Borough of Sutton and Cheam ANNUAL REPORT of the Medical Officer of Health for the Year 1941 William File, Ltd., Printers (T.U.), 46-50, High Street, Sutton BOROUGH OF SUTTON & CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1941. PUBLIC HEALTH AND HOUSING COMMITTEE. HIS WORSHIP THE MAYOR (Alderman JOHN G. KIPLING, J.P.). Alderman F. C. LOHDEN, O.B.E. Alderman GEORGE H. DENNIS, J.P. Coun. H. H. COOTE. Coun. L. SHAW DAVIS. „ J. EVERETT „ Mrs. SMYTH. (Chairman). „ T. STOKER. „ J. M. FIRTH. „ W. T. VENTON. „ W. E. HEATH. „ W. L. WHITELEY, „ G. J. JEWETT. B.Sc. „ A. E. KIRKUS, O.B.E. 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. 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. FRANK SUTCLIFFE, Certif. R.S.I, and S.I.E.J.B.; Certif. Meat & Food. †Mrs. A. BOZWARD, Certif. R.S.I. *In H.M. Forces. †Temporary. 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 on the health of the Borough for the year 1941. The year under review was a period of revival of the normal domestic and social life of the community. The health of the people remained good, and nutritional standards were well maintained. The general incidence of infectious diseases was low except for an epidemic of measles which continued during the first six months of the year, and a constant prevalence of whooping cough throughout the year. There was an increase in the number of cases of scabies, the spread of which is facilitated under war-time conditions by the close personal contact of people at home and at work. The death rate was lower. The birth rate was lower. The maternal mortality rate was higher. The infantile mortality rate was lower. The sanitary circumstances of the area were satisfactory, and the work of general sanitation, housing and food supply was efficiently carried out under the direction of the Chief Sanitary Inspector (Mr. C. W. Newbery). 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 Civil Defence Casualty Services operated efficiently and I would express my appreciation of the continued devotion to duty and high standard of service of the many volunteers of the First Aid Posts, Mobile First Aid Units and Ambulance Services. 3 I thank members of the Council for their advice and assistance during the year, and I 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 OF THE AREA. Area in Acres 4338.15 Registrar-General's Estimate of the Resident Population, 1941 70070 Number of inhabited houses (end of 1941) according to Rate Books 22133 Rateable Value and sum represented by £893781 a Penny Rate £3588 EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1941. LIVE BIRTHS: T. M. F. Birth-rate per 1,000 of the estimated resident population, 12.8 Total 899 448 451 Legitimate 843 422 421 Illegitimate 56 26 30 STILL BIRTHS: T. M. F. Rate per 1,000 (live and still) births, 30.2 Total 28 14 14 Legitimate 27 13 14 Illegitimate 1 1 — T. M. F. Death-rate per 1,000 of the estimated resident population, 10.8 Deaths 758 358 400 4 Deaths from puerperal causes:— Deaths 3 Rate per 1,000 total (live and still) births 3.23 Deaths from— Puerperal Sepsis 1 Other Puerperal causes 2 Total 3 Death-rate of Infants under one year of age:— All Infants per 1,000 live births 38.93 Legitimate Infants per 1,000 legitimate live births 40.33 Illegitimate Infants per 1,000 illegitimate live births 17.85 Deaths from Cancer (all ages) 121 ,, Measles (all ages) 2 ,, Whooping Cough (all ages) 3 ,, Diarrhoea (under 2 years of age) 4 Percentage of Deaths from certain causes to the total number of Deaths:— Diseases of the heart and circulation 26.8 Cancer and malignant disease 16.0 Diseases of lungs (not tuberculous) 10.7 Tuberculous Diseases 5.7 Cerebral haemorrhage 12.1 Congenital Diseases 3.3 Suicide and violence 5.9 Diseases of the digestive system 6.3 Infectious diseases 1.9 Diseases of the kidney 2.5 Other defined causes 8.8 The number of Deaths from the common infectious diseases were:—Measles 2, Diphtheria 3, Scarlet Fever 0, Whooping Cough 3, and Influenza 5. 5 Maternal Mortality.— The maternal mortality rate was slightly higher at 3.23 per 1,000 total births. The rate for England and Wales was 2.23 per 1,000 total births. There was one death from puerperal sepsis and there were two deaths from toxaemia of pregnancy and nephritis. Infantile Mortality.— The infantile mortality rate was lower at 38.93 per 1,000 live births. The rate for England and Wales, was 59 per 1,000 live births. The thirty-five deaths of children under one year were due to the following causes:— Congenital Malformations 13 Prematurity 6 Broncho-Pneumonia 4 Acute Bronchitis 1 Cerebral Hæmorrhage 1 Gastro-Enteritis 3 Misadventure 2 Other Diseases of Infancy 4 Unascertained 1 6 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1941. M. F. Total. 1 Typhoid and paratyphoid fevers — - — 2 Cerebro-spinal fever - — — 3 Scarlet fever - — — 4 Whooping cough 2 1 3 5 Diphtheria 1 2 3 6 Tuberculosis of respiratory system 17 20 37 7 Other forms of tuberculosis 1 5 6 8 Syphilitic diseases 1 — 1 9 Influenza 2 3 5 10 Measles 1 1 2 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infective encephalitis — — — 13 Cancer of buccal cavity Oesophagus (M) and Uterus (F) 5 3 8 14 Cancer of stomach and duodenum 9 9 18 15 Cancer of breast — 11 11 16 Cancer of all other sites 41 43 84 17 Diabetes 2 3 5 18 Intracranial vascular lesions 36 56 92 19 Heart disease 98 94 192 20 Other diseases of circulatory system 4 7 11 21 Bronchitis 16 21 37 22 Pneumonia 16 23 39 23 Other respiratory diseases 1 4 5 24 Ulcer of stomach or duodenum 12 1 13 25 Diarrhœa under 2 years 1 3 4 26 Appendicitis 3 2 5 27 Other digestive diseases 9 12 21 28 Nephritis 11 8 19 29 Puerperal sepsis — 1 1 30 Other maternal causes — 2 2 31 Premature birth 1 5 6 32 Congenital malformations, birth injuries and infantile diseases 10 9 19 33 Suicide 3 2 5 34 Road traffic accidents 7 3 10 35 Other violent causes 16 14 30 36 All other causes 32 32 64 358 400 758 7 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. Legislation.— The Scabies Order, 1941, became operative on 28th October, 1941. This order empowers local authorities, to secure the examination and cleansing of infested persons. 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 Dirtrict 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 160°C. Ammonia, free. Ammonia, Albuminoid Nitrogen as Ni rates. Nitrogen as Nit ites. Oxygen absorbed in i hours at 27ºC. Chlorine (in chlorides). Hardness total (soap test) No. of Bacteria growing on Agar per c.c for 3 days at 20° C. No. of Bacteria glowing on Agar per e.c. for 1 day at 37o C. Presence of Bacillus Coli in 100 o.c. Average 18.6 .0137 .0004 1025 0 .0058 1.958 7.3 2.4 .25 0 8 Drainage and Sewerage.— Owing to the restrictions imposed by war conditions, no reconstruction work or new constructions have been carried out, either at the Sewage Works or in connection with the main drainage system. Refuse Collection and Scavenging.- The collection and disposal of house refuse and salvage, together with the scavenging of public highways, is carried out under the supervision of the Borough Engineer and Surveyor. The work has been executed in a satisfactory manner. Rivers and Streams.— The streams within the Borough have been maintained in a satisfactory condition. Closet Accommodation.— There are 15 cesspools in use. Some six pail closets and one privy are in use, excluding pail and chemical closets used in connection with Civil Defence Services. In the past fourteen 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 this wishes of the Ministry of Health, the Report on Sanitary Inspection, Housing, Food Supply, etc. (pages 10 to 22), has been condensed. 9 Record of Inspections and Notices Served. Number. Special Inspections, Interviews on Premises, and Advisory Visits 2234 Re-inspections 2440 Visits to Works in Progress 1362 Visits to Factories and Workplaces 310 Visits to Bakehouses 53 Visits to Outworkers' Premises 31 Visits to Slaughterhouses 11 Visits to Butchers' and Food Shops 301 Visits to Dairies, and Milkshops 105 Visits to Ice Cream Premises and Vehicles 99 Visits to Stables 2 Visits to Pigsties 6 Visits re Rat Infestation 518 Food and Drug Sample Visits 55 Visits re H.C.N. Regulations 10 Visits re Merchandise Marks Act 9 Visits in connection with Infectious Disease 108 Visits re Overcrowding and "Permitted Number" Measurements 58 Visits to Petroleum Spirit and Cinematograph Film Stores 28 Visits to Foodshops re food damaged by enemy action 9 Visits to Refugee Billets 7 Visits to Evacuee Billets 84 Visits and Revisits re Shops Acts 583 Visits re Air Raid Shelters for Tuberculosis persons 571 Miscellaneous 937 9933 Premises at which defects or nuisances were discovered 1121 Dwelling-houses inspected for housing defects under Public Health or Housing Acts 93 Defects or nuisances discovered 1826 Defects or nuisances, remedied 1537 10 Defects or nuisances in hand 56 Defects or nuisances outstanding 233 Informal Notices served 928 Statutory Notices served 22 Complaints received and investigated 571 Summary of Remedial Works and Sanitary Improvements carried out. Number. Drainage and Sanitary Fittings. No. of houses and premises redrained 54 Repairs or amendments to existing drains 71 Drains or gullies unstopped and cleansed 216 Rain water pipes disconnected from soil drains 1 Sanitary fittings repaired, renewed or provided 633 Water and Smoke tests applied 519 W.C. Apartments. New Apartments provided 13 W.C. Apartments lighted and/or ventilated 22 Ventilated lobbies to W.C. apartments provided 1 Separate accommodation for sexes provided 1 Structural Repairs or Improvements. Roofs renewed or repaired 64 Guttering and rain water pipes provided, repaired, etc. 44 Damp walls remedied 49 Brick walls repointed, repaired or rendered 12 Chimney stacks repaired or rebuilt 4 Yards paved or repaired 39 Floors relaid or repaired 33 Additional lighting or ventilation to rooms 2 Windows and/or cills repaired or renewed 78 Doors and thresholds provided or repaired 20 Staircases and handrails repaired or provided 1 Ranges, stoves and coppers repaired or renewed 17 Miscellaneous 58 11 Cleansing. Rooms, passages, larders, etc., cleansed 233 Trade premises cleansed 42 Verminous houses disinfested 27 General. Dustbins provided 233 Accumulation of refuse removed 52 Rat-infested premises cleared 73 Nuisance, from animals, abated 13 Manure pits provided 2 Offensive ponds and ditches cleansed 3 Overcrowding abated 3 Miscellaneous 32 Smoke Abatement. There are few chimneys attached to industrial premises in this district. No smoke nuisances have occurred. 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) (2) (3) (4) Factories with Mechanical Power 189 63 — Factories without Mechanical Power 153 50 — Other Premises (other than Outworkers' premises) — — — Total 342 113 — 12 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 22 21 - - Inadequate Ventilation 2 2 - - Overcrowding 1 1 — - Unreasonable Temperature — — — - Ineffective Drainage of Floors — — - - Absence of Thermometers 2 2 — - Absence of suitable lighting in W.C. apartments 30 17 - - Other Nuisances 95 91 - — Sanitary accommodation— (a) Insufficient 2 2 - - (b) Unsuitable or defective 30 27 - - (c) Not separate for sexes 1 1 - - 185 166 — — 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. 21 3 — HOUSING. 1. Inspection of Dwelling Houses during the Years:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 93 13 (b) Number of inspections made for the. purpose 370 (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 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 32 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 29 3. Action under Statutory Powers during the Years:— 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:— — 14 (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 1 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 1 (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 1941:— 15 Article Number Examined Number Adulterated, etc. formal Formal Total Informal Formal Total Milk 15 15 2 2 Margarine 5 5 5 5 Lard 5 5 Batter 5 5 1 1 Cheese 2 2 Processed Cheese 1 1 Sausage Meat 4 4 Sausages 6 1 7 „ (preserved) 1 1 Meat Pie 2 2 Meat Roll 1 1 Steak Pie 1 1 Brawn 1 1 Minced Beef 1 1 Pressed Beef 1 1 Iceland Fish Balls 1 1 Fish Cakes 1 1 Bice 1 1 Sago 1 1 Semolina 1 1 Tapioca 1 1 Ground Rice 2 2 Corn Flour 1 1 Arrowroot 1 1 Sultanas 1 1 Cocoa 1 1 Coffee 3 3 Vinegar (Malt) 1 1 „ (Spirit) 1 1 Dried Eggs 1 1 Egg (substitute) 2 2 Laxatives 1 1 Aspirin Tablets 1 1 Boric Acid Ointment 1 1 Camphorated Oil 1 1 Castor Oil 1 1 Lung Syrup 1 1 Iodine, Tincture of 2 2 Tannic Acid Jelly 2 2 Anti-Gas Ointment, No. 2 1 1 Fruit Preserving Tablets 2 1 3 1 1 2 Lem-Lem 1 1 1 1 Lemon Substitute 1 1 1 1 Lemonstead (Lemon substitute) 1 1 P.N. Lemola (Lemon substitute) 1 1 1 1 Onion Extract 1 1 Orange Juice 1 1 1 1 „ Squash 1 1 Baking Powder 2 2 Curry Powder 1 1 Custard Powder 1 1 Ground Cinnamon 1 1 Desiccated Soup 1 1 Jelly Crystals 1 1 Green Colouring Matter 1 1 Chocolate Vermicelli 1 1 Pea Flour 1 1 Pepper, White 2 2 Sterilised Wheat Germ 1 1 Bread 1 1 Tomato Ketchup 1 1 Pickles 1 1 Total 107 2 109 13 1 14 16 No prosecutions were instituted during the year. In the case of adulterated samples warnings were given to the vendors, with the result that the orange juice and fruit preserving tablets were withdrawn from sale. The margarine samples are reported as adulterated, but nevertheless they conformed to the Margarine (Addition of Borax) Order, 1940. The lemon substitutes reported as adulterated constituted offences under Section 6 (misleading labels). The position as to these and other substitutes has now been clarified by the Food Substitutes (Control) Order, 1941, under which food substitutes may be manufactured and sold only under Ministry of Food licence. Milk Supply. There are 16 dairymen and 54 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 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 1941:- Grade of Milk. Type of Licence. Dealers'. Supplementary. Tuberculin Tested 13 2 Accredited — 1 Pasteurised 19 5 The following Tables show the results of examinations of samples of milk during 1941:— 17 MILK SAMPLES. Twenty-five samples of milk were submitted for bacteriological examination as below:— 1. Pasteurised Milk. No. of Samples. Below 100,000 bacteria per millilitre. 7 Coliform Test Phosphatase Test. — + Satisfactory Unsatisfactory 11 Above 100,000 bacteria per millilitre. 4 5 6 3 5 2. Ordinary Milk. No. of Samples. Total bacteria per millilitre. Coliform Test. Under 50,000 50,000 100,000 100,000— 250,000 1,280,000 — + 14 7 2 3 2 9 5 ICE CREAM. At the end of 1941, 99 premises, had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. On eight of these premises ice cream is manufactured. The premises, together with vehicles used by purveyors, were inspected during the season and found to be generally well kept. Fourteen instances of unsatisfactory conditions were dealt with, action in twelve of these cases being due to the storage of foodstuffs, other than ice cream, in the ice cream cabinets. 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 6 cases where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. 18 At the end of 1941, 54 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. Fifteen cases of insanitary conditions in food shops were dealt with. There is one licensed slaughter-house in the district. The only animals slaughtered during the year have been 21 pigs from pig clubs slaughtered under licences issued by the Ministry of Food. These were inspected at the time of slaughter, and one whole carcase (4.7% of the whole) condemned on account of non-tubercular disease. Cattle, excluding Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — 21 Number inspected - - — 21 All diseases except Tuberculosis. Whole carcasses condemned — — — 1 Carcasses of which some part or organ was condemned - - - — Percentage of the number inspected affected with disease other than tuberculosis - — - 4.7% Tuberculosis only. Whole carcasses condemned — - — - Carcasses of which some part or organ was condemned - - - - Percentage of the number inspected affected with Tuberculosis — - — - 19 The following diseased and/or unsound meat and other foods have been surrendered and destroyed or, where suitable, utilised for pig food:— Carcases or parts of carcases Number found to be diseased in slaughter-houses. PIGS Carcass and Offal (Pleurisy and Peritonitis) 1 MEAT AND OTHER FOODS IN RETAIL SHOPS 2 Irish Turkeys; 7 Irish Chickens; 45f lbs. Bacon; 11 lbs. Ox Liver; 105 Irish Kids; 485 lbs. Irish Rabbits; 14| lbs. Beef; 12 lbs. tinned Boiled Beef; 18 lbs. tinned Luncheon Meat; 9 lbs. 14 ozs. Veal and Ham Galantine; 18 lbs. tinned Ox Tongue; 1 bag Winkles; 28 lbs. Filleted Haddock; 7 stones Whiting; 6 stones 4 lbs. Cod; 8 stones Coal Fish; 11 stones Witches; 5 stones Fish Cheeks; 112 Fish Cakes; 5 lbs. Cheese; 15 packets processed Cheese; 12£ lbs. Cake; 462 English Eggs; 3,149 Imported Eggs; 168 tins or bottles Miscellaneous Foodstuffs. FOODSTUFFS DAMAGED BY ENEMY ACTION. Foodstuffs in premises damaged by enemy action have been examined with a view to salvage or destruction. 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. One person was licensed to act as a Slaughterman during 1941. BAKEHOUSES. There are 27 bakehouses within the District, and of these 16 are provided with mechanical power. A good standard of cleanliness and sanitary condition is generally obtained. 20 RATS & MICE (DESTRUCTION) ACT, 1919. During 1941, 518 visits were made in connection with rat or mice infested or suspected infested premises. In addition to these visits, the Corporation's Disinfector has. made 376 visits to private premises and 50 visits to premises in the occupation of the Corporation. 73 premises were satisfactorily cleared of rats or mice. MOSQUITO BREEDINC. No evidence of mosquito breeding was detected in the various static water tanks in the Borough. SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. ERADICATION OF BED BUCS. Twenty-seven bug-infested houses were dealt with a follows:— By the use of Insecticides. Sulphur. Hydrocyanic (H.C N.) Gas. Council Houses — — — Other Houses 21 — 6 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 (approx.) 1,000 Number of visits paid to Shops during 1941 583 21 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 mantained — Number of Shops where means of heating provided as the result of— (a) Informal action — (5) Formal action — Number of Shops where suitable and sufficient sanitary accommodation not provided 12 Number of Shops where suitable and sufficient sanitary accommodation provided as the result of— (a) Informal action 11 (b) Formal action — Number of Shops where the provisions of Section 10 (1) and (2) were complied with at the end of 1941 999 Number of Certificates granted by the Local Authority exempting Shops from the provisions of Section 10 (2) 25 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. One thousand six hundred and seventeen cases of infectious disease were notified during the year. Measles was epidemic and contributed one thousand and twenty-seven cases towards this total. Whooping Cough was. prevalent and three hundred and thirty-one cases were notified. There was a decline in the number of cases of Scarlet Fever. Cases of Diphtheria were more numerous. Forty-six cases, including sixteen from institutions, were notified. None of these had beerv immunised. There was an increase in Pneumonia mainly associated with Influenza and Measles. Sporadic cases of Cerebro Spinal Fever 22 tinued. Enteric infections were few. There was one severe cases of acute Anterior Poliomyelitis which recovered with some residual paralysis . The control of the majority of infectious diseases is. mainly the control of spray infection from the throat and nose. This is dependent on the more general recognition that the primary phase of illness is always the most infectious, that it is nearly always, catarrhal affecting the throat, nose or lungs, and that the early isolation of one case on suspicion may prevent numerous other cases. Measles and Whooping Cough are liable to be regarded as minor infections but the complications and sequelae leave a trail of disability which calls for every care in the nursing of such cases until full convalescence has been established. Scarlet Fever.— One hundred and eighteen cases were notified, a decrease of three cases. Of these twenty-five were institutional cases. The disease was mild. The case rate was 1.65 per 1,000 of population, compared with a case rate of 1.47 for England and Wales. Diphtheria.— Forty-six cases were notified, an increase of twenty-three cases. Of these sixteen were from institutions. The case rate was 0.59 per 1,000 of population compared with 1.25 for England and Wales. There were three deaths of children aged 4, 5 and 11 years. None of the affected children had been immunised. ARTIFICIAL IMMUNISATION ACAINST DIPHTHERIA. Diphtheria is a very dangerous disease. It is the most fatal disease in children between the ages of four years and ten years, and the second most fatal disease among children between two and five years. Young children are very susceptible. By the time a child has reached the age of one year all inherited immunity to disease has been lost. Every child should be immunised on reaching the age of one year. 23 To prevent epidemic spreading of Diphtheria 75% of the children must be immunised. At the end of 1941 37% of our children had been immunised under the Council's scheme. The immunisation of children does not reduce the number of carriers, and while a proportion of children remains unprotected serious and fatal cases of Diphtheria will continue to occur. Parents should avail themselves of this protective measure in the saving of child life. It is in the interests of the child, of the family, and of the nation. Two clinics are held weekly (1) at the Public Hall, No. 1, Hill Road, Sutton, every Friday, at 2 p..m.; (2) at the Clinic, Priory Crescent, Cheam, every Thursday, at 3 p.m. Schools are visited in rotation for the immunisation of groups of new entrants. During 1941 two thousand seven hundred and seventy-five children were immunised under the Council's scheme. The materials used were Alum Precipitated Toxoid in two doses of .2 c.c. and .5 c.c. and Toxoid Antitoxin Floccules in three doses of 1 c.c. Propaganda by the distribution of explanatory leaflets was carried out through the Health Visitors and by the school teachers, to whom my thanks are due for their co-operation and assistance. The following Table shows the distribution in agegroups of the children who received injections:— DIPHTHERIA IMMUNISATION, 1941. Under 1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 Over 14 Total Clinic 8 185 168 148 150 105 94 72 49 63 43 33 9 16 20 1163 Schools 1 27 33 42 62 250 249 177 96 76 92 136 116 107 43 1507 Medical Practitioner's Cases 1 18 7 13 11 10 9 2 2 7 5 2 4 2 12 105 Total 10 230 208 203 223 365 352 251 147 146 140 171 129 125 75 2775 24 In addition, medical practitioners reported that they had immunised as private patients 126 children under five years of age and 133 children over five and under fifteen years of age. Thus, the total number of children immunised in the Borough during the year 1941 was 3,034. Measles.— There was an epidemic of measles during the first six months of the year. One thousand and twenty-seven cases were notified by medical practitioners. These cases represent only a -proportion of the children affected. The disease was not of unusual severity, and the large number attended by medical practitioners reflects a general high standard of care on the part of parents. One hundred and eight cases were at institutions, and nine hundred and nineteen in the district. The course of the epidemic is indicated by the following figures of monthly incidence. Month January February March April May June July to Total December Cases 93 199 372 190 104 50 19 1027 The age-groups of district cases are shown in the following Table:— Age — 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Over 15 Total Number of Cases 10 48 63 76 109 204 133 125 33 18 10 8 22 6 4 6 44 919 The Fable shows that the children in the infant classes at school suffered most severely, and that the young children and babies were also heavily involved. Eleven of the cases were complicated by pneumonia and there were two deaths. The prevention of the spread of Measles is only possible by the early detection of the catarrhal symptoms of onset and prompt and effective isolation until diagnosis is established. All cases should be kept in bed and nursed carefully during the acute phase in order to avoid pneumonic complications, which are the principal cause of mortality. 25 Whooping Cough.— Whooping Cough was prevalent throughout the year. Three hundred and thirtyone cases were notified, of which fifty-five cases were from institutions. There were three deaths from pneumonic complications. The notifications were evenly distributed but slightly higher in April and November. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total 23 21 27 41 27 21 27 25 21 24 43 31 331 Of the 276 district cases, 153, or 55%, were children under 5 years, and of these 16 were under 1 year of age. This suggests that the spread of infection was more prevalent in the houses and in the streets than in the schools. The disease is very infectious and the safeguarding of young infants is a primary consideration in the prevention of mortality. Patients suffering from Whooping Cough should be regarded as infectious for a period of six weeks. Control over the infected patient must be rigid if younger children are to be saved from infection., Fresh air is essential during convalescence, but the taking of fresh air must exclude possible contact with other children and parents should not permit convalescent but infectious children to play in the streets with young susceptible children. Puerperal Pyrexia.— Eight cases of Puerperal Pyrexia were notified during the year. The case rate was 8.97 per 1,000 total births compared with 11.91 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. 26 Typhoid and Paratyphoid Fever.— There was no case of Typhoid Fever . Three cases of Paratyphoid were notified. There was no evidence of sources of infection within the Borough. Dysentery.— Four 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 cases 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. Pneumonia.— Thirty-nine deaths occurred from all forms of Pneumonia. The total number of cases notified in the district was fifty-four. 27 Notifiable Diseases (other than Tuberculosis) during 1941. 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 5 6 5 8 52 5 7 2 2 - - 93 73 - Diphtheria — - 1 1 7 8 3 4 5 1 — — 30 28 3 Typhoid Fever — — — — — - - - - - - - - - — Para-typhoid — - — - — - 1 - 1 - 1 — 3 3 — Puerperal Pyrexia - - - - - - - - 6 2 - - 8 3 - Pneumonia 1 3 5 1 1 5 1 1 3 7 11 12 54 12 39 Erysipelas — — — — — — — 2 1 2 3 3 11 3 — Dysentery — — — — 1 1 1 1 - — - — 4 1 — Poliomyelitis - - - - - 1 - - - - - - 1 - - Cerebro-Spinal Fever - - - 1 1 3 2 2 3 1 - - 13 12 - Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 - - Measles 10 48 63 76 109 513 50 26 21 2 1 - 919 7 2 Whooping Cough 16 25 44 37 31 108 7 1 6 1 - — 276 12 3 London S.F cases in Dip. the Meas. Downs W.C. Hospital - 3 9 1 2 7 1 - 2 - - - 25 23 - — 2 1 2 3 5 - 2 1 - - — 16 16 — 7 36 39 12 7 6 1 - - - - - 108 108 — 3 21 14 8 6 3 - - - - - - 55 52 - *Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. 23 Distribution of Notifiable 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 9119 8060 9710 11760 6842 6793 5388 5218 7180 70070 Scarlet Fever 12 5 16 24 14 12 5 4 1 93 1.32 1.47 Diphtheria 10 — 2 2 4 3 — 1 8 30 0.42 1.25 Para-typhoid — — — - — — — 1 2 3 0.04 0.09 Pneumonia 4 8 7 7 1 12 7 3 5 54 0.77 1.25 Erysipelas 1 1 1 4 — — — — 4 11 0.15 0.30 Puerperal Pyrexia 1 - - 1 - 1 1 4 - 8 - - Dysentery — — — - 3 — — — 1 4 0.05 - Cerebro-Spinal Fever 7 1 1 1 - - - - 3 13 0.18 0.25 Ophthalmia Neonatorum - - - - 1 - - - - 1 - - Poliomyelitis — 1 — - — — — — — 1 — — Measles 143 85 87 217 130 66 34 56 101 919 13.12 10.33 Whooping Cough 47 35 40 59 18 34 9 10 21 276 3.94 4.39 Total 225 136 154 315 171 128 56 79 149 1413 Bacteriological Examinations.- The following examinations of specimens were made by direction of the Borough Council:— Diphtheria. Enteric. Tuberculosis. Positive. Negative. Positive. Negative. Positive. Negative. 24 293 7 27 5 54 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table. Non-Notifiable Diseases.— German Measles was epidemic during the second quarter of the year. School teachers reported 36 cases of German Measles, 126 cases of Chicken Pox, 80 cases of Mumps, 117 cases of Whooping Cough and 544 cases of Measles. 29 Scabies.— This skin infection became prevalent during the last quarter of the year. Eighty-one cases were reported. Most of these were children in one area of the Borough. Exclusion from school and instruction as to treatment quickly reduced the spread of infection. Six cases were complicated by septic infection and required a few days of hospital treatment Scabies is caused by a mite named Sarcoptes Scabiei. The female burrows into the skin and lays its eggs, which hatch in sixty-five hours. The larvæ thus produced move over the skin and create new burrows, where they reach maturity. It is this burrowing which produces the intense itching, resulting in loss of sleep and lowered capacity for work. Spread is mainly by direct personal contact, and only to a limited extent by clothing or bedding. Treatment consists of hot baths during which the whole of the skin of the body and limbs is lathered with soap, and of scrubbing of the burrows to expose the mite to the subsequent application of sulphur ointment or of an emulsion containing benzyl benzoate. The latter is preferable as it is less likely to stain underclothing and bedding. Sulphur ointment has to be applied after baths on three or four successive nights. Benzyl benzoate emulsion is a national formula and is applied to the skin after hot baths on two successive nights or on two occasions at an interval of a week. As soon as treatment has become effective underclothing shou'ld be changed and disinfected by boiling or soaking, together with bed sheets, and night attire. All persons suffering from "itch" which may be due to scabies should seek medical advice without delay. 30 TUBERCULOSIS. On 31st December, 1941, there were on the Register 568 cases of Tuberculosis, of which 459 were pulmonary and 109 non-pulmonary cases. The death rate for Pulmonary Tuberculosis was 0.53 per 1,000 of population, and for non-pulmonary Tuberculosis 0.08 per 1,000 of population. The total Tuberculosis death rate in 1941 was 0.61 per 1,000 of population, compared with 0.56 per 1,000 of population in 1940. The corresponding death rates for England and Wales in 1941 were: Pulmonary, 0.60 per 1,000 of population; non-pulmonary, 0.13 per 1,000 of population. Total rate, 0.73 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 — 2 — 1 — — — 1 5 1 2 1 1 — — — 1 15 10 10 3 1 2 2 — 2 25 11 14 — 8 5 1 — 35 6 5 1 1 3 9 — 1 45 7 3 - - 3 1 - - 55 5 1 — — — 1 — — 65 & above - 1 - - 1 2 - - Totals 40 38 5 4 17 20 1 5 NOTIFICATION OF TUBERCULOSIS. Respiratory Forms of Death—32 out of 37 were notified. Other Forms of Death—None were notified. 31 BOROUGH OF SUTTON AND CHEAM. Clinics Controlled by the Surrey County Council. SUTTON DISTRICT— Clinic.— The Public Hall, 1, Hill Road, Sutton Ante-Natal Clinic.— Every Monday, at 2 p.m., and every first, second and third Wednesday in the month at 10 a.m. to 12 noon. Infant Welfare.— Every Tuesday, at 1.30 p.m. Diphtheria Immunisation Clinic.— Every Friday at 2.15 p.m. CHEAM AND WORCESTER PARK DISTRICTClinic.— Parochial Rooms, Maiden Road, Cheam Infant Welfare.— Every Wednesday at 1.30 p.m. Clinic.— Priory Crescent, Cheam. Infant Welfare.— Every Monday and Thursday at 1.45 p.m. Ante-Natal.— Every second, fourth and fifth Monday in the month at 9.30 a.m., and every Friday at 9.30 a.m. Diphtheria Immunisation Clinic.— Every Thursday at 3.5& p.m. Clinic.— St. Oswald's Hall, Brocks Drive, North Cheam. Infant Welfare.— Every Friday at 1.30 p.m., and every second and fourth Tuesday in the month at 1.30 p.m. Clinic.— Jubilee Institute, Maiden Green, Worcester Park. Infant Welfare.— Every Monday and Thursday at 1.30 p.m. Tuberculosis Dispensary.- St. Helier County Hospital, Wrythe Lane, Carshalton. Every Wednesday at 2 p.m., every second Wednesday in each month at 5.30 p.m., and every Thursday at 10 a.m. 32