MAL15 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Sanitary Inspector FOR THE YEAR ENDED 31st DECEMBER 1951 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. Jeffery, Junior. PUBLIC ANALYST: Daniel D. Moir, M.Sc., F.R.I.C. Borough of Malden and Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1951 Public Health Department, Municipal Offices, New Malden. July, 1952. To the Mayor, Aldermen and Councillors of the Borough of Malden and Coombe. Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1951, which has been prepared in accordance with Ministry of Health circular 42/51. The health of the district remains good and the vital statistics, which are dealt with in the text, are very satisfactory. During the year an immunisation campaign against whooping cough has been started and the results have already been promising. Work on behalf of the welfare of old people continues. In September the National Assistance Amendment Act came into force. This provides for the removal to hospital, without delay, of urgent cases in need of care and attention to whom section 47 of the National Assistance Act, 1948, applies. In conclusion I should like to thank the Chairman and members of the Public Health Committee for their helpful co-operation and the staff of the department for the energy and ability with which they 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. Population—Census 1951 45,559 Population—Registrar-General's estimate (midyear) 1951 45,640 VITAL STATISTICS. Total M. F. Birth rate per 1,000 of the estimated resident population10.8* Live Births 516 263 253 (Legitimate) 257 245 (Illegitimate) 6 8 Stillbirths 9 4 5 Stillbirth rate per 1,000 total (live and still births) 171 Deaths 447 236 211 Death rate per 1,000 of the estimated resident population 100* * Corrected. Deaths from puerperal causes :— Deaths. Rate per 1,000 Total (Live & Still) Births. Puerperal sepsis Nil — Other Maternal Causes 1 1.9 Death rates of Infants under one vear of aee :— All Infants per 1,000 live births 15.5 Legitimate Infants per 1,000 legitimate live births 15.9 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer 79 Deaths from Measles 1 Deaths from Whooping Cough Nil BIRTHS. During the year 516 live births were registered, being 17 less than last year's total. The rate per thousand population was 10.8 comparing with an average for England and Wales of 15.5. Of the total number 14 or 2.7 per cent were illigitimate. The birth rate was the lowest recorded for a number of years. 3 DEATHS. During the year 447 deaths were registered, an increase of 54 compared with those recorded in 1950, the rate per thousand being 10.0 compared with an average of 12.5 for England and Wales. The infantile mortality rate was 15.5 per thousand, an exceptionally low rate, comparing with the figure of 29.6 for England and Wales. One death occurred from maternal causes, the first for seven years. CAUSES OF DEATH.0 M. F. Total. Typhoid and paratyphoid fevers — — — Meningococcal infections - — — Scarlet fever — — — Whooping cough — — — Diphtheria — — — Respiratory tuberculosis 7 2 9 Other forms of tuberculosis 1 1 2 Syphilitic diseases 1 1 2 Influenza 11 10 21 Measles — 1 1 Acute poliomyelitis — — - Acute infective encephalitis — — — Cancer 39 40 79 Leukaemia, aleukaemia 1 1 Diabetes 1 1 2 Vascular lesions of nervous system 32 36 68 Coronary disease, angina 35 16 51 Hypertension with heart disease 8 10 18 Other heart diseases 30 37 67 Other circulatory diseases 9 8 17 Pneumonia 7 9 16 Bronchitis 13 7 20 Other diseases of respiratory system 2 3 5 Ulcer of stomach or duodenum 3 1 4 Gastritis, enteritis and diarrhoea — 1 1 Nephritis and nephrosis 5 1 6 Hyperplasia of prostate 3 — 3 Pregnancy, childbirth, abortion — 1 J 1 Congenital malformations 2 4 6 Other defined or ill-defined diseases 17 17 34 Motor vehicle accidents 4 1 5 All other accidents 2 1 3 Suicide 4 1 5 Homicide and operations of war — — — 236 211 447 4 DEATHS AGE GROUPS. Under 1 1-4 5-14 15-24 25-34 35-44 4 5-54 55-64 65-79 80 & over Totals Males 4 — — 7 3 9 21 30 112 50 236 Females 4 1 1 — 1 13 11 21 90 69 211 Totals 8 1 1 7 4 22 32 51 202 119 447 STATEMENT SHOWING WHERE DEATHS OCCURRED. In District. Kingston Hospital. Other Surrey Hospitals. London and other Hospitals. Other Districts. 259 74 75 23 16 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years :— 1947 (19 Legitimate. Nil. Illegitimate) 19 1948 (15 „ 1 „ ) 16 1949 (12 „ 2 „ ) 14 1950 ( 8 „ 1 „ ) 9 1951 ( 8 „ Nil. „ ) 8 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE. Broncho-pneumonia Congential heart Cerebral haemorrhage Prematurity ... Bilateral suprarenal haemorrhage Hydrocephalus Spina bifida ... 3 weeks. 4 months. 6 months. 6 months. 9 hours. 1 day. 2 days. 2 weeks. 5 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST SIX YEARS. Year. Births. Infantile Mortality. Deaths. 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 1951 10.8 15.5 10.0 MORTUARY. Thirty-four bodies were brought to the Mortuary and a postmortem examination was performed on each. Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal in the year 1951. Provisional figures 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. Live Births 15.5 17.3 16.7 17.8 Still Births 0.36 0.45 0.38 0.37 Deaths All Causes 12.5 13.4 12.5 13.1 Typhoid and Paratyphoid 0.00 0.00 0.00 - Pneumonia 0.61 0.65 0.63 0.61 Whooping Cough 0.01 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 Influenza 0.38 0.36 0.38 0.23 Small-pox 0.00 0.00 0.00 — Tuberculosis 0.31 0.37 0.31 0.38 Ac. Poliomyelitis & 0.00 0.01 0.01 0.00 Polioencephalitis Notifications Typhoid Fever 0.00 0.00 0.00 0.01 Paratyphoid Fever 0.02 0.03 0.02 0.01 Meningococcal Infection 0.03 0.04 0.03 0.03 Scarlet Fever 1.11 1.20 1.20 1.10 Whooping Cough 3.87 3.62 4.00 3.11 Diphtheria 0.02 0.02 0.03 0.01 Erysipelas 0.14 0.15 0.12 0.15 Small-pox 0.00 0.00 0.00 — Measles 14.07 13.93 14.82 14.64 Pneumonia 0.99 1.04 0.96 0.72 Ac. Poliomyelitis (ini Polioencephalitis) Paralytic c. 0.03 0.03 0.03 0.02 Non-Paralytic 0.02 0.02 0.03 0.02 Food Poisoning 0.13 0.15 0.08 0.23 Mortality and Case rates for certain Infectious diseases based on 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 Rates per 1,000 Live Births. Deaths under 1 year of age 29.6* 33.9 27.6 26.4 Deaths from Diarrhoea and Enteritis under 2 years of age 1.4 1.6 1.0 0.7 Rates per 1,000 Total Births (Live and Still) Notification :— Puerperal Fever and 1066 13-77 808 1490 Pyrexia ) Maternal Mortality in England and Wales Abortion with Sepis 0.09 Abortion without Sepis 0.05 Puerperal Infections 0.10 Other Maternal Causes 0.35 * Per 1,000 Related Live Births. 6 NOTIFICATION OF INFECTIOUS DISEASES, 1951. DISEASES Totals Under 1 1-2 3-4 5-9 10-14 15-24 25 and over Measles 807 9 146 256 372 9 5 10 Whooping Cough 206 8 59 54 80 2 1 t Scarlet Fever 32 — 2 3 20 4 2 1 Pneumonia 27 — 2 2 5 — — 18 Puerperal Pyrexia 4 — — — — — 1 3 Paralytic 1 — — — — — 1 — Poliomyelitis Non-paralytic — — — — — — — — Dysentery 26 2 3 7 5 — 3 6 Food poisoning 1 — — 1 — — — — Erysipelas 3 — — — — — — 3 Totals 1107 19 212 323 482 15 13 43 DISEASES WARDS Totals Coombe Dickerage Mount Cambridg Norbiton Park Burlington Maiden Green St. James Maiden Manor Measles 807 84 153 114 101 131 76 42 68 38 Whooping Cough 206 10 50 28 20 19 13 14 20 32 Scarlet Fever 32 1 5 1 3 3 3 7 3 6 Pneumonia 27 — 5 5 2 ?. 3 2 5 3 Puerperal Pyrexia 4 — 2 1 — 1 — — — — Poliomyelitis 1 — — — — — — — — 1 Dysentery 26 1 4 1 1 12 1 — 6 — Food poisoning 1 — — — — 1 — — — — Erysipelas 3 — 2 — — — — 1 — — Totals 1107 96 221 150 127 169 96 66 102 80 7 8 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The number of cases of scarlet fever notified during the year was thirty-two, giving an incident rate of 0.70 per thousand population. This compares with a rate of 1.11 for England and Wales. All the cases were very mild and no fatalities occurred. Fifteen cases were treated at home and seventeen removed to hospital. DIPHTHERIA. For the fourth year in succession and the fifth 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 immunised during the year (pre-school, 443, school 81) 524 Number of children receiving reinforcing doses 1042 Of the above, 125 were immunised and 52 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 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. 9 The following extract from the monthly bulletin of the Ministry of Health on the recent trends of diphtheria is worthy of note, showing as it does, the remarkable progress in the control of diphtheria due to immunisation :— "Almost 10,000 persons died from diphtheria in England and Wales in 1901; 32 in 1951 (provisional figure). From being one of the most serious causes of death of children in this country, diphtheria has now fallen to a position of numerical insignificance. It is to be noted that of the total reduction in the mortality from diphtheria during the past half century by far the greatest part has taken place in the last ten years, the period of large scale immunisation; and that during these ten years there had been a sudden and enormous reduction in the incidence of notified cases as well as deaths. The situation is now being reached—a situation scarcely dreamed of in 1940 when the immunisation campaign started—where the eradication of diphtheria as an indigenous disease in this country can be foreseen as a very real possibility within the next few years, provided there is no slackening in the immunisation efforts that have been so dramatically successful in the past 10 years. Complacency resulting from what has already been achieved or loss of interest or of confidence in immunisation, may mean that diphtheria will go on occurring endemically and epidemically in this country indefinitely, with the ever present risk of a return to high mortality; but a vigorously continued immunisation programme, combined with existing methods of epidemic control, may free us entirely from the disease except for the occasionally imported case 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 eight vears 1944-1951 :— Year 1944 1945 1946 1947 1948 1949 1950 1951 Deaths 934 722 472 244 156 84 49 34* Corrected Notifications 23,199 18,596 11,986 5,609 3,575 1,890 962 699* * Provisional 10 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 0DD0rtunitv to provide services for carrvine out vaccinations. During the year the following were performed :— Vaccinations 515 Revaccinations 192 Total 707 Of the above five hundred and sixteen were vaccinated or revaccinated by private practitioners. Three hundred and thirty-seven of the persons vaccinated were under one year of age. ACUTE POLIOMYELITIS. The one case which occurred during the year was of the paralytic type. The patient, a young student, had been on a cycling tour in Brittany where he was taken ill. Prior to going abroad he had lived in the north country and only came to this district as his parents were staying here. He was critically ill for some time but recovered from the acute stage, suffering later from resultant paralysis for which he was treated at an Orthopaedic hospital in Shropshire. MEASLES. The number of cases of Measles notified (807) was a high record. The epidemic really commenced towards the end of 1950 and continued unabated for the first six months of 1951. Notifications during the second half of the year were far less numerous. Eleven cases were removed to hospital. One death occurred, the first since 1947. During the period 1947-1951 two thousand one hundred and seven cases of Measles were notified, giving a case death rate of 0.94 per thousand. Prophylactic serum for contacts etc., was supplied to all doctors who made application. WHOOPING COUGH. The number of cases of whooping cough notified was 206. Seven cases were removed to hospital. No deaths occurred. 11 Details of the number of children immunised against whooping cough during the year, are as follows :— Primary immunisations carried out by medical officer of health 319 Primary immunisations carried out by medical practitioners 62 Children receiving reinforcing doses by medical officer of health 9 Children receiving reinforcing doses by medical practitioners 5 DYSENTERY. The twenty-six cases of dysentry were of the mild sonne type and the outbreak was an extension of that commencing in December 1950 about which I commented in my last annual report. Most of the cases occurred in the first half of the year. SCABIES. During 1951 only five persons received treatment for Scabies. VERMINOUS CONDITIONS. Only four persons were treated for headlice during the year. One case of body louse infestation came under notice. FOOD POISONING. The were no outbreaks of food poisoning reported during the year. One single case, however, occurred. The source of infection was not discovered. CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales Borough of Maiden and Coombe Scarlet fever 1.11 0.70 Diphtheria 0.02 — Typhoid fever 0.00 — Paratyphoid fever 0.02 — Meningococcal infection 0.03 — Measles 14.07 17.68 Whooping cough 3.87 4.51 *Puerperal pyrexia 10.66 7.61 * per 1,000 total births (i.e. live and stillbirths). 12 CASES REMOVED TO TOLWORTH ISOLATION HOSPITAL. Scarlet fever 8 Scarlet fever (not confirmed) 1 Poliomyelitis 1 Poliomyelitis (not confirmed) 2 Measles 6 Whooping cough 4 Dysentry 2 Dysentry (not confirmed) 2 Mumps 1 Chicken pox 1 Diphtheria (not confirmed) 1 Total 29 CASES ADMITTED TO HOSPITAL OTHER THEN TOCWORTH. Scarlet fever 9 Scarlet fever (not confirmed) 1 Measles 5 Whooping cough 3 Meningitis 1 Dysentry 1 Pneumonia 1 Total 21 13 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1946 1947 1948 1949 1950 1951 Scarlet fever 44 49 33 68 76 32 Diphtheria 5 3 —. — — — Typhoid fever — 2 — — — — Paratyphoid fever — — 1 1 — — Erysipelas 7 8 3 6 2 3 Pneumonia 15 18 22 27 21 27 Encephalitis lethargica — — — — — — Puerperal pyrexia 2 4 1 — 4 4 Meningococcal infection 1 2 — — 1 — Acute poliomyelitis 2 5 — 3 10 1 Ophthalmia neonatorum — — — — — — Dysentery 2 — — 1 20 26 Malaria — — 1 — — — Measles 152 240 386 503 171 807 Whooping cough 75 39 267 94 79 206 Tuberculosis (all forms) 52 42 63 41 35 36 TUBERCULOSIS 1951. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 — — 1 — — — — — 1 1 — — — — — — — 5 — — 1 — — — — — 15 2 5 1 2 — — — — 25 5 3 — — — — — — 35 3 1 — 1 2 2 — 1 45 3 — — — 2 — — — 55 5 — — — — — — — 65 & upwards 1 1 — — 3 — 1 — Totals 20 10 3 3 7 2 1 1 The number of cases of pulmonary tuberculosis was the same as during the previous year and the rate per thousand population (0.65) is the lowest for a number of years. The death rate per thousand population (0.19) was the lowest for, at least, the past 30 years, with the exception of 1950. 14 TUBERCULOSIS 1938 - 1951. NEW CASES DEATHS Year Estimated Population Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary No. Rate per 1,000 Population No. Rate per 1,000 Population No. Rate per 1,000 Population No. per 1,000 Population 1938 38,820 29 0.74 8 0.20 10 0.25 I 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 1951 45,640 30 0.65 6 0.10 9 0.19 2 0.04 Notification of tuberculosis was, on the whole, satisfactory. There were four cases 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 twenty-six less than that for the previous year. Non- Pulmonary Pulmonary Males 139 18 Females 95 20 WORK OF THE PUBLIC HEALTH NURSE. The following is a record of certain aspects of the work done by the nurse to the public health department during the year:— Home visits in connection with infectious diseases— Measles and whooping cough 943 Scarlet fever, poliomyelitis and pneumonia 47 Sonne dysentry (including visits to laboratory) 276 Attendances at diphtheria immunisation sessions 30 Visits for treatment of scabies 10 Visits for treatment of head lice 15 Visits in regard to old people 533 Poliomyelitis survey 13 Miscellaneous 74 15 SANITARY ADMINISTRATION. ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR 1951 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-second Annual Report of work done and matters of interest concerning the Sanitary Department. As the years go by it becomes increasingly difficult to produce a report different in character to those that have preceded it, which will be informative and, at the same time, of interest both to members of the Council and to ratepayers in general. The report could be full of statistics with little written matter and, in this form, produced with little effort. Some statistics, however dull, are of course essential but they can be mollified by an accompanying text and, at the risk of being thought loquacious, I have always endeavoured to keep that in view. Repetition is sometimes unavoidable but it must be remembered that the composition of the Council is always changing and if, occasionally, a member reads something substantially the same as in a previous report there may many others who will be reading it for the first time. The year under review has been uneventful. No departmental changes occurred and this allowed the work to proceed smoothly and, at the same time, for certain sections to be brought up-to-date. Food matters again occupied a great deal of the inspectors' time. 16 Notifications of food poisoning have, as we all know, greatly increased throughout England and Wales during the past few years due, in part, to the administrative measures which increased the proportion of the outbreaks notified whilst the use of the Public Health laboratory service has increased the number of cases reported. The real and substantial increase however, has been mainly due to three causes and as these are not generally known I think they are of sufficient importance and interest for me to quote the following extract from a report of the Chief Medical Officer of the Ministry of Health. "The first of these is the retention overnight and reheating of meat dishes cooked the day before they are to be eaten in consequence of the necessity for economy in using rationed meat supplies. The second is the great increase in communal feeding in school, mine and factory canteens ; in these the practice of cooking meat or gravy in large containers the day before they are to be eaten is dangerous, for the large containers cool slowly and may, for many hours, maintain a temperature favourable to the rapid multiplication of organisms which the reheating temperature is too low to kill. The third case is neglect of personal hygiene often due to lack of facilities, rationing of supplies and shortage of staff, though in some outbreaks the standard of kitchen hygiene was high ". No outbreak was reported due to freshly cooked joints of fresh meat eaten hot but 195 were due to processed, made up or reheated meat. A circular embodying the above was sent out during the year to all restaurants, cafes and factory canteens in the district. There is some gratification in being able to report that, although a few isolated cases have been reported, no outbreak of food poisoning has occurred in this district for some years. For the purpose of abating nuisances or executing repairs to houses the following notices were served :— Preliminary 145 Abatement 50 Informal (dustbin only) 3 Formal (dustbin only) 1 17 These figures do not include verbal notices often given in regard to minor matters. Ten informal notices referring to food premises were also sent. Once again it has been noticeable that a considerable amount of sanitary work has been carried out by Owners without service of notice. Schedules of repairs are not infrequently sent 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 damaged repairs have been going on works which normally would be included in notices, have also been put in hand. Applications to the Court for Nuisance Orders had to be made in eight 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 2 Applications withdrawn, work having been completed before hearing 6 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. In two instances it became necessary to issue summonses for non-compliance with Nuisance Orders. These were in respect two houses belonging to the same Owner. The defendant was fined £2 and the Council awarded £2 2s. Od. costs in each case. A fortnight was given in which to complete the works after which a daily penalty of 10/- was ordered. 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. 18 INFECTIOUS DISEASES. The following number of rooms were disinfected for the undermentioned causes:— Scarlet fever 7 Tuberculosis 21 Vermin (including fleas) 18 Other 28 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 159 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 Apricots in syrup — 1 1 — — — Almonds, ground 2 — 2 — — — Antipasto — 1 1 — — — Butter, peanut — 1 1 — — — Breadcrumbs, golden — 1 1 — — — Butter — 2 2 — — — Beer, bitter 5 — 5 — — — Beer, mild 2 — 2 — — — Bacon — 1 1 — — — Cake mixture — 3 3 — — — Cough linctus — 1 1 — — — Condensed milk — 1 1 — — — Curry powder — 1 1 — — — Cocoanut flake — 1 1 — — — Cheese — 1 1 — — — Cough tablets 1 — 1 — — — Chocolate roll 2 — 2 1 — 1 Fudge, fruit cream 1 — 1 — — — Fudge, chocolate 1 — 1 — — — Flour, self-raising 1 — 1 — — — 19 ARTICLES ANALYSED Adulterated or below standard. Formal Informal Total Formal Informal Total Fondant 1 — 1 — — — Fat, cooking — 1 1 — — — Ginger pudding — 1 1 — — — Golden syrup — 1 1 — — — Gin 1 — 1 — — — Ginger wine 1 — 1 — — — Graveylets — 1 1 — — — Honey — 2 — — — Health salts — 1 1 — — — Ice cream 6 14 20 — — — Jasco fruitade — 1 1 — — — Jelly — 2 2 — — — Jellycream — 1 1 — — — Junket powder — 1 1 — — — Jam — 6 6 — — — Ketchup, tomato — 1 1 — — — Kipper paste — 1 1 — — — Luncheon meat — 1 1 — — — Lard — 1 1 — — — Licorice — 1 1 — 1 1 Milk 35 16 51 — — — Mincemeat — 1 1 — — — Margarine — 2 2 — — — Malt choco — 1 1 — — — Marzipan 1 — 1 1 — 1 Pudding mixture — 1 1 — — — Pimento — 1 1 — — — Pepper, cayenne — 2 2 — — — Pepper, white 1 — 1 — — — Rum 1 — 1 — — — Soup, chicken noodle — 1 1 — — — Spice, mixed — 1 1 — — — Sausage, pork 2 — 2 — — — Sausage, beef 6 — 6 — — — Sausage meat, beef 3 — 3 — — — Saccharin tablets 1 — 1 — — — Sugar, demerara — 1 1 — — — Tapioca — 1 1 — — — Tea — 1 1 — — — Tomato juice — 1 1 — — — Vinegar 1 — 1 1 — 1 Whiskey 1 — 1 — — — Yestamin tablets — 1 1 — — — Totals 76 83 159 3 1 4 20 Notes in regard to samples shown as adulterated or below standard or otherwise. Milk. It is satisfactory to note that none of the fifty-one samples of milk were adversely reported upon. Chocolate Roll. One sample was devoid of chocolate or cocoa material. The article was coloured with a brown dye but there was neither the smell nor taste of chocolate. Proceedings were instituted in this case, the defendants being fined £15. Vinegar. Before the purchase of this article was complete, the seller made a declaration that it was "non-brewed". This term was accepted until recently by the Ministry of Food subject to certain labelling requirements. A decision of the High Court held, however, that the application of the description "non-brewed" vinegar to a solution of acetic acid and caramel was an offence against the Merchandise Marks Act. The effect of this is that the term vinegar must not be used except in relation to an article obtained by a process of double fermentation e.g. malt vinegar containing not less than 4 per cent acetic acid. A circular letter was sent to all known sellers of vinegar in the district giving them a brief summary of the present legal position concerning the sale of vinegar. Marzipan. This sample consisted of mock almond paste prepared with sugar, flour, soya flour, edible oil and flavouring but contained no ground almonds. Marzipan is a sweetmeat prepared with sugar and ground almonds. The proportion of ground almonds varies but should not, in the opinion of the Public Analyst be Jess than one quarter of the finished article. Proceedings were instituted in this case, the defendants being fined £15. MILK. 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. Dealers Tuberculin tested 7 Pasteurised 7 Pasteuriser's 1 Sterilised 7 Supplementary. Tuberculin tested 8 Pasteurised 8 Sterilised 10 The difference between a dealers and a supplementary licence is that, if a dairyman has premises in a 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 of that area. 21 DETAILS OF MILK TESTING. 'Pasteurised' Passed Failed Total Phosphatase test (To determine whether or not the milk has been adequately heat treated 182 3 185 Methylene blue test (To determine whether or not the milk is of good keeping quality) 179 8 187 'Sterilised' Turbidity test (To determine whether or not the milk has been adequately sterilised) 16 16 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. Three failures occurred out of 185 examined. This test is a highly sensitive one and a failure will result if the milk has been heated to only 101/2° than the correct temperature of 145°F (holder process), or held for twenty minutes at 145°F instead of thirty minutes. The addition of as little as a quart of raw milk in 100 gallons of pasteurised milk will produce an adverse result. Failures may result from any one of these three factors and inspection of the plant in necessary to ascertain what may be the offending cause. A slight failure by no means indicates that any tubercle baccilli which may have been in the milk before processing will not have been destroyed. The failure might be due to some small error in pasteurising technique, requiring adjustment, but not necessarily demonstrating inadequate treatment. Eight samples 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 lengthy period. Farm bottled (tuberculin tested) milk is not pasteurised and is retailed as it comes from the cow. In order to ensure, as far as possible that this does not contain any tubercle bacilli thirteen samples were taken and submitted for biological examination (animal experiment). These all gave negative results. 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. Various sections of this report deal with foods and make it unnecessary to report more fully under this head.. The following unfit foodstuffs were voluntarily surrendered and destroyed or handed over for salvage:— Fish, wet 281 lbs. Fish 21 tins Eggs 298 Fruit 201 tins Vegetables 205 tins Beans, baked 96 tins Tomato ketchup 1 bottle Tomato juice 18 tins Milk, condensed 2 tins Milk, evaporated 48 tins Milk, full cream 4 tins Milk, skimmed 3 tins Milk, dried 525 lbs. Crawfish 2 tins Braised kidneys 1 tin Meat and Gravy 4 tins Sheeps tongue 1 tin Jam or marmalade 23 tins Soups, various 218 tins Luncheon meat 38 tins Sauce 1 bottle Herrings roes 3 tins Ham, veal or beef loaf 2 tins Braised steak 1 tin Oranges 2 cases Spaghetti 2 tins Spaghetti 39 lbs. Jellied eels 3 tins Meat paste 34 jars Gammon 90 lbs. Bacon, Polish 30 lbs. Ham, tinned 331 lbs. Mincement 8 tins Pork pies 48 Orange juice 11 tins Pease puddings 3 tins Salt 8 pkts. Block barley 2 cwt. Lentils 40 lbs. Sago 80 lbs. Flour 70 lbs. Barley pudding 92 pkts. Figs 56 lbs. Sausages 6 tins Ox tongues 1 tin Rice 6 lbs. Pickles 2 jars Beef 213 lbs. 23 Tripe 20 lbs. Mutton 8¼ lbs. Corned beef 1½ lbs. Liver 11 lbs. Ox kidney 10½ lbs. A number of complaints regarding foodstuffs were received during the year, some of which are worth recording:— (1) A portion of breakfast sausage was found to have a piece of string embedded in it. Proceedings were instituted and the defendants were fined £3 with £1 1s. Od. costs. (2) Two bottles of milk (channel islands T.T.) were the subjects of complaint. These obviously contained foreign matter. They were sent to the public analyst who gave a lengthy report. The dirty deposits in one of the bottles, amounting to 18 parts per 100,000 consisted of numerous particles of vegetable matter and debris including those from cereal and other seeds and from hay or grass, weighted and contaminated with mineral dirt of a siliceous nature. There was no evidence of the presence of dung or other wholly objectionable matter. The deposit in the second bottle was similar in character but only amounted to two parts per 100,000. Enquiries showed that the bottles, after being washed and sterilised at a London depot, were transported to a farm in a country district on an open lorry and uncapped. The significant fact that the dirty deposits consisted of what has been described above indicated that the bottles, shortly before filling, were placed in a position near to some animal feeding stuff and that during transport, dust had gained access. Although a decision was made at first to institute proceedings, after detailed enquiries into all the circumstances, this was abandoned and the facts were sent to the Ministry of Agriculture and Fisheries. It was subsequently learned that the method of cleansing the bottles in London and sending them uncapped to the country had been so altered that an occurrence of this nature should not be repeated. (3) A complaint was received in regard to the presence of pieces of string in a loaf of brown bread. The largest piece measured 4 inches in length whilst two smaller pieces measured l¼ and } of an inch respectively. Proceedings were instituted in this case and the defendant was fined £5 with £5 5s. Od. costs. (4) A nail was found embedded in some sponge roll. Proceedings were instituted in this case and the defendant was fined £5 with £5 5s. 0d. costs. (5) Several small pieces of wood were found embedded in a scone. It was decided not to instituted proceedings in this case and a warning was given. (6) The presence of a pin, alleged to have been found in a penny bun was the subject of a complaint. Careful consideration was given to this incident and a number of factors came to light which persuaded the Committee not to institute proceedings. (7) A nail found in a fruit loaf was made the subject of a detailed investigation. The Committee decided in this case not to institute proceedings and a letter of warning was sent to the firm who made the loaf. (8) Complaint was made of the gritty nature of some imported fruit cake and this was confirmed on eating a portion. A sample was forwarded to the public analyst who reported that it contained 0.15 per 24 cent by weight of sand and siliceous matter. His comments were "In my opinion the quantity of extraneous sandy matter, although not necessarily harmful, was such to render the article unsuitable for human consumption". As the grit had obviously been introduced in the country of origin, the action taken in this case was to inform the Food Hygiene Division of the Ministry of Food, together with the firm importing the article and the Health Authority in which the wholesalers warehouse is situated, of the facts. The whole of the cake had been quickly sold which prevented seizure of any remaining stocks. N.B.—With the exception of instance 6, all the articles mentioned in the above notes were produced outside this area. ICE CREAM. Seventy-nine samples were submitted for testing by the methylene blue method and, of these, seventy-four reached grades I or II standards. Five were placed in grade III and none in the low category of grade IV. As I have previously explained the methylene blue test does not provide a guarantee of safety but it does serve as a sample 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 handling requiring further investigation. The results are not quite as good as last year but the difference is hardly appreciable and can still be said to be very gratifying. The certificate giving the results of testing has the following note appended:— "Owing to the numerous factors governing the hygienic quality of ice-cream it is unwise to pay too much attention to the bacteriological results of any single sample. Judgement should be based rather on a series of samples. It is suggested over a six monthly period 50 per cent of vendors samples should fall into grade 1, 80 per cent into grades I or II, not more than 20 per cent into grade III and none into grade IV". The following table shows the results of samples taken since 1947 and it will be seen that those for the past two years are well within the limits indicated in the above note. Year Total Samples Taken Grades I or II. % Grade III. % 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. — 1951 79 74 93.7 5 6.3 Nil. — It may be noted that all five samples placed in Grade III were manufactured outside this Borough. Three of these occurred during a short period as a result of follow-up sampling. 25 The firm concerned and the Health Department of the Council in whose area the ice-cream was made were notified and subsequent samples proved satisfactory. As I anticipated in my last report an Order came into operation during the year, prescribing minimum standards of composition for ice-cream. This is a welcome step. Ice cream generally must now contain not less than 5% fat, 10% sugar and 1½% milk solids other than fat, although some variations in this standard are permitted where ice-cream contains fruit or, because of the Jewish dietary law, is sold as Parev (Kosher) Ice. A number of samples were taken during the year, all of which, on analysis, gave satisfactory results. Details will be found in the table giving a list of food and drugs samples analysed. THE RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. This Act came into operation on 1st November, 1951. Among other things provision is made for the issue of licences for the manufacture or storage of Rag Flock and for the registration of premises where filling materials to which the Act applies, are used. These activities include any form of upholstering and in particular the stuffing or lining of bedding, toys, baby carriages, etc. Specially exempted, however, is the remaking or reconditioning of any article, and this, in my opinion limits the usefulness of the Act considerably. Certain records have to be kept by the occupiers of licensed or registered premises and provision is made for taking samples of filling material by authorised officers to see that they comply with standards of cleanliness laid down in Regulations made under the Act. Both the medical officer of health and myself are deemed authorised officers by virture of our appointments. A survey of the district was made and, as a result, one licence to store rag flack was issued and two premises were registered. SMOKE ABATEMENT. There is little to report under this heading. Occasionally attention has been drawn to the managements of one or two factories when excessive smoke has been noted but the periods of emission have been short and insufficient otherwise than to issue warnings. 26 SHOPS ACT. Generally speaking, the provisions of the Shops Act have been well observed throughout the district. There have been one or two exceptions when warnings have had to be given. These occurred during the winter months when restricted hours of business are prescribed. I feel the time cannot be far distant when the times of closing shops will become the same—winter and summer. Few shops keep open after 6 p.m. during the summer, although they are entitled to do so. ERADICATION OF BED BUGS. During the year the following number of houses were found to be infested with bed bugs:— Infested Disinfested Council houses (rooms) 6 6 Other houses (rooms) 3 3 There is no doubt that the incidence of bed bug infestation in council houses is far less now than in the pre-war years. I think this may be due to the discovery of D.D.T. and Gammaxane whereby second hand furniture etc., which was so often the vehicle for introducing these vermin into houses, can now be effectively and more easily disinfested. RATS AND MICE DESTRUCTION. This important work has gone without interruption. As I have reported previously a free service is given in the case of private dwellings, charges being made in the case of business premises. Sewers and council property have also received systematic attention. Each year the soil sewers throughout the district are test baited and any section showing evidence of 'takes' are given special treatment. Under the Prevention of Damage by Pests Act, 1949, the tenant is no longer under duty, except on receipt of a notice of requirement to destroy rats or prevent reinfestation but he is not deprived of the right to do so. He is however, now put under duty to notify the local authority if it is within his knowledge that rats or mice are living or resorting to his premises in substantial numbers. In destroying rats I feel all will agree that the most humane methods possible should be adopted. In the course of recent years there have been considerable advances in the methods and materials used in rodent destruction. A new bait has recently been approved for use by the Ministry and has proved very successful. In some cases, also, it is a great time saver. With 27 most poisons it is necessary, according to circumstances, to prebait with innocent material several times on every day before the poison bait is laid. This is to gain the confidence of the rats so that all or nearly all will take the poison bait simultaneously. They do not thereby become bait shy which often occurs when many poison baits are laid without prebaiting. The new preparation can be laid without prebaiting and left as it takes five to eight days to kill a rat and, during that time, most or all the rats in the vicinity have taken some, not having been scared by seeing other rats lying about dead. The new poison causes rats to develop a haemorrhagic condition and to suffer capilliary damage. They feel no pain nor do they undergo physiological disturbance. As only a very low concentration is needed to kill rats, its use materially reduces the risk of accidental poisoning of other animals. With the exception of pigs, larger mammals or chicken would need to eat a considerable quantity before being harmfully affected. Periodical meetings of workable area committees are held at various places in the County and attended by representatives from the Ministry of Agriculture and Fisheries. These are very useful and enable officers in charge of rat destruction to keep abreast of the latest information and ensures that co-ordinated action is being taken by the various authorities. MISCELLANEOUS. The National Assistance Act, 1948, places a duty on Local Authorities to arrange for the burial or cremation of any person who has died or has been found dead and where it appears that no suitable arrangement for the disposal of the body has been made. Where possible the expenses so incurred may be recovered from the estate of the deceased person or, when a death grant is made under the National Insurance Act, sixty per cent of this may be claimed by the authority effecting the burial or cremation. During the year it only became necessary to bury the body of a dead infant. Once again the refuse tip at the Norbiton Potteries, and the depot and pigstyes at California Road have been, more or less, free from cricket infestation and only the minimum precautions were called for against these pests. During the past few years requests have been received from householders for wasps nests to be destroyed. These are 28 quently built in roof spaces, under floors and other awkward positions rendering their destruction a matter of some difficulty and requiring skilled approach. The use of cyanide also necessitates the employment of a reliable operative. To assist ratepayers, this work has been done by the Rodent Officer, the occupier being charged with the expenses involved. During the past two years 85 treatments have been carried out, more than 100 nests being destroyed. I may add that some requests were declined where the nests have been in positions not causing inconvenience. Wasps are not entirely harmful, in fact it is known that they do much good and it is only, therefore, in those instances where real inconvenience arises that the nests are destroyed. Requests also are not infrequent for the identification of all sorts of insects and grubs infesting houses, and for advice on methods of control. In cases where I have been unable to do this the assistance of the Entomological section of the British Museum has been sought and has been most freely given. Thirty-nine vacant council houses were inspected for any signs of bed bug infestation and where evidence was discovered appropriate steps were taken. 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. Two licences, both of a limited character, were granted to station moveable dwellings in the area. No applications were received during the year for Improvement Grants under the Housing Act, 1949, although several enquiries were made. I am led to think that the rather onerous conditions which must be complied with before a grant is made is the reason why there is apparent lack of interest. Stoppages in public sewers (combined drains) were cleared by the department on two hundred and eigthy-seven occasions. In a few instances the assistances of sewermen from the Borough Engineer's department had to be obtained. 29 RAINFALL, 1951. Table showing rainfall in the district during 1951, taken at the Sewage Disposal Works, California Road, New Maiden. Inches January 2.92 February 5.46 March 2.85 April 2.33 May 1.95 June 0.83 July 1.28 August 2.38 September 2.69 October 0.70 November 5.09 December 1.80 30.28 Increase on previous year 6.26 inches. Average for past five years 22.61 inches. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, HENRY TUNBRIDGE, Sanitary Inspector. 30 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. 13 19 2 — Factories not included in (i) in which section 7 is enforced by Local Authorities. 91 93 7 — Other premises in which section 7 is enforced by the Local Authority. 7 2 — — Total 111 114 9 — 31 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 6 6 — 5 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences: (a) Insufficient — — — — — (b) Unsuitable or defective 2 2 — — — (c) Not separate for sexes (absence of screening) 1 1 — 1 — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 9 9 — 6 — 32 PART VIII OF THE ACT. OUTWORK. No. of out-workers in August list req'd. by Sect. 110(i) (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 2 — — — — — Brush making 75 — — — — — Cleaning of wearing material 2 — — — — — File making 2 — — — — — Total 81 — — — — — Printed by Raynes Park Press, Lambton Road, London, s.w.20.