SUTC 7 LIBRARY BOROUGH OF SUTTON AND CHEAM ANNUA REPORT of the Medical officer of Health For the Year 1943. BOROUGH OP SUTTON & CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1943. PUBLIC HEALTH AND HOUSING COMMITTEE HIS WORSHIP THE MAYOR (Alderman John J. Goossens, J.P.) Alderman F.C. Lohden, O.B.E. Coun. J.H. Booth. Coun. A.E. Kirkus, O.B.E. " H.H. Coote. " H.S. Oakley. " W.E. Heath. " T. Stoker. " J.M. Firth. " L. Shaw Davis. (Chairman) " Mrs. Harper. " Mrs. Smyth. Coun. W.T. Venton, C.C. (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. REGINALD WILLIAM NORMAN Certif.R.S.I. and S.I.E.J.B.; 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.J 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 Gentlemen,, I have the honour to present to you the Annual Report on the health of the Borough for the year 1943, Despite the prolonged strain of war the general standard of health and nutrition of the community remained good. The incidence of infectious disease vac increased by an epidemic of Measles during the first six months, and by a high prevalence of Scarlet Fever throughout the year. There was a further decline in the number of cases of Diphtheria. Influenza reached epidemic proportions during December and was accompanied by an increase in Pneumonia, The birth rate rose from 16.2 to 16.7 per 1000 of population. The death rate was stationary at 10.9 per 1000 of population. The rates for maternal mortality and for infantile mortality were the lowest on record since the constitution of the Borough, The sanitary circumstances of the district were satisfactory, except in relation to the adequacy of housing accommodation. The work of general sanitation, of maintenance and repair of houses, and of supervision of 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 chlorination was continued. From the 19th April 1943, the Council's Civil Ambulance Service was operated by Civil Defence personnel, who have shown a fine spirit of devotion to duty and of service to the community, 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, Ladies and Gentlemen, Your obedient Servant, ENEAS J. MACINTYRE. Medical Officer of Health. (3) STATISTICS OP THE AREA. 1942 1943 Area in Acres 4338.15 4338.15 Registrar General's Estimate of the Resident Population 72010 71400 Number of inhabited houses (end of year) according to Rate Book 22235 22268 Rateable Value and sum represented by ) £838,165 £889,041 £3,530 £3,675 EXTRACTS FROM VITAL STATISTICS COMPARATIVE OF THE YEARS 1042 AND 1943. Total 1042 Female Total 1943 Female England & Wales 1943 Male Male Live Births 1163 592 571 1195 594 601 Legitimate 1097 557 540 1132 565 567 Illegitimate 66 35 31 63 29 34 Birth Rate per 1000 of the Estimated Resident Population 16,2 • 16,7 16,5 Still Births 35 20 15 25 10 15 Legitimate 31 17 14 23 9 14 Illegitimate 4 3 1 2 1 1 Rate per 1000 total (live and still births) 29,2 20.5 Deaths 791 370 421 778 378 400 Death Rate per 1000 of the estimated resident population 10.9 10.9 12.1 Deaths from Puerperal Sepsis Other Puerperal Causes 0 3 1 0 Death rate from Puerperal Causes 2.50 0.82 1.84 Deaths of Infants under one year of age. All Infants per 1000 live births 38.69 30.96 | 49.00 Legitimate Infants per 1000 legitimate live births 34.64 30.04 Illegitimate Infants per 1000 Illegitimate live births 106. 06 47.62 . (4)  1942 1943 Deaths from Cancer 135 127 " " Measles 1 1 " " Whooping cough 0 1 " " Diarrhoea, 4 4 Percentage of Deaths from certain causes co the total number of deaths. 1942 1943 Diseases of the heart and circulation. 31.1 33.1 Cancer and malignant disease 17.1 16.3 Diseases of the lungs (non tuberculous) 11.0 9.5 Tuberculous diseases 6.1 5.5 Cerebral Haemorrhage 9.9 10.7 Congenital diseases 4.3 4.0 Suicide and Violence 2.2 2.9 Diseases of the digestive system 5.9 4.2 Infectious diseases 1.3 3.3 Diseases of the kidney 2.5 1.0 other defined diseases 8.6 9.5 The number of deaths from the common infectious diseases were:- 1942 1943 Measles 1 1 Diphtheria 1 1 Scarlet Fever 0 0 Whooping cough 0 1 Influenza 3 19 MATERNAL MORTALITY:- The maternal mortality rate for the year 1943 was reduced to 0.82, per 1000 live births. The rate for England and Wales was 1.84 per 1000 live births. The one death was due to Puerperal Sepsis and pelvic Cellulitis. INFANTILE MORTALITY:-The infantile mortality rate of 30.96 per 1000 live births compared with 38.69 per 1000 live births for the previous year. The rate for ???ngland and Wales was 49 per 1000 live births. The thirty seven deaths of children under one year were due to the following causes:- Congenital Malformations 14 Prematurity 14 Broncho Pneumonia 2 Pneumonia 2 Acute Bronchitis 1 Whooping Cough 1 Gastro Enteritis 1 Misadventure 1 Violence 1 (5) CAUSES OP DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1943 M. P. - . • . ..a Total 1 Typhoid and paratyphoid fevers - - - 2 Cerebro-spinal fever 1 2 3 3 Scarlet Fever , - - - 4 Whooping Cough 1 - 1 5 Diphtheria - 1 1 6 Tuberculosis of rercpiicatory system 24 14 38 7 Other forms of tuberculosis 3 2 5 8 Syphilitic diseases 3 1 4 9 Influenza 9 10 19 10 Measles 1 1 11 Acute poliomyelitis and polioencephalitis 1 - 1 12 Acute infective encephalitin - - 13 Cancer of buccal cavity 3 6 9 14 Cancer of stomach and duodenum 11 S 19 15 Cancer of breast - 20 20 16 Cancer of all other sites 39 40 79 17 Diabetes - 4 4 18 Intracranial vascular lesions 32 51 83 19 Heart disease 117 114 231 20 Other diseases of circulatory system 11 16 27 21 Bronchitis 13 13 26 22 Pneumonia 22 13 35 23 Other respiratory diseases 8 5 13 24 Ulcer of stomach or duodenum 6 4 10 25 Diarrhoea under 2 year 1 3 4 26 Aopendiciti3 2 0 2 27 Other digestive diseases 6 11 17 28 Nephritis 5 3 8 29 Puerperal sepsis - 1 1 30 Other maternal causes - - - 31 Premature birth 6 8 14 32 Congenital malformations, birth injuries and infantile diseases 10 7 17 33 Suicide 1 1 2 34 Road traffic accidents 7 2 9 1 35 Other Violent causes 4 8 12 36 All other causes 32 31 63 378 400 778 (6) GENERAL PROVISION OP PUBLIC HEALTH SERVICES FOR THE AREA LEGISLATION. HOSPITALS ard MORTUARY There was no change during the year. LABORATORIES :- An arrangement was made with the Ministry of Health from 1st July 1943 for bacteriological examinations to be Carried out at their Laboratories at St. Helier Hospital, and at Epsom College, AMBULANCES The Council's ambulance, which was staffed by personnel attached to the Fire Brigade, was transferred to the Sutton Civil Defence Depot on 19th April, 1943, and has been operated by members of the Civil Defence Ambulance Service. Details of the service are recorded on page 27, CLINICS AVAILABLE FOR THE DISTRICT. SUTTON DISTRICT 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 Infant Welfare Centre - 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 T E PAROCHIAL ROOMS, MALPEN ROAD. CHBAM. 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, atl.45 n.m. Diphtheria Immunisation Clinic - Every Thursday, at 2 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. MAIDEN GREEN. WORCESTER PARK. t Infant Welfare Centre - Every Monday and Thursday, at 1.30 p.m TUBBRCULOSIS DISPENSARY St. Helier County Hospital, Wrytho 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. (7) SANITARY CIRCUMSTANCES OP 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 wells of the Sutton District Water Company is softened to 9 degrees of hardness. Chlorine is applied in the form of chloramine as a protective measure. Samples are examined daily by the Company's chemist and bacteriologist in the laboratory at the Sutton works. Samples are also examined at monthly intervals by the Company's Consultant Analyst, and monthly samples are examined in rotation by the District Councils in the area of supply. The supply from all sources has been satisfactory in quality and quantity, and below is the average of monthly analyses. Average Total solid residue dried at 180° C. 19.00 Ammonia, free 0.0101 Ammonia, Albuminoid 0.0001 Nitrogen as Nitrates 0.87 . . Nitrogen as Nitrites 0 Oxygen absorbed in 4 hours at 27° c. 0.004 Chlorine (in chlorides) 1.883 Hardness total (soap test) 8.28 No. of Bacteria growing on Agar per c.c. for 3 days at 2 0° C. 2.3 No. of Bacteria growing on Agar per c.c. for 1 day at 37° C. ■ 0.08 Presence of Bacillus coli in 100 c.c. 0 (8) DRAINAGE,& SEWERAGE Owing to the restrictions imposed by war conditions,no major reconstruction work or new constructions have been carried cut, 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 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 fifteen 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 9 to 19) has been condensed. RECORD OF INSPECTIONS AND NOTICES SERVED. Number. Special Inspections, Interviews on Promises, and Advisory Visits 1866 Re-ins pections 2732 Visits to Works in progress 898 Visits to Factories and Workplaces 145 Visits to Bakehouses 35 Visits to Outworkers' Premises 56 Visits to Slaughterhouses 48 Vis its to Butchers' & Food Shops 523 Visits to Dairies and Milkshops 70 Visits to Stables 10 Visits to Pigsties 23 Visits ro Rat Infestation 1335 Food and Drug Sample Visits 224 Visits re II.C.N. Regulations 5 Visits re Merchandise Marks Act 5 Visits in connection with infectious Disease... 508 Visits re Overcrowding and Permitted Number" Measurements 28 Visits to Petroleum Spirit and Cinematograph Film Stores 64 Visits and Revisits re Shops Act 235 Miscellaneous 1379 10189 -9- Premises at which defects or nuisances were discovered 1269 Dwelling-houses surveyed for housing defects under Public Health cr Housing Acts 268 Defects or nuisancer discovered 1994 Defects or nuisances remedied 1442 Defects or nuisances in hand 191 Defects or nuisances outstanding 361 Informal Notices served 1037 Statutory Notices served 32 Compla-ints received and investigated 810 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROYEM?? CARRIED OUT. DRAINAGE AND SANITARY FITTINGS. Number No. of houses and premises redrained 7 Premises connected to surface water sewers 1 Repairs or amendments to existing drains 63 Drains or gullies unstopped and cleansed 182 Rainwater pipes disconnected from soil drains 2 Sanitary fittings repaired, renewed, provided or cleansed 519 Eater and smoke tests applied 230 W.C. APARTMENTS. . New Apartments provided 6 W.C. Apartments lighted and/or ventilated 9 Ventilated lobbies to W.C. Apartments provided 4 Alternative sanitary accommodation provided 2 Separate accommodation for sexes provided 1 STRUCTURAL REPAIRS OR IMPROVEMENTS. Roofs, renewed or repaired 103 Guttering and rainwater pipes provided, repaired etc 87 Damp walls remedied 90 Brick walls repointed,.ropaired or rendered 10 Chimney stacks repaired or rebuilt 8 Yards pa-ved or repaired 19 Sites of houses concreted 13 Floors relaid or repaired 112 Additional lighting or ventilation to rooms 2 Windows and/or cills repaired or renewed 34 Doors and thresholds provided or repaired 25 Staircases and handrails repaired or provided 3 Ranges, stoves and coppers repaired or renewed 21 Miscellaneous 141 CLEANSING Rooms, passages, larders etc., cleansed 370 Trade promises cleansed 54 Verminous houses disinfested - Bugs, fleas and Scabies 35 (10) GENERAL Offal bins provided 8 Dustbins provided 303 Manure Pits constructed 1 Accumulation of refuse and offal removed 37 Rat or Nouse infested premises cleared 110 Nuisance from animals abated 4 Offensive ponds and ditches cleansed 1 Overcrowding abated 3 Smoke nuisances abated 3 Miscellaneous 6 SMOKE ABATEMENT. There are few chirmneys 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(1) Number of Inspection (2) Written Notices (3) Occupiers Prosecuted (4) i Factories with . Mechanical Power 113 17 - Factories without Mechanical Power 65 8 — Other Premises (other than Outworkers premises) -- . -- -- Total 178 25 -- (11) 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. Pound i • Remedied 7 Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness 1 3 -- -- Inadequate Ventilation -- -- --j -- Overcrowding -- -- -- -- Unreasonable Temperature -- -- -- — — Ineffective drainage of floors -- -- -- -- Absence of Thermometers 3 2 -- -- Absence of suitable lighting in W.C. • apartments 6 5 -- Other nuisances 37 27 — — —- Sanitary accommodation • (a) Insufficient. 4 2 - - (b) Unsuitable or defective 8 8 -- -- (c) Not separate for sexes 2 1 -- -- 64 48 -- _ _ OUTWORK IN UNWHOLES0NE PREMISES. / Nature of Work Instancos Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel 1 1 — PUBLIC HEALTH ACT, 1936 - WORKPLACES. Number of Inspections Written Notices Occupiers Prosecuted (12) H0USING 1. .INSPECTION OF DWELLING HOUSES DURING THE YEAR:- (1) (a) Total Number of dwelling houses incepected for, housing defects (under Public Health or ???) 268 (b) Number of ??ions made for the purpose (2) Number of dweling-houses (exclusive of those refered to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 108 2. REMEDY OP 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 86 3. ACTION UNDER STATUTORY POWERS DURING THE YEAR:- A. Proceedings under Sections 9, 10 And 16 of the Housing Act, 1956:- Nill. B. -Proceedings under Public Health Acts;- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 14 (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 OP FOOD. Pood and Drugs Act, 1938. The following table indicates the samples taken during the year 1943:- NUMBER EXAM NED I NUMBER ADULTERATED ETC. Informal Formal Total Informal Formal Total Milk 60 60 Milk Powder (Skimmed) 1 1 Milk (Condensed) | Butter 9 9 Margarine 9 9 8 8 Lard 8 8 Cheese Cooking Fat 1 1 Malted Milk Tablets 2 2 Black Pudding 1 1 • 31 60 91 8 8 (13) NUMBER EXAMINED NUMBER ADULTERATED Informal Formal Total Informal Formal Total Brought forward 31 60 91 8 8 Meat paste 1 1 Sausage Meat 1 1 Saveloys 1 1 Sausages 3 1 4 Arrowroot 2 2 Dessert Powder 2 2 Ground Mace 1 1 Junket powder 1 1 Marmalade 1 1 Pearl Barley l 1 Cocoa 4 4 Coffee 1 1 Jam 3 1 4 1 1 Meat Sandwich Spread 1 1 Soya Flour 1 l Sugar 1 l Tea 1 1 Yorkshire Pudding Mixture 2 2 1 1 Blancmange Powder 1 1 Coffee & Chicory Essence 1 1 Gelatine 2 2 Ground Ginger 4 4 Ground Mixed Spice 1 1 Ground Nutmegs 5 5 Bunflour 1 1 Cinnamon 1 1 Flour, Self-raising 1 1 Curry Powder 2 2 Mint Sauce 1 1 Mustard 1 1 1 1 Mustard Mixture 2 2 4 2 2 4 Mustard Continental 1 1 Mustard Liniment, solidified 1 1 Pepper 2 2 Mustard Cream 1 1 Mint 1 1 Horseradish Powder 1 1 Pickles 1 1 Vinegar, Malt 2 2 Fish Cakes 6 6 Fish Paste 1 1 Soup 2 2 Ginger Wine Essence 1 1 Lemon Essence 1 1 Essence of Raspberry 1 1 Lemonade Powder l 1 Lemon flavour 2 2 Ginger Cordial 1 1 Green Ginger wine 1 1 Raisin Flavour 1 1 Boracic Acid Powder 1 1 Honey & Lemon Linctus 1 1 2 1 1 2 Zinc & Castor Oil Cream 1 1 Camphorated Oil 1 1 Halibut Liver Oil with Orange juice 1 1 111 69 180 11 6 17 (14)  NUMBER EXAMINED NUMBER ADULTERATED Informal Formal Total Informal Formal Total Brought forward 111 69 180 11 6 17 Bicarbonate of Soda 2 2 Boracic Acid Ointment 1 1 Chest & Lung Mixture 2 2 Glycerine, Lemon & Ipecacuanha 1 1 2 1 1 2 Liquid Paraffin, Medicinal 1 1 Syrup of Pigs, Compound 1 1 Compound Glycerine & Thymol 1 1 Anti-gas Ointment 15 15 2 2 Ale, Bitter 3 3 Materials for making Home-brewed Oatmeal Stout 1 1 Gin 1 1 Whisky 2 2 1 1 TOTAL 142 70 212 15 7 22 During 1943 it was again possible to maintain a satisfactory numerical standard of sampling. Of the total samples 3.77% were found to be adulterated or carrying misleading labels. This percontage figure excludes informal samples repeated formally; samples of No. 2 Anti-gas ointment and Margarine. No prosecutions were instituted but warnings were given in all cases of unsatisfactory samples. MILK SUPPLY. There are 12 dairymen and 15 retail purveyors of milk in the district. Two persons whose premises are outside the district are also registered as retail purveyors. Routine inspection of promises has again revealed that the provisions of the Milk and Dairies Order, 1926, have been genorally well observed. Under the Ministry of Pood Milk Rationalisation Scheme the number of premises from which milk wa3 sold in 1943 was considerably reduced. The following Licences to sell graded milks were granted in 1943:- Grade of Milk Type of Licence Dealers Supplementary Tuberculin Tested 11 - Accredited — - Pasteurised 14 1 The following Tables show the results of examinations of samples of milk during 1943:- (15) MILK SAMPLES. Twenty-four samples of milk were submitted for bacteriological examination as below:- A. Pasteurised Milk. No. of Samples. Below 100,000 bacteria per litre 12 Goliform Test Phosphatase Test - - Satisfactory Unsatisfactory 13 Above 100,000 bacteria per millilitre 10 3 12 1 2. Tuberculin Tested (Pasteurised). No. of Samples. Below 30,000 bacteria per millilitre Coliform Test Phosphatase Test - - Satisfactory Unsatisfactory 3 3 3 - 3 - 3. Ordinary Milk. No. of Samples Total bacteria per millilitre Coliform test Under 50,000 50,000100,000 100,000250,000 Over 500,000 — + 8 7 - 1 - 6 2 ICE CREAM. At the end of 1943, 106 premises had been registered in accordance with Section 14 of the Pood and Drugs Act, 1938. On ten of these premises ice cream could be manufactured. Owing to the war-time ban upon the manufacture and sale of ice-cream it was not necessary to visit these premises during 1943. MEAT AND OTHER FOODS. The 53 butchers' shops within the Borough have been inspected and observation kept upon the vehicles used for the conveyance of moat, 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 7 cases where sanitary conditions were (16) not satisfactory,, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. At the end of 1945, 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. Sixty cases of insanitary or defective conditions in food shops generally wore dealt with. There it: 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. The following Table Indicates the number of animals killed, inspected and found to be diseased. Cattle excluding Cows Calves Sheep and Lambs Pigs Number killed - - - 56 Number inspected - - - 56 All diseases except Tuberculosis - - - - Whole carcasses condemned - - - 1 Carcass of which some part or organ was condemned - - - 3 Percentage of the number inspected affected with disease other than Tuberculosis - - - 7.14% Tuberculosis only Whole carcasses condemned - - - - Carcasses of which some part or organ was condemned - - - - Percentage of the number inspected affected with Tuberculosis - - - - The following diseased and/or unsound moat 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. 1 Carcase and offals (Swine Erysipelas) Head, Neck & Shoulders (Injuries) 25 lbs Pluck (Injuries) 1 Lungs (Pleurisy) 1 set Heart (Pericarditis.) 1 Lungs (Pleurisy) 1 MEAT AND OTHER FOODS IN RETAIL SHOPS, Pork 51-lbs; Sausages 104-lbs; Perk Sausage Meat 60-lbs; Pelenses 53-7033; Eacon 43f-lbs. Rabbits 273-lbs; Ducks 3; fish 245 stones; Fish Cakes 377; Eggs; 266; Butter ¾ lb; sugar 35½ lbs; Rice 10-lbs; Biste 10-lbs Flour 140 lbs; Cheese 25-lbs; Apple Tarts 4; frunes 127-lbs; Apples 41-lbs; Tomatoes 22-lbs; Baricot Beans 18-lbs; Miscellaneous foodtuffs 225½ tins, jars, bottles and packets. TEE SLAUGHTER OF ANIMALS ACT - 1933. All animals slaughtered in ^he 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 1943. There are 25 Bakehouses within the District, and of these 18 are provided "with meeha nical power. A good standard of cleanliness and sanitary condition generally obtained. RATS AND MICE (DESTRUCTION) ACT, 1919. THE INFESTATION ORDER 1943. Pursuant to the Direction given by the Minister of Food under Article 5 of the above-mentioned Order, a survey of the Borough was made and, as a result, no major infestations of rats or mice were discovered. The survey was carried out by individual visits to all possible but not necessarily probable sites of infestation. During 1943, 1335 visits were made in connection with rat or mice infested or suspected infested premises. In addition to these visits, the Corporation's Disinfector made numerous visits to private premises and to premises in the occupation of the Corporation. 110 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. SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. (18) ERADICATION OF BED BUGS. Twenty-seven bug- infosted houses were dealt with as follows:- By the use of Insecticides Sulphur Hydrocyanic (H.C.N.)Gas Council Houses 3 - - Other houses 24 - — The work of disinfection has continued to be carried cut upon the lines indicated in previous Reports. The Insecticides used were "rexam T.C.Y." and "Fuminol". SHOP'S ACT, 1934, Two hundred and thirty-five visits were made in connection with Section 10 of the Shops Act, 1934. PREVALENCE OP AND CONTROL OVER INFECTIOUS DISEASES One thousand two hundred and seventy one cases of infectious disease were notified during the year. Of these six hundred and fifty seven were cases of Measles which was epidemic from January to July, and four hundred and forty one were cases of scarlet Fever, which sustained a high prevalence throughout the year. There was a further decline in Diphtheria. Two cases of Typhoid Fever and one case of Paratyphoid Fever were notified but there was no evidence of infection arising within this district. There were four sporadic cases of cerebro Spinal Fever, and there was one case of Acute Anterior Poliomyelitis. SCARLET FEVER the increase in the number of cases of Scarlet Fever at the end of 1942 was sustained during 194,3. This rise in incidence corresponded to a phase of higher virulence of the causative organism, the streptococcus, which affected urban areas throughout the country. In this Borough four hundred and forty one cases'-were notified compared with one hundred and sixty two during the previous year. The case rate was 6.17 per 1000 of copulation compared with 3.01 per 1000 of copulation for England and Wales. There was no increase in the severity of the disease. Most of the cases were very mild and there was no death. The increased infectivity was demonstrated by a rapid progression of cases in schools, a higher rate of residual infection in cases discharged from hospital, and a larger number of secondary cases in the homes. The mildness of the initial symptoms and the transient nature of the rash tended to allay suspicion of infection and to delay isolation of the patients. The spread of infection was (19) most pronounced among the susceptible infant school children. Localisation of infection in and around certain infant schools was well defined and in this respect the West Central Ward was particularly affected. The monthly .incidence of cases was as follows. Jan. Feb, Mlarch April May June July Aug. Sep. Oct. Nov. Dec, 26 30 41 22 28 23 J 46 42 48 67 35 28 These figures show the continued high incidence during the year and the chary characteristic rise in the Autumn. At the end of the year there was evidence of less localisation of infection and a tendency towards decline., All the factore involved were considered in consultations with the school medical officer and efforts were made to reduce infection in schools by extending the period of exclusion of suspected carriers, by adjusting educational methods likely to favour the spread of infection, by the maximum use of floor space and fresh air, and concurrently by close attention to individual cases and their contacts. During the period of maximum incidence the hospital accommodation for eases of scarlet Fever was severely taxed, and every effort was made to arrange for the treatment of cases at home, where conditions for homo nursing were suitable. DIPHTHERIA Seven cases were notified during 1943, a reduction of nineteen cases on the number for the previous year. Four of the cases were from institutions. There was one death of an adult from laryngeal infection. Of the three cases occurring in the district two were adults. One was a child of fourteen years who had been immunised, and who suffered primarily from septic tonsilitis, but carried diphtheria bacilli in the throat. The case rate was 0.09 per 1000 of population compared with 0.88 per 1000 of population for England and Wales. The following table shows the number of notified cases of Diphtheria and the number of deaths during the period 1933 - 1943. Year 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 District Gases 63 50 32 58 25 12 11 10 30 14 3 Institutional Cases 13 8 20 23 8 2 19 13 16 12 4 Total Cases 76 58 52 81 33 14 30 23 46 26 7 Total Deaths 5 2 1 5 5 1 1 3 3 1 1 x Immunisation commenced. The above table is of interest in showing a general tendency towards decline in the number of notified cases. There is also evidence of reduction of mortality. During the nine years since the introduction of the scheme no immunised child has died of Diphtheria in this Borough. During the same period four immunised children have been notified as cases of Diphtheria and all suffered from mild attacks. The trend towards decline of the incidence and mortality of Diphtheria justifies a belief that the beneficial influence of diphtheria immunisation is in operation. (20) DIPHTHERIA IMMUNISATION ;- Diphtheria remains a very dangerous disease. Diphtheria immunisation gives a high measure of protection and provided that the immunisation of a high percentage of the child population is maintained, epidemic spread of the disease can be prevented. It should be routine for mothers to have their babies immunised at the age of one year, and reinforced by a further injection at the age of five years just before they enter school. This can be arranged through the clinics or under the Council's scheme whereby persons with incomes under ^420 per annum may have their children under five years of age immunised by their own medical practitioner free of cost. Five hundred and nine babies were immunised at the age of one year during 1943. This represents forty four per cent of the number reaching that age during the year, ai increase of one per cent on the previous year. The total number of ch'ldren immunised during the year 1943 was 1293 of whom 797 were under five years of age and 486 between five and fifteen years of age. At the end of the year 9385 children, representing 70.04 per cent of all the children, had been immunised. Of these 2830 represents 64.32 per cent of the children under five years of age and 6555 represents 72.83 per cent of the children between five and fifteen years of age, • The clinics for diphtheria immunisation are as follows, 1, At the Public Hall, No, 1, Hill ^oad, Sutton, Every Friday, at 2 p.m. 2. At the Clinic, Priory Crescent, Cheam. Every Thursday, at 2 p.m. The following table shows the distribution in age groups of children who received injections during the year 1943. 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9- 10 lOll 11- 12 1213 1314 1415 Over 15 Total 509 93 87 108 138 ... .. 61 55 53 51 55 29 23 12 9 10 1293 MEASLES Measles was epidemic during the first six months of the year. Six hundred and fifty seven cases were notified. Thirteen cases were admitted to hospital on account of pulmonary complications. There was one death of a child aged fourteen months from Pneumonia. The course of the epidemic is indicated by the following figures of monthly incidence. Month January February March April May June July August to December Total No. of Cases 57 133 179 111 81 66 24 6 657 The age groups of the notified cases are shown in the following table. Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 and over Total 20 32 49 51 69 136 121 57 26 19 19 13 4 7 6 28 657 (21) A higher proportion of the cases than usual was of children un'er the age of five, and suggests a lowering of the standard of protection of the young child in the homes, which can he attributed, to war conditions. Young children are very susceptible, and every effort should be made to defer infection as long as possible. Every year gained lessens the risk of mortality. Complications can only be avoided by the most careful nursing during the acute phase of the illness. WHOOPING COUGH Whooping cough was less prevalent. Ninety one cases were notified, a reduction of eleven cases from the previous year. There was one death of a child ased six months. The monthly distribution of cases was as follows. Month Jan. Feb. March April r May June July Aug. Sep. Oct. Nov. Dec. No, of Cases 4 8 8 6 9 13 8 11 4 6 6 8 The age groups of notified cases are shown in the following table. Under 6 months 6 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Over 15 2 7 8 11 14 13 22 8 - 2 - - - - - - 4 Whooping Cough is a disease of young children. Sixty per cent of the cases were of children under five. The first year of life is a period of high fatality. Two fifths of all deaths occur in children under the age of one year, and nine tenths of deaths occur in children under five years. It is important in the prevention of mortality that infection should be deferred for as long as possible, and that the serious risk of the illness in early childhood should be reduced by the careful nursing of cases, and the avoidance of complications. PUERPERAL FYREXIA - Eleven cases were notified compared with six during the previous year. The case rate was 9,01 per 1000 total births compared with 11,68 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 case occurring in a maternity home, TYPHOID FEVER Two cases of Typhoid -^ever and one case of Paratyphoid Fever were notified. There was no death. Investigation did not reveal any source of infection within this district. DYSENTERY One case of Sonne Dysentery was notified. Mild and transient cases of gastro enteritis are frequently due to infection with Sonne Dysentery, To establish diagnosis in such cases, early bacteriological examinations are necessary, A high standard of hygiene in persons engaged in the handling of food is the best form of prevention. (22) CEREBR0 SPINAL FEVER There were four cases of Ceretire Spinal Fever during the year, and there were three deeths of young children amongst whom the fatality rate is Highest, Early diagnosis and early treatment are the only means of preventing mortality from this serious infection. ACUTE ANTERIOR POLIOMYELITIS One case was notified during the year of a child aged five, who suffered from a severe attack, but who recovered'with some residual paresis. There was one death of a boy aged 16 years from Acute Polioencephalitis. PNEUMONIA Of the thirty-five deaths occurring from ail forms of Pneumonia, three were notified previous to death. The total number of notified cases arising in the district was thirty five. INFLUENZA : - During the month of December the number of cases of Influenza increased rapidly to epidemic proportions. The type of illness was generally mild and the average duration of illness was between four and seven days. Residual debility was a common sequel and complication by Bronchitis frequent. Schools and places of industry suffered considerable depletion, but there was evidence of rapid improvement at the end of the year. A scheme for domestic and nursing assistance in homes affected by Influenza was introduced with the assistance of the Defence Staff, the Women's Voluntary Services, the Youth Organisations and the British Red. Cross Society. Fourteen calls were dealt with through these agencies, and many were helned by the good spirit of neighbourliness which prevailed in the streets, NON-NOTIFIABLE DISEASES :- School teachers reported 214 cases of mumps, 128 cases of chicken pox, 22 cases of German Measles, 36 cases of infective Jaundice, and 17 cases of Scabies. The outbreak of infective Jaundice was confined to one school and was controlled by rigid exclusion of suspected cases. School notifications are a useful index of the prevalence of non notifiable diseases and form a basis for consultation with the school medical officers. SCABIES :- This skin infection continued to be prevalent. The treatment clinic at the First Aid Post, The Public Hall, Sutton, operated efficiently under the direction of Nurse James, and dealt with four hundred and fifty three cases during the year. The number of attendances at the clinic for treatment and observation was one thousand eight hundred and sixty three. The reference of cases by doctors, and from schools and child welfare clinics has heloed to provide information of the true incidence of the disease, and towards the end of the year there was evidence of a considerable reduction of infection. LICE :- The facilities provided at the First Aid Post, The Public Hall, Sutton, have also proved of great value in the reduction of the incidence of infestation of head lice. Eighty four patients were treated during the year. The number of attendances for treatment and observation was three hundred and sixty nine. (23) DISTRIBUTION OP NOTIFIABLE DISEASES IN WARDS . DISEASE WARDS Case Rate per 1000 Fopulatn (Mid-Year) Case Rate per 1000 England & Wales. N. N.W. M.E. w.c. E.G. E. S.W. S.E. S. Total Population 9336 8288 9923 11797 " 6829 6943 5553 5312 7414 71400 Scarlet Fever 53 48 52 166 43 24 11 13 12 422 5.91 3.01 Diphtheria - - - 1 - - - - 2 3 0.04 0.88 Typhoid Fever - - - - - - 1 1 - 2 0.03 0.01 Para-typhoid - - - 1 - - - - - 1 0.01 0.01 Puerperal Pyrexia 1 - 1 - 2 - - 7 - 11 - - Pneumonia 5 3 5 5 3 2 2 4 6 35 0.49 1.34 Erysipelas 3 4 4 4 - 3 - - 2 20 0.28 0.31 Dysentery - - - 1 - - - - - 1 — — Poliomyelitis 1 - - - - 1 — - - 1 — — Cerebro-Spinal Fever 2 - - 2 - - - - - 4 0.06 0.08 Measles 43 49 97 152 71 62 30 46 107 657 9.20 9.38 Whooping Hough 7 4 20 22 9 7 6 4 12 91 1.27 2.54 Total 115 108 179 354 128 98 50 75 141 1248 (24) NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1943 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 i Hospital Died Scarlet Fever 1 5 25 25 37 265 42 4 9 7 2 - 422 294 - Diphtheria - - - - - - 1 - 2 - - - 3 3 1 Typhoid Fever - - - - - - - - - 2 - - 2 1 - Para-typhoid - - - - - - - - - - - - 1 1 - Puerperal Pyrexia - - - - - - - - 11 - - - 11 4 - Pneumonia - 1 - 1 - 3 1 - 3 5 9 11 35 5 35 Erysipelas — - - - - - - - 1 8 8 2 20 8 - Dysentery - - - - - - 1 - - - - - 1 l - Poliomyelitis - - - - - 1 - - - - - - 1 1 1 Cerebro-Spinal Fever - 2 - - - 1 - - 1 - - - 4 4 3 Measles 20 32 49 51 69 359 49 16 10 2 - - 657 13 1 Whooping Cough 9 8 11 14 13 32 - - 1 2 1 - 91 - 1 LondonCases in the Downs Hospital S.F. 1 2 - 1 2 9 - 3 1 - - - 19 5 - Dip. - - - - 1 2 - - 1 - - - 4 1 - k Under Column "Died" all deaths, whether notified in the District or outside it, or not notified at all, are included. BACTERIOLOGICAL EXAMINATIONS The following examinations of specimens were made by direction of the Borough Council, Diphtheria Enteric Tuberculosis Positive Negative Positive Negative Positive Negative 11 215 - 21 2 16 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table. (25) TUBERCULOSIS. On 31st December 1943, there were on the Register 652 cases of Tuberculosis, of which 519 were pulmonary and 133 non pulmonary. The death rate for Pulmonary Tuberculosis was 0,53 per 1000 of population, and for non Pulmonary Tuberculosis 0,07, The total tuberculosis death rate in 1943 was 0,60, compared with 0,67 per 1000 of population in 1942, The corresponding death rates for England and Wales in 1943 were : Pulmonary, 0,55 per 1000 of population; non pulmonary, 0,11 per 100 0 cf population. Total rates 0,66 per 1000 of population. Noteworthy advances in the Tuberculosis Scheme during the year we re the paymenl; of allowances to enable and to encourage early casea' to undertake treatment, and the appointment of almoners to the dispensary districts to undertake the social care or patients. The Sutton and Cheam Tuberculosis Care Committee carried out very useful work in assisting patients with extra nourishment and in helping to overcome many of the financial and domestic difficulties associated with the disease. The following table shows new cases and deaths in age groups. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - - - - - - - - 1 - 1 - - - - - 1 5 1 2 3 4 - - - - 15 11 11 2 2 1 4 1 - 25 8 9 4 1 2 3 - - 35 7 5 1 - 9 2 - 1 45 6 1 1 — 2 3 - - 55 5 2 - — 9 1 2 - 65 and above 1 - - 1 1 1 - - Totals 39 31 11 8 24 14 3 2 NOTIFICATION OF TUBERHJLCSIS. Respiratory Forms of Death - 33 out of 38 were notified, other Forms of Death - 4 out of 5 were notified, (26) CIVIL AMBULANCE SERVICE The Council's Civil Ambulance has been operated by personnel of the Civil Defence Ambulance Service since 19th April 1943, and is stationed at the Sutton Civil Defence Depot (Telephone Vigilant 5458). The ambulance is primarily intended for street accidents and cases of urgent Illness and maternity, but when possible deals with any reasonable calls where private arrangements cannot be made. The numbers of calls dealt with since 19th April 1943 were as follows. Type of Case Accident Illness in Street Urgent Illness, at Home Non-urgent Illness at Horns Maternity Total No. of Cases:- 232 97 15.5 85 ! 99 647 Of the 647 cases, 55 were dealt with by using Civil Defence Ambulances as additional vehicles, 5 were dealt with by assistance from adjoining districts, and 14 were dealt with by private ambulances on behalf of the Council. The number of calls per month and the number of calls per day are shown in the following tables. April May June July August Sept. Oct. Nov. Dec. Total No. of Calls 35 70 64 75 82 77 73 82 89 647 No. of days in month April May June July Aug. Sept. Oct. Nov. Dec. Total with 0 calls 1 3 4 1 3 0 3 3 0 18 days 1 call 2 8 7 9 7 7 10 1 8 59 days 2 calls 3 7 6 12 5 9 7 7 6 62 days 3 calls 1 8 7 4 7 10 6 9 8 60 days 4 calls 3 2 2 3 5 2 — 10 3 30 days 5 calls 1 2 2 2 3 — 2 4 16 days 6 calls — 1 1 - - - 2 - 1 5 days 7 calls 1 — - - 2 - - 1 4 days 8 calls — ~ — 1 - — - — — 1 day 9 calls - - - - 1 - 1 - - 2 days Highest No. of calls on one day 7 6 6 8 9 7 9 4 7 (27)