MAL 14 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED 31st DECEMBER 1950 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 Stanley J. T. Wood, M.R.San.I. Deputy Chief Sanitary Inspector. Leslie E. Bowskill, M.R.San.I., Sanitary Inspector. Mrs. M. J. Butler, S.R.N., Public Health Nurse. Bernard Ll. Prichard, Rodent Officer. Frederick W. W. Mitchell, Chief Clerk. Leslie S. Frazer, Mortuary Keeper, Disinfector, etc. Thomas Arnell, Junior. (H.M. Forces). TEMPORARY. Mrs. A. Savage. Shorthand Typist. A. E. Wilson. Assistant to Rodent Officer. T. Clarkson, Assistant to Rodent Officer. B. Jeffrey, Junior. PUBLIC ANALYST: Danill D. Moir. M.Sc., F.R.I.C. Borough of Malden and Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1950 Public Health Department, Municipal Offices, New Malden. July, 1951. 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 which has been prepared in accordance with Ministry of Health Circular 112/50. The health of the district remains good. 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. During the year a great deal of work has again been done by the department for the welfare of old people and there have been several cases in which it has been possible to provide adequate care and attention for old people in need of it. Consequently it has not been necessary to take any action under section 47 of the National Assistance Act, 1948, which provides for the compulsory removal to hospital of this type of case. I wish to offer my thanks to the Chairman and Members of the Public Health Committee for their helpful co-operation and my appreciation for the energy and ability with which the staff of the department have carried out their duties. 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 civilian and non-civilian population (mid-year, 1950) 44,830 VITAL STATISTICS. Total M. F. Live Births 533 265 268 Birth rate per 1,000 of the estimated resident population 11-9 (Legitimate) 251 260 (Illegitimate) 14 8 Stillbirths 8 3 5 Stillbirth rate per 1,000 total (live and still births) 14 7 Deaths 393 174 219 Death rate per 1,000 of the estimated resident population 8-7 Deaths from puerperal causes :— Deaths. Rate per 1,000 Total (Live & Still) Births. Puerperal sepsis Nil — Other Maternal Causes Nil — Death rates of Infants under one year of age:— All Infants per 1,000 live births 16-9 Legitimate Infants per 1,000 legitimate live births 156 Illegitimate Infants per 1,000 illegitimate live births 454 Deaths from Cancer (all ages) 82 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) Nil BIRTHS. During the year 533 live births were registered, being 15 less than last year's total. The rate per thousand population was 11-9 compared with an average for England and Wales of 15 8. Of the total number 22 or 41 per cent were illegitimate. The birth rate was the lowest recorded since 1934. 3 DEATHS. During the year 393 deaths were registered, a decrease of 40 compared with those recorded in 1949, the rate per thousand being 8 7 compared with an average of 11.6 for England and Wales. The infantile mortality rate was 16 9 per thousand live births, an exceptionally low rate, comparing with the figure of 29 8 for England and Wales. CAUSES OF DEATH. M. F. Total Typhoid and paratyphoid fevers — — — Meningococcal infections — — — Scarlet fever — — — Whooping cough — — — Diphtheria — — — Respiratory tuberculosis 5 1 6 Other forms of tuberculosis 1 — 1 Syphilitic diseases 3 — 3 Influenza 2 6 8 Measles — — — Acute poliomyelitis 1 — 1 Acute infective encephalitis — — — Cancer 38 44 82 Leukaemia, aleukaemia 1 3 4 Diabetes — — — Vascular lesions of nervous system 19 36 55 Coronary disease, angina 22 19 41 Hypertension with heart disease 1 9 10 Other heart diseases 21 42 63 Other circulatory diseases 4 7 11 Pneumonia 11 8 19 Bronchitis 15 5 20 Other diseases of respiratory system 2 3 5 Ulcer of stomach or duodenum 4 1 5 Gastritis, enteritis and diarrhoea 1 — 1 Nephritis and nephrosis 2 3 5 Hyperplasia of prostate — — — Pregnancy, childbirth, abortion — — — Congenital malformations 1 — 1 Other defined or ill-defined diseases 14 26 40 Motor vehicle accidents 3 1 4 All other accidents 1 1 2 Suicide 1 1 2 Homicide and operations of war 1 3 4 174 219 393 4 DEATHS AGE GROUPS. Under 1 1-4 5-14 15-24 ■ 25-34 35-44 45-54 55-64 65-79 80 & over Totals Males 6 2 1 — 2 6 17 37 77 26 174 Females 3 4 1 — 1 7 12 29 94 68 219 Totals 9 6 2 — 3 13 29 66 171 94 393 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District. Kingston Hospital. Other Surrey Hospitals. London and other Hospitals. Other Districts. 230 53 46 34 30 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years :— 1946 ... (14 Legitimate. 1 Illegitimate) ... 15 1947 ... (19 „ Nil. „ ) ... 19 1948 ... (15 „ 1 „ ) ... 16 1949 ... (12 „ 2 „ ) ... 14 1950 ... ( 8 „ 1 ) ... 9 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Prematurity 15 minutes; 1 hour; 2 hours ; 12 hours. Congenital heart 6 days. Broncho-pneumonia ... ... 4 days. Lobar pneumonia 3 months. Birth injury 1 hour; 13 hours. 5 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST SIX YEARS. Year. Births. Infantile Mortality. Deaths. 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 1949 12.3 25.5 10.0 1950 11.9 16.9 8.7 MORTUARY. Twenty-six bodies were brought to the Mortuary and postmortem examinations were performed on each. RAINFALL, 1950. Table showing rainfall in the district during 1950, taken at the Sewage Disposal Works, California Road, New Maiden. Inches January 0.85 February 3.41 March 0.59 April 2.88 May 1.73 June 1.11 July 3.19 August 1.31 September 2.41 October 0.26 November 4.70 December 1.58 24.02 Increase on previous year 5.29 inches. Average for past 5 years 22.00 inches. 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious diseases in the year 1950. Provisional figures based on Quarterly Returns. England and Wales 126 C.B$. 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 Births Rates per 1,000 Home Population. Rates per 1,000 Live Births. Live Births 15.8 17.6 16.7 17.8 Deaths under 1 year of age 29.8* 33.8 29.4 26.3 Still Births 0.37 0.45 0.38 0.36 Deaths Deaths from Diarrhoea and Enteritis under 2 years of age 1.9 2.2 1.6 1.0 All Causes 11.6 12.3 11.6 11.8 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 Pneumonia 0.46 0.49 0.45 0.48 Whooping Cough 0.01 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 Rates per 1,000 Total Births (Live and Still). Influenza 0.10 0.09 0.10 0.07 Small-pox — — — — Tuberculosis 0.36 0.42 0.33 0.39 Notification Ac. Poliomyelitis & Polioencephalitis 0.02 0.02 0.02 0.01 Puerperal Fever and Pyrexia 5.81 7.43 4.33 6.03 Notifications Typhoid Fever 0.00 0.00 0.00 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 Meningococcal Infection 0.03 0.03 0.02 0.03 Maternal Mortality in England and Wales Scarlet Fever 1.50 1.56 1.61 1.23 Whooping Cough 3.60 3.97 3.15 3.21 Diphtheria 0.02 0.03 0.02 0.03 Erysipelas 0.17 0.19 0.16 0.17 Abortion with Sepsis 0.09 Small-pox 0.00 0.00 — - Abortion without Sepsis 0.05 Measles 8.39 8.76 8.36 6.57 Puerperal Infections 0.03 Pneumonia 0.70 0.77 0.61 0.50 Ac. Poliomyelitis (inc. Polioencephalitis) Paralytic 0.13 0.12 0.11 0.08 Other Maternal Causes Complication of Pregnancy and Delivery 0.54 Other Complications of Puerperium 0.15 Non-Paralytic 0.05 0.05 0.06 0.05 Food Poisoning 0.17 0.16 0.14 0.25 *Per 1,000 Related Live Births. 7 NOTIFICATION OF INFECTIOUS DISEASES, 1950. DISEASES Totals Under 1 1-2 : 2-3 3-4 4-5 5-10 10-15 15-20 20-25 I 25-35 35-45 65 and 45-65 over. Measles 171 1 9 23 18 21 95 3 — — 1 — — — Whooping Cough 79 5 9 15 21 7 18 1 — — 2 — — 1 Scarlet Fever 76 — 1 1 9 3 48 8 i — 1 — — — Pneumonia 21 2 1 1 — 1 6 1 — — — 4 3 2 Erysipelas 2 - - - - - - - - -- - - 1 — Puemeral Pvrexia 4 - - - - - - - - 1 3 — — — Poliomyelitis Paralytic 7 — 1 — — 2 2 — — — 1 — 1 — Non-paralytic 3 — — — — — 1 1 1 - - - - - Dysentery 20 — 3 5 1 2 2 1 — 4 — 2 — — Meningococcal Infection 1 — 1 - - - - - - - - - - - Totals 384 8 25 45 49 38 172 15 5 5 8 6 5 3 DISEASES Totals Coombe Dickerage : Mount t Cambridge WARDS Norbiton Park Burlington Maiden Green St. James Maiden Manor Measles 171 25 8 6 4 12 5 32 39 40 Whooping Cough 79 5 13 13 5 8 4 5 13 13 Scarlet Fever 76 7 7 11 10 4 7 10 10 10 Pneumonia 21 — 7 1 2 — 2 2 3 4 Erysipelas 2 — — — — — — 1 1 — Puerperal Pyrexia 4 — 2 — — 2 — — — — Poliomyelitis Paralytic 7 — 1 1 — 2 2 — 1 — Non-paralytic 3 1 - - — - — 1 — 1 Dysentery 20 — — — — 20 — — — — Meningococcal Infection 1 — — — — — — — — 1 Totals 384 38 38 32 21 48 20 51 67 69 8 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The number of cases of scarlet fever notified during the year was seventy-six, giving an incident rate of 1.69 per thousand population. This compares with a rate of 1.56 for England and Wales. The great majority of cases were very mild and no fatalities occurred. Twenty-four cases were treated at home and fifty-two removed to hospital. There were no ' return cases DIPHTHERIA. For the third year in succession and the fourth occasion since records were available, the district was completely free from this disease, the last case having been notified in April, 1947. Immunisation against diphtheria progresses smoothly and the great majority of parents are now accepting it as a matter of course. It is now being recommended at the age of seven months. 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 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, 370, school, 60) ... 430 Number of children receiving reinforcing doses 764 Of the above, 159 were immunised and 34 given reinforcing doses by private practitioners. Special efforts are made to encourage mothers to bring their babies for immunisation in those cases where persuasion by the health visitor has failed. A note is made of every child aged ten months and older who has not been immunised and 9 the parents of these babies are circularised in regard to the importance of immunisation against diphtheria. In many cases this personally addressed circular succeeds where other methods of encouragement have failed. In previous reports, details have been given showing the rapid decline in the number of notifications and deaths from diphtheria since the immunisation campaign got under way in 1941. The following table shows the total number of corrected notifications and deaths for England and Wales during the six years 1944-1949:— Year Deaths Cases corrected 1944 934 23,152 1945 722 18,571 1946 472 11,867 1947 244 5,592 1948 156 3,560 1949 85* 1,897* *Provisional. When it is realised that for the 10 year period 1931/40 the average annual number of cases notified and deaths were 55,000 and 2,800 respectively the vaue of immunisation against this disease will be readily appreciated. VACCINATIONS. Vaccination against smallpox is not now compulsory, the Vaccination Acts 1867 to 1907 having been repealed by the National Health Service Act, 1946. As with diphtheria immunisation all medical practitioners providing general medical services in the area are given an opportunity to provide services for carrying out vaccinations. During the year the following were performed :— Vaccinations 389 Revaccinations 110 Total 499 Of the above, two hundred and forty-one were vaccinated or revaccinated by private practitioners. Two hundred and eighty-three of the persons vaccinated were under one year of age. 10 ACUTE POLIOMYELITIS. Ten cases of acute poliomyelitis were notified during the year, seven paralytic and three non-paralytic. Two deaths occurred. One of these, a young soldier stationed in the district, was not diagnosed until after a post-mortem examination. His home address was not in this district. The second death occurred in the person of a male adult, the illness having a rapid fatal termination. All the other cases recovered from the acute stage of the illness, but afterwards suffered in varying degree from resultant paralysis. MEASLES. The number of cases of Measles notified (171) although numerous, was far below the figure for 1949 (503). Five cases were removed to Hospital and no deaths occurred. Prophylactic serum for contacts was supplied to all doctors who made application. WHOOPING COUGH. The number of cases of whooping cough notified was seventy-nine which was a few below the figure for 1949 (94). Two cases were removed to hospital. No deaths occurred. DYSENTERY. The twenty cases of dysentery were of the mild sonne type and occurred among the infants and staff at a Day Nursery. The outbreak occurred in the last month of the year and energetic measures were taken to stamp it out. There was no definite evidence as to the original source of infection but the following facts were suggestive. One child who, during the outbreak, gave positive results was excluded during October. She returned on 5th November having a doctor's certificate stating that she had suffered from enteritis but was free from infection. After an interval she commenced passing loose motions again and was excluded once more on 4th December. It was then found that her mother, brother and two sisters all gave positive results. 11 Two of the children who returned persistent positive results were removed to hospital and, in several other cases, prolonged treatment was necessary to render the patients free from infection. The standard of hygiene at the nursery concerned was high and the matron gave the fullest co-operation throughout. SCABIES. During 1950 twenty-eight persons received treatment for scabies. Of these twelve showed definite lesions, the remainder being contacts in the same family. VERMINOUS CONDITIONS. Only two persons, both 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 reported during the year. Two single cases, however, occurred. In each of these the source of infection was almost certainly outside this area. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales Borough ol Maiden and Coombe Scarlet fever 1.50 1.69 Diphtheria 0.02 — Typhoid fever 0.00 — Paratyphoid fever 0.01 — Meningococcal infection 0.03 0.02 Measles 8.39 3.81 Whooping cough 3.60 1.76 ♦Puerperal pyrexia 5.81 7.37 *per 1,000 total births (i.e. live and stillbirths). 12 CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 38 Scarlet fever (not confirmed) 1 Pneumonia 6 Poliomyelitis 3 Poliomyelitis (not confirmed) 3 Measles 4 Whooping cough 2 Dysentery 2 Mumps 3 Chicken pox 1 Otitis media 2 Gastro-enteritis 2 Tubercular glands of neck 1 Total 68 CASES ADMITTED TO HOSPITALS OTHER THAN TOLWORTH. Scarlet fever 14 Scarlet fever (not confirmed) 4 Poliomyelitis 5 Poliomyelitis (not confirmed 2 Measles 1 Puerperal pyrexia 2 Erysipelas 1 Meningococcal infection 1 Meningitis 1 Mumps 1 Dysentery 1 Cervical adenitis 1 Gastro-enteritis 1 Total 35 13 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1945 1946 1947 1948 1949 1950 Scarlet fever 25 44 49 33 68 76 Diphtheria 10 5 3 — — — Typhoid fever — — 2 — — — Paratyphoid fever — — — 1 1 — Erysipelas 5 7 8 3 6 2 Pneumonia 14 15 18 22 27 21 Encephalitis lethargica — — — — — — Puerperal pyrexia 4 2 4 1 — 4 Cerebro-spinal fever 2 1 2 — — 1 Acute poliomyelitis — 2 5 — 3 10 Ophthalmia neonatorum — — — — — — Dysentery 53 2 — — 1 20 Malaria 28 — — 1 — — Measles 589 152 240 386 503 171 Whooping cough 43 75 39 267 94 79 Tuberculosis (all forms) 44 52 42 63 41 35 TUBERCULOSIS, 1950. Age Periods NEW CASES DEATHS Respiratory Male Female Male Female Male Female Male Female 0 - - - - - - - - l — — — 1 — — — — 5 — I 1 — — — 1 — 15 6 2 — 1 — — — — 25 6 6 - - - - - - 35 2 1 — — 1 — — — 45 3 3 — — 2 — — — 55 — — 1 1 2 1 — — 65 & upwards - - - - - - - - Totals 17 13 2 3 5 1 1 — The number of notifications of pulmonary tuberculosis has, with the exception of 1948 shown a steady decline since 1945 and the rate per 1,000 (0.67) for the current year is the lowest for a number of years. The death rate per 1,000 (0.13) was exceptionally satisfactory being the lowest rate, at least for the past 30 years. 14 TUBERCULOSIS 1938 - 1950. NEW CASES DEATHS Year Estimated Population Pulmonarv Non-Pulmonarv Pulmonary Non-Pulmonary No. Rate per 1,000 Population No. Rate per 1,000 Population No. Rate per 1,000 Population No. Rate per 1,000 Population 1938 38,820 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 1949 44,580 37 0.83 4 0.09 14 0.31 1 0.02 1950 44,830 30 0.67 5 0.11 6 0.13 1 0.02 Notification of tuberculosis was, on the whole, satisfactory. There was only one case during the year which did not come to light until after death. At the end of the year the following numbers of cases were shown to be suffering from the disease and living in the district, the total being five more than that for the previous year. Non- Pulmonary Pulmonary Males 149 20 Females 105 24 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 and whooping cough 325 Scarlet fever, poliomyelitis and pneumonia 96 Sonne dysentery (including visits to laboratory) 375 Attendances at diphtheria immunisation sessions 34 Visits for treatment of scabies 45 Visits for treatment of head lice 11 Visits in regard to old people 592 Miscellaneous 203 15 SANITARY ADMINISTRATION. ANNUAL REPORT of THE SANITARY INSPECTOR 1950 Public Health Department, Municipal Offices, New Malden. To the Mayor, Aldermen and Councillors of the Borough of Maiden and Coombe, Ladies and Gentlemen, I have the honour and pleasure to submit my thirty-first Annual Report of work done and matters of interest concerning the Sanitary Department. The year under review has passed more easily administratively. My deputy Mr. Wood and Mr. Bowskill, both of whom came in 1949 have settled down to their duties and this has enabled a good year's work to be accomplished. Much of this was concentrated on visits to premises where food is sold or prepared, in an endeavour to obtain a high standard of hygiene at these places. There are differences of opinion as to the best methods to be employed in achieving this. Some advocate courses of lectures to all food handlers ; others favour instruction by means of pamphlets. In some areas Food Hygiene Committees have been set up who issue certificates or diplomas to those traders reaching certain standards. The display of these in the shop windows of those traders who have gained them indicates to the purchasing public that the conditions, under which food sold there is prepared, have been officially approved. Districts differ and what may be successful in one may prove of little value in another. My course of action has been guided by the conviction that, in an area such as this, individual approach is the method most likely to produce the best results and, I feel this has been borne out by experience. The dirty or careless food handler has little or no interest in lectures or l6 pamphlets but his shortcomings can be demonstrated and eventually remedied by visits and talks at the place where the work is actually being done. At the same time advice can be given on his practical difficulties. Clean food handlers are not in need of lectures. They are really a waste of time when given to those who are already keenly appreciative of their responsibilities and. except on some points of detail, are fully conversant with all that is required of them. What I have expressed in the foregoing is based on experience. Only a few years ago the Medical Officer of Health and myself organised a course of lectures in the lecture hall of the Public Library but the response was very poor and by no means compensated us for the considerable efforts involved and certainly did nothing to further the object we set out to achieve. It may be said that, during the year, every shop or place where food is prepared or sold was visited, some on several occasions and where defects or deficiences were noted these were brought to the notice of the manager or proprietor, or to the offending employee. The most frequent shortcoming was the lack of a constant supply of hot water for washing hands. The Food and Drugs Act, 1938 lays down that there shall be provided in or within a reasonable distance of the room (in which food is being prepared for sale) suitable washing basins with a sufficient supply of ... . clean water, both hot and cold. I cannot myself see that this can mean anything other than a constant supply of hot and cold water. It has been argued however, that this could not be legally enforced. Nevertheless, by dint of persuasion constant supply hot water heaters have been installed at a number of premises where they did not previously exist. Sixty-eight letters were sent to proprietors requesting remedial measures in addition to verbal notifications of minor deficiences given at the time of visit. Copies of the new food bye-laws were sent to the occupiers of all premises where food is prepared or sold. It is important that these be read in conjunction with section 13 of the Food and Drugs Act which they do not supersede but supplement. For the purpose of abating nuisances or executing repairs to houses the following notices were served:— Preliminary 184 Abatement 42 Informal (dustbin only) 6 Formal (dustbin only) 5 17 These figures do not include verbal notices often given in regard to minor matters. It has been especially noticeable that a considerable amount of sanitary work has been carried out by owners without service of notice. Schedules of repairs have often been submitted to me and later approved after being checked, during visits to the properties concerned to see that they have included all items requiring attention from a sanitary standpoint. Whilst war damage repairs have been going on, works which normally would be included in notices, have also been put in hand. This is reflected in the smaller number of abatement notices it was found necessary to serve. Applications to the Court for Nuisance Orders had to be made in four instances only. 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 3 Application withdrawn, work having been completed before hearing 1 In the case of one house and by agreement with the Owner the Council, pursuant to section 275 of the Public Health Act, 1936, carried out the works necessary to comply with an abatement notice. Later, in accordance with section 291 (2) of the same Act, an Order was made for the recovery of expenses by instalments. 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 routine bacteriological and chemical examinations carried out by the Water Examination Department of the Board it was not considered necessary to make any special local tests. All dwelling houses in the area are supplied by public water mains direct to the houses. INFECTIOUS DISEASES. The following number of rooms were disinfected for the undermentioned causes:— 18 Scarlet fever 21 Tuberculosis 25 Vermin (including fleas) 43 Other 18 A number of books from the public library and schools were also disinfected as far as practicable for a variety of reasons. A few 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. FOOD AND DRUGS ACT, 1938. During the year 157 samples were submitted to the Public Analyst for analysis. These comprised the following:— ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Aspirin — 1 1 — — — Butter — 3 3 — - — Blancmange powder — 1 1 — — — Beef suet — 2 2 — — — Bacon — 1 1 — — — Beef extract — 1 1 — — — Beer 2 1 3 — — — Bloater paste — 1 1 — — — Brandy 1 — 1 — — — Banana flavouring — 1 1 — — — Curry powder — 2 2 — — — Cooking fat — 3 3 — — — Chutney - 1 1 — — — Coffee and chicory essence - 2 2 - - - Cocoa — 1 1 - — — Crab paste — 1 1 — — — Cayenne — 1 1 — — - Cheese - 2 2 - - Coconut - 1 1 - - Cream of tartar - 1 1 - - - Condensed milk - 1 1 - - — Dessert powder — 2 2 — - — Flour mixture - 2 2 — - — Fruit pudding — 1 1 — - — Fish cakes — 1 1 — - — 19 ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Glucose tablets — 1 1 — — — Ground almonds — 1 1 — — — Gin 1 — 1 — — — Herbs, mixed — 1 1 — — — Jam — 1 1 — — — Jelly crystals — 1 1 — — — Junket tablets — 1 1 — — — Lemonade crystals — 1 1 — — — Lemon flavouring — 1 1 — — — Lemonade powder — 1 1 - - - Lime juice cordial 1 — 1 — - - Milk 39 11 50 1 — 1 Margarine — 3 3 — — Maralyn milk plus — 1 1 - — - Meat paste — 1 1 - — - Marmalade — 2 3 - — - Mustard — 1 1 - — — Mayonaise — 1 1 - — — Milk whipping compound _ 1 1 — — — Mincemeat — 1 1 - - - Nutmeg, ground — 1 1 - - - Olive oil 1 — 1 - - - Oatmeal, malted - 1 1 - 1 1 Orange squash — 1 1 - - - Pepper — 1 1 - - - Pepper compound — 1 1 - - - Peel, mixed — 1 1 - - - Rum 1 — 1 - - - Rum flavouring — 1 1 - - - Sausage meat 3 — 3 - - - Sausages, beef 9 — 9 - - - Sausages, pork 3 — 3 - - - Sauce — 1 1 - - - Spice, mixed — 1 1 - - - Sardine and Tomato paste - 1 1 - - - So-tast-ee extract - 1 1 - - - Salad Cream - 2 2 - 1 1 Saccharin - 2 2 - - - Savora — 1 1 - - - Sugar Wheat puffs - 1 1 - - - Sparkling orange 1 — 1 _ - - Soup, powdered — 1 1 _ - - Salmon spread — 1 1 - - _ Skimmed milk - 2 3 - 1 - Tea - 1 1 - - - Tomato relish - 1 1 - - - Tonic water 1 - 1 - - - Tinned peas — 1 1 - - - Whisky 2 — 2 - — — Wine, white 1 — 1 - - - Vinegar 1 1 2 1 — 1 Totals 67 90 157 2 3 5 20 Notes in regard to samples shown as adulterated or below standard. Milk. Only one milk sample was adversely reported upon. This showed a very small deficiency in solids other than milk, fat, whilst the milk fat content was up to standard. A warning was given in this case. Salad Cream. The only complaint in this case was that the cream was excessively thick and could not be poured from the bottle. The composition ot the article however, was in accordance with the Food Standards (Salad cream and Mayonaise) Order 1945. Malted Oatmeal. The oatmeal was contained in a paper bag inside a carton. The bag was pierced by a number of small ' grub holes' and the oatmeal was permeated with insect webbing and excreta which was also present on the outside and in the folds of the paper. Immediate enquiry was made but the manager of the shop where the purchase took place had already noted that the article was sub-standard and returned all his stock to head office for disposal. Vinegar. One sample of malt vinegar contained 0.8 per cent of salt. Salt is not a natural ingredient ot malt vinegar but up to just prior to when the sample was taken, the Minister of Food gave certain manufacturers a special temporary dispensation to add, without declaration, a small quantity of salt to help preserve the vinegar. As from 1st November, 1950 the Labelling of Food Order, 1950 came into operation under which no dispensation of this character may be granted. In future therefore, if malt vinegar is sold which contains salt, this fact must be clearly noted, either by a notice in the shop or the label on the bottle containing the vinegar. Skimmed Milk, Sweetened. When a tin of condensed (sweetened) skimmed milk was examined by the Public Analyst he found it to be contaminated by a fungoid growth. This consisted of a light brown 'button' about inch in diameter attached to the side of the can at the surface of the milk. The growth was one of the basidiomycetes group of fungus and exhibited the typical gill formation such as is seen in mushrooms and similar fungi. This was an isolated instance of contamination by fungi and no further action could be taken. MILK. In my last Annual Report I gave full particulars in regard to recent legislation concerning milk. One additional Act— The Food and Drugs (Milk, Dairies and Artificial Cream) Act was passed during the year and came into operation on 1st January, 1951. This, however, only consolidates certain existing enactments relating to milk, dairies and artificial cream. During the year the following licences were issued under the Milk (Special Designations) (Raw Milk) or the (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. 21 Dealers Tuberculin tested 7 Pasteurised 7 Pasteuriser's 1 Sterilised 7 Supplementary. Tuberculin tested 8 Pasteurised 8 Sterilised 10 I am often asked what is the difference between a dealers and a supplementary licence. It is this. If a dairyman has premises in the local government area where he retails milk, he is issued with a dealers licence. Should he retail milk in another area he must obtain a supplementary licence from the Council for that area. DETAILS OF MILK TESTING. ' Pasteurised ' ] Passed Failed Total Phosphatase test (To determine whether or not the milk has been adequately heat treated) 199 3 202 Methylene blue test (To determine whether or not the milk is of good keeping quality) 198 4 ' Sterilised' Turbidity test (To determine whether or not the milk has been adequately sterilised) 13 Nil. 13 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. The fact that there were only three failures out of two hundred and two samples examined is satisfactory. All three failures occurred at about the same time from one dairy and were due to a small defect in the recorder which was quickly rectified. Four samples only failed to pass the methylene blue test. These occurred during the hot weather, when it is recognised that milk kept at an atmospheric shade temperature of above 65°F., even if efficiently pasteurised, will not remain sweet for any lengthly period. 22 FOOD SUPPLY. As far as practicable watch is kept on premises where foodstuffs are prepared or sold, which includes butchers' and fishmongers' shops, bakehouses, dairies, restaurant kitchens, etc. No animals were killed for sale in local slaughterhouses during the year. The following unfit foodstuffs were voluntarily surrendered and destroyed or handed over for salvage Evaporated or Condensed Milk 120 tins. Brawn 2 tins. Vegetables 110 tins. Fruit juice 11 tins. Soup 33 tins. Jam and Marmalade 242 jars. Beans 25 tins. Fruit 389 tins. Figs 4 lbs. Cereals 35 tins. Cereals 194 lbs. Dried Egg 4 tins. Peanut Butter 1 tin. Meat and Fish Paste 21 jars. Wet Fish 531 lbs. Spaghetti 4 tins. Cod's Roe 65 tins. Beef Loaf, Luncheon Meat, etc. 32 tins. Oranges 45 lbs. Fish 31 tins. Corned Beef 24 lbs. Eggs 1373 Meat and Vegetable Stew 7 tins. Ginger Wine 3 bottles. Pickled Walnuts 1 jar. Pressed Meat 14 lbs. Salad Cream 77 bottles. Pea Flour 70 packets. Ham 5½lbs. Mincemeat 1 tin. Bacon 20 lbs. Bacon Rashers 1 tin. Pease Pudding 2 tins. Christmas and Date Puddings 5 tins. Pork Sausages 2 tins. Lemon Curd 49 jars. Sweets 152 lbs. Dried Apricots 600 lbs. Ground Almonds 28 lbs. Potato Powder 25 lbs. Ground Cashew Nuts 40 lbs. Cocoa 40 lbs. Dillseed 30 lbs. Caraway Seed Powder 40 lbs. Gelatine 8 lbs. 23 Antelope Powder 30 lbs. Ginger 4 lbs. Pudding mixture 52 packets. Bengers Food 2 tins. Beef 537¼ lbs. Kidney Knob 5½lbs. A Dumber of complaints regarding foodstuffs were received during the year, some of which are worth recording:— (1) Some strawberry jam was alleged to have a peculiar taste. The public analyst reported that it was rather dark in colour and a little out of the ordinary. It was, nevertheless, free from preservatives, contained the correct proportions of strawberries and sugar and was pure and wholesome. (2) A complaint was received of some foreign matter in a packet of flour. This proved to be mice dirts. The flour had been purchased about three weeks before complaint was made and about 2/3rds of it had been used. Contamination may have occurred, therefore, after purchase although a visit to the house failed to reveal any obvious signs of infestation. In view of this and other facts the town clerk advised against a prosecution and it was decided to take no further action. (3) A half pound packet of butter was brought to me which was alleged to have been nibbled by mice. A close examination of the shop failed to reveal any evidence of mice but several other damaged packets were found, ft was eventually established that the damage was due to a defective fastener on the case in which the butter was delivered. (4) A match was found embedded in the interior of a cream wafer. The wafer was retailed in a tin which had been imported from Holland. Particulars were forwarded to the Food Standards and Hygiene Division of the Ministry of food. (5) A cigarette end was found in a packet of potato crisps. As the crisps had been cooked, packeted and purchased outside this area, particulars were sent to the district concerned for action. (6) A piece of medicated elastic plaster soiled with blood was found in a packet of sliced bread. Proceedings were instituted in this case. The bakers concerned were fined £5. (7) Some fancy cakes were brought to me with the complaint that they had an objectional taste. The public analyst reported that, apart from some slight staleness, the cakes were of a satisfactory nature and suitable for human consumption. (8) A cigarette end was found embedded in a loaf of bread. Proceedings were instituted in this case. The defendants pleaded guilty and were fined £5 with £3 3s. Od. costs. (9) A piece of metal, about ¾ of an inch in length in the shape of a nail or pin was found embedded in a wrapped sweet. Proceedings were instituted in this case. The defendants were found guilty but were granted an absolute discharge on payment of £10 10s. Od. costs. N.B.—The sliced bread and the wrapped sweet in the notes above (instances 6 and 9) were produced outside this area, whilst the loaf of bread (instance 8) was of local origin. 24 ICE CREAM. Eighty-five samples were submitted for testing by the methylene blue method and, of these, eighty-one reached grades 1 and II standards. Four were placed in grade 111 and none in the low category of grade IV. It was also very satisfactory that none of the samples tested contained faecal coli. As 1 have previously explained, the methylene blue test does not provide a guarantee of safety but it does serve as a simple and practical method of grading ice cream according to its degree of bacterial cleanliness and samples which consistently fail to reach grades I or II give reasonable grounds to indicate defects in manufacture or of handling calling for further investigation. One naturally would desire all samples to reach grades 1 or II and the results of those taken since 1947 when the test was first officially put into operation show progressive improvement as the following table indicates, the results for the year under review being particularly gratifying:— Year Total Samples Taken Grades lor II. % Grade 111. % Grade IV. % 1947 29 13 44.8 13 44.8 3 10.4 1948 84 55 65.4 22 26.2 7 8.4 1949 63 54 85.7 ~8 12.7 1 1.6 1950 85 81 95.3 4 4.7 Nil. — From November, 1948, additional quantities of sugar and, in certain cases, fats were made available to ice cream manufacturers. To ensure that these materials were used to the best advantage manufacturers wishing to avail themselves of the additional supplies were required to sign an undertaking that their ice cream would have a minimum fat content of 2\ per cent. This minimum does not of course, constitute a legal standard, nor indeed must it be interpreted even as meaning that this figure is regarded officially as a proper standard. Seven samples were taken during the year and submitted to the Public Analyst and copies of results were forwarded to the Ministry of Food. All exceeded 2.5 per cent the lowest containing 5.7 per cent and the highest 10.9 per cent. There is now, no doubt that a legal standard of composition of ice cream will be prescribed in 1951. SMOKE ABATEMENT. The year has passed with practically no complaints in regard to smoke emission from the chimneys of industrial buildings. This is a satisfactory state of affairs and is probably due to 25 the improvements in plant which have taken place during the past few years coupled possibly with improvement in the quality of fuel. SHOPS ACTS. The Defence Regulation whereby the closing hours of certain shops are earlier during the winter months, remained in force. All shopkeepers were circularised regarding this but visits and warnings had to be made in a few cases to see that these Regulations were being observed. All the Shops Acts from 1912 to 1938 and certain others enactments relating to shops were consolidated into one Act which came into operation on 1st October, 1950. The passing of this Act will help to prepare the way for the introduction, in due course, of amending legislation in the light of the Gowers report on the closing hours of shops. 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 6 6 Council houses (rooms) 7 7 (b) Other houses (rooms) 32 32 RATS AND MICE DESTRUCTION. It is now obligatory for the occupier of land (which includes houses, buildings, etc.) to give the Local Authority notice, in writing, if it comes to his knowledge that rats or mice are living on or resorting to the land in substantial numbers. I am doubtful if many of the general public are aware of this and those who are will probably have no idea what the term 'substantial numbers' means. In this district, however, there is little need to worry. For a number of years we have tried to induce householders to inform us immediately when rats are seen, however small in number, and this has borne fruit. The fact also, that a free service is given for the destruction of rats in private dwellings encourages occupiers to let us know, without delay, when trouble arises. Charges are made in the cases of business premises and a system has been adopted whereby, in return for a yearly payment, periodical visits are made to these places so that they may be kept free from the pest. If trouble 26 does arise between visits a telephone call is all that is needed to obtain the services of an operator. The majority of those whose premises, by nature of the business carried on, are prone to infestation, have come into the scheme. The result is that a very satisfactory and efficient service has gradually been built up aimed at getting the co-operation of all concerned rather than basing our course of action on the threat of proceedings with consequent hostility of the public and the tendency to hide infestations or to try and deal with them privately and individually. This latter method is doomed to failure. It is generally hopeless for one occupier to take active steps whilst his neighbour remains quiescent. To inform and allow us to deal with the trouble enables all the houses or buildings in the area to be visited and dealt with, thereby making sure that the whole area rather than a small part of an infestation is taken in hand. The risk of reinfestation is thereby minimised. The art of rat destruction is no longer one of simply obtaining the services of a rat-catcher to lay poison haphazardly and trust to luck or to hunt out a rat or two with a dog and ferret. To deal successfully with an infestation an appreciation of all the circumstances has first to be made such as the degree and extent of infestation; the predisposing causes so that these may be removed if possible; traces left such as smears, holes and scrapes, runways, droppings, footmarks, gnawing marks, etc., so that pre-baiting and poison baiting may be done at the places where they are most likely to be taken. A further important point is to find out whether or not the infestation is connected with a sewer or drains. Prebaiting (non-poisonous) is done at carefully selected points and continued daily or every other day until it is being readily taken. Then the same bait but this time containing poison is laid so that the rats readily eat it and suffer the penalty. Special methods are needed in dealing with infestations associated with poultry keeping, so often the case, or places where domestic animals might gain access. The experience and skill of the operative is tested in these circumstances and, although occasionally the loss of a hen or two occurs, this is very rare and can generally be attributed to circumstances beyond the control of the worker. Besides private and business premises, sewers throughout the area have to be periodically test baited— a rather long and arduous procedure —to make sure that they are not infested. Should any portions show signs of rats these are dealt with by special methods. Allotments, refuse tips, council depots, etc., are all given their share of regular attention. I hope I may be excused from going into some detail regarding this section of public health administration, but the 27 importance of the subject is so often neglected or made the subject of jokes that I have thought some special mention might be made. The Corporation has a rodent officer and two operatives constantly employed throughout the district in an endeavour to keep the rat and mice population at a minimum and I have tried to show that they have to exercise quite a degree of skill and much tact in carrying out their duties. MISCELLANEOUS. It became necessary to arrange for the burials of two bodies during the year. This is a new duty placed upon Local Authorities under the National Assistance Act, 1948 in cases where any person has died or been found dead and where it appears that no suitable arrangements for the disposal of the body have been made. Where possible the expenses may be recovered from the estate of the deceased person. The provision of the National Insurance Act, 1946, 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 of certain persons is also made to apply to all Authorities. It was unnecessary to take more than minimum precautions to prevent undue cricket infestation in the Corporation refuse tip at the Norbiton Potteries or at the depot and piggeries in California Road. This may have been due in part to the dull weather experienced during the summer but I am led to think that the measures taken in previous years, which were on a fairly extensive scale, greatly contributed to the comparative freedom of these pests. Movements of tenants from and to council houses were again fairly frequent. In all cases (numbering forty-eight) the houses, on becoming vacant are carefully inspected for any signs of bed bug infestation and, in those cases where evidence is discovered, appropriate steps are taken. In addition five occupied houses were inspected at the request of the Housing Manager. Modern methods of treatment are far more simple and effective than those of a few years ago and cases of infestation are less frequently met with now than previously. A special report was made to the Council during the year on the operation of the Housing Act, 1949. Among other things this Act makes provision for Exchequer contributions to 28 local authorities and other persons, through the agency of local authorities in respect of expenditure incurred by them on the improvement of housing accommodation. Improvement proposals are divided into two classes:— (i) the provision of dwellings by means of conversion of houses or other buildings, and (ii) the improvement of dwellings. An improvement grant can only be entertained where the estimated cost is not less than £100 and not more than £600 and must not exceed one-half the approved expense except in particular cases. "Improvement" includes alteration, enlargement and repair other than ordinary repairs except such ordinary repairs that are incidental to the works of improvement. A number of other requirements have to be satisfied and important conditions attached before a grant is made and these would require a lengthy report to explain fully. Should anyone reading my report require detailed information of the subject 1 shall be pleased to supply this on request. Only one application was made during the year and was granted. The works in this case mainly related to the provision of a back addition at a house to form a bathroom. The cost was £298 and the amount of grant 40 per cent. Choked public sewers (combined drains) were cleared on two hundred and fifty-nine occasions by the department. In a few instances the assistance of sewermen from the Borough Engineer's department had to be obtained. 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. 12 15 3 — Factories not included in (i) in which section 7 is enforced by Local Authorities. 90 39 9 - Other premises in which section 7 is enforced by the Local Authority. 7 7 2 Total 109 65 14 — 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 2 2 — 2 — Overcrowding 1 1 — 1 — Unreasonable temperature 1 1 — 1 — Inadequate ventilation 1 1 — 1 — Ineffective drainage of floors — — — — — Sanitary Conveniences : (a) Insufficient 4 3 — 3 — (b) Unsuitable or defective ... 3 3 — 1 — (c) Not separate for sexes (absence of screening) - - - - - Other offences against the Act (not including offences relating to Outwork) 6 2 4 2 — Total 18 13 4 11 — 31 PART VIII OF THE ACT. OUTWORK. No. of out-workers in August list req'd. by Sect. IIo(i) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lista 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 12 — — — — — Brush making 86 — — — — — Cleaning of wearing material 2 — — — — — File making 2 — — — — — Total 102 — — — — — Printed by RAYNES PARK PRESS, Lambton Road, London, S.W.20.