Sutc 4 LIBRARY Borough of Sutton and Cheam ANNUAL REPORT of the Medical Officer of Health for the Year 1940 William Pile, Ltd., Printers (t.u.), 46-50, High Street, Sutton. BOROUGH OF SUTTON & CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1940. PUBLIC HEALTH AND HOUSINC COMMITTEE. HIS WORSHIP THE MAYOR (Alderman GEORGE H. DENNIS, J.P.), ex-officio. Alderman F. C. LOHDEN, O.B.E. COUN. W. COOKE. J. EVERETT J. M. FIRTH. W. E. HEATH. G. J. JEWETT. A. E. KIRKUS. O.BE. Coun. L. SHAW DAVIS. T. STOKER. W. T. VENTON. (Chairman). W. L. WHITELEY, B.Sc. 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 Sanitary Inspectors: JOHN HENRY LOTT, Certif. R.S.I.; Certif. Meat & Food. KEMPTON HUDDLESTONE PRIOR, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. ARTHUR CHARLES RUSSELL, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food (On Active Service). "FRANK SUTCLIFFE, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. Mrs. A. BOZWARD, Certif. R.S.I. "Appointed 24th June, 3940. 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 Annual Report for the year 1940. The year under review will remain memorable for the now historic " Battle of Britain " and for the fortitude of our civil population under enemy bombing-. The mode of life of the community had to be altered to meet new conditions but, despite the lower hygienic standards produced by the black-out and air-raid protection, the mental and physical health of the people remained good. Opportunity for the spread of infections was increased by the limitation of sleeping accommodation in the homes. The policy of dispersal by the provision of family shelters and the tendency for people to prefer to remain in their own homes localised the spread of infection. Life in public shelters was on a small scale and there was no evidence of adverse effect. The fair distribution of available protective foods under the rationing system and the preferential consideration given to mothers and children in the supply of milk were important factors in maintaining nutritional standards and resistance to disease. There was no increase in the incidence of infectious diseases. The death rate was higher at 11.5 per 1,000 of population. The birth rate was lower at 13.4 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). No serious dislocation of the sanitary services resulted from enemy action. 3 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 measures adopted to deal with bomb damage to water supply proved effective. The casualty services carried out their work with zeal and efficiency. 1 would express my appreciation of the devotion to duty of the personnel of the First Aid, Ambulance and Mortuary services. 1 thank members of the Council for their advice and assistance during the year, and 1 am indebted to the Officers of the Council for their co-operation. I am, Mr. Mayor, Madam, and Gentlemen, Your obedient servant, ENEAS J. MACINTYRE, Medical Officer of Health. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in Acres 4338.15 Registrar-General's Estimate of the Resident Population, 1940 73810 Number of inhabited houses (end of 1940) according to Rate Books 21894 Rateable Value and sum represented by £904327 a Penny Rate £3411 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 1940. LIVE BIRTHS : T. M. F. Birth-rate of the resident 13.4. per 1,000 estimated population, Total 990 525 465 Legitimate 948 499 449 Illegitimate 42 26 16 STILL BIRTHS: T. M. F. Total 26 13 13 Rate per 1,000 (live and still) births, Legitimate 25 12 13 25.5. Illegitimate — 1 1 Death-rate per 1,000 of the estimated resident population, 11.5. T. M. F. Deaths 799 406 393 Deaths from puerperal causes :— Deaths ... 3 Rate per 1,000 total (live and still) births 3.03 Deaths from— Puerperal Sepsis 0 Other Puerperal causes 3 Total 3 Death-rate of Infants under one year of age :— All Infants per 1,000 live births 42.25 Legitimate Infants per 1,000 legitimate live births 26.37 Illegitimate Infants per 1,000 illegitimate live births 23.81 Deaths from Cancer (all ages) 103 ,, Measles (all ages) 0 ,, Whooping Cough (all ages) 0 ,, Diarrhoea (under 2 years of age) 5 5 Percentage of Deaths from certain causes to the total number of Deaths :— Diseases of the heart and circulation 34.0 Cancer and malignant disease 12.9 Diseases of lungs (not tuberculous) 11.6 Tuberculous Diseases 4.0 Cerebral haemorrhage 6.8 Congenital Diseases 2.2 Suicide and violence 11.1 Diseases of the digestive system 4.1 Infectious diseases 2.5 Diseases of the kidney 2.2 Senility 3.4 Other defined causes 5.2 The number of Deaths from the common infectious diseases were :—Measles 0, Diphtheria 3, Scarlet Fever 0, Whooping Cough 0, and Influenza 13. Maternal Mortality.— The maternal mortality rate was lower at 3.03 per 1,000 total births. There were two deaths from haemorrhage due to placenta praevia and one death consequent on self-induced abortion. Infantile Mortality.— The infantile mortality rate was lower at 42.25 per 1,000 live births. The fortytwo deaths were due to the following causes :— Congenital Malformations 10 Prematurity 9 Broncho-Pneumonia 5 Acute Bronchitis 5 Cerebral Haemorrhage 5 Gastro-Enteritis 3 Misadventure 2 Other Diseases of Infancy 3 6 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1940. M. F. Total. 1 Typhoid and paratyphoid fevers — — — 2 Cerebro-spinal fever 2 — 2 3 Scarlet fever — — — 4 Whooping cough — — — 5 Diphtheria — 3 3 6 Tuberculosis of respiratory system 22 13 35 7 Other forms of tuberculosis 5 2 7 8 Syphilitic diseases 5 2 7 9 Influenza 6 7 13 10 Measles •— — — 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infective encephalitis 1 1 2 13 Cancer of buccal cavity Oesophagus (M) and Uterus (F) 3 11 14 14 Cancer of stomach and duodenum 10 12 22 15 Cancer of breast 1 15 16 16 Cancer of all other sites 30 21 51 17 Diabetes 3 3 6 18 Intracranial vascular lesions 21 33 54 IS Heart disease 100 102 202 20 Other diseases of circulatory system 10 6 16 21 bronchitis 24 19 43 22 Pneumonia 19 16 35 23 Other respiratory diseases 5 10 15 24 Ulcer of stomach or duodenum 11 3 14 25 Diarrhoea under 2 years 4 1 5 26 Appendicitis 5 0 5 27 Other digestive diseases 8 11 19 28 Nephritis 10 8 18 29 Puerperal sepsis 0 0 0 30 Other materna causes 0 3 3 31 Premature birth 6 3 9 32 Congenital malformations brth injuries and infantile diseases 10 8 18 33 Suicide 2 2 4 34 Road traffic accidents 7 2 9 35 Other violent causes 40 36 76 36 All other causes 36 40 76 406 393 799 7 BIRTH-RATES, CIVILIAN DEATH-RATES—ANALYSIS OF MORTALITY IN THE YEAR 1940. England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns, resident population 25,000-50,00) at 1931 census London Adm. County Sutton and Cheam Hates per 1,000 civilian population .— Live births 14.6 1.60 15.7 13.7 13.4 Still „ 0.55 0.64 0.55 0.44 0.35 Deaths:— All causes 14.3 1.58 12.9 17.8 11.5 Typhoid and paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping cough 002 0.02 0.02 0.00 0.00 Diphtheria 0.06 0.07 0.05 0.01 0.04 Influenza 0.32 0.29 0.30 0.18 0.18 Smallpox — — — — — Measles 0.02 002 0.02 0.01 0.00 Rates per 1,000 live births:— Deaths under 1 year of age 55 61 54 50 42 Deaths from diarrhoea and enteritis under 2 years of age 4.6 5-9 4.4 5.8 5.0 Maternal Mortality:— Rate per 1,000 total births;— Puerperal infection 0.52 0.00 Others 1.64 3.03 Total 2.06 3.03 8 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. Legislation.—The Measles and Whooping Cough Regulations, 1939 (which were provisional regulations), and became operative on the 23rd October, 1939, were confirmed as statutory regulations by the Measles and Whooping Cough Regulations, 1940. 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 Water 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 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. 9 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 Nirates. 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 lor 3 days at 20° 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 18.375 .0135 .0006 .9908 0 .0002 1.983 7.08 2. 6 .25 0 Drainage and Sewerage.— Owing to the restrictions imposed by war conditions, it has been found impossible to proceed with the schemes for the construction of the High Level Relief Soil Sewer, which it is proposed to construct to serve the greater portion of the Parish of Sutton, and the scheme for a new sewer from the Gander Green Lane area to the Worcester Park Sewage Works has also had to stand over. The proposals for additions and alterations to the Worcester Park Sewage Works have also had to be abandoned for the time being. Owing to the cessation of building development during the war there has been no demand for the construction of new sewers. Refuse Collection and Scavenging.—The collection and disposal of house refuse, together with scavenging of public highways, are carried out under the supervision of the Borough Engineer and Surveyor, and the arrangements made continue as reported in 1939. Rivers and Streams.—The rivers and streams within the Borough have been maintained in a satisfactory condition during the year. Closet Accommodation.—There are 14 cesspools in use. Some six pail closets and one privy are in use. In the past thirteen 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, Food Supply, etc., has been condensed. 10 Record of Inspections and Notices Served. Number. Special Inspections, Interviews on Premises, and Advisory Visits 1032 Re-inspections 2478 Visits to Works in Progress 483 Visits to Factories and Workplaces 231 Visits to Bakehouses 36 Visits to Outworkers' Premises 81 Visits to Slaughterhouses 42 Visits to Butchers' and Food Shops 250 Visits to Dairies and Milkshops 121 Visits to Ice Cream Premises and Vehicles 65 Visits to Stables 5 Visits to Pigsties 2 Visits re Rat Infestation 377 Food and Drug Sample Visits 62 Visits re H.C.N. Regulations 7 Visits re Merchandise Marks Act 169 Visits in connection with Infectious D isease 151 Visits re Overcrowding and " Permitted Number " Measurements 73 Visits to Petroleum Spirit and Cinematograph Film Stores 107 Visits to Foodshops re food damaged by enemy action 46 Visits to Refugee Billets 239 Visits to Evacuee Billets 324 Visits and Revisits re Shops Acts 1398 Miscellaneous 1025 8804 Premises at which defects or nuisances were discovered 578 Dwelling-houses inspected for housing defects under Public Health or Housing Acts 211 Defects or nuisances discovered 1896 Defects or nuisances remedied 1591 Defects or nuisances in hand 49 Defects or nuisances outstanding 256 Informal Notices served 539 Statutory Notices served 5 Complaints received and investigated 456 11 Summary of Remedial Works and Sanitary Improvements carried out. Number. Drainage and Sanitary Fittings. No. of houses and premises redrained 4 Houses connccted to surface water sewers 1 Repairs or amendments to existing drains 13 Drains or gullies unstopped and cleansed 79 Sanitary fittings repaired, renewed or provided 362 W.C. Apartments. New Apartments provided 4 W.C. Apartments lighted and/or ventilated 24 Ventilated lobbies to W.C. apartments provided 2 Structural Repairs or Improvements. Roofs renewed or repaired 79 Guttering and rain water pipes provided, repaired, etc. 69 Damp walls remedied 60 Brick walls repointed, repaired or rendered 35 Chimney stacks repaired or rebuilt 2 Yards paved or repaired 11 Floors relaid or repaired 56 Additional lighting or ventilation to rooms 8 Windows and/or cills repaired or renewed 101 Doors and thresholds provided or repaired 75 Larders provided 4 Staircases and handrails repaired or provided 9 Ranges, stoves and coppers repaired or renewed 65 Miscellaneous 168 12 Cleansing. Rooms, passages, larders, etc., cleansed 359 Trade premises cleansed 35 Verminous houses disinfested 48 Ceneral. Accumulations of refuse removed 38 Nuisances from smoke abated 3 Rat-infested premises cleared 55 Nuisance from animals abated 4 Miscellaneous 50 Smoke Abatement. There are few chimneys attached to industrial premises in this district. Informal action resulted In the abatement of three nuisances from smoke. 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 Notices. Occupiers Prosecuted. (1) (12) (3) 14) Factories with Mechanical Power 143 19 — Factories without Mechanical Power 94 11 — Other Premises (other than Outworkers' premises) — — — Total 237 30 — 13 Outwork in Unwholesome Premises. Nature of Work. Instances. Notices served. Prosecutions. (1) (2) (3) — — — — Public Health Act, 1936—Workplaces. Number of Inspections. Written Notices. Occupiers Prosecuted. 30 - - HOUSINC. 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) 211 14 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. Referred to H.M Inspector (1) (2) (3) (4) (5) Want of Cleanliness 29 27 — Inadequate Ventilation — — — — Overcrowding 1 1 — — Unreasonable Temperature 3 1 — — Ineffective Drainage of Floors — — — — Absence of Thermometers 6 5 — — Absence of suitable lighting in W.C. apartments 13 10 — — Other Nuisances 10 10 — — Sanitary accommodation— (a) Insufficient (b) Unsuitable or defective 2 2 — — (c) Not separate for sexes 64 56 — — (b) Number of inspections made for the purpose 952 (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 — (b) Number of inspections made for the purpose — (3) Number of dwelling-houses found to 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 precedingsub-head) found not to be in all respects reasonably fit for human habitation 76 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwellingthouses rendered fit in consequence of informal action by the Local Authority or their Officers 68 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 :— — 15 (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 5 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By Owners 5 (b) By Local Authority in default of owners — C.— Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— Nil. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act, 1938. The following table indicates the samples taken during the year 1940 :— 16 Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Milk 19 48 67 2 2 Milk (condensed) 1 1 Baiter 1 4 1 1 Margarine 3 3 3 3 Lard 1 1 Cooking Fat 2 2 Beef Suet 1 1 2 1 1 2 Dripping 1 1 Cheese 1 1 Meat Paste 1 1 Liver Sausage 1 1 Minced Beef 1 1 Sausages 1 1 Rice 1 1 Sultanas 1 1 Coffee 1 1 Baking Powder 1 1 Jelly Crystals .. 2 2 4 2 2 4 Jelly 1 1 Milky Chocolate Powder 1 1 Vinegar, malt 1 1 Tomato Sauce 1 Confectionery 2 2 Egg Powder (substitute) 1 Ammoniated Tincture of Quinine 1 l Medicinal Liquid Paraffin .. 1 1 Iodine, Tincture of 1 1 Sal Volatile 1 1 Olive Oil 1 1 Total 23 84 107 4 8 12 No prosecutions were instituted during the year. In the case of the beef suet and jelly crystal samples warnings were given lo the vendors. The margarine samples are reported as adulterated but, nevertheless, they conformed to the Margarine (Addition of Borax) Order, 1940. Milk Supply. There are 16 dairymen and 62 retail purveyors of milk in the district. Eight persons whose premises are outside the district are also registered as retail purveyors. Routine inspection of premises has again 17 revealed that the provisions of the Milk and Dairies Order, 1926, have been generally well observed. The following Tables show the results of examinations of samples of milk during 1940 :— MILK SAMPLES. Forty-eight samples of milk were submitted for bacteriological examination as below:— 1. Pasteurised Milk. No. of Samples. Below 100,000 bacteria per milliter. Coliform Test Phosphatase Test. — + Satisfactory Unsatisfactory 12 16 15 1 16 - 2. Tuberculin Tested Milk. No. of Samples. Methylene Blue Test. Coliform Test. Satisfactory . Unsatisfactory. Satisfactory. Unsatisfactory. 5 5 — 5 13 The following Licences to sell graded milks were granted in 1940 :— Grade of Milk. Type of Licence. Dealers'. Supplementary. Tuberculin Tested 13 2 Accredited — 1 Pasteurised 19 3. Ordinary Milk. No. of Samples. Total bacteria per millimetre. Coniform Test. Under 50,000 50,000 100,000 100.000 328,000 — + 27 19 3 5 12 15 ICE CREAM. At the end of 1940, 97 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. On 9 of these premises ice cream is manufactured. The premises, together with vehicles used by purveyors, were inspected during the season. Eight instances of unsatisfactory conditions were dealt with. 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 3 cases where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. At the end of 1940, 55 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. The majority of the registered premises are concerned with the manufacture of sausages only. Thirteen cases of insanitary conditions in food shops were dealt with. There are two licensed slaughter-houses in the district. Neither of these is included in the Government Centralised Slaughtering Scheme. 19 The number of carcasses inspected at the time of slaughter, and prior to the coming into operation of the Livestock (Restrictions on Slaughtering) Order, 1940, 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 — — 135 — 125 Number inspected .. — — 135 — 125 All diseases except Tuberculosis. Whole carcasses condemned — — — — — Carcasses of which some part or organ was condemned — — — — 11 Percentage of the number inspected affected with disease other than tuberculosis — — — 8.8% Tuberculosis only. Whole carcasses condemned — — 1 — — Carcasses of which some part or organ was condemned — — 7 — 1 Percentage of the number inspected affected with Tuberculosis 5.92% .8% 20 The following diseased and unsound meat and other foods have been detected, surrendered, and destroyed :— MEAT. Carcasses or parts sof carcasses Number found to be diseased in slaughter-houses. BOVINES Calves. Carcasses and Offals (Generalised Tuberculosis) 1 Sets of Lungs (Pneumonia) 6 Head (Glandular Inflammation) 1 PIGS Heads and Tongues (Localised Tuberculosis) 1 Sets of Lungs (Pneumonia) 1 Livers (Cirrhosis) 11 Legs and Loin (Injuries) 2 MEAT AND OTHER FOODS IN RETAIL SHOPS 121½ lbs. Beef (Bone Taint) ; 58 lbs. Ox Tails (Decomposition) ; 29½ lbs. Lamb (Decomposition) ; 6 lbs. Sweetbreads (Decomposition) ; 43 lbs. Bacon (Decomposition) ; 2 Boxes Cod (Unsound) ; 20 lbs. Iceland Salmon (Unsound) ; 2 Boxes Whiting (Unsound) ; 3 Boxes Kippers (Unsound) ; 2 Boxes Herrings (Unsound) ; 91 lbs. Rabbits (Decomposition) ; 13¾ lbs. Ham (Unsound) ; 6 dozen Fishcakes (Unsound) ; 86 Pork Pies (Unsound) ; 2 Veal and Ham Pies (Unsound) ; 12 Cornish Pasties (Unsound) ; 6 lbs. Apple Rings (Unsound) ; 243 tins Miscellaneous Foodstuffs (Blown and Damaged). 21 FOODSTUFFS DAMAGED BY ENEMY ACTION. All foodstuffs in premises damaged by enemy action have been examined with a jview to salvage or destruction. A considerable quantity of food has been handled in this connection. Full publicity has been given through the local Press, by poster and letter on the danger of splintered glass in foodstuffs. 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. Three persons were licensed to act as Slaughtermen during 1940. BAKEHOUSES. There are 26 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 1940, 877 visits were made in connection with rat or mice infested or suspected infested premises, and 55 premises were satisfactorily cleared of rats or mice. SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. ERADICATION OF BED BUCS. Forty-eight bug-infested houses were dealt with as follows :— 22  By the use of Insecticides. Sulphur. Hydrocyanic (H.C N. Gas. Council Houses 1 — — Other Houses 4 — The work of disinfestation has continued to be carried out upon the lines indicated in previous Reports. The Insecticide used is 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 1080 Number of visits paid to Shops during 1940 1398 Number of Shops where ventilation found to be not suitable and sufficient — Number of Shops where ventilation rendered suitable and sufficient as the result of— (a) Informal action — (b) Formal action — Number of Shops where reasonable temperature not maintained 22 Number of Shops where means of heating provided as the result of— (a) Informal action 19 (b) Formal action — Number of Shops where suitable and sufficient sanitary accommodation not provided 53 Number of Shops where suitable and sufficient sanitary accommodation provided as the result of— (a) Informal action 39 (b) Formal action — Number of Shops where the provisions of Section 10 (1) and (2) were complied with at the end of 1940 1041 Number of Certificates granted by the Local Authority exempting Shops from the provisions of Section 10 (2) 25 23 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Four hundred and seventy cases of infectious disease were notified during the year 1940. Cases of Measles and Whooping Cough are included for the first complete year since these diseases became notifiable. Excluding Measles and Whooping Cough, which have short cycles of prevalence, other infectious diseases showed a decline of forty cases. The incidence of Scarlet Fever and Diphtheria remained low. Enteric infections were few. The number of cases of Pneumonia ' was much reduced. There was an increase in cases of Cerebro-Spinal Fever, which is in accordance with the higher general prevalence of this disease, but the cases were sporadic and no epidemic conditions existed. No case of Anterior Poliomyelitis was notified. SPRAY INFECTIONS. The importance of the prevention of spray infections from the nose and throat cannot be over-emphasised at a time when even temporary incapacity means loss of national effort. The restricted ventilation resulting from black-out conditions and air-raid protection increases the danger of spray infections. In homes and in shelters, persons with catarrhal conditions of the throat or nose or with active cough should separate themselves as far as possible from their companions and bv the judicious and frequent use of the handkerchief interrupt the passage of those invisible particles of infection which are sprayed by coughs and sneezes over a wide range. It should be remembered that nearly all the commoner infectious diseases are spread by spray from the throat and nose. Scarlet Fever.—One hundred and twenty-one cases were notified, a decrease of ten cases. Of these nine were Institutional cases. The disease was generally mild. The case rate for the Borough was 1.64 per 1,000 of population, compared with a case rate of 1.63 for England and Wales. 24 Diphtheria.— Twenty-three cases were notified and of these thirteen were Institutional cases. There were three deaths of two adults and one child. The case rate was 0.31 per 1,000 of population, compared with 1.16 for England and Wales. Diphtheria is a dangerous disease. Risks of infection are increased in war time. The germ mutliplies in the infected throat and produces poisons which are quickly injurious to the heart. Early diagnosis and treatment are essential. As to the Prompt Use of Antitoxin.—The effects of the toxin or poison produced by the Diphtheria bacillus can only be counteracted by the prompt use of antitoxin. Medical practitioners should give large initial doses of antitoxin on clinical diagnosis and without waiting for bacteriological confirmation of the diagnosis. The relatively small number of cases of Diphtheria should not engender complacency, and abnormal throat conditions should always be regarded with suspicion. Early diagnosis and early treatment with antitoxin are essential for the prevention of mortality. ARTIFICIAL IMMUNISATION ACAINST DIPHTHERIA. The prevention of Diphtheria is better and easier than the cure. Immunisation will prevent diphtheria and stop epidemic spread. Young children are the most susceptible and the risk of mortality is highest between the ages of 1 year and 5 years. Too often parents are willing only to have older children immunised and to leave the younger children susceptible until thev reach school age. This is misdirected kindness. All children should be immunised before they reach school age. During 1940 one hundred and sixty-one children received three injections of Toxoid Antitoxin Floccules. Attendance was restricted by the frequency of air raids. 25 Puerperal Pyrexia.— Eight cases of Puerperal Pyrexia were notified during the year. The case rate was 8.08 per 1,000 total births compared with 11.96 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.—There was no case of Typhoid Fever. Two cases of Paratyphoid were notified. There was no evidence of sources of infection within the Borough. Dysentery.—Eight cases of Dysentery of the Sonne type were notified. The cases were mild. The disease is endemic and spread can only be prevented by the strictest attention to personal and domestic hygiene. Many cases are very mild and may be manifested only by slight abdominal discomfort, slight vomiting or slight diarrhoea. Such symptoms are also transient and may fail to arouse suspicion of infectivity. The disease is highly infectious. Mild cases may by infection produce more serious eases with severe symptoms and incapacity extending over weeks. The habitat of the organism is in the bowel. It is transmitted by infected fingers or flies to food. All those engaged in the handling of food, whether in the factory, dairy,, shop or kitchen, must be scrupulous in the cleanliness of hands in order to prevent the spread of all such enteric infections. Non-Notifiable Diseases.—German Measles was epidemic during the second quarter of the year. School teachers reported 272 cases of German Measles, 116 cases of Chicken Pox, 75 cases of Mumps, 24 cases of Whooping Cough and 12 cases of Measles. 26 School notifications formed the basis of consultation with the School Medical Officer. Pneumonia.— Thirty-five deaths occurred from all forms Of Pneumonia. The total number of cases notified in the district was thirty-three. Notifiable Diseases (other than Tuberculosis) during 1940. Disease. Under 1 Year. 1 Year. 2 Years. 3 Year. 4 Years. 5 Years. 10 Years. 15 Year . 10 Years. 35 Years. 45 Years. 65 Years. Totals. Removed to Hospital Died. Scarlet Fever - 2 7 8 10 61 8 4 8 2 2 - 112 90 - Diphtheria — — — — — 6 — 1 2 — 1 — 10 10 2 Typhoid Fever — — — — — — — — — — — — — — — Para-typhoid — — — — — — — — 2 — — — 2 — — Puerperal Pyrexia — — — — — — — — 5 3 — — 8 3 — Pneumonia — 1 1 2 — 2 1 2 2 8 10 4 33 1 1 Erysipelas — — — 2 — — — — 1 1 1 2 7 2 — Dysentery — 1 1 — 1 — — 1 2 — 2 — 8 — — Poliomyelitis — — — — — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — 1 4 3 2 — 10 10 — Ophthalmia Neonatorum 3 — — — — — — — — — — — 3 — — Malaria — — — — — — — — — 1 — — 1 — — Measles 1 5 7 11 13 58 10 8 10 2 3 — 128 1 — Whooping Cough 2 12 11 6 4 47 — — 1 1 — — 84 — — London S.F — — 1 — 2 3 — — 1 — — — 9 5 — cases in Dip. 1 — _ 2 2 4 1 2- — 1 — — 13 9 1 the Erys — — — — — 1 — — — — — 1 — — Downs Meas. 9 7 14 11 1 3 1 — — — — — 39 — — Hospital W.C. — — — — — — — — — — — — 2 — — "Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. 27 Bacteriological Examinations.— The following examinations of specimens were made by direction of the Borough Council :— Diphtheria. Enteric. Tuberculosis. Positive. . Negative. Positive. Negative. Positive. Negative. 16 300 5 14 9 44 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory ; these are not included in the above Table. Disease. WARDS. Case Rate per 1000 Populatn (Midyear) Case Rate per 1000 England and Wales. N. N W. NR. w.c. E.G. E. S.W. S.E. S. Total Population 9777 8549 1031612366 7218 7080 5556 5370 7578 73810 Scarlet Fever 19 5 21 22 23 9 3 2 8 112 1-51 1-63 Diphtheria 6 — 2 — 2 — — — 10 013 1-16 Para typhoid 1 — — — — — — 1 2 0 03 004 Pneumonia 8 2 1 8 3 4 1 4 7 33 0 45 1-20 Erysipelas 2 — — 3 1 — — — 1 7 009 0-33 Puerperal Pyrexia — 2 — 1 1 1 2 1 8 011 — Dysentery — 8 — — — — — 8 011 — Cerebro-Spinal Fever — 1 3 1 — 3 1 1 10 013 Ophthalmia Neonatorum 1 — — — 1 1 — — — 3 — Therapeutic M alalia — — 1 — — — — — — 1 — — Measles 17 5 56 21 4 6 8 1 46 167 — — Whoopin g Cough 17 15 11 34 2 3 — 1 3 86 — — Total .. 66 27 103 91 36 26 16 11 68 447 28 TUBERCULOSIS. On 31st December, 1940, there were on the Register 498 cases of Tuberculosis, of which 400 were pulmonary and 98 non-pulmonary cases. The death rate for Pulmonary Tuberculosis was 0.47 per 1,000 of population, and for non-pulmonary Tuberculosis 0.09 per 1,000 of population. The total Tuberculosis death rate in 1940 was 0.56 per 1,000 of population, compared with 0.56 per 1,000 of population in 1939. The corresponding death rates for England and Wales in 1940 were : Pulmonary, 0.58 per 1,000 of population; non-pulmonary 0.11 per 1,000 of population. Total rate, 0.69 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 — — 1 — 5 — 3 1 — — — 2 — 15 8 13 — 4 3 3 — 1 25 13 7 3 3 a 3 — — 35 6 3 1 2 7 4 — — 45 4 2 1 — 3 2 2 — 55 4 — 1 4 l — — 65 above 2 1 — 1 2 — 1 Totals .. 38 29 6 12 22 13 5 2 NOTIFICATION OF TUBERCULOSIS. Respiratory Forms of Death —23 out of 35 were notified. Other Forms of Death—6 out of 7 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., every Thursday at 2 p.m.,, and every fourth Saturday at 2 p.m. Ante-Natal Clinic.—Every Monday, at 1.30 p.m. Infant Welfare.—Every Tuesday, at 1.30 p.m. CHEAM AND WORCESTER PARK DISTRICT- Clinic.—Parochial Rooms, Maiden Road, Cheam Infant Welfare.—Every Wednesday at 1.30 p.m. Ante-Natal.—Every first, third and fifth Thursday in the month at 1.30 p.m. Clinic.—Priory Crescent, Cheam. Infant Welfare.—Every Monday and Thursday at 1.30 p.m. Ante-Natal.—Every second, fourth and fifth Monday at 9.30 a.m. till 11.30 a.m., and every Friday morning- at 9.30 a.m. till 11.30 a.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 I\