Suti E INTELL LIBRARY Sutton (Surrey) Urban District Council. ANNUAL REPORT OF THE Medical Officer of Health FOR the year 1925. William Pile, Ltd., Printers, 26, High Street, Sutton. ANNUAL REPORT, 1925. To the Members of the Sutton Urban District Council. By the direction of the Ministry of Health the report for the year 1925 has to be a Survey Report, which should deal with the measure of progress made during the previous five years in the improvement of the public health, and the extent and character of the changes made during that period in such public health services as housing, water-supply, sewerage, scavenging or refuse disposal, food inspection, maternity and child welfare, etc., etc., These matters are dealt with in the body of this report. For the purpose of estimating the birth and death rates the Registrar-Ceneral has stated the population of the District to be 21,320. The population at the last Census—1921—was 21,063. This gave an average of 4 66 persons per dwelling; a smaller number than at any previous Census. It is not unlikely that on the occasion of the last Census householders, who had sublet for gain and thereby caused overcrowding, failed to include all the occupants on the prescribed form. It is not unusual when an inspection is being made by the Public Health Department to meet with considerable reticence on the part of a tenant in stating the number of his family and lodgers. In making these inspections several cottages of 4 or 5 rooms have been found to have an average of seven persons above the age of twelve years and four below that age. Keeping, however, to the Census average of 4.66 persons per dwelling, and allowing that average to be applied to the 407 houses erected since the Census [the overcrowding in many of the older cottages will 2 balance any deficiency in numbers in the new] the population occupying the 4,921 dwellings in this District would be 22,932. In addition, there is a resident staff of 127 at the Downs Hospital for Children, and 46 at the Belmont Institution; these bring the net population to 23,105; and, with these Institutions' inmates (339 and 954) the gross populartion to 24,398. For estimating the birth and death rates the Registrar-General's figures, 21,320, must be used. The Birth-rate is 14 9 [corresponding figure for England and Wales 18 3]. The Death-rate is 11.3 [corresponding figure for England and Wales 12.2]. This Death-rate is reduced by 01 when standardised to what it would be if the sex and age constitution of the population were identical with that of England and Wales, the standardising factor being 099. At the 1911 Census this factor was 0 9359. This Death-rate is higher than usual, the average rates for the last 20 years, in 5-year periods, being 10 4, 10 0, 10 9, 10 4., As can be seen in a table in the body of this report the reduced number of deaths under 5 years of age is balanced by an increase of deaths at 65 years of age and above. In this year of 1925, no less than 54 per cent, of the total deaths occurred at 65, or more, years of age. As a single cause of death cancer heads the list. A table referring to this is placed in the body of this report. There was no death from Scarlet Fever, Diphtheria, Measles, Whooping Cough, or Enteric Fever, and four only from Influenza. The Infant Mortality rate—deaths per 1,000 births —is higher than usual [57 to England and Wales's 75], but one-half of the deaths occurred before a week of life had been completed. As to the future: more 3 cottages at reasonable rents are required; the rent charged for the new buildings causes tenants to meet it by taking lodgers. I still hold the opinion that for the improvement of the public health a knowledge and use of what is proper for food is the important thing. The defects of nutrition so common amongst the children attending the elementary schools will persist so long as their parents will not realise that, as the means at their disposal compel them to make bread the chief article in the daily diet, by using a bread deprived of the indispensable food values contained in the germ, and—to a slighter degree—in the coat of the wheat grain, they are excluding from the children's food that which is absolutely necessary for healthy growth. This is no longer a matter of conjecture; it has been proved many times by the experimental feeding of both birds and animals. An objection has been raised that flour containing the germ will not keep well. If that be so, then let the wheat grain be imported whole and labour be employed in milling it in this country. No matter how efficiently the people be housed, how well they be clothed, if they be not properlv fed physical defects will follow; the first requirement of all living things is that they get adequate nourishment. W. HABGOOD. 4 SUTTON URBAN DISTRICT. MEDICAL OFFICER'S REPORT FOR THE YEAR 1925. Area (in acres) 1836 Population (Census 1921) 21063 (Estimated 1925) 21320 PHYSICAL FEATURES AND CENERAL CHARACTER OF THE AREA. Sutton is situated 11 miles south of Whitehall in the watershed of the Thames in the north-east portion of the County of Surrey, the centre of the town being a little above the line where the chalk of the London Basin comes to the surface to form the North Downs. A narrow band of the London Tertiaries, running due east and west, appears between the chalk and the clay. Towards the north and north-west and on the clay is the lowest land—81 feet above sea level—and through it runs the Pyl Brook, receiving- the chief part of the surface water of the whole district and the outflow from the sewage works. The rest of the surface water drains into a small brook discharging on the north-east into the Wandle. Further north, where the London and Brighton Road crosses the border, the ground rises to 147 feet. This is the most rural part. Southwards, on the chalk, towards Banstead Downs, there is a gradual ascent to 293 feet. Number of Inhabited Houses (1921) 4514 Number of Families of Separate Occupiers (1921) 4793 Rateable Value £188183 Sum represented by a Penny Rate £750 5 SOCIAL CONDITIONS. A large proportion of the residents is engaged in business in London. The remainder consists chiefly of tradesmen and their assistants, gardeners, domestic servants, laundry workers, and employees of the London General Omnibus Company, which has recently erected an extensive garage in the town. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. BIRTHS: Total. M. F. Legitimate 306 140 166 Illegitimate 11 6 5 Total 317 146 171 Birth Rate: 14.9. DEATHS: 241. Death-rate 11.3 Death-rate corrected, for the age and sex distribution of the population 10.2 x 0.99 = 11.2 Number of women dying in, or in consequence of, childbirth— From Sepsis — From other causes — Deaths of infants under one year of age per 1,000 births 57 Legitimate, 18; Illegitimate, 0; Total 18 Deaths from Measles (all ages) — ,, Whooping Cough (all ages) — ,, Diarrhoea (under 2 years of age) 2 Amount of Poor-Law Relief—£2082 12s. 6½d. 6 Gratuitous Medical Relief.—The number of nonpaying patients admitted to the Wards of the Sutton Hospital was 306. There were also 81 operations for tonsils and adenoids performed in this Hospital for the Surrey Education Committee. There has been nothing specially noteworthy to record regarding causes of sickness or invalidity. Birth-rate, Death-rate, and Analysis of Mortality during the Year 1925. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns.) Birthrate per 1,000 Total Population . Annual Death-rate per 1,000 Population. Kate per 1,000 Births. Prrcentage of Total Deaths. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 Years) Total Deaths under One Year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London. 188 12.2 0.01 0.00 017 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (1921 18.3 11.2 0.01 0.00 0.15 0. 02 0.14 0.06 0.31 0.33 7.6 74 93.0 5.9 1.1 AdjustedPopulations 20,000— 50,000). London 18.0 11 7 0.01 0.00 0.08 0.02 0.19 0.11 023 0.46 10.6 67 91.1 8.9 0.0 SUTTON 14.9 11.2 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.14 6.3 57 92.1 7.9 0.0 8 CAUSES OF DEATH, 1925. Total. Under 1 year. 1—2 years. 2—5 years. 5—15 years. 15—65 years. 65 and above. Deaths in Public Institutions in the District. Enteric Fever - - - - - - - - Small-pox - - - - - - - - Measles - - - - - - - - Scarlet Fever - - - - - - - - Whooping Cough - - - - - - - - Diphtheria - - - - - - - - Influenza 4 4 1 Encephalitis Lethargica - - - - - - - - Meningococcal Meningitis - - - - - - - 2 Respiratory Tuberculosis 12 - - - 1 11 - - Other Forms of Tuberculosis 4 2 - - 2 - 2 Cancer 30 - - - - 9 21 1 Rheumatic Fever 4 — — — 2 2 — 2 Diabetes 3 — — - — — 3 — Cerebral Hœmorrhage 17 — — - - 3 14 1 Heart Disease 29 - - - - 11 18 17 Arterio-sclerosis 14 — — — 2 12 13 Bronchitis 13 2 — — 1 10 3 Pneumonia 8 2 5 1 3 Other Respiratory Diseases 1 - - - - - 1 Ulcer of Stomach or Duodenum 1 - - - - 1 - - Diarrhoea (under 2 years) 2 2 - - - - - - Appendicitis 4 - - - - 4 - 3 Cirrhosis of Liver 2 - - 2 - 2 Nephritis 6 — — — — 4 2 2 Puerperal Sepsis Other diseases & accidents of Pregnancy 2 - - - - 2 - - Congenital Debility and Premature Birth 8 8 - - - - - 1 Suicide 4 — — - — 3 1 — Violence 3 1 — - — 2 — 2 Other Defined Diseases 70 3 — 3 1 21 44 14 Totals 241 18 2 1 4 85 131 69 Note.—Nine out of the sixty-nine deaths in Public Institutions belong to this District. Of the total 241 persons dying : 65 were from 66—74 years old, 49 ,, 75—84 " ,, 17 ,, 85 and above. 131 9 The deaths occurring at 65 years, and above that age, amount to 54 per cent. of the total deaths at all ages. In recent years, for England and Wales the deaths above 65 have been 36 per cent. of the total deaths. Inquests were held on 19 deaths:— Violence 2 Suicide 4 Natural Causes 13 Birth-rate, Death-rate, and Infant Mortality-rate during the last 20 Years. Quinquennial Periods. Birth Rate. Death Rate. Infant Mortality Rate. 1906—1910 23 10.4 72 1911-1915 19 10.0 77 1916—1920 15.8 10.9 52 1921—1925 16.1 10.1 42 Deaths at various age periods in the four quinquennial periods of the last 20 Years. Period. Total Deaths. Under 1 year. 1—5 years. 5—15 years. 15-65 years. 65 and above. Percentage to total deaths Under 1 year. 1-5 years. 5—15 years. 15—65 years. 65 and above. 1906—1910 952 151 74 30 373 324 15.8 7.8 3.2 39.2 34 1911—19!5 1016 149 44 29 408 386 14.6 4.4 3.0 38 38 1916—1920 1112 89 46 44 438 495 8.0 4.0 4.0 39 45 1921—1925 1095 71 26 26 447 525 65 2.4 2. 4 40 48 10 CANCER DEATHS. Five-Year Periods. Total Number of Deaths from all Causes. Deaths from Cancer. Deaths from all causes at 65 years of age and upwards. Percentage of deaths from Cancer to total deaths. Percentage of deaths at 65 years and upwards to total deaths. Percentage of deaths from Cancer to deaths from all causes at 65 years of age and upwards. 1906—1910 952 74 324 7.8 34 23 1911—1915 1010 109 386 10.7 38 28 1916—1920 1112 147 495 13.2 45 30 1921—1925 1095 133 625 12.6 48 26 11 INFANT MORTALITY, 1925. Causes or Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3 4 weeks. Total under 4 weeks. 4 weeks& under 3 months. 3 months A under 6 months. 6 months A under 9 months. 9 months & under 12 months. Total Deaths under 1 year. Premature Birth 4 — — — 4 — — — — 4 Debility at Birth 2 1 — — 3 — — - — 3 Congenital Defects 1 — — — 1 — 1 — — 2 Convulsions — - - - - - - 1 - 1 Asphyxia at Birth 1 — — — 1 — — — — 1 Broncho Pneumonia - - - - - - 1 1 - 2 Bronchitis - - - - - - - 2 — 2 Gastro Enteritis — - — — — 2 — — — 2 Meningitis - - - - - - 1 - - 1 Totals 8 1 — — 9 2 3 4 — 18 M. F. Tota Nett Deaths registered during the calendar year of legitimate infants 18 Nett Births registered during the calendar legitimate 140 166 306 illegitimate infants — illegitimate 6 5 11 Totals 146 171 S17 Mortality = £ 57 deaths per 1000 births. 12 Table showing in quinquennial periods the Infant Mortality-rate [Deaths per 1,000 Births] tor the past 20 Years. It can be seen that the increase of infant life at ages under one month has been slight; above that age the mortality of 1921-5 is 58 per cent. below the figure for 1911-15. The Infant Welfare Centre began its work; in 1916. Quinquennial Periods. Number of births. Number of deaths Infant mortality rate. Number of deaths under 1 month. Death rate. Number of deaths 1—12 months Death rate. 1906—1910 2075 151 73 56 27 95 46 1911—1916 1923 149 71 57 80 92 41 1916—1920 1735 89 51 41 25 45 26 1921—192J 1688 71 42 43 25 28 17 CENERAL PROVISION OF HEALTH SERVICES. Hospitals provided or subsidized by the Local Authority. Fever.—The Cuddington Isolation Hospital is a Joint Hospital serving the Urban Districts of Sutton, Carshalton and Leatherhead, and the Rural District of Epsom. It is within a mile of the South border of Sutton. The accommodation is 76 beds, providing for those suffering from Scarlet Fever, Diphtheria, Enteric Fever, Cholera, Cerebrospinal Meningitis and Influenzal Pneumonia. Ceneral Hospital.—The Local Authority contributes an amount equal to the rate paid for the year. The sum in 1925 was £35 15s. 4d. The hospital has 10 male, 15 female, and 6 children's beds, and 2 private wards. It is situated in the middle of the town. 13 Ambulance Facilities.—The Isolation Hospital has a motor ambulance. For general purposes an ambulance is kept by the proprietor of a motor garage, for the use of which a charge is made. Clinics and Treatment Centres. Maternity and Child Welfare are accommodated in the Public Hall, which belongs to the Council. School Clinics, Tuberculosis Dispensary are held by the County Council in rooms adjoining the Public Hall. Public Health Officers of the Local Authority. The Medical Officer of Health is a part-time Officer; he also acts as an Assistant Medical Officer to the Surrey Education Committee. Sanitary Inspector—Mr. F. W. Kain, A.R.S.I., is a whole-time Officer, and has a whole-time Assistant. Health Visitor—Miss C. L. Jew, C.M.B. and A.R.S.I. There is a whole-time Junior Clerk for office work. Mr. G. M. Vincent, M.R.C.V.S., is the Veterinary Inspector for examining the cows in the District. He was appointed, as from 1st December, 1925, as Inspector under the Public Health Meat Regulations, 1924. These offices are part-time. Professional Nursing in the Home. (a) Ceneral.—Private associations of the joint parishes of St. Nicholas and St. Barnabas, and the Parish of All Saints', Benhilton, each provide one nurse. The latter of these acts also as a midwife. (b) For Infectious Diseases—None is provided. 14 Midwives.—-The Local Authority neither employs or subsidises Midwives. There are three certified Midwives practising:. Legislation in Force. Adopted Acts. Date of Adoption. Infectious Diseases [Prevention] Act, 1890 1890 Public Health Acts [Amendment] Act, 1890 1890 Private Street Works Act, 1892 1892 Baths and Washhouses Acts, 1846-99 1894 Public Libraries' Act, 1892 1902 Public Health Acts [Amendment Act, 1907 (Parts of) 1908 Public Health Act, 1925 1926 Bye-Laws. Powers conferred on Sanitary Com mittee 1886 Whirligigs and Swings 1894 Telegraph and Other Wires 1894 Nuisances 1894 Regulations as to Dairies, Cowsheds and Milk Shops 1899 Houses Let in Lodgings 1902 Baths 1903 Regulations as to Allotments 1903 Streets and Buildings 1906 Sutton Green 1912 Nuisances 1913 Manor Park 1915 SANITARY CIRCUMSTANCES OF THE AREA. Water.—The supply is from deep wells in the chalk. The Sutton District Waiter Company have their pumping station in the town. The water is softened in settling tanks by the lime process, and is re-carbonated before distribution. 15 The softening is compulsory by Act to nine degrees of hardness. The supply is constant, practically all dwelling houses are supplied direct. Twelve old cottages are served by means of stand-pipes, and some wooden huts that have been erected contrary to the Bye-laws have no direct supply. The chemical and bacteriological reports on the supply show the water to be of good quality. Rivers and Streams.—A very small stream, the Pyl brook, receives nearly all the surface water and also the sewage works outflow. This stream runs outside the District into the Beverley brook, and so to the Thames. Drainage and Sewerage.—The District is sewered except in the outlying sparsely populated parts on the clay where cesspools are used. The local authority pumps these out on to the land as occasion arises. Mr. Grieves, the Surveyor, has reported that plans are being prepared for the sewering of the North-West part of the District, embracing an area of about 200 acres, the estimated cost being £21,000. Sewage Disposal. — There are 10 revolving sprinklers dealing with a daily flow of 950,000 gallons. A new 100ft. sprinkler, detritus tank and screening chamber is to be constructed. During the year, a Smith's rotary screen and a fixed screen with detritus tanks have been constructed at both the high and low level works. Closet Accommodation.—Water closets are in use throughout the District, excepting in the case of the few wooden huts that have been erected contrary to the Byelaws, where earth closets are used. Scavenging.—The Surveyor reports that the whole of the house refuse is collected by motor transport, except from the High Street, which is done by horse 16 haulage. Motor transport has proved more speedy and economical than horse, the whole of the District's refuse being collected in 4 to 5 days. Refuse Disposal.—The new pulverising plant is now in full working order and deals with all refuse. It comprises a 24in. x 20in. Jeffery pulveriser, driven by a 35 h.p. motor, with a 5. h.p. motor conveyor, which passes the refuse to a hopper, whence it is taken, by lorries to the sludge lagoons. The movable ashbin is the only form employed for household use. Rainfall at the Sewage Farm. Total 27 49 inchest In 1924, the fall was 3702. Rainy days, 153. In 1924 there were 168 rainy days. On one day only, February 12th, did more than one inch of rain fall in 1925. SANITARY INSPECTION OF THE AREA. Report of the Sanitary Inspector under Art. 19 (12) of the Sanitary Officers' Order, 1922. Number of complaints received in writing 91 Number of premises inspected under Sec. 92 of the Public Health Act, 1875 257 Number of nuisances discovered 581 Number of nuisances discovered, remedied without being reported 16 Number of nuisances reported to the Sanitary Authority 565 Number of nuisances remedied after report 554 Number of preliminary notices served by the Inspector for the abatement of nuisances 219 Number of notices for the abatement of nuisances served by order of the Sanitary Authority 53 17 Particulars of work done by owners or occupiers for the abatement of nuisances in compliance with notices. Number of privies, cesspools, ditches, pools, water courses, urinals, ashpits, and drains cleansed, and number of deposits removed 158 Number of new privies or water closets provided — Number of premises at which the drains were reconstructed, ventilated, trapped, or disconnected from the house pipes 16 Number of houses at which the water closets were provided with water under Sec. 36 of the Public Health Act, 1875 — Number of premises from which animals improperly kept were removed 1 Number of houses which were provided with efficient ventilation 40 Number of houses at which injurious overcrowding was abated 1 Legal proceedings taken under Sec. 96 for the abatement of nuisances (number of times) — Houses closed as unfit for human habitation — Number of houses at which disinfection was carried out after notice, under Section 5 of the Infectious Diseases (Prevention) Act, 1890 29 Number of houses at which disinfection was carried out after Tuberculosis 29 Number of foul houses cleansed and whitewashed, after notice under Section 46 of the Public Health Act, 1875 21 Number of premises from which offensive accumulations have been removed after notice, under Sec. 49 of the Public Health Act, 1875 5 Surrender of unwholesome meat, fish, poultry, fruit, vegetables, corn, bread, flour, or milk 5 18 Number of registered cowkeepers, dairymen, and purveyors of milk, carrying on business at the commencement of the year 22 Number since registered 2 Number who gave up or transferred their business during the year 3 Number of registered premises inspected during the year 24 Total number of visits paid during the year 62 Number of dairies and cowsheds at which improvements in the lighting, ventilation, paving, drainage, means of cleaning, or water supply, were made during the year 2 Number of cowsheds or dairies which were found in a dirty state 2 Number of premises at which the milk vessels were found in an unclean state — Number of new cowsheds erected — 19 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. No. of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (including Factory laundries) 36 - - Workshops (including Workshop laundries) 144 7 - Workplaces (other than Outworkers' premises) 11 - - Total 191 7 - 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of defects. Number of offences in respect to which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (5) (5) Nuisances under the Public Health Acts— Want of cleanliness 6 5 - - Other Nuisances 2 2 - - Sanitary accommodation unsuitable or defective 1 — — — 9 7 — — Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices Prosecutions. (1) (2) (3) (4) Nil. — — — 20 Smoke Abatement. There has arisen on need for action. Premises and Occupations which can be Controlled by Byelaws or Regulations. There are no bye-laws in force for houses let in lodgings, and no offensive trades being- carried on in the district. Other Sanitary Conditions Requiring Notice. There are no conditions requiring comment beyond those dealt with in other parts of the Annual Report. Schools. The elementary schools are under the control of the County Council, and the inspection of children both at school and in their homes is done by a CountyCouncil Health Visitor. HOUSING. 1.—Ceneral Housing Conditions in the Area. (1) The general housing conditions are good, apart from the fact that, owing to the high rent of the recently erected cottages, many of the older cottages are occupied by members of more than one family, although they are not suitably constructed for this purpose. (2) (a) The shortage is not great, and is being reduced. (b) Vide report placed at end of "Housing Statistics." (3) The establishment of a large garage by the London General Omnibus Company has caused an increased demand for small dwellings. II.—Overcrowding. (1) Extent.—747 applications for cottages have been made, and of the forms sent to these applicants, 321 have been returned requesting a house. 21 There are at present no cottages to be rented. There are 92 to allot for sale. Overcrowding has been discovered in 31 cottages. (2) Causes.—Increase of population; too high a rental for those cottages erected since 1918. (3) Measures Taken.—Vide I. (2), (b). (4) Cases.—Vide II. (1). No action as to crowding has been taken. III.—Fitness of Houses. (1) (a) General Standard of Housing:—With the exception of eleven cottages, the standard is reasonably good. (b) General Character of Defects found to exist in Unfit Houses.—Of the eleven mentioned under (a), seven consist of one room on ground floor, a lean-to scullery behind large enough to contain steps leading to one bedroom ; five others are similar, but have a larger scullery and staircase and rwo bedrooms. In the case of the seven and the five cottages, there is a water standpipe for common use* and the common use of five water-closets. Any marked unfitness in the cottages is due chiefly to defects in roofs, guttering, and the plaster on inside walls, and, to slighter extent, dampness in walls. (c) There is rarely any difficulty in getting the owners to execute the necessary repairs. There is a considerable amount of dirty walls due to neglect by tenants; sub-letting also causes further dirt and neglect. (2) General Action Taken as regards Unfit Houses under— (a) The Public Health Acts:—Serving notices on owners and seeing them carried out. (b) Vide "Housing Statistics." 22 (3) The difficulty of the careless tenant is being partly met by the sale of new cottages on the instalment plan. In this district it is rare to have to issue a summons against an owner. (4) Water supply, closet accommodation and refuse disposal are satisfactory. HOUSINC STATISTICS FOR THE YEAR 1925. Number of new houses erected during the year:— (a) Total 146 (b) With State assistance under the Housing Acts, 1919, 1923, or 1924:— (i) By the Local Authority 56 (ii) By other bodies or persons 90 1. Unfit Dwelling Houses—Inspection:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 182 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 43 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11* (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 29 * This applies only if the parents have children living with them. 23 2. Remedy Of Defects without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 139 3. Action under Statutory Powers:— A.—Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit:— (a) By owners — (b) By Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 43 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners 41 (b) By Local Authority in default of owners — 24 C.—Proceedings under Section 11, 14 and 15 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of Closing Orders — (2) Number of dwelling-houses in rerespect of which Closing Orders were made — (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — Report on Housing by Mr. W. H. Crieves, the Council's Surveyor. At the end of 1923, No. 2 Housing Scheme of 34 house in Clensham Lane and Collingwood Road was begun, and completed by November, 1924. Of these houses 22 were parlour type and 12 non-parlour. Cost, £17,600. No. 3 Housing Scheme began November, 1924, for 34 houses in Clensham Lane and Collingwood Road: 16 parlour and 18 non-parlour. Cost £18,308. No. 4 Housing Scheme commenced in July, 1925, for 68 houses in Benhill and Ersikine Roads, and No. 5 Scheme for 24 houses in Constance and Oliver Roads. Cost of No. 4 estimated at £37,930; of No. 5 at £13,517. 25 These schemes have all been carried out under the Chamberlain Act, and the houses are sold to owneroccupiers on the instalment plan. On the completion of No. 5 Scheme, the total number of houses built by the Council (including- 72 built under the Addison Scheme), will be 232. Rental of New Cottages. Assisted (Addison) Scheme.—19/-, 20/-, 21/-, including rates; 13/-, 14/-, 15/- excluding rates. Flat rate of 6/- per week, afterwards adjusted so that l1d. is generally returned. By Purchase.-—£550, parlour; £475, non-parlour. Deposit of £5 and upwards, balance over 20, 25 or 30 years. On this basis the lowest rental works out at 15/6—21/-, inclusive of rates. The weekly cost will vary according to the amount left on mortgage and the period of years over which repayment is spread. INSPECTION AND SUPERVISION OF FOOD, (a) Milk Supply. The quarterly reports of the Veterinary Inspector give a yearly average of 44 cows in milk. Some supply comes from farms in the immediate neighbourhood, but it is small compared to that which comes by rail. The seven cowkeepers have kept their cowsheds reasonably clean, and exercised care to prevent fouiing of the milk, either from the cows' quarters or the milkers' hands. (i.) Three cows were found to be tuberculous by the Veterinary Inspector, and confirmed by postmortem examination. (ii.) Three licences were granted for the sale of certified milk. 26 There has been no application for a licence of any apparatus for pasteurising. (iii.) There has been no refusal or revocation of registration of retailers or of licences for graded milk. (iv.) Samples of certified milk were sent to the Clinical Research Association in May, July and October. In no sample was Bacillus Coli found. The presence of other organisms was as follows:— Quantity. May. July. October 1/10 c.c. 181 121 166 1/100 c.c. 17 13 17 1/1000 c.c. 2 2 2 The demand for the graded milks of the Milk (Special Designations) Order, 1923, is very small, and the only graded milk sold by the retailers is that known as Certified, the cost of which is double that of ordinary milk. (b) Meat. (i.) Inspection at the time of slaughter is made by Mr. 'G. M. Vincent, M.R.C.V.S. Tuberculosis of the throat glands was found in one heifer, and the head was condemned. Condemned meat is removed to the Sewage Farm and buried. (ii.) Stalls, shops, stores and vehicles have been kept under observation, but no special action has been taken under the Public Health (Meat) Regulations, 1924. (iii.) There is no public slaughter-house. PRIVATE SLAUGHTER HOUSES. In In In 1920. Jan., 1925. Dec., 1925. Registered 5 5 5 Licensed 1 1 l 27 (c) Other Foods. Boxes of fish have been surrendered and condemned on five occasions. The thirteen bakehouses, of which three only were not provided with motor power, have been kept reasonably clean. In four cases the owners were required to whitewash and in one case to repair a stopped drain. (d) No case of food poisoning has been reported. (e) The following report is from the County Medical Officer:— Articles Analysed. Adulterated or Deteriorated Prosecutions ConTictions Formal In- formal Total Formal In formal Total Milk 48 1 49 2 - 2 - - Preserved Cream - 1 1 - - - - - Butter 12 4 16 - - - - - Spirits 5 - 5 1 - 1 1 1 Other Articles — 2 2 - - - - - Totals 65 8 73 3 — 3 1 1 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Diseases Cenerally. The prevalence of notifiable infectious diseases during the five years 1916-1920 and the five years 1921-1925 is shown in the following table:— NOTIFIABLE DISEASES. Reported by Schools and Health Visitor. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Pneumonia. Dysentery. Malaria. Encephalitis Lethargica. Anterior Poliomyelitis. Cerebro Spinal Meningitis. Ophthalmia Neonatorum. Measles. Whooping Cough. Quinquennial Periods. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Notifications. Impaired Vision. Notifications. Deaths. Notifications. Deaths. 1916—1920 153 3 134 9 7 1 2 2 14 3 67 80 2 — 3 — - - 4 - 1 - 8 - 928 7 69 5 1921—1925 126 — 95 5 18† - 5 1 8 — 94 47 — — 1 — 2 1 1 — 1 — 16 — 448 2 436 6 † Ten cases of Para-typhoid B in February and March, 1923, due to food. Cerebro-Spinal Meningitis became notifiable on 1/9/12. Encephalitis Lethargica became notifiable on 1/1/19. Polio-myelitis became notifiable on 1/9/12. Measles became notifiable on 1/12/15; rescinded 31/12/19. Pheumonia, Malaria and Dysentedy became notifiable on 1/7/19. 29 Notifiable Diseases (other than Tuberculosis) during 1925. Disease. Under 1 Year. 1 Year. 2 Years. 3 Years. 4 Years. 5 Years. 10 Years. 15 Years. 20 Years. 35 Years. 45 Years. 65 Years. Totals. Removed to Hospital. Died. Small Pox - - - - - - - - 1 - - - 1 1 1* Scarlet Fever - 3 5 2 2 18 11 3 3 — — - 47 40 — Diphtheria — 1 1 3 2 3 - 10 10 - Enteric Fever - - - - - - - - - - - - - - - Puerperal Fever - - - - - - - - - - - - - - - Pneumonia — — — — - 1 — 1 1 — 3 - 6 — 8 Erysipelas - - - - - - 1 - - - 1 - 2 - - Encephalitis Lethargica - - - - - - - - - - 1 - 1 - - Ophthalmia Neonatorum 2 - - - - - - - - - - - 2 - - Totals 2 3 5 2 3 20 15 6 8 — 5 — 69 51 9 *Vide Note "Small-pox. The months in which they occurred. Small-pox. Scarlet Fever. Diphtheria. Pneumonia. Erysipelas. Encephalitis Lethargica. Ophthalmia Neonatorum. January 1 i February — 2 — — — March .. 1 _ April 6 1 i 1 May 1 12 i — — 1 June 5 i — — July 9 1 2 August 1 September - 1 — — — — 3 9 i November 6 2 December — 4 1 i — — Totals 1 47 10 6 2 1 2 30 The Distribution of the Cases of Scarlet Fever, Diphtheria and Pneumonia. Scarlet Fever. Diphtheria. Pneumonia One case in one household 19 6 6 Two cases in two households 4 - - Three cases in two households 6 — — Four cases in one household 4 - - Total of Sutton cases 33 6 6 London Children in the M.A.B. Downs Hospital 14 4 - SMALL POX. The explanation of this case appearing on the list of notifiable infectious diseases is as follows:— A young- woman, a waitress in a London underground restaurant, came—on account of a breakdown in health—to spend a few days with friends in this district. She soon became so ill that a doctor was called in who, as her condition rapidly worsened', had her removed to the Sutton Hospital. The physician on duty realised her serious condition, and found her high temperature was accompanied with pleurisy. An eruption was noticed on the eve of her second day in hospital resembling, in the opinion of two members of the medical staff, that of Small-pox. I saw the patient with them the next morning, and we agreed that, although her serious state was not due to Smallpox, yet as the eruption so closely resembled this disease, the safest course would be to remove her for observation to a Small-pox hospital, and she was 31 removed within an hour by the Metropolitan Aslums Board. It was not until the 3rd day after her removal, by which time she had died, that I was informed that the physician in charge of the Small-pox hospital had diagnosed the eruption as purely septic. In the meantime all the usual preventive precautions, such as vaccination of contacts, disinfection or destruction of clothing, had been taken. As to this final diagnosis of the eruption:—I accepted the opinion of a physician having so extensive an experience of Small-pox. On the other hand, the two members of the medical staff of the Sutton Hospital declined to withdraw their diagnosis. After communicating with the Ministry of Health, I was instructed to report the case in the return of Infectious Diseases, made weekly to the RegistrarGeneral, as one of Small-pox, and thus it must appear in this Annual Report. Non-Notifiable Infectious Diseases. The following cases were reported by school teachers and by the District Council's Health Visitorr: 1925 Whooping Cough. Measles. German Measles Chicken Pox. Mumps. January - - - 3 - February 2 - - 2 - March 5 26 5 April 2 4 9 1 May 9 - - 1 3 June 13 1 — 2 5 July 28 — — 2 2 August 17 — — — — September 20 1 1 — 4 October 16 3 1 — 5 November 15 16 — 4 50 December 17 37 1 1 82 Totals 144 62 3 50 157 32 The prevalence of infectious diseases since 1920 is shown in a preceding table. Measles and Whoopingcough are the most predominating, the latter being three times more fatal. No death arose from the 126 cases of Scarlet Fever, and five from 95 cases of Diphtheria. The case mortality of Pneumonia indicates that the notification of this disease is partially neglected, and the same applies to Puerperal Fever. Bacteriological Specimens. Disease. Cases. Report. Positive. Negative. Diphtheria 26 — 26 Tuberculosis 16 4 12 No use has been made of the Schick and Dick tests in Diphtheria and Scarlet Fever respectively. Influenza caused four deaths at 65 years or above, out of a total of 241 deaths. In the previous four years the deaths were seven out of 199, six out of 216, none out of 221, and eight out of 218 total deaths. Tuberculosis. New Cases and Mortality during 1925. Ages. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M F M F M F M F 0 - - - - - - - - 1 — — 1 1 — — 1 — 5 2 1 - 10 - 1 - - 15 1 2 1 2 — - - 20 1 1 - - - - - - 25 5 4 - - - 1 - 1 35 6 3 1 - 45 2 1 - - 4 1 - - 65 1 - - 1 1 1 - - 65 1 - - - - - - - Totals 17 8 4 4 8 4 3 1 Of these 33 cases, the first information received of six of them was on their admission to a hospital or sanatorium. 33 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS. No case of Tuberculosis was notified in any person to whom these regulations apply. PUBLIC HEALTH ACT, 1925, SECTION 62. No action was taken under this Section. MATERNITY AND CHILD WELFARE. Infant Welfare Meeting's are held in the Public Hall on Tuesday afternoons, under the superintendence of Miss Edith Hoole, a member of the District Council, and for expectant mothers the meetings are monthly, on Tuesday mornings—Miss Ethel Vernon, M.D., B.S., Lond., is the physician in charge. The Infant Welfare Centre was opened in 1916; the ante-natal at end of 1924. In 1925 the average weekly attendances were:—Mothers, 108; children, 123. At the ante-natal meeting the average was seven mothers. 2,037 visits were made to children under one year, of which 331 were first visits, and 1,863 visits were made to children between one and five years; 299 visits to expectant mothers, of which 82 were first visits. Enquiries were made into 14 infant deaths; in none of these had the mother attended the Welfare Centre. Enquiries were also made as to eleven still-born. In one case only had a mother attended the Centre in the early months of her pregnancy. No case of Puerperal Fever was notified. There were two case of Ophthalmia Neonatorum. WhoopingCough was prevalent in the last six months, and Measles in the last two months of the year, but caused no death. 34 OPHTHALMIA NEONATORUM. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated. At Home In Hosp. 2 2 — 2 — — — Towards the close of the year arrangements were made for the dental treatment of expectant and nursing mothers; children under five years of age are treated by a dentist at the Sutton Hospital. Notification of Births.—Of the 316 registered as born in the district (28 of these belonging to other districts), 95 per cent. were notified.