Sutc 8 LIBRARY BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OP HEALTH FOR TEE YEAR 1944. BOROUGH OF SUTTON & CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1944. PUBLIC HEALTH AMD HOUSING COMMITTEE HIS WORSHIP THE MAYOR (Alderman F.C.Lohden, O.B.E.> J.P») Alderman H.J.Trlckett, C.C. !oun. J.H.Booth Coun. J.Nicholson " H.-H.Coote " H.S.Oakley " J.M.Firth " L.Shav; Davis " Mrs.Harper " Mrs.Smyth " W.E.Heath " T.Stoker (Chairman) Coun. V/. T.Venton,C.C. (1) PUDLIC HEALTH OFFICERS OF TUB AUTHORITY MEDICAL OFFICER OF HEALTH: ENEAS J. MuCINTYRE, 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; k ARTHUR SYDNEY WILLIAMS, Certif .R.S.I, i Certif, Meat & Food. . ASSISTANT SANIT.J1Y INSPECTORS: x JOHN HENRY LOTT, Certif.R.S.I.: Certif. Heat & Food. REGINALD WILLIAM NORMAN, Certif.R.S.I, and S.I.E.J.B.; Certif.Meat & Food. KEMPTON HUDDLEST ONE PRIOR, Certif.R.S.I, and S.I.E.J.E.; Certif.Meat & Food. ARTHUR CHARLES RUSSELL, Certif .R.S.I, and S.I.E.J.B.: Certif.Meat Sr. Food. (To 13.11.1944) FRANK SUTCLIFFE, Certif.R.S .I. and S.I.E.J.B.: Certif.Meat & Food. x 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 1944, The year is memorable for the courage and endurance of the people under intensive air attacks from flying bombs. The loss of life, the physical injury, and the strain of air raid alerts with the constant oassage of noisy missiles were borne with a wonderful fortitude. Between the 16th June and 15th November, thirty-six flying bombs fell within the Borough, Sixty-six persons were killed, and seven hundred and twenty-four persons were injured. One hundred and eighty-seven houses were destroyed or damaged beyond repair and eighteen thousand nine hundred and ninety-one houses suffered lesser degrees of damage. Extensive organised evacuation of expectant mothers mothers with young children and of school children was carried out. while private evacuation proceeded si-niltaneously, leaving a resident population of a^oroximatel7f forty eight thousand. The immediate effect of the loss of homes for the oeople was to some extent and for the time being relieved by the extent of evacuation, by concurrent first aid reoairs to houses, by rest centres, by requisitioning'and by billeting, but a very serious problem of housing involving overcrowding, debased hygienic standards, and a disruption of family life remains as an aftermath requiring urgent remedy in the interests of the public health. The higher death rate reflects the number of deaths from enemy action. The total number of births was lower, and the higher birth rate is derived from the lower estimate of total population at mid year while evacuation was in progress. The infantile and maternal mortality rates remained low, desoite the disturbance of population which created unusual risks for mothers and babies. The year was fortunately free from major epidemics. The general incidence of infectious diseases, with the exception of Tuberculosis, declined. The work of general sanitation, of the prevention of nuisances, and of the protection of food, which was greatly complicated by air raid conditions, was efficiently carried out under tne direction of the Chief Sanitary Inspector (Mr. C.W.Newbery) to whom with the sanitary and clerical staff of the Public Health Deoart^ent I am indebted for their constant devotion to duty. The water supply of the district maintained a high standard of ohemical and bacteriological ourity. Effective control by daily samoling and by chlorination was continued. Localised damage to water mains ana to the sewerage system were expeditiously dealt with and precautions against incidental pollution or the water supply were adequate. The Council's Civil Ambulance, operated by Civil Defence personnel throughout the year, provided an efficient service which carried on uninterruptedly through many air attacks with commendable courage. To all who served in rescue parties, First A'd Posts, Mobile Units, in the ambulance service, and in the mortuary service, I would express my admiration and aporeciation of the work they performed, I thank tne medical practitioners of the Borough for tneir unfailing support of the services at all times, the nurses and midwives of the district for their steadfast courage in visiting patients, and the staffs of the local hospitals for their unremitting care of the sick and wounded. I thank members of the Council for their advice and assistance. I am grateful to all the officers of the Council for their co-operation and especially to Mr. N.H.Michell, the Controller of Civil Defence, for his able guidance and help during the emergency. I am, Mr, Mayor, Ladies and Gentlemen, Your obedient Servant, ENEAS J. MACINTYRE Medical Officer of Health, (3) STATISTICS OF THE AREA. 1943 1944 Area in Acres 4338,15 4338.15 Registrar General's Estimate of the Resident Population 71,400 67,360 Number of inhabited bouses (enc1 of year) according to the Rate Book 22,268 21,698 Rateable Value and sura represented by a ) £889.041 £884,629 Penny Rats £3,676 £3,'556 EXTRACTS FROM VITAL STATISTICS COMPARATIVE OF THE YEARS 1943 AND 1944. 1943 1944 England & Wales 1944 Total Male Female Total Male Female Live Births 1195 594 601 1162 604 558 Legitimate 1132 565 567 1092 561 531 Illegitimate 63 29 34 70 43 27 Birth Rate per 1000 of the Estimated Resident Population 16.7 17.3 17.6 Still Births 25 10 15 29 15 14 Legitimate 23 9 14 26 13 13 Illegitimate 2 1 3 2 1 Rate per 1000 total (live and still births) 20.5 | 24.3 Deaths 778 378 400 834 387 447 Death Rate per 1000 of the estimated resident population 10.9 12.4 11.6 Deaths from Puerperal Sepsis 1 0 Other Puerperal Causes 0 1 Death rate from Puerperal Causes 0.82 0.84 1.53 Deaths of Infants under one year of age. All Infants per 1000 live births 30.96 34.42 46.00 Legitimate Infants per 1000 legitimate live births 30.04 33.55 Illegitimate Infants per 1000 illegitimate live births 47.62 14.28 (4) 1943 1944 Deaths from Cancer 127 116 " " Measles 1 0 " " Whooping Cough 1 1 " 11 Diarrhoea 4 1 Percentage of Deaths from certain 1943 1944 causes to the total number of deaths. Diseases of the heart and circulation 33.1 29,8 Cancer and malignant disease 16.3 13.9 Diseases of the lungs (non tuberculous) 9.5 9.6 Tuberculous diseases 5.5 5.9 Cerebral Haemorrhage 10.7 8.1 Congenital Diseases 4.0 2.7 Suicide and Violence 2.9 12.5 Diseases of the digestive system 4.2 3.5 Infectious diseases 3.3 1.2 Diseases of the kidney 1.0 2.0 Other defined diseases 9.5 10.8 The number of deaths from the common 1943 1944 "infectious diseases were:- Measles 1 0 Diphtheria 1 2 Scarlet Fever 0 0 Whooping Cough 1 1 Influenza 19 5 MATERNAL MORTALITY The maternal mortality rate for the year 1944 was 0.84 per 1000 live births. The rate for England and Wales was 1.53 per 1000 live births. The one death was due to Toxaemia of pregnancy. INFANTILE MORTALITY The infantile mortality rate of 34.42 per 1000 live births compared with 30.96 per 1000 live births for the previous year. The rate for England and Wales was 46 per 1000 live births. The forty deaths of children under one year were due to the following causes Congenital Malformations 11 Prematurity 13 Broncho Pneumonia 5 Influenzal Meningitis 2 Cerebral Haemorrhage 2 Acute Bronchitis 2 Whooping Cough 1 Gastro Enteritis 1 Infective Hepatitis 1 Sonne Dysentery 1 Misadventure 1 (5) CAUSES OF DEATH IN THE BOROUGH OP SUTTON AND CHEAM DURING 1944 M. P. Total 1 Typhoid and paratyphoid favors - - - 2 Cerebral-spinal fever - - - 3 Scarlet Fever - - - 4 Whooping Cough 1 - 1 5 Diphtheria 1 1 2 6 Tuberculosis of respiratory system 16 20 36 7 Other forms of tuberculosis 7 6 13 e Syphilitic diseases 2 1 3 9 Influenza 2 3 5 10 Measles - - - 11 Acute poliomyelitis and polioencephalitis - - - 12 Acute infective encephalitis - - - 13 Cancer of buccal cavity Oesophagus (M)and Uterus (F) - 7 7 14 Cancer of stomach and duodenum 6 11 17 15 Cancer of breast - 21 21 16 Cancer of all other sites 35 36 71 17 Diabetes - 5 5 18 Intracranial vascular lesions 27 41 68 19 Heart disease 114 108 222 20 Other diseases of circulatory system 14 13 27 21 Bronchitis 25 16 41 22 Pneumonia 25 22 37 23 Other respiratory diseases 5 7 12 24 Ulcer of stomach or duodenum 8 - 8 25 Diarrhoea under 2 years 1 - 1 26 Appendicitis 1 - 1 27 Other digestive diseases 9 14 23 28 Nephritis 7 10 17 29 Puerperal sensla - - - 30 Other maternal causes - 1 1 31 Premature birth 8 5 13 32 Congenital malformations, birth injuries and infantile diseases 9 9 18 33 Suicide 4 4 8 34 Road traffic accidents 1 - 1 35 Other violent causes 41 55 96 36 All other causes 28 31 59 387 447 834 (6) GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA LEGISLATION. HOSPITALS, and MORTUARY :- There was no change during the year. LABORATORIES The r.rrangement which was made with the Ministry of Health on 1st July 1943 for bacteriological examinations to be carried out at their Laboratories at St. Helier Hospital, and at Epsom College was continued during the year 1944. AMBULANCES The Council's ambulance was staffed by personnel of The" Civil Defence Ambulance Service, and stationed at Sutton Civil Defence Depot. The ambulance is now stationed at the Fire Station, Throwley Road, Sutton. (Telephone No. Vigilant 2222-3-4) Details of the service are recorded on oage 26. 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. CHBAM AND WORCESTER PARK DISTRICT THE PAROCHIAL ROOMS. MALDEN ROAD. OHEAM. Infant Welfare Centre - Every Wednesday, at 1.30 p.m. (Including Diphtheria Immunisation) THE CLINIC. PRIORY CRESCENT. CHEAM. Ante-Natal Clinic - Every Monday and Friday, at 9.30 a.m. Infant Welfare Centra - Every Monday end Thursday, at 1.45 p.m. Txnciuding Diphtheria Immunisation every Thursday) 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. (Including Diphtheria Immunisation every 2nd and 4th Tuesday) JUBILEE INSTITUTE. MALDEN GREEN. WORCESTER PARK. Infant Welfare Centre - Every Monday and Thursday, at 1,30 p.m. (Including Diphtheria Immunisation every 1st Monday in month) SCABIES CLINIC Adjoining No. 3. St. Nicholas Road. Sutton, Every Tuesday and Friday, from 10 a.m. to 12 noon. 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. \ (7) SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLY The water supply is mainly derived from trie' deep wells in the chalk of the Sutton District Water Company, situated at Sutton, Cheam and Woodmansterne. A small area in the North Yard 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 of the raw and treated waters 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. All the dwelling houses have a direct supply from the public mains. Below is the average of monthly analyses. Average Total solid residue dried at 180° C. 17.45 Ammonia, free 0.0103 Ammonia, Albuminoid 0 Nitrogen as Nitrates 0.87 Nitrogen as Nitrites 0 Oxygen absorbed in 4 hours at 27° C. 0.004 Chlorine (in chlorides) 1.79 Hardness total (soap test) 7.6 No. of Bacteria growing on Agar per c.c. for 3 days at 20° C. 2.18 No. of Bacteria growing on Agar per c.c. for 1 day at 37° C. 0.09 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 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 ha3 been executed in a satisfactory manner. RIVERS AND STREAMS. The streams within the Borough have been maintained in a satisfactory condition, CLOSET ACC0MM0DATION. 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 sixteen 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 Premises, and Advisory Visits 1529 Re-inspections 1942 Visits to Works in progress 558 Visits to Factories and Workplaces 284 Visits to Bakehouses 32 Visits to Outworkers' promises 60 Visits to Slaughterhouses 14 Visits to Butchers' and Food shops 1384 Visits to Dairies and Milkshops 57 Visits to Stables 9 Visits to Pigsties 15 Visits re Rat Infestation 6093 Food and Drug Sample Visits 138 Visits in connection with Infectious Disease.. 213 Visits re overcrowding and "permitted number" measurements 36 Visits to Petroleum Spirit and Cinematograph Film Stores 85 Visits and Revisits re.Shops.Act 79 Mlsce11aneous 1224 13752 (9) Premises at which defects or nuisances were discovered 998 Dwelling-houses surveyed for housing defects under Public Health or Housing Acts 207 Defects or nuieiinces discovered 1831 Defects or nuisances remedied 1323 Defects or nuisances in hand 139 Defects or nuisances outstanding 369 Informal notices served 530 Statutory Notices served 44 Complaints received and investigated 486 SUMMARY OP REMEDIAL WORKS AND SANITARY IMPORTANT CARRIED OUT DRAINAGE AND SANITARY FITTINGS. Number No.of houses and premises re-drained 10 Repairs or amendments to existing drains 49 Drains or gullies unstopped arid cleansed 182 Rainwater pipes disconnected from soil drains 6 Sanitary fittings repaired, renewed, provided or cleansed 397 Water and smoke tests applied 158 W.C. APARTMENTS. New Apartments provided 2 W.C. Apartments lighted and/or ventilated 1 Ventilated lobbies to W.C. Apartments provided 3 Separate accommodation for sexes provided 1 STRUCTURAL REPAIRS OR IMPROVEMENTS Roofs, renewed or repaired 90 Guttering and rainwater pipes provided, repaired etc, 44 Damp walls remedied 41 Brick walls repointed, repaired or rendered. 17 Chimney stacks repaired or rebuilt 2 Yards paved or repaired 7 Sites of houses concreted 9 Floors relaid or repaired 38 Windows and/or cills repaired or renewed 56 Doors and thresholds provided or repaired 16 Staircases and handrails repaired or provided 3 Ranges, stoves and coppers repaired or renewed 17 Miscellaneous 138 CLEANSING. Rooms, passages, larders etc., cleansed 222 Trade premises cleansed 35 Verminous houses disinfested - Bugs, Pleas, Lice and Scabies 27 (10) GENERAL Offal bins provided 8 Dustbins provided 144 Accumulation of refuse and offal removed 46 Rat or Mouse infested premises cleared 342 Nuisance from animals abated 12 Offensive ponds and ditches cleansed 2 Overcrowding abated 3 Wasp Nests destroyed 104 Miscellaneous 38 SMOKE ABATEMENT There are few chimneys attached to industrial premises in this district. No smoke nuisances were detected. 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) Factories with Mechanical Power 182 16 - Factories without Mechanical Power 127 10 - Other Premises (other than Outworkers premises) - - - Total 309 26 — (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. Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness 9 7 - - Inadequate ventilation - - - - Overcrowding - - - - Unreasonable Temperature - - - - Ineffective drainage of floors - - - - Absence of Thermometers - - - - Absence of suitable lighting in W.C. apartments - - - - Other nuisances 63 57 - - Sanitary accommodation- (a) Insufficient 1 1 - - (b) Unsuitable or defective 10 8 - - (c) Not separate for sexes 1 1 - - 84 74 - - OUTWORK IN UNWHOLESOME PRE1HSES. Neture of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing Apparel - - - PUBLIC HEALTH ACT, 1936 - WORKPLACES. Inspections Number of Written Notices Occupiers prosecuted 4 - - (12) HOUSING 1. INSPECTION OF EWELLING HOUSES DURING THE YEAR- (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 207 (b) Number of inspections made for the purpose 479 (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 60 2, REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FQRMAL NOTICES:- Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 33 3* ACTION UNDER STATUTORY POWERS DURING THE YEAR:- A. - Proceedings under Sections 9, 10 & 16 of the Housing Act 1936;- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 14 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By Owners 8 (b) By Local Authority in default of Owner s 3 B. - Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied - (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners - (b) By Local Authority in default of Owners — C. - Proceedings under Sections 11 and 13 of the Housing Act, 1936:- Nil. (13) INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act 1938 The following table indicates the samples taken during the year 1944;- number examined number adulterated etc. Informal Formal Total Informal Formal Total . Milk 21 55 76 2 5 7 Butter 9 9 Margarine 9 9 Laid 9 9 Meat Pie 1 1 Sausage rolls 1 1 Sausages 3 3 1 1 Tea 1 1 Malt Chocolate Spread 1 1 Cake & Pudding Mixture (Sweetened) 1 1 1 1 Cake flour 1 1 Cake Mixture 2 2 Cake & Bun flour 1 1 "Scona" 1 1 Soya flour 1 1 Semolina 2 2 Yorkshire Pudding & Pancake Mixture 2 2 Baking Powder 2 2 Bread Crumbs 1 1 Sage & Onion Stuffing 1 1 Salad Dressing Powder 1 1 Dessert Powder 1 1 Dessert Mould 2 2 Flavouring, Blackcurrant 1 1 Lemon 1 1 Lemon, essence of 1 1 Fruit Cubes 1 1 Junket Powder 3 3 "Friquix" 1 1 Pudding Mixture 1 1 Sponge Mixture 1 1 Ginger pastilles 1 1 Jam. ''Energen'1 low sugar 1 1 Raspberry & Gooseberry Preserve 1 1 Jelly Crystals Gelat ine 3 1 2 1 5 1 1 Fig Vita-Bran 1 1 Barley Flakes 1 1 Blackcurrant flavoured Syrup 1 1 Mixed Spice 1 1 Mustard 1 1 Pudding Spice 1 1 Pepper, Black 1 1 Curry 1 1 Cinnamon 2 2 Ground Ginger 4 4 Ground Nutmegs 2 2 Mushroom Ketchup 1 1 Pepper 4 4 Spinach Powder 1 1 Fish Cakes 2 2 Fish Dressing 1 1 Carried forward 115 58 173 5 5 10 (14)  NUMBER EXAMINED number adulterated etc. Informal Formal Total formal Formal Total Brought forward 115 58 173 5 5 10 Castor Oil 1 1 Compound Liquorice Powder 1 1 Glycerine 1 1 Tincture of Rhubarb 1 1 Epsom Salts 1 1 Iodine, tincture of 1 1 Sulphur Ointment 1 1 Zinc Ointment 1 1 Liniment of Iodine 1 1 AntI-gas Ointment no.2 8 8 Camphorated Oil 1 1 Glycorine, lemon & honey with Ipecacuanha. 1 1 Boric Acid Ointment 1 1 Rismuthated Magnesia 1 1 Tablets 1 1 Aspirin Tablets 5 gr. 1 1 Saccharin Tablets 1 1 Vironlta 1 1 1 1 Whisky 2 2 4 1 1 Gin 3 3 TOTAL 145 60 205 6 6 12 A satisfactory numerical standard of sampling was again maintained. Of the total samples 5.88% were found to be adulterated or carrying misleading labels. One prosecution for the sale of Whisky 39.4 degrees under proof was instituted with the result that the defendant licensee was fined £5 and the actual seller (the barmaid) discharged under the Probation of Offenders' Act. MILK SUPPiy 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 premises has again revealed that the provisions of the Milk and Dairies Order, 1926, have been generally well observed. Under the Ministry of Food Milk Rationalisation Scheme the number of premises from v/hich milk is sold continues to be considerably reduced. Tho following Licences to sell graded milks were grant in 1944:- 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 1944;- (15) MILK SAMPLES Twenty-one samples of milk were submitted for bacteriological examination as below:- 1. Pasteurised Milk. No.of Samples Below 100,000 bacteria per millilitre 9 Coliform Test Phosphatase Test Satisfactory Unsatisfactory 9 Above 100,000" bacteria per millilitre 5 4 9 - 2. Tuberculin Tested (Pasteurised) No. of Samples Below 30,000 bacteria per millilitre 1 Coliform Test Phosphatase Test - - Satisfactory Unsatisfactory 3 Above 30,000 bacteria per millilitre 2 2 1 3 - 3. Ordinary Milk No, of Samples Total bacteria per millilitre Coliform test Under 50,000 50,000100,000 Over 1,000,000 - - 9 6 2 1 6 3 The Methylene Blue (Reductase) Test was satisfactory in all but one of the 21 samples. The "Ordinary" milk samples were from flash pasteurised or pasteurised (unlicensed) supplies. In these cases the phosphatase test was not satisfied in two samples of the flash pasteurised milk. With these two exceptions the presence of B. Coli in all the samples appears to be due to postpasteurising processes. ICE CREAM At the end of 1944, 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 1944. In view of the removal of this ban at the end of the year a resumption of the inspections will take place in 1945 and the Register will be revised. (16) 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 meat, with the result that it has been found that the provisions of the Public Health (Heat) Regulations have been generally well observed. Necessary action was taken in 4 cases where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations, 1924, existed. At the end of 1944, 54 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. Forty cases of insanitary or defective conditions in food shops, other than butchers' shops, were dealt with. There is one licensed slaughter-house in the district. The only animals slaughtered during the year have been 33 pigs from pig clubs slaughtered under licences issued by the Ministry of Food. 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 - - - 33 Number inspected - - - 33 All diseases except Tuberculosis - - - - Whole carcasses condemned - - - - Carcasses of which some part or organ was condemned - - - 3 Percentage of the number inspected affected with diseases other than Tuberculosis - - - 9.9% 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 neat and other foods have been surrendered and destroyed or, where suitable, utilised for pig food:- Carcasses or parts of caresses found to be diseased in slaughter-houses. Number PIGS Hearts (Pericarditis) 3 MEAT AND OTHER FOODS IN RETAIL SHOPS Fish 181 stones; Pork Sausage Meat 106-lbs; Pork Sausages 200-lbs; Sausages 12-lbs; Rabbits 480-lbs; Pork 1-lb.ll-ozs. Mutton l-lb.2-ozs; Goose lx8½-lbs; Bacon 100-lbs; Cheese 85¼lbs; Eggs 209; Butter l-lb.l4-ozs; Tea 13½-lbs; Dates 22½-lbs Figs 86-lbs; Confectionery 5½-lbs; Dried Fruit (Raisins, Sultanas) 33-lbs; Oranges 78-lbs; Tomatoes 168-lbs; Potatoes 10-cwts; Flour 242-lbs; Mustard 299-lbs.& 46 jars; Salad Dressing 2-gallons; Rice 48-lbs; Beans & Peas 39-lbs; Marmalade/Jam/Syrup/Honey 404-lbs; Miscellaneous Foodstuffs tins/jars/bottles and packets 3173. 17 The foregoing Summary does not include a considerable quantity of foodstuffs dealt with as the result of enemy action for which/visits were made to foodshops. 947 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, Five persons were licensed to act as Slaughtermen during 1944. •• BAKEHOUSES. There are 25 Bakehouses within the District, and of these 19 are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obtained. RAT AND MOUSE REPRESSION RATS AND LUCE (DESTRUCTION) ACT, 1919. THE INFESTATION ORDER 1943 During 1944, 6093 primary and subsequent visits were made in connection with rat or mice infested or suspected infested premises. No major infestations were recorded. 342 premises were satisfactorily cleared of rats or mice and the work for the year is generally summarised below:- The total number of complaints received or cases discovered during the year 1944 389 Total number investigated 389 Total number of premises on which no evidence of infestation was found 75 Total number of premises found to be infested 314 Total number of premises cleared of rats or mice 342 (Including 87 premises cleared which were discovered during 1943). Causes of infestation at the 314 premises found to be infested during theyear: Keeping of poultry etc, 104 Accumulations of refuse 7 Harbourage under or in garden sheds etc. 96 Defective drains 16 Inside premises (under floors etc.) 98 Buries 42 Source untraced 8 371 Type of premises cleared of Rats and Mice. Dwelling-houses (mainly in gardens) 276 Foodshops and food premises 24 Non-food shops 13 Yards and/or stables 6 Workshops and Garages 10 Allotments and Nurseries 5 Refuse tips 1 Poultry farms and pig styes 3 Inns 4 342 Methods employed in clearing 342 premises of Rats and Mice. Poison baits 272 Trapping 53 Gassing 11 Rat & Mouse proofing 18 Accumulations removed 8 Drains repaired 17 Other means 15 394 (18) 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. ERADICATION OP BED BUGS Twenty-six bug-infested houses were dealt with as follows:- By the use of Insecticides Sulphur cyanic (H.C.N.)Gas Council Houses 3 - - Other houses 23 - - The work of disinfestation has continued to be carried out upon the lines indicated in previous Reports. The Insecticides used were "Roxem T.C.Y." and "Fuminol"• SHOPS ACT. 1934. Seventy-nine visits were made in connection with Section 10 of the Shops Act, 1934. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES Three hundred and seventy four cases of infectious disease were notified, a decline of eight hundred and ninety seven from the previous year. This reduction was due to the absence of major epidemics, and to the large scale evacuation of children. Scarlet Fever fell rapidly from its high prevalence during 1943. The incidence of Diphtheria remained low. Measles was in an inter-eoidemic phase. There was no increase In Whoooing Cough. One case of Typhoid Fever, infected outside this district, was notified. Other enteric infections were few. There was one case of Cerebrospinal Fever, and no case of Anterior Poliomyelitis. SCARLET FEVER:- One hundred and ninety six cases were notified, a decline of two hundred and forty five from the previous year. This decline occurred rapidly during the second quarter of the year, and the incidence was favourably low at the time of evacuation. The case rate was 2.76 per 1000 of population compared with 2.40 per 1000 of population for England and Wales, The disease was mild and there was no death. i (19) DIPHTHERIA:- Six cases were notified. The case rate was 0.08 per 1000 of population, compared with 0.58 per 1000 of population for England and Wales. There were two deaths of children aged 1 and 11 years from laryngeal infection and cardiac failure. Neither had been immunised. DIPHTHERIA IMMUNISATI0N:-In the past the mild or intermediate types of the Diphtheria bacillus have been dominant in this Borough, but the war-time movement of population has led to a predominance of the gravis or severe type with a corresponding increase in the gravity of the illness. The object of Diphtheria Immunisation is to prepare and stimulate the natural protective mechanism of the body to repel the invasion of Diphtheria bacilli and to neutralise their poisons. This object has been largely attained against the mild and intermediate types of the Diphtheria bacillus, but experience has shown that the gravis type of the bacillus may break through the barrier of immunity if this is not reinforced. from time to time, and sustained at a high level. The advantages of artificial immunisation are (1) that the risk of acquiring infection is reduced (2) that if acquired the illness tends to be modified and symptoms are less acute (3) the response to treatment by antitoxin is more rapid (4) the risks of mortality are greatly reduced. Reinforcement of immunity can be obtained by a further injection, and the following scheme of protection for children is advised. First injections at the age of 1 year. Reinforcement injection at the age of 4 to 5 years. Reinforcement injection at the age of 8 to 9 years. During the period of evacuation there has been a definite lag in progress of the immunisation scheme. This can only be made good by the active co-operation of parents whose children have missed immunisation. The probability of a higher incidence of infection of the gravis type of Diphtheria bacillus in the years during resettlement of the population is a grave risk which requires the insurance against mortality provided by immunisation. Six hundred and forty three children were Immunised during the year 1944, The number of children immunised at the age of 1 year was 341 which represents only 29 per cent of the babies reaching that age during the year, compared with 44 per cent for this age group in the previous year. The following table shows the distribution in age groups of children who received injections during the year 1944. 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 14-15 Over 15 Total 341 66 48 56 64 15 6 11 10 l0 6 5 5 - - 643 At the end of the year 9,356 children, representing 62,1 per cent of all the children, had been immunised. Of these 2214 represents 42.5 per cent of the children under five years of age, and 7142 represents 72.5 per cent of the children between five and fifteen years of age. (20) The Clinics for Diphtheria Immunisation are as follows. 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 2 p.m. (For children under five years of age) 3. At the Clinic, St. Oswald's Hall, Brocks Drive, N. Cheam. Every 2nd and 4th Tuesday in each month, at 2 p.m. (For children under five years of age) 4. At the Clinic, Parochial Rooms, The Broadway, Maiden Road, Cheam. Every Wednesday, at 2 p.m. (For children under five years of age) 5. At the Clinic, Jubilee Institute, Maiden Green Worcester Park. Every 1st Monday in each month, at 2 p.m. (For children under five years of age) MEASLES:- In contrast to the epidemic involving six hundred and fifty seven cases in 1943, only twenty seven cases were notified during 1944. There was no death. Measles recurs in epidemic form approximately every two years. Careful nursing and careful convalescence are required in every case to avoid complication by pneumonia. WHOOPING COUGH:-There were eighty nine notified cases of Whooping Cough, a reduction of two cases on the previous year. Forty two of the cases occurred during the first quarter of the year. The case rate was l.3l per 1000 of population compared with 2.49 per 1000 of population for England and Wales. There was one death of a male child, aged 3 months. Whooping Cough is a disease of young children. Nine tenths of the deaths occur in children under 5 years of age. IMMUNISATION AGAINST WHOOPING COUGH:-At the end of the year a scheme for immunisation against Whooping Cough was under consideration, and at the time of writing this report, a scheme applicable only to children between the ages of 1 year and 5 years of poorer persons, to weakly children and to children from overcrowded homes is in operation. The vaccine is injected in four small doses of 0.4 c.c. each containing 8000 million B. Pertussis. The first three injections are given at weekly intervals, and the fourth one month later. Reactions are few and slight. Children under one year do not respond effectively to immunisation and the greatest care should be taken by parents to protect young babies from infection by Whooping Cough. PUERPERAL PYREXIA:- Seven cases were notified during the year compared with eleven cases in the previous year. The case rate was 5.87 per 1000 total births compared with 10.34 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. (21) TYPHOID FEVER:- One case was notified. Investigation proved that the source of infection was not in this district. No case of Paratyphoid Fever was notified during the year. DYSENTERY:- Thirteen cases of Sonne Dysentery were notified compared with only one case in the previous year. The disease is endemic, and varies in intensity from mild cases of gastro enteritis, which may be attributed to other causes, to severe cases showing typical symptoms and signs of dysentery. Mild cases are liable to escape identification and notification unless early bacteriological examinations are made. The disease is spread by the contamination of food, and persons engaged in the handling of food whether in the home, the shop, the factory, or in transport mast recognise a high responsibility to the public health by the most scrupulous hygiene of the hands, CEREBROSPINAL FEVER :- One case was notified compared with four cases in 1915. There was no death. ACUTE ANTERIOR POLIOMYELITIS:- No case was notified, PNEUMONIA:- Of thirty seven deaths occurring from all forms of pneumonia, no cases were notified previous to death. The total number of notified cases arising in the district was twenty. NON-NOTIFIABLE DISEASES:- School teachers reported thirtythree cases of Mumps, forty-one cases of German Measles, and one hundred and thirty cases of Chicken Pox. School notifications are a useful index of the prevalence of non-notifiable diseases and form a basis for consultation with the school medical officer. SCABIES:- There was a definite reduction in the incidence of Scabies. The treatment clinic at the Public Hall, Sutton, operated efficiently and dealt with two hundred and ninety four cases, compared with four hundred and fifty three cases in 1943. The number of attendances at the clinic for treatment and observation was one thousand, compared with one thousand eight hundred and sixty three in 1943. The clinic has now been removed to the Civil Defence Quarters, adjoining No. 3. St. Nicholas Road, Sutton, LICE:- The facilities provided at the above clinic have also proved of great value in the reduction of head lice and of body lice, the absence of which is the best insurance against the soread of Typhis Fever, a potential danger under war conditions. Seventy five cases were treated during the year, compared with eighty four cases in 1943. The number of attendances for treatment and observation was two hundred and forty seven, compared with three hundred and sixty nine in 1943. (22) (23) DISTRIBUTION OP NOTIFIABLE DISEASES IN WARDS DISEASE ] WARDS Case Rate per 1000 Populatn (Mid-Year) Case Rata per 1000 England & Wales N. N.E. N.E. W.C. E.C. E. S.W. S.E. S. Total Population 8683 7801 9391 | 11058 j 6526 6581 5241 i j 5085 6994 67360 Scarlet Fever 52 38 23 43 8 4 7 5 13 193 2.76 2.40 Diphtheria - - - - 1 1 - - 2 4 0.06 0.58 Typhoid - 1 - - - - - — - 1 0.01 0.01 Para-typhoid - - - - - — - — - - 0.00 0.01 Puerperal Pyrexia 1 - - - - — - 4 2 7 — - Pneumonia - 1 2 3 4 3 1 - 6 20 0.29 0.97 Erysipelas - 2 1 4 2 3 1 1 - 14 0.21 0.29 Dysentery 2 2 - 6 - — - 1 2 13 02 0 - Poliomyelitis - - — - - — - - - - 0.00 - Cerebrospinal Fever - -- - - - — - — 1 1 0.01 0.05 Measles 2 - 6 10 2 1 2 2 2 27 0.40 4.16 Whooping Cough 3 2 20 24 13 5 7 4 10 88 1.31 2.49 Total 60 46 52 90 31 17 18 17 38 369 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1944 Disease Under 1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 10 Years 15 Years 20 Years 35 Years 45 Years 65 Years Totals Removed to Hospital Died Scarlet Fever 1 3 8 10 18 106 . .26 i 8 4 6 2 1 193 125 - Diphtheria - 1 - - - - 2 - 1 - - - 4 4 2 Typhoid Fever - - - - - - - - 1 - - - 1 1 - Para-typhoid - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - 6 1 - - 7 4 - Pneumonia 1 - 1 - - 1 1 - - 2 8 6 20 5 37 Erysipelas - - - - - - - - 2 3 7 2 14 5 - Dysentery - - - 1 - 6 1 1 - 3 1 — 13 3 1 Poliomyelitis - - - - - - - - - - - - - - - Cerebrospinal Fever - - - - - - - - 1 - - - 1 1 - Measles - 2 3 1 3 12 - 1 3 1 1 — 27 3 - Whooping Cough 9 14 10 6 7 37 1 - 1 1 2 - 88 9 1 London Cases in the Downs Hospital S.F. - - - 1 1 1 - - - - - - 3 3 - Dip. - - - - - 2 - - - - - - 2 2 - W. Cough - - 1 - - - - - - - - - 1 1 - * 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 1 76 4 10 1 13 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table. (24) TUBERCULOSIS. On 31st December 1944, there were on the Register 693 cases of Tuberculosis, of which 541 were Pulmonary cases and 152 non-pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.53 per 1000 of population, and for nonpulmonary Tuberculosis 0.19. The total Tuberculosis death rate in 1944 was 0.72 compared with 0.60 per 1000 of population in 1943. The corresponding death rates for England and Wales in 1944 were: Pulmonary, 0.52 per 1000 of population; non-pulmonary, 0.10 per 1000 of population. Total rate: 0.60 per 1000 of population. The number of new cases of Pulmonary Tuberculosis notified during the year rose to 86 from 70 in the previous year. The increase is apparent in the younger age groups involving the child, the school child, and the adolescent. Increase in child infection is also indicated by an increase in deaths from Tuberculous Meningitis, which is usually the dramatic and fatal sequel to the intimate contact of the young child with an infectious patient, The hops of reduction of incidence lies in improvement of housing conditions, increase in sanatorium accommodation, and in early diagnosis aided by mass radiography. The introduction of mass radiography will lead to an increase in the notifications of early cases, and provided that immediate treatment can be given, will reduce the number of chronic infectious cases in the community. A unit for mass radiography is now in operation at St. Helier Hospital. The Sutton and Cheam Tuberculosis Care Committee continued to carry out very useful work. The scheme of allowances to enable early cases to undertake treatment was continued with good effect', and is worthy of extension. 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 2 - 1 - - - 2 5 3 4 3 2 - - 2 1 15 13 14 3 4 - 2 - 1 25 5 13 2 2 1 3 2 1 35 5 8 - 1 2 3 1 - 45 8 1 1 1 3 1 1 - 55 3 3 — 3 6 6 - 1 65 and above 3 - - - 4 - 1 - Totals 41 45 9 14 16 20 7 6 NOTIFICATION OF TUBERCULOSIS Respiratory Forms of Death-30 out of 36 were notified. Other Forms of Death-9 out of 13 were notified, (25) CIVIL AMBULANCE SERVICE The Council's Civil Ambulance was operated by personnel of the Civil Defence Ambulance Service, and was stationed at the Sutton Civil Defence Depot during the year 1944. 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 ambulance is new stationed at bhe Fire Station, Throwley Road. Sutton (Telephone Vigilant 2222-3-4) The numbers of calls dealt with during the 1944 were as follows. Type of Case Accident Illness in Street Urgent Illness at Home Non-urgent Illness at Home Maternity Total No. of Cases 274 158 353 46 198 1029 Of the 1029 cases, 107 were dealt with by using Civil Defence Ambulances as additional vehicles, 13 were dealt with by assistance from adjoining districts, and 6 were dealt with by private ambulances on behalf of the Council, In addition to the above, 50 calls for inter hospital transport were dealt with. The following table shows the number of calls per month. Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total 79 61 97 92 105 83 109 58 62 75 95 113 1029 The following table shows the number of days in the year on which the number of calls varied from 0 to 9. No. of calls per day 0 1 2 3 4 5 6 7 8 9 No. of days in year 33 65 94 58 56 22 14 12 8 4 (26)