Library MAL17 Borough of Malden and Coombe Annual Report OF THE Medical Officer of Health AND THE Chief Sanitary Inspector FOR THE YEAR ENDED 31st DECEMBER 1953 PUBLIC HEALTH COMMITTEE Chairman: Councillor R. A. Taylor. Vice-Chairman: Councillor A. R. Hill. Alderman F. S. Wagner. Councillor W. A. Ravennhill. Councillor A. E. Hope. Councillor F. A. W. Selley. Councillor C. W. H. Adams. Councillor J. S. Yellop. Councillor A. A. Peckham. Councillor L. W. Hawkins. Ex-Officio Members: The Mayor Alderman C. H. Johnson, J.P. and the Deputy Mayor Alderman W. J. Alexander. OFFICERS AND STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J. B. Morwood, M.B., F.R.C.S.I., D.P.H. Chief Sanitary Inspector: °* Henry Tunbridge, F. R.San.I., M.S.I.A. (Retired 31st May, 1953). †*‡ S. J. T. Wood, M.R.San.I., M.S.I.A. (Promoted from Deputy 1st June, 1953). Deputy Chief Sanitary Inspector: †*§ P. E. Kinton, M.R.San.I., M.S.I.A., (Commenced 4th August, 1953). Additional Sanitary Inspector: †* L. E. Bowskill, M.R.San.I., M.S.I.A. Nurse: Mrs. M. J. Butler, S.R.N. Clerks: F. W. W. Mitchell. I. Wilson (Resigned 30th June, 1953). J. Wapshere (Commenced 6th July, 1953). Mrs. A. Savage (Shorthand/Typist). Rodent Officer: B. Ll. Prichard. Rodent Operatives: A. E. Wilson. T. Clarkson. Mortuary Attendant, Disinfector, etc.: H. J. N. Breach. Public Analyst: Daniel D. Moir, M.Sc., F.R.I.C. ° Sanitary Inspector's Certificate (R.S.I.). † Sanitary Inspector's Certificate (R.S.I. & S.I.E.J. Board). * Certificate as Inspector of Meat and other Foods (R.S.I.). ‡ Smoke Inspector's Certificate (R.S.I.). § Certificate in Sanitary Science (R.S.I.). Borough of Malden and Coombe ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH 1953 Public Health Department, Municipal Offices, New Malden. July, 1954. 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 1953 which has been prepared in accordance with Ministry of Health Circular 42/51. The health of the district remains good and the vital statistics compare favourably with those of the country as a whole. During the year a great deal of work has 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 those 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. Continued vigilance has been maintained in the inspection of all food and catering establishments in the Borough. As a result the standard generally is quite high and improvements are continually being carried out. Mr. S. J. T. Wood, Mr. Tunbridge's Deputy since 1949, was promoted to the post of Chief Sanitary Inspector in June, 1953, and the change over was effected without interruption of the smooth running of the department. In conclusion I should like to thank the Chairman and members of the Public Health Committee for their helpful cooperation and the staff of the department for the efficiency 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) 1953 45,500 VITAL STATISTICS. Total M. F. Live Births 595 294 301 Birth rate per 1,000 of the estimated resident population 13.7* (Legitimate) 277 292 (Illegitimate) 17 9 Stillbirths 14 5 9 Stillbirth rate per 1,000 total (live and still) births 23.0 Deaths 430 222 208 Death rate per 1,000 of the estimated resident population 9.5* * Corrected. Deaths from puerperal causes:— Rate per 1,000 Deaths. Total (Live & Still) Births. Puerperal sepsis Nil — Other Maternal Causes 1 1.6 Death rates of Infants under one year of age:— All Infants per 1,000 live births 13.4 Legitimate Infants per 1,000 legitimate live births 10.5 Illegitimate Infants per 1,000 illegitimate live births 76.9 Deaths from Cancer 64 Deaths from Measles Nil Deaths from Whooping cough Nil BIRTHS. During the year 595 live births were registered, being 73 more than last year's total. The rate per thousand population was 13.7 comparing with an average for England and Wales of 15.5. Of the total number 26 or 4.4 per cent were illegitimate. 3 DEATHS. During the year 430 deaths were registered, a decrease of 16 compared with those recorded in 1952, the rate per thousand being 9.5 compared with an average of 11.4 for England and Wales. The infantile mortality rate was 13.4, an exceptionally low rate, compared with the figure of 26.8 for England and Wales. One death occurred from maternal causes. There were 9 deaths due to cancer of the lung; considerably fewer than the 23 deaths from this cause in 1952. CAUSES OF DEATH. M. F. Total 1. Tuberculosis, respiratory 5 5 10 2. Tuberculosis, other - - - 3. Syphilitic disease 2 - 2 4. Diphtheria - - - 5. Whooping cough - - - 6. Meningococcal infections - - - 7. Acute poliomyelitis - - - 8. Measles - - - 9. Other infective and parasitic diseases - 1 1 10. Malignant neoplasm, stomach 6 5 11 11. „ „ lung, bronchus 9 - 9 12. „ „ breast - 8 8 13. „ „ uterus - 3 3 14. Other malignant and lymphatic neoplasms 20 13 33 15. Leukaemia, aleukaemia 1 2 3 16. Diabetes 1 10 11 17. Vascular lesions of nervous system 29 35 64 18. Coronary disease, angina 47 22 69 19. Hypertension with heart disease 7 7 14 20. Other heart disease 18 29 47 21. Other circulatory disease 9 20 29 22. Influenza 3 5 8 23. Pneumonia 3 11 14 24. Bronchitis 20 7 27 25. Other diseases of respiratory system 6 1 7 26. Ulcer of stomach and duodenum 5 4 9 27. Gastritis, enteritis and diarrhoea - 2 2 28. Nephritis and nephrosis 2 2 4 29. Hyperplasia of prostate 7 - 7 30. Pregnancy, childbirth, abortion - 1 1 31. Congenital malformations 1 - 1 32. Other defined and ill-defined diseases 14 9 23 33. Motor vehicle accidents 3 - 3 34. All other accidents 2 3 5 35. Suicide 2 3 5 36. Homicide and operations of war - - - Total 222 208 430 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 5 1 1 2 4 3 22 43 97 44 222 Females 3 2 2 - 3 2 19 14 86 77 208 Totals 8 3 3 2 7 5 41 57 183 121 430 STATEMENT SHOWING WHERE DEATHS OCCURRED. In this district 261 In various hospitals 150 In other districts 19 INFANTILE MORTALITY. Number of deaths occurring in infants under one year of age during the past five years:— 1949 (12 Legitimate. 2 Illegitimate) 14 1950 (8 „ 1 „) 9 1951 (8 „ Nil. „ ) 8 1952 (8 „ 1 „) 9 1953 (6 „ 2 „) 8 CAUSES OF DEATH OF INFANTS UNDER ONE YEAR OF AGE Prematurity 1 day; 5 days; 8 days; 1 month. Cerebral haemorrhage 30 mins.; 7 hours. Epilepsy 1 month. Broncho pneumonia 14 days. 5 SUMMARY OF BIRTH, INFANTILE MORTALITY AND DEATH RATES FOR THE PAST SIX YEARS. Year. Births. Infantile Mortality. Deaths. 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 1952 11.0 17.2 10.1 1953 13.7 13.4 9.5 MORTUARY. Forty-Five bodies were brought to the Mortuary and a postmortem examination was performed on each. 6 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality and Case-rates for Certain Infectious Diseases in the Year 1953. Provisional figures based on Quarterly Returns. England and Wales 160 County Boroughs and Great Towns (including London) 160 Smaller Towns (Resident Pop. 25.000-50.000 at 1951 Census) London Administrative County Births— Rates per 1,000 Home Population Live births 15.5 17.0 15.7 17.5 Still births 0.35 0.43 0.34 0.38 22.4* 24.8* 21.4* 21.0* Deaths— All Causes 11.4 12.2 11.3 12.5 Typhoid and paratyphoid 0.00 0.00 — — Whooping cough 0.01 0.01 0.00 0.00 Diphtheria 0.00 0.00 0.00 — Tuberculosis 0.20 0.24 0.19 0.24 Influenza 0.16 0.15 0.17 0.15 Smallpox 0.00 0.00 0.00 — Acute poliomyelitis (including polioencephalitis) 0.01 0.01 0.01 0.01 Pneumonia 0.55 0.59 0.52 0.64 Notifications (Corrected) Typhoid fever 0.00 0.00 0.00 0.01 Paratyphoid fever 0.01 0.01 0.01 0.01 Meningococcal infection 0.03 0.04 0.03 0.03 Scarlet fever 1.39 1.50 1.44 1.02 Whooping cough 3.58 3.72 3.38 3.30 Diphtheria 0.01 0.01 0.01 0.00 Erysipelas 0.14 0.14 0.13 0.12 Smallpox 0.00 0.00 0.00 — Measles 12.36 11.27 12.32 8.09 Pneumonia 0.84 0.92 0.76 0.73 Acute poliomyelitis (including polioencephalitis) Paralytic 0.07 0.06 0.06 0.07 Non-paralytic 0.04 0.03 0.04 0.03 Food poisoning 0.24 0.25 0.24 0.38 Puerperal pyrexia 18.23* 24.33* 12.46* 28.61* Deaths— Rates per 1,000 Live Births All causes under 1 year of age 26.8† 30.8 24.3 24.8 Enteritis and diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 * Per 1,000 Total (Live and Still) Births, † Per 1,000 related live births. 7 Maternal Mortality in England and Wales. Intermediate List No. and cause Number of Deaths Rates per 1,000 Total (Live and Still) Births Rate per million women aged 15-44 A 115 Sepsis of pregnancy, childbirth and the puerperium 68 0.10 A116 Abortion with toxaemia 7 0.01 1 Other toxaemias of pregnancy and the puerperium 166 0.24 A 117 Haemorrhage of pregnancy and childbirth 90 0.13 A 118 Abortion without mention of sepsis or toxaemia 30 0.04 3 A 119 Abortion with sepsis 39 0.06 4 A 120 Other complications of pregnancy, childbirth and the puerperium 125 0.18 8 NOTIFICATION OF INFECTIOUS DISEASES, 1953. DISEASES Totals Under 1 1-2 3-4 5-9 10-14 15-24 25 and over Measles 574 9 102 156 286 12 3 6 Whooping cough 165 12 29 41 75 7 — 1 Scarlet fever 40 — — 2 33 4 1 — Pneumonia 26 4 2 4 4 1 — 11 Poliomyelitis Paralytic 2 — — — 1 - 1 - Non-paralytic 6 — — 1 - 4 1 — Puerperal pyrexia 3 - - - - - 2 - Dysentery 1 - 1 - - - - - Food poisoning 5 — - — — 1 1 3 Erysipelas 1 — — — — — — 1 Para-typhoid B. 4 — — — 4 — — — Malaria 2 — — — — — 2 — Meningococcal infection 1 — 1 — — — — — Acute encephalitis Infective 1 — — — 1 - - - Post-infectious 1 — — — - — — 1 Totals 832 25 135 204 404 29 11 24 diseases Totals Coombe Dickerage Mount WARDS Burlington Maiden Green St. James Maiden Manor Cambridg Norbiton Park Measles 574 68 78 49 51 98 60 32 77 61 Whooping cough 165 24 19 18 6 18 6 26 19 29 Scarlet fever 40 4 3 8 - 7 3 3 5 7 Pneumonia 26 6 2 2 2 2 2 - 2 8 Poliomyelitis Paralytic 2 — — - 1 - 1 - - - Non-paralytic 6 3 1 - - 1 - - 1 - Puerperal pyrexia 3 - 1 - - 1 1 - - - Dysentery 1 — - — — - - 1 - - Food poisoning 5 1 1 — 1 2 - - — - Erysipelas 1 1 — — — - - - - - Para-typhoid B. 4 — — — - - - 4 - - Malaria 2 1 1 - - - - - - - Meningococcal infection 1 — 1 - - - - - - - Acute encephalitis Infective 1 1 - - - - - - - - Post-infectious 1 1 — — — — - — — — Totals 832 110 107 77 61 129 73 66 104 105 9 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. SCARLET FEVER. The number of cases of scarlet fever notified during the year was forty, giving an incidence rate of 0.88 per thousand population. This compares with a rate of 1.39 for England and Wales. All the cases were very mild and no fatalities occurred. Thirty-one cases were treated at home and nine removed to Hospital. DIPHTHERIA. For the sixth year in succession the district was completely free from this disease, the last case having been notified in April, 1947. Immunisation against diphtheria progresses smoothly. 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 seven 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. 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. This has resulted in a number of children being immunised 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 394, school 48) 442 Number of children receiving reinforcing doses 579 Of the above, 147 were immunised and 57 given reinforcing doses by Private Practitioners. 10 The fear of diphtheria has declined among parents in a direct relation to the decline of the disease itself; the majority of parents of young children nowadays have never seen or heard of a case of diphtheria among their neighbours' children and are more afraid of illnesses they know than of the dangers of diphtheria. It cannot be said too often "Diphtheria still kills". Elimination of this disease is conditional upon the maintenance of an adequate level of immunisation. In 1901, 10,000 persons died from diphtheria in England and Wales: In 1952 this number had been reduced to 32. Since 1944 (when records of corrected notifications were first kept) notifications have fallen from over 23,000 in that year to a new low figure of 240 for 1953. The following are figures for deaths and notifications (corrected) since 1944:— Year Deaths Corrected Notifications 1944 934 23,199 1945 722 18,596 1946 All 11,986 1947 244 5,609 1948 156 3,575 1949 84 1,890 1950 49 962 1951 33 664 1952 32 376 1953 24* 240* * Provisional. 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 must not be allowed to revert. 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 425 Revaccinations 91 Total 516 11 Of the above, two hundred and fifty-seven individuals were vaccinated or revaccinated by private practitioners. Three hundred and sixty-eight of the persons vaccinated were under one year of age. ACUTE POLIOMYELITIS. Eight cases of acute poliomyelitis were notified during the year, two as paralytic and six as non-paralytic. There were no deaths. MEASLES. The number of cases of measles notified (574) was much higher than in 1952. Seven cases were removed to hospital. No deaths occurred. Prophylactic serum for contacts, etc., was supplied to doctors on application. WHOOPING COUGH. The number of cases of whooping cough notified was 165. Five cases were removed to hospital and no deaths occurred. The immunisation campaign against whooping cough which was commenced in the Borough in February, 1951 was intensified in 1952 and 1953. Whooping cough is one of the most serious diseases of childhood and mothers appreciate the facilities for immunisation which are available. Fortunately the whooping cough immunisation campaign has had a beneficial effect on the diphtheria immunisation campaign because the prophylactic material most commonly used gives combined protection against both whooping cough and diphtheria. It is to be hoped that whooping cough immunisation will prove as effective as immunisation against diphtheria. Details of the number of children immunised against whooping cough during the year are as follows:— Primary immunisations carried out by the medical officer of health 293 12 Primary immunisations carried out by private practitioners 128 Children receiving reinforcing doses by the medical officer of health 17 Children receiving reinforcing doses by private practitioners 13 PARATYPHOID B. During the year a child was notified as suffering from paratyphoid B. Three further cases were diagnosed among children attending the same school. In collaboration with the Medical Officers of Health of two neighbouring authorities a full investigation was made. Faecal specimens were obtained from the staff and all children attending the school which, in this district alone, necessitated over a thousand visits. Six symptomless excreters were discovered and isolated until free from infection. Extensive investigations finally shewed that the probable cause of this outbreak was a baked chocolate sponge with jam and cream filling. DYSENTERY. Only one case of sonne dysentery occurred during the year. SCABIES AND VERMINOUS CONDITIONS. Necessary action in reference to the conditions noted above has been very limited and calls for no special comment. FOOD POISONING OUTBREAKS. (a) Total number of outbreaks 1. (b) Number of cases 2. (One case in this district and one in an adjoining local authority). (c) Number of deaths Nil. (d) Organism responsible Salmonella typhi murium (e) Food involved Duck eggs. In addition there were four single cases of food poisoning of which two were due to staphylococcus aureus, one to salmonella typhi murium and one case of poisoning following the consumption of field gathered mushrooms. 13 CASE RATES PER 1,000 POPULATION FOR CERTAIN INFECTIOUS DISEASES. England and Wales Borough of Maiden and Coombe Scarlet fever 1.39 0.88 Diphtheria 0.01 0.00 Typhoid fever 0.00 0.00 Paratyphoid fever 0.01 0.09 Measles 12.36 12.62 Whooping cough 3.58 3.63 * Puerperal pyrexia 18.23 4.92 * per 1,000 total births (i.e. live and stillbirths). *CASES REMOVED TO ISOLATION HOSPITALS. Scarlet fever 9 Poliomyelitis (Paralytic) 2 Poliomyelitis (Non-paralytic) 5 Poliomyelitis (not confirmed) 7 Measles 9 German measles 3 Erysipelas 1 Paratyphoid B 4 Paratyphoid B (Symptomless excreters) 5 Paratyphoid B (not confirmed) 1 Whooping cough 4 Diphtheria (not confirmed) 2 Meningitis (not confirmed) 4 Mumps 3 Pneumonia 3 Gastro-enteritis 2 Gastro-enteritis (not confirmed) 1 Meningococcal meningitis 1 Malaria 1 67 *Not including cases of tuberculosis and certain other noninfectious illness. 14 NUMBER OF NOTIFICATIONS RECEIVED YEARLY FOR THE PAST SIX YEARS. 1948 1949 1950 1951 1952 1953 Scarlet fever 33 68 76 32 52 40 Diphtheria — — — — — — Typhoid fever - - - - - - Paratyphoid fever 1 1 — — 1 4 Erysipelas 3 6 2 3 1 1 Pneumonia 22 27 21 27 15 26 Encephalitis lethargica - - - - - — Puerperal pyrexia 1 — 4 4 2 3 Meningococcal infection — - 1 — — 1 Acute poliomyelitis — 3 10 1 14 8 Ophthalmia neonatorum — — — — — — Dysentery — 1 20 26 97 1 Malaria 1 — — — — 2 Measles 386 503 171 807 244 574 Whooping cough 267 94 79 206 76 165 Tuberculosis (all forms) 63 41 35 36 47 39 TUBERCULOSIS 1953 Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory Male Female Male Female Male Female Male Female 0 - - - - - - - - l - - - - - - - - 5 3 1 — - - - - - 15 2 3 — 1 — — — — 25 5 1 — — — l — — 35 3 3 — — — l — — 45 1 1 — 1 l 2 — — 55 5 — — — 1 — — — 65 & upwards 7 1 l - 3 1 - - Totals 26 10 l 2 5 5 — — 5 persons suffering from tuberculosis died from other causes. Thirty-six cases of pulmonary tuberculosis were notified; six fewer than in 1952. 15 TUBERCULOSIS 1938 - 1953. 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. Kate 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 37 083 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 1952 45,390 42 0.92 5 0.11 8 0.17 1 0.02 1953 45.500 36 0.79 3 0.06 10 0.22 — - Notification of tuberculosis was, on the whole, satisfactory. There were four cases during the year which were not diagnosed 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 thirteen more than that for the previous year. Pulmonary Pulmonary Males 152 16 Females 22 WORK OF THE PUBLIC HEALTH NURSE. The following is a record of certain aspects of the work done by the nurse during the year:— Home visits in connection with infectious diseases— Measles and whooping cough 660 Paratyphoid B 498 Attendances at diphtheria immunisation sessions 25 Visits for treatment of head lice 21 Treatment for scabies 27 Visits in regard to old people 572 Poliomyelitis survey 168 Miscellaneous 209 16 SANITARY ADMINISTRATION. ANNUAL REPORT of THE CHIEF SANITARY INSPECTOR 1953 Public Health Department, Municipal Offices, New Malden. July, 1954. To the Mayor, Aldermen and Councillors of the Borough of Maiden and Coombe, Ladies and Gentlemen, I have the honour to present my first annual report on the work carried out by your sanitary inspectors during the year. The year under review has been one of continued effort, although nothing of a spectacular nature has occurred. The general standard of housing in the Borough is good and property owners generally have co-operated well in carrying out works of repair. It is pleasing to report that in no case has it been necessary to resort to Court action to enforce notices under the Public Health or Housing Acts. For the purpose of abating nuisances or executing repairs to houses the following notices were served:— Preliminary 135 Abatement 19 Informal (dustbin only) 16 Formal (dustbin only) 2 These figures do not include verbal notices often given in regard to minor matters. During the year it was not found necessary to apply to the Court for Nuisance Orders. 17 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 numbers of rooms were disinfected for the undermentioned causes:— Measles 2 Scarlet fever 2 Tuberculosis 14 Poliomyelitis 12 Paratyphoid 5 Vermin (including fleas) 18 Other 11 Three loads of bedding were removed for steam disinfection or destruction, and four bags of clothing were disinfected. Routine disinfection after Scarlet fever is not now carried out and is only done in those instances where a special 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. FOOD & DRUGS ACT, 1938. During the year 154 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 tablets — 1 1 — — — Almond flavouring — 1 1 — — — Blanc mange powder — 1 1 — — — Butter — 4 4 — — — Baking powder — 1 1 — — — Batter mixture — 1 1 — — — Beer 2 — 2 — — — Bacon — 1 1 — — — Cheese — 3 3 — — — Cooking fat — 4 4 — — — Cream, sterilised — 1 1 — — — Chocolate laxative — 1 1 — — — Cocoa — 1 1 — — — Coffee essence — 1 1 — — — 18 ARTICLES ANALYSED Adulterated or below standard. Formal Informa Total Forma' Informal Total Coffee, ground 1 1 Cornflour 1 1 — — — Cordial 1 1 — — — Crab, dressed 1 1 — — — Custard powder — 3 3 — — — Cake mixture — 2 2 — — — Epsom salts — 1 1 — — — Flour, self-raising — 1 1 — — — Gravy browning — 1 1 — — — Gin 1 — 1 — — — Glucose drink — 1 1 — — — Glucose 1 1 — — — Ice Lollies — 7 7 — 1 1 Ice cream — 6 6 — — — Jam 2 2 — — — Jelly — 1 1 — — — Lemonade crystals — 1 1 — — — Lozenges, throat — 1 1 — — — Margarine — 4 4 — — — Milk 21 26 47 — — — Milk, condensed — 1 1 — — — Milk, evaporated — 1 1 — — — Mincemeat — 1 1 — — — Mayonnaise — 1 1 — — — Marmalade — 2 2 — — — Mustard — 2 2 — — — Marzipan — 1 1 — — — Pastilles, blackcurrant — 1 1 — — — Paraffin, liquid — 1 i — — — Peas — 1 1 — — — Pudding mixture — 2 2 — — — Paste, fish — 2 2 — — — Pineapple juice 1 — 1 — — — Rum 1 — 1 — — — Salad cream — 1 1 — — — Sauce — 3 3 — — — Spice, mixed — 1 1 — — — Stuffing, sage and onion — 1 1 — — — Suet — 1 1 — — — Sweets 2 — 2 — — — Syrup — 1 1 — — — Syrup, cough — 1 1 — — — Sugar, demerara — 1 1 — — — Sausages, pork 1 — 1 — — — Sausages, beef 7 — 7 — — — Sausage meat 1 — 1 — — — Tea — 4 4 — — — Vinegar 1 — 1 — — — Vanilla flavouring — 1 1 — — — Welsh rarebit — 1 1 — — — Whisky 1 — 1 — — — Totals 39 115 154 1 1 19 Notes in regard to samples shown as adulterated or below standard or otherwise. Milk. — It is satisfactory to note that none of the forty-seven samples of milk was adversely reported upon. Ice Lollies. — An informal sample was submitted to the public analyst. It was found to contain 1 part per million of lead which was in excess of 0.2 part per million which is considered a reasonable limit. On further samples being taken it was found that the moulds had been renewed and the results were satisfactory. 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 10 Supplementary. Tuberculin tested 9 Pasteurised 9 Sterilised 10 The difference between a dealer's 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 dealer's licence. Should he retail milk in another area he must obtain a supplementary licence from the Council of that area. DETAILS OF MILK TESTING. Pasteurised Passed Failed Total Phosphatase test (To determine whether or not the milk has been adequately heat treated) 168 2 170 Methylene blue test (To determine whether or not the milk is of good keeping quality) 169 1 170 20 ' Sterilised' Passed Failed Total Turbidity test (To determine whether or not the milk has been adequately sterilised) 12 — 12 The greater importance must be attached to the phosphatase test as correct heat treatment or pasteurisation reasonably ensures that all pathogenic organisms have been eliminated. Two failures occurred out of 170 examined. This test is highly sensitive and a failure will result if the milk has been heated to only 1½°F lower 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 is necessary to ascertain the cause. One sample only failed to pass the methylene blue test. This 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 without treatment. In order to ensure, as far as possible that this does not contain any tubercle baccilli ten samples were taken and submitted for biological examination (animal experiment). These all gave negative results. 21 FOOD SUPPLY. The following table lists the food premises in the district by type of business. FOOD PREMISES No. in District No. of Inspections Made Public Houses and Hotels (7 with dining rooms) 11 15 Works Canteens 5 12 School Canteens 5 15 Restaurants and Cafes 17 27 Grocers (including off licences) 52 63 Greengrocers 21 25 Confectioners 18 24 Bakehouses 4 13 Bakers shops 8 12 Butchers 18 29 Dairy 1 14 Milk Depots 5 8 Milk Shops 10 12 Fish Shops (wet, dry and fried) 3 8 Fish Shops (wet) 6 12 Fish Shops (fried) 4 11 Greengrocers stalls 2 12 Ice Cream Manufacturers 3 20 193 332 FOOD PREMISES No. in District No. of Inspections Made Ice cream manufacture, sale and storage 3 25 Ice cream, sale and storage 72 65 The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 43 62 118 152 It has not been necessary to take legal action under the provisions of the Food and Drugs Act or the byelaws made under Section 15 of the Act, informal action in all cases having produced the desired results. 22 The following unfit foodstuffs were voluntarily surrendered ajid destroyed or handed over for salvage:— Milk, condensed, evaporated, etc. ... 45 tins Fruit 128 tins Fish 22 tins Vegetables 69 tins Luncheon meat 13 tins Soup 160 tins Jams or marmalade 16 tins Coffee 2 tins Irish stew 1 tin Lemonade powder 3 pkts. Oats and cereals 4 pkts. Blanc mange powder 15 pkts. Tea 1 pkt. Peanut butter 1 jar Pickles 7 jars Fish, wet 336 lbs. Cheese 66 lbs. Flour 3 lbs. Sweets 177 lbs. Sauce 18 bottles Eggs 180 Christmas puddings 12 Jelly 1 Sausages, beef 12 lbs. Rabbits 30 lbs. Ham 4 lbs. Corned beef 18 lbs. Offal 12 lbs. Beef 872 lbs. Pork 93 lbs. Mutton or lamb 77 lbs. A number of complaints regarding foodstuffs was received during the year, some of which are worth recording :— 0) A cream slice was found to have some greyish substance embedded in the interior. The Public Analyst, however, certified that the substance was of an entirely innocent nature. (2) A complaint was received with respect to a loaf of bread containing a nail. After leaving the roundsman the bread had passed through several hands before the complainant received the loaf. The Public Health Committee decided that a warning should be given to the manufacturers. (3) On two occasions milk bottles were found to contain some hard adherent deposit. In each case the purity of the milk had not been affected and the Public Health Committee decided to issue warning letters to the offending firms. (4) A complaint was received regarding a packet of crumpets. The bottom surfaces of the crumpets were disfigured by the presence of patches of a black substance and examination shewed this to be burnt starchy material. The Public Health Committee decided to send a warning letter to the manufacturers. 23 (5) A complaint was received regarding a piece of glass found in a loaf of bread. On investigation it was found that this piece of glass fitted perfectly to a damaged butter dish at the complainants home. (6) A complaint was received that a loaf of bread sold under a proprietory name was not genuine. The loaf was submitted to the Public Analyst who was able to certify that it was satisfactory. ICE CREAM. Forty-six samples were submitted to the methylene blue test and, of these forty-three were placed in grades I and II. One was placed in grade III and two in the low category of grade IV. The results can be said to be satisfactory. 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 handling requiring further investigation. 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. Total Samples Grades Grade Grade Year Taken I or II. % III. % 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. — 1952 76 71 93.4 5 6.6 Nil. — 1953 46 43 93.5 1 2.2 2 4.3 It should be noted that the three samples placed in grades 3 and 4 were manufactured by a firm outside this Borough. The Health Department of the Council concerned was notified and subsequent samples proved satisfactory. 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. 24 A number of samples were taken during the year, details of which will be found in the table giving a list of food and drugs samples analysed (pages 17 and 18). MERCHANDISE MARKS ACT. By reason of the fact that the Council appoints an analyst for the purposes of the Food and Drugs Acts, 1938 and 1944, they may execute any of the provisions of the Merchandise Marks Act other than those relating to importation, so far as relates to any foodstuff to which an Order in Council under the Act applies. These are administered by my department. As much of the work can be done whilst visits are being made for other purposes, it does not take up a great deal of time. The Act requires that an indication of origin be given in the case of certain imported goods. A few cases were found where foreign apples or tomatoes were not labelled as such and verbal warnings were given. HEATING APPLIANCES (FIREGUARDS) ACT, 1952. This Act came into operation on the 23rd March, 1953, and Regulations made under this Act came into force on the 1st October, 1953. One year's grace is allowed until 1st October, 1954, for the sale of heating appliances manufactured before that date. The purpose of the above Act is to ensure that adequate guards are provided for heating appliances and standards are laid down with which they must comply. No action was taken during the year. RAG FLOCK & OTHER FILLING MATERIALS ACT, 1951. The duties of a local authority are to enforce this Act with a view to securing the use of clean filling materials. One licence to store rag flock was issued for a wholesale store during the year. Two premises are registered for the purposes of the Act. These are premises where upholstery work is carried on. No samples were taken during the year. 25 PET ANIMALS ACT, 1951. This Act provides for a system of licensing and inspection of pet shops by local authorities. Two applications were received and after inspection and report, licences were granted. SHOPS ACT, 1950. I have little to report under this heading. A few warnings regarding minor offences were given. A brief summary of certain provisions of this Act was circulated to all shopkeepers in the Borough. SMOKE ABATEMENT. During the year complaints were investigated with respect to several factory chimneys in the district. Although observations were kept, in no case was smoke emitted in such quantity as to be a nuisance. Improvements were brought about following discussions with the managers of the factories concerned. ERADICATION OF BED BUGS. During the year the following numbers of houses were found to be infested with bed bugs:— Infested Disinfested Council houses (rooms) 7 7 Other houses (rooms) 5 5 There is little doubt that the incidence of bed bug infestation is far less now than in the pre-war years. The use of D.D.T. and Gammexane may have some bearing on this, whereby secondhand furniture, etc., so often the vehicle for introducing these vermin into houses can be effectively and more easily disinfested. RATS AND MICE DESTRUCTION. This important work under the Prevention of Damage by Pests Act, 1949, has continued without interruption. The policy of the Department has been to encourage occupiers of premises to give immediate notification when rats are seen or their presence suspected. This service is now accepted by the majority of ratepayers, which does tend to increase the number of premises inspected and treated, but has the overall effect of reducing major infestations to a really low figure. 26 The free service to householders for the destruction of rats and mice has been maintained. Charges are made in the case of business premises on the satisfactory basis which was fully explained in the Annual Report for 1950. The soil sewer system was subjected to the annual 10% test baiting resulting in two localised areas being found to be infested. These were later subjected to initial and maintenance treatments. The Council depots, sewage disposal works, piggeries and open spaces received constant attention. MISCELLANEOUS. Under the provisions of Section 50 of the National Assistance Act, 1948, it was not necessary during the year to arrange any burials. The depot and pigstyes at California Road have been practically free from cricket infestation, but treatment was necessary with respect to flies. Cricket infestation occurred at the Norbiton Potteries pit and adjoining property which necessitated extensive treatment of the area with insecticide. As was mentioned in last year's report, the pit at Norbiton Potteries, had become flooded and was coloured a yellowish green due .to the presence of chromates (as Cr03). During the year the chromate content fell from 480 parts per million to 200 parts per million, but the oxidising and sterilising properties were still sufficient to prevent the formation of objectionable odours which usually arise from stagnant water. Requests were received from a number of householders for assistance in the destruction of wasps nests. Thirty-five wasps nests and two hornets nests were destroyed. Some requests were declined where the nests were found to be in positions not causing real inconvenience. The department also gave advice or assistance in dealing with bats, squirrels, beetles, slugs, ants, bees, moths, flies, mites and pigeons. By arrangement with the Surrey County Council the school kitchens and canteens (seven in number) were thoroughly sprayed at the appropriate time with D.D.T. solution as a deterrent against insect infestation. 27 Forty-one vacant council houses were inspected for any signs of insect infestation and where evidence was discovered (in two instances) appropriate steps were taken. No licences were granted to station moveable dwellings in the area. No application was received during the year for an Improvement Grant under the Housing Act, 1949, although several enquiries were made. Stoppages in public sewers (combined drains) were cleared by the department on two hundred and thirty-nine occasions. In a few instances the assistance of sewermen from the Borough Engineer's department had to be obtained. RAINFALL, 1953. Table showing rainfall in the district during 1953, taken at the Sewage Disposal Works, California Road, New Maiden. Inches January 0.98 February 1.25 March 0.45 April 2.08 May 1.18 June 1.32 July 3.70 August 1.21 September 2.57 October 3.08 November 0.9j December 0.58 19.33 Decrease on previous year 6.14 inches Average for past five years 22.76 inches I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, STANLEY J. T. WOOD, Chief Sanitary Inspector. 28 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 (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities. 9 10 — — (ii) Factories not included in (i) in which section 7 is enforced by Local Authorities. 89 81 2 — (iii) Other premises in which section 7 is enforced by the Local Authority. 4 4 1 — Total 102 95 3 — 29 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 Refe To H.M. Inspector rred By H.M. Inspector Want of cleanliness — — — — — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences: (a) Insufficient — — — — — (b) Unsuitable or defective 3 3 — — — (c) Not separate for sexes (absence of screening) — — — — — Other offences against the Act (not including offences relating to Outwork) ... — — — — — Total 3 3 — — — 30 PART VIII OF THE ACT. OUTWORK. No. of out-workers in August list req'd. by Sect. 110(1) (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 Manufacture of brass articles 24 — — — — — . Making of wearing material ... 1 — — — — — File making 2 — — — — — Total 27 — — — — — Printed by RAYNES PARK PRESS, Lambton Road, London, S.W.20.