Sutc 10 borough of sutton and cheam ANNUAL REPORT of the medical officer of health FOR THE YEAR 1946 BOROUGH OF SUTTON & CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1946 PUBLIC HEALTH COMMITTEE HIS WORSHIP THE MAYOR (Alderman H.J. Trlckett, J.P.) Alderman F.C. Lohden, O.B.E. Alderman II. Oakley (Chairman) Alderman W.T. Vent on C.C. Coun.S.J. Barton, C.C. Coun. F.E.Smyth (Mrs) " J.W. Bradley " F. Stoker " W.E. Heath " D.Webster (Miss) J.P, " J. Kingston " Kingsley Williams PUBLIC HEALTH OFFICERS OF THE AUTHORITY MEDICAL OFFICER OF HEALTH ENEAS J, MACINTYRE, M.D., D.P.H. CHIEF SANITARY INSPECTOR CHARIES WILLIAM NEWBERY, Certif.R.S.I.,Certif. Meat & Food,Certif. S.I. Exam.Board. DEPUTY CHIEF SANITARY INSPECTOR ARTHUR SYDNEY WIILIAMS, Certif. R.S.I., Certif. Meat & Food. ASSISTANT SANITARY INSPECTORS WALTER BLACK Certif .R .S. I. and S.I.E.J.B,, Certif. Meat & Food (from 21.6.1945) PETER EVERT KINTON Certif. R.S.I. and S.I.E.J.B Certif. Meat & Food (from 1.12.1946) 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 FRANK SUTCIIFFE Certif. R.S. I. and S.I.E.J.B., Certif. Meat & Food 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 1946. This first year of peace brought full realisation of the evil consequences of war. The serious deficiency in housing accommodation was accentuated by the steady increase in population to pre-war proportions. Shortages in labour and materials retarded progress in building. No new houses, other than the replacement of war damaged houses, were completed. Rehousing was limited to the accommodation of distressed families in requisitioned houses and in premises adapted as communal dwellings. Progress in the preparation of plans and acquisition of sites for approximately 500 houses continued. At the end of the year the number of applicants for houses exceeded 3,000. It is apparent that only one sixth of these applicants can be provided with new houses under local plans, and that the remainder must await a fuller development of the National Housing programme. Social, domestic and medical problems related to housing and involving the care of the aged, the welfare of children and the prevention of infectious illness became more serious and were complicated by an increasing shortage of beds in hospitals and sanatoria. These problems were considerably relieved by the fine service of domiciliary nursing provided by the District Nursing Associations, The general health and nutritional standard of the population remained good. There was no major epidemic of infectious disease. An outbreak of Diphtheria among children attending a school outside the Borough remained localised. There was a rise in the birth rate, and a rise in the death rate. The infantile mortality rate rose sharply from the record low level of the previous year. 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) who has done excellent work under difficult conditions in securing the many urgent sanitary repairs required to maintain the habitability of houses, and in helping to preserve the amenities of the district. 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 Service was efficiently conducted. A Bedford Ambulance in excellent condition was presented to the Council by the Board of Sutton and Cheam Hospital, and is a valuable asset to the Ambulance Service. I would record my personal sorrow at the death of the Chairman of the Public Health Committee, Alderman H.S.Oakley, and my aopreciation of his contribution to the progress of Public Health in the Borough. I thank the members of the Council for their advice and help during the' year, and I am grateful to the officers of the Council for their close cooperation. I am, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, ENEAS J. MACIHTYRE Medical Officer of Health. 4. STATISTICS OF THE AREA 1945 1946 Area in Acres 4338.15 4338.15 Registrar General's Estimate of the Resident Population 70,250 78,770 Number of inhabited houses (end of year) according to the Rate Book 22,031 22.149 Rateable Value and sum represented by a £884,211 £888,304 Penny Rate £3,536 £3,590 EXTRACTS PROM VITAL STATISTICS COMPARATIVE OP THE YEARS 1945 AND 1946 1945 1946 England & Wales 1946 Total Male Female Total Male Female Live Births 1051 539 512 1390 745 645 Legit imate 967 490 477 1322 704 618 Illegitimate 84 49 35 68 41 27 Birth Rate per 1000 of the Estimated Resident Population 14.9 . 17.6 19.1 Still Births 23 9 14 29 16 13 Legitimate 20 7 13 29 16 13 Illegitimate 3 2 1 ! - - Rate per 1000 total (live and still births) 21.4 20.4 26.0 Deaths 747 346 401 811 403 408 Death Rate per 1000 of the Estimated Resident Population 10.6 12.9 11.5 Deaths from Puerperal Sepsis 0 1 Other Puerperal Causes 1 0 Death rate from Puerperal Causes 0.93 0.70 1.24 1 Deaths of Infants under one year of age All Infants per 1000 live births 23.78 35.96 43.0 I Legitimate Infants per 1 1000 legitimate live births 23.78 36.63 Illegitimate Infants per 1000 illegitimate live births 23.80 29.41 5.  1945 1946 Deaths from Cancer 153 132 " " Measles 2 1 " " Whooping cough 0 0 " " Diarrhoea 2 0 Percentage of Deaths from certain causes to the total number of deaths. 1945 1946 Diseases of the heart and circulation 30.3 29,8 Cancer and malignant disease • 20.5 16.3 Diseases of the lungs (non tuberculous) .. 10 . 8 11,6 Tuberculous diseases 5,5 3.3 Cerebral Haemorrhage 9# 7 11.3 Congenital Diseases 2,7 4.3 Suicide and Violence 4.5 4,6 Diseases of the digestive system 4.4 4.8 Infectious diseases 2.3 2c2 Diseases of the kidney 1.5 2.8 Other defined diseases 7.8 9.0 The number of deaths from the common infectious diseases were:- 1945 1946 Measles 2 1 Diphtheria 0 0 Scarlet Fever 0 0 Whooping Cough 0 0 Influenza 7 8 MATERNAL MORTALITY:- The maternal mortality rate for the year 1946 was 0.70 per 1000 total births. The rate for England and Wales was 1.24 per 1000 total births. The one death was from pulmonary embolism. INFANTILE MORTALITY The infantile mortality rate was 55,96 per 1000 total bi.rths, compared with 23.78 per 1000 total births in 1945. The rate for England and Wales was 43 per 1000 thirty six occurred In the neo-natal period, within one month of birth, as is shown in the following table of causes and age-groups. Causes of Death Age Groups Under 1 month 1-3 months 3-12 months Congenital Abnormality 17 - - Prematurity 12 - - Broncho-Pneumonia 2 3 2 Infantile Diseases 2 1 2 Accident 1 1 1 Meningitis - - 2 Cerebral Haemorrhage 1 - - Asphyxia 1 - - Bronchitis - 1 - Phelitis - 1 - 36 7 7 6. CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1946 M. F. Total 1 Typhoid and paratyphoid fevers - - _ 2 Cerebro-spinal fever - - - 3 Scarlet Fever - - - 4 Whooping Cough - - - 5 Diphtheria - - 6 Tuberculosis of respiratory system 13 8 21 7 other forms of tuberculosis 3 3 6 8 Syphilitic diseases 5 2 7 9 Influenza 3 5 8 10 Measles 1 - 1 11 Acute poliomyelitis and polioencephalitis - 1 1 12 Acute infective encephalitis 1 1 13 Cancer of buccal cavity Oesophagus (M) and Uterus (F) 4 10 14 14 Cancer of stomach and duodenum 8 9 17 15 Cancer of breast 1 9 10 16 Cancer of all other sites 56 35 91 17 Diabetes 3 2 5 18 Intracranial vascular lesions 42 50 92 19 Heart disease 97 116 213 20 Other diseases of circulatory system 12 17 29 21 Bronchitis 25 17 42 22 Pneumonia 17 27 44 23 Other respiratory diseases 4 4 8 24 Ulcer of stomach or duodnum 7 3 10 25 Diarrhoea under 2 years - - - 26 appendicitis 2 3 5 27 other digestive diseases 10 8 18 28 Nephritis 5 18 23 29 Puerperal Sepsis - 1 1 30 Other maternal causes - - - 31 Premature birth 9 3 12 32 t Congenital malformations, birth injuries and infantile diseases 12 11 23 33 Suicide 4 3 7 34 Road traffic accidents 4 1 5 35 Other violent causes 15 10 25 36 All other causes 40 32 72 i 403 408 811 7. GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA LEGISLATION, HOSPITALS, and MORTUARY:- There was no change during the year. LABORATORIES:- The arrangement 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, was continued during the year 1946, AMBULANCES:- Details of the service are recorded on Page 32, 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 Wednesday, 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, MAIDEN ROAD, CHEAM. Infant Welfare Centre - Every Wednesday, at 1.30 p.m. (Including Diphtheria Immunisation every first Wednesday in the month) 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 first Thursday in the month) 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, MADDEN 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 St. Nicholas Road, button. Every Tuesday, from 10 a.m. to 11 a.m, TUBERCULOSIS DISPENSARY St. Helier Hospital, Wrythe Lane, Carshalton. Every Wednesday, at 2 p.m. Second Wednesday in the month, at 5.30 p,m. Every Friday, at 10 a.m. 8. SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLY:- The water supply is mainly derived from the deep wells in the chalk of the Sutton District Water Company, situated at Sutton, Cheam and Woodmansterne. A small area in the North Ward is supplied by the Metropolitan Water Board. The water from all 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 water 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. 17.96 Ammonia, free 0.0084 Ammonia, Albuminoid 0.0001 Nitrogen as Nitrates 0.76 Nitrogen as Nitrites 0 Oxygen absorbed in 4 hours at 27° C. 0.0025 Chlorine (in chlorides) 1.708 Hardness total (soap test) 7.99 No, of Bacteria growing on Agar per c.c. for 3 days at 20° C. 0.539 No, of Bacteria growing on Agar per c.c. for 1 day at 37° C. 0 Presence of Bacillus Coli in 100 c.c. 0.15 9. DRAINAGE and SEWERAGE. Owing to the restrictions imposed by war conditions, no major reconstruction work or. new constructions have been carried out, either at the Sewago Works or in connection with the main drainage system. REFUSE COLLECTION AND SCAVENGING. The collection and disposal of house refuse and salvage, together with the scavenging of public highways, is carried out under the supervision of the Borough Engineer and Surveyor. The work has been executed in a satisfactory manner. RIVERS AND STREAMS. The streams within the Borough have been maintained in a satisfactory condition. CLOSET ACCOMMODATION. There are 15 cesspools in use. Some six pail closets and one privy are in use. In the past eighteen 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 10 to 23 ) continues to be condensed. RECORD OF INSPECTIONS AND NOTICES SERVED Number Special Inspections, Interviews on Premises, and Advisory Visits 2,205 Re-inspections 3,897 Visits to Works in progress 1,108 Visits to Factories and Workplaces 285 Visits to Bakehouses 25 Visits to Outworkers' premises 46 Visits to Slaughterhouses 7 Visits to Butchers' and Food Shops 369 Visits to Dairies and Milkshops 21 Visits to Ice Cream Premises 72 Visits to Stables 5 Visits to Pigsties 3 Visits re Rat Infestation 6,264 Food and Drug Sample Visits 253 Visits in connection with Infectious Disease 386 Visits re overcrowding and "permitted number'' measurements 149 Smoke observations 17 Visits and Revisits re Shops Act 148 Miscellaneous 2,320 17,580 10. Premises at which defects or nuisances were discovered 2,061 Dwelling-houses surveyed for housing defects under Public Health or Housing Acts 535 Defects or nuisances discovered 2,911 Defects or nuisances remedied 1,894 Defects or nuisances in band 59 Defects or nuisances outstanding 958 Informal notices served 947 Statutory Notices served 107 Complaints received and investigated 894 SUMMARY OP REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT DRAINAGE AND SANITARY FITTINGS Number Number of houses and premises re-drained 2 Number of drains disconnected from Surface water sewers and connected to soil sewers 1 Repairs or amendments to existing drains 88 Drains or gullies unstopped and cleansed 277 Sanitary fittings repaired, renewed, provided or cleansed 869 Water and smoke tests applied 264 Water service pipes, cisterns repaired, renewed or c1eansed 48 W.C. APARTMENTS New Apartments provided 3 W.C. Apartments lighted and/or ventilated 19 Ventilated lobbies to W.C. Apartments provided 3 Separate accommodation for sexes provided 1 Alternative means of Sanitary accommodation provided 1 STRUCTURAL REPAIRS OR IMPROVEMENTS Roofs, renewed or repaired 235 Guttering and rainwater pipes provided, repaired etc. 141 Damp walls remedied 240 Brick walls, repointed, repaired or rendered 10 Chimney stacks repaired or rebuilt 21 Yards paved or repaired 26 Sites of houses concreted 23 Floors relaid or repaired 129 Windows and/or cills repaired or renewed 161 Doors and thresholds provided or repaired 40 Staircases and handrails repaired or provided 10 Ranges, stoves and coppers repaired or renewed 62 Miscellaneous 24 CLEANSING Rooms, passages, larders etc. cleansed 236 Trade premises cleansed 60 Verminous houses disinfected - Bugs, Fleas and Lice 38 Houses sprayed on account of Flies, Crickets, Silver Fish and Cockroaches 12 11. GENERAL Offal bins provided 3 Dustbins provided 408 Accumulations of refuse and manure removed 39 Nuisance from animals abated 2 Offensive ponds and ditches cleansed 3 Wasp Nests destroyed 60 Miscellaneous 72 SMOKE ABATEMENT There are few chimneys attached to industrial premises in this district. Three smoke nuisances were detected and three abated. The 1945 Annual Report refers to a case' where a considerable emission of grit particles was detected. A recommendation was made to the firm concerned, and delivery of special plant was awaited at the end of the year. During 1946 a grit extractor and mechanical stoker were installed, resulting in abatement of the nuisance. 1. INSPECTION OF FACTORIES AND OTHER PREMISES UNDER THE ACT Inspections made by Sanitary Inspectors for purposes of provisions as to health Number of Premises Inspections Notices Written & Oral Occupiers Prosecuted (1) (2) (3) (4) Factories with Mechanical Power 173 42 • • Factories without Mechanical Power 129 30 • • Other Premises (Other than Outworkers' premises) • • • • • • Total 302 72 • • 12 HOUSING 1. INSPECTION OF DWLLINGHOUSES DURING THE YEAR (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 535 (b) Number of inspections made for the purpose 438 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 116 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. 121 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 59 (2) Number of dwelling-houses which wore rendered fit after service of formal notices (a) By Owners 38 (b) By Local Authority in default of Owners 1 B. - Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 10 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners 7 (b) By Local Authority in default of Owners 1 C. - Proceedings under Sections 11 and 13 of the Housing Act, 1936:- Nil 13. 2. DEFECTS FOUND IN FACTORIES AND OTHER PREMISES UNDER THE ACT. Particulars Number of defects Number of defects in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness 9 7 - - Inadequate ventilation 2 - - - Overcrowding 1 - - - Unreasonable Temperature 1 - - - Ineffective drainage of floors - - - - Absence of Thermometers - - - - Absence of suitable lighting in W.C. apartments - - - - Other nuisances 57 44 - - Sanitary Accommodation (a) Insufficient 4 3 _ - (b) unsuitable or defective 22 15 - - (c) Not separate for sexes 1 - - 97 69 - - OUTWORK IN UNWHOLESOME PREMISES Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) - - - - PUBLIC HEALTH ACT, 1936 - WORKPLACES Number of Inspections Written Notices Occupiers prosecuted 8 - - 14. INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act 1958 The following table indicates the samples taken during the year 1946 NUMBER EXAMINED NUMBER ADULTERATED ETC Informal Formal Total informal Formal Total Milk 64 64 \ 1 1 Shredded Beef Suet 1 1 Black Pudding 1 1 Coffee & Chicory Extract 4 4 Coffee & Chicory Essence 5 1 6 3 3 Cocoa 1 1 Liquid Chocolate 1 1 Malt Cup 1 1 Chocolate Cup 1 1 Cake Mixture 1 1 Pudding Mixture 2 2 Sponge Mixture 2 2 Biscuit Mixture 1 1 Semolina 1 1 Barley Flakes 1 1 Golden Raising Powder 4 4 1 1 Baking Powder 2 2 Self Raising Flour 2 2 Soya Cream (Malted) 1 1 1 1 Oatova Oatflour 1 1 Rye Meal 1 1 Ground Mace 1 1 Oatmeal 1 1 Flavourings Ginger Wine 1 1 " Orange Wine 2 2 " Raspberry Wine 1 1 " Egg Culinary 1 1 Butter Culinary Essence 1 1 Table Jelly 4 4 " " Crystals 1 1 " " Creams 1 1 Junket Powder 1 1 Blanc Mange 1 1 Custard Powder 1 1 Kreamy Kurd 1 1 1 1 Dessert Mould 1 1 Lemon Powder 1 1 " Crystals 1 1 Orange Squash 1 1 Lime Cordial 2 2 Food Flavouring powder 1 1 3weets 2 2 Gelatine 2 2 Arrowroot 1 1 Jams 5 5 Honey 1 1 Glycerine 2 2 Costor or Oil 1 1 Malt and God Liver Oil 1 1 Cod Liver Oil Capsules 1 1 Carried forward: 75 65 140 6 1 7 15. NUMBER EXAMINED NUMBER ADULTERATED ETC Informal Formal Total Informal Formal Total Brought forward: 75 65 140 6 1 7 Medicinal Liquid Paraffin 3 1 4 1 1 2 Camphorated Cil 1 1 Lemon Linctus 1 1 Tonic for children 1 1 Lung Syrup 2 2 Kerrier Tunic 1 1 Elixir Jeffol 1 1 1 1 Ground Cinnamon 3 3 Ground Ginger 4 4 Ground Nutmeg 3 3 Turmeric (powdered) 1 1 Spice 2 2 Cleves 1 1 Senna 1 1 Cream of Tartar 1 1 Tartaric Acid 1 1 Seidlitz powder 1 1 Compound Syrup of Figs 1 1 Blackcurrant Cough Mixture 1 1 Soups 5 5 Horse Radish Cream 1 1 Savourie 1 1 Peas/Beans 2 2 Baked Beans 1 1 Sauces 3 3 Fish Paste 1 1 Fish Cakes 2 2 Pepper Cayenne _ 2 2 Celery Salt 2 2 Mustard (Ground & Compound 4 1 5 1 1 2 French Mustard 1 1 1 1 Curry Powder 2 2 Mixed Herbs 1 1 Vinegar 4 4 1 1 Gravy Maker 2 2 Bicarbonate of Soda 4 4 Boracic Crystals 2 2 Campden Solution Tablets 1 1 Cochineal 1 1 Whisky 1 1 Rum 1 1 1 TOTALS 147 69 216 ll 3 14 During 1946 it was again possible to maintain a satisfactory numerical standard of sampling over a wide range of commodities. Of the total samples 3.70 per cent were found to be other than genuine, this fact being a very gratifying feature of the year's sampling, This percentage figure excludes informal samples repeated formally. Two successful prosecutions were instituted. 16. Details of the unsatisfactory samples are as follows:- Sample No, Commodity Infringement Remarks 584 Mustard (Informal) 0.225% of Allyl Isotniocynate, instead of 0.35% Followed up by formal sample No. A273 A273 Mustard (Formal) 25% deficiency of Allyl Isothioeynate PROSECUTION Retailer fined £5 634 Medicinal Liquid Paraffin (Informal) Light Liquid Paraffin supplied. Fallowed up by formal sample No. A297 A297 Medicinal Liquid Paraffin (Formal) Light Liquid Paraffin supplied PROSECUTION Retailer Fined £3 with £5.5.0. costs A234 Milk (Formal) 1% added water Warning. Subsequent sample sat is factory 575 Elixir Jaffol (Informal) Vitamin A & C content not in accordance with label declaration Labelling Infringement Warning. Manufacturers withdrew old stocks and replaced with new 578 French Mustard (Informal) Labelling Infringement Correspondence revealed composition of product warranted different classification, therefore exempt from Ingredients declaration requirements of the Labelling of Food Order 1944. 622 Kreamy Kurd (Informal) Labelling Infringement Circumstances warranted the acceptance of the label as a temporary expedient. Satisfactory explanation given. 617 Coffee & Chicory Essence (Informal) 0.21% Caffeine Liquid Coffee & Chicory Essence should contain not less than 0.25% weight in volume of caffeine 629 Coffee & Chicory Essence (Informal) 0.20% Caffeine Formal samples will be taken when these particular brands reappear in the shops 642 Coffee & Chicory Essence (Informal) 0.12% Caffeine 644 Gold en Raising Powder (Informal) 3% added powdered Turmeric Manufacturers explanation accepted 667 Soya Cream Malted (Informal) Labelling Infringement The manufacture of this product has now ceased 687 Malt Vinegar (Informal) 0.75% of added salt Addition of salt was dictated by the then prevailing conditions, and of a temporary character. Explanation accepted. 17. Pork Sausages In the annual report for 1945 it was stated that an informal sample and a repeat sample revealed a meat content of only 30 per cent and 20 per cent respectively, instead of 50 per cent as prescribed by the Meat Products, Canned Soups and Canned Meat (Control & Maximum Prices) Order 1944, and a prosecution was pending. The case was heard early in 1946, and resulted in the defendant pleading guilty and being fined £5. MILK SUPPLY There are 12 dairymen and 12 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 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 1946:- Grade of Milk Type of Licence Dealers' Supplomentary Tuberculin Tested 10 1 Accredited - - Pasteurised 12 2 MILK SAMPLES 45 samples of milk were submitted for bacteriological examination as below 1. Pasteurised, Heat Treated and Sterilised Milk Number of Samples Phosphatase Test Methylene Blue (Reductase) Test Satisfactory Unsatisfactory Decolourised in less than 30 min3 Not decolourised in 30 mins 36 35 1 2 34 18. 2. Tuberculin Tested (Pasteurised) Milk Number of Samples Phosphatase Test Methylene Blue (Reductase) Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory 5 5 - 5 - 3. Tuberculin Tested Milk Number of Samples Coliform Test Methylene Blue (Reductase) Test Negative Positive Satisfactory Unsatisfactory 1 1 - 1 - 4. Ungraded Milk Number of Samples Total Bacteria per Mililitre Coliform Test Methylene Blue (Reductase)Test Under 50,000 150,000200,000 Negative Positive Satisfactory Unsatisfactory 3 2 1 1 2 3 - In the case of the two unsatisfactory samples examined by the Methylene Blue (Reductase) Test, both were of Heat Treated milk, one being decolourised in five minutes and the second at the end of fifteen minutes. Subsequent sampling of milk from the same source proved to be satisfactory. ICE CREAM At the end of 1946, 106 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. On eight of these premises ice cream could be manufactured. 19. 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 (Meat) Regulations have been generally well observed. Necessary action was taken in seven cases where sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations 1924 existed. At the end of 1946, 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. 14 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 11 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 Calve 3 Sheep and Lambs Pigs Number killed - - - 11 Number inspected - - - 11 All diseases except Tuberculosis Whole carcasses condemned - - - - Carcasses of which some part or ogan was condemned - - - 1 percentage of the number inspected affected with disease other than Tuberculosis - - - 9.9% Tuberculosis onlyWhole carcasses condemned - - - Nil Carcasses of which some part or organ was condemned - - - Nil Percentage of the number inspected affected with Tuberculosis - - - Nil 20 The following diseased and/or unsound meat and other foods have been surrendered and destroyed or, where suitablo, utilised for pig food:- Carcasses or parts of carcasses found to be diseased in slaughter-houses Number PIGS Sets of Lungs (Congestion) 1 HEAT AND OTHER FOODS IN RETAIL SHOPS Beef 55 lbs, Tinned Meats 143 tins, Savouree 2 jars, Ox Liver 15 lbs, Pork/Beef Sausages 7 lbs, Sausage Meat 3 tins, Brisket of Beef. 3 tins, Mutton 24 lbs, Giblets 24½ lbs, Chickens and Goslings 119 lbs, Venison 147 lbs, Pork Pie3 112, Rooks 10½ lbs, Fish 1,132½, Irish Rabbits 60, Tinned Fish 247 tins, Salmon 71, lbs, Shellfish 25 tins, Sauces 158 Jars, Meat & Fi3h Pastes 58 tins, Miscellaneous 540½ packets, Oats 124½ lbs, Haricot and Broad Beans 504 lbs, Milk 835 tins, Tinned Vegetables 377, Marmalade/ Jam/Syrup 106 tins, Mincemeat 3 tins, Eggs 586, Cheese 58 lbs, Macaroni & Cheese 2 tins, Prunos/Dates/ Figs 117 lbs, Tinned Fruit 86 tins, Fruit Cocktail 2 tins, Cake Mixtures 17 tins, Shredded Suet 1 packet, Confectionery 141 lbs. 4 oz, Cocoa & Coffee 44 lbs 3 oz, Tea 17 packets, Bovril 1 jar, Vinegar 2 bottles, Sugar 47½ lbs, Biscuits 52½ lbs. THE SLAUGHTER OF ANIMALS ACT, 1933 All animals slaughtered in the district have boon 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 1946. bakehouses There are 25 Bakehouses within the District, and of these 20 are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obtained. 21 rat and mouse repression rats and mice (destruction) act, 1919 the infestation order ,1943 During 1946. 3,264 primary and subsequent visits were made in connection with rats or mice infested or suspected infested premises. No major infestations were recorded. 343 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 1946 396 Total number investigated 396 Total number of premises on which no evidence of infestation was found 43 Total number of premises found to be infested 333 Total number of premises cleared of rats or mice (including 70 promises cleared which were discovered daring previous years) 343 Cause of infestation at the 353 premises found to be infested during the year Keeping of poultry etc. 77 Accumulations of refuse or debris 8 Harbourage under or in garden sheds etc. 95 Defective drains 11 Inside premises (under floors etc) 108 Buries in gardens &c. 7l 370 Type of premises cleared of rats or mice Dwelling-houses (mainly in gardens) 290 Foodshops and food premises 27 Non-food shops and stores 8 Factories 5 Parks, allotments and sports grounds 5 Offices 2 Refuse Tips and Sewage Works 2 Miscellaneous 4 343 Methods employed in clearing the 343 premises of rats or mice Poison baits 316 Trapping 22 Gassing 12 Rat & Mouse proofing 6 Drains repaired 12 Other means 10 378 22. SCHOOLS The sanitary condition and water supply of the Schools are satisfactory. ERADICATION OF BED BUGS 34 bug-infested houses were dealt with as follows By the use of Insecticides Thermatox Hydrocyanic (H.C.N.) Gas Council Houses - - - Other Houses 34 - - The work of disinfestation has continued to be carried out upon the lines indicated in previous Reports. The Insecticides used were "Fuminel" and D.D.T. SHOPS ACT, 1954 One hundred and forty-three visits were made in connoction with Section 10 of the Shops Act, 1934. INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Six hundred and fourteen cases of infectious disease were notified during the year 1946. Of these, eighty-six were institutional cases, and five hundred and twenty eight were district cases. This is a decrease of one hundred and fifty-seven cases compared with the number of cases notified in 1945, and is accounted for mainly by a lower prevalence of Measles. The incidence of Scarlet Fever remained low. Cases of Diphtheria were more numerous. There was an increase in Whooping Cough. One fatal case of acute Anterior Poliomyelitis occurred in the Autumn. Two adult oases of Cerebro-Spinal Fever were notified. SCARLET FEVER:- One hundred and thirty cases were notified, an increase of three cases. Thirty-six of these case were notified from an institution. The case rate was 1.65 per 1000 of population, compared with 1.38 per 1000 of population for England and Wales. The disease was generally mild. There was no death. 23 DIPHTHERIA:- Twenty-two cases were notified, an increase of five cases. One, was an institutional case. The twenty-one district cases occurred in separate groups. During January and February, six sporadic cases occurred in the Sutton area. The cases were not interconnected, and were due to carrier infection. Two carriers were detected and freed from infection. During March and April there was an outbreak of Diphtheria in the Worcester Park and North Cheam areas among older children attending a school outside the Borough. Eight girls aged 10 to 15 years were infected, and six secondary cases occurred. One sporadic case occurred in September, but no local source of infection was found. Of the total cases, eight had been immunised. The organism was of the gravis type, and was extremely virulent. In some cases serious symptoms developed within 24 hours from onset. Where more than four years had elapsed, from th6 date of primary immunisation there was no modification of illness. Four of the patients were adults, twelve were between 10 and 16 years of age, five were aged 5 to 10 years, and one was under 5 years. The concentration of attention on primary immunisation in infancy has led to a shift of the incidence of infection to older age groups. Therefore it is highly/important that immunity should be sustained by reinforcing injections at regular intervals of not more than four years throughout school life. The case rate was 0.28 per 1000 of population, compared with 0.28 per 1000 of population for England and Wales. There was no death from Diphtheria. DIPHTHERIA ANTITOXIN:- Early diagnosis and the early administration of Diphtheria Antitoxin remain the greatest safeguards against mortality. Diphtheria antitoxin should be administered in large doses by medical practitioners on suspicion of infection and while awaiting bacteriological confirmation of the diagnosis. Otherwise, suspected cases should be admitted to hospital for observation. Any delay in the administration of antitoxin gives time for the fixation of the powerful toxin in the heart and nervous system leading to protracted illness and subsequent disability. Diphtheria antitoxin is available free of cost for necessitous cases. DIPHTHERIA IMMUNISATION:- Experience of artificial immunisation has shown that primary immunisation is protective for a period of from three to four years. Immediately following injection, a high level of immunity is obtained, but this gradually declines, and after four years may have reached such a low level as to be insecure against infection. Reinforcing injections restore immunity to a safe level. Primary immunisation should be completed at the age of 1 year. Reinforcing injections must always be given before entry to nursery schools at the age of 3 years, or to day schools at the age of 5 years. School children should be reinforced by injection every four years. Parents have responded well to the campaign for immunisation, but there must be no relaxation. Each year over 1300 babies are born within the Borough. The complete success of the campaign depends on the primary immunisation of all these babies at or before the age of 1 year, and their subsequent reinforcement at regular.intervals. Carriers of infection are not increased in number by immunisation, but they are not diminished in number. The danger lurks in our midst, and immunisation is a barrier protecting the individual and the community against epidemic spread of the disease. 24 During the year 1946, one thousand and fifty-two children were immunised against Diphtheria, The number immunised at the age of 1 year was 449, which represents 43 per cent of the babies reaching that age during the year, compared with 45 per cent for this age group in 1945. One thousand, four hundred and nineteen children received reinforcing injections. The following table shows the distribution in age groups of children who received primpary injections during the year. 1-2 2-3 3-4 4-6 5-6 6-7 7-8 8-9 9- 10 1011 1112 1213 1314 14- 15 Over 15 Total 449 182 71 47 51 53 55 36 31 18 20 19 18 2 0 1052 At the end of the year, 10,103 children, representing 63.3 per cent of all the children, had been immunised. Of these, 2,440, represents 43.6 per cent of the children under five years of age, and 7,663 represents 75.8 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 first Thursday in the month, at 2 p.m. (For children under five years of ago) 3. At the Clinic, St. Oswald's Hall, Brocks Drive, N. Cheam. Every second and fourth Tuesday in the month, at 2 p.m. (For children under five years of age) 4. At the Clinic, Parochial Rooms, The Broadway, Cheam. Every first Wednesday in the month, at 2 p.m. (For children under five years of age) 5. At the Clinic, Jubilee Institute, Maiden Green, Worcester Park,. Every first Monday in the month, at 2 p.m. (For children under five years of age. MEASLES:- Two hundred and thirty-three cases were notified in 1946, compared with five hundred and thirty in 1945. The prevalence was highest during the Summer months. The case rate was 2,95 per 1000 of population, compared with 3.92 per 1000 of population for England and Wales. There was one death of a child aged 8 years from Broncho-pneumonia. The danger of complication by Broncho-pneumonia should be realised. Some children lose their powers of resistance to secondary infections during an attack of Measles. These children are not always . from poor homes, nor are they necessarily the weakly children in a family, although the risk of Broncho-pneumonia to the weakly child is always high. All children should be protected from infection by the speedy isolation of any suspected case in a family. A mild attack of Measles in one child in a family may be severe and serious when transmitted to another child. Careful nursing and careful convalescence of all cases are essential. Information of notifications of children under five years of age are sent to the health visitors in order that advice and help may be given where necessary, A leaflet of advice is sent to the home of every notified case. 25 The age 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  No. of Cases 6 23 24 37 30 57 22 13 7 3 3 1 2 - - - 5 233 WHOOPING COUGH:- There was an increase in the incidence of Whooping Cough, One hundred and forty-three cases were notified during 1946, compared with forty-two cases in 1945. Of these cases nineteen were from an institution. There was no death. The case rate was 1.81 per 1000 of population, compared with 2.28 per 1000 of population for England and Wales. The age 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 8 25 17 19 18 20 20 6 1 4 1 1 — - 1 1 1 143 The incidence of Whooping Cough falls most heavily on very young children. One of the main problems is the protection of babies under one year of age, for whom the illness if always serious, and to whom immunisation by injection is not yet applicable. Young babies should be protected from infection for as long as possible in the hope that they may escape infection until they are older and stronger and more able to withstand the protracted and debilitating illness. Bronchopneumonia is a constant danger and careful nursing and careful convalescence are essential. IMMUNISATION AGAINST WHOOPING COUGH:- The scheme of immunisation is restricted to the children between 1 year and 5 years of the poorer inhabitants, to weakly children, and to children from overcrowded homes. During 1946, 111 children received injections making a total of 200 children treated since the scheme was introduced in 1945. It is estimated that immunity does not develop fully until four months have elapsed from the time of injection, and the success of the scheme has to be judged on this basis. At the end of 1946, two immunised children were reported to have contracted Whooping Cough, One case was mild and the other of moderate intensity. With the small numbers so far recorded, it is not possible to estimate the value of the injections. The material used is Bacillus Pertussis, 'S' Vaccine, 20 million bacilli per c.c. The dose given is 0.4 c.c. in four doses, three at weekly intervals, and the fourth one month later. It has been found convenient and satisfactory to combine the vaccine with Toxoid Antitoxin Floccules (T.A.F) as a diluting fluid and for combining immunisation against Diphtheria. PUERPERAL PYREXIA:- Seven cases were notified in 1946, compared with two cases in 1945. The case rate was 4.93 per 1000 total births, compared with 8.50 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. 26 TYPHOID FEVER AND PARA TYPHOID FEVER:- No case was notified. DYSENTERY:- Thirty-five cases were notified. Twenty-eight of these cases were from an institution. Of the district cases, six were of the mild Sonne type. One case was of the severe Flexner type, and died of complication by appendicitis. The danger of the intrusion of Eastern types of Dysentery following demobilisation of the forces has to be recognised, and all cases of Dysentery should have early medical treatment with the effective Sulphonamide drugs which can quickly reduce the infection. Scrupulous cleanliness of the hands and of utensils by all engaged in the handling of food is essential for the elimination of this disease. CEREBRO-SPINAL FEVER:- Two adult cases were notified. Both recovered. Early treatment with Sulphonamide drugs is essential to prevent mortality. ANTERIOR POLIOMYELITIS:-One case of a child aged 8 years was notified and proved fatal from involvement of the respiratory centre. This disease is caused by a virus, an ultramicroscopic organism. The infection lies in the nasopharynx and in the wall of the bowel. It may be transmitted by spray from the breath or from the contamination of food from the stools of infected persons. Carriers who harbour the infection cannot be detected easily. Contacts may be infectious for a period of three weeks from the time of contact, and should restrict their mode of life to reduce the possibility of transmission of infection. Patients are infectious for three days before the onset of symptoms. The early symptoms are fever with vague signs of irritation of the nervous system which may be attributed to Influenza, These early symptoms may be followed by limited paralysis, or may disappear for several days and recur with the classical signs of the disease, of which pain and rigidity in the back of the neck is the most prominent and constant. In some patients the infection is located in the spinal cord while in others the brain stem is involved with the great danger of paralysis of the vital brain centres including the centre for respiration, A large number of cases recover spontaneously without paralysis, and during epidemics it is probable that many cases of very mild illness unrecognised as being related to this infection occur, and that the immunity of the population rises progressively by subminimal infections. The number of severe paralytic cases is small in proportion to the number of persons probably infected, and it may be hoped that as an epidemic wave orogresses the number of non-paralytic cases will rise proportionately with an increase in general immunity, and that the latter phase of an epidemic may be less productive of paralysis than the first. During epidemics people should avoid crowded indoor assemblies. Adequate rest and sleep are essential protectives. Scrupulous personal and domestic hygiene including hand washing after defaecation, disinfection of lavatories, and the protection of the larder and kitchen from flies, are all measures which may help to reduce infection. PNEUMONIA:- Of forty-four deaths occurring from all forms of Pneumonia, three cases were notified previous to death. The total number of notified cases arising in the district was thirty-two. 27 NON-NOTIFIABLE DISEASES:- School teachers reported sixty-three cases of Mumps, sixty-two cases of Chicken Pox and eight cases of German Measles. 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 further reduction in the incidence of this parasitic infection of the skin. The treatment clinic adjoining No.28. St. Nicholas Road, Sutton, operated efficiently under the care of Nurse James, and with the voluntary help of Mrs. Berry, and dealt with one hundred and sixty-eight cases, compared with two hundred and twenty-nine cases in 1945. The number of attendances at the clinic was six hundred and twentyfive, compared with seven hundred and eighty in 1945. The treatment is by bathing and the application of Benzyl Benzoate Emulsion to the skin. LICE:- There was an increase in the number of cases of head lice treated at the clinic. Sixty-seven cases were treated during the year, compared with forty-four cases in 1945. The number of attendances for treatment was two hundred and fifty-four compared with one hundred and seventy-two in 1945. The treatment of head lice is by cleansing and the application of lethane oil. This is supplemented by the application of a hair cream containing D,D,T. which helps to keep children free from infestation. 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 78 1 19 2 25 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above Table. 28 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1946 Disease Under 1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 10 Years 15 Years 20 Years 3 5 Years 45 Years 65 Years Totals Removed to Hospital x Died Scarlet Fever - 1 1 6 13 39 23 5 4 2 - - 94 65 - Diphtheria - - - - 1 5 7 5 1 - 2 - 21 21 - Typhoid Fever - - - - - - - - - - - - - - - Para-typhoid - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - 5 2 - - 7 3 - Pneumonia —- 2 4 - - 6 2 1 2 3 3 8 31 8 44 Erysipelas - - - - - - - - - 1 5 3 9 3 - Dysentery - - - - - 2 1 - 2 - 1 1 7 3 1 Poliomyelitis - - - - - 1 - - - - - - 1 1 1 Cerebro-spinal Fever - - - - - - - - - 1 1 - 2 2 Measles 5 23 24 37 30 102 6 2 2 1 - - 232 10 1 Whooping Cough 5 13 13 19 18 51 3 1 1 1 - - 124 4 - London Cases in the Downs Hospital. Scarlet Fever 6 17 6 - - - - 5 2 - - - 36 36 Diphtheria - - - - - - - - 1 - - - 1 1 Dysentery 12 12 1 - - - - 3 - - - - 28 28 Pneumonia 1 - - - - - - - - - - - 1 Measles 1 - - - - - - - - - - - 1 1 Whooping Cough 3 12 4 - - - - - - - - - 19 19 _ x Under Column "Died" all deaths, whether notified in the district or outside it, or not notified at all, are included. 29 30 DISTRIBUTION OP NOTIFIABLE DISEASES IN WARDS DISEASE WARDS Case Rate per 1000 Populatn (Mid-Year) Case Rate per 1000 England & Wales N. N.W. N.E. W.C. E.C. E. S.W. S.E. S. Total Population 10280 9132 11006 12863 7566 7649 6117 5937 8220 78,770 Scarlet Fever 14 8 25 26 6 4 4 4 3 94 1.19 1.38 Diphtheria 6 2 1 5 1 4 - 1 1 21 0.27 0.28 Typhoid - - - - - - - - - - 0.00 0.01 Para-typhoid - - - - - - - - - - 0.00 0.02 Puerperal Pyrexia - - 1 1 - 2 - 3 - 7 - - Pneumonia 4 5 6 - 3 8 2 2 1 31 0.39 0.89 Erysipelas - 1 - 1 - 3 - - 4 9 0.11 0.22 Dysentery - - 1 1 - 3 1 - 1 7 0.09 - Poliomyelitis - 1 - - - - - - - 1 0.01 - Cerebro-spinal Fever - 1 - - 1 - - - - 2 0.02 0.05 Measles 8 9 29 46 30 52 8 23 27 232 2.95 3.92 Whooping Cough 18 10 26 24 13 18 - 7 8 124 1.57 2.28 Total 49 38 89 104 54 95 15 40 45 528 TUBERCULOSIS On the 31st December, 1946, there were on the Register 755 cases of Tuberculosis, of whom 604 were Pulmonary cases, and 151 Non-Pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.26 per 1000 of population, and for Non-Pulmonary Tuberculosis 0.08. The total death rate from Tuberculosis was 0.34 per 1000 of population, compared with 0.58 per 1000 of population in 1945. The corresponding death rates for England and Wales in 1946 were: Pulmonary, 0.46 per 1000 of population; Non-Pulmonary, 0.08 per 1000 of population. Total rate 0.54 per 1000 of papulation. The lowering of the death rate from Pulmonary Tuberculosis is satisfactory, but may still be a reflection of the lower incidence of the disease in the years before the war, as there is always a lag of years between higher incidence as occurred during the war years, and higher death rate. The number of new cases of Pulmonary Tuberculosis was 71, the same number as in 1945. The number of new cases of NonPulinonary Tuberculosis was 9, compared with 12 in 1945. The hope of reducing the incidence of Tuberculosis lies in improving the social and economic standards of the people as a whole, in eliminating overcrowding, and in removing insanitary and unhealthy dwellings, while making use of modern aids to diagnosis and modern methods of treatment, and providing sanatoria of adequate capacity to deal with the problem. The Sutton and Cheam Tuberculosis Care Committee continued to function with success in dealing with the many and varied social problems connected with the disease. The Committee is essentially a social welfare committee, and is now able to, devote its resources to the intimate personal needs of patients and of their families, and to assist materially in the rehabilitation of the 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 Pulmonary Non-Pulmonary M F M F M F M F 0 - - - - - - - 1 1 1 1 1 - - - - _ 5 4 2 - 1 - - - - 15 12 12 2 3 1 1 1 1 25 11 7 - - 2 2 - - 35 7 3 - 1 1 3 - 1 45 5 - 1 - 4 1 1 - 55 5 - - - 3 - - - 65 and above 1 - - - 2 1 1 - Totals 46 25 4 5 13 8 3 3 NOTIFICATION OF TUBERCULOSIS Respiratory Forms of Death - 17 out of 21 were notified. Other Forms of Death - 5 out of 6 were notified. 31 CIVIL AMBULANCE SERVICE The Council's Ambulance Service operated satisfactorily during the year. The number of calls increased. The staff carried out their duties with keeness and efficiency. The service continued to function in close association with the National Fire Service for depot control and call purposes. The Austin Ambulance, which had been submitted to much wear during the years of war, was given an extensive mechanical overhaul, and a higher number of calls for mutual support had to be made. The gift to the Council of an American Red Cross Bedford Ambulance, well equioped and in good mechanical condition, from the Board of Sutton and Cheam Hospital in September, was a valuable and much appreciated addition to the service, and replaced the adapted Civil Defence vehicle as a second ambulance. The number of calls and types of call In 1946 are here compared with the calls in 1945. Accident Illness in Street Urgent Illness Non-urgent Illness Maternity Hospital Transport Total 1945 345 141 337 148 137 140 1248 1946 303 141 237 225 204 215 1325 Of the 1325 calls, 226 were dealt with by the second ambulance, and 259 by mutual support from other districts: 210 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 17 8 26 33 41 19 12 55 39 53 303 Urgent 13 17 42 45 40 28 12 66 47 68 378 Non-Urgent 35 12 32 34 32 28 28 85 123 51 440 Maternity 11 8 30 23 27 32 6 14 15 38 204 Totals 56 45 130 135 140 107 58 220 224 210 1325 The following table shows the number of calls per month in 1946 compared with the number of calls per month in 1945. Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total 1945 118 110 86 97 104 93 92 116 120 110 82 120 1248 1946 105 109 103 103 87 97 98 116 97 105 133 172 1325 The following table shows the number of days in the year 1946 on which the number of calls varied from 0 to 11. Comparison is made with the year 1945. No. of calls per day 0 1 2 3 4 5 6 7 8 9 10 ll 1945 No. of days in year 12 47 71 77 65 42 20 18 9 2 0 2 1946 No, of days in year 11 58 41 88 57 40 29 24 7 7 1 2 32