SUTC 6 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR TEE YEAR 1942. BOROUGH OF SUTTON & CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1942. PUBLIC HEALTH AND HOUSING COMMITTEE. HIS WORSHIP THE MAYOR (Alderman W. Howard Crosland, J.P.) Alderman F.C. Lohden, O.B.E. Alderman George H. Dennis. Coun. J.W. Bradly. Coun. G.J. Jewett. " H.H. Coote. " A.E. Kirkus, " J. Everett. " H.S. Oakley. " J.M. Firth. " L. Shaw Davis. (Chairman) " Mrs. Harper. " Mrs. Smyth. " W.E. Heath. " T. Stoker. (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, Meet & Food, REGINALD WILLIAM NORMAN, Certif.R.S.I. and S.I.E.J.B.; Certif. Meat & Food. (from 16th February 1942) 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. (from 17th August 1942) FRANK SUTCLIFFE Certif.R.S.I. and S.I.E.J.B.; Certif, Meat & Food. In H.M. Forces. (2) To the Mayor, Aldermen and Councillors of the Borough of Sutton and Cheam. Mr. Mayor, Ladies and Gentleman, I have the honour to present to you the Annual Report on the health of the Borough for the year 1942. Social and domestic conditions remained normal, and the standard of health was good. Nutrition was well maintained. The incidence of infectious disease declined, with the exception of Scarlet Fever, which increased during the last quarter of the year. There was a reduction in the number of cases of Diphtheria, and further progress was made with Diphtheria Immunisation. Measles and Whooping Cough were less prevalent. Enteric infections were few. The number of cases of Scabies increased, and in August a clinic for treatment was opened at The Public Hall. The birth rate showed a considerable rise from 12.8 to 16.1 per 1000 of population, and the death rate remained stationary. Maternal mortality and infantile mortality rates were lower. The Sanitary circumstances of the district were satisfactory, and the work of general sanitation, housing, and food supply was efficiently carried out under tho direction of the Chief Sanitary Inspector (Mr. C.W. Newbcry). The water-supply of the district maintained a high standard of chemical and bacteriological purity. Fffective control by daily sampling and by protective chlorination was continued. The Civil Defence Services operated efficiently, and the personnel of the First Aid Posts and Ambulance Services assisted in the work of the clinics, hospitals, and nursery school, I thank members of tho 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, Ladies and Gentlemen, Your obedient Servant, ENEAS J. MACINTYRE, Medical Officer of Health. (3) STATISTICS OF THE AREA. Area in Acres 4338.15 Registrar - General's Estimate of the Resident Population, 1942 72010 Number of inhabited houses (end of 1942) according to Rata Books 22235 Rateable Value and sum represented by a £888,165 Penny Rate £3,530 EXTRACTS FROM VITAL STATISTICS OF THE YEAR 1942. LIVE BIRTHS: T. M. F. Birth-rate per 1,000 of the estimated resident population, 16.2 Total 1163 592 571 Legitimate 1097 557 540 Illegitimate 66 35 31 STILL BIRTHS: T. M. F. Rate per 1,000 (live and still) births, 29.2 Total 35 20 15 Legitimate 31 17 14 Illegitimate 4 3 1 DEATHS: T. M. F. Death-rate per 1,000 of the estimated resident population, 10.9 791 370 421 Deaths from puerperal causes;- Deaths 3 Rate par 1,000 total (live and still) births, 2.54 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 38.69 Legitimate Infants per 1,000 legitimate live births 34.64 Illegitimate Infants per 1,000 illegitimate live births 106.06 (4) Deaths from Cancer (all ages) 135 " " Measles 1 " " Whooping Cough (all ages) 0 " " 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 31.1 Cancer and malignant disease 17.1 Diseases of lungs (not tuberculous) 11.0 Tuberculous Diseases 6.1 Cerebral haemorrhage 9.9 Congenita] Diseases 4.3 Suicide and violence 2.2 Diseases of the digestive system 5.9 Infectious diseases 1.3 Diseases of the kidney 2.5 Other defined causes 8.6 The number of deaths from the common infectious diseases were:- Measles 1. Diphtheria 1, Scarlet Fever 0, Whooping Cough 0, and Influenza 3. MATERNAL MORTALITY:- The maternal mortality rate was lower at 2.54 per 1000 total births. The rate for England and Wales was 2.01 per 1000 total births. Of the three deaths two were due to Eclampsia and Post partum haemorrhage, and one from rupture of a congenital aneucism of the left renal artery during childbirth. INFANTILE MORTALITY:- The infantile mortality rate was 38.69 per l000 live births, a rate similar to that of the previous year. The rate for England and Wales was 49 per 1000 live births. The forty five deaths of children under one year were due to the following causes:- Congenital Malformations 15 Prematurity 13 Broncho Pneumonia 4 Acute Bronchitis 3 Cerebral Haemorrhage 1 Gastro Enteritis 3 Misadventure 3 Other diseases of infancy 3 (5) CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1942. M. F. Total 1. Typhoid and paratyphoid fevers - - - 2. Cerebro-spinal fever - - - 3. Scarlet Fever - - - 4.Whooping cough - - - 5. Diphtheria 1 - 1 6. Tuberculosis of respiratory system 24 12 36 7. Other form of tuberculosis 6 6 12 8. Syphilitic diseases 1 1 2 9. Influenza 2 1 3 10. Measles - 1 1 11. Acute poliomyelitis and polioencephalitis 1 - 1 12. Acute poliomyelitis and polioencephalitis - - - 13. Cancer of buccal cavity Oesophagus (M) and Uterus (F) 3 10 13 14. Cancer of stomach and duodenum 10 10 20 15. Cancer of breast 1 11 12 16. Cancer of all other sites 54 36 90 17. Diabetes 6 3 9 18. Intracranial vascular lesions 27 51 78 19. Heart diseases of circulatory system 103 114 217 20. Other diseases of circulatory system 9 20 29 21. Bronchitis 27 15 42 22. Pneumonia 15 16 31 23. Other respiratory diseases 6 8 14 24. Ulcer of stomach or duodenum 5 3 8 25. Diarrhoea under 2 years 3 1 4 26. Appendicitis 0 2 2 27. Other digestive diseases 5 19 24 28. Nephritis 9 11 20 29. Puerperal sepsis .. - - 30. Other maternal causes •• 3 3 31. Premature birth 6 7 13 32. Congenital malformations, birth injuries and infantile diseases 13 8 21 33. Suicide 2 1 3 34. Road traffic accidents 3 2 5 35. Other violent causes 3 7 10 36. All other causes 24 41 65 570 421 791 (6) GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. LEGISLATION, LABORATORIES, HOSPITALS, AMBULANCES and MORTUARY:There was no change during the year. CLINICS CONTROLLED FY THE SUPREY COUNTY COUNCIL. SUTTON DISTRICT THE PUBLIC HALL, 1, HIER 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. Infant Welfare Center- Every Tuesday, at 1.30 p.m. Diphtheria Immunisation Clinic- Every Friday, at 2 p.m. Scabies Clinic - Every Wednesday, at 10 a.m. Lice Disinfestation Clinic- Every Tuesday, at 10 a.m. CHEAM AND WORCESTER PARK DISTRICT THE PAROCHIAL ROOMS, MALDEN R0AD, CHEAM. Infant Welfare Centre- Every Wednesday, at 1.30 p.m. THE CLINIC, PRIORY CRESCENT, CHEAM. Ante-Natal Clinic - Every Monday and Friday, at 9.30 a.m. Infant Welfare Centre - Every Monday and Thursday, at 1.45 p.m. Diphtheria Immunisation Clinic- Every Thursday, at 3 p.m. (For children under five years of age) ST. OSWALD'S HALL, BROCKS DRIVE, NORTH CHEAM. Infant Welfare Centre- Every Friday, at 1.30 p.m., and every second and fourth Tuesday in the month, at 1.30 p.m. JUBILEE INSTITUTE, MALDEN GREEN WORCESTER PARK. Infant Welfare Centre- 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 Friday, at 10 a.m., and every second Wednesday in the month, at 5.30 p.m. (6a) 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 is softened to 9 degress of hardness. Chlorine is applied in the form of chloramine as a protective measure. Samples are examined daily by the Company's chemist and bacteriologist in the laboratory at the Sutton works. Samples are also examined at monthly intervals by the Company's Consultant Analyst, and monthly samples are examined in rotation by the District Councils in the area of supply. The supply from all sources has been satisfactory in quality and quantity, and below is the average of monthly analyses:- Total solid residue dried at 180° C. Ammonia, free. Ammonia, Albuminoid. Nitrogenx as Nitrates. Nitrogen as Nitrites. Oxygen absorbed in 4 hours at 27° C, 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 growing on Agar per c.c. for 1 day at 370 c. Presence of Bacillus Coli in 100 c.c. Average 18.5 .0123 .0002 .9145 0 .0045 1.818 7.9 2.18 .09 0 (6b) DRAINAGE & 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 frith in 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, 156 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 of the Chief Sanitary Inspector on Sanitary circumstances. Housing, Food Supply, etc., (pages 7 - 17), has been condensed RECORD OF INSPECTIONS AND NOTICES SERVED. Number. Special Inspections, Interviews on mises, and Advisory Visits 1642 Re-inspections 2800 Visits to Works in Progress 595 Visits to Factories and workplaces 303 Visits to Bakehouses 49 Visits to Outworkers' Premises 44 Visits to Slaughterhouses 29 Visits to Butchers' and Food Shops 635 Visits to Dairies and Milkshops 93 Visits to Ice Cream Premises and Vehicles 115 Visits to Stables 13 Visits to Pigsties 41 Visits re Rat Infestation 973 Food and Drug Sample Visits 198 Visits re H.C.N. Regulations 5 Visits re Merchandise Marks Act 6 Visits in connection with Infectious Disease 188 Visits re Overcrowding and "Permitted Number" Measurements 19 Visits to Petroleum Spirit and Cinematograph Film Stores 99 Visits to Ponds and Ditches 12 Smoke Observations 5 Visits and Revisits re Shops Acts 321 Miscellaneous 1044 9229 (7) Premises at which defects or nuisences were discovered 1031 Dwelling-houses surveyed for housing defects uncder Public Health or Housing Acts. 215 Defets or nuisances discovered 1899 Defects or nuisances remedied 1481 Defects or nuisances in hand Defects or nuisances outstanding 279 Informal Notices served 697 Statutory Notices served 27 Complaints received and investigated 552 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT. DRAINAGE AND SANITARY FITTINGS. Number No. of houses and premises redrained 6 Premises connected to soil sewers 4 Premises connected to surface water sewers 1 Repairs or amendments to existing drains 32 Drains or gullies unstopped and cleansed 191 Cesspools abolished 1 Rainwater pipes disconnected from soil drain 2 Sanitary fittings repaired, renewed, provided or cleansed 486 Water and Smoke tests applied 104 W.C. APARTMENTS. New Apartments provided 5 W.C. Apertments lighted and/or ventilated 23 Ventilated lobbies to W.C. Apartments provided 6 Alternative sanitary accommadation provided 1 Separate accommodation for sexes provided. 1 STRUCTURAL REPAIRS OR IMPROVEMENTS. Roofs, renewed or repaired 90 Guttering and rainwater pipes provided, repaired 52 Damp walls remedied 69 Brick walls, repointed, repaired or rendered 3 Chimney stacks repaired or rebuilt 4 Yards paved or repaired. 19 Sites of houses concreted 7 Floors relaid or repaired 63 Additional lighting or ventilation to rooms 4 Windows and/or cills repaired or renewed 54 Doors and thresholds provided or repaired. 32 Staircases and handrails repaired or provided 5 Ranges, stoves and coppers repaired or renewed 29 Ventilation to larders provided 2 Miscellaneous 68 (8) CLEANSING. Rooms, passages, larders etc., cleansed 368 Trade premises cleansed 63 Verminous houses disinfested 39 GENERAL. Dustbins provided 83 Accumulation of refuse and offal removed 49 Rat or Mouse infested promises cleared 102 Nuisance from animals abated 8 Offensive ponds and ditches cleansed 3 Overcrowding abated 5 Smoke nuisances abated 3 Miscellaneous 50 SMOKE ABATEMENT. There are few chimneys attached to industrial premises in this district. Three smoke nuisances were detected and abated. 1. INSPECTION OP FACTORIES AND OTHER PREMISES UNDER THE ACT. Inspections made by Sanitary Inspectors for purposes of provisions as to health. Premises Number of Inspection. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with Mechanical Power 226 22 — Factories without Mechanical Power 122 80 - Other Premises (other than Outworkers' premises) - - — Total 348 30 - (9) 2. DEFECTS POUND 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. Ins pector (1) ! (2) (3) (4) (5) Want ofeleanlines 17 14 -- -- Inadequate Ventilation. -- -- mm mm -- Overcrowding, -- -- -- Unrescnahle Tempecature -- -- -- -- Ineffeetive drainage CI flcors -- - -- -- Absence of Thermo- meters 1 -- -- -- Absence of snitale ligntins in W.,C, apetments 14 10 -- -- Other ouisances 27 23 • -- -- Sanitary acecmnodetion (a) Insufficisnt 1 1 -- -- (b) Unsuitacle or defective 16 14 -- -- (c) Not soparate for sexes 2 — - -- -- 78 62 -- -- 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* 4 — - — (10) HOUSING. 1. INSPECTION OF DWELLING HOUSES DURING THE YEAR:- (1) (a) Total number of dwelling-house inspected for housing defects (under Public Health or Housing Acts) 215 (b) Number of inspections made for the purpose 869 (2) 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 99 2. REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL NOTICES Number of defective dwelling-houses rendered fit in consequence of informa1 action by the Local Authority or their Officers 73 3. ACTION UNDER SATUTORY POWERS DURING THE YEAR:- A.-Proceedings under Sections 9, 10 and 16 of the housing Act, 1936:- Nil. B.-Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 7 (2) Number of dwelling-houses in which defects wers remedied after service of formal notices:- (a) By Owners 7 (b) By Local Authority in default of owners - C.-Proceedings under Sections 11 and 13 of the Housing Act, 1956:- Nil. INSPECTION AND SUPERVISION OF FOOD. Food ana Drugs Act, 1938. The following table indicates the samples taken during the year 1942:- NUMBER EXAMINED NUMBER ADULTERATED ETC. Informal Formal Total Informal Formal Total Milk 2 55 57 1 1 Margarine 13 13 13 13 Lard 12 12 Butter 13 13 40 55 95 13 1 14 (11)  NUMBER EXAMINED NUMBER ADULTERATED ETC. Informal Formal Total Informal Formal Total Brought forward 40 55 95 13 1 14 Cheese 3 3 Cheese Powder 1 1 Sausage Meat 1 1 Sausage Rolls 1 1 Sausages 1 4 Pork Pie 1 1 1 1 Brawn 2 2 Liver Sausage 1 1 Beef & Vegetable Extract 1 1 Meat Extract 1 1 Meat Extract Liquid 1 1 Stuffing 1 1 Forcemeat 1 1 Anti -gas Ointment 10 10 1 1 Antiseptic jelly l 1 Aspirin Tablets 2 2 Boracic Ointment 1 1 Cascara Sagrada Tablets 1 1 "Colissa-rine" 1 1 Compound Liquorice Powder 1 1 Compound Tincture of Rhubarb 1 1 California Syrup of Figs 1 1 Camphorated Oil 1 1 Castor Oil 1 1 Cod Liver Oil 1 1 Iodised Throat Tablets 1 1 Koray Tablets 1 1 Mineral Salts 1 1 Multivite Vitamin Tablets 1 1 Petroleum Jelly 1 1 Tannic Acid Jolly 1 1 2 1 1 2 Zinc Ointment 1 1 Ginger Wine 2 2 4 Ruby Fancy Tawny Wine 1 1 1 1 Shrimp Paste 1 1 Porridge 1 1 Self-raising Flour containing real egg 1 1 1 1 Arrowroot 1 1 Oatmeal 2 2 Rice 2 2 Ground Barley 1 1 Ground Ginger 2 2 Sugar 3 3 Tea 4 4 Coffee 4 4 1 1 Cocoa 1 1 Cocoa Essence 1 1 Chocolate Spread 1 1 Milky Chocolate Powder l 1 127 58 175 17 4 21 (12)  NUMBER EXAMINED NUMBER ADULTERATED ETC. Informal Formal Total Informal Formal Total Brought forward 117 58 175 17 4 21 Chocolate Powder (Sweetened) 1 1 1 Baking Powder 1 1 Cochineal 1 1 Curry Powder 1 1 Custard Powder (Sweetened) 1 1 Custard Pudding 1 1 Egg substitute Powder 1 1 2 Flavoured drinke 8 8 Fruit Preserving Tablet 1 1 Ground Cinnamon 1 1 Ground Nutmeg 1 1 Jam 2 2 1 1 Jelly Crystals 1 1 1 1 Lemon Squash (Concentrated). 1 1 Lemon Essence 1 1 Lemon Flavouring 1 1 Lemon substitute 1 1 1 1 Mint Sauce 2 2 Mixed Spice 1 1 Mustard Sauce 1 1 Orange Squash 1 1 Onion Extract 1 1 Onion Powder 1 1 2 1 1 2 Onion substitute Condiment 1 1 Peppermint Essence 1 1 Pudding Mixture 1 1 Pepper - White 1 1 Raspberry Essence 1 1 Saccharin Tablets 1 1 2 1 1 Sponge Mixture 2 2 Sandwich Spread 1 1 Tomato Ketchup 2 2 Table Jellies 1 1 Vanilla Essence 1 1 Vanilla Spread 1 1 Vinegar - Malt 1 1 2 Worcester Sauce 1 1 Yeast Spread 1 1 Yorkshire Pudding, including Egg 1 1 1 1 158 71 229 24 4 28 It has been possible to devote rather more attention to sampling during the year under review, and, for the first time during the war period, the number of samples generally considered comparable with the population (3 per 1,000) has been taken. Of the total samples 6.5% were found to be either substandard or carrying misleading labels. All unsatisfactory cases were followed by warnings. There were no cases considered suitable, by the Public Health Committee, for prosecution. (13) MILK SUPPLY. There are 15 dairymen and 49 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. Under the Ministry of Pood Milk Rationalisation Scheme the number of registrations in 1943 is likely to be much varied. The following Licences to sell graded milks were granted in 1942:- Grade of Milk Type of Licence Dealers Supplementary. Tuberculin Tested 13 2 Accredited - - Pasteurised 20 4 The following Tables show the results of examinations of samples of milk during 1942:- MILK SAMPLES. Thirty samples of milk were submitted for bacteriological examination as below:- 1. Pasteurised Milk. No. of Samples. Below 100,000 bacteria per millilitre 13 Coliform Test Phosphatase Test - + Satisfactory. Unsatisfactory. 16 Above l00,000 bacteria per litre 3 15 1 16 - 2. Ordinary Milk. No. of Samples Total bacteria per millilitre Coliform Test Under 50,000 50,000- 100,000 100,000250,000 Over 500,000 - - 14 10 2 1 1 11 3 (14) ICE CREAM. At the end of 1942, 106 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. On ten of those 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. MEAT AND OTHER FOODS. The 54 butchers, shops within the Borough have been inspected and observation kept upon the vehicles used for the conveyance of meat, with the result that it has been found that the provisions of the Public Health (Meat) Regulations have been generally well observed. Necessary action was taken in 8 cases where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. At the end of 1942, 53 premises had been registered in accordance with Section 14 of the Pood and Drugs Act, 1938. The majority of the registered premises are concerned with the manufacture of sausages only. Eighty-eight cases of insanitary or defective 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 56 pigs from pig clubs slaughtered under licences issued by the Ministry of Pood. These were inspected at the time of slaughter and parts of three carcasses (5.35% of the whole) condemned on account of tuberculosis. Cattle excluding Cows Calves Sheep and Lambs Pigs Number killed - - - 56 Number inspected - - - 56 All diseases except Tuberculosis - - - - Whole carcasses condemned. Carcasses of which some part or organ was condemned. - - - - Percentage of the number inspected affected with disease other than Tuberculosis - - - - Tuberculosis only Whole carcasses condemned - - - - Carcasses of which some part or organ was condemned - - - 3 Percentage of the number inspected affected with Tuberculosis - - - 5.35% (15) The following diseased and/or unsound meat and other foods have been surrendered and destroyed or, where suitable, utilised for pig food Carcasses or parts of carcasses found to be diseased in slaughterhouses. Number PIGS. Head (Localised tuberculosis) 3 Liver " " 1 Heart (Pericarditis) 1 MEAT AND OTHER FOODS IN RETAIL SHOPS. 70 Meat Pies; 122 Sausage Rolls; 6 boxes Herring Roes; 10 stones Coal Pish; 4½ stones Cod Livers; 10 stones Witch Soles; 2 stones Mackerel; 6 stones Cod; 5 stones Whiting; 5 stones Haddocks; 19 boxes Kippers; 131½ lbs. Coffee; l05-lbs, Jam; 111½-lbs. Oranges; 32½-lbs. Tea; 74-lbs. Cheese; 13-lbs. Sweets; 56-lbs. Onions; 25-lbs. Prunes; 72-lbs. Chocolate Bars; ½-cwt. Spaghetti; 27-lbs. Potatoes; 14-lbs. Sugar; 394 Eggs; 1774 tins miscellaneous Foodstuffs. THE SLAUGHTER OF ANIMALS ACT. 1933. All animals slaughtered in the district have been stunned by means of a mechanically-operated instrument in accordance with the terms of this Act. Two persons were licensed to act as Slaughtermen during 1942. BAKEHOUSES. There are 28 bakehouses within the District, and of these 20 are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obtained. RATS AND MICE (DESTRUCTION) ACT. 1919. During 1942, 973 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 259 visits to private premises and 38 visits to premises in the occupation of the Corporation. 102 premises were satisfactorily cleared of rats or mice. MOSQUITO BREEDING. No evidence of mosquito breeding was detected in the various static water tanks in the Borough. (16) SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. ERADICATION OF BED BUGS. Thirty-nine bug-infested houses were dealt with as follows:- By the use of Insecticides Sulphur Hydrocyanic (H.C.N.)Gas Council Houses 2 - - Other Houses 35 - 2 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. Three-hundred and twenty-one visits were made in connection with Section 10 of the Shops Act, 1934. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Five hundred and twenty two cases of infectious disease were notified during the year. The incidence of Measles fell from the high epidemic level of the previous year. Whooping Cough also declined. There was an increase in the number of cases of Scarlet Fever, coincident with a general rise throughout the country. There was a decline in Diphtheria. No case of Typhoid Fever was recorded and other enteric infections were few in number. Three sporadic cases of Cerebro Spinal Fever were notified, and there was one case of Acute Anterior Poliomyelitis. One case of Ophthalmia Neonatorum was notified, SCARLET FEVER:- One hundred and sixty two cases were notified during the year, an increase of forty-four over the number in 1941. Twelve of the cases were from institutions. The case rate was 2.24 per 1000 of population compared with 2.19 per 1000 of population for England and Wales. The disease was generally mild and there was no death. The increase in the number of cases occurred during the last quarter of the year and corresponded to a general increase throughout the country. This increased incidence has been sustained and has been favoured by the relatively mild weather of the winter months. Scarlet Fever is an infection spread by the infectious secretions of the throat, nose and ear. Susceptibility is highest at the age of 2 years, and remains high during infancy. The majority of infections occur after entry to infant school where the susceptible child is first exposed to mass spray infections. It is therefore very important in this period of (17) higher incidence of Scarlet Fever that parents should avoid sending children to school in the early phase of infection by recognising catarrhal symptoms and transient rashes as suggestive of an infection. Patients returned from hospital after Scarlet Fever often develop mild catarrh of the throat and nose which brings down residual infection from the recesses of the nasopharynx. These mild 'colds' after hospital treatment should indicate retention of the child at home until the catarrh has ceased. Within the schools the prevention of spray infection depends on the free use of available floor space and the maximum spacing of the children, and the liberal supply of fresh air as the chief diluent of infection. DIPHTHERIA:- Twenty six cases of Diphtheria were notified, a reduction of twenty cases. Twelve cases were from institutions. There was one death of a child aged seventeen months from toxaemia. This child had not been immunised. Of the twenty six notified cases, one was a child who had received injections for immunisation, and had a mild attack. The case rate was 0.36 per 1000 of population, compared with 1.05 per 1000 of population for England and Wales. DIPHTHERIA IMMUNISATION:- The fact that Diphtheria is a very dangerous disease cannot be over emphasised. Immunisation gives protection against the infection, and against mortality from the disease. The response to and local propaganda has been good, and those parents who have not yet responded should be aware that while a proportion of children remains unprotected, serious and fatal cases of diphtheria will continue to occur. The number of children immunised against Diphtheria during 1942 was two thousand seven hundred and thirty-six, bringing the total number of childred treated to eight thousand and forty-nine, representing 60.7 per cent of the total children. Of this total two thousand and. eighty nine represents a percentage of 47.5 of the children under five years of age and five thousand nine hundred and sixty represents a percentage of 66.2 of the children between five years and fifteen years of age, A renewed effort was made to obtain the immunisation of children aged one year in co-operation with the health visitors. The ideal is for a child to be immunised at the age of one year and to receive a reinforcing injection at the age of five years just before entering school. Forty three per cent of the children reaching one year of age during 1942 were immunised under tho Council's scheme. This is satisfactory as an index of the growing appreciation by the parents of early protection. At the end of the year the Council had under consideration a scheme for closer co-operation with tho medical practitioners of the Borough in securing the immunisation of younger children, and at the time of writing this report a scheme is in operation whereby persons with incomes under £4-20 per annum may have their children under five years of age immunised by their own doctor free of cost. Two clinics for Diphtheria Immunisation 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. (18) The following table shows the distribution in age groups of the children who received injections during the year 1942. 1-2 2-3 3-4 4-5 5-6 6-7 7-6 8-9 910 l0ll 1112 12- 13 1314 Over 14 Total 389 234 197 238 289 147 159 180 242 198 151 151 123 38 2736 MEASLES:- One hundred and sixty one cases were notified. Of these six were from institutions. The disease was less prevalent following the epidemic of the previous year. The case rate was 2.23 per 1000 of population compared with 7.46 per 1000 of population for England and Wales. There was one death of an adult from meningitis complicating measles. The possible complications of measles have always to be considered seriously, and careful nursing of all cases during the acute phase of the illness is essential. WHOOPING COUGH:- One hundred and two cases wore notified. Of these thirty four were from institutions. There was no death. The case rate was 1.41 per 1000 of population compared with 1.73 per 1000 of population for England and Wales. Whooping Cough is a serious disease when it affects a weakly child, or is complicated by pneumonia. Young children should as far as is possible be protected from contact with active infectious cases. PUERPERAL PYREXIA:- Six cases of Puerperal Pyrexia were notified during the year. The case rate was 5.01 per 1000 total births, compared with 12.61 per 1000 total births for England and Wales. The early notification 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 services 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. One case of Paratyphoid Fever was notified, and investigation did not reveal any source of infection within the district. DYSENTERY:- Fourteen cases of Dysentery were notified and were all of the Sonne type. Although the disease is generally mild, a number of these cases were severe, and suffered from acute diarrhoea, with blood and mucous in the stools. The disease is spread by the milder cases, who may only suffer from minor degrees of abdominal discomfort, and particular care should be taken by all concerned in the preparation and handling of food, to ensure that hands, which are the common vehicles of enteric infections, are properly cleansed. CEREBRO-SPIITAL FEVER:- There were three sporadic cases of Cerebro Spinai Fever, a reduction of ten cases on the number during 1941. There was no death. ACUTE AHTERIOR POLIOMYELITIS:- There was one notified case, a child aged three year's, who recovered with some residual paralysis of tho legs, and one death from Acute Polio-encephalitis. PNEUMONIA:- Thirty one deaths occurred from all forms of pneumonia. The total number of cases notified in the district was twenty seven. (19) 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 9421 8365 10022 11910 6909 6980 5602 5330 7471 72010 Scarlet Fever 30 10 21 63 13 6 3 6 8 150 2.08 2.19 Diphtheria 1 1 2 3 2 3 - 2 - 14 0.19 1.05 Para-Typhoid - - - - - - — - 1 1 0.01 0.01 Pneumonia 1 2 1 2 3 3 3 5 7 27 0.37 1.07 Erysipelas 2 1 1 6 - 1 1 1 5 18 0.25 0.30 Puerperal Pyrexia - - 1 - - 1 1 2 1 6 - - Dysentery - - - 11 - - 1 1 1 14 0.19 - Cerebro-Spinal Fever 1 - - 2 - - - - - 3 0.04 0.14 Ophthalmia Neonatorum - - - - - 1 - - - 1 - - Poliomyelitis - - - - - - - - 1 1 - - Measles 21 22 39 30 6 8 3 9 17 155 2.15 7.46 hooping Cough 1 4 11 18 5 2 3 7 17 68 0.94 1.75 Total 57 40 76 125 29 25 15 33 58 458 (20) NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1942. 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 - 4 3 7 106 19 4 3 2 1 - 150 108 - Diphtheria - 1 1 - - 3 3 3 1 - 2 - 14 13 1 Typhoid Fever - - - — - - - - - - - - — - - Para- typhoid - - - - - - - - 1 - - - 1 1 - Puerperal Pyrexia - - - - - - - - 6 - - - 6 - - Pneumonia 2 1 1 1 3 4 2 2 5 1 3 2 27 1 31 Epysipelas - - - - - 1 1 - 3 2 6 5 18 3 - Dysentery - - - 1 - 7 - - 1 4 - 1 14 - - Poliomyelitis - - - 1 — - - - - - - - 1 1 1 Cerebro-Spinal Fever - - - - - - 1 - 1 - 1 - 3 3 - Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 - - Measles 3 6 13 14 16 88 10 2 1 - 1 1 155 5 1 Whooping Cough 5 1 9 7 11 32 1 - 1 1 - - 68 1 - London cases in the Downs Hospital S.F. — 5 2 2 1 2 - - - - - - 12 12 - Dip. - 1 2 2 2 2 - - - - - - 12 12 - Meas — 2 1 1 - 2 - - - - - - 6 6 - W.C. 6 11 14 1 1 1 - - - - - - 34 34 - Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. BACTERLOLOGICAL EXAMINATIONS:- The following examinations of specimens were mace by direction of the Borough Council:- Diphtheria. Enteric. Tuberculosis. Positive. Negative Positive. Negative Positive. Negative. 26 260 3 15 9 57 Diphtheria swabs arc also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table NON-NOTIFIABLE DISEASES:- School teachers reported 204 cases of German Mesles, 149 cases of Chicken Pox, 135 cases of Mumps, 21 cases of Scabies, and 29 cases of Conjunctivitis. An outbreak of acute contagious conjunctivitis occurred in one school during February and March, and was reduced by exclusion of suspected cases. School notifications are a useful index of the prevalence of non notifiable diseases, and are a basis for consultations with the school medical officers. (21) SCABIES:- This skin infection increased in prevalence, and on 28th August a treatment clinic was opened at the First Aid Post, The Public Hall, Sutton. A portion of the gas cleansing station was adapted as a treatment centre, and proved to be very suitable for the purpose. The treatment is carried out by Nurse Constant, the nurse in charge of the First Aid Post, with the help of volunteer assistants from the staff of the First Aid Post and Ambulance Service, to whom ray thanks are due for the excellent manner in which they have carried out the work. The reference of cases by doctors and from schools and clinics has provided information of the true incidence of the disease. Scabies is a disease which affects the family, and where one member is affected, it is necessary for the other members to be examined, and to have a preventive treatment at The same time. The severe irritation of the disease causes lose of working capacity and loss of working time. Treatment given immediate relief, and gives freedom from infection. One hundred and ninety eight patients were treated during the years. The material used for treatment was Benzyl Benzoate Emulsion. LICE:- Facilities were also provided at the First Aid Post the Public Hall, Sutton, for the disinfestation of head lice, and thirty eight patients were treated during the year by shampooing of the head, and the application of lethane oil. TUBERCULOSIS. On 31st December, 1942, there were on the Register 615 cases of Tuberculosis, of which 496 wore pulmonary and 117 non- pulmonary cases. The death rate Pulmonary Tuberculosis was C.50 per 1000 of copulation, and for non-pulmonary Tuberculosis 0.17 per 1ooo of population. The total Tuberculosis death rate in 1942 was 0.67 per 1000 of population, compared with 0.61 per 1000 of population in 1941. The corresponding death rates for England and Wales in 1942 were. Pulmonary, 0.54 per 1000 of population, non-pulmonary, 0.12 per 1000 of population. Total rate, 0.66 per 1000 of population. The following Tables shows new cases and deaths in age groups:- Age Periode. New Cases. Deaths. Pulmonary Non- Pulmonary Pulmonary NonPulmonary M F M F M F M F 0 - - - - - - - 1 1 2 1 1 - - - - - 5 3 3 1 - - .. - 1 15 13 13 2 2 3 1 3 3 25 8 9 3 2 1 4 2 - 35 11 2 - - 5 3 - - 45 7 1 - - 7 - - - 55 2 2 1 - 4 3 1 - 65 and above 1 1 - 1 1 1 - 1 Totals 49 32 10 5 24 12 6 6 NOTIFICATION OF TUBERCULOSIS. Respiratory Forms of Death - 33 out of 36 were notified. Other Forms of Death - 6 out of 12 were notified. (22)