not an infrequent occurrence that an article of food, generally meat, is brought to me several days after purchase (having been cooked in the meantime) with the complaint that it smells and is not fit to eat. Although, in some cases, replacement has been obtained from the shopkeeper by tactful persuasion it is not possible for me, in these circumstances, to arrive at a conclusion that the article was not, in fact, of sound quality at the time of purchase. There is no doubt that complaints of foreign matter found in foodstuffs have increased during the past few years but when compared, however, with the vast quantities of each individual commodity sold, it will be realised that these constitute an infinitesimal proportion. One has only to calculate in the case of bread alone that if each household in this district receives only one loaf every other day during the year this represents more than 2| million loaves per annum. Whilst I realise that not all cases of contamination come to the knowledge of the Public Health Department, this simple fact should be sufficient to reassure anyone who might think that there is cause for any alarm. ICE CREAM. In my last report I gave a fairly full statement regarding the operation of the Ice Cream (Heat Treatment) etc. Regulations which came into force on the 1st May, 1947. Regulation 3 (b) (iv) which 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 had not been put into force by the Minister of Health by the end of the year. Eighty-four samples were submitted for testing by the methylene blue method and of these fifty-five reached Grades I and II standards. Twenty-two were placed in Grade III and seven in Grade IV. Faecal coli were present in only two of the samples examined. 23 To appreciate the significance of these results it should be understood that ice cream which consistently fails to reach Grades I or II gives reasonable grounds to indicate defects in manufacture or of handling calling for further investigation. In one such instance trouble was experienced over a period of two or three months by a local manufacturer and accounts for a third of those shown in Grades III and IV. Investigations proved that the low grading was not caused by inefficient methods or lack of cleanliness, but was due to a small defect in the apparatus which was only discovered after prolonged search. Samples were taken at all stages of manufacture and by a process of elimination the trouble was eventually located and put right. I might, perhaps, add that the methylene blue test 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. SMOKE ABATEMENT. There is no doubt that the year has seen an improvement in conditions under this heading, probably due to conversion of coal burning furnaces to oil, the installation of a more efficient grit catcher at one laundry and improvement in the quality of fuel. I am aware that occasionally trouble does occur, but complaints have been far less. In one instance the Ministry of Fuel and Power, at my request, sent an engineer expert and a stoker demonstrator to one large factory and they were able to advise as to ways and means of avoiding trouble which was then being experienced. Their visit was much appreciated and the co-operation, which was freely given, by the factory management had a most beneficial result. SHOPS ACT. The whole of these Acts are administered by my Department and there appears to have been no instances of intentional evasion. ERADICATION OF BED BUGS. During the year the following number of houses were found to be infested with bed bugs:— Infested Disinfested (a) Council houses 2 2 Council houses (rooms) 4 4 (b) Other houses (rooms) 2 2 24 RATS AND MICE DESTRUCTION. In my Annual Report for 1947 I made passing reference to the scheme inaugurated by the Ministry of Food whereby a comprehensive survey was made throughout the Borough to discover any premises that were rat infested and a free service of rat destruction given to occupiers of private dwellings houses. I then indicated that I would give a full statement of the operations involved in this year's report. I have pleasure therefore, in doing so now. The scheme originated in May, 1946 by the issue of circular N.S. 12 which due to certain difficulties, mainly owing to the late issue of the circular, was not adopted. In March, 1947, however, a further circular, N.S. 15 was received repeating the terms previously made, which was adopted by the Council. Very briefly the scheme can be summarised in the following extract taken from the circular:— "The Ministry is prepared to join with local authorities in relieving occupiers of private dwellings of charges for the work of destroying rats at such premises when carried out by local authorities in the course of an approved systematic campaign during the fiscal year 1946/47". Certain conditions were imposed but it is unnecessary for me to quote these in detail. Two however, should be mentioned — (1) charges had to be made in the case of business premises and (2) local authorities had to satisfy the Ministry that approved action was being taken to deal with rats in sewers, sewage disposal works, refuse dumps, destructors, etc under the control of the local authority. Provided the conditions were complied with the Ministry agreed to contribute 60% of the cost, the local rate fund being responsible for 40%. This arrangement was really an extension of a grant already in force and did not disturb existing financial arrangements detailed in a previous circular F/2 dated 29th April, 1944. I mention this in order to correct the impression that the 60% grant was clear of all other considerations. Running concurrently with circular N.S. 15 (surface infestations) was N.S. 11 (sewers). The basis of financial aid in regard to sewers was 30% of the total overall costs of two approved treatments against rats in sewers. Acceptance of N.S. 12 automatically meant the acceptance of N.S. 11. It became necessary, therefore, for me to prepare a scheme at short notice whereby the whole district could be systematically 25 combed to find out where rats existed and to destroy them, and to put into effect the obligations in regard to test baiting of all the soil sewers in the area and the necessary maintenance treatments where pockets of infestations were discovered. The method to be employed could not be left to casual complaints. As far as possible all premises infested had to be discovered and dealt with. This could be done in two ways. The first would be to engage investigation officers who would visit every house in the district. Although the cost of investigation officers would have been reimbursed 100% I considered the cost to be unwarranted, the difficulty of obtaining suitable men at the time for a restricted period of engagement ruled against this method and the number of revisits to people who were out at work all day provided another objection. Just prior to the adoption of these schemes I had conducted a vigorous campaign in the self-contained Kingston Vale area. This was done by circularising each householder and proved very successful, prompting me to adopt a similar method over the whole area. In other words the co-operation of the public was invited. This method was accepted by the Ministry. The district was divided into 18 sub-areas carefully delineated so that each could be taken individually, in sequence, and to a carefully prepared timetable. Some two or three weeks before actual operations were commenced all the householders in each area were circularised and asked to return a form stating whether or not they had any trouble with rats or mice. Primary visits were made to those houses where infestations had been indicated. In addition, however, other houses in the neighbourhood were visited to ensure that no unrecognised infestations had been missed. To carry out the scheme successfully needed adequate staff and in addition to the senior rodent officer, three men operatives were engaged more or less constantly throughout the year. In addition, to relieve the senior rodent officer of much clerical work, one clerk was engaged whole time in keeping records. For the treatment of sewers the staff was reinforced for certain limited periods by two sewermen from the borough engineer's department. Fine weather was essential for the sewer treatments and the first three weeks were occupied in test baiting throughout the area whilst awaiting the first replies from No. 1 sub-district. Baiting of sewers is a laborious operation, one in every ten soil sewer manholes had to be baited with sausage rusk (unpoisoned) to discover 'takes'. The actual number baited was 292. Specially 26 constructed depositors for lowering the bait into the chambers and placing it on the benching were obtained. After an interval of one day each manhole was again opened to ascertain the 'takes' and so to judge the extent of infestation. It will thus be seen on this preliminary procedure 582 operations were involved. Where 'takes' were found initial treatment was given at a later date. This however, was done, not only in those manholes where 'takes' had been recorded, but in a number of others in the same vicinity to be sure of complete success. Initial treatment consisted of each selected manhole being pre-baited twice (with an interval of one day) with inocuous bait to encourage feeding, followed by a third baiting with poison (zinc phosphide). A fourth visit was made to record 'takes' of poison bait. 57 manholes were given initial treatment (11 having actually given positive results on test baiting) and as these involved 4 visits each, 228 operations were thereby necessary. A few weeks later in the year manholes which showed positives on the first initial treatment and others in the vicinity were given a second treatment (arsenic) — termed the first maintenance treatment. These numbered 40 involving 160 operations. A second maintenance treatment was given in the case of 11 manholes at the end of the year. I have given these figures to show that the work was by no means of a light character. Over 12,000 circulars were delivered to householders and, after visiting, 802 premises were found to be infested in various degrees. Treatment consisted of laying pre-baits on four consecutive days (except when this was done directly into holes etc, when two pre-baits were considered sufficient) followed by a poison baiting on the third or fifth day. A further visit had subsequently to be made to collect any untaken poison baits. The results of the treatment were carefully kept and the figures give the following results:— Cleared on first treatment 691 Cleared on second treatment 85 Cleared on third treatment 26 The number of individual visits made was 6,067. One indication of the success achieved was that during the progress of operations many casual complaints were received from sub-districts which had not been reached but very few came from those areas which had received comprehensive treatment. 27 614 business premises were surveyed and 107 infestations were found. The results were as follows:— Cleared on first treatment 91 Cleared on second treatment 10 Cleared on third treatment 6 The number of individual visits made was 1,304. It can be estimated that about 8-9% of all premises in the area were found to have some evidence of rat infestation. In addition to the work on sewers, private dwellings and business premises extensive measures were taken on the Council's own property such as the refuse destructor, sewage disposal works, controlled tip, allotments etc. An unexpected result was that, generally speaking, the older parts of the district revealed a lower percentage of premises infested than the more modern. The scheme has now been extended for the financial year 1948/49 with certain financial and other modifications but, more or less, on the same lines as for the year 1947/8. MISCELLANEOUS. A new obligation has been imposed on the Council by Section 50 of the National Assistance Act, 1948. This provides that it shall be the duty of the local authority to cause to be buried or cremated the body of any person who has died or been found dead in their area, in any case where it appears to the Authority that no suitable arrangements for the disposal of the body have been or are being made otherwise than by the authority. The cost may be recovered from the estate of the deceased person or from any other person who for the purposes of the Act was liable to maintain the deceased person immediately before his death. It is also provided that sub-section (5) of Section 22 of the National Insurance Act, 1922 (which enables the Minister of National Insurance to make payments to certain authorities out of the National Insurance fund in respect of the cost of burial or cremation of certain persons) shall apply to local authorities such as this Council. This, however, is not operative in the case of deaths occurring before the 5th July, 1949. One instance occurred during the six months ended the 31st December, 1948, where this duty had to be undertaken by the Council. The case was one where it was not possible to recover the cost of burial or any part thereof. 28 The trouble experienced in the neighbourhood of the California Road Depot due to the prevalence of crickets during the past few years was much less in evidence during the year under review. I think this must be attributed to the energetic steps taken in the previous year followed up by modified measures during 1948. The fact that tipping in this area has now ceased should render the problem far more easy to control. A number of complaints were again received in reference to unsightly conditions produced by the dumping of rubbish on vacant plots in the area. Where it was considered essential some plots were attended to. The power to take formal action in these cases has been very limited and is dealt with only in section 28, Town Police Clauses Act, 1847, as amended by section 81 of the Public Health Acts (Amendment) Act, 1907, which enables an Urban Authority only to take action against any person responsible for depositing the rubbish on any unfenced ground adjoining or abutting a street. The restrictive nature of these provisions can easily be realised. Section 33 of the Town and Country Planning Act, 1947 gives a local planning authority power to require the proper maintenance of waste land. It has to be proved, however, that the amenities of the area are seriously injured in order to justify formal action against the owner of the land, but the advantages of proceeding under this section are that it applies to a wider class of waste land than that for which provision is made in the Acts of 1847 and 1907 and it is not necessary to discover the actual person responsible for depositing rubbish on the land. Vacant land, however, is diminishing and the time cannot be far away when all will be built upon. 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 I and Part VIII of the Act which are administered by the District Council. PART I OF THE ACT. 1. INSPECTIONS. Number on Register Number of Inspections Written Notices Occupiers prosecuted Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities. 79 43 3 — Factories not included in (i) in which section 7 is enforced by Local Authorities. 17 10 1 - Other premises in which section 7 is enforced by the Local Authority. — — — — Total 96 53 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 3 3 — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences: (a) Insufficient — — — — — (b) Unsuitable or defective — — — — — (c) Not separate for sexes (absence of screening) 1 1 - 1 - Other offences against the Act (not including offences relating to Outwork) — — — — — Total 4 4 — 1 — 31 PART VIII OF THE ACT. OUTWORK. No. of out-workers in August list req'd. by Sect. 110(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 4 — — — — — Brush making 68 — — — — — Cleaning of wearing material 1 — — — — — File making 2 — — — — — Making of artificial flowers 2 — — — — — Total 77 — — — — —