SUTC 9 library BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT the MEDICAL OFFICER OF HEALATH FOR THE YEAR 1945. 0O0 B0R0UGH OF SUTTON & CHEAM. ??? MEDICAL OFFICER OF HEALTH for the year 1945. PUBLIC HEALTH AND HOUSING COMMITTEE. HIS WORSHIP THE MAYOR. (??? J.P ) ??? C.C. Coun. J.H.Booth Coun. S.W.Mills. M.C.D.C.M. " H.H.iuCoote " J. Nicholson. " ??? " H.S.Oakley (Chairman) " Mrs. Harper " L.Shaw Davis " W.E.Heath " Mrs. Smyth " G.E. ??? " T.Stoker. C??? W.T. Venton, C.C. oOo (1) ??? MEDICAL OFFICER OF HEALTH ???, M.D.,D.P.H ??? INSPECTOR Charles WILLIAM ??? Certif .R.B.I., Cerr-if., Meet & Food; Certif.S.I. ???, Board. D??? SANITARY INSPECTOR: ARTHUR SYDNEY ???, Certif.S.I.: Certif, Meat & Food. (From 23.9.1945 after demobilization from H.M.Forces) ASSISTANT SANITARY INSPECTOR: WALTER BLACK. Certif.R.S.I. and S.I•F.J.B. Certif. Meat & Food. (from 21.6.1945.) * JOHN HENRY LOTT. Certif.R.S.I.; Cerif. Meat & Food. REGINALD WILLIAM NORMAN. Certif.R.S.I and S.I.E.J.B Certif, Meat & Food. ??? Certif ,R.S.Iand S.I.F.J.B;certif, Meat & Food. FRANK S??? Certif.R.S.I, and S.I.E.J.B.: Certif. Meat & Food. * In E.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 1945. After the ordeal of the flying bombs in 1944, and the menace of enemy rockets during the early months of 1945, the coming of peace brought welcome relief from the prolonged strain of war. The near completion of first-aid repairs to houses, the ending of shelter life, and the raising of blackout restrictions, improved hygienic standards, but the return of evacuees and of service personnel made the population even more disproportionate to the housing accommodation. Overcrowding increased, and with the intermingling of families, caused much unhappiness, discord and depression. The Rest Centre at the Masonic Hall, Sutton, was reopened by Surrey County Council for families rendered homeless by eviction, and provided only the minimum of comfort and amenity. Some relief was afforded by the requisitioning of houses, and by the erection of fifteen temporary hutments, and progress was made with the selection of sites and preparation of plans for permanent houses, There was insufficient temporary accommodation available to meet the immediate needs of many families living in severe discomfort, At the end of the year applications for housing numbered over 2000, Housing remained the most serious and urgent problem affecting the public health, Respite these adverse factors, and mainly because of the wide distribution of protective foods, the general health of the community remained good. There was no abnormal incidence of infectious disease. Measles was epidemic during the first six months of the year. Scarlet Fever and whooping Cough declined. There was an Increase in cases of Diphtheria, Immunisation against Diphtheria progressed, and immunisation against Whooping Cough was introduced. There was a fall in the birth rate. The death rate was lower. The infantile mortality rate was the lowest yet recorded. The maternal mortality rate remained low. The work of general sanitation, of the prevention of nuisances, and of the protection of food, was efficiently carried out under the direction of the Chief Sanitary Inspector (Mr. C.W.Newbery), to whom much credit is due for his efforts in preserving the habitability of many houses in the Borough, despite difficulties of labour and of materials. 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. The Council's Civil Ambulance was transferred from the Civil Defence Depot to the Fire Station, Throwley Road, Sutton, on 1st July, 1945, and from that date the Civil Ambulance Service has operated as an independent unit, controlled and financed by the Council, and working in close association with the National Fire Service. This arrangement has provided, a satisfactory service* I thank the members of the Council for their advice and assistance during the year, and I am grateful to all the officers of the Council for their close co-operation, I am, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, ENEAS J. MACINTYRE. Medical Officer of Health, (3) STATISTICS OP THE AREA 1944 1945 Area in Acres 4333.15 4338.15 Registrar General's Estimate of the Resident Population 67,360 70,250 Number of inhabited houses (end of year) according to the Rate Book 21,698 22,031 Rateable Value and sun re???esented £884,629 £884,211 by a Penny Hate £5,556 £3,536 EXTRACTS FROM VITAL STATISTICS COMPARATIVE OF THE YEARS 1944 and 1945 Total 1944 Female Total 1945 Female England. & Wales 1945 Male Male Live Births 1162 6 04 5 58 1051 539 512 Legitimate 1092 561 531 967 490 477 * Illegitimate 70 43 27 84 49 35 Birth Rate per 1000 of the Estimated Resident Population 17.3 14.9 i 16.1 Still Births 29 15 14 23 9 14 Legit imato 26 13 13 20 7 13 Illegitimate 3 2 1 3 2 1 Rate per 1000 total (live and still births) 24.3 21.4 28.00 Deaths 834 387 447 747 346 401 Death Rate per 1000 of the estimated resident population 12.4 10.6 1 ' 11.4 i i Deaths from Puerperal Sepsis Other Puerperal Causes 0 1 0 1 Death rate from Puerperal Causes 0.84 0.93 1.46 Deaths of Infants under one year of age. j ! i 1 ! All Infants per 1000 live births 34.42 23.78 ! 46.00 Legitimate Infants per 1000 legitimate live births 33.55 i 23.78 Illegitimate Infants per 1000 illegitimate live births 14.28 i 23.80 (4)  1944 1945 Deaths from cancer 116 153 " " Monales 0 2 " " whooping cough 1 0 " " Diarrhoea 1 2 Percentage of Deaths .from certain causes to the total number of deaths. 1944 1945 Diseases of the heart and circulation 29.8 30.3 Cancer and ivalignar.it disease 13 . 9 20.5 Diseases of the lungs (non tuberculous). 9.6 10.8 Tuberculous diseases 5.9 5.5 Cerebral Haemorrhago 3.1 9.7 Congenital diseases 2.7 2.7 Suicide and Violence 12.5 4.5 Diseases of the digestive system 3.5 4.4 Infection diseases 1.2 2.3 Diseases of the Kidney 2.0 1.5 Other defined diseases 10.8 7.8 The number of deaths from the common infectious diseases were:- 1944 1945 Measles 0 2 Diphtheria 2 0 Scarlet Fever 0 0 Whooping Cough 1 0 Influenza 5 7 MATERNAL MORTALITY:- The maternal mortality rate for the year 1945 was 0.93 per 1000 total births. The rate for England and Wales was 1.46 per 1000 total births. The one death was from post partum haemorrhage due bo retained placenta. INFANTILE MORTALITY:- The infantile mortality rate was 23.78 per 1000 live births, compared with 34.42 per 1000 live births for the previous year. The rate for England and Wales was 46 per 1000 live births. This reduction in infantile mortality is mainly due to a considerable fall in deaths from prematurity from 13 in 1944 to 2 in 1945. The twenty-five deaths of children under one year were due to the following causes Congenital malformations 13 Prematurity 2 Broncho pneumoknia 3 Tuberculous Meningitis 2 Cerebral Haemorrhage 2 Acute Bronchitis 2 Gastro Enteritis 1 (5) CAUSES OF DEATH IN TEE BOROUGH CP SUTTON AND CREAM DURING 1945 M. F. Total 1 Typhoid and paratyphoid fever _ - _ 2 Cerebro-spinal fever 1 1 2 3 Scarlet fever - - - 4 Whooping Cough - - - 5 Diphtheria - - - 6 Tuberculosis of respiratory system 17 17 34 7 Other forms of tuberculosis 3 4 7 8 Syphilitic diseases 2 3 3 9 Influenza 1 6 7 10 Measles 1 1 2 11 Acute poliomyelitis and polioencephalitis 1 - 1 12 Acute infective encephalitis - - - 13 Cancer of buccal cavity Oesophagus (M) and Uterus (P) 6 8 14 14 Cancer of stomach and duodenum 10 8 18 15 Cancer of breast - 16 16 16 Cancer of all other sites 60 45 105 17 Diabetes 3 6 9 18 Intracranial vascular lesions 26 47 73 19 Heart disease 96 107 203 20 Other diseases of circulatory system 10 13 23 21 Bronchitis 23 19 42 22 pneumonia 12 12 24 23 Other respiratory diseases 5 10 15 24 Ulcer of stomach or duodenum 7 1 8 25 Diarrhoea under 2 years 1 1 2 26 Appendicitis 1 1 2 27 Other digestive disease 3 9 12 28 Nephritis 7 4 11 29 Puerperal sepsis - - - 30 Other maternal Causes - 1 1 31 Premature birth 1 1 2 32 Congenital malformations, birth injuries and infantile diseases 11 7 18 33 Suicide 3 3 6 34 Road traffic accidents 2 7 9 35 Other violent causes 7 12 19 36 All other causes 26 31 57 346 401 747 (6) GENERAL PROVISION 0F PUBLIC HEALTH SERVICES FOR THE AREA LEGISLATION, HOSPITALS, and MORTUARY: - There was no change during the year. I. A BORATORIES: - The arrangement which was made with the Ministry of Health on 1st July, 1943, for bacteriological examinations to bo carried out at their Laboratories at St. Helier Hospital, and at Epsom College, was continued during tie year "1945. AMBULANCES :- On 1st July, 1945, the Council's Ambulance was transferred to the Fire Station, Throwley, Road, Sutton, (Telephone Number Vigilant 2222-3-4). Details of the service are recorded on Page 28. CLINICS AVAILABLE FOR THE DISTRICT SUTTON DISTRICT THE PUBLIC HALL, 1, HILL ROAD, SUTTON Ante-Natal Clinic - Every Monday, at 1.30 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. CHEAM AND WORCESTER PARK DISTRICT THE PAROCHIAL ROOMS, THE BROADWAY, HAPPEN ROAD. CHEAM. 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 Centre - Every Monday and Thursday, at 1.45 p.m. "(Including Diphtheria Immunisation every Thursday) ST. OSWALD'S HALL. BROOKS 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 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 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. . 19.2 Ammonia, free 0.0098 Ammonia, Albuminoid 0 • Nitrogen as Nitrates 0.8 Nitrogen as Nitrites 0 Oxygen absorbed in 4 hours at 27° c. 0,005 Chlorine (in chlorides) 1.7 Hardness total (soap test) 8.7 ' No. of Bacteria growing on Agar per c.c. for 3 days at 20° c. 4.8 No, of Bacteria growing on Agar per c.c. for 1 day at 37° C. 0 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"Rouse reTuse 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 mannor. RIVERS AND STREAMS. The streams within the Borough have been maintained in a satisfactory condition. CLOSET ACCOMMODATION. There are 15 cesspools in use. Some six pail closets and one privy are in use. In the past seventeen years 156 premises, originally with cesspool drainage, have been connected to sewers. SANITARY INSPECTION OF THE AREA. REPORT OF THE CHIEF SANITARY INSE CTOR 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 H0aith, the Report of the Chief Sanitary Inspector on Sanitary circumstances, Housing, Food Supply, etc.., (pages 9 to 20 ) has been condensed. RECORD OF INSPECTIONS AND NOTICES SERVED.. Number Special Inspections, Interviews on Premises, and Advisory Visits 2,159 Re-inspections 3,226 Visits to Works in progress 1,053 Visits to Factories and Workplaces 161 Visits to Bakehouses 44 Visits to Outworkers* premises 47 Visits to Slaughterhouses 15 Visits to Butchers' and Food Shops 535 Visits to Dairies and Milkshops 56 Visits to Ice Cream Premises 58 Visits to Stables 6 Visits to pigsties 4 Visits re Rat Infestation 5,092 Food and Drug Sample Visits 218 Visits in connection with Infectious Disease 180 Visits re overcrowding and "permitted number" measurements 78 Smoke observations 9 Visits and Revisits re Shops Act 174 Miscellaneous 1,575 14,690 9. Promises at which defects or nuisances were discovered 1,442 Dwe11ing-houses surveyed for housinc defects under Public Health or Housing Acts 408 Defects or ruisan??? Discovered 2,113 Defects or nuisances readied 1,508 Defects or ??? in hand , 213 Defects or ??? out standing 392 Informal notices or served 774 Statutory Notices served 80 Complaints received and investigated 800 SUMMARY OF REMEDIAL WORES AND SANITARY IMPROVEMENTS CARRIED OUT DRAINAGE AND SANITARY FITTINGS, Number. Ho. of houses and premises re-drained 11 No. of drains disconnected from Surface water sewers and connected to soil sewers 1 Repairs or amendments to existing drains 81 Drains or gullies unstopped and cleansed., 289 Rainwater pipes disconnected from soil drains 1 Sanitary fittings repaired, renewed, provided or cleansed 534 Water end smoke teats applied 234 Water service pipes, cisterns repaired, renewed or cleansed 48 W.C. APARTMENTS. New Apartments provided 4 W.C. Apartments lighted and/or ventilated 9 Ventilated lobbies to W.C. Apartments provided 1 Separate accommodation for sexes provided 1 Alternative means of Sanitary accommodation provided ... ... 1 STRUCTURAL REPAIRS OR IMPROVEMENTS Roofs; renewed or repaired 139 Guttering and. rainwater pipes provided,repaired etc. 94 Damp walls remedied 52 Brick walls repointed, repaired or rendered, 7 Chimney stacks repaired or rebuilt 2 Yards paved or repaired 7 Sites of houses concreted 29 Floors relaid or repaired 117 Windows and/or cills repaired or renewed 59 Doors and thresholds provided or repaired. 11 Staircases and handrails repaired or provided 9 Ranges, stoves and coppers repaired or renewed 44 Miscellaneous 273 CLEANSING, Rooms, passages, larders etc., cleansed 124 Trade premises cleansed 60 Verminous houses disinfested - Bugs, Fleas and Lice 21 Houses sprayed on account of Flies, Crickets, Silver Fish and Cockroaches 18 10. GENERAL. Offal bins provided 16 Dustbins provided 361 Accumulations of refuse and manure removed 59. Nuisance from animals abated 5. Offensive ponds and ditches cleansed 2. Wasp Nest destroyed 48. Miscellaneous 51. SMOKE ABATEMENT. There are few chimneys attached to industrial premises in this district. Pour smoke nuisances were detected, and three abated. In the fourth case, where a considerable emission of gritty particles was detected, a grit extractor and mechanical stoker were recommended and were awaiting delivery at the end of the year. 1. INSPECTION OP FACTORIES AND OTHER DEMISES UNDER THE ACT. Inspections made by Sanitary Inspectors, for purposes of provisions as to health. Premises. Number of Inspection Not ices Written & Oral Occupiers Prosecuted. (1) (2) (3) (4) Factories with Mechanical Power 141 37 • • Factories without Mechanical Power 54 14 • • Other Prmises (Other than Outworkers' premises.) • • .. .. Total 195 51 .. 11. 2• DEFECTS FOUND in FACTORIES AND OTHER PREMISES under THE ACT. Particulars Number of defects Number of defects on respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness 2 1 - - Inadequate lation - - - - Overcrowding 1 1 - ~ Unreasonable Temperature - - - - Ineffective drainage of floors _ - _ - Absence of ters 1 1 - - Absence of suitable lighting in W. c. apartments 3 1 - - Other nuisances 57 48 - - Sanitary Acconmodation. (a) Insufficient 2 _ - - (b) Unsuitable or defective 8 5 - - (c) Not separate for sexes 1 - - - 75 57 - - 0UTWORK IN UNWHOLESOME PREMISES Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) - - - - PUBLIC HEALTH ACT, 193 6 - WORKPLACES Number of Inspections Written Notices Occupiers prosecuted 10 - - 12. HOUSING. 1. INSPECTION OF DWELLINGHOUSES DURING THE YEAR; - (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 408. (b) Number of inspections made for the purpose 1100. (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 85. 2. REMEDY OF DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL "NOTICES Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 89. 5. ACTION UNDER STATUTORY PO'YERS 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 repaL rs .... 34. (2) Number of dwelling-houses which were rendered fit after service of formal notices : - (a) By Owners 22. (b) By Local Authority in default of Owners 6. Bo - Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5. (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners 3. (b) By Local Authority in default of Owners 2. C. - Proceedings under Sections 11 and 13 of the Housing Act, 1936:- Nil. 13. I INSPECTION AND.??? OF FOOD. Pood and Drugs Act 1938 The following table indicates the samples taken during the year 1945:- NUMBER EXAMINED NUMBER ADULTERATED ETC. _ Informal Formal Total Informal Formal Total Milk 58 58 Butter 4 4 Margarine 4 4 Lard 4 4 Suet 2 2 Meat Extract 1 1 i Sausages 1 3 4 Sausages, Pork 1 1 2 1 1 2 Sausages, Beef 1 1 1 1 Sausages, Vegetable 1 1 Sausage meat 1 1 * Tea 1 1 Drinking Chocolate 1 1 Cake mixture 1 1 Pudding Mixture 1 1 Sponge Pudding 1 1 Semolina 1 ' 1 Semolina (Lemon Flavour) 1 1 Golden Raising Powder 5 5 • Egg Substitute Powder 1 1 Baking Powder 3 3 Flour - Batter 1 1 Flour - Bun 1 1 Flour - Cake 1 1 Flour - Self-raising 5 5 Oat Flour 1 1 Flour - Soya 1 1 Breadcrumbs 1 1 Stuffing, Sage & Onion 1 1 Flavouring Essence - Almond 2 V 2 Flavour - Blackcurrant 1 1 Flavouring Essence, Banana 1 1 Flavouring Essence, Cocoanut 1 1 Flavouring Essence, Lemon 1 1 "Semolalf 1 1 Table Jelly crystals 1 1 Cornflour flavoured Raspberry 1 1 Cornflour flavoured strawberry 1 1 Cornflour flavoured Vanilla i 1 Arrowroot I 1 Jam 8 8 Marmalade 3 3 Invert Sugar & Honey 1 - 1 Gelatine 5 5 Glycerine 1 1 Glycerine & Rosewater 1 1 Cinnamon, Ground 1 1 Ground Ginger 4 4 Nutmegs, Ground 2 2 Kesbah Kidney Cure 1 1 Horseradish Cream 1 1 "Sevoura" 1 1 Pepper 1 I Mustard - liquid 2 2 Mustard - mixture 1 1 Carried forward 91 64 155 2 1 3 14.  NUMBER EKAMINED NUMBER ADULTERATED ETC. Informal TotFormal al Informal Formal Total Brought forward 91 64 155 2 1 I 3 1 Curry Powder 3 3 Curry Sauce 1 1 Vinegar, Tarragon 1 1 Spice, Pickling 1 1 Frying Oil 1 1 Pre serve 2 2 Vecon Vegetable Tonic Broth 1 1 Aspirin Tablets - 5 gr. 2 2 Bi-carbonate of Soda 1 1 Camphorated Oil 2 2 Caster Oil 1 1 Cascara Sagrada 1 1 "Complevite" 1 1 Epsem Salts 2 2 Laxative tablets 1 1 Liquid paraffin 1 1 Saccharin Tablets 3 3 Seidlitz Powder 2 2 Sulphur & Yeast Tablets 1 1 Glycerin of Thymol 1 1 Iodised Throat Tablets 1 1 Yeast Tablets 1 1 Iodine,Tincture of 1 1 Bismuthated Magnesia Tablets 1 1 Vinecta (Superior Tonic) 1 1 Gin 2 2 Rum 1 1 Whiskey 1 1 2 129 65 194 2 1 3 A satisfactory numerical standard of Sampling over a wide range of commodities was again maintained in 1945 and of the total Samples only l„54$j were found to bo other than genuine, this fact being a very gratifying feature of the year's sampling. The details of the unsatisfactory Samples are:- Beef Sausages. ^n^qrmaT Sample. Ifo meat' and no soya flour. j In this case there was a doubt as to whether vegetable sausages were not sold as beef. In view of a possible mistake no further action was taken. Pork Sausages. A'n Informal sample and a repeat Formal Sample revealed a meat content of only 30fo end 20/o respectively instead of 50$ as- prescribed by the Meat Products, Canned Soup and Canned Meat (Control & Maximum Prices) Order, 1944. to A prosecution was pending at the end of the year. 15. MILK SUPPLY, There are 12 dairymen and 15 retail purveyors of milk in the district. Two persons vifoose 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 premises from which milk is sold continues to be considerably reduced. The following Licences to sell graded milks were granted in 1945- ' Grade of Milk. Type of Licence Deal er s' Supplementary 10 1 Accredited • • • • Pasteurised 12 2 The following Tables show the results of examinations of samples of Milk during 1945;- MILK SAMPLES, Porty-one samples of milk were submitted for bacteriological examination as belowj- 1. Pssteurised.,Heat-treated & Sterilised Milk. No. of Sample s Below 100.000 bacteria per millilitre 24 Coliform Test Phosphatase Test Satisfactory Unsatisfactory 27 Above 100,000 bacteria per millilitre 3 22 5 26 1 2.Tuberculin Tested (Pasteurised) No. of Samples Below 30,000 bacteria per mllli-litre 4 Coliform Test. Phosphatase Test - - Satis factory Unsatisfactory 7 Above 30,000 bacteria per millilitre 3 5 2 7 - 16. / 3, Tuberculin Tested Mill; • No of Samples Below 30,000 Bacteria per millilitre Above 30,000 bacteria per millilitre Coliform Test - - 2 - 2 - 2 4, Ordinary Milk. Number of Samples Total bacteria per millilitre Coliform test Under 50,000 100,000 150,000 Over 1,000,000 - 4 5 2 2 1 2 3 The Methylene Blue (Reductase) Test was satisfactory in all hut three of the 41 samples. In these three cases 1 sample of Tuberculin Tested Milk was decolorized at the end of 5 hours; 1 Tuberculin Tested (Pasteurised) Milk at the end of 15 minutes and 1 Pasteurised Milk at the end of 10 miniites. ICS CREAM. At the end of 1945 106 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938, On ten of these premises ice cream could be manufactured. Although the war-time ban on the manufacture, and sale of ice-cream was lifted for the 1945 Season there was no return to the same level of sale as obtained in the pre-war period. MEAT AND OTHER FOODS. The 53 butchers' shop3 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 20 cases where sanitary conditions were 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. Seventy-four 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 23 pigs from pig clubs slaughtered under licences issued by 17. the Ministry of Pood. The following Table indicates the number of animals killed, inspected and found to be diseased* Cattle excluding Cows Calves j Sheep and Lambs Pigs Number killed - - - 23 Number inspected - - 23 All diseases except Tuberculosis Whole carcasses condemned - - - - Carcasses of which some part or organ was condemned - - - 2 Percentage of the number inspected affected with disease other than Tuberculosis - - - 8.69% Tuberculosis only Whole carcasses condemned - - - 1 Carcasses of which some part or organ was condemned - - - 1 Percentage of the number inspected affected with Tuberculosis. - - - 8.69% The following diseased and/or unsound meat aid oth?r foods have been surrendered and destroyed or, where suitable,: utilised for pig food:- Carcasses or parts of carcasses found to be diseased in slaughter-houses Number PIGS. Carcass & Offals (Generalised Tuberculosis) 1 Mesentery (Localised Tuberculosis) 1 Sets of Lungs (Congestion) 1 Hearts (Pericarditis) 1 MEAT M D 0THEIR FOODS IN R2TAIL SHOPS. Boneless Beef 53-lbs; Pork Trimmings 97-lbs; Veal l-lb.7ozs; Pork Sausages 44-lbs; Pork Sausage Meat 12-lbs; Bacon 15¼lbs; Fish 175 stones11-lbs; Chickens 43 (133 lbs) Suet 28lbs; Rolled Oats 450-lbs; Haricot Beans 100-lbs: Butter Beans 3-lbs; Dried Peas 164-lbs; Dried Fruit 33¾-lbs; Dates 112-lbs; Potatoes 56-lbs; Oranges 468-lbs; Flour 64lbs end 3 bags; Batter/Cake flour 96-lbs; Cheese 117½-lbs; 18. Sugar 6-lbs; Margarine 7¾-lbs; Sphaghetti 168-lbs; Semolina ½lb; Biscuits ½ also 13 pkts, Eggs 925; Dried Egg 1-pkt; Dried Milk 200-lbs; Frutella Fruit Dessert 5 cartons; Mixed Spice 16-lbs; Confectionery 36¼-lbs; Marmalade/Jam/Syrup/Honey - 326-lbs; Miscellaneous Foodstuffs tins/Jars/Bottles and Packets 3391. 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 1945. BAKEHOUSES. There are 25 Bakehouses within the District, and d of these 20 are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obta ined. RAT AND MOUSE REPRESSION RATS AND MICE (DESTRUCTION) ACT, 1919, THE INFESTATION ORDER 1943. During 1945 5092 primary and subsequent visits were made in connection with rat or mice infested or suspected infested premises. No major infestations were recorded. 336 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 1945 375 Total number investigated 374 Total number of premises on which no evidence of infestation was found 34 Total number of premises found to be infested 340 Total number of premises cleared of rats or mice 336 (Including 67 premises cleared which were discovered during 1944) 19 Causes of infestation at the 340 premises found to be infested during the year: Keeping of poultry etc. 117 Accumulations of refuse 9 Harbourage under or in garden sheds etc 83 Defective drains 12 Inside premises (under floors etc.) 101 Buries 53 Source untraced 5 380 Type of premises cleared of Rate and Mice. Dwelling-houses (Mainly in Gardens) 288 Foodshops and food premises 19 Non-food shops and stores 11 Offices 2 Factories 5 Parks, Allotments and Nurseries. 4 Miscellaneous 2 Poultry farms and pig styes 2 Inns 3 336 Methods employed in clearing 336 prrmises of Rats & Mice. Poison baits 313 Trapping 15 Gassing 7 Rat & Mouse proofing 6 Accumulations .removed 4 Drains repaired 10 Other means 9 364 SCHOOLS. The sanitary condition and water supply of the Schools are satisfactory. ERADICATION OF BED BUGS. Fifteen bug-infested houses were dealt with as follows:- Council Houses Other Houses By the use of Insecticides Thermatox Hydrocyanic (H.C.N.)Gas - - — 13 , 2 - The work of disinfestation has continued to be carried out upon the lines indicated in previous Reports. The Insecticide used was "Fuminol". SHOPS ACT. 1934. One hundred and seventy-four visits were made in connection with Section 10 of the Shops Act, 1934. (20) INCIDENCE OF AND CONTROL OVER IMECTCTIOUS DESEASES Seven hundred and seventy-one eases of infectious disease were notified during the year 1945, an increase of three hundred and ninety-seven over the previous year. This increase is mainly due to an epidemic of measles, with five hundred and thirty notified case. Oases of Diphtheria increased from six in 1944 to seventeen in 1945. Scarlet Fever and Whooping Cough declined. No case of Typhoid Fever was notified. One case of paratyphoid Fever, contracted in another district, war reported. Other enteric infections were few. There were two cases of Cerebro Spinal Fever. One case of Anterior Poliomyelitis occurred. SCARLET FEVER:- One hundred and twenty-seven cases were notified, a decline of sixty-nine cases. The case rate was 1.81 per 1000 of population, compared with 1.89 per 1000 of population for England and Wales. The disease was generally mild. There was no death. DIPHTHERIA:- Seventeen cases were notified, an increase of eleven cases. The case rate was 0,24 per 1000 of population, compared with 0,46 per 1000 of population for England and Wales, A majority of the eases were mild or moderate in severity, Three of the cases had been immunised, and responded well to treatment. The infecting bacillus was of the gravis type, a highly virulent and dangerous organism. Eecovery was dependent or. speed in diagnosis, and in the administration of antitoxin. There was no death. DIPHTHERIA ANTIXIN:- Early diagnosis and early treatment with Antitioxin remain principal safeguards against cortality. Where there is suspicion of Diphtheria, medical practitioners should administer Diphtheria Antitoxin at once and in large doses, while awaiting bacteriological confirmation of the diagnosis, or should arrange for the case to be removed to isolation hospital for observation and treatment, DIPHTHERIA IMMUNISATION:- Diphtheria Immunisation is a valuable protective measure against Diphtheria, and has reduced the general incidence and mortality of Diphtheria in this country, but it Is opportune to reassess its value in the light of experience. Experience proves that the protection given by the first series of injections of toxoid is not permanent. Immunity rises to its highest lev 1 during the first year after the injections, and thereafter slowly declines, until at the end of four years the level of immunity is too low to give protection against the gravis or severe type of Diphtheria bacillus. Fortunately the mechanism of protection of the individual has been sensitised by these first injections, and immunity can be restored by one further injection. Thus, if a child is immunised at the age of one year, a further raninforcing injection is necessary at the ago of five years, preferably before the child enters school, and subsequent reinforcing injections should be given every four years until the child leaves school. Thin revival of immunity by reinforcing injection must become a routine in our campaign against Diphtheria. 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 reduced. (21) In my report for 1944 I referred to the probability of a higher incidence of infection by the gravis type of bacillus during the years of resettlement of the population. This probability is now a reality. Parents are advised to have their children immunised at the age of one year, and reinforced every four years, as an insurance against disability and mortality. Nine hundred and ninety-eight children were immunised during the year 1945. The number of children immunised at the age of 1 year was 519, which represents 45 per cent of the babies reaching that age during the year, compared with 29 per cent for this age group in 1944, The following table shows the distribution in age groups of children who received primary injections during the year 1945. 1-2.2-3 3-4 4-5 5-6 6-77-8 8-9 9- 10-11-112- 13- 14-Over Total 10 11 12 13 14 15 15 519 193 40 20 47 43 26 25 22 15 22 14 8 4 998 At the end of the year, 9720 children, representing 65,2 per cent of all the children, had been immunised, Of these, 2303 represents 46.7 per cent of the children under five years of age, and 7417 represents 74.3 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 Road, Sutton, Every Friday, at 2 p.m. 2. At the Clinic, Priory Crescent, Cheam. Every Thursday, at £ 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, Every Wednesday, at 2 p.m. Cheam. (For children under five years of age) 5. At the Clinic, Jubilee Institute, Maiden Green, Worcester Every 1st Monday in each month, at 2 p.m. Park. (For children under five years of age) MEASLES:- An epidemic of Measles occurred from January to July. Five hundred and thirty cases were notified. The case rate was 7.54 per 1000 of population, compared with 11.67 per 1000 of population for England and Wales. The highest incidence was during February and March, a season of the year when respiratory infections are most prevalent. Nineteen cases were admitted to hospital. There were two deaths of children aged 4 years and 12 years from Pneumonia. The monthly distribution of cases was as follows. Month Jan, Feb March April May June July Aug Sept Oct Nov. Dec Total No. of Cases 40 106 136 88 88 35 31 3 j 1 1 i - 1 530 (22) The ago groups of notified cases are shown in the following table. Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Over 15 Total No. of Cases 13 46 48 49 49 125 83 49 16 8 8 5 3 4 4 3 17 530 The incidence of Measles fails most heavily on infant children and on children of early school age. It is those age groups which are most liable to mortality. Very careful nursing during the acute phase of illness, and very careful convalescence are necessary in order to avoid complications. Mothers should try to recognise the early catarrhal signs of Measles. The timely isolation of a suspected case may help to prevent secondary cases in the home. The patient should be kept warm in bed. The room should bo well aired. Stuffy, airless rooms cause complications. The diet should be light during the period of fever. A doctor should be called if the case is severe or any signs of complication arise. Infant children should be protected until they reach an age of greater resistance to secondary infections. Information of all notifications of children under five years of age is sent to the appropriate health visitor, in order that advice and help may be given where necessary, A leaflet of advice is sent to the home of every notified case, WHOOPING COUGH:- There was a decline in the incidence of Whooping Cough. Forty-two cases were notified, a reduction of forty-seven cases. The case rate was 0.59 per 1000 of population, compared with 1.64 per 1000 of population for England and Wales, There no death. Whooping Cough is a disease of young children. Approximately one tenth of the cases occur in the first year of life. Children under one year do not respond effectively to immunisation, and the greatest care must be taken to protect young babies from infection. Similar advisory methods as for Measles are applied to cases of Whooping Cough, IMMUNISATION AGAINST WHOOPIING COUGH:- A scheme was introduced applicable to children between 1 year and 5 years of the poorer inhabitants, to weakly children, and to children from overcrowded homes. The vaccine is injected in four small doses of 0.4 c.c, each containing 8000 million B. Pertussis, The first throe injecting are given at weekly intervals, and the fourth a month later. This concentrated vaccine can suitable be combined with Toxin-Antitoxin-Floccules (T.A,F.) for Diphtheria Im unisation, using the T.A.F. as a diluting and immunising agent. During the year 1945 eighty-nine children received four injections of Whooping Cough Vaccine. The incidence of Whooping Cough has been so low that It has not been possible to judge the efficiency of the vaccine. PUERPERAL PYREXIA:- Two cases wero notified, compared with seven cases In the previous year. The case rate was 1.86 per 1000 total births, compared with 9.93 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. * (23) I TYPHOID FEVER AND PARA-TYPHOID FEVER :- No case of Typhoid Fever was notified. One case of Paratyphoid Fever was notified. Infection occurred in another district, DYSENTERY:- Thirteen eases of Sonne Dysentery were notified, the same number as in the previous year. The disease is endemic. Only the more severe cases show the signs typical of Dysentery. Mild cases may escape recognition unless early bacteriological examinations are made. The disease is spread by these mild cases of gastro enteritis, and persons who are. engaged in the handling of food, whether in the home, the shop, the factory, or in transport, must beware of their infectivity when suffering from any mild form of diarrhoea, and at all times take adequato precautions by the most scrupulous cleansing of the hands before handling food. CEREBRO-SPINAL FEVER:- Two fatal cases of this disease were reported. One, a child aged 8 years, who was notified, succumbed quickly to acute infection. The other, a male adult, died at home after a short severe illness, and was certified by post-mortem examination as having died from Cerebro Spinal Meningitis. The acute forms of this disease are especially liable to mortality unless treatment by the Sulphonamide drugs is initiated in the early phase of illness, ANTERIOR POLIOMYELITIS:- One case was notified of a boy, aged 16 years, who died in hospital from aoute respiratory paralysis. PNEUMONIA :- Of twenty-four deaths occurring from all forms of Pneumonia, no case was notified previous to death. The total number of notified oases arising in the district was twenty-five, NON-NOTIFIABLE DISEASES:- School teachers reported ninetytwo cases of Mumps, thirty-seven cases of Chicken Pox, fifteen cases of German Measles, and one case of infective jaundice. School notifications are a useful index of the prevalence of non-notifiable infectious diseases, and form a basis for consultation with the School Medical Officer. SCABIES :- There was a further reduction in the incidonce of this parasitic infection of the skin. The treatment clinic adjoining No. 3. St, Nicholas Road, Sutton, operated efficiently under the care of Nurse James, with the voluntary help of Mrs, Berry and other former members of First Aid Post No. 1., and dealt with two hundred and twenty-nine cases, compared with two hundred and ninety-four cases in 1944. The number of attendances at the clinic was seven hundred and eighty, compared with one thousand in 1944. The treatment is by bathing, and the application of Benzyl Benzoate emulsion to the skin, LICE:- The facilities provided at the (above clinic have also been of great value in the reduction of head lice. Forty-four cases were treated during the year, compared with seventy-five in 1944, The number of attendances for treatment was one hundred and seventy-two, compared with two hundred and forty-seven in 1944, The treatment of head lice by cleansing and the application of lethane oil has provod effective, and is now supplemented by attractive hair cream containing D,D,T., which by its prolonged activity, even after washing of the hair, helps to keep children free from infestation, (24) (25) DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS DISEASE WARDS Case Rate per 1000 Populatn (Kid-Year) Case | Rate per 1000 England & Wales N. N.W. N.E . W.C. E.C. E.; S.W. S.E. S. Total Population:- 9183 8133 9360 11465 6756 6833 5498 5254 7218 70250 Scarlet Fever 17 16 20 34 10 10 12 3 3 125 1.78 1.89 Diphtheria - - 2 1 4 9 - 1 - 17 0.4 0.46 Typhoid - - - - - - - - - - 0.0 0.01 Para-typhoid - - - - 1 - - - - 1 0.01 0.01 Puerperal Pyrexia - - 1 - - - 1 - 2 - - Pneumonia 3 1 4 1 2 2 2 5 5 25 0.35 0.87 Erysipelas - - - 3 2 2 - - 4 11 0 .15 0.25 Dysentery 4 — 2 2 3 - - - 2 13 0.18 - Poliomyelitis - - - 1 - - - - - 1 0.01 - Ceretro-spina1 Fever 1 - - - 1 - - - - 2 0.03 0.05 Measles 39 33 72 136 71 56 32 35 56 530 7.54 11.67 Whooping Cough 5 2 8 11 1 1 3 4 7 42 0.59 1.64 Total 69 52 108 190 95 80 49 49 77 769 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 19 4 5 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 - 2 2 8 5 63 32 5 5 1 2 - 125 70 _ Diphtheria 1 - 2 1 6 5 1 - - 1 - 17 17 - Typhoid Fever - - - - - - - - - - - - - - - Para-typhoid - - - - - - - - - 1 - - 1 1 - Puerperal Pyrexia - - - - - - - - 2 - - - 2 1 - Pneumonia - - - - - 2 2 - 3 6 10 2 25 10 24 Erysipelas - - - - - - - - - 1 6 4 11 3 - Dysentery - 2 1 1 4 1 1 - - 3 13 5 - Poliomyelitis - - - - - - - 1 - - - 1 1 1 Cerebro-spinal Fever - - - - - 1 - - - - - 1 - 2 Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 1 - Measles 13 46 48 49 49 281 24 9 6 2 3 - 530 19 2 Whooping Cough 3 4 6 5 3 16 1 1 2 1 - - 42 3 London Cases in the Downs Hospital S.F. - 2 - - - - - - ; - - - 2 2 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 10 127 4 11 1 3 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table. (26) TUBERCULOSIS. On 31st December, 1945, there were on the register 732 cases of Tuberculosis, whom 576 were Pulmonary eases and 156 non-pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.48 per 1000 of population, and for nonpulmonary tuberculosis 0.10. The total Tuberculosis death rate in 1945 was 0.58 compared with 0.72 per 1000 of population in 1944. The corses ponding leath rotes for England and wales in 1945 were: Pulmonary, 0.52 per 1000 of population; nonpulmonary, 0,10 per 1000 of population. Total rate. 0.62 per 1000 of population. The number of new. cases of Pulmonary Tuberculosis notified fell from 86 in 1944 to 71 in 1945. The fall was amongst females of all age groups excepting the adolescents, who showed an increase of three cases. The number of new cases of non-pulmonary Tuberculosis was almost halfed. It is premature to attach any significance to this decline. Modern aids to diagnosis and early treatment will in time reduce the number of new cases, but, for the present, the greatest hope of reduction in incidence lies in the early provision of adequate housing, and increase of Sanatorium accomodation. The Sutton and Cheam Tuberculosis Care Committee has given very useful service during the year in helping to solve the social and financial problems affecting many families. This social service has been extended and expedited by the efficient work of the Lady Almoner, and Surrey County Council are accepting a wider responsibility for the essential needs of patients. The scheme of allowances continued to operate beneficially. The following table shows new cases and deaths in age groups. Age Periods New Cases Deaths Pulmonary Non-Pulmonary V Pulmonary Non-Pulmonary M F M F M F M F 0 - - - 1 - 1 1 1 - - - 1 1 - - - 5 2 2 1 - - - 1 1 15 13 16 4 2 3 - 1 25 7 5 1 2 2 4 1 - 35 14 5 1 1 2 5 - - 45 4 1 — - 4 1 - - 55 2 - - - 3 4 - - 65 and above - - - 4 - - 1 Totals 42 29 3 • 9 17 17 3 4 NOTIFICATION OF TUBERCULOSIS Respiratory Forms of Death - 23 out of 34 were notified. Other Forms of Death - 4 out of 7 were notified. (27) CIVIL AMBULANCE SERVICE On 1st July, 1945, the Council's Civil Ambulance was transferred from the Civil Defence Depot to the Fire Station, Throwley Road, Sutton, A staff of eight men was engaged as ambulance drivers and attendants, on a temporary basis, and at Civil Defence rates of pay. This staff operates on a twentyfour hour shift system, with four men on each shift. A Civil Defence ambulance was purchased as a second ambulance, and has proved necessary for urgent calls, and as a replacement of the first line vehicle during repairs. A Civil Defence motor car was also purchased to maintain inter-hospital transport, as requested by the Ministry of Health, but was sold later, as this need could be met by the use of the second ambulance. The Civil Ambulances now operate as a separate service, controlled and wholly financed by the Council. For depot control and call purposes the service functions in close association with the National Fire Service. The total number of calls increased during the year. The service provided was in keeping with the needs of the Borough. The numbers of calls and types of call in 1945 are here compared with the calls in 1944. Accident Illness in Street Urgent Illness Non-urgent Illness Maternity Hospital Transport Total 1945 345 141 337 148 137 140 1248 1944 274 158 353 46 198 50 1079 Of the 1248 calls, 122 were dealt with by the second ambulance, and 114 by mutual support from other districts: 193 calls were from adjoining authorities and from hospitals outside the Borough. The Ward distribution of calls was as follows :- N. N.W. N.E. W.C. E.C. E. S.W. S.E. S. Out of District Total Accident 26 10 52 26 33 35 18 53 42 50 345 Urgent 15 16 68 49 59 39 23 84 62 63 478 Non-urgent 11 11 26 9 20 21 13 20 95 62 288 Maternity 6 10 23 21 34 15 1 3 6 18 137 58 47 169 105 146 110 55 160 205 193 1248 (28) The following table shows the number of calls per month in 1945, compared with the number of calls per month in 1944. Jan. Feb. .. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total 1945 118 110 36 97 104 93 92 116 12 0 110 82 120 1248 1944 79 61 97 92 105 83 109 58 62 75 95 113 1029 The following table shows the number of days in the year 1945 on which the number of calls varied from 0 to 11. Comparison is made with the year 1944. No. of calls per day 0 1 2 3 4 5 6 7 8 9 10 11 1945 No. of days in year 12 47 71 77 65 42 20 18 9 2 0 2 1944 No. of days in year 33 65 94 58 56 22 14 12 8 4 0 0 The figures for the year 1044 in the last two tables exclude 50 hospital transport cases. (29)