SUTC 2 Borough of Sutton and Cheam. ANNUAL REPORT of the Medical Officer of Health For the Year 1938. William Pile, Ltd., Printers, 46-50, High Street, Sutton. BOROUGH OF SUTTON AND CHEAM. With Compliments of the Medical Officer of Health ENEAS J. MACINTYRE, M.D., D.P.H., MANOR PARK HOUSE, MANOR PARK ROAD, SUTTON, SURREY. BOROUGH OF SUTTON & CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1938. PUBLIC HEALTH AND HOUSING COMMITTEE. HIS WORSHIP THE MAYOR (Alderman GRAHAME R. GLEGG, J.P.), ex-officio. Alderman CECIL COLMAN, J.P. Alderman F. C. LOHDEN, O.B.E., (Chairman). Coun. W. COOKE. Coun. R. W. JENKINS. „ Mrs. A. DUVAL. „ G. J. JEWETT. „ J. EVERETT. „ H. J. TRICKETT, C.C. „ E. GELLETT „ W. T. VENTON. 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.; Cerlif. Meat & Food; Certif. S.I. Exam. Board. Assistant Inspectors: JOHN HENRY LOTT, Certif. R.S.I.; Certif. Meat & Food. JOSEPH NORMAN JENKINSON, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. *JAMES RICHARDSON WHITE, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. +GEORGE EDWARD MATON, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. *Resigned :—4th June, 1938. †Appointed :—2nd August, 1938. 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 fifth Annual Report on the health of the Borough of Sutton and Cheam. The standard of health of the community during the year 1938 was high. There was a further decrease in the general incidence of notifiable infectious diseases. The prevalence of Scarlet Fever again declined, and the number of cases of Diphtheria was the lowest yet recorded. Serious enteric infections were absent, and a smaller number of cases of mild Dysentery of the Sonne Type were notified. A small outbreak of Epidemic Catarrhal Jaundice affecting school children occurred during November. Measles was epidemic during the first six months of the year. The water supply of the district maintained a satisfactory standard of chemical and bacteriological purity. Efficient control by daily sampling and by protective chlorination was carried out. The death rate at 9.1 per 1,000 of population was lower. The birth rate was higher at 15.9 per 1,000 of population. The maternal mortality and infantile mortality rates were lower. The sanitary circumstances of the area were satisfactory and the sanitary work was efficiently carried out under the direction of the Chief 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 the 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 433815 Registrar-General's Estimate of the Resident Population, 1938 75580 Number of inhabited Houses (end of 1938) according to Rate Books 21606 Rateable Value and sum represented by a £876636 Penny Rate £3511 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 1938. LIVE BIRTHS: T. M. F. Total 1206 614 592 Birth-rate of the resident 15.9. per 1,000 estimated population, Legitimate 1156 582 574 Illegitimate 50 32 18 STILL BIRTHS: T. M. F. Rate per 1,000 (live and still) births, 290. Total 36 25 11 Legitimate 35 24 11 Illegitimate 1 1 - T. M. F. Death-rate per 1,000 of the estimated resident population, 9.1. Deaths 655 328 327 3 Deaths from puerperal causes :— Deaths 4 Rate per 1,000 total (live and still) births 3.32 Deaths from— Puerperal Sepsis 1 Other Puerperal causes 3 Total 4 Death-rate of Infants under one year of age :— All Infants per 1,000 live births 28.2 Legitimate Infants per 1,000 legitimate live births 26.8 Illegitimate Infants per 1,000 illegitimate live births 60.0 Deaths from Cancer (all ages) 125 ,, Measles (all ages) 1 ,, Whooping Cough (all ages) 0 ,, Diarrhœa (under 2 years of age) 2 Registrar's Estimate of the Resident Population :— Mid-Year 1938 75,580 Resident Staff, Patients, Inmates and Scholars (not having their residence in the District):— Staff. Inmates. London Industrial Colony 16 513 Hospitals 243 624 Private Schools 12 58 271 1195 By adding the non-resident Inmates to Registrar's Estimate of the Resident Population the Gross Population was at Mid-Year 77,046 On the population estimate of 75,580:— The Birth-rate was 15.9 per 1,000 persons living. The Death-rate was 91 per 1,000 persons living. The Infant Mortality (deaths under 1 year per 1,000 births) 28.2 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, 1938. England and Wales, 126 County Boroughs and Great Towns, and 148 Smaller Towns. Provisional figures based on weekly and quarterly returns. — Rate per 1,000 Population. Annual Death rate per 1,000 population. Rate per 1,000 Live Births. All Causes. Typhoid and Para-typhoid fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhœa and Enteritis Hinder 2 Years). Total Deaths under One Year. Live Births. Still Births. England and Wales 151 0.60 11.6 0.00 - 0.04 0.01 0.03 0.07 0.11 5.5 53 126 County Boroughs and Great Towns, including London 15.0 0.65 11.7 0.00 - 0.05 0.01 0.03 0.07 0.10 7.8 57 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 15.4 0.60 11.0 0.00 - 0.03 0.01 0.02 0.06 0.11 3.6 57 London 13.4 0.48 11.4 0.00 - 0.06 0.01 0.03 0.05 0.06 13.1 57 Sutton and Cheam 15.9 0.48 9.1 0.00 - 0.01 0.01 0.00 0.01 0.08 1.6 28 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows : per 1,000 Live Births 0.89 2.19 3.08 ,, ,, Total Births 0.86 2.11 2.97 „ „ ,, „ Sutton & Cheam are as follows : per 1,000 Live Births 0.83 2.49 3.32 ,, „ Total Births 0.81 2.41 3.22 The averages of the ten years 1928-1937 were:— Birth-rate 151 Death-rate 95 Percentage of deaths in age-groups :— Percentage of Deaths. Under 1 year 52 1—4 years 1.8 5—14 0.8 15—64 40.0 65 and above 52.2 Percentage of Deaths from certain causes to the total number of Deaths :— Diseases of the heart and circulation 30.9 Cancer and malignant disease 19.0 Diseases of lungs (not tuberculous) 8.2 Tuberculous diseases 6.5 Cerebral hæmorrhage 4.7 Congenital diseases 3.2 Suicide and violence 3.2 Diseases of the digestive system 7.2 Infectious diseases 1.7 Diseases of the kidney 2.7 Senility 2.3 Other defined causes 10.4 The number of Deaths from the common infectious diseases were:—Measles 1, Diphtheria 1, Scarlet Fever 1, Whooping Cough 0, and Influenza 6. 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 Rate. 7.9 6.6 6.8 6.8 10.9 10.1 13.4 9.6 9.8 Maternal Mortality.— There was one death from puerperal sepsis. Two deaths occurred from toxaemia related to placenta prævia and to miscarriage respectively. There was one death from pulmonary embolism. Infantile Mortality.— The rate is reduced from 50 per 1,000 live births to 28 2 per 1,000 live births. The majority of deaths were due to premature birth and congenital debility. 6 CAUSES OF DEATH IN 1938. Total. Under 1 year. 1—2 years. 2—5 years. 5—15 years. 15—65 years. 65 and above. Typhoid and Para-typhoid Fevers - - - - - - - Measles 1 - - 1 - - - Scarlet Fever 1 - - 1 - - - Whooping Cough - - - - - - - Diphtheria 1 - - - - 1 - Influenza 6 - - - - 4 2 Enœphalitis Lethargica 1 - - - - - 1 Cerebro-spinal Fever 1 - - 1 - - - Tuberculosis of the Respiratory System 37 - - - 1 31 5 Other Tuberculous Diseases 6 1 - 2 - 3 - Syphilis 3 - - - - 1 2 General Paralysis of the Insane, Tabes Dorsalis 2 - - - - 1 1 Cancer, malignant disease 125 - - 1 1 65 58 Diabetes 5 - - - - 3 2 Cerebral Hœmorrhage, etc. 31 2 - - - 10 19 Heart Disease 154 - - - - 34 120 Aneurysm 3 - - - - 1 2 Other Circulatory Diseases 47 - - - - 14 33 Bronchitis 14 1 - - - 4 9 Pneumonia (all forms) 37 4 1 2 1 15 14 Other Respiratory Diseases 3 - - - - 1 2 Peptic Ulcer 5 - - - - 2 3 Diarrhoea, etc. (under 2 years) 2 2 - - - - - Appendicitis 8 - - - - 7 1 Cirrhosis of Liver - - - - - - - Other Diseases of Liver 4 - - - - 1 3 Other Digestive Diseases 10 - - - - 6 4 Acute and Chronic Nephritis 18 - - - 1 8 9 Puerperal Sepsis 1 - - - - 1 - Other Puerperal causes 3 - - - - 3 - Congenital Debility, Premature Birth, Malformation, etc. 21 20 - 1 - - - Senility 15 - - - - - 15 Suicide 9 - - - - 6 3 Other Violence 22 2 - - - 11 9 Other Defined Diseases 59 2 - 2 1 29 25 Causes Ill-defined - - - - - - - Totals 655 34 1 11 5 262 342 52.2 per cent. of deaths are at 65 years or above— 65—74 years 156 75—84 years 147 85—94 years 38 95 and above 1 342 7 INFANT MORTALITY, 1938. Causes of 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. 13 3 1 - 17 2 1 - - 20 Whooping Cough - - - - - - - - - - Measles - - - - - - - - - - Pneumonia - - - 1 1 1 1 1 - 4 Bronchitis - - - - - 1 - - - 1 Enteritis - - - - - 2 - - - 2 Other defined causes 5 - 1 - 6 - - 1 - 7 Totals 18 3 2 l 24 6 2 2 - 34 M. F. Total M. F. Total Nett Births registered during the calendar year Total 614 592 1206 Nett Deaths registered during the calendar year legitimate 18 13 31 legitimate 682 674 1156 illegitimate 32 18 50 illegitimate 1 2 3 Still Births Total 25 11 36 Death Rate per 1000 births legitimate .. 25 7 legitimate 24 11 35 illegitimate .. 2.5 illegitimate 1 - 1 Death Rate to total births .. 28.2 Ward Distribution. Ward. N. N.W. N.E. W.C. E.C. E. S.W. S.E. S. No. or Deaths. 6 2 6 7 2 6 — 3 2 8 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. Legislation.— The Factory Act, 1937, became operative on 1st July, 1938. Public Health propaganda.- The series of Health Days arranged under the National Health Campaign at approximately monthly intervals was concluded in March, 1938. On 25th June, 1938, a display of propaganda literature was arranged in association with the Fete of the Sutton and Cheam Labour Party, and a similar display was included in the Fete of the Sutton and Cheam Hospital on 9th July, 1938. Exhibitions of physical culture were given at the latter event by the gymnastic section of the Sutton Adult School and by the Women's League of Health and Beauty to whom thanks are due for their ready support. A "Youth Drive" was organised by the Sutton and Cheam Council of Social Services on 15th, 16th and 17th July, 1938. All these efforts helped to stimulate interest in healthy living as the basis of happy community life. The action of the Council in promoting the use of the parks for plays and dancing during the summer has induced a wider appreciation of the value of open spaces. 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 sixteen nurses. The increased staff necessitated by increased work has in the cases of the Sutton Association and Cheam Association required the provision of better accommodation. The new home of the Sutton Nursing Association at Hampden House, Sutton Court Road, Sutton, was officially opened on 19th October, 1938. The Cheam Nursing Association decided to purchase "Church Farm House," Spring 9 Close Lane, Cheam. The cost involved in these purchases and the increased annual expenditure consequent on the growing demands for service, place a heavy strain on the financial resources of the associations. The extensive and efficient work of these associations constitutes a valuable social service to the community which should receive recognition by increased financial support. Reports of cases nursed through each of the associations in relation to Maternity, Midwifery, Pneumonia and infectious disease were received at the end of the year. Proportionate grants were made and agreements continuing representation of the Council on the Committees of the Associations were renewed. 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.— Cases of infectious disease are admitted to Cuddington Isolation Hospital, where excellent provision is made for treatment. The hospital is administrated by the Cuddington Joint Hospital Board. Ambulance.— The Council's ambulance is of modern design, and has continued to give efficient service in dealing with accidents and urgent illness. Arrangements continue for co-ordination of service with1 surrounding districts. "The Cheam and District Ambulance Contributory Scheme" provides an efficient supplemetary service in cases of accident, illness and maternity, from their Ambulance Station at Farm Way, Worcester Park. Mortuary.— The Council's mortuary is situated at Sutton Cemetery. During the year 55 bodies were received, and 51 post-mortem examinations were made. 10 Sanitary Circumstances of the Area. Water Supply.— The water supply is mainly derived from the deep wells in the chalk of the Sutton District Water Company, situated at Sutton, Cheam and Woodmansterne. A small area in the North Ward is supplied by the Metropolitan Water Board. The Cheam wells were re-opened to supply on 18th June, 1938, with the approval of the Minister of Health. Efficient safeguards by tank settlement, chlorination, and bacteriological control have been adopted. The water from all the wells of the Sutton District Water Company is softened to 9 degrees of hardness. Chlorine is applied in the form of chloramine as a protective measure. Samples are! examined daily by the Company's chemist and bacteriologist in the laboratory at the Sutton works. Samples are also examined at monthly intervals by the Company's Consultant Analyst, and monthly samples are examined in rotation by the District Councils in the area of supply. The supply from all sources has been satisfactory in quality and quantity, and below is the average of monthly analyses:— Total solid residue dried at 180° C. Ammonia, free. Ammonia Albuminoid. Nitrogen as Nitrates. Nitrogen as Nitrites. Oxygen absorbed in 4 hours at 80°F. Chlorine (in chlorides). Hardness total (soap test). No. of Bacteria growing on Agar per c.c. for 3 days at 20o C. No. of Bacteria growing on Agar per c.c. for 1 day at 37o C. Presence of Bacillus Coli in 100 c.c. Average 18.25 .0171 .0006 0.8400 0 .0037 1.8833 7.22 3 1 .1 11 Drainage and Sewerage.— During the year a new Relief Soil Sewer has been laid in Sandy Lane, from Glebe Road to Cuddington Avenue, and thence half way along Cuddington Avenue. New Surface Water Sewers have been constructed to drain the Hilldale and Upper Mulgrave Road areas, and to drain the Bushey Lane and St. James' Road areas. A new Relief Surface Water Sewer has been laid in Forest Road, Sutton. A new Soil Sewer has been laid in The Drive, Belmont. Specifications and Bill of Quantities are being prepared for the construction of a new High Level Relief Soil Sewer to serve the greater part of the Parish of Sutton, and a new Main Sewer will shortly be laid from Gander Green Lane to the Worcester Park Sewage Works. The enlargement of the Worcester Park Sewage Works is under consideration, and plans are in course of preparation for large scale additions and alterations. 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 at the present time low loading mechanical vehicles are hired under contract. The original term of this contract having now expired, the Council have purchased six modern rear loading 15 cubic yard refuse collection vehicles, and one 7 cubic yard side loading vehicle, which will be put into commission in April, 1939. The house refuse is disposed of at the Refuse Disposal Plant at Boscombe Road, Worcester Park, which consists of an eight-cell top feed mechanically clinkered trough grate incinerator. 12 All scavenging of the public highways is carried out by the Borough Council under the direction of the Borough Engineer and Surveyor. Rivers and Streams.— During the year the Surrey County Council have been actively engaged on the improvement of the Beverley and Pyl Brooks, and the work within this Borough is now practically complete. Closet Accommodation.— There are 34 cesspools in use. The work of redraining 20 of these in The Drive, Belmont, is now in hand. During 1938, 13 houses and one set of stables with cesspool drainage have been connected to the sewers and the cesspools abolished. Some seven pail closets and one privy are in use. In the past eleven years 135 premises, originally with cesspool drainage, have been connected to sewers. SANITARY INSPECTION OF THE AREA. Report of the Chief Sanitary Inspector under Art. 27 of the Sanitary Officers (Outside London) Regulations, 1935. Record of Inspections and Notices Served. Number. House to House Inspections 162 Special Inspections, Interviews on Premises, and Advisory Visits 1475 Re-inspections 3363 Visits to Works in Progress 1766 Visits to Factories and Workplaces 444 Visits to Bakehouses 61 Visits to Outworkers' Premises 77 Visits to Slaughterhouses 337 Visits to Butchers' and Food Shops 304 Visits to Dairies and Milkshops 153 13 Number. Visits to Ice Cream Premises and Vehicles 145 Visits to Stables 5 Visits to Pigsties 22 Visits re Rat Infestation 897 Visits re Rag Flock Act 6 Visits in connection with Infectious Disease 178 Visits re Overcrowding and "Permitted Number" Measurements 496 Visits to Petroleum Spirit and Cinematograph Film Stores 321 Miscellaneous 998 11210 Premises at which defects or nuisances were discovered 931 Dwelling-houses inspected for housing defects under Public Health or Housing Acts 391 Defects or nuisances discovered 4032 Defects or nuisances remedied 3054 Defects or nuisances in hand 601 Defects or nuisances outstanding 377 Informal Notices served 1103 Statutory Notices served 16 Complaints received and investigated 530 Summary of Remedial Works and Sanitary Improvements carried out. Number. Number of Houses and Premises re-drained 49 Repairs or amendments to existing drains 23 Drains or gullies unstopped or cleansed 114 Lengths in feet of stoneware drains laid 3316 Lengths in feet of iron drains laid 1530 Manholes provided, covered or repaired 124 Fresh air inlets provided or repaired 50 New gully and intercepting traps fixed 73 Gully curbs, channels and gratings provided or repaired 105 New soil pipes and ventilating shafts provided 31 14 Number. Soil pipes and ventilating shafts repaired 15 Cesspools abolished 16 Pail Closets abolished 2 Rainwater soakaways provided 2 Water and Smoke tests applied to drains 288 New W.C. Basins fixed 79 W.C.'s unstopped, cleansed or repaired 65 W.C. Seats provided or repaired 104 New Flushing Cisterns provided 29 Existing Flushing Cisterns repaired 39 Joints between W.C.'s and flush pipes repaired 26 New W.C. Apartments provided 30 W.C. Apartments lighted and/or ventilated 9 Separate W.C.'s for Sexes provided 3 Ventilated Lobbies to W.C. Apartments provided 2 Urinals cleansed 4 Urinals provided 2 Lavatory Basins provided 11 Old insanitary sinks removed 34 New impervious sinks provided 53 New waste pipes fixed 49 Waste pipes trapped, repaired or unstopped 29 New roofs provided 4 Roofs repaired 231 Eaves guttering provided, cleansed or repaired 105 Rainwater pipes provided, repaired or unstopped 78 Rainwater pipes disconnected from drains 1 Damp walls remedied by :— (a) Provision of horizontal damp-proof Courses only 29 (b) Provision of vertical damp-proof courses only 84 (c) Provision of horizontal and vertical damp-proof courses 56 (d) Rendering of walls internally 63 (e) Rendering of walls externally 24 (f) Other means 172 15 Number. Brick walls repointed, rendered or repaired 199 Copings to parapet walls, provided 8 Settlements in walls remedied 6 Scullery rebuilt 1 Chimney stacks repaired or pots provided 44 Chimney stacks rebuilt 4 Ventilation under floors provided 61 Curbs and gratings to vent openings provided 10 Yards to dwelling-houses paved 55 Yard paving to dwelling-houses repaired 51 Yards of other premises repaired 7 Yards of other premises paved 1 Yards of other premises cleansed 12 Floors of rooms relaid 25 Floors of rooms repaired 72 Sites of floors concreted 22 Floors of other premises relaid 28 Floors of other premises repaired 11 House approaches paved 27 Floors of other premises cleansed 5 Rooms cleansed, distempered or repapered 727 Passages and staircases and landings cleansed, distempered or repapered 93 Larders cleansed and distempered 14 W.C. Apartments cleansed and distempered 135 Permanent ventilation to rooms provided 5 Additional lighting and ventilation to rooms 22 New windows provided 13 Windows repaired or made to open 189 New sash cords provided 217 Window sills provided or repaired 81 Doors provided or repaired 44 Thresholds to doors provided or repaired 31 Reveals to windows and doors repointed 122 Fasteners to windows and doors provided 46 Handrails to staircases provided 21 Staircases repaired 6 Houses provided with a sufficient water supply 6 16 Number. Water service pipes and cisterns repaired 5 Movable sanitary dustbins provided 81 Offal bins provided 4 Ranges and stoves provided or repaired 58 Hearths provided or repaired 5 Coppers provided or repaired 22 Slaughterhouses cleansed 1 "Rooms" in Butchers' Shops and Stores. cleansed 14 Dairies, Food Shops and Ice Cream premises cleansed 31 Proper Stores provided in Food premises 2 Refrigerators cleansed 4 Refrigerators provided 2 Food premises provided with Ventilation 4 Bakehouses, Restaurant Kitchens and Workrooms limewashed 76 Manure Pits constructed 1 Nuisances from keeping of animals abated 9 Nuisances from smoke abated 2 Accumulations of refuse removed 80 Accumulations of manure removed 6 Offensive ditches cleansed 1 Miscellaneous 204 Infectious Disease, Disinfection, &c. Rooms disinfected after Notifiable Infectious Diseases 173 Rooms disinfected after Tuberculosis and other Diseases 97 Smoke Abatement. There are few chimneys attached to industrial premises in this district. Two instances of emission of grit and sooty particles were dealt with by informal action. 17 1. Inspection of Factories and other premises under the Act. Inspections made by Sanitary Inspectors for purposes of provisions as to health. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories with Mechanical Power 226 73 - Factories without Mechanical Power 234 60 - Other Premises (other than Outworkers' premises) - - - Total 460 123 - 2. Defects found in Factories, and other premises under the Act. Particulars. (1) Number of defects. Number of defects in respect to which prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector Want of Cleanliness 63 62 - - Inadequate Ventilation 2 2 - - Overcrowding - - - - Unreasonable Temperature - - - - Ineffective Drainage of Floors - - - - Other Nuisances 67 66 - - Sanitary accommodation— (a) Insufficient 3 3 - - (b) Unsuitable or defective 7 5 - - (e) Not separate for sexes - - - - 142 138 - - 18 Outwork in Unwholesome Premises. Nature of Work. (1) Instances. (2) Notices served. (3) Prosecutions. (4) - - - - Public Health Act, 1936—Workplaces. Number of Inspections Written Notices. Occupiers Prosecuted. 45 17 - 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) 391 (b) Number of inspections made for the purpose 1947 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 162 (b) Number of inspections made for the purpose 757 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 225 19 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 274 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 — (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 9 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By Owners 8 (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 — 20 (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 — 4. Housing Act, 1936. Part IV— Overcrowding. (a) Number of dwellings overcrowded at the end of the year:- Dwellings Families Persona Council Mouses 10 10 78 Privately Rented 32 32 206 Owner/Occupier 11 11 81 Totals 53 53 365 (b) Number of new cases of overcrowding reported during the year 15 (c) (1) Number of cases of overcrowding relieved by the Council during the year — (2) Number of persons concerned in such cases — (3) Number of cases abated during the year 6 (4) Number of persons concerned in such cases 32 21 (d) Cases in which dwelling-houses have again become overcrowded At the end of 1938, an investigation was made into the dwellings which were found to be fully taxed at the time of the Overcrowding Survey. This investigation involved enquiry in the case of 166 dwellings, and the result is tabulated below :— No. of separate dwellings visited 166 No. of cases where families :— ½ unit below capacity 10 1 unit below capacity 31 More than 1 unit below capacity 77 No. of cases still taxed to capacity 34 No. of overcrowding cases revealed 7 No. of dwellings unoccupied 7 From an analysis of the returns, the following facts emerged :— (1) The number of fully taxed dwellings had reduced from 148 to 34. (2) Seven cases of overcrowding were revealed as under :— No. of units in family. Permitted No. of dwelling. Extent overcrowded. 2½ 2 ½ unit 3½ 3 ½ unit 4 3 1 unit 4 3 1 unit 5½ 5 ½ unit 6 5 1 unit 9½ 8½ 1 unit Plans for the erection of 44 houses to provide for the rehousing of the overcrowded cases revealed by the Survey have been completed and it is anticipated that building will commence in 1939. HOUSING ACT, 1936. Applications for "Permitted Number" Certificates continue to be received, and 271 premises were measured in 1938. 22 5188 Certificates have now been issued to landlords or agents. Seventy-one instances of non-compliance with Section 62 (1) were noted, and action taken resulted in compliance with the provision by landlords in all but five cases, these 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 1938. Articles. Analysed. Adulterated or Deteriorated. Prosecut'ns. Convic tions. Fines & Costs. Formal. Inform'l. Total. Formal. Inform'l. Total. Milk 26 4 30 .. .. .. .. .. .. Cream .. .. .. .. .. .. .. .. .. Butter 12 .. 12 .. .. .. .. .. .. Meat .. .. .. .. .. .. .. .. .. Sausages 2 .. 2 .. .. .. .. .. .. Flour 8 .. 3 1 .. 1 .. .. .. Sugar 4 .. 4 1 .. 1 .. .. .. Spirits 2 .. 2 .. .. .. .. .. .. Confectionery and Jam 4 .. 4 1 .. 1 .. .. .. Olive Oil .. 1 1 .. .. .. .. .. .. Mint Sauce .. 1 1 .. .. .. .. .. . . Sardines .. 1 1 .. .. .. .. .. .. Raspberry Syrup .. 1 1 .. .. .. .. .. .. Chocolate Roll 1 .. 1 1 .. 1 .. .. .. Sila .. 1 1 .. 1 1 .. •• .. Totals 54 9 63 4 1 5 .. .. .. 23 Milk Supply. There are 66 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 1938 :— Grade of Milk. Type of Licence. Dealers'. Supplementary. Tuberculin Tested 15 1 Accredited .. .. Pasteurised 16 3 The following Tables show the results of examinations of samples of milk during 1938:— Ordinary Milk Samples. Sample. Temperature on arrival at Laboratory Total Bacteria Presence of B. Coli Methylene Blue Test. Period before decolonisation (in hours) or satisfactory (S) 1 .. .. Negative S 2 .. .. ,, S 3 .. .. S 4 .. .. ,, 4½ 5 .. .. ,, 4 6 14° C. 57,000 + in l/100th c.c No Test done 7 8° C. 48,500 ,, ,, 8 ,, 44,500 Negative ,, 9 ,, 43,500 ,, ,, 10 ,, 32,500 ,, ,, 11 13° c. 16,960 ,, ,, 12 ,, 63,000 ,, ,, 13 ,, 17,600 ,, ,, 14 ,, 153,000 ,, ,, Tuberculin-Tested Milk Samples l 11° c. 11,230 Negative S 2 ,, 2,560 ,, S 3 ,, 7,260 ,, s 4 ,, 4,500 ,, S 24 Pasteurised Milk Samples. Sample. Temperature on arrival at Laboratory. Total Bacteria. Presence of B. Coli Phosphatase Test 1 11°C. 28,500 Negative Satisfactory 2 8° C 3,500 ,, ,, 3 ,, 11,960 ,, ,, 4 ,, 7,260 ,, ,, 5 ,, 29,500 ,, ,, 6 ,, 3,660 ,, ,, 7 ,, 21,500 ,, ,, 8 ,, 7,430 ,, ,, 9 ,, 6,630 ,, ,, 10 ,, 5,700 ,, ,, 11 13° C. 3,630 ,, Not done 12 ,, 14,430 ,, ,, 13 ,, 17,260 ,, ,, 14 ,, 5,500 ,, ,, 15 ,, 15,330 ,, ,, 16 ,, 2,560 ,, ,, Tuberculin-Tested (Pasteurised) Milk Sample. 1 11° C. 830 Negative Satisfactory ICE CREAM. Number. Vendors' premises on Register at beginning of 1938 129 Premises where ice cream is manufactured ... 14 Premises, where ice cream is sold but not Manufactured 110 Ice Cream Distributing Depot 1 Vendors' premises on Register at end of 1938 125 All these premises, together with vehicles used by purveyors, were inspected during the Season. It will be observed that ice cream is not manufactured to any large extent within the Borough. The large majority of the retailers obtain their supply from wholesalers, whose factories are outside the district. 25 MEAT AND OTHER FOODS. The 57 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 28 cases where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. By Order of the Corporation one Registered Slaughter-house was removed from the Register on account of non-user for a period of 21/3 years. There are now two licensed slaughter-houses in the district. Following the inspection of carcasses in one slaughter-house, the presence of Swine Fever was detected. This resulted in the slaughter of all the pigs on the farm on which the slaughter-house is situated. This outbreak accounted for the large percentage of whole cacasses condemned as shown in the Table below. 26 The number of carcasses inspected at the time of slaughter, together with percentages of the animals found to be diseased either wholly or in part, are given in the following Table:— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — 1181 27 445 Number inspected — — 1181 27 446 All diseases except Tuberculosis. Whole carcasses condemned — — 4 — 77 Caroasses of which some part or organ was condemned — — 21 9 81 Percentage of the number inspected affected with disease other than tuberculosis — — 2.11% 33½% 35.4% Tuberculosis only. Whole carcasses condemned — — 11 — 1 Carcasses of which some part or organ was condemned — — 11 — 12 Percentage of the number inspected affected with Tuberculosis — — 1.86% — 2.9% 27 The following diseased and unsound meat and other foods have been detected, surrendered, and destroyed :— M EAT. Carcasses or parts of carcasses found to be diseased. Number. BOVINES. Calves. Carcasses and Offals (Generalised Tuberculosis) 11 Livers (Localised Tuberculosis) 5 Plucks (Localised Tuberculosis) 9 Carcass and Offal (Emaciation) 1 Carcass and offal (jaundice) 1 Carcass and Offal (Fevered) 1 Carcass and Offal (Pneumonia and Pleurisy) 1 Kidneys (Nephritis) 5 Kidneys (Hæmorrhagic) 6 Livers(parasitic) 4 Liver(Abscess) 1 Sets of Lungs (Pneumonia) 4 Sets of Lungs (Melanosis) 1 Sets of Lungs(congestion) 4 PIGS. Carcasses and Offals (Generalised Tuberculosis) 1 Heads and Tongues (Localised Tuberculosis) 6 Mesenteric Fats (Localised Tuberculosis) 6 Carcasses and Offals (Swine Fever) 77 Sets of Lungs (Pneumonia) 38 Livers (Cirrhosis) 16 Kidneys (Hæmorrhagic) 13 Kidneys (Cystic) 3 Plucks (Pleurisy) 3 Spleen (Engorged) 1 SHEEP. Sets of Lungs (Parasitic) 9 Other Foods. 1 stone Cod Fillets ; S stones Skate ; 6¼ stones Dogfish ; 20 lbs. Dabs; 1½ gallons Shrimps ; 24 Babbits; 1 cwt tinned Ham. 28 THE SLAUGHTER OF ANIMALS ACT, 1933. All animals slaughtered in the district have been stunned by means of a mechanically-operated instrument in accordance with the terms of this Act. Seven persons were licensed to act as Slaughtermen during 1938. BAKEHOUSES. There are 25 Bakehouses within the District, and of these 18 are provided with mechanical power. A good standard of cleanliness is generally obtained. 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 1938, 897 visits were made in connection with rat or mice infested or suspected infested premises, and 166 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 17 visits to the Council's properties and 651 visits to private premises. SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. SWIMMING BATHS. There are two public swimming baths in the Borough situated at Throwley Road, Sutton, and 29 at Maiden Road, Cheam. The new baths at Maiden Road, Cheam, were opened officially by His Worship the Mayor, on 9th April, 1938. The water in both of these baths is purified by filtration, aeration, and continuous chlorination. Tests for " free " chlorine and for alkalinity are made four times each day. ERADICATION OF BED BUCS. Fifty-six bug-infested houses were dealt with as follows:— By the use of Insecticides. Sulphur. Hydrocyanic (H.CN.)Gas. Council Houses 7 — — Other Houses 43 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. The Insecticides used are "Riz" and "Zaldecide." 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. 30 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 1176 Number of visits paid to Shops within the Borough during 1938 1749 Number of Shops within the Borough where ventilation found to be not suitable and sufficient 7 Number of Shops within the Borough where ventilation rendered suitable and sufficient as the result of— (a) Informal action 7 (b) Formal action — Number of Shops within the Borough where reasonable temperature not maintained 35 Number of Shops within the Borough where means of heating provided as the result of— (a) Informal action 35 (b) Formal action — Number of Shops within the Borough where suitable and sufficient sanitary accommodation not provided 45 Number of Shops within the Borough where suitable and sufficient sanitary accommodation provided as the result of— (a) Informal action 45 (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 1938 1151 Number of Certificates granted by the Local Authority exempting shops from the provision of Section 10 (2) 25 31 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Two hundred and seventeen cases of infectious disease were notified during 1938, a decrease of fifty-six cases on the previous year. The decline in Scarlet Fever continued, and the incidence during the last six months of the year was low. Cases of Diphtheria showed a further reduction, and there was no mortality in children during the year. Typhoid and Paratyphoid Fevers were absent. Cases of mild Dysentery were less numerous. There was one severe and fatal case of Cerebro-spinal Fever. There was one case of Anterior Poliomyelitis, and recovery has been almost complete. Four cases of Opthalmia Neonatorum were notified during the year. The following Table gives a comparison of notifications in 1938 with the average for the preceding four years :— Scarlet Fever Diphtheria Pneumonia Enteric Puerperal Pyrexia Average rate ) 1934-1937 151 47 18 7 10 1938 127 14 29 0 11 Scarlet Fever.—One hundred and twenty-seven cases were notified. Eleven of these were institution cases. The disease was generally mild, but there was one death following mastoid infection. The case rate for the Borough was 166 per 1,000 of population, compared with a case rate of 2 41 per 1,000 of population for England and Wales. Seventeen of the one hundred and twenty-seven cases were nursed at home. Ten secondary cases of infection occurred after the removal of patients to hospital, and indicate the need for early diagnosis and isolation. There were four return cases related to infection by patients discharged from hospital. Patients discharged from hospital should be guarded from chills likely to induce catarrh of the throat and nose which 32 may revive infection. Patients who suffer from chronic discharges from the nose or ear after Scarlet Fever should remain under medical observation, and take all antiseptic precautions to avoid transference of infection. Diphtheria.—The incidence of Diphtheria remained very low. Fourteen cases were notified, and of these two were institution cases. The case rate was 018 per 1,000 of population, compared with 158 per 1,000 of population for England and Wales. There was one death of a male adult, but this was more directly due to an associated Streptococcal infection. The relatively small number of cases notified is satisfactory, but it should be understood that a continued low incidence is usually followed by a higher susceptibility, and that secure protection for the future lies in the Artificial Immunisation of children. No immunised child developed Diphtheria during the year. As to prompt use of Antitoxin.—Early diagnosis and early treatment with Diphtheria Antitoxin are the safeguards against mortality from Diphtheria. Medical practitioners should be called to see suspected cases at the earliest possible moment, and large initial doses of Antitoxin should be given on clinical diagnosis and without awaiting for bacteriological confirmation of the diagnosis. Artificial Immunisation against Diphtheria.— There was an increase in the number of children immunised during the year. The number receiving three injections was five hundred and sixty-four. There was a higher acceptance rate at schools where the facilities provided are becoming increasingly appreciated by parents and teachers. The number of voluntary attendances without request varies directly with the incidence of cases of Diphtheria. It should be recognised that immunity takes several weeks to develop effectively after innoculation, and that inter-epidemic periods should be utilised to 33 secure immunity in children before infection occurs. The Schick testing of forty-three children after injection showed that a satisfactory degree of immunity was established. Propaganda was carried out by Health Visitors and at the Welfare Centres. The material used was Toxoid-Antitoxin-Floccules (T.A.F.) given in three doses into the upper arm. The freedom from reaction of this material is an important factor in popularising immunisation. The following Table shows the distribution in age-groups of the children receiving three Injections of T.A.F. during 1938:— DIPHTHERIA IMMUNISATION, 1938. 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 1 6 22 26 21 30 18 4 1 2 - - 131 Chatsworth Road J.M. & Infts. - 3 5 4 3 40 30 3 - - - 1 89 St. Cecilia's R.C. School - - 1 1 3 12 25 11 12 10 15 1 91 Benhilton J.M. & I. School - - - 1 - 3 3 - - - - - 7 Cheam Common I. School - 10 14 10 9 28 11 2 - - - - 84 Park Fa m Infants' School - 2 2 3 7 29 37 12 - - - - 92 Crown Road Infants - - 1 1 7 24 12 - - - - - 45 Medical Practitioners' Cases - - 3 2 7 6 6 1 - - - 25 Total 1 21 48 48 57 172 142 33 13 12 15 2 564 Bacteriological Examinations.—The following examinations of specimens were made by direction of the Borough Council :— Diphtheria. Enteric. Tuberculosis. Positive. Negative. Positive. Negative. Positive. Negative. 29 514 1 52 19 105 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory ; these are not included in the above Table. 34 Notifiable Diseases (other than Tuberculosis) during 1938. 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. Scarlet Fever — 8 5 8 12 53 12 5 10 1 2 — 116 87 1 Diphtheria — — — 1 3 2 1 2 1 — 2 — 12 12 1 Typhoid Fever — — — — — — — — — — — — — — — Para typhoid B — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — 7 4 — — 11 4 — Pneumonia — — 2 — 1 2 1 1 5 7 8 2 29 8 37 Erysipelas 1 — — — — 1 — 1 3 2 6 1 l5 3 1 Dysentery — 1 2 — — 2 1 — — 5 3 — 14 1 — Poliomyelitis — — 1 — — — — — — — — — 1 1 — Cerebro-Spinal Fever — — — 1 — — — — — — — — 1 1 1 Ophthalmia Neonatorum 4 — — — — — — — — — — — 4 2 — Therapeutic Malaria — — — — — — — — — — 1 — 1 — — London S.F 1 1 1 1 2 5 — — — — — — 11 11 — cases in the Downs Hospital Dip. — — — — — — — — 1 — — — 2 2 — *Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. 35 Distribution of Notifiable Infectious Diseases in Wards. Disease. WARDS. Case Rate per 1000 Populatn (MidYear) Case Rate per 1000 England and Wales. N. N W. N.E. W.C. E.C. E. S.W. S.E. S. Total Population 10205 8772 10255 12839 7494 7051 5563 5755 7646 75580 Scarlet Fever 20 6 17 19 25 15 6 1 7 116 1.53 2.41 Diphtheria 1 — 3 4 1 3 — — — 12 0.16 1.58 Typhoid Fever — — — — — — — — — — 0 .00 0.03 ,, Para B — — — — — — — — — — Pneumonia 2 2 4 5 3 7 — 1 5 29 0.38 1.10 Erysipelas 5 2 1 3 — 3 — — 1 15 0.20 0.40 Puerperal Pyrexia 1 — 3 1 1 2 — 1 2 11 0.14 — Dysentery 1 1 3 2 4 1 1 — 1 14 0.19 — Poliomyelitis 1 — — — — — — — — 1 0.01 — Cerebro-Spinal Fever 1 — — — — — — — — 1 0.01 — Ophthalmia Neonatorum — — — 2 — 1 1 — — 4 — — Therapeutic Malaria — — — 1 — — — — — 1 — — Total 32 11 31 37 34 32 8 3 16 204 36 37 Monthly distribution of cases of Notifiable Infectious Disease throughout 1938. DISEASE. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Scarlet Fever 19 10 11 14 12 5 13 3 7 8 5 9 Diphtheria 3 .. .. 1 .. 2 1 2 .. 1 .. 2 Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. Paratyphoid B .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Pyrexia 2 2 2 2 .. 2 .. 1 .. .. .. .. Pneumonia 6 4 6 1 2 3 1 1 4 .. 1 2 Erysipelas 4 1 3 .. 1 .. .. .. .. 3 2 1 Dysentery 7 1 .. .. .. 1 .. .. 1 2 2 .. Poliomyelitis .. .. .. .. .. .. 1 .. .. .. .. .. Cerebro—Spinal Fever .. .. .. .. 1 .. .. .. .. .. .. .. Ophthalmia Neonatorum 1 .. .. .. 2 1 .. .. .. .. .. .. Therapeutic Malaria .. .. .. .. .. 1 .. .. .. .. .. .. Typhoid and Paratyphoid Fever.—No cases were notified during the year. Puerperal Pyrexia.—Eleven cases of Puerperal Pyrexia were notified during the year. The case rate was 8 94 per 1,000 total births, compared with 14 42 per 1,000 total births for England and Wales. The early notification of cases of Puerperal Pyrexia is of primary importance in the prevention of maternal mortality. Medical practitioners should make the fullest use of the consultant, bacteriological, and hospital service provided by the Authority, and secure immediate and effective isolation of any suspected case occurring in a Maternity Home. Dysentery—Fourteen cases of Dysentery of the Sonne Type were notified. The cases were generally mild. Their number was considerably reduced, but indicates that the disease remains endemic. Control can only be effected by strict attention to personal and domestic hygiene and by the utmost care of all concerned in the exposure, handling, and distribution of food. Epidemic Catarrhal Jaundice.-On 8th December, 1938, seven cases of Catarrhal Jaundice were reported from the Worcester Park district. Investigation revealed sixteen cases, thirteen being children and three adults. The sequence of cases in families and in school showed the condition to be infectious. The onset was gradual in the majority of cases and early symptoms included, malaise, anorexia, headache, pain in the chest and back, and muscular stiffness. Vomiting was pronounced and followed in two to four days by Jaundice. In a few cases a primary sickness was followed by a quiescent period of a week, terminating in vomiting and subsequent Jaundice. The degree of sickness varied in members of the same family. In some cases Jaundice was absent and diagnosis based on known direct and intimate contact with a confirmed case. The acute phase lasted for from one to four days. There was pain in the 38 epigastric region, enlargement of the liver and tenderness over the liver. The urine was bile-stained and the stools pale. Invalidity continued for two to three weeks. The incubation period appeared to be from seven to ten days. The isolation of cases at home and the exclusion ol suspected cases of sickness from schools limited the spread of infection. Influenza.—No major epidemic occurred during the year. Six deaths were recorded, mainly in elderly people. Non-Notifiable Diseases.—School teachers also reported 176 cases of Chicken-pox, 34 of Whooping Cough, 543 of Measles, 16 of German Measles and 238 of Mumps. School notifications formed the basis of frequent consultations with the School Medical Officer. There was one death from Measles due to pulmonary complications. An arrangement has been made for the preparation of serum from the blood of healthy parents of individual children for the prevention or attenuation of measles on request by medical practitioners. Two such requests were received, and attenuated attacks resulted. Notification of Pneumonia.—Of the 37 deaths occurring from all forms of pneumonia, seven were notified previous to death. The total number of notified cases arising in the district was 29. TUBERCULOSIS. On 31st December, 1938, there were on the Register 419 cases of Tuberculosis, of which 332 were pulmonary and 87 non-pulmonary cases. The death rate for Pulmonary Tuberculosis was 049 per 1,000 of population, and for Non-pulmonary 59 Tuberculosis 0.08 per 1,000 of population. The total Tuberculosis death rate in 1938 was 0.57 per 1,000 of population, compared with 0.47 per 1,000 of population in 1936. The corresponding death rates for England and Wales in 1938 were: Pulmonary, 0.53 per 1,000 of population; Nonpulmonary, 0.10 per 1,000 of population. Total rate, 0 63 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 1 - 1 - - - 1 - 5 1 2 4 - - 1 - - 15 9 9 2 2 2 3 1 1 25 12 6 - 1 4 3 - 1 35 13 4 1 - 6 1 - - 45 4 2 - - 4 2 - - 55 3 2 - - 6 2 - - 65 & above 1 1 1 — 1 2 — 1 Totals 43 26 9 4 23 14 2 4 NOTIFICATION OF TUBERCULOSIS. Respiratory Forms of Death—30 out of 37 were notified. Other Forms of Death—5 out of 6 were notified. RAINFALL IN 1938. Total. Days with o oi in. or more. Days with 0-04 in. or more. Sutton Sewage Farm 18-93 143 90 Worcester Park Sewage Farm 19-79 148 95 40 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. Clinic.—Priory Crescent, Cheam. Ante-Natal Clinic.—Every Friday, 10—12 noon, and 2nd and 4th Thursdays in the month from 2—4 p.m. Infant Welfare.—Every Monday from 2—4 p.m. Clinic.—St. Oswald's Hall, Brocks Drive, North Cheam. Infant Welfare.—Every Friday at 2 p.m. Borough Immunisation Clinic.—The Public Hall, No. 1, Hill Road, Sutton, on Tuesdays, at 2.15 p.m. 41