\ Public Health Officers of the Local Authority. *Medical Officer of Health : W. H. Butcher, m.a., d.m., d.p.h., Barrister-at-Law, Surgeon Commander R.N.V.R. (Also Medical Officer to the Clerk’s Croft Institution and District Medical Officer and Public Vaccinator of th& S.E.18 District of the Surrey County Council.) Deputy Medical Officer of Health (part time): P. C. V. Bent, m.r.c.s., l.r.c.p. Health Department ^Sanitary Inspector : C. F. Payne, Sanitary Inspector’s Certificate and Meat Inspector’s Certificate, Royal Sanitary Institute. (Also Superintendent of Refuse Disposal). Assistant Sanitary Inspector : A. H. Sewell, Sanitary Inspector’s Certificate and Meat Inspector’s Certificate, Royal Sanitary Institute. Office Clerk : R. Middleton (resigned 17th March) R. Dunnett (appointed 18th March) Godstone District Hospital (Infectious Diseases)! Consulting Surgeon : G. C. Wellish, M.ch., F.R.C.S. (Eng.) Matron : J. D. McLay Smith, s.r.n., r.f.n., s.c.m., m.b.c.n. Staff Nurses : D. Passby, r.f.n. D. E. Workman Assistant Nurses : P. Bradford (resigned 30th April) S. Barbour W. Ashford F. Shuttleworth Probationers : H. M. Yeo (resigned 10th August) Hospital Porter : G. Allen * Contribution to salary made by Exchequer Grants. f Transfered to the Caterham and Godstone Joint Hospital Board on 1st July. To the Chairman and Members of the Public Health and of the District Hospital Committees. I have the honour to submit herewith the forty-fifth Annual Report made to the Rural District Council of Godstone as the Local Sanitary Authority. I wish to express my sincere thanks to the Chairmen and Members of these Committees for their support and consideration through the year. An event worthy of special notice occurred during the year, namely the taking over on the 1st July of the Local Authority’s Hospital (Infectious Diseases) by the Caterham and Godstone Joint Hospital Board. The Local Authority had administered this hospital for nigh on 41 years, the first patient having been admitted on the 10th September, 1897. I beg to acknowledge the helpful and conscientious service of all members of the Health Department and the co-operation of the chief officers of the Council. I am, Your obedient servant, 1st April, 1939 W. HERBERT BUTCHER, Medical Officer of Health. Council Offices, Oxted, 1st April, 1939. To the Rural District Council of Godstone, the local Sanitary Authority. I beg to submit herewith the Annual Report for Godstone for the year 1938. The Report includes :— (1) The Annual Report of the health and sanitary conditions of the District. (2) The Report of the District Hospital (Infectious Diseases) till 30th June. The Report is written in accordance with the requirements of the Ministry of Health. SECTION 1. Statistics of the Area. Area in acres, 52,591. Resident population as estimated by the Register General for the mid-year 1938, 26730. Number of inhabited houses at the end of 1938 according to the rate books, 7660. Rateable value, 287,830. Sum represented by the Id. rate, 1093 9s. lid. 1938 TABLE 1. Parishes Area in Acres Rateable Value 31st December, 1938 Population at Census 1931 of Parishes as reconstituted Bletchingley ... 5822 £ 24,084 2465 Burstow 3377 16,320 1905 Chelsham 2707 11,319 1143 Crowhurst 2119 2,130 303 Godstone 5715 32,720 3153 Horne 3932 8,266 842 Limpsfield 4673 47,058 3167 Lingfield 9239 48,002 5214 Nutfield 4760 18,616 2079 Oxted 3659 61,268 3799 Tandridge 3295 7,884 740 Tatsfield 1304 8,523 925 Titsey 1989 1,640 163 Totals ... 52591 287,830 25908 Vital Statistics. TABLE 2. Total M F ( Legitimate 356 178 178 Live Births \ 8 15 ( Illegitimate 23 Birth Rate per 1,000 of estimated resident population —14.2 Total M F f Legitimate 9 5 4 Still Birth ( Illegitimate — Rate per 1,000 total births=23 Deaths: male, 157, female, 130, total, 287 Death rate per 1,000 of estimated resident population^ 10.7 Death rate corrected for comparison with that of the Country as a whole=9.3 Deaths from diseases and accidents of pregnancy and child- birth ; from sepsis, nil; from other causes, 1 Death rate of infants under one year of age : ( Legitimate 13 Actual number < l Illegitimate 1 All infants per 1,000 live births = 36.9 Legitimate infants per 1,000 legitimate live births = 36.5 Illegitimate infants per 1,000 illegitimate live births = 111 Deaths from measles (all ages) ... ... ••• 0 ,, ,, whooping cough (all ages) ... ... 2 ,, ,, diarrhoea (under 2 years of age) ... 3 Causes of Death, 1938, TABLE 3. Typhoid ... ... ... ••• Syphilis G.P.l ... ... ... Influenza Tuberculosis of respiratory system Other tuberculosis Cancer, malignant disease Diabetes ... ... ... ••• ••• Cerebral haemorrhage, &c. Heart Disease Aneurysm Other circulatory diseases Bronchitis Pneumonia (all forms) Other respiratory diseases Peptic ulcer .. Digestive diseases Appendicitis ... Congenital debility, premature birth, malformations, etc. Senility Suicide ... ... ... ... ••• Other violence Puerperal diseases (not puerperal sepsis) ... Diarrhoea (under 2 years of age)... Whooping cough Poliomyelitis ... Acute or chronic nephritis Other defined diseases ... M. 1 0 1 1 4 0 23 1 10 42 1 11 3 13 1 2 1 1 5 1 4 8 0 2 0 0 4 17 F. 0 1 0 0 5 0 18 0 12 50 0 7 2 2 1 0 4 1 2 4 1 5 1 1 2 1 l 10 • • • TABLE 4. Birth-rates, Death-rates,Analysis of ) England and Wales, London Mortality, Maternal Death-rates, \ 126 Great Towns and and Case-rates for certain Infec- ( 148 Smaller Towns, tious Diseases in the year 1938. J (Provisional Figures based on Weekly and Quarterly Returns) <u en -TD « . W c G o G C £ TJ u “ </>§ O C§ £ c la >-> Cu -w u G o o C tf g rt O G * S 2° S o C/5 G cr Q H3 . O (V ew JS £ Sue C T3 td c 03 O tn h o 0 o - J 1 A ^ ^3 * S ° « 13 E^. rt oO "Z. 3 “ — oo c ^ > OOO- — 0 - |cm a. 'O G O J U T3 > < 2 Rates per 1,000 Population Births— Li ve ••• ••• 15.1 15.0 15.4 13.4 Still ••• ••• ••• Deaths— 0.60 0.65 0.60 0.48 All causes Typhoid and Para- 9.3 11.6 11.7 11.0 11.4 0.00 typhoid fevers 0.03 0.00 0.00 0.00 Smallpox 0.00 0,00 — 0.00 — Measles ... 0-00 0.04 0.05 0.03 0.06 Scarlet Fever ... 0.00 0.01 0.01 0.01 0.01 Whooping Cough 0.06 0.03 0.03 0.02 0.03 Diphtheria 0.00 0.07 0.07 0.06 0.05 Influenza Notifications— 0.03 0.11 0.10 0.11 0.06 Smallpox 0.00 0.00 0.00 0.00 2.05 Scarlet Fever — 2.41 2.60 2.58 Diphtheria 0 03 1.58 1.85 1.53 1.90 Enteric Fever ... 0.09 0.03 0.03 0.04 0.05 Erysipelas 0.3 0.40 0.46 0.39 0.46 Pneumonia 0.51 1.10 1.28 0.98 0.98 Rates per 1,000 Live Births Deaths under 1 year of age Deaths from Diarrhoea and 36 53 57 51 57 Enteritis under 2 years of age 7.9 5.5 7.8 3.6 13.1 Maternal Mortality— Puerperal Sepsis 0.00 0.89) Not available Others ... 2.6 2.19 f Total ••• ••• ••• 2.6 3.08 ) Rates per 1,000 Total Births (i.e. Live and Still) Maternal Mortality— 0.86', 2.11 - 1 1 Puerperal Sepsis Others ... 0.00 2.6 Not available T o t al ••• ••• • • Notifications— 2.6 2.97 J 3.53 15.46 * Puerperal Fever Puerperal Pyrexia 2.6 14.42 / 18.08 j 12.51 * The final statistics were received on 30th May. It is impossible therefore tp complete the printing of the report earlier. SECTION 2. General Provision of Health Services in the Area. Detailed information was given in the Annual Report for 1930 regarding the health services provided in the area and subsequent changes have been noted in later reports. Ambulance Facilities. The question of ambulance facilities was reviewed during the year. In view of the proposal of the County Council to provide an ambulance at the Redhill County Hospital, it appears that there would be insufficient use for an ambulance in the parish of Lingfield. At present ambulance facilities in the District appear adequate and co-ordination both within and without the District is satisfactory. Ihe Division of the St. John Ambulance Brigade at Godstone, owing to the kindness of Mr. J. V. Rank of Ouborough, are now provided with a new and modern ambulance. Laboratory Facilities. At the Conference of district Medical Officers of Health for South-East Surrey, held in connection with the public water supplies, the matter of laboratory facilities was raised and Dr. F. R. Edbrooke, the Medical Officer of Health for the Urban District of Coulsdon and Purley, very kindly agreed to collect some figures. On the 12th July, 1938, the Clerk of the Urban District of Coulsdon and Purley communicated with this Authority suggesting a conference. The Memorandum of your Medical Officer of Health on Laboratory Facilities is contained in Appendix A. In October the suggested conference met when it was decided to appoint a Sub-Committee to consider the matter. At the end of the year the Sub-Committee had not reported. Legislation. The following Acts of Parliament, Local Government Orders, Memoranda and Circular Letters issued by Government Depart- ments in regard to Public Health were received by the Health Department during the year 1938 :— TABLE 5. Circular 1684 of the Minister of Health. Water Supplies, Circular 1685 of the Minister or Health. Agriculture Act 1937. Part IV. Milk & Dairies Acts and Orders. Tuberculosis Order 1938. 1938 Milk & Dairies Amendment Order 1938 dated 15th March, 1938, made by the Minister of Health under the Milk & Dairies (Consolidation) Act 1915. The Milk (Special Designation) Amendment Order 1938 dated 15th March, 1938, made by the Minister of Health under Section 3 of the Milk & Dairies (Amendment) Act 1922. Circular 1677 of the Minister of Health. Public Health (Aircraft) Regulations 1938. The Public Health (Aircraft) Regulations 1938, dated 7th April, 1938, made by the Minister of Health after consultation with the Secretary of State and with the consent of the Commissioners of Customs and Excise under the Public Health Act 1936. Circular 1702 of the Minister of Health. Departmental Committee on the cost of Hospitals. Final Report. Circular 1724 of the Minister of Health. Smallpox. Memorandum 215 Medical. Ministry of Health. Memorandum on Smallpox. Food and Drugs Act 1938. Circular 1755 of the Minister of Health. Food and Drugs Act, 1938. Circular 1728 of the Minister of Health as to the contents and arrangements of the annual reports of Medical Officers of Health for 1938. Memorandum of the Home Office as to the duties of Local Authorities under the Factories Act 1937. The Factories (Cleanliness of Walls and Ceilings) Order 19-/8 dated 5th May, 1938, made by the Secretary of State under the Factories Act 1937. The Local Authorities (Transfer of Enforcement) Order 1938, dated 5th May, 1938, made by the Secretary of State under Section 8 of the Factories Act 1937. The Sanitary Accommodation Regulations 1938, made by the Secretary of State under Section 7 of the Factories Act 1937. Factories Act 1937. A Guide to the Factories Act 1937 of the Home Office. SECTION 3. Sanitary Circumstances of the Area. Rainfall. By the courtesy of the East Surrey Water Company the following figures relating to the rainfall are available. TABLE 6. Westwood Kent Hatch January 4.07 3.90 February 1.00 1.10 March .49 .50 April .43 .90 May 2.59 3.00 June .50 .60 July 1.65 1.80 August 1.67 1.70 September 2.38 2.45 October 3.33 3.30 November 3.47 3.20 December 4.49 3.50 Totals 26.07 25.95 Water Supply. East Surrey Water Company. The conference of the neighbouring Medical Officers of Health which had met in 1937 continued its meetings in 1938, of which two were held, one at the Purley Town Hall and the second one by invitation of the East Surrey Water Co. at their offices, London Road, Redhill, on the 22nd March, there being present on behalf of the East Surrey Water Co.:— Mr. Christopher Ogle, Deputy Chairman and Joint Managing Director. Mr. A. E. Cornewall Walker, Engineer and Joint Managing Director. Mr. F. R. Lowe, Assistant Engineer. Mr. K. Hepburn, Secretary. Dr. Ernest Suckling, the Company’s bacteriologist and analyst. The question of co-operation between the Company and the Local Authorities within its area of supply was discussed and the Company agreed to notify those Local Authorities of any major operations at the Company’s works which may affect adversely the purity of the water supplies. The Medical Officers of Health stated their willingness to notify the Company of the occurrence of any water-borne diseases in their district. 1938 With regard to the question of medical examination of the Company’s employees, the Company agreed to submit those employees whose work brought them into direct contact with waters in wells and reservoirs, to such medical examination as might be considered reasonably necessary to eliminate the employment of any possible typhoid carrier in such work. Bacteriological examinations of all the waters as supplied to the consumers in this district were made at monthly intervals and were in every case found to be entirely satisfactory. During the year some complaints were received regarding the presence of milkiness in the water after drawing, which quickly subsided, a whitish deposit however being formed at the bottom o the jugs. This is due to a secondary deposition of chalk which often occurs when the water is softened by Clark s process. t is perfectly harmless and of no significance to the public health. Metropolitan Water Board. Westerham Hill Well. Bacterio- logical examinations at monthly intervals of the water as delivered to the consumer were made and in every case were entire y satisfactory. Periodic observations were kept on the houses within the catchment area of the Well regarding the discharge of their cesspool contents. On the 7th December the Local Authority passed a resolution to the effect that further applications for permission for development of the land in the vicinity of the Metropolitan Water Board Well will be refused on the grounds that by reason of the situation or nature of the land, the erection of buildings thereon would be likely to involve danger or injury to health. Rivers, Streams and Sewerage. During the year the Local Authority completed its scheme for the sewering of parts of the Smallfield area in the parish of Burstow, and the owners of dwellings along the lines of the sewers were required to make the necessary connections. On the 31st March a Ministry of Health Enquiry was held at the Forman Institute, Blindley Heath, regarding the Local Authority’s scheme for the sewering of Blindley Heath. The Local Authority’s case was presented by Mr. Christopher Phillips, Clerk of the Council, while the Engineer and Surveyor and the Medical Officer of Health gave evidence. Subsequently the Ministry of Health sanctioned the scheme excepting for some 200 yards in Tandridge Lane. During the year work was begun and under the direction of the Engineer and Surveyor, Mr. Easter, was well advanced at the end of the year. Analyses of the effluent from the sewage disposal works of the Local Authority were carried out by the Counties Public Health Laboratories at frequent intervals and were found all satis- factory. These works are administered by the Department of the Engineer and Surveyor. Closet Accommodation. 43 pail closets were converted to W.C.s. Public Cleansing. (l) Refuse Disposal. TABLE 7. Parishes Frequency of Collection Method of Collection Bletchingley ... Weekly Council’s Motor Vehicle Burstow Quarterly (indestructible only) Chelsham Monthly >> n Crowhurst Monthly >> »> Godstone Weekly Horne Quarterly (indestructable only) >> >> Limpsfield Weekly 5> n Lingfield Weekly >> >> Nutfield Fortnightly >> n Oxted Weekly >> Tandridge Weekly >» >> Tatsfield Monthly Collection by Contractor Titsey Monthly Council’s Motor Vehicle The disposal of refuse remains under the control of the Public Health Committee. All the refuse is removed to the Local Authority’s tip at Crowhurst Brick Works except in the case of Tatsfield where it is tipped locally. The Local Authority’s tip is maintained by Mr. C. F. Payne, Superintendent of Refuse Disposal, in an entirely satisfactory condition, controlled tipping being carried out on thoroughly sound lines. 1938 (2) Cesspool Cleansing. In the parishes of Oxted, Limps- field and Lingfield this is done by the Local Authority on application only at the cost of the householder. This service is now provided by the Department of the Engineer and Surveyor. SANITARY INSPECTION. Annual Statement by Mr. Chas. F. Payne, M.R. San. I. TABLE 8. General Inspections • ♦ • 895 Re-Inspections • • • 526 Inspections under Housing Acts • ♦ • 209 Re-Inspections • • • 770 Drainage Inspections . » « 276 Inspections of Slaughter Houses • • • 462 Inspections of Dairies and Cowsheds ... • • • 478 Number of samples of Milk and Ice Cream • • • 84 Inspections of Bakehouses • • • 39 Inspections of Factories and Workshops • * • 20 Inspection of Tents, Vans, etc. # • • 15 Drains tested by water • c • 84 Notices served : (a) Informal • • • 204 (6) Statutory » * • 34 Complaints received • • • 78 Samples of Drinking Water tested • • • 6 Samples of Drinking Water submitted for Bacterial and/or Chemical Analyses 48 SUMMARY OF REPAIRS. Carried out under the supervision of the Public Health Department during the year, as the result of Notices served. TABLE 9. Dirty Houses cleaned and limewashed ... ... ... 61 Houses to which : Internal repairs to plaster, etc., executed ... ... 52 Ventilation and lighting improved ... ... ... 17 Defective windows repaired ... ... ... 52 Dampness in walls remedied ... ... ... 78 Dampness in floors remedied ... ... ... 23 Defective roofs repaired ... ... ... ... 61 Firegrates repaired or supplied ... ... ... 20 Cooking ranges repaired or supplied ... .. 19 Sinks repaired or supplied ... ... 17 Sink waste pipes repaired ... ... ... 8 Rain water pipes repaired ... ... ... 61 Eaves gutters provided and repaired ... ... 69 Floors repaired or relaid ... ... ... ... 28 Yard paving provided or repaired ... ... ... 12 Drainage repaired ... ... ... ... 31 Drains laid ... ... ... ... ... 84 Choked drains opened and cleansed ... ... 12 Cesspools cleansed ... ... ... ... 9 Public water supply laid on ... ... ... 8 New sanitary dust bins provided ... ... ... 71 Flushing cisterns to W.C.s repaired or supplied ... 9 Miscellaneous nuisances abated ... ... ... 34 E.C.s converted to W.C.s ... ... ... 43 Defective coppers repaired ... ... ... 9 New pail closet ... ... ... ... Nil Additional W.C.s provided ... ... ... 10 Food store provided or repaired ... ... ... 8 Cesspools abolished and drainage connected to sewer ... 65 Cesspools provided ... ... ... ... i Extension of water supply to houses ... ... 9 Overflows from cesspools cut off ... ... ... 28 Underfloor ventilation provided ... ... ... 9 Defective walls repaired ... ... ... ... li Staircases repaired ... ... ... ... 4 Defective chimnies repaired ... ... 8 Weather boards to doors supplied ... ... ... 7 Pail closet structures repaired ... ,.. ... 10 1938 W.C. pans provided Verminous premises disinfected W.C. structures repaired Defective doors renewed and repaired W.W. Pasterns provided and repaired Dairies and Cowsheds. Old sheds disused New or improved drainage provided Floors improved or repaired Yards improved Light and ventilation improved Cooling dairies improved Accumulations of manure removed 5 4 29 12 9 2 2 4 3 1 Air Raid Precautions. Throughout the year the closest liaison has existed between the Air Raid Precautions Officer, Brigadier H. S. Mosley, D.S.O., and the Med.cal Officer of Health. Details of the medical arrangements will not be considered in this report since they have been reviewed by the appropriate Committee of the Local Authority at frequent intervals throughout the year. Smoke Abatement. No complaints were received during the year. Shops Act, 1934. 8 Shops were inspected during the year. No action was taken. Eradication of Bed Bugs. Particulars of action taken for the eradication of bed bugs are given below : — (1) (a) Council houses infested ... 1 (6) Other houses infested ... 1 (2) The Lawes Block Disinfestator was used in both houses. (3) No methods were employed for ensuring that tenants are free from vermin before removal to Council Houses. (4) The work of disinfestation is carried out by the Local Authority. (5) No special measure are taken by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing. Schools. Godstone C. of E. School and Nutfield C. of E. School both of which have been the subject of comment by the Medical Officer of Health in his Reports for 1936 and 1937 were again inspected in 1938. The memoranda on these schools "" reproduced in Appendix B. are Premises and Occupations which can be controlled by Byelaws and Regulations. (1) Tents, Vans, Sheds.—New Byelaws were confirmed by the Minister of Health on 10th November, 1936, and came into operation on 1st January, 1937. (2) Offensive Trades.—None. (3) Mortuaries.—Controlled by the Local Authority’s Byelaws, dated May, 1931. (4) Slaughter Houses : (a) Registered ... ... ... ... 4 (b) Licensed ... ... ... ... 17 These are controlled by the Local Authority’s Byelaws, dated January, 1928. (5) Hop-pickers. — None, (6) Houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family to be enforceable in the contributory places of Burstow and Oxted. These are controlled by Byelaws dated 9th February, 1934. At present there are no houses of this type in the parishes in question. SECTION 4. Housing. TABLE 10. 1. Inspection of Dwelling-houses during the year. 0) («) (b) (2) (a) (b) (3) (4) Total number of dwelling-houses inspected for housing defects (under Public Health or H ousing Acts) ... Number of inspections made for the purpose Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Number of inspections made for this purpose Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all repects reasonably fit for human habitation 410 569 209 239 9 2. Remedy of Defects during the Year without Service of formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or its officers ... 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs ... 22 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (rr) By owners (b) By Local Authority in default of owners 18 Nil B.—Proceedings under Public Health Act:— 0) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied ... 8 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners (б) By Local Authority in default of owners 7 Nil C,—Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (i) Number of dwelling-houses in respect of which Demolition Orders were made 7 (2) Number of dwelling-houses demolished in pur- suance of Demolition Orders 6 D.—Proceedings under Section 12 of the Housing Act, 1936 (1) Number of separate tenements or underground rooms in respect of which Closing Orders were mad e ... ... ... ... ... Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement of room having been rendered fit ... ... ... Nil 4. Housing Act, 1936—Overcrowding : (ci)—(i) Number of dwellings overcrowded at the end of the year ... ... ... 25 (ii) Number of familes dwelling therein ... 29 (iii) Number of persons dwelling therein ... 172 (b) Number of new cases of overcrowding reported during the year ... ... ... 1 (c) (i) Number of cases of overcrowding relieved during the year ... ... ... 3 (ii) Number of persons concerned in such cases 17 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding ... ... Nil Some 7 owners of a total of 23 dwellings have applied for particulars of the permitted numbers of occupants of their houses. Representations under Section 11 Housing Act, 1936, were made to the Local Authority during 1938 regarding the following dwellings as being unfit for human habitation but not capable at a reasonable expense of being rendered so fit. TABLE 11. Locality No. of dwellings Action of Local Authority and result of such action Moorhouse Cottages, Limpsfield 7 Pending at end of year Sbanklin, 1 Demolition Order made Lake View Road, Horne Demolished Ferndene, Lake View Road, Horne 1 Pending at end of year 13 1938 Representations have been made to the Local Authority during the years 1934, 1935, 1936 and 1937 regarding the following dwellings as being unfit for human habitation and not capable at a reasonable cost of being rendered so fit. The subsequent action of the Local Authority and its results are given below for the year 1938 regarding the dwellings still outstanding at the end of the year 1937. TABLE 12. Locality No. of dwellings Action of Local Authority and result of such action Rennicks, Furzefield Road, Lingfield 1 Unoccupied Dormans Cottage, Dormansland 2 One occupied, one un- occupied Malthouse Cottages, Godstone Nos. 1-6 6 Demolition Orders made Mayfield Cottages, Dormansland Nos. 3-7 5 Still occupied. Local Authority negotiating their purchase Chapel Lane, Dormansland Nos. 1-3 3 1-2 unoccupied in accor- dance with owner’s under- taking, No. 3 still occupied Long Row, Bletchingley 2 Still occupied Dormers Cottage Bletchingley 1 Demolished Little Tilgates, Bletchingley 1 Unoccupied in accordance with owner’s undertaking not to relet The Mint, Bletchingley 2 Unoccupied in accordance with undertaking given by owner not to relet TABLE 12—continued. Locality No. of dwellings Action of Local Authority and result of such action Brewer Street, Bletchingley 1 Unoccupied in accordance with undertaking given by owner not to relet Warners Cottage, Nutfield . 1 Unoccupied—matter of demolition pending 2 Beadles Lane, Oxted 1 Remain occupied under owner’s undertaking not to relet Coldharbour, Lingfield 2 One occupied, one un- occupied 1, 2, 3, Saltbox Cottages, also known as Spring Cottages, Oxted 3 Demolished Melbourne Cottage, Dormansland 1 Demolished Faulkner’s Cottage, Dormansland 1 Decision of Local Authority pending The Hutment9, Nags Hall, Tandridge 4 Unoccupied The Cottage, Place Farm, Bletchingley 1 Unoccupied in accordance with undertaking given by owner not to relet Applications for1 Council Houses. TABLE Houses Allotted Bletchingley and Nutfield 5 13. No. of live Applications at 31/12/38 52 Ag. Lab. 5 Non- Ag. Labourers 47 Burstow — 3 1 2 Crowhurst — 5 2 3 Godstone 4 133 11 122 Horne — 3 1 2 Lingfield and Dormansland 2 65 3 62 Tandridge — 11 — 11 Oxted and Limpsfield 33 104 3 101 Tatsfield 4 9 1 8 48 385 27 358 SECTION 5. Inspection and Supervision of Food. (a) Milk Supply. There were 82 wholesale cowkeepers, 80 retail cowkeepers, and 13 milk purveyors on the Register on 31st December, 1938. Of these 9 were licensed by the County Council as producers of Tuberculin Tested Milk and 51 as produceisof Accredited Milk. The following bacterial analyses were made of the milk and of the ice-cream produced or sold within the area in 1938. A1X1 - Die SIo. 1 2 4 5 6 7 8 9 11 12 13 14 15 16 17 18 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 42 1938 21 Ungraded Milks. TABLE 14. Place at which collected 5 > 9 9 South Nutfield School Bletchingley School Producer’s Premises Oxted School ... Smallfield School Merle Common School South Godstone School Tandridge School Tatsfield School Producer’s Premises Smallfield School Oxted School ... Producer’s Premises Bacteria per 1 m.l. B.Coli present in 39,200 1/10 m.l. 163,200 1/100 m.l. 12,900 1/10 m.l. 16,240 Nil 22,400 Nil 29,890 1/10 m.l. 21,120 1 /10 m.l. 9,200 Nil 12,600 Nil 6,800 Nil 4,880 Nil 22,080 1 /10 m.l. 13,500 1/10 m.l. 11,900 Nil 33,600 Nil 13,600 Nil 40,800 1 /10 m.l. 44,480 1 /10 m.l. 19,050 1/10 m.l. 21,600 Nil 35,820 Nil 36,900 1/10 m.l. 4,400 Nil 22,560 Nil 8,480 Nil 38,520 Nil 1,280 Nil 9,050 Nil 11,050 Nil 1,920 Nil 33,120 Nil 58,120 1/100 m.l. 78,600 1 /10 m.l. 74,000 Nil 25,000 Nil 21,200 Nil 60,200 1 /10 m.l. 120,000 1/100 m.l. 21,720 Nil 65,200 1 /10 m.l. Tatsfield School Frogits Heath School Oxted School ... Merle Common School Baldwins Hill School Frogits Heath School South Godstone School Dormansland School Godstone School Lingfield School Producer’s Premises Smallfield School Merle Common School Tandridge School Nutfield School Bletchingley School Tatsfield School Oxted School ... Lingfield School Baldwins Hill School Dormansland School Godstone School Horne School ... Producer’s Premises Godstone District Hospi Producer’s Premises al TABLE 14—continued Sam- ple No. Date of Collection Place at which coMected Bacteria per 1 m.l B.Coli present in 46 1.9.38 Outwood School 83,200 Nil 47 1.9.38 Nutfield School 11,160 1/10 m.l. 48 15.9.38 Baldwins Hill School 112,000 1/1000 m.l. 49 15.9.38 Merle Common School ... 101,000 I/10 m.l. 50 15.9.38 Dormansland School 89,100 1/10 m.l. 51 15.9.38 Lingfield School 40,050 1/100 m.l. 52 15.9.38 Godstone School 58,650 1/100 m.l. 53 15.9.38 Tandridge School 9,100 Nil 55 5.10.38 Bletchingley School 48,500 1/10 m.l. 57 5.10.38 Tatsfield School 92,000 1/100 m.l. 58 18.11.38 South Godstone School ... 12,800 Nil 59 17.11.38 Frogits Heath School 32,000 Nil 60 17.11.38 South Nutfield School 76,800 1 /10 m.l. 61 17.11.38 Smallfield School 81,600 1/100 m.l. 64 7.12.38 Baldwins Hill School 27,200 1/10 m.l. 65 7.12.38 Dormansland School 9,920 Nil 66 7.12.38 Oxted School ... 5,200 Nil 67 7.12.38 Tandridge School 6,200 Nil 68 7.12.38 Merle Common School ... 14,800 1/10 m.l. 69 7.12.38 Godstone School 1,200 Nil 72 23.6.38 Borough of Reigate Passed Failed 73 23.6.38 n >> Passed Passed 74 2.11.38 > J ) 5 Passed Passed Designated or Graded Milks. TABLE 15. Sam- ple No. Date of Collection Place at which collected Designations Bacteria per 1 m.m. B. Coli- present in 3 13.1.38 Chelsham School ... Pasteurised 5,400 Nil 10 7.2.38 Horne School Accredited Passed Passed 19 9.3.38 Outwood School ... Accredited Passed Passed 20 21.3.38 Chelsham School ... Pasteurised 5,400 Nil 41 23.6.38 Chelsham School ... Pasteurised 37,660 Nil 48 1.9.38 Producer’s Premises Accredited 22,360 1/100 ml 54 17.10.38 District Hospital, Tuberculin 73,200 Nil Bletchingley Tested 56 6.10.38 Chelsham School ... Pasteurised 9,870 Nil 62 17.11.38 Horne School Accredited Passed Passed 63 17.11.38 Outwood School ... Accredited Passed Passed 70 7.12.38 Bletchingley Hosp. Accredited Passed Passed Chelsham School Pasteurised Passed Passed 71 11.5.38 s.c.c. 75 22.11.38 U.D.C. of East Tuberculin Failed Failed Grinstead Tested 76 30.11.38 n Accredited Passed Failed Ice Cream. TABLE 16. Sam- ple No. Date of Collection Place at which collected Bacteria per 1 c.c. B. Coli present in 77 1.9.38 Tricycle 89,600 1/10 m.l. 78 23.8.38 Producer’s Premises 576,000 1/100 m.l. 79 23.8.38 Dealer’s Premises ... 3,010 Nil 80 23.8.38 Dealer’s Premises ... 26,040 Nil 81 23.8.38 Producer’s Premises 26,400 Nil 82 23.8.38 Producer’s Premises 9,200 Nil 83 23.8.38 Producer’s Premises 32,900 1/10 m.l. 84 23.8.38 Tricycle 35,580 1/100 m.l. Each sample of milk taken by the officers of the Local Authority was submitted to the biological test for tubercle bacille. In every case the result was negative. There is no legal bacterial standard for ungraded milk or for ice-cream. Since the standard of accredited milk is not unreason- ably stringent, this has been taken by the Department as a working standard, though the absence of a legal one undoubtedly hampers the endeavours of the Local Authority. (b) The following is a list of the meat surrendered and con- demned as being unfit for human food :— Carcases Inspected and Condemned. TABLE 17. Cattle, exclud- ing Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) Number inspected 157 Unk 13 nown 52 143 554 All diseases except Tuberculosis. Whole carcases condemned Carcases of which some part or organ was condemned 2 2 3 7 Percentage of the number inspected affected with disease other than tuberculosis Tuberculosis only. Whole carcases condemned 3 1 Carcases of which some part or organ was condemned 4 15 _ 16 Percentage of the number inspected affected with tuber- culosis 1938 (c) Food and Drugs (Adulteration) Act, 7925. This Act is administered by the County Council. The following Table shows the number of samples taken in the District during the year 1938. TABLE 18. Articles Analysed Adulteration or Deteriorated Prose- cutions Con- victions For- mal T2F 2 1 1 1 1 1 3 Infor mal Total 130 2 1 1 2 1 1 1 3 4 For- mal Infor mal Total Milk Cream Butter Cheese Margarine Card Meat Flour Tea Coffee Cocoa Sugar Sausages Coufectionery Sausage Meat Wine Beer Spirits Drugs *Other articles ... 6 1 1 3 1 11 11 Totals 134 12 146 11 11 *Details of other articles. Lemon Squash ... 1 1 Sultanas ... 1 1 Currants 1 1 Raisins 1 1 Factories and Workshops. The Factory Act, 1937, came into effect on 1st July. A memorandum on the Act is contained in Appendix C. A meeting was held with H.M. Inspector of Factories on 31st August to discuss details on the matter of co-operation. TABLE 19. Non- Mechanical Mechanical Agricultural Engineers Power 1 Power 0 Total 1 Aircraft Repairs • • « 1 0 1 Bakeries * « « 6 15 21 Boot Repairing • • • 2 2 4 Brass Finishing • • • 1 0 1 Brick Making • • • 6 0 6 Builders • • • 2 11 13 Cabinet Makers • • * 1 1 2 Cake Making • • • 0 1 1 Carpenters • • • 1 1 2 Chemical Manufacturers 1 0 1 Cleaners and Dyers • • • 1 0 1 Coach Builders 0 2 2 Cycle Repairers • • • 1 1 2 Dressmaking 1 2 3 Electrical Engineering • • • 0 2 2 Engineers 1 0 1 Firewood Cutting • • • 1 0 1 Flour Milling t * • 4 0 4 Fullers Earth Works 2 0 2 French Chalk Grinders 1 0 1 Gas Works 2 0 2 Jewellers 0 3 3 Joinery 3 3 6 Launderies • • • 1 5 6 Letterpress Printers 0 0 0 Millinery • • • 0 1 1 Milk Separating 0 0 0 Motor Repairers 19 5 24 Plumbers 0 1 1 Portable Buildings • • • 1 0 1 Printers 2 0 2 Projection Room • • • 1 0 1 Corn Provenders • • • 1 0 1 Saddlery • 9 • 0 2 2 Sawmills • • • 2 0 2 Stonemason • • • 0 1 1 Smithies • • • 0 3 3 Tile and Concrete • « • 1 0 1 Tailoring . • • 0 5 5 Upholstery 9 • • 1 0 1 Van Builders i • • 0 1 1 Wheelwrights • * * 1 0 1 TOTALS 69 68 137 SECTION 6. Prevalence and Control of Infectious and other Diseases. During 1938 76 cases of infectious diseases were notified as compared with 65 in 1937. 1 tie total of 76 includes 1 notification of diphtheria as compared to 5 ; 25 notifications of scarlet fever as compared to 13 ; t 7 notifications of pneumonia as compared to 9 ; 3 notifications of typtioid as compared to 4 and 10 notifications of dysentery as compared to 24 in 1937. Diphtheria. I his is the eighth year in succession in which the notifications of diphtheria appear at a very low level. Artificial immunization has been continued throughout the district during the year. The following table gives particulars of the work done. TABLE 20. No. Schick Tested No. who did not attend again No. Schick Neg. No. Schick Pos. No. completely immunized Lingfield Epileptic Colony ... 67 1 25 41 41 Outwood C.C. School Bletchingley Infant C.C. 17 1 2 14 14 School 56 4 11 41 37 Crowhurst C.E. School 15 1 5 9 9 Baldwins Hill C.C. School ... 117 2 71 44 40 Nutfield C.E. School 53 1 27 28 21 Eimpsfield C.E. School Caterham and Godstone Joint 72 12 12 18 14 Hospital ... Children under School Age who attended at Welfare Centres or at Immuniza- tion Clinics Children of School Age who — — — — 17 attended same ■ — — — 1 397 22 153 195 194 With the passing of the District Hospital (Infectious Diseases) to the Caterham and Godstone Joint Hospital Board, it was necessary for me to obtain other assistance in the performance of this work. The County Medical Officer, Dr. J. Ferguson, was able to place the services of his Health Visitors at my disposal, for which I have to thank him. The drop in the figures of children immunized at the Welfare Centres is decidedly disappointing. Scarlet Fever. The cases of this disease that occurred during the year were sporadic in character except in the case of an outbreak at Copthorne School in May. Here some 8 cases were notified. Typhoid. One case was that of a male nurse who had been employed in nursing a typhoid case. The second case occurred in the same Institution. The third case occurred towards the end of the year in a lady. The source of her infection was not traceable. Dysentery. The outbreak of Sonne dysentery which was noticed in the Annual Report for 1937 continued into January 1938. The first case notified was an infant of some 5 months, though since the infecting organism was only found after death, the notification was actually post mortem, the patient having died on the last day of 1937. While Sonne dysentery may be considered in the robust at present a trifling infection, such a death shews that the disease is not entirely negligible from the point of view of mortality. Pneumonia. Though 1938 was not an influenza year, notifica- tions of pneumonia have risen. Possibly practitioners are notifying this disease more thoroughly. An interesting localised outbreak of febrile catarrh occurred in Lingfield in February and March. It was complicated in 4 cases by pneumonia. The organism was typed in 3 out of the 4 and was found in each case to be pneumococcus type 2. Non-Notifiable Infectious Dise ase. No notable outbreaks occurred during the year. Measles. In the case of 2 children application was made to me for convalescent measles serum. Owing to the kindness of Dr. W. Gunn, Medical Superintendent of the North Western Fever Hospital I was able to obtain a supply. Investigations were made during the year into the possibility of convalescent measles serum being made available by the Pathologist to the East Surrey Hospital, Redhill, Dr. L. P. Chamberlain. At present, however, there are administrative difficulties in the way. The annual report of the District Hospital (Infectious Diseases) till 30th June is reported later herein. After that date the Hospital was administered by the Caterham and Godstone Joint Board. During the latter period all the requirements of the District regarding the admission of patients were satisfied and the administration of the Hospital was in no way prejudicial to the public health of the District. 1938 Rats and Mosquitoes. Sixteen complaints were received regarding rats. Upon investigation they were forwarded to the County Council for action. In March in Dormansland a complaint was received regarding infestation by mosquitoes. Investigations ptoved negative though the occupier was given advice regarding precautionary measures. Pathological Investigations. The following were made by Dr, L. P. Chamberlain, Pathologist to the East Surrey Hospital, Redhill, and by the Clinical Research Association, London TABLE 21. Throat swabs ... ... ... 101 Sputa ... ... ... ... 28 Blood for agglutination reactions ... 1 Blood for culture of typhoid bacilli ... 1 Specimens of excreta ... ... 2 Notifiable Diseases (other1 than Tuberculosis) during the year 1938. TABLE 22. Total Total Cases notified Cases admitted to Council’s Hospital Total Deaths Smallpox Scarlet Fever 25 25 ____ Typhoid Fever 3 1 1 Puerperal Pyrexia 2 _____ Pneumonia 17 7 1 Diphtheria 1 1 - Erysipelas 9 5 — Dysentery 10 1 — Prevention of Blindness. No action was called for during the year under Section 176, Public Health Act, 1936. Ophthalmia Neonatorum. No cases were notified during the year. Tuberculosis. New Cases and Mortality during 1938. The Public Health (Prevention of Tuberculosis) Regulations 1925. The Public Health Act, 1936, Section 172. No action was taken under these sections during the year. The Public Health (Tuberculosis) Regulations, 1930. The housing of tuberculous persons was kept under supervision during the year, the closest co-operation existing with the Tuber- culosis Officer, Dr. A. H. Campbell. SECTION 7. Statement of any special action taken during the year to arouse public interest in the Prevention of 111 health. During the year Health Talks continued to be inserted by the courtesy of the Editors in “The Surrey Mirror,” “The Sevenoaks Chronicle,” The Kent and Sussex Courier,” and in the Parish Magazines of the Ecclesiastical Parishes of Bletchingley, Blindley Heath, Dormansland, Limpsfield, Lingfield, Horne, Godstone, Oxted and South Nutfield, while the Vicar of Tandridge continued to undertake the distribution of the articles to the Mothers’ Uniop and Women’s Institute in the Parish, Altogether 6 Health Talks were written during the year. They had the following titles : (1) Health Education. (2) A Pure Water Supply: How the Public can Assist. (3) Cleanliness in our Food. (4) If it is preventable why not prevent it. (5) Sleep. (6) Good Rule and Government. The Practical Application of New Knowledge.* It is now 25 years since the Government decided to promote medical research by setting up the Medical Research Committee, which became the Medical Research Council in 1920. In this period there has been a great increase in medical investigation in Great Britain, some of which is undoubtedly due to the support provided by the State. In other countries there has been a similar acceleration in intensity of medical discovery, particularly in the United States of America, where it has been made possible mainly by private endowment. All this activity has brought a great increase in knowledge of the body in health and disease—greater even than that of the previous 25 years, which in itself was large. Historians are likely to pronounce this period as outstanding in the improved level of health of civilised communities made possible by the access of knowledge won by medical research. The Application of Ktiowledge in Treatment. Apart from its effect in raising the standard of health and physique, this new knowledge has had two influences which, in their effect on medical practice, are often opposed to each other. It has resulted, in the first place, in a great improvement in methods of diagnosis and treatment of disease. These discoveries, together with the development of the social conscience of the community in regard to the unhealthy individual, have involved a vast increase in medical services. The number of medical men, both in public and private practice, has increased greatly, hospital accommodation and facilities have multiplied, and the total cost of medical care has risen enormously. The development of new methods of diagnosis and treatment has called for so much additional personnel and costly apparatus that it has become more and more necessary for the sick to enter public institutions in order to receive the full benefits now available. The radiographic department, the biochemical, the hsematological and the bacteriological laboratories, which hardly existed 25 years ago, are now large and important factors in all * An abstract from the Introduction to the report of the Medical Research Council 1937-38. efficiently run medical institutions. Hardly a patient enters such an institution whose condition does not call for the help of these newly grown hospital services. While everyone will agree that all these changes have been justified and beneficial, there must often pass through the mind the question—what is to be the end of this development ? Will medical science with its ever greater knowledge require hospitals and their scientific services to grow continuously ; are there to be no limits to their size ? The economist might even wonder whether a time will not come when the expense and trouble involved will hardly justify this extension of medical practice, especially that large part concerned with chronic and degenerative forms of disease and for which the practical return in terms of human health is often small. This, of course, is only one aspect of the matter. The whole trend of medicine in the present century has been to study the basic aetiological factors of individual diseases in order to find methods for curing them, and it is to the application of this side of medicine that the extended hospital services are mainly directed. A large number of diseases of which treatment at the beginning of the century was essentially concerned with the relief of symptoms and the comfort of patients—leaving the cure to the care of vis medicatrix natures—can now be cured or controlled by specific remedies and the sufferers returned to normal healthy existence. Many thousands of patients suffering from diseases which, 25 years ago, were incurable and uncontrollable, can now be restored to health as the result of recently acquired knowledge applicable to diagnosis and treatment. Applications of chemotherapy.— It sometimes happens that new knowledge of curative treatment may in itself also biing about reduction in incidence of disease, as, for instance, in infectious diseases and those of a chronic nature. This will probably prove to be the case in some infectious diseases following the recent advances in treatment by sulphanilamide and allied substances. For example, the more rapid and effective cure of gonorrhoea by these drugs ought to result in a definite reduction in its incidence, not only because of their curative action but because they may reduce the spread of the infection. Resent results give hope also that these drugs may lead to the reduction of one of the most common chronic disabilities, namely, middle ear disease, which often follows measles and scarlet fever or may be a sequel to a sore throat due to streptococcal infection. If the claims that 2-sulphanilyl-aminopyridine has a powerful destructive action on the pneumococcus prove to be true, it ought to be possible to extend the curative effect to those cases of middle ear disease which are due to this organism. How enormous such preventive effects might prove can be estimated from the fact that there are said to be 2,500,000 people in this country with disabling degrees of deafness, and that disease of the middle ear is admittedly responsible for a large proportion of these cases. Thus it has been estimated that this condition is responsible for 90 per cent, of all cases of acquired incomplete deafness in children. It is obvious that optimum results along these lines will be obtained only by medical skill alert to the development of the condition, especially in young children, and to the need for immediate treatment by the chemotherapeutic agents now available. A good opportunity may well be at hand for seriously attacking middle ear disease and reducing greatly this widespread and serious disability and its sequelae, running ears and deafness. Application of Knowledge in Preventive Medicine. On the other hand, medical research has brought another kind of knowledge which, if properly used, leads directly to the prevention and elimination of disease. The effect on medical practice and its ancillary services of this kind of knowledge is clearly opposed to the first-mentioned effect since, by eliminating disease, it tends to reduce the needs for curative aids. In view of the large increase in hospital services and medical personnel in recent times, it might be thought that the results and effects of research in preventive medicine might be negligible. This is not, or ought not to be, the case ; but undoubtedly there is often great delay in bringing about the application of new discoveries to preventive ends. Fresh means of curative treatment, on the other hand, are generally applied at once by medical practitioners, and the latent period between such discoveries and their application is often short. Everybody will agree that, of the two types of knowledge, that which leads to the eradication of disease is much the more important to the community. Why then should there be great delay in its application ? No simple answer can be given to this question. Prophylaxis against disease does not depend solely on the alertness of medical men or of Government departments to procure rapid application of new knowledge. Just as important is enlightment of the public as to the merits of a particular discovery, since these applications of medical science often require direct action on the part of individuals. The public, however, cannot understand the merits of such very technical subjects unless they are clearly expounded and the meaning of the results driven home. Again, successful cure of disease is always dramatic, and brings with it intense relief both to patients and their friends. There is, however, nothing dramatic about the disappearance of disease. It is here to-day and gone to-morrow, and the very success of prevention of disease is measured by forgetfulness. Whoever thinks nowadays of the decimation once caused in this country by plague, cholera, typhus and other diseases now eliminated from our midst ? The relative lack of dramatic interest in the prevention of disease, as compared with that in its cure, is partly responsible for the difference in rates with which their advantages are obtained by the public. A third cause of delay is the fact that preventive medicine mostly concerns children, and it is curious that illness and death in the young do not, apparently, impress themselves on the public mind with the emphasis associated with disease in the adult. It is becoming every day more clear that these difficulties in matters of health and disease, especially when the co-operation of the public is necessary, will remain so long as there is no means of educating and giving them the requisite guidance. It does not seem to be anybody’s business in this country to undertake this task. Only too often are the public dependent for information and guidance on advertising propaganda, exaggerated and false as it so often is, financed by those with something to sell. Others who are most assiduous in publicity are those who believe that advances in medical knowledge, especially when of great practical value in public health, are snares and delusions, and who by extensive propaganda mislead in every conceivable way and hinder the process of application. It is not the duty of the Medical Research Council to guide the public on the importance of medical discovery in its practical applications to human needs. Their task is wholly to promote discovery and to announce it to the world when it is made. They cannot but view with regret, however, the delay which so often occurs between medical discovery and its application, especially when the discovery is one that provides an immediate opportunity of preventing or even eliminating disease. What the ultimate solution of this difficulty will be is not obvious, but with the present increase in knowledge of methods of preventing disease, a better method of informing and educating the public becomes imperative. The prevention of diphtheria.—One of the most striking instances of the delay in the application of new knowledge is the relative lack of public recognition, in Great Britain at the present time, of the existence of a method of proven value for the prevention of diphtheria. Diphtheria is the commonest single cause of death among school children. In 1937, there were 61,339 cases of this disease in England and Wales, causing 2,963 deaths, nearly all in children between the ages of one and 15 years. This is pure tragedy, in view of the needlessness of such deaths, for since 1929 prophylatic inoculation against diphtheria has proved increasingly successful wherever it has been properly used. In parts of the United States and of Canada (notably in the Province ot Ontario), diphtheria as a clinical entity has practically disappeared, as the result of preventive inoculation with diphtheria toxoid. In the town of Hamilton, Ontario, with a population of 175,000, not one case of diphtheria has been diagnosed in the past five years. In the city of Quebec, on the other hand, where prophylaxis by inoculation of diphtheria toxoid was not used, the deaths from diphtheiia in 1936 were even more numerous than in 1927. In New York City there has been a reduction in diphtheria incidence from 8,548 cases in 1929 to 1,143 in 1936, and a reduction in deaths from 463 to 35, following the introduction of preventive inoculaion. In 1936 the death-rate of children during the ages one to 15 from diphtheria was 2.1 per 100,000 in New York, and 31.8 per 100,000 in England and Wales. As long ago as 1932 the Ministry of Health drew the special attention of local authorities to the advantages of this prophylatic treatment, and in his most recent annual report the Chief Medical Officer again urges its adoption. It is true that it is sporadically used here, but for complete effectiveness the method must be generally applied, and not limited to a small proportion of children in any community. Parents would be well advised, thetefore, to demand this prophylatic inoculation, not only for their own children but for all children. There seems no room for doubt that the general adoption of diphtheria prophylaxis would cause the virtual disappearance of the disease from the country. The family tragedies, the high public expense, and the waste of medical effort caused in Great Britain by diphtheria call for a united effort to eradicate it. The value of improved nutrition.—A second type of preventive measure against disease, of which the proper application has now been delayed for many years, is to be found in improved nutrition. The need for this has been often discussed in previous annual reports of the council; but the adoption of modern teachings on the subject by the public is depressingly slow, in spite of the evidence often advanced that the increased consumption of protective foods would not only be beneficial to the physique and general health of the people but also of great economic value to the country. Better feeding in infancy has caused a gratifying reduction in rickets throughout the country, although the time has not yet arrived when an incident would be possible here such as recently occurred at the Children’s Hospital at Toronto, where a case of rickets created such surprise that a meeting of staff and students was summoned to examine the baby. There is still room for great improvement in this respect, for, with the knowledge and public assistance available, the persistence of rickets in this country is an indication of ignorance or neglect. It is of interest to recall that an attack on the problem of rickets was included in the first research programme of the original Medical Research Committee in 1914, and that it is owing to the results of this work that the disease can now be prevented. A much greater consumption of milk, and other dairy products, of eggs, of vegetables, including potatoes, of fruit, and of fat fish, at the expense of bread, biscuits, sugar and sweets, especially in early life, is an urgent national requirement; it will not only improve the physique of the people but will reduce the amount of dental decay and greatly raise the standard of health. An increase in breast-feeding will still further reduce the high mortality rate of infants from gastro-intestinal troubles and broncho-pneumonia. Whatever advances in medical knowledge may come, until these simple precepts are adopted there will still remain a great deal of preventable disease in this country. The co-operation of the public.—These few instances will probably suffice to emphasise the possibilities of applying the result of medical research to immediate problems of preventive medicine. It is clear that some of the methods for preventing disease require close co-operation on the part of an enlightened public. There is great need for some authoritative body to transmit the necessary information which will stimulate public co-operation. With a more rapid understanding of the facts on the part of the public, delay in application of new knowledge to human needs ought not to be so long as it has been in the past. Only by improving the general health and eliminating disease can it be hoped to reduce this present tendency of ever-increasing medical services, and the annual expenditure of between two and three hundred million pounds which such services necessitate. SECTION 8. Report of the Local Authority’s District Hospital (Infectious Diseases) to 30th June, 1938. Up to the 30th June 61 patients were admitted. Of these 34 were from the Rural District of Godstone and 27 from the Urban District of Caterham and Warlingham. The following table gives a list of the diseases ;— TABLE 24 Scarlet Fever ... 31 Diphtheria ... ... 2 Erysipelas ... ... 2 Typhoid ... ... 1 Pneumonia ... ... 7 Influenza ... ... 1 Measles ... ... 3 Streptococcal Tonsillitis 2 Parotitis ... ... 1 Dysentery ... ... 1 Pertussis ... ... 2 Rubella ... ... 1 Observation ... ... 7 61 Scarlet Fever. 31 cases were admitted. The type of disease was of moderate severity. The following complications occured :— TABLE 25. Serum rashes Nephptis Rheumatism 7 1 1 Diphtheria. 2 cases were admitted. One of these was dangerously ill with the severe form of the disease caused by the gravis strain of the corynebacterium. Typhoid. One case was admitted very dangerously ill. Not- withstanding the immediate administration of anti-typhoid serum from the Lister Institute he died on the 11th day after admission. Dysentery. The single case admitted was a food worker. She was 19 days in hospital before she was free from the infecting organism. Pneumonia. 7 cases were admitted, of these two were fatal. Three of the others presented points of considerable interest. The organism present in each case was pneumococcus type 2 and each patient developed an empyema. A rib resection was done on each of the three by the Consulting Surgeon of the Hospital, Mr. G. C. Wellish, F.R.C.S., under nitrous oxide and oxygen anaesthesia administered by Dr. Palethorpe. After an average stay of 83 days in hospital all three patients were discharged completely recovered. 1938 Infuenza. One patient was admitted for observation of a possible case of scarlet fever. She was finally diagnosed as influenza. Measles. One case, though without complications, was admitted fur reasons of public health. Another was admitted as scarlet fever, but on the diagnosis being altered was discharged to her home. The third case was complicated by an abscess and when the patient was free from infection he was transferred to the Redhill County Hospital for treatment of his abscess. i>ertus*i». I his was a child of 3i with meningitic symptoms, e patient died of cerebral haemorrhage 22| hours after admission. Among the cases admitted for observation was one patient with a diagnosis of scarlet fever. She was, however, suffering from erythema exfoliata. A similar error in diagnosis had been made in the case of this patient some years before. She was transferred to the Redhill County Hospital for treatment. Treatment for enlarged Tonsils and Adenoids. Two patients were advised to seek medical advise regarding these after discharge. Sick Staff. During the period under review one member of the nursing staff was on the sick list for a total period of 6 days owing to an abscess of the arm. Nursing. The Matron, Miss J. D. McLay Smith, has as usual been zealous in maintaining a requisitely high standard of nursing among her staff. When it is considered that at times there may be 6 or 7 different types of diseases in the hospital, all of which have to be strictly barrier nursed, the vital necessity for the utmost efficiency and zeal among the nursing staff is obvious. Buildings and Equipment. The present laundry is in many respects unsatisfactory, paticularly the drying arrangements Six concrete steps were put in place of the old earth and wooden ones on the path between A and B blocks. Fire Precautions. During the period under review quarterly fire drills were carried out under the direction of Station Officer Whitmore of the Reigate Fire Brigade. The staff are instructed in the methods of fire extinguishing and of life saving. Typhoid Inoculation. During the period of typhoid admissions the matter of offering inoculation to the staff, both nursing and domestic, was carefully considered. The position was fully explained to each, of whom two expressed a wish to be inoculated. This was in consequence performed. Telephone. The automatic system was installed in May. I am, Your obedient servant, W. HERBERT BUTCHER, Medical Officer of Health. APPENDIX A. Memorandum on Laboratory Facilities. During the course of meetings of neighbouring medical officers of health which took place at the suggestion of your medical officer during the winter of 1937-38 in connection with the safeguarding of the public water supplies, the question was incidentally raised of a joint laboratory being established by Local Authorities in south- east Surrey for the examination of samples of water, sewage and milk. The discussion at the time was only of a tentative and general nature, and it was suggested that Dr. Edbrooke, the Medical Officer of Health of the Urban District of Coulsdon and Purley, should obtain some figures and particulars for detailed discussion. No further meeting however has been held, but on 12th July, 1938, the following communication was received from the Clerk of the Urban District of Coulsdon and Purley:— “ I beg to inform you that this Council have given con- sideration to a report from the Medical Officer of Health stating that for some time past the Medical Officers of Health of various Districts in East Surrey have considered the possibility of a Central Laboratory being established, possibly in Croydon, to which samples of water and milk might be sent for examination. The matter arose owing to the increased number of samples of water which Local Authorities desire to take as a result of the Croydon typhoid outbreak. It will also become necessary for Authorities to consider their increased duties arising under the Food and Drugs Bill now before Parliament. The Council understand that the Medical Officers of Health consider that if sufficient Local Authorities were interested a Central Laboratory would probably prove economical, either less money being necessary per annum or an increase in the number of samples being obtainable for the present annual outlay. Further, it is considered that it would be advantageous if the person reporting on samples was independent financially of the water companies, milk producers, etc., as is not now the case, a number of the chemists and bacteriologists employed by the Local Authorities being also employed privately by the companies concerned. I enclose a tabular statement prepared by the Medical Officer of Health for this District from information supplied by the Medical Officers of the adjoining areas shewing the approximate number of samples of water and milk taken by Local Authorities in the neighbourhood, together with the approximate annual expenditure involved. It is suggested that the work to be undertaken at such a laboratory as is contemplated should, at first, be limited to the chemical and bacteriological examination of water and the bacteriological examination of milk, though possibly arrangements might be made to include the biological examination of milk samples. The following is an approximate estimate of the necessary capital outlay and the annual cost of such a laboratory :— Salary of Bacteriologist and Chemist ... ^700 ,, Assistant ditto ... ... 200 ,, Laboratory boy .... ... 75 Cost of material ... ... ... ... 250 Cost of lighting, heating, etc. ... ... 115 Rates and taxes ... ... ... ... 60 £ 1400 Capital Cost : Purchase of building ... ^*1500 Purchase of equipment and material ... 350 ^1850 My Council are of the opinion that the matter is one worthy of consideration by the various Authorities and I am requested to ask if your Council would be willing to send representatives to a Conference to be held at these offices in September next for the purpose of considering the matter. It is suggested that if your Council are willing to send representatives that the number should be limited to three and that probably the Chairman of the Public Health Committee, the Town Clerk (or Clerk of the Council) and Medical Officer would be the appropriate represen- tatives.” Undertaken by Medical Officer of Health. Undertaken by Council’s Pathologist. p O c/) -t s O - < O o 3 3 P 3 Cl o : cr • CD DO ctq' Cl r-f- 0) 2 r o W C O Q cd - T3 C O ° 75 o B p o cr p 3 CD P o o o cr CD cr CD P £X O Cl 7) Q 9 tc w ?r ?r o 3 CD p W CD 3 30 P 3 CX ZC o CD ro 3 P 3 CfQ cr p 3 O- o 3 P 3 Cl 3 -t CD P -n 7) cr SL r-r o 3 P r-r CD 3" P 3 3 d 3 3Q r-r o 3 P 3 7) CD P cx p 3 Cl. P 3 P 3 CL -• P 3 — GfQ -• cr 3 p gtq 3 g CO O u» Ct j-1 Cn OO obb O tO •—* U» M in Ln On W CO O 4 h-* 05 O O O to to >—i1 cr o to o o • to _ k—i h—1 Co cr 05 05 GO •o o O o 4 4 o o o to o o a • _ to 05 Co * Co _ Uo CO O' 05 CO to o o to 4- 4 o o o 1 to 1 to 1 1 1 1 | , 1 ' o 00 ' ' ' ' ' tr o ! O i Co H-* h— ID •or 4- to 4 to 05 50 to 1 to 05 to O o to 00 00 o o o 4 h—i , ■ H—* On 4 O j or o 4- 4- 05 o to 05 •o o O I to o o O 05 o o o cr r— 1 1 o 1 to to H—1 1 1 1 1 1 o 1 1 o 4* o h—1 1 to H—1 O 1 OI o 4 05 lO f—* to 05 o o 1 to o O 1 o o o *-* o I 1 4 1 1 1 1 O 1 1 O or CD B o' pj „ tE o £ CfQ o o' £ P3 C. CD O o ° H o r^ Cn to Cd • *-* • o o *o 7Q H o *—*■ PJ 1! D CfQ cr> CD CD X CD *3 CD c 2. 0> P> H W & r > *o -t o X 3 p r-p 3 3 3 cr CD r sa 3 P CD P 3 CL O O 7) in P CD 75 P CD 75 CD 3 <-P CD X P 3 o’ CD Cl Laboratory Facilities in East Surrey. It is noted that no mention of sewage examinations is made in this communication. Since however, if water examinations be carried out, the examination of sewage would present no difficulty, I assume that the functions of the laboratory would include the examination of sewage and sewage effluents, an important part of the duties of this Authority. Present procedure of this Authority. The examinations of samples of water and of sewage is done by the Counties Public Health Laboratories under the direction of Dr. Ernest V. Suckling, the eminent analyst and bacteriologist. The examination of milk samples is done at the Laboratory of the Surrey County Hospital, Guildford, under the direction of Dr. R. C. Matson, who is respon- sible for the bacteriological examinations of milk for the County Council and many local authorities. The fees charged for the above examinations are as follows :— Water, complete chemical ... ... ^"150 Water, complete bacteriological ... ... £\ 5 0 "Water, B.Cob only ... ... ... 15 0 Sewage effluent, complete chemical ... £\ 5 0 Milk, plate count, coliform test and biological examination ... ... ... 19 0 Milk, methylene blue and coliform tests ... 6 0 In addition there is the carriage on each sample which averages about l/6d. each way. For the first six months of 1938 ending 30th June, the Health Department has submitted the following samples Water, Chemical and Bacteriological ... 3 Water, B.Coli only ... ... ... 28 Milk, Plate count, coliform test ... 40 Milk, Methylene blue, coliform test ... 2 Milk, Biological ... ... ... 42 The total cost of the above is ^*68 8s. Od. for the half year, or say, 133 Os. Od. a year. This figure may be taken as fairly representative of the samples likely to be submitted under conditions similar to those existing during the last few years. On grounds of expense sampling is rigidly limited and this figure must be regarded as a minimum. For the routine examinations of public supplies these data are adequate for my information and effect considerable financial saving. In addition Mr. Stanley Easter, the Engineer and Surveyor, informs me that he submits some 40 samples of sewage effluent for chemical examination every year at a cost of £\ 5s. Od. per sample, say, with carriage £56 a year. I hus we arrive at the present cost of examinations of samples, some £\90 a year. Proposed Joint Laboratory. Under Section 196, Public Health Act, 1936, a Local Authority may provide a laboratory. Moreover, under Section 272, without prejudice to the powers of combination conferred by the Local Government Act, 1933, any two or more Councils may by agreement combine for the purposes of any of their functions under the Act. For a basis of this memorandum I take provisionally and without prejudice the figures outlined in the communication of the 12th July, 1938, of the Urban District of Coulsdon and Purley, subject to any comments below. T he suggested advantages of a joint laboratory may be grouped under two headings, one economic and the other administrative. (l) Economic advantages. According to the figures submitted in the above communication, allowance being made for loan charges, the total annual cost of the laboratory will amount to some ,£"1520. No provision however is made for any annual increments in the salaries’ scale of the staff. Moreover the sum of ,£"250 for cost of material obviously depends on the activity of the laboratory. It seems to me a small sum, particularly since no provision is made for the re-placement of worn-out or obsolete equipment. Finally no provision appears to have been made for maintenance of the fabric, domestic cleaning, stationery, postage and telephone. 1 think that an annual cost of some ,£"2,000 would appear a more likely estimate. Since this cost would be distributed over authorities whose aggregate penny rate brings in some ;£*30,000, without attempting to explore the alternative methods of financial maintenance — in view of the predominant number of samples submitted by the County Borough of Croydon some basis per sample would appear the most equitable—there is prima facie evidence of considerable economy to this Authority. Even if for the sake of argument we assume that the total annual cost was distributed according to the penny rate of each authority, the cost to this Authority would be some ;£"70. I thank Mr. F. W. Walpole the binancial Officer fora helpful discussion regarding the above. As I described earlier in this memorandum the number of samples submitted by the Health Department is at present a minimum. If more samples could be examined without matetial increase of cost, the amount of sampling could well be increased. Regarding the sampling by the Department of the Engineer and Surveyor, Mr. Easter in response to my enquiry has written as follows :— Under date 19th July—- “In reply to your letter of the 18th instant, the number of sewage effluents which I submit for analysis regularly every year, is 32. On occasion, when anything arises of a doubtful nature, additional samples are forwarded, so that I think the average number per annum could be taken as 40, I have not yet had occasion to call for any bacteriological examinations. You will realise that these remarks apply to the analyses of sewage effluents alone. There are various factors which I should like to keep an eye on from time to time, such as the examination of crude sewage and tank effluent samples, but which I now dispense with, with a view to keeping costs down. The cost of each analysis as at present charged by the Counties Public Health Laboratories, is 25/-.” Under date 25th July— “ In reply to your letter of the 25th July, it is, of course, difficult to estimate the number of examinations of sewage and effluents which one would do if a laboratory was at the Council’s disposal. I think, however, I should be safe in saying that I should like to take at least three times the number 1 do at present or, say, about 120 per annum in all.” Administrative Advantages, It has been alleged in the above communication of the Urban District Council of Coulsdon and Purley, that it would be advantageous if a person reporting on the samples was independent financially of the Water Companies, Milk Producers, etc., as is not now the case, a number of chemists and bacteriologists employed by the Local Authorities being also employed privately by the Companies concerned. On general principles it might appear advantageous that the person reporting should be a whole time officer of the Local Authorities. This argument, however, cuts both ways. Although we do not envisage actions as that of Bastin and Young versus the Godstone Rural District Council, any samples submitted may become the subject of 1938 evidence in a Court of Law. Obviously evidence given by a person not an officer of the Local Authority may be less open to destructive cross examination. In fact even with a Joint Laboratory 1 can envisage the necessity of submitting contentious samples to an independent analytical bacteriologist. I bus it would seem that on grounds of finance and economy the possibility of a Joint Laboratory is well worthy of exploration by the Local Authority. I he advantages of a whole time officer for routine examinations may also be accepted with the reservation that the services of an independent gentlemen of outstanding eminence may at times be necessary in addition. Finally, a joint laboratory will enable the officers of a local authority to do some original research in matters of rural engineering and rural hygiene, matters that receive too little investigation. I have in mind the sterilisation of sewage effluents by means of chlorine, effluents both from small private filters and from larger plants, a matter of prime importance to a rural area since rural areas ate primarily concerned with the bacterial purity of ditches, water courses and streams.* W. HERBERT BUTCHER, Medical Officer of Health. In addition to a sample sent away some 150 field tests are done by the Department of the Engineer and Surveyor of sewage and sewage effluents and some 2 dozen by the Health Department on water. 18th August, 1938. APPENDIX B. (a) Memorandum on Godstone C.E. School, Mixed and Infants' Department. Hygienic Conditions. Further to my remarks furnished in accordance with a resolution of the Godstone Rural District Council made on 2nd July, 1937, I have again inspected the School on 3rd May, 1938, and report as follows :— Number on Books 149. Boys 76. Girls 73 (including infants 27 B General Arrangement of School (Environment, Playground, etc.) Single-storey brick built building. Playground quite inadequate and open to public highway. Environment satisfactory. General structual condition very poor. Class Room 1. Lighting. Inadequate. Artificial by gas inadequate. Some window glass frosted—windows too high. Heating. Heating by fire and inefficient stove—inadequate. Ventilation. Adequate. Cleanliness. Adequate. Desks (type and adequacy). Bench type adequate. Ceiling too high. Glazed wood partition from room 3. Class Room 3. Lighting. Inadequate both natural and artificial (gas). Heating. Inadequate—fire only. Ventilation. Adequate. Cleanliness. Adequate. Desks (type and adequacy). Bench adequate. Windows too high. Frosted glass. Ceiling too high. One outside wall damp and defective, with skirting boards defective. Class Room 2. This room is unsatisfactory in every respect, and is unfit for use as a classroom. Lighting. Inadequate natural and artificial (one oil lamp). Heating. Inadequate — fire only. Ventilation. Barely adequate. Cleanliness. Dilapidated. Desks (type and adequacy). Bench—grossly overcrowded. Outside wall very damp and defective. Windows too high and small. Class Room. Infants 2. Lighting. Inadequate natural and artificial (oil lamp). Heating. Inadequate—fire. Ventilation. Adequate. Cleanliness. Clean. Desks (type and adequacy). Chairs and tables. Ceiling too high. Windows too high, 1938 Class Room. Infants 1. Lighting. Grossly inadequate and window shaded by evergreen tree. Heating. Inadequate. Ventilation. Adequate but draughty. Cleanliness. Dark and dilapidated. Desks (type and adequacy). Bench and chair-table. Damp wall from defective gutter. Windows too high and small. Cloak Rooms. Infants grossly defective, dark damp and dilapidated with no washing accommodation. Dirty. Girls—recently redecorated and reroofed. Adequate apart from washing facilities q.v. Boys—dark, damp, dilapidated—floor defective, door missing; structurally unsound—grossly defective. Arrangements for drying clothes and boots. Nil. Water Supply. Drinking—Source, Mains. No facilities in infants cloakroom. Girls and boys source handbasin, tap and cup. Unsatisfactory. Washing—G and B cloakrooms only. Lavatories. Type—Brickbuilt outhouses, separate from school. Number of Basins. G. 2. B. 2. Number of Towels. G. 2. B. 2. Kept in schoolrooms. Condition Most unsatisfactory and dilapidated. See remarks on cloakrooms. Closets. Type. Have recently been improved and new installation water closets of satisfactory type and with separate hand flush (individual cisterns). Buildings satisfactory. Number—G. 5. B. 3. Condition. Satisfactory. Disposal of excreta. Main Drainage. Urinals. Type and adequacy. Boys approx. 12 feet with automatic flush. Adequate. Condition. Satisfactory. Drainage. Main to sewer. General Observations. The structure is in very bad repair, external walls require repointing, roof recently repaired shows several defective tiles, the coal storage at the back of rooms 2 and 3 is a disgrace, the walls consequently being damp to above the top of the high windows, pointing missing and many bricks crumbled away through damp. The chimney stack on the roof edge is defective, has lost consider- able quantity of mortar, is about one foot out of perpendicular and appears likely in the near future to collapse into the playground, with possible disastrous results. Classroom 2 and the boys cloak- room should be condemned as they stand, and need extensive alterations. Playground is grossly inadequate and opens direct without any barrier onto the public road. W. HERBERT BUTCHER, Medical Officer of Health. 4th July, 1938. (b) Memorandum on Nutfield C.E. School (All Depts.) Hygienic Conditions. Further to my remarks furnished in accordance with a resolution of the Godstone Rural District Council made on 2nd July, 1937, I have again inspected the School on 4t'n May, 1938, and report as follows :— Roof. Front roof repaired as required. Entire rear roof stripped and retiled. Defective guttering repaired. Condition for the time being satisfactory. Girls' Cloakroom. Roof repaired and internally renovated. Condition satisfactory. Heating. One gas radiator has been installed at the rear of the East ” room. It is very doubtful if this will prove an adequate supplement to the existing open coal fire. Two gas radiators have been installed along the west wall of the “ Schoolroom.” Very doubtful adequacy. Heating in other rooms as before and inadequate. Lighting. As before. Natural lighting barely adequate, artificial lighting inadequate. All windows and ceilings too high. Ventilation. As before. Adequate but draughty and difficult to control. 1938 Washing arrangements. Adequate, but insufficient roller towels are provided. Playground. Rough, uneven, inadequate. Requires asphalting. Field at rear of school used as additional playground. Bars have been erected inside the school gates in a satisfactory position to prevent children rushing out into public roadway. Infants Cloakroom. Satisfactory apart from dampness on one wall. Recommendations for further improvements. Installation of further heating arrangements. Provision of lower false ceilings. Lowering level of all windows, with provision of proper additional ventilating panes. Provision of further gas burners in all rooms for artificial light. Removal of glazed wooden partition and control of diaughts. Removal of cause of dampness in infants’ cloakroom. Abolition of roller towels and provision of small individual towels. Asphalting of front playground, and purchase of ground at rear, levelling and provision of playground at rear. Outside woodwork requires repainting. Provision of adequate arrangements for drying clothes and boots. 4th July, 1938. W. HERBERT BUTCHER, Medical Officer of Health. APPENDIX C. Memorandum on the Factories Act, 1937. I his is largely a consolidating Act. Nevertheless it contains also certain innovations that revise, strengthen and extend pre- existing industrial legislation. Broadly speaking it will still be the duty of the Local Authority to enforce various general provisions for protecting the health of persons employed in establishments where mechanical power is not used and they will still have special functions relative to means of escape in case of fire, the keeping of lists of outworkers and the taking of steps to prevent the carrying on of home-work in unwholesome premises. The new Act will however extend their duties in some important respects as well as on points of detail. This memorandum will attempt to state concisely the powers and duties of the Local Authority as laid down in the Factories Act, 1937. A description of the minutiae of these powers and duties will be avoided and no attempt will be made to condense the 145 pages of the Act itself, the 20 pages of the Memorandum of Duties of Local Authorities, the 51 pages of the Guide to the Act as well as sundry Orders and Regulations already made under the Act. The expression “factory” is interpreted by Section 151. The old distinction between a factory and workshop is abolished and the workshop disappears. Instead there are factories and factories where mechanical power is not used. For this purpose mechanical power does not mean power used for the purpose of heating, ventilation or lighting. This distinction involving factories where mechanical power is not used is important because on it depends much of the allocation of duties as between the Factory Inspector- ate and the Local Authority, under Part 1 of the Act. Part 1 of the Act. Health (General Provisions). The provisions of Section 7 relating to sanitary conveniences are enforced by the Local Authority in all factories whether mechanical power is, or is not, used. Draft statutory regulations have been issued by the Secretary of State prescribing the number of con- veniences and other detailed requirements. There are some 131 establishments in this District to which this Section applies. Sections 1, 2, 3, 4, and 6 are to be enforced by the Local Authority only in the case of factories in which mechanical power is not used. Section 1 relates to cleanliness, detailed requirements being given. The Factories (Cleanliness of Walls and Ceilings) Order 1938, dated 5th May, 1938, in the case of some classes of factories modifies these. Section 2 relates to overcrowding. The space per person has been raised from 250 to 400 cubit feet. There are, however, certain concessions in the case of rooms used as workrooms at the date of the passing of the Act. Section 3 deals with temperature and the matter of comfortable temperatures and methods of heating is elaborated in the Appendix to the Memorandum of Duties of Local Authorities. Section 4 deals with the matter of ventilation. Section 5 makes provisions for securing and maintaining sufficient and suitable lighting. 1 his Section however is not administered by the Local Authority, but by the Inspectorate of Factories. Section 6 deals with the drainage of floors. Under sub-section (2) of Section 8 the Secretary of State has power to remove certain classes of factories as regards the provisions of Sections 1, 2, 3, 4 and 6 from the purview of Local Authorities and for this purpose he has made the Local Authorities (Transfer of Enforcement Order 1938, containing a Schedule of the classes of Factories so removed. One factory within the District appears to fall within the above schedule. Registration of Factories. The Local Authority is required to keep a register of all factories situate within its district in respect to which the Local Authority is responsible for the enforcement of any of the above provisions. The District Inspectors of Factories are being instructed that they should give every assistance to the Local Authority in compiling these registers, and that they should furnish the Local Authorities with copies of notifications of new factories and of new buildings or engineering operations or the introduction of mechanical power or other information as to the factory which may come to their notice and appear to affect the jurisdiction of the Local Authority. Conversely the Act specifically makes it the duty of the Medical Officer of Flealth and of every other officer of the Local Authority who is appointed for the purpose of inspecting factories, to give in writing notice to H.M. District Inspector of any factory coming to his notice in which no abstract of the Act is fixed. The Medical Officer of Flealth is also required in his Annual Report to report specifically on the administration of the Act. Other specific functions of the Medical Officer of Health under Part 1 of the Act relate to Sections 1, 2, 3, 4, 6 and 7 as above. Under Section 8 (4) it is laid down that :— for references in any of the foregoing provisions of this Part of this Act to an inspector there shall, as respects any factory or part there- of in which provision is enforceable by a District Council be substituted references to a Medical Officer of Health. There are some 70 establishments in the District to which Sections 1, 2, 3, 4 and 6 apply. Part 2 of the Act. Means of Escape in Case of Fire. (Sections 34 and 35.) Provisions as to means of escape in case of fire are strengthened and widened in scope and are administered in all factories by the Local Authority. It is an offence for any premises to which Section 34 applies to be used as a factory unless there is in force a certificate from the Local Authority that it is provided with such means of escape in case of fire for persons employed therein as may reasonably be required in the circumstances of the case. The certificate must specify precisely and in detail the means of escape provided and must contain particulars as to the maximum number of persons employed or proposed to be employed. The factories to which Section 34 applies are (a) all factories in which more than 20 persons are employed, (b) factories being constructed or coverted for use as factories on 30th July, 1937, or constructed or so converted after that date within which more than 10 persons are employed in the same building on any floor above the ground floor of the building (c) factories of which the con- struction has been completed before the 30th July, 1937, and in which more than 10 persons are employed in the same building above the first floor of the building or more than 20 feet above the ground level, (d) factories in or under which explosive or highly inflammable materials are stored or used. It is the duty of the Local Authority to ascertain as soon as possible the position under these sections of factories in their district. There would appear to be some 6 factories to which Section 34 is applicable in the District. It must be observed that while the Section clearly contemplates that the determination of what should be required by way of means of escape is primarily a matter for the Local Authority, it does not place upon the Local Authority the duty of instituting proceedings under Section 34 for failure to comply with its requirements. That would be a matter for the District Inspector. Section 35 enables the Secretary of State to make regulations as to means of escape in case of fire to be provided in factories. Part 3 of the Act. Supply of Drinking Water (Section 41). This Section is enforceable by the Factory Inspectorate not by the Local Authority. The latter, however, has to approve the source of the supply if it be not a main supply. Part 7 of the Act. Home Work (Sections 110 and 111). These sections re-enact with minor modifications Sections 107 and 108 of the 1901 Act requiring a list of outworkers employed in certain classes of work and empowering the Local Authority by notice to prohibit the giving out of work to be done in a place dangerous to health of the persons employed there. The main changes are (l) the lists have to be sent to the Local Authority during February and August (not as previously on or before 1st February and 1st August). They are to show all outworkers employed during the preceding six months. The lists sent to the Local Authority are to be open to inspection by any Inspector or Officer of any Government Department. (2) Section 110 applies to out work irrespective of whether the material for the work is supplied by the factory occupier or not. (3) The period of compliance with the notice under Section 111 is reduced from one month to ten days and the notice should indicate the Council’s reasons for serving it. The Secretary of State does not at present propose to alter the classes of work to which existing Home Work Orders apply. A conference has been arranged with H.M. District Inspector of Factories for a general discussion and for the strengthening of co-operation. Inspections of the various establishments in the District will be forthwith carried out for the specific purposes of the Factories Act, 1937. W. HERBERT BUTCHER, Medical Officer of Health. 23rd August, 1938. Contents. Section Page 1 Statistics 3 2 General Provision of Health Services 7 3 Sanitary Circumstances 9 4 Housing 15 5 Inspection and Supervision of Food ... 20 6 Prevalence of, and Control over, Infectious and other Diseases 26 7 Statement of any Special Action during the year to arouse public interest in the Prevention of Ill-health 29 8 Report on the District Hospital (Infectious Diseases) to 30th June 35 Appendices A Memorandum on Laboratory Facilities 38 B Memorandum on Godstone C.E. School and • Nutfield C.E, 44 C Memorandum on the Factory Act, 1937 48