Sutc 3 LIBRARY Borough of Sutton and Cheam. ANNUAL REPORT of the Medical Officer of Health for the Year 1939. William Pile, L.td., Printers (T.U.), 46-50, High Street, Sutton. BOROUGH OF SUTTON & CHEAM. ANNUAL REPORT of the MEDICAL OFFICER ON HEALTH for the Year 1939. PUBLIC HEALTH AND HOUSING COMMITTEE. HIS WORSHIP THE MAYOR (Alderman JOHN J. GOOSSENS, J.P.), ex-offlcio. Alderman CECIL COLMAN, J.P. Alderman F. C. LOHDEN, O.B.E. Coun. Mrs. A. DUVAL. Coun. W. E. HEATH. „J. EVERETT „ J. S. HORNE, J.P. (Chairman). „ G. J. JEWETT. „ J. M. FIRTH. „ H. J. TRICKETT, C.C. W. T. VENTON. 1 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. * Deputy Chief Sanitary Inspector: ARTHUR SYDNEY WILLIAMS. Certif. R.S.I.; Certif. Meat & Food (On Active Service). Assistant Inspectors: JOHN HENRY LOTT, Certif. R.S.I.; Certif. Meat & Food. †ARTHUR CHARLES RUSSELL, Certif. R.S.I. & S.I.E.J.B. ††JOHN WANN, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. Mrs. A. BOZWARD, Certif. R.S.I. ‡JOSEPH NORMAN JENKINSON, Certif. R.S.I, and SJ.E.J.B.; Certif. Meat & Food. ‡‡GEORGE EDWARD MATON, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. * Appointed 1st July, 1939. †Appointed 1st August, 1939. ‡‡Appointed 20th November, 1939. ‡Resigned 2nd September, 1939. ‡‡Resigned 19th June, 1939. Transferred from Town Clerk's Dept., 1st July, 1939. 2 To the Mayor, Aldermen, and Councillors of the Borough of Sutton and Cheam. Mr. Mayor, Madam, and Gentlemen, 1 have the honour to present to you the sixth Annual Report on the health of the Borough of Sutton and Cheam. The standard of health of the community during 1939 was good. The general prevalence of infectious diseases remained low. The incidence of Scarlet Fever and of Diphtheria was unchanged. Enteric infections were few. Influenza was epidemic during the first quarter of the year, and cases of pneumonia were consequently increased. The water supply of the district maintained a high standard of chemical and bacteriological purity. Effective control by daily sampling and by protective chlorination was continued. The death rate at 9.5 per 1,000 of population was. slightly higher. The birth rate at 14.7 per 1,000 of population was lower. 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 Chief Sanitary Inspector (Mr. C. W. Newbery). As this Report is being presented at a time when the life of the community has become adjusted to war conditions, I would emphasise the need for the co-operation of all in the prevention of the spread of infectious, diseases, and advise all parents to secure the immunisation of their children against Diphtheria. I thank members and officers of the Council for their assistance during the year, and express my appreciation and thanks to the large number of A.R.P. personnel who have steadfastly served at First Aid Posts, Mobile Units and at Ambulance and Stretcher Partv Depots. I am, Mr. Mayor, Madam, and Gentlemen, Your obedient servant, ENEAS J. MACINTYRE, Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in Acres 4338.15 Registrar-General's Estimate of the Resident Population, 1939 76510 Number of inhabited Houses (end of 1939) according to Rate Books 21903 Rateable Value and sum represented by a £897541 Penny Rate £3580 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. 4 EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1939. LIVE BIRTHS: Total T. M. F. Birth-rate per 1,000 of the estimated resident population. 1129 580 549 Legitimate 1080 553 527 Illegitimate 49 27 22 14.7. STILL BIRTHS: Total T. M. F. Rate per 1,000 (live and still) births, 309. 36 21 15 Legitimate 33 18 15 Illegitimate 3 - Death-rate per 1,000 of the estimated resident population, 9.5. T. M. F. Deaths 723 356 367 Deaths from puerperal causes:— Deaths ... 4 Rate per 1,000 total (live and still) births 3.43 Percentage of Deaths from certain causes to the total number of Deaths :— Diseases of the heart and circulation 27.7 Cancer and malignant disease 14.9 Diseases of lungs (not tuberculous) 6.2 Tuberculous diseases 5.9 Cerebral hemorrhage 5.l Congenital diseases 6.6 Suicide and violence 1.1 Diseases of the digestive system 4.6 Infectious diseases 3.3 Diseases of the kidney 2.2 Senility 2. 6 Other defined causes 19.8 The number of Deaths, from the common infectious diseases were:—Measles 0, Diphtheria 1, Scarlet Fever 0, Whooping Cough 0, and Influenza 17. Maternal Mortality.—There was one death from puerperal sepsis. Two deaths from haemorrhage were related to morbid conditions of the placenta. There was one death from eclampsia. 5 Deaths from— Pueperal Sepsis 1 Other Puerperal causes 3 Total 4 Death-rate of Infants under one year of age :— All infants per 1,000 live births 485 Legitimate Infants per 1,000 legitimate live births 40-7 Illegitimate Infants per 1,000 illegitimate live births 224 5 Deaths from Cancer (all ages) 108 „ Measles (all ages) 0 „ Whooping Cough (all ages) ... 2 „ Diarrhœa (under 2 years, of age) 2 Infantile Mortality.—The death rate was 485 per 1,000 live births. The majority of deaths was due to premature birth and congenital debility. 6  M. F. Total M. F. Total Nett Births registered during the calendar year Total 580 551 1131 Nett Deaths registered during the calendar year legitimate 26 18 44 \ legitimate 553 529 1082 illegitimate 27 22 49 illegitimate 8 3 11 Still Births Total 21 15 36 Death Rate per 1000 births legitimate .. 388 18 15 33 illegitimate .. 9.7 illegitimate 3 - 3 Death Rate to total births .. 48.5 CAUSES OF DEATH IN THE BOROUCH OF SUTTON AND CHEAM DURINC 1939. M. F. Total. 1 Typhoid and paratyphoid fevers — — — 2 Measles — — — 3 Scarlet fever — — — 4 Whooping cough 2 2 5 Diphtheria 1 — 1 6 Influenza 11 6 17 7 Encephalitis lethargica 1 — 1 8 Cerebro-spinal fever 1 1 2 9 Tuberculosis of respiratory system 22 15 37 10 Other tuberculous diseases .. 2 4 6 11 Syphilis 4 — 4 12 General paralysis of the insane, tabes dorsalis 1 1 13 Cancer, malignant disease .. .. .. 63 55 108 14 Diabetes 5 2 7 15 Cerebral haemorrhage, <tc. .. 12 25 37 16 Heart disease .. 97 103 200 17 Aneurysm 1 3 4 18 Other circulatory diseases 20 23 43 19 Bronchitis 10 9 19 20 Pneumonia (all forms) 15 6 20 21 Other respiratory diseases .. 3 3 6 22 Peptic uloer 5 3 8 23 Diarrhcea, Ac. (under 2 years) 1 1 2 24 Appendicitis .. 1 4 a 25 Cirrhosis of liver 1 1 2 26 Other diseases of liver, &c. .. 1 5 6 27 Other digestive diseases 6 5 10 28 Acute and chronic nephritii.. 6 10 16 — 1 1 30 Other puerperal causes — t a 31 Congenital debility, premature birth, mal 23 15 48 32 Senility.. 8 11 19 33 Suicide.. 3 5 8 34 Other violence.. 8 10 18 35 Other defined diseases 34 34 68 36 Cause ill-defined or unknown .. .. 1 1 Special causes (included in No. 35 above):— Small-pox — — — Poliomyelitis — — — Polioencephalitis 1 — 1 356 567 723 7 8 BIRTH-RATES, DEATH-RATES AND ANALYSIS Of MORTALITY IN THE YEAR, 1939. 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 pub 1,000 Population. rate feb 1 000 Live Births. All Causes. Typhoid and Para-typhoid fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis Hinder 2 Years) Total Deaths under One year. Live 1 Births. Still Births. England and Wales 15.0 0.59 12.1 0.00 - 0.01 0.01 0.03 0.05 0.21 4.6 50 126 County Boroughs and Great Towns, including London 14.8 0.59 12.0 0.00 - 0.01 0.00 0.03 0.05 0.19 6.3 53 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 193) 15.6 0.5 11. 2 0.00 - 0.01 0.00 0.02 0.04 0.20 3.0 40 London - 12.3 0.44 11.9 0.00 - 0.00 0.00 0.03 0.02 0.18 8.2 48 Sutton and Cheam 14.7 0.47 9.5 0.00 — o.oo 0. 00 0.03 0.01 0. 22 1.7 48 The maternal mortality rates for England and Wales are as follows : Puerperal Sepsis. Others. Total. per 1,000 Live Births 0.77 2.16 2.96 „ „ Total Births 0.74 2.08 2.82 „ „ „ „ Sutton & Cheam are as follows ; per 1,000 live Births 0.88 2.65 3.53 „ „Total Births 0.86 2.57 3.43 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. Legislation.—The Measles and Whooping Cough Regulations, 1939, became operative on the 23rd October, 1939. These were provisional regulations and required all cases of measles and whooping cough to be notified by medical practitioners. Laboratories, Hospitals, Ambulances and Mortuary. —There was. no change during the year. 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 water from all the wells of the Sutton District W'ater Company i§ 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 chcmist 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 Ni rates. Nitrogen as Nitrites. Oxygen absorbed in 4 hours at 80OF. 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°o. Average 1809 .0138 .0007 0.9800 0 .0058 1.9667 7.09 2. 4 .08 0 9 Drainage and Sewerage -During the year a short length of sewer has been laid from Cornwall Road to open up some building plots fronting the Sutton By-Pass Road, which it has not been possible to develop owing to their low position. A relief surface water sewer varying in diameter from 12 ins. to 15 ins. has been laid along a considerable length of Tudor Avenue in substitution for the existing inadequate sewer. A considerable length of 9-in. diameter soil sewer has also been laid from the Refuse Disposal Plant in Boscombe Road, Worcester Park, down the public footpath to the existing sewer in Green Lane. Owing to the outbreak of war, little progress has been made in the preparation of the contracts for the construction of the High Level Relief Soil Sewer to serve the greater portion of the Parish of Sutton and the new sewer to be laid from Gander Green Lane area to the Worcester Park Sewage Works. The plans for the large scale additions, and alterations to the Worcester Park Sewage Works have been commenced, but little progress has been made owing to the demands of more urgent work. 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 during the year under review eight modern rear-loading large capacity refuse collection vehicles have been purchased by the Council and put into commission, in substitution for those previously hired. The house refuse is disposed of at the Refuse Disposal Plant, 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. 10 Rivers and Streams.—During the year the Surrey County Council have completed the improvement works to the Beverley and Pyl Brooks. Closet Accommodation.—There are 14 cesspools in use. During 1939, 20 houses with cesspool drainage have been connected to the sewers and the cesspools abolished. Some six pail closets and one privy are in use. In the past twelve years, 155 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. On the grounds of economy and in accordance with the wishes of the Ministry of Health, the report on Sanitary Inspection, Housing and Food Supply has been condensed. Record of Inspections and Notices Served. Number. House to House Inspections 118 Special Inspections, Interviews on Premises, and Advisory Visits 1353 Re-inspections 3374 Visits to Works, in Progress 1379 Visits to Factories and Workplaces 388 Visits to Bakehouses 59 Visits to Outworkers' Premises 69 Visits to Slaughterhouses 384 Visits to Butchers' and Food Shops 371 Visits to Dairies, and Milkshops 133 Visits to Ice Cream Premises and Vehicles 147 Visits to Stables 4 Visits to Pigsties 9 11 12 Visits re Rat Infestation 756 Food and Drug Sample Visits 12 Visits re H.C.N. Regulations 5 Visits re Merchandise Marks Act 29 Visits in connection with Infectious Disease 225 Visits re Overcrowding and "Permitted Number " Measurements 229 Visits to Petroleum Spirit and Cinematograph Film Stores 294 Miscellaneous 1104 10459 Premises at which defects or nuisances were discovered 981 Dwelling-houses inspected for housing defects under Public Health or Housing Acts 392 Defects or nuisances discovered 3748 Defects or nuisances remedied 2884 Defects or nuisances in hand 131 Defects, or nuisances outstanding 733 Informal Notices served 1051 Statutory Notices served 16 Complaints received and investigated 603 Summary of Remedial Works and Sanitary Improvements carried out. Number. Drainage and Sanitary Fittings. No. of houses and premises, redrained 5 Houses connected to soil sewers. 20 Cesspools, abolished 24 Repairs or amendments to existing drains 27 Drains or gullies unstopped and cleansed 113 Sanitary fittings repaired, renewed or provided 680 W.C. Apartments. New Apartments, provided 1 W.C. Apartments lighted and/or ventilated 34 Ventilated lobbies to W.C. apartments provided 4 Structural Repairs or Improvements. Roofs renewed or repaired 177 Guttering and rain water pipes provided, repaired, etc. 184 Damp walls remedied 256 Brick walls, repointed, repaired or rendered 204 Chimney stacks repaired or rebuilt 36 Yards paved or repaired 39 Approaches to houses paved 25 Floors relaid or repaired 98 Additional lighting or ventilation to rooms 44 Windows and/or cills repaired or renewed 338 Doors and thresholds provided or repaired 115 Larders provided 1 Staircases and handrails repaired or provided 18 Ranges, stoves and coppers repaired or renewed 101 Miscellaneous. . 569 Cleansing. Rooms, passages, larders, etc., cleansed 969 Trade premises cleansed 52 Verminous rooms disinfested 252 Ceneral. Accumulations of refuse removed 108 Nuisances from smoke abated 1 Rat-infested premises cleared 144 Nuisance from animals abated 5 Contraventions of Section 72 abated 5 Miscellaneous ... ... ... ... ... 743 Infectious Disease, Disinfection, etc. Rooms disinfected after Notifiable Infectious Diseases 164 Rooms disinfected after Tuberculosis and other Diseases 37 Smoke Abatement. There are few chimneys attached to industrial premises in this district. Informal action resulted in the abatement of one nuisance from smoke. 13 1. Inspection of Factories and other premises under the Act. Inspections made by Sanitary Inspectors for purposes of provisions as to health. Premises. Number of Inspections. Written Notions. Occupiers Prosecuted. (1) (2) (3) (4) Factories with Mechanical Power 162 51 — Factories without Mechanical Power 185 48 — Other Premises (other than Outworkers' premises) — — — Total 347 99 — 2. Defects found in Factories, and other premises under the Act. Particulars. Number of defects. Number of defects in respect to which prosecutions were instituted. Found. Remedied. lief erred to H.M Inspector (1) (2) (3) (4) (6) Want of Cleanliness 44 40 - - Inadequate Ventilation 1 — - - Overcrowding — — — - Unreasonable Temperature — — — - Ineffective Drainage of Floors - - - - Absence of Thermometers 21 15 — - Absence of suitable lighting in W.C. apartments 27 21 - - Other Nuisances 36 28 — — Sanitary accommodation— (a) Insufficient 3 - - - (b) Unsuitable or defective 4 4 — - (c) Not separate for sexes 1 1 - - 134 100 — — 14 Outwork in Unwholesome Premises. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) (4) — — — — Public Health Act, 1936—Workplaces. Number of Inspections Written Notices. Occupiers Prosecuted. 41 4 - HOUSINC. 1. Inspection ot Dwelling Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 392 (b) Number of inspections made for the purpose 1635 (2) (a) Number of dwelling-houses cluded under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 118 (b) Number of inspections made for the purpose 588 (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 174 15 2. Remedy of Defects (luring 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 176 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 10 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners 4 (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 3 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 3 (b) By Local Authority in default of owners C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— Nil. 16 4. Housing Act, 1936. Part IV—Overcrowding. (a) Number of dwellings overcrowded at the end of the year:— Dwellings Families Persons Council Houses 9 9 84 Privately Rented 18 18 133 Owner/Occupier 7 7 55 Totals 31 34 272 (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 (2) Number of persons concerned in such cases (3) Number of cases abated during the year 20 (4) Number of persons concerned in such cases 132 (d) Cases in which dwelling-houses have again become overcrowded 2 INSPECTION AND SUPERVISION OF FOOD. Food and Drugs (Adulteration) Act, 1928. Food and Drugs Act, 1938. Under the provisions of Section 64 of the Food and Drugs Act, 1938, the Borough Council became the Food and Drugs Authority on the 1st October, 1939. 17 The following table indicates the samples taken on behalf of the Surrey County Council and the Sutton and Cheam Borough Council during the year 1939. Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convic tions. Fines St Costs. Formal. Informl. Total. Formal. Inform1. Total. Milk 22 22 4 1 •• 2 2 .. .. .. Margarine 2 1 3 .. .. .. .. .. .. Butter 6 1 7 •• .. .. .. .. .. Meat 2 .. 2 .. • • .. .. .. .. Sausages 2 1 3 .. .. .. .. .. .. Lard .. 1 1 .. 1 1 .. .. .. Beer 1 .. 1 .. .. .. .. .. .. Confectionery and Jam 2 .. 2 .. .. .. .. .. .. Raspberries 1 .. 1 .. .. .. .. .. •• Apples 1 .. 1 1 .. 1 .. .. •• Bleach Ointment 1 1 2 1 1 2 1 .. Case Dismissed Totals 40 27 67 2 4 6 1 .. •• Milk Supply. There are 85 dairies and milkshops in the district; eight 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 1939 :— Grade of Milk. Typo of Licence. Dealers'. Supplementary. Tuberculin Tested 12 2 Accredited .. 1 Pasteurised 20 5 18 The following Tables show the results of examinations of samples of milk during 1939:— MILK SAMPLES. Thirty-eight samples of milk were submitted for bacteriological examination as below:— 1. Pasteurised Milk. No. of Samples. Below 100,000 bacteria per millilitre. Above 100,000 bacteria per millilitre. Phosphatase Test. Satisfactory Unsatisfactory 16 16 - 14 2 |B. Coli) - 2. Tuberculin Tested Milk. No. of Samples. Methylene Blue Test. Coliform Test. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. 3 2 1 2 1 3. Ordinary Milk (All Flash Pasteurised). No. of Samples. Totnl bacteiia per miililitre. Coliform Test. Under 80,000 50 000 100,000 100.000— 180,000 Satisfactory. Unsatisfactory. 19 13 2 4 11 3 19 ICE CREAM. Number. Vendors' premises on Register at beginning of 1939 125 Premises where ice cream is manufactured 16 Premises where ice cream is sold but not Manufactured 102 Ice Cream Distributing Depot 1 Vendors' premises on Register at end of 1939 119 All these premises, together with vehicles used by purveyors, were inspected during the Season. MEAT AND OTHER FOODS. The 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 23 cases where sanitary conditions, were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. There are two licensed slaughter-houses in the district. 20 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 — — 1474 860 309 Number inspected — — 1474 860 309 All diseases except Tuberculosis. Whole carcasses condemned — — 2 — — Carcasses of which some part or organ was condemned - - 19 360 33 Percentage of the number inspected affected with disease other than tuberculosis - - 1.42% 41.86% 10.68% Tuberculosis only. Whole carcasses condemned — — 14 — — Carcasses of which some part or organ was condemned - - 12 - 10 Percentage of the number inspected affected with Tuberculosis — — 1.76% — 3.24% N.B.—The high percentage of Sheep and Lambs found to be diseased was due to Stiongylus Rufescens. 21 The following diseased and unsound meat and other foods have been detected, surrendered, and destroyed:— MEAT. Carcasses or parts of carcasses found to be diseased in slaughter-houses. Number. BO VINES. Calves. Carcasses and Offals (Generalised Tuberculosis) 14 Plucks (Localised Tuberculosis) 2 Sets of Lungs (Localised Tubercolosis) 8 Livers (Localised Tuberculosis) 2 Carcass and Offal (Extensive Bruising) 1 Carcass and Offal (Oedema and Emaciation) 1 Sets of Lungs (Pneumonia 6 Sets of Lungs (Melanosis) 1 Sets of Lungs (Abscess) 3 livers (Parasitic) 2 Spleen (Hæmorrhagic) 1 Kidneys (Nephritis) 12 Kidneys (Hæmorrhagici 10 PIGS. Heads and Tongues (Localised Tuberculosis) 8 Mesenteric Fats (Localised Tuberculosis) 4 Pluck (Pleurisy) 1 Sets of Lungs (Pneumonia) 23 Sets of Lungs (Parasitic) 3 Livers (Cirrhosis) 10 Liver (Parasitic) 1 Hearts (Pericarditis) 2 SHEEP. Pluoks (Parasitic Pneumonia and Pericarditis) 6 Sets of Lungs (Parasitic Pneumonia) 26 Sets of Lungs (Parasitic) 292 Livers (Parasitic) 159 Livers (Cirrhosis) 9 Livers (Necrosis) 4 Spleen (Engorged) 1 Kidney (Nephrities) 1 MEAT AND OTHER FOODS IN RETAIL SHOPS. 1 Set of Bovine Lungs (Localised Tuberculosis); 4 Sets of Bovine Lungs (Decomposition); 6 Bovine Speens (Decomposition); 253 lbs. Beef (Decomposition); 40 lbs. Lamb's Livers (Decomposition) ; 25 lbs. Kippers (Unsound) ; 254 lbs. Halibut (Unsound); 41 lbs. Haddock (Unsound); 56 lbs. Dabs (Unsound); 42 lbs Herrings (Unsound). 22 THE SLAUCHTER 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. Five persons were licensed to act as Slaughtermen during 1939. BAKEHOUSES. There are 25 bakehouses, within the District, and of these 18 are provided with mechanical power. A good standard of cleanliness and sanitary condition is generally obtained. RATS & MICE (DESTRUCTION) ACT, 1919. During 1939, 756 visits were made in connection with rat or mice infested or suspected infested premises, and 144 premises were satisfactorily cleared of rats or mice. In addition to these visits, the Council's Disinfector, who has been trained to assist in ths work, has made 554 visits to 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 at Maiden Road, Cheam. 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. 23 ERADICATION OF BED BUCS. Sixty-two bug-infested houses were dealt with as follows:— By the use of Insecticides. Sulphur. cyanic (H.C N.) Gas. Council Houses — — — Other Houses 59 — 3 One other case was in hand at the end of the year. The work of disinfestation has continued to be carried out upon the lines indicated in previous Reports. The Insecticides used are "Riz" and "Zaldecide" and Roxem T.C.Y. SHOPS ACT, 1934. The following Table indicates action taken under Section 10 of the above Act. Number of Shops within the Borough 1151 Number of visits paid to Shops within the Borough during 1939 1746 Number of Shops within the Borough where ventilation found to be not suitable and sufficient 6 Number of Shops within the Borough where ventilation rendered suitable and sufficient as the result of— (a) Informal action 5 (b) Formal action Number of Shops within the Borough where reasonable temperature not maintained 28 Number of Shops within the Borough where means of heating provided as the result of— (a) Informal action 23 (b) Formal action 24 Number of Shops within the Borough where suitable and sufficient sanitary accommodation not provided 56 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 1939 1126 Number of Certificates granted by the Local Authority exempting shops from the provision of Section 10 (2) 25 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Two hundred and ninety-three cases of infectious disease were notified during 1939, an increase of 76 crses on the previous year. This increase is mainly due to cases of Pneumonia, of which there were 72. The incidence of Scarlet Fever and of Diphtheria remained low. Two cases of Typhoid Fever and two cases of Paratyphoid Fever were notified. There were 11 cases of mild Dysentery. Four cases of Acute Anterior Poliomyelitis were notified. Recovery was complete in three, but there was one death from a very acute attack. Scarlet Fever.—One hundred and thirty-one cases were notified. The disease was generally mild. No death was recorded. The case rate for the Borough was. 1.71 per 1,000 of population, compared with a case rate of 1.89 per 1,000 of population for England and Wales. 25 Diphtheria.—Thirty-one cases were notified, and of these 19 occured in institutions. There was one death of a child aged five years. The case rate was- 0'40 per 1,000 of population, compared with 114 for England and Wales. The relatively small number of cases is satisfactory, but should not be regarded with complacency in the face of war-time risks of overcrowding under domestic and shelter conditions. As to the Prompt Use ot Antitoxin.—The prevention of mortality from Diphtheria depends on early diagnosis and early treatment. Responsibility rests on the parents and on the medical practitioners. Parents should call medical practitioners to sec suspected cases at the earliest possible moment. Medical practitioners should give large initial doses of Antitoxin on clinical diagnosis and without waiting for bacteriological confirmation of the diagnosis. ARTIFICIAL IMMUNISATION ACAINST DIPHTHERIA. It was necessary to reduce the time devoted to this service owing to the work of Air Raid Precautions, but the service at the clinic was continued and 147 children received three injections of Toxoid Antitoxin Floccules (T.A.F.). Diphtheria is a dangerous disease and liable to epidemic spread under the lowered hygienic standards associated with war. Younger children are much more susceptible than adults, and the mortality is highest in the lower age groups. Immunisation protects children against Diphtheria, and all children should be immunised before they reach school age. Parents are advised to have their younger children immunised at once in order to protect each child, each family, each school and the community against the epidemic spread of the disease. Pueperal Pyrexia.—Fifteen cases of Puerperal Pyrexia were notified during the year. The case rate 26 was 12.85 per 1,000 total births, compared with 14 35 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 the immediate and effective isolation of any suspected cases occurring in maternity homes- Typhoid and Paratyphoid Fever.—Two cases of Typhoid Fever and two cases of Paratyphoid Fever were notified during the year. There was no evidence of sources of infection within the Borough. Dysentery. —Eleven cases of Dysentery of the Sonne type were notified. The cases were mild. The disease is endemic and spreads rapidly unless the strictest attention is paid to personal and domestic hygiene by all concerned in the exposure, handling and distribution of food. Non-Notifiable Diseases. -School teachers reported 246 cases of Chicken-pox, 154 of Whooping Cough, 5 of Measles and 36 of Mumps. School notifications formed the basis of consultations with the School Medical Officer. There were two deaths from Whooping Cough due to pulmonary complications. Notification of Pneumonia.—Twenty deaths, occurred from all forms of pneumonia. The total number of notified cases arising in the district was 72. 27 Notifiable Diseases (other than Tuberculosis) during 1939. 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 1 3 1 15 8 62 12 4 8 4 3 - 121 97 - Diphtheria — — 2 — 1 2 — 2 4 — — - 11 10 1 Typhoid Fever — — — — — — — 1 1 — — — 2 — — Para typhoid B - - - - 1 - 1 - - - - - 2 - - Puerperal Pyrexia - - - - - - - - 15 - - - 15 3 - Pneumonia 1 — 2 1 2 6 1 7 12 11 15 15 72 16 20 Erysipelas — — — — — 1 — — 1 3 7 5 17 8 — Dysentery 1 — — 2 1 3 — - 3 — — 1 11 — — Poliomyelitis — — — — — 3 — 1 — — — — 4 3 1 Cerebro-Spinal Fever 1 - - - - - - - 1 1 1 - 4 3 1 Ophthalmia Neonatorum 3 - - - - - - - - - - - 3 - - Measles — - — — — — — - 1 — — — 1 — — Whooping Cough - - - 1 - - - — - - - - 1 - - London S.F - 1 - 1 - 3 2 1 - - - - 10 10 - cases in the Downs Hospital Dip. - - 3 — 3 6 3 2 1 — — — 19 19 — #Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. Bacteriological Examinations.—The following examinations of specimens were made by direction of the Borough Council:— Diphtheria. Enteric. Tuberculosis. Positive. 31 Negative. Positive. Negative. Positive Negative. 532 0 14 9 62 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table. 28 TUBERCULOSIS. On 31st December, 1939, there were on the Register 450 cases of Tuberculosis, of which 365 were pulmonary and 85 non-pulmonary cases. The death rate for Pulmonary Tuberculosis was 048 per 1,000 of population, and for Non-pulmonary Tuberculosis 0.08 per 1,000 of population. The total Tuberculosis death rate in 1939 was 0.56 per 1,000 of population, compared with 0.57 per 1,000 of population in 1938. The corresponding death rates for England and Wales in 1939 were: Pulmonary, 0.53 per 1,000 of population; Non-pulmonary, 0.09 per 1,000 of population. Total rate, 0.62 per 1,000 of population. The following Table shows new cases and deaths in age groups:— Age Periods. New Cases. Deaths. Pulmonary. NonPulraonary Pulmonary. NonPulmonary. M F M F M F M F 0 - - - - - - - - 1 - 1 - 2 — — — — 5 - — 2 1 — — — — 15 6 10 1 — 3 3 — — 25 12 11 - - 5 6 — 2 35 7 3 - - 6 4 1 - 45 5 2 - - 4 1 - - 55 4 2 - 1 4 - — 1 65& above 1 1 — - — 1 1 1 Totals 34 30 3 4 22 15 2 4 NOTIFICATION OF TUBERCULOSIS. Respiratory Forms of Death—35 out of 37 were notified. Other Forms of Death—2 out of 6 were notified. 29 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 every fourth Saturday at 2 p.m. Ante-Natal Clinic.—Every Monday, at 1.30 p.m., and every fourth Monday at 9.30 a.m. till noon. Infant Welfare.—Every Tuesday, at 1.30 p.m. CHEAM AND WORCESTER PARK DISTRICTClinic.—Parochial Rooms, Maiden Road, Cheam. Infant Welfare.—Every Wednesday at 1.30 p.m. Ante-Natal.—Every Friday at 10 a.m., and every Thursday at 1.30 p.m. Clinic.—Priory Crescent, Cheam. Infant Welfare.—Every Monday and Thursday at 1.30 p.m. Clinic.—St. Oswald's Hall, Brocks Drive, North Cheam. Infant Welfare.—Every Friday at 1.30 p.m., and second and fourth Tuesdays in the month at 1.30 p.m. Borough Immunisation Clinic.—The Public Hall, No. 1, Hill Road, Sutton, on Fridays., at 2.15 p.m. 30