SUTC 1 LIBRARY Borough of Sutton and Cheam ANNUAL REPORT of the Medical Officer of Health For the Year 1937. William Pile, Ltd., Printers, 46.50, High Street, Sutton, BOROUGH OF SUTTON & CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1937. PUBLIC HEALTH AND HOUSINC COMMITTEE. HIS WORSHIP THE MAYOR (Alderman S. H. MARSHALL, J.P., C.C.), ex-officio. Alderman CECIL COLMAN, J.P. Alderman S. J. CROWTHER SMITH, C.C. Coun. Mrs. A. DUVAL. Coun. F. C. LOHDEN, O.B.E. „ J. EVERETT. „ S. D. ODDY. „ J. B. HUTCHINSON „ H. J. TRICKETT, C.C. (Chairman). ,, F. H. WYATT. „ G. J. JEWETT. PUBLIC HEALTH OFFICERS OF THE AUTHORITY. Medical Officer of Health: ENEAS J. MACINTYRE, M.D., D.P.H. Chief Sanitary Inspector: CHARLES WILLIAM NEWBERY, Certif. R.S.I.; Certif. Meat Food; Certif. S.I. Exam. Board. Assistant Inspectors: JOHN HENRY LOTT, Certif. R.S.I.; Certif. Meat <5- Food. JAMES RICHARDSON WHITE, Certif. R.S.I, and S^I.E.J.B. ; Certif. Meat <5^ Food. *ALWYN JOHN, Certif. R.S.I, and S.I.E.J.B. tJOSEPH NORMAN JENKINSON, Certif. R.S.I, and S.I.E.J.B. *Resigned :—14th April, 1937. +Appointed :—12th July, 1937. 1 To the Mayor, Aldermen, and Councillors of the Borough of Sutton and Cheam. Mr. Mayor, Madam, and Gentlemen, I have the honour to present to you the fourth Annual Report on the health of the Borough of Sutton and Cheam. The standard of health of the community during the year 1937 was good. The general incidence of infectious diseases was lower. There was a substantial decline in the prevalence of Scarlet Fever. The number of cases of Diphtheria was reduced, but included a small proportion of a virulent type. An epidemic of Influenza, which was continued into the first quarter of the year, was generally of a mild type, but reacted unfavourably on the weakly and aged. In November the district was involved in a widespread outbreak of mild Dysentery. The water supply of the district maintained a satisfactory standard of chemical and bacteriological purity throughout the year. Efficient control by daily sampling and protective chlorination was carried out. The death rate of 9.5 per 1,000 of population was lower than in 1936, and the birth rate was lower at 155 per 1,000 of population. The maternal and infantile mortality rates were higher. The sanitary circumstances of the area were satisfactory, and the sanitary work was efficiently carried out under the direction of the Sanitary Inspector (Mr. C. W. Newbery). I wish to express my thanks to members of the Council for their helpful advice during the year, and my appreciation of the co-operation of officers of the Council and of the medical practitioners of the Borough. I am, Mr. Mayor, Madam, and Gentlemen, Your obedient servant, ENEAS J. MACINTYRE, Medical Officer of Health. 2 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in Acres 4338 15 Registrar-General's Estimate of the Resident Population, 1937 74530 Number of inhabited Houses (end of 1937) according to Rate Books 20717 Rateable Value and sum represented by a £856187 Penny Rate £3366 Social conditions, including the chief industries carried on in the area, and the influence of any particular occupation on the public health:— A great proportion of the residents is engaged in business in London. The remainder consists chiefly of domestic servants, tradesmen and their employees, and workers in factories, garages and laundries. In none of these instances is the occupation apparently affecting the public health. EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1937. LIVE BIRTHS: T. M. F. Birth-rate per 1,000 of the estimated resident population, 155. Total 1160 616 544 Legitimate 1125 597 528 Illegitimate 35 19 16 STILL BIRTHS: T. M. F Rate per 1,000 (live and still) births, 27.6. Total 33 16 17 Legitimate 31 14 17 Illegitimate 2 2 - Deaths Death-rate per 1,000 of the estimated resident population, 9.5. 3 Deaths from puerperal causes:— Deaths 4 Rate per 1,000 total (live and still) births 3.36 Deaths from— Puerperal Sepsis 2 Other Puerperal causes 2 Total 4 Death-rate of Infants under one year of age:— All Infants per 1,000 live births 50.0 Legitimate Infants per 1,000 legitimate live births 49.8 Illegitimate Infants per 1,000 illegitimate live births 57.1 Deaths from Cancer (all ages) 113 ,, Measles (all ages) 0 ,, Whooping Cough (all ages) 1 ,, Diarrhoea (under 2 years of age) 5 Registrar.s Estimate of the Resident Population:— Mid-Year 1937 74,530 Resident Staff, Patients, Inmates and Scholars (not having their residence in the District):— Staff. Inmates. London Industrial Colony 18 342 Hospitals 309 431 Private Schools 21 60 348 833 By adding the non-resident Inmates to Registrar.s Estimate of the Resident Population the Gross Population was at Mid-Year 75,711 On the population estimate of 74,530:— The Birth-rate was 15.5 per 1,000 persons living. The Death-rate was 9.5 per 1,000 persons living. The Infant Mortality (deaths under 1 year per 1,000 births) 50.0 These figures compare favourably with those for the whole of England and Wales, and for the great towns and smaller towns, as shown in a table on the following page. 4 5 BIRTH.RATES, DEATH.RATES AND ANALYSIS OF MORTALITY IN THE YEAR, 1937. England and Wales, 125 County Boroughs and Great Towns, and 148 Smaller Towns. Provisional figures based on weekly and quarterly returns. rate p ICR 1,000 Population. Annual Diiath uate peb 1.000 Population. Rate per 1,000 LiveBirth All Causes. Typhoid and Para.typhoid fevers. Small.pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis under 2 Years). Total Deaths under One Year. Live Births. Still1 Births. England and Wales . 14 9 0.60 12.4 000 — 0. 02 0.01 0. 04 0.07 0. 45 0 .54 5. 8 58 125 County Boroughs and Great Towns, including London. 14 9 0.67 12.5 001 0.03 0.01 004 008 0.39 0.45 7.9 62 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) . 1V3 0.6) 11 9 000 0.04 0 .01 0.03 0 .05 0.42 0.42 3.2 55 London 13 3 0.54 12.3 000 — 0.01 0.01 0 06 0.05 0.38 0 51 12.0 60 Sutton and Cheam . 15..5 9 5 0 01 — 0.0 0.00 0.00 0 .07 0 .21 0. 51 4 .3 50 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows : . per 1,000 Live Births 0.97 2.26 3.23 ,, ,, Total Births 0 .94 2 17 311 ,, „ ,, „ Sutton & Cheam are as follows per 1,000 Live Births 1.72 1.72 3.44 ,, „ Total Births 1.68 1 68 3.86 The averages of the ten years 1927.1936 were:— Birth-rate 15.3 Death-rate . 9.8 Percentage of deaths in age-groups:— Percentage of Deaths. Under 1 year 8.5 1—4 years 0.6 5—14 1.2 15—64 38 4 65 and above 51.3 Percentage of Deaths from certain causes to the total number of Deaths:— Diseases of the heart and circulation 30.3 Cancer and malignant disease . 16.7 Diseases of lungs (not tuberculous) 81 Tuberculous diseases 5.2 Cerebral haemorrhage 4 0 Congenital diseases 4.9 Suicide and violence 5.6 Diseases of the digestive system 8 2 Infectious diseases 3.7 Diseases of the kidney 2.6 Senility 20 Other defined causes 8.7 The number of Deaths from the common infectious diseases were:—Measles 0, Diphtheria 5, Scarlet Fever 0, Whooping Cough 1, and Influenza 16. Recorded Death Rates per 1,000 of Population for Wards. Ward. N. N.E. N.W. W.C. E.C. E. S.E. S.W. S. Death Rath. 7.1 7.7 6.4 7.6 11.5 9.4 14.9 10.0 10.9 Maternal Mortality.—There were two deaths from Puerperal Sepsis. One was from septicaemia following Thrombo.phlebitis, and one from septic abortion. The two deaths from other causes were from inversion of the uterus and miscarriage respectively. Infantile Mortality.—The rate is increased from 34 8 to 50 per 1,000 live births. The highest number of deaths is again recorded in the West Central Ward. Congenital debility,, premature birth and malformations remain the chief cause of mortality. 6 CAUSES OF DEATH IN 1937. Total. Under 1 year. 1—2 years. 2—5 years. 5—15 years. 15—65 years. 65 and above. Typhoid and Paratyphoid Fevers 1 - - - - 1 - Measles - - - - - - — Scarlet Fever - - - - - - — Whooping Cough 1 - - - - - 1 Diphtheria 5 - - 2 2 — 1 Influenza 16 - - — — 8 8 Encephalitis Lethargica 1 - - — — 1 — Cerebro-spinal Fever 1 - - — — 1 — Tuberculoids of the Respiratory System 31 - - — - 25 6 Other Tuberculous Diseases 4 1 - — 1 2 — Syphilis - - - - - - — General Paralysis of the Insane, Tabes Dorsalis - - - - - - - Cancer, malignant disease 113 - - - — 55 58 Diabetes 14 - - — — 6 8 Cerebral Hœmorrhage, etc. 27 - - — — 8 19 H eart Disease 155 - - — — 39 116 Aneurysm 5 - — — — 1 4 Other Circulatory Diseases 45 - - — — 14 31 Bronchitis 11 - - — — 5 b Pneumonia (all forms) .. 40 9 1 — 1 17 12 Other Respiratory Diseases 4 — - — — — 4 Peptic Ulcer 3 3 Diarrhoea, etc. (under 2 years) 5 5 - — — — — Appendicitis 9 — - — — 6 a Cirrhosis of Liver 4 — - — — 2 2 Other Diseases of Liver 8 — - — — 1 2 Other Digestive Diseases 18 1 - — — 8 9 Acute and Chronic Nephritis 18 9 9 Puerperal Sepsis 2 — — — 2 — Other Puerperal causes .. 2 — - — — 2 — Congenital Debility, Premature Birth, Malformation, etc. 33 33 - - - - - Senility 13 - - - - - 13 Suicide 10 — — — 8 2 Other Violence 28 4 - 1 1 12 10 Other Defined Diseases .. 56 5 - — 3 27 21 Causes Ill-defined — — - — — — — Totals 678 58 1 3 8 260 348 51-3 per cent, of deaths are at 65 years or above— 65—74 years 170 75—84 years 139 85—94 years 37 95 and above 2 348 7 INFANT MORTALITY, 1937. Causes or Death. Ages at Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Deaths under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Congenital Debility Premature Birth Malformations, etc. 17 4 2 — 23 9 1 — — 33 Whooping Cough - - - - - - - - - - Measles - - - - - - - - - — Pneumonia — — 1 — 1 5 — 2 1 9 Bronchitis — - — — — — — — — — Enteritis — - 1 i 2 — 2 1 — 5 Other defined causes .. 4 1 — — 5 2 - 1 3 11 Totals 21 5 4 1 31 16 3 4 4 58 Ward Distribution. Ward. N. N.W. N.E. W.C. E C. E. S.W. S.E. S. No. or Deaths. 7 1 6 21 5 8 2 6 2 8 M. F. Total M. F. Total Nett Births Total 616 544 1160 Nett Deaths legitimate 32 24 56 registered registered during the legitimate 597 528 1125 during the calendar calendar year illegitimate 19 16 35 year illegitimate 112 Total 16 17 33 Death Rate legitimate 48 3 Still per 1000 births illegitimate 1.7 Births legitimate 14 17 31 illegitimate 2 - 2 Death Rate to total births 50. 0 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. Legislation.—The Public Health Act, 1936, became operative on 1st October, 1937. Public Health Propaganda.—Commencing in October on the inauguration of the National Health Campaign, a series of Health Days, at approximately monthly intervals, was held in the Borough. Each Health Day included a cinema display of health films to older school children, an afternoon meeting for mothers with health talks and cookery demonstrations, and an evening public meeting. Large audiences of children were obtained, and the displays were appreciated. 1 should like to thank the teachers of the Borough for their perfect organisation of attendance, and for the keen interest they have shown in the health campaign. The response to the afternoon meetings for mothers was encouraging, but attendances at evening meetings were small. The subjects dealt with were nutrition,, the prevention of disease, and physical fitness. Experience of this campaign tends to prove that public health teaching is most effective through the schools and clinics. Nursing Associations.—There are three Nursing Associations in the Borough named after the respective districts of Sutton, Cheam, and Worcester Park, which employ a total of fourteen nurses. There has been a continuous expansion of their work, and they have also co-operated with the Surrey County Council in the operation of the Midwives Act, 1936. Returns of cases nursed through each Association in relation to Maternity, Midwifery, Pneumonia, and Infectious Diseases were received at the end of the year, and indicate the extensive and valuable services which these Associations provide. . 9 Proportionate grants were made and agreements continuing representation of the Council on the Committees of the Associations were renewed. The Sutton District Nursing Association has purchased Hampden House, Sutton Court Road, to provide a more commodious home for their increased staff of nurses. Laboratories.—Pathological and bacteriological specimens are examined at the "James" Laboratory, Sutton and Cheam Hospital, under the direction of Dr. K. E. Hughes. This service has been convenient and efficient. Hospitals.—Extensions comprising one new ward block of 24 beds, 10 cubicle beds and a nurses' home of 52 beds became available at Cuddington Isolation Hospital. The Cuddington Joint Hospital Board who administer the hospital are to be congratulated on the structure, design and equipment of these new buildings, and the accommodation provided for the comfort and recreation of the nurses is a valuable contribution to the solution of the problem of attracting entrants to the nursing profession. Ambulances.—The new Austin S. Type Ambulance, acquired by the Council in 1936, has continued to give satisfaction in comfort and efficiency. Arrangements have been made with surrounding authorities for co-ordination of service. "The Cheam and District Ambulance Contributory Scheme" provides an efficient supplementary service in cases of accident, illness and maternity. A new service station for three ambulances was opened at Farm Way, Worcester Park. Mortuary.—The Council's mortuary is situated at Sutton Cemetery. During' the year 50 bodies were received, and 46 post-mortem examinations were made. Sanitary Circumstances of the Area. Water Supply.—The water supply is derived from deep wells in the chalk situated at Sutton and Woodmansterne. The Cheam Wells remain closed. The water supplied to the district is softened to nine 10 degrees of hardness. Chlorine is applied in the form of chloramine as a protective measure. Samples arc examined daily by the Company's chemist and bacteriologist in a well.equipped laboratory at the Sutton works. Monthly samples are also examined by the Company's consultant analyst, and monthly samples are examined in rotation by the district councils in the Drainage and Sewerage.—During the year the soil sewer in Gander Green Lane from Cheam Road to just beyond Bourne Way has been re-laid in cast iron. The soil sewer from Quarry Park Road to pick up "The Old Cottage" and the seven houses fronting St. Dunstan's Hill, adjacent to Perrett's Brickfield., to abolish the cesspools, has been commenced. A new soil sewer has also been laid in Green Lane, thus completing the soil sewerage of this road, and a start has been made on the new soil sewer in Sandy Lane from Glebe Road to Cuddington Avenue, and partly along Cuddington Avenue. The construction of new surface water sewers is in progress in the Hilldale Road to Upper Mulgrave Road areas and in the Bushey Lane to St. James' Road areas, and it is hoped shortly to commence the construction of a surface water sewer in Forest Road, Sutton. 11 area of supply. The supply has been satisfactory in quantity and in quality, and below is a table giving the average of monthly analyses:— Total solid residue dried at 180º c. Ammonia, free. Ammonia Albuminoid. Nitrogen as Nitrates. Nitrogen as Nitrites. Oxygen absorbed in 4 hours at 80ºF Chlorine (combined). Hardness total (soap test) Organisms cultured on gelatine plate for 3 days at 20º C. On Agar plate 1 C.C. 24 hours at 37º c. Presence of Bacillus Coli in 100 C.C. Average Per c.c. 19.5 .0233 .0007 1.055 0 .0116 2.244 6.95 50 2 0 At the Sutton Sewage Works a mechanically operated Detritor and a settlement tank, fitted with Dorr Flocculator and Clarifier mechanism,, have been installed, and are giving good results. The existing settlement tanks have been converted to deal with storm water. At the Worcester Park Sewage Works plans are in course of preparation for large scale additions and alterations. Rivers and Streams.—'During the year the Surrey County Council have commenced work on the improvement of the Beverley and Pyl Brooks and good progress is being made within this Borough. Refuse Collection and Scavenging.—The collection of house refuse and its subsequent disposal is carried out under the supervision of the Borough Engineer and Surveyor. The whole of the manual labour in the collection and disposal of refuse is provided by the Council, and modern dustless, low loading mechanical vehicles are hired under contract. The original term of the contract having now expired, the Council has decided to purchase modern rear loading refuse collection vehicles and operate this side of the collection as well. During the year the previous method of disposing of house refuse by controlled tipping has been completely superseded by the new Refuse Disposal Plant situated at the end of Boscombe Road, Worcester Park, which consists of an eight-cell top feed mechanically clinkered trough grate incinerator. All scavenging of the public highways is carried out by the Borough Council under the direction of the Borough Engineer and Surveyor. Closet Accommodation.—There are 45 cesspools in use. Extensions of sewers to facilitate drainage of 31 houses, thus abolishing 29 cesspools, are in hand or projected. 12 Some eight pail closets and one privy are in use. In the past ten years 121 premises, originally with cesspool drainage, have been connected to sewers. SANITARY INSPECTION OF THE AREA. Report of the Sanitary Inspector under Art. 27 of the Sanitary Officers (Outside London) Regulations, 1935. Record of Inspections and Notices Served. Number. House to House Inspections 210 Special Inspections, Interviews on Premises, and Advisory Visits 1677 Re-inspections 3292 Visits to Works in Progress 1277 Visits to Factories, Workshops and Workplaces 397 Visits to Bakehouses 65 Visits to Outworkers' Premises 70 Visits to Slaughterhouses 347 Visits to Butchers' and Food Shops 296 Visits to Dairies and Milkshops 120 Visits to Ice Cream Premises and Vehicles 153 Visits to Stables 11 Visits re Rat Infestation 825 Visits in connection with Infectious Disease 194 Visits re Overcrowding and "Permitted Number" Measurements 201 Visits to Petroleum Spirit and Cinematograph Film Stores 369 Miscellaneous 993 10497 Premises at which defects or nuisances were discovered 904 Dwelling-houses inspected for housing defects under Public Health or Housing Acts 528 13 Number. Defects or nuisances discovered 4351 Defects or nuisances remedied 2871 Defects or nuisances in hand 1078 Defects or nuisances outstanding 402 Informal Notices served 966 Statutory Notices served 27 Complaints received and investigated 627 Summary of Remedial Works and Sanitary Improvements carried out. Number. Number of Houses and Premises re-drained 4 Repairs or amendments to existing drains 28 Drains or gullies unstopped or cleansed 115 Lengths in feet of stoneware drains laid 537 Lengths in feet of iron drains laid 36 Manholes provided, covered or repaired 60 Fresh air inlets provided or repaired 44 New gully and intercepting traps fixed 45 Gully curbs, channels and gratings provided or repaired 61 New soil pipes and ventilating shafts provided 16 Soil pipes and ventilating shafts repaired 12 Cesspools abolished 2 Rainwater soakaways provided 9 Water and Smoke tests applied to drains 86 New W.C. Basins fixed 45 W.C.'s unstopped, cleansed or repaired 33 W.C. Seats provided or repaired 61 New Flushing Cisterns provided 5 Existing Flushing Cisterns repaired 27 Joints between W.C.'s and flush pipes repaired 4 New W.C. Apartments provided 2 W.C. Apartments lighted and/or ventilated 1 Separate W.C.'s for Sexes provided 1 Sanitary Accommodation in Factories or Workshops provided 2 Ventilated Lobbies to W.C. Apartments provided 1 14 Number. Urinals cleansed 4 Urinals provided 1 Lavatory Basins provided 6 Old insanitary sinks removed 25 New impervious sinks provided 30 New waste pipes fixed 41 Waste pipes trapped, repaired or unstopped 27 Waste pipes disconnected from drains or soakaways 1 New roofs provided 13 Roofs repaired 255 Eaves guttering provided, cleansed or repaired 104 Rainwater pipes provided, repaired or unstopped 67 Rainwater pipes disconnected from drains 11 Damp walls remedied by :— (a) Provision of horizontal damp-proof courses only 10 (b) Provision of vertical damp-proof courses only 37 (c) Provision of horizontal and vertical damp-proof courses 44 (d) Rendering of walls internally 44 (e) Rendering of walls externally 36 (f) Other means 92 Bricks walls repointed, rendered or repaired 162 Settlements in walls remedied 7 Chimney stacks repaired or pots provided 75 Ventilation under floors provided 27 Curbs and gratings to vent openings provided 9 Yards to dwelling-houses paved 39 Yard paving to dwelling-houses repaired 26 Passageways paved 6 Yards of other premises repaired 2 Yards of other premises paved 2 Floors of rooms relaid 27 Floors of rooms repaired 64 Sites of floors concreted 2 Floors of other premises relaid 6 Floors of other premises repaired 2 15 Number. Floors of other premises cleansed 4 Rooms cleansed, distempered or repapered 705 Passages and staircases and landings cleansed, distempered or repapered 91 Larders cleansed and distempered 25 W.C. Apartments cleansed and distempered 94 New windows provided 19 Windows repaired or made to open 199 New sash cords provided 344 Window sills provided or repaired 99 Doors provided or repaired 38 Thresholds to doors provided or repaired 20 Reveals to windows and doors repointed 292 Handrails to staircases provided 49 Staircases repaired 8 External paintwork renewed 4 Houses provided with a sufficient water supply 1 Water service pipes and cisterns repaired 7 Movable sanitary dustbins provided 68 Offal bins provided 12 Ranges and stoves provided or repaired 55 Hearths provided or repaired 7 Coppers provided or repaired 28 "Rooms" in Butchers' Shops and Stores cleansed 11 Dairies and Food Shops cleansed 14 Bakehouses, Restaurant Kitchens and Workrooms limewashed 42 Nuisances from keeping of animals abated 6 Nuisance from smoke abated 1 Accumulations of refuse removed 86 Accumulations of manure removed 7 Offensive ditches cleansed 2 Miscellaneous 290 Infectious Disease, Disinfection, &c. Rooms disinfected after Notifiable Infectious Diseases 210 Rooms disinfected after Tuberculosis and other Diseases 61 16 Smoke Abatement. No nuisance has been detected from the few chimneys attached to industrial premises in this district. On one occasion only was it necessary to direct attention to a nuisance arising from the emission of smoke in connection with a greenhouse boiler chimney. 17 1. Inspection of Factories, Workshops and Workplaces. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) (including Factory laundries) 154 46 — Workshops (including Workshop laundries) 270 49 — Workplaces .. (other than Outworkers' premises) 38 13 — Total 462 108 — 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) (4) (5) Nuisanccs under the Publio Want of olnanliness 44 42 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 118 112 — — Sanitary accommodation— (a) Insufficient 4 3 — — (b) Unsuitable or defective 13 12 — — (c) Not separate for sexes 1 1 — — 180 170 — — Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) - — — — 18 HOUSING. 1. Inspection of Dwelling Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 528 (b) Number of inspections made for the purpose 2384 (2) (a) Number of dwelling-houses cluded under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1932 210 (b) Number of inspections made for the purpose 756 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 296 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 their Officers 230 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 — 19 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners — (b) By Local Authority in default of owners — B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 25 (b) By Local Authority in default of owners — C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — (3) Number of dwelling-houses demolished by owners in anticipation of formal procedure under Section 11 — 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 made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 20 4. Housing Act, 1936. Part IV—Overcrowding. (a) Number of dwellings overcrowded at the end of the year:— Dwellings Families Persons Council Houses 10 10 93 Privately Rented 23 23 166 Owner/Occupier 11 11 88 Totals 41 44 347 (b) Number of new cases of overcrowding reported during the year 6 (c) (1) Number of cases of overcrowding relieved by the Council during the year 1 (2) Number of persons concerned in such cases 6 (d) Cases in which dwelling-houses have again become overcrowded - The Form "C" Return, submitted as the result of the Overcrowding Survey in 1935-1936, revealed 116 cases of overcrowding. By leason of removals, deaths or marriages, overcrowding has continued automatically to abate, with the result that the number of dwellings now overcrowded is 44. Plans for the erection of houses to deal with these cases are in course of preparation. In 1936 two cases were added to the Register, and in 1937, six. Seven of these have been abated by informal action and the other by the allocation of a Council House. Slum Clearance. Nos. 1, 2, 3, 4 and 7, Pit Cottages, Station Road, Cheam, were demolished in 1937. 21 The Corporation's Slum Clearance programme is now complete. HOUSING ACT, 1936. The work of measuring working-class dwellings for the purpose of calculating the "permitted number" was continued in 1937 and, in all, 4,924 Certificates have now been issued to landlords or agents. Fourteen instances of non-compliance wiih Section 62 (1) were noted, and action taken resulted in compliance with the provision by landlords in seven cases, the remainder being outstanding at the end of the year. INSPECTION AND SUPERVISION OF FOOD. The following table of analyses is from the Offices of the County Council:— Food and Drugs (Adulteration) Act, 1928. Return of Samples Analysed during Year 1937. Articles. Analysed. Adulterated or Deteriorated. Prosecut'ns. Convic tions. Fines & Costs. Formal. Inform'l. Total. For- J Inmal. |form'l. Total. Milk 26 1 27 .. .. .. .. .. .. Cream 1 1 .. .. .. .. .. .. Butter 8 .. 8 .. .. .. .. .. .. Meat 11 .. 11 1 .. 1 .. . . .. Sausnges 4 .. 4 .. .. .. .. .. .. Devon Cream Scones .. 1 1 .. .. .. .. .. .. Confectionery and Jam 1 .. 1 .. .. .. .. .. .. Preservative Powder 1 .. 1 .. .. .. .. .. .. Sweet Almonds 2 .. 2 .. .. .. .. .. .. Ground Almonds 1 .. 1 .. .. .. .. .. .. Totals 55 2 57 1 .. 1 .. .. .. 22 Milk Supply. There are 60 dairies and milkshops in the district; 15 persons whose premises are outside the district are registered as retail purveyors. Routine inspection of premises has again revealed that the provisions of the Milk and Dairies Order, 1926, have been generally well observed. The following Licences to sell graded milks were granted in 1937:— Grade of Milk. Type of Licence. Dealers'. Supplementary. Tuberculin Tested 18 1 Accredited 1 — Pasteurised 18 3 23 The following Tables show the results of examinations of samples of milk during 1937:— Ordinary Milk Samples. Sample. Grade of Milk. Temperature on arrival at Laboratory Total Bacteria Presence of B. Coli in Methylene Blue Test Period before decolourisation (in hours) or satisfactory (S) l/10th c.c. l/100th c.c. l/1000th c.c. 1 Ordinary 12° C. 18,200 S 2 Ordinary „ 63,660 — — — S 3 Ordinary „ 19,960 — — — S 4 Ordinary „ 119,000 — + — 4 6 Ordinary „ 86,660 — — — S 6 Ordinary „ 130,330 — — — No Test done 1 Ordinary „ 149,330 — + — 5 8 Ordinary „ 34,830 — — — S 9 Ordinary 11° C. 275,000 — + — 3 10 Ordinary „ 63,660 — — — S 11 Ordinary „ 65,330 — — — s 12 Ordinary „ 51,330 — — — s 13 Ordinary „ 25,000 — — — s 14 Ordinary 14° C. 34,330 — — — s 15 Ordinary 11° C. 430,000 — + + 3 16 Ordinary „ 157,660 — — — 4 17 Ordinary „ 54,330 — — — S 18 Ordinary „ 130,660 — — — S 19 Ordinary 10° c. 49,500 + + — No Test done 20 Ordinary „ 22,500 — — — ,, 21 Ordinary ,, 24,500 — — — „ 22 Ordinary „ 26,000 — — — „ 23 Ordinary „ 27,000 — — — „ 24 Ordinary „ 29,000 — — — „ 25 Ordinary „ 30,500 — „ In the case of samples Numbers 19, 20, 21, 22, 23, 24, No. 19 represents a raw milk before Flash Pasteurisation ; Nos. 20, 21, 22 and 23 samples taken in sterile bottles at various points through the process, and No. 24 taken in an ordinary milk bottle. The samples represent an investigation into the reason for a high count and presence of Bacillus Coli in the case of Sample No. 15. 24 Pasteurised Milk Samples. Sample. Temperature on arrival at Laboratory. Total Bacteria. Presence of B. Coli in Phosphatase Test. l/10th c.c. l/100th c.c. l/1000th c.c. 1 12°C 5,430 - - - Satisfactory 2 „ 13,600 — — — „ 3 11°C 29,500 • + — — „ 4 „ 3,630 - — — „ 5 „ 15,300 — — — „ 6 „ 2,C30 — — — „ 7 „ 11,160 — — — „ 8 - 12,300 — — — No Test done. 9 - 13,130 - - - „ 10 14°C. 39,500 — + — Satisfactory 11 11°C. 13,760 — - — „ 12 „ 44,500 + - — „ 13 „ 17,930 — - — „ 14 „ 23,500 — - — „ 15 „ 2,560 — - — „ The presence of the Bacillus Coli in samples Nos. 3, 10 and 12 was investigated and the cause attributed to a post-pasteurisation feature. A subsequent sample proved negative. ICE CREAM. Number. Vendors' premises on Register at beginning of 1937 132 Premises where ice cream is manufactured 15 Premises where ice cream is sold but not manufactured 114 Vendors' premises on Register at end of 1937 129 All these premises, together with vehicles used by purveyors, were inspected during the Season. MEAT AND OTHER FOODS. The 54 butchers' shops within the Borough have been inspected and observation kept upon the vehicles used for the conveyance of meat, with the result that it had been found that the provisions of the Public Health (Meat) Regulations have been generally well observed. Necessary action was taken in 18 cases 25 where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. There are three private slaughter-houses in the district, of which two are licensed annually. The number of carcasses inspected at the time of slaughter, together with percentages of the an'mals found to be diseased either wholly or in part, are given in the following Table:— Cattle, excluding Cowi. Cows. Calves. Sheep and Lambs. Pigs. Number killed — 6 1045 — 475 Number inspected — 6 1045 — 475 All diseases except Tuberculosis. Whole oarcasses condemned — — 2 — 35 Carcasses of which some part or organ was condemned 5 — 97 Percentage of the number inspected with disease other than tuberculosis .. — — .670% — 27.79% Tuberculosis only. Whole carcasses condemned — — 5 — 12 Carcasses of which some part or organ was condemned 6 6 18 Percentage of the number inspected affected with Tuberculosis — 83.3% .96% — 6.3% 26 The following diseased and unsound meat and other foods have been detected, surrendered, and destroyed:— Other Foods. 6 lbs. Cod Fillets; 3 stones Lemon Soles; 7 lbs. Haddock Fillets ; 5 stones 1 lb. Dogfish ; Two tins Prawns ; 9 lbs. Chilled Salmon ; 1 box Kippers ; 28 lbs. Peaches ; 14 tins Fruit; 1 tin Jam; 10 tins Condensed Milk; 23 tins Vegetables. 27 MEAT. Carcasses or parts of carcasses found to be diseased. Number. BOVINES. Heads and Tongues (Localised Tuberculosis) 1 Sets of Lungs (Localised Tuberculosis) 4 2321bs. Beef (Bone Taint and Mould) Calves. Carcasses and Offals (Congenital Tuberculosis) 5 Livers (Localised Tuberculosis) 2 Plucks (Localised Tuberculosis) 3 Carcase and Offal (Nephritis and Urasmia) 1 Carcase and Offal (Septicaemia) 1 Head (Actinomycosis) 1 Kidneys (Bruising) 2 Livers (Parasitic) 1 Sets of Lungs (Pneumonia) 3 PIGS. Carcasses and Offals (Generalised Tuberculosis) 12 Heads and Tongues (Localised Tuberculosis) 7 Sets of Lungs (Localised Tuberculosis) 2 Mesenteric Fats (Localised Tuberculosis) 4 Plucks (Localised Tuberculosis) 5 Carcasses and Offals (Swine Fever) 35 Sets of Lungs (Pneumonia) 88 Livers (Cirrhosis) 9 SHEEP. Livers (Parasitic) 2 THE SLAUGHTER OF ANIMALS ACT, 1933. Steps have been taken to ensure that all animals slaughtered in the district have been stunned by means of a mechanically-operated instrument in accordance with the terms of this Act. Eleven persons were licensed to act as Slaughtermen during 1937. BAKEHOUSES. There are 25 Bakehouses within the District, and of these 17 are provided with moving power, the remainder being Workshops. Systematic inspection revealed the existence of certain sanitary defects. These, together with the necessary limewashing, were dealt with without the need for the service of formal notices. RATS & MICE (DESTRUCTION) ACT, 1919. During 1937, 825 visits were made in connection with rat or mice infested or suspected infested premises, and 163 premises were satisfactorily cleared of rats or mice. In addition to these visits the Council's Disinfector, who has been trained to assist in this work, has made 34 visits to the Council's properties and 254 visits to private premises. SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. 28 ERADICATION OF BED BUCS. Fifty bug-infested houses were dealt with as follows By the use of Insecticides. Sulphur. Hydrocyanic (H.CN.)Gas. Council Houses — — 2 Other Houses 42 1 5 One other case was in hand at the end of the year. Except where H.C.N, gas is used, the work of disinfestation is carried out by co-operation between the landlord and the Corporation on the lines indicated in previous reports. Contractors employed by private landlords, or by the Corporation in the case of Council houses, apply the H.C.N, method. In these cases bedding is dealt with by steam disinfection. EXCHANGE OF ARTICLES OF FOOD AND DRINK, ETC., FOR RAGS. Under Section 154 of the Public Health Act, 1936, it is not lawful for any person who collects or deals in rags, old clothes or similar articles, to sell or deliver any article of food or drink to any person or any article to a person under fourteen years of age. A warning was given in one case where toys were given in exchange for rags to children. The offence was not repeated. SHOPS ACT, 1934. The following figures are given by courtesy of the Town Clerk, who administers the above Act:— Number of Shops within the Borough 1190 Number of visits paid to Shops within the Borough during 1937 2082 29 Number of Shops within the Borough where ventilation found to be not suitable and sufficient — Number of Shops within the Borough where ventilation rendered suitable and sufficient as the result of— (a) Informal action — (b) Formal action — Number of Shops within the Borough where reasonable temperature not maintained 29 Number of Shops within the Borough where means of heating provided as the result of— (a) Informal action 29 (b) Formal action — Number of Shops within the Borough where suitable and sufficient sanitary accommodation not provided, 47 Number of Shops within the Borough where suitable and sufficient sanitary accommodation provided as the result of— (a) Informal action 47 (b) Formal action — Number of Shops within the Borough where the provisions of Section 10 (1) and (2) were complied with at the end of 1937 1091 Number of Certificates granted by the Local Authority exempting shops from the provision of Section 10 (2) 23 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Two hundred and seventy-three cases of infectious disease were notified during 1937, a decrease of seventv-nine eases on the previous year. The decline in Scarlet Fever was in keeping with a general decline 30 in prevalence of the disease. Other forms of streptococcal infection did not appear to share in this decline, and notifications of puerperal pyrexia were higher. The incidence of Diphtheria was low, but the mortality was relatively high owing to a number of cases of virulent infection. The principal enteric infection was a mild Dysentery of the Sonne Type which became prevalent in November. There were two cases of Anterior Poliomyelitis, and recovery in both has been almost complete. One acute case of cerebro-spinal fever of a sporadic type ended fatally. Three cases of Opthalmia Neonatorum were notified during the year. The following Table gives a comparison of notifications in 1937 with the average for the preceding four years:— Scarlet Fever Diphtheria Pneumonia Enteric Puerperal Pyrexia Average rate 1933 -1936 180 59 19 9 9 1937 159 28 13 3 11 Scarlet Fever.—One hundred and fifty-nine cases were notified. Of these, eight were institution cases. The disease was generally mild, but there was a higher proportion of more severe cases suggesting an increase of virulence of the causative organism with the decline in the epidemic wave. The highest numbers of cases were again in the West Central and NorthEast Wards which, with the North and East-Central Wards, contributed sixty-eight per cent, of the cases. The case rate for the Borough was 2 02 per 1,000 of population compared with a case rate of 2 33 for England and Wales. Thirty of the one hundred and fiftyone district cases were nursed at home. Twelve secondary cases of infection occurred after removal of patients to hospital, and there were six "return" cases related to infection by patients discharged. The prevention of secondary cases depends on speedy isolation in the home or removal of any suspected cases. 31 Diphtheria.—The incidence of Diphtheria was very low. Twenty-eight cases were notified and of these three were institution cases. The case rate was 0 37 per 1,000 of population compared with 149 per 1,000 of population for England and Wales. A sequence of cases of a virulent type caused a high mortality. The source of infection of two fatal cases occurring simultaneously was a nasal carrier. The extremely rapid development of the illness, the profound toxaemia, and the poor response to treatment of this type of infection, make the necessity for the safeguard of immunisation apparent. One of the cases notified was a child who had received immunising injections the previous year. The clinical evidence of infection was slight, toxaemia was absent, and complete recovery was rapid. As to the Prompt Use of Anti-toxin.—Early treatment depends on early diagnosis. Parents should call their medical practitioner to see cases of suspected Diphtheria at the earliest possible moment. In severe cases a large initial dose of Anti-toxin is essential. Artificial Immunisation against Diphtheria.—The facilities provided for immunisation continue to be appreciated. Five hundred and twenty-one children receive three immunising injections each. Clinics were arranged at schools and explanatory leaflets and consent forms distributed to the parents of the younger children. The acceptance rate remained between 20 and 40 per cent., but the groups of new entrants approached were slightly smaller and the number of acceptances correspondingly reduced. The number of children attending the weekly clinic at the Public Hall increased and indicated a higher voluntary response. Propaganda was carried on by Health Visitors and at the Child Welfare Centres. The material used was Toxoid-Antitoxin-Floccules (T.A.F.) given in three doses of 1 c.c. into the upper arm, and very satisfactory freedom from reaction has continued. Of eighty-two children submitted to the Schick Test, after injection eighty were negative and 32 two were mildly positive, giving an immunising rate of 976 per cent. Of twenty-one older children submitted to the Schick Test before injection, seventeen were positive and four negative. These figures suggest that the child population has a relatively low natural immunity to Diphtheria and that artificial immunisation produces a very satisfactory percentage of immunes. The following table shows the distribution in age groups of the children receiving three injections of T.A.F. during 1937 DIPHTHERIA IMMUNISATION, 1937. Children receiving three injections of 1cc. T.A.F. Age Group:— —1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 Total Clinic - 19 2.5 29 30 48 17 14 10 2 6 6 206 Benhilton C. of E. Infants - - - - 1 2 3 1 - - 1 - 8 Chatsworth Koad School - 1 2 2 3 27 22 4 5 - - - 66 Cheam Common Infants School - 5 9 7 9 41 13 - 4 1 4 1 98 Ridge Road School - - 1 - 1 20 11 2 1 3 2 - 41 Sutton East Juniors Mixed and Infants School - - 3 3 3 35 25 6 2 - - - 77 Medical Practitioners' Cases - - - 1 4 10 2 2 3 1 - 2 25 Total - 25 40 42 51 183 93 33 25 7 13 9 521 Bacteriological Examinations.—The following examinations of specimens were made by direction of the Borough Council:— Diphtheria. Enteric. Tuberculosis. Positive. Negative. Positive. Negative. Positive. Negative. 33 611 4 72 14 110 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory ; these are not included in the above Table. 33 Notifiable Diseases (other than Tuberculosis) during 1937. Disease. Under 1 Years. 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 Scarlet Fever 2 4 11 11 66 19 5 26 4 3 151 121 - Diphtheria 1 1 1 4 3 6 3 1 3 1 — 1 25 24 5 Typhoid Fever - - - - - - - - 1 - - — 1 1 1 Para-typhoid B — — — — — — — — 1 - — — 1 1 — C — — — — — — — — — 1 — - 1 — — Puerperal Pyrexia - - - - - - - - 10 - - - 10 6 1 Puerperal Fever - - - - - - - - - 1 - - 1 - - Pneumonia — 2 — — 1 1 — - 1 1 5 2 13 — 40 Erysipelas 1 — — — — — — — 2 4 6 3 16 9 - Dysentery 4 2 1 — 1 12 1 1 5 4 4 1 36 2 — Poliomyelitis - - - 1 - 1 - - - - - - 2 1 - Cerebro-Spinal Fever - - - - - - - - 1 - - - 1 1 1 Ophthalmia Neonatorum 3 - - - - - - - - - - - 3 2 - Therapeutic Malaria — — — — — — — - - 1 — - 1 1 — London S.F cases in the Downs — — — — 3 2 1 — 2 - — — 8 7 — Hospital Dip. — — — 1 1 — — 1 — — — — 3 3 — *Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. 34 WARDS. Disease. N. N.W. N.E. W.C. E.C. E. S.W. S.E. S. Total Case Rate per 1000 Populatn (MidYear) Case Rate per 1000 England and Wales. Population 10082 8648 9998 12740 7409 6594 5198 5786 7775 74530 Scarlet Fever 24 12 31 25 23 10 2 11 13 151 2.02 2.33 Diphtheria 6 2 3 4 4 4 — 1 2 25 0.34 1.49 Typhoid Fever — 1 — — — — — — — 1 0.04 ,, Para B 1 1 0.05 ,, c — — — — — — — — 1 1 Pneumonia 2 1 1 1 1 2 1 3 1 13 0.17 1.36 Erysipelas 3 3 2 2 2 — — 1 3 16 0.20 0.37 Puerperal Fever — — — — — — 1 — — 1 0.15 Puerperal Pyrexia 3 1 6 10 — Dysentery 5 — 5 7 14 — 1 1 3 36 0.48 — Poliomyelitis — — — — 1 — — — 1 2 0.08 — Cerebro-Spinal Fever - - - 1 - - - - - 1 - - Ophthalmia Neonatorum - - 3 - - - - - - 3 - - Therapeutic Malaria - 1 - - - - - - - 1 - - Total 39 20 48 41 45 17 5 17 30 262 35 36 Monthly distribution of cases of Notifiable Infectious Disease throughout 1937. DISEASE. Jan. Feb. March. April. May. June. July. Aug. Sept. Oot. Nov. Dec. Scarlet Fever 16 14 18 16 11 8 9 5 17 15 11 11 Diphtheria 2 5 9 3 .. 1 .. 1 .. 1 .. 3 Typhoid Fever .. .. .. .. .. 1 .. .. .. .. .. .. Paratyphoid B .. .. .. .. .. .. .. 1 .. .. .. .. „ C .. .. .. .. .. 1 .. .. .. .. .. .. Puerperal Pyrexia .. .. 1 1 .. .. 1 .. 1 .. 5 1 Puerperal Fever .. .. .. .. .. .. .. .. 1 .. .. • • Pneumonia 1 2 2 1 .. .. 1 1 1 .. 1 .. Erysipelas 7 2 2 1 .. 2 .. 1 .. 1 .. .. Dysentery .. .. .. .. .. .. .. .. 1 .. 29 .. Poliomyelitis .. .. .. .. .. .. .. .. 1 1 .. .. Cerebro—Spinal Fever • • .. .. .. 1 .. .. .. .. .. .. .. Ophthalmia Neonatorum 1 .. .. .. 2 .. .. .. •• •• •• .. Therapeutic Malaria .. .. .. 1 •• .. .. .. .. •• •• •• Typhoid and Paratyphoid Fever One case of Typhoid Fever and two cases of Paratyphoid Fever were notified. They were of a sporadic type and probably related to carrier infection. The case of Typhoid occurred in June in a man who worked outside the district. Investigation did not reveal any probable source of infection within the Borough. Puerperal Fever and Puerperal Pyrexia.—Ten cases of Puerperal Pyrexia and one case of Puerperal Fever were notified. The case rate for Puerperal Pyrexia was 8 6 per 1,000 total births compared with 13 93 per 1,000 total births for England and Wales. Medical practitioners were informed of their obligation to continue the notification of cases of Puerperal Pyrexia under Part III of the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Four of the notifications of Puerperal Pyrexia were of cases occurring in sequence in one nursing home. The subsequent deaths of two of the cases and the rescinding of the registration of the nursing home by the County Authority, emphasise the responsibility of persons in charge of nursing homes, and of medical practitioners in attendance on cases in nursing homes, to take all practicable steps to prevent infection by the strictest aseptic and antiseptic precautions, the transmission to the Authority of information of any undefined febrile condition occurring in the puerperium, the effective isolation of any suspected case, and the fullest use of the consultant, bacteriological and hospital services provided by the Authority. Dysentery.—In November the district became involved in an outbreak of Dysentery of the Sonne Type which occurred over a wide area of the country. Thirty-six cases were notified. These notifications represented only a small percentage of the total incidence, which was characterised by a wide range of severity, and a high proportion of mild ambulant cases which sustained the transmission of infection. The 37 dysentery appeared in homes even of the highest hygienic standard. Investigation suggested that foods not submitted to secondary heat treatment were to some extent involved, and a circular was sent to food retailers drawing attention to the need for the utmost hygienic care in the exposure, handling and distribution of foods. Direct personal contact with infected persons was also a common source of infection. The high infectivity and wide range of severity could be demonstrated by cases with slight and transient symptoms being followed by others of severe diarrhoea with blood and mucus in the stools. The predominant symptoms in a proportion of cases were sickness and vomiting without diarrhoea, and the number of cases showing the typical symptoms of dysentery was relatively low. The recurrence of this type of infection suggests that persistent carriers exist and that those can only be rendered innocuous by the maintenance of a very high standard of personal and domestic hygiene, and of hygienic food control by the food distributing trades, both wholesale and retail. Influenza.—The epidemic during the first quarter of the year was generally of a mild type. Of the sixteen deaths during the year, thirteen occurred in the first quarter mainly from pulmonary infection in persons over 60 years of age. Non-Notifiable Diseases.—School teachers also reported 143 cases of Chicken-pox, 21 of Whooping Cough, 112 of Measles, 31 of German Measles and 36 of Mumps. School notifications formed the basis of frequent consultations with the School Medical Officer. There was no death from Measles and one death from Whooping Cough due to pulmonary complications. An arrangement has been made for the preparation of serum from the blood of healthy parents of individual children when requested by medical practitioners for the prevention or attenuation of measles. Two such 38 requests were received, and attenuated attacks resulted. Notification of Pneumonia.—Of the 40 deaths occurring from all forms of pneumonia, two were notified previous to death. The total number of notified cases arising in the district was 13. TUBERCULOSIS. On 31st December, 1937,, there were on the Register 405 cases of Tuberculosis, of which 321 were pulmonary and 84 non-pulmonary cases. The death rate for Pulmonary Tuberculosis was 0'42 per 1,000 of population, and for Non-pulmonary Tuberculosis 0'05 per 1,000 of population. The total Tuberculosis death rate in 1937 was 0'47 per 1,000 of population, compared with 0'61 per 1,000 of population in 1936. The corresponding death rates for England and Wales in 1937 were : Pulmonary, 0'58 per 1,000 of population ; Non-pulmonary, 0T1 per 1,000 of population. Total rate0'69 per 1,000 of population. The following Table shows new cases and deaths in age groups :— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary Pulmonary. NonPulmonary. M F M F M F M F 0 - - - - - - - 1 1 1 - - - - - - - 5 — 3 4 3 — — 1 — 15 6 15 — 2 3 4 — — 25 8 6 3 — 3 6 1 — 35 8 3 3 1 1 1 — — 45 4 - - - 2 1 - - 55 7 - - 1 4 1 - 1 65&above - 2 - — 2 3 - — Totals . 34 29 10 7 15 16 2 2 39 NOTIFICATION OF TUBERCULOSIS. Respiratory Forms of Death—27 out of 31 were notified. Other Forms of Death—3 out of 4 were notified. RAINFALL IN 1937. Total. Days with o-oi in. or more Days with 0-04 in. or more. Sutton Sewage Farm 33.99 184 126 Worcester Park Sewage Farm 31.05 176 120 BOROUGH OF SUTTON AND CHEAM. Clinics Controlled by the Surrey County Council. SUTTON DISTRICT— Clinic.—The Public Hall, 1, Hill Road, Sutton. Tuberculosis Dispensary.—Every Wednesday, at 2 p.m., and the third Wednesday in the month at 5.30 p.m. Ante-Natal Clinic.—Every Friday, at 1.30 p.m., and 2nd and 4th Monday in the month at 10 a.m. Infant Welfare Every Tuesday, from 2 p.m. to 4 p.m. CHEAM AND WORCESTER PARK DISTRICT— Clinic.—Parochial Rooms, Maiden Road, Cheam Infant Welfare.—Every 1st and 3rd Wednesday in the month at 2 p.m. to 4 p.m. Ante-Natal Clinic.—Every Friday at 10 a.m., and 2nd and 4th Thursdays at 10 a.m. Clinic.—St. Oswald's Hall, Brocks Drive, North Cheam. Infant Welfare.—Every Friday at 2 p.m. Borough Immunisation Clinic.—The Public Hali, No. 1, Hill Road, Sutton, on Tuesdays, at 2.15 p.m. 40