SUTC II LIBRARY BOROUGH OF SUTTON AND CHEAM ANNUAL REP0RT. of the Ir EPICAL OFFICER OF HEALTH FOR THE YEAR 1947. 1 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, for the year 1947. PUBLIC HEALTH COMMITTEE. HIS WORSHIP THE MAYUR (Councillor J.H.Nelson Curtis J.P.) Alderman F.C.Lohden, O.B.E. Alderman W.T.Venton. Coun. S.J. Barton, C.C. Coun. F.E.Smyth (Mrs) J.P. " I. A. Co ok (Miss) " D.Sparks (Mrs) M.B.E. " W.E.Heath. " D.Webster (Miss) J.P. " J.Nicholson. " Kingsley Williams (Chairman) 1 PUBLIC HEALTH OFFICERS OF TEL AUTHORITY. MEDICaL OFFICER OF HEALTH. ENEAS J. MaCIUTYRE, M.D., D.P.H. chief sanitary inspector. CHARLES WILLIAM HEW. ERY. Certif. R.S.I. , Certif. Meat & Food,Certif. S.I. Exam. Board. DEPUTY chief sanitary INSPECTOR. ARTHUR SYDNEY WILLIAMS. Certif. R.S.It. , Certif -Meat & Food. ASSISTANT Sa3.ITARY INSPECTORS. WALTER BLACK. Certif.R.S.I. and S.I.E.J.b., Certif. Meat & Food. PETER EVERT KINTON. Certif.R.S.I. and S.I.E.j.b., Certif. Meat & Food. REGINALD WILLIAM NORMAN. Certif.R.S.I. and S.I.E.J.B., Certif. Moat & Food. KEHPTON HUDDLESTONE PRIOR. Certif. R.S.I, and S.I.E.J.B., Certif. Meat & Food. FRANK SUTCLIFFE. Certif. R.S.I. and S.I.E.J.b., Certif. Meat & Food. 1 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 1947. The serious deficiency in housing accommodation was the most adverse factor affecting the health of the people. The completion and occupation of 115 temporary bungalows at Cuddington was a small but welcome contribution, but there is a most urgent need to release many more families from the discomforts of the single all purpose room, which is demoralising and disruptive of family life. The problem of large families in overcrowded conditions remains untouched. The number of applicants for houses rose to 3500. As a result of the steady rise in population, and the concurrent deterioration of properties there is an increase in the annual demand for houses. This is not being provided for by present or projected building within the Borough. It is apparent that additional building sites should be found in other areas, if minimum essential requirements for housing and for health are to be mot within a reasonable time. The general health and nutritional standards of the community were maintained, but the stresses of adverse housing conditions are reacting on many families, A severe epidemic of Poliomyelitis was the principal epidemiological feature of the year. Otherwise there was no abnormal incidence of infectious diseases. The child population was free from cases of Diphtheria, a result attributable to Immunisation. There was a further rise in the birth rate, and a fall in the death rate. The infantile mortality rate was reduced, and 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 hi3 constant endeavour to sustain the habitability of houses, and to preserve the amenity 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 operated efficiently, and the number of calls showed a substantial increase. 3 The National Health Service Act 1946 will become operative on 5th July, 1948, The Ambulance Service, and the services for Immunisation against Diphtheria and against Whooping Cough will become the administrative and financial responsibility of the Surrey County Council. The continued efficiency and expansion of these services are provided for in the proposals of the Surrey County Council. 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 co-operatiion. I am, Mr, Mayor, Ladies and Gentlemen, Your obedient Servant, ENEAS J. MACINTYRE, Medical Officer of Health, 4. STATISTICS OF THE AREA 1946 1947 Area in Acres 4338.15 4338.15 Registrar General's Estimate of the Resident Population 78,770 80,590 Number of inhabited houses (end of year) according to the Rate Book 22,149 22,306 Rateable Value and sum represented by a Penny Rate £888,304 £901,065 £3,590 £3,685 EXTRACTS -FROM VITAL STATISTICS COMPARATIVE OP THE YEARS 1946 AND 1947 1946 1947 England & Wales 1947 Total Male Female Total Male Female Live Births 1390 ■ 745 645 1446 753 693 Legitimate 1322 704 618 1380 717 663 Illegitimate 68 41 27 66 36 30 Birth Rate per 1000 of the Estimated Resident Population 17.6 17.9 20.5 Still Births 29 16- 13 30 15 15 Legitimate 29 16 13 27 12 15 Illegitimate - - - 3 3 Rate per 1000 total (live and still births) 20.4 20.3 24. 0 Deaths 811 403 408 886 .. 435 451 Death Rate .per 1000 of the Estimated Resident Population ' 12.9 10.9 . 12.0 Deaths from Puerperal Sepsis Other Puerperal Causes 1 0 1 0 Death rate from Puerperal Causes per 1000 total (live and still births) 0.70 0.68 1.01 Deaths of Infants under one year of age All Infants per 1000 live births 35.96 30.43 41.0 Legitimate Infants per 1000 legitimate live births 36.63 29.0 Illegitimate Infants per 1000 illegitimate live births 29.41 60. 6 5. 1946 1947 Deaths from Cancer 132 148 Measles 1 1 " " Whooping Cough 0 1 " " Diarrhoea 0 0 Percentage of Deaths from certain causes to the total number of deaths. Diseases of the heart and circulation 29.8 31.5 Cancer and malignant disease 16.3 16.7 Diseases of the lungs (non tuberculous) 11.6 12.5 Tuberculous diseases 3.3 4.3 Cerebral Haemorrhage 11.3 12.0 Congenital Diseases 4.3 3.7 Suicide and Violence 4.6 3.6 Diseases of the digestive system 4.8 4.0 Infectious diseases 2.2 2.4 Diseases of the kidney 2.8 2.1 Other defined diseases 9.0 7.2 MATERNAL MORTALITY:-The maternal mortality rate for the year 1947 was 0,68 per 1000 total births. The rate for England and Wales was 1.01 per 1000 total births. The one death was due to post abortion sepsis. INFANTILE MORTALITY :-The infantile mortality rate was 30.43 per 1000 total births, compared with 35.96 per 1000 total births in 1946. The rate for England and Wales was 41 per 1000 total births. Of the forty-four deaths, thirty-four 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 7 - - Prematurity 14 - - Broncho-Pneumonia 4 1 2 Infantile Diseases 4 2 2 Accident 1 _ - Cerebral Haemorrhage 1 - - Asphyxia 3 1 1 Whooping Cough - 1 - 34 5 5 6. CAUSES OP DEATH IN THE BOROUGH OP SUTTON AND CHEAM DURING 1947. M. F. Total 1 Typhoid and paratyphoid fevers - - - 2 Cerebro-spinal fever - - - 3 Scarlet Fever 1 - 1 4 Whooping Cough 1 - 1 5 Diphtheria - - _ 6 Tuberculosis of respiratory system 19 12 31 7 Other forms of tuberculosis 2 5 7 8 Syphilitic diseases 5 4 9 9 Influenza 4 2 6 10 Measles '- 1 1 11 Acute poliomyelitis and polioence phalitis - — 2 12 Acute infective encephalitis - 1 1 13 Cancer of buccal cavity Oesophagus (M) and Uterus (F) 1 7 8 14 Cancer of stomach and duodenum 9 9 18 15 Cancer of breast - 18 18 16 Cancer of all other sites 68 36 104 17 Diabetes 1 4 5 18 Intracranial vascular lesions 44 62 106 19 Heart disease 100 144 244 20 Other diseases of circulatory system 17 18 35 21 Bronchitis 34 17 51 22 Pneumonia 25 17 42 23 Other respiratory diseases 7 11 18 24 Ulcer of stomach or duodenum 1 8 3 11 25 Diarrhoea under 2 years - - 26 Appendicitis 3 4 7 27 Other digestive diseases 5 7 12 28 Nephritis 9 10 19 29 Puerperal Sepsis - 1 1 30 Other maternal causes - - _ 31 Premature birth 10 4 14 32 Congenital malformations, birth injuries and infantile diseases 7 12 19 33 Suicide 2 3 5 34 Road traffic accidents 6 1 7 35 Other violent causes 13 7 20 36 All other causes 32 31 63 435 1 451 886 7. GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA LEGISLATION:- Byelaws as to the business of Hairdresser or Barber were confirmed by the Minister of Health on 29th November, 1947. LABORATORIES:- Arrangements were continued with the laboratory at Sutton and Cheam Hospital, A free service was introduced at the Public Health Laboratory, Epsom, but its use is limited owing to the distance from the Borough. MORTUARY:- During 1947 seventy-eight bodies were received, and seventy-eight post mortem examinations were made. The mortuary premises and equipment have been well maintained, and at the tirro of writing this report, a three body refrigerated chamber has been installed. AMBULANCES:- Details of the service are recorded on Page 34, 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. 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 second and fourth Tuesdayin the month) JUBILEE INSTITUTE. MALDEN GREEN. WORCESTER PARK. Infant Welfare Centre - Every Monday and Thursday, at 1,30 p.m, (Including Diphtheria Immunisation every first Monday in the month) 8 SCABIES CLINIC St. Nicholas Road, Sutton. Every Monday and Thursday, from 10 a.m. to 12 noon. CHEST CLINIC St. Heller Hospital, Wrythe Lane, Carshalton. Every Monday, from 9.30 a.m. to 12 noon. Every Wednesday, from 2 p.m. to 4.30 p.m. Every Friday, from 9.30 a.m. to 12 noon. Every second Wednesday in each month, from 5 p.m. to 7 p.m. (Old oases only) 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 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° 18.79 Ammonia, free 0.0079 Ammonia, Albuminoid 0 Nitrogen as Nitrates 0.76 Nitrogen as Nitrites 0 . . Oxygen absorbed in 4 hours at 27° C. 0.0016 Chlorine (in chlorides) 1.86 Hardness total (soap test) 7.78 No. of Bacteria growing on Agar per c.c. for 3 days at 20° C. 0.116 No. of Bacteria growing on Agar per c.c. for 1 day at 37° C, 0. 033 Presence of Bacillus Coli in 100 c.c. 0 9 DRAINAGB and SEWERAGE. Owing to the restrictions imposed by war conditions, no major reconstruction work or new constructions have been carried out, either at the Sewage works or in connection with the main drainage system. REFUSE COLLECTION AND SCAVENGING. The collection and disposal of house refuse and salvage, together with the scavenging of public highways, is carried out under the supervision of the Borough Engineer end 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 9 premises with cesspools in use. Some 6 pail closets and 1 privy are in use. In the past nineteen years 158 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 t be grounds of economy the Report of the Chief Sanitary Inspector on Sanitary circumstances, Housing, Food Supply, etc., (pages 10 to 25 ) continues to be condensed. RECORD OF INSPECTIONS AND NOTICES SERVED. Number. Special inspections, interviews on premises, and advisory visits 2302. Reinspections 3942. Visits to works in progress 972. Visit3 to Factories (with and without Power)&Workplaces. 302. Visits to Bakehouses (with and without Power) 31. Visits to Outworkers promises 83. Visits to Slaughterhouses 4. Visits to Butcher's, Grocer's and other food premises. 402. Visits to Dairies and Milk shops 40. Visits to Ice Cream Premises 60. Visits to Stables, Passages etc. 24. Visits to Pigsties 5. Visits to Premises re Rat Infestation 6148. Visits to Tents, vans, shed3 , etc. 17. Visits to Cinemas, Theatres, Halls etc. 20. Visits to Premises re infectious diseases 250. Visits to premises re over crowding and ''permitted number" measurement 1652. Visits and Revisits re Shops Act 129. Food and Drug Sample visits.178. Bacteriological Sample visits (Milk and Water) etc.86. Smoke observations 12. Miscellaneous Visits 2966. 19,625 (10) Premises at which defects or nuisances were discovered. 2242. Dwelling-houses surveyed for housing defects under Public Health or Housing Acts 329. Defects or nuisances discovered 2793. Defects or nuisances remedied 1679. Defects or nuisances in hand. 182. Defects or nuisances outstanding 932. Informal notices served 966. Statutory Notices served 156. Complaints received and investigated 1007. SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT. DRAINAGE AND SANITARY FITTINGS. Number of houses and other premises redrained 15. Number of houses and other premises connected to soil sewers 2. Number of houses and other premises connected to surface water sewers 6. Repairs or amendments to existing drains 316. Drains or gullies unstopped and cleansed 348. Sanitary fittings repaired, renewed, provided or cleansed. 618. Water, Smoke and Chemical tests applied 290. Water service pipes, cisterns repaired, renewed or cleansed.138. W.C. APARTMENTS. New Apartments provided 4. W.C. Apartments lighted and/or ventilated 4. Ventilated lobbies to W.W. apartments provided 6. Separate accommodation for sexes provided 1. Alternative means of Sanitary accommodation provided. W.C. apartments cleansed 35. STRUCTURAL REPAIRS 0R IMPROVEMENTS. Roofs, renewed or repaired 221. Guttering and rainwater pipes provided, repaired etc. 149. Damp walls remedied 107. Brick walls, repointed, repaired or rendered 28. Chimney stacks repaired or rebuilt 25. Yards paved or repaired 12. Sites of houses concreted 6. Floors relaid or repaired 93. Windows and/or cills repaired or renewed 254. Doors and thresholds provided or repaired 45. Staircases and handrails repaired or provided 8. Ranges, stoves and coppers repaired or renewed 79. Miscellaneous 19. CLEANSING. Rooms, passages, larders etc. cleansed 264. Trade premises cleansed 49. Verminous houses disinfected - Bugs, Fleas and Lice. 67. Houses sprayed on account of Flies, Crickets, Silver Fish and Cockroaches.78. Premises disinfected after various diseases 290. (11) GENERAL. Offal bins provided 4. Dustbins provided 154. Accumulations of refuse and manure removed.35. Nuisance from animals abated 2. Offensive pond3 and. ditches cleansed 2. Wasp nests destroyed 71. Miscellaneous 58. SMOKE ABATEMENT. There are few chimneys attached to industrial premises in this district. One smoke nuisance was detected and abated. 1. INSPECTION OF FACTORIES AND OTHER PREMISES UNDER THE ACT. Inspections made by Sanitary Inspectors for purposes of provisions as to health. Premises. Number of Inspect ions Notices Written Oral Occupiers Prosecuted. (1) (2) (3) (4) Factories with Mechanical Power, 181. 41. • • Factories without Mechanical Power. 130. 26. • • Other Premises (Other than Outworkers' premises) 4 .. • • Total. 315 67 .. 2. DEFECTS FOUND IN FACTORIES AND OTHER PREMISES UNDER THE ACT. Number of defects. No . of defects in respect of which prosecutions were instituted. Particulars. Found Remedied Referred to E.M. Inspector Referred by E.M. Inspectcr. (1) (2) (3) -• (4) (5) (6) Want of cleanliness. 7 6 1 1 - Inadequate ventilation. 2 1 1 _ — Carried forward. 9 7 2 1 - 12 Particulars. Number of Defects. Number of defects in respect of which prosecutions were instituted. Pound Remedied Referred to H.M. Inspector Referred by E.M. Inspector. (1) (2) (3) (4) (5) (6) Brought forward. 9 7 2 1 - Overcrowding 1 - 1 - - Unreasonable Temperature. - - - - - Ineffective drainage of floors. - - - - - Absence of Thermometers . - - - - - Absence of suitable lighting in W.C.Apartments. 4 1 - - - Other nuisances. 55 45 - 2 - Sanitary accomodation. - - - - - (a) Insufficient. 5 2 - 3 _ (b) Unsuitable or defective. 10 8 - - (c) Not separate for sexes. /- - - - - Totals. 84 63 3 6 - OUTWORK IN UNWHOLESOME PREMISES. Nature of Work. (1) Instances. (2) Notices served (3) Prosecutions (4) - - - - PUBLIC HEALTH ACT. 1936 - WORKPLACES. Number of. Inspections. Written Notices. Occupiers prosecuted. 18. - - HOUSING. 1. inspection of dwellinghouses during the yeAr:- (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Hoalth or housing Acts) 329 (13) (b) Number of inspections made for the purpose 1061. (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 228. 2. REMEDY OP DEFECTS DURING THE YEAR WITHOUT SERVICE OF FORMAL-NOTICES:- Number of defective dwelling-houses rendered fit in consequence of informal action by the Local authority or their Officers 105. 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 repair 60. (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 23. (b) By Local authority in default of Owners5. B. Proceedings under Public Health (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 52. (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners 32. (b) By Local authority in default of Owners 5. C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:- Nil. (14) INSPECTION AND SUPERVISION OF FOOD. Food & Drugs Act, 1938. The following table indicates the samples ta ken during the year 1947:- NUMBER EXAMINED. NUMBER ADULTERATED ETC. In formal Formal Total. Informal Formal Total. Milk. - 62 62 - 1 1 Rum. - 3 3 — - - Gin. - 3 3 - - - Whisky. - 4 4 - - - Brandy. - 1 1 - - - Evaporated Milk. 1 - 1 - — - Malted Milk. 1 - 1 - - - Butter. 4 - 4 - - - Margarine. 5 - 5 - - - Cheese. 1 - 1 - - - Cooking Fat. 4 - 4 - - - Jam/Marmalade/syrup. 4 - 4 - - - Lemon Cheese. 1 - 1 - - - Christmas Pudding 1 - 1 - - - Sponge Mixture. 2 - 2 - - - Yorkshire Pudding & Pancake Mixture. 1 - 1 - - - Yorks Pudding etc. Flour Mixture. 1 - 1 - - - Baking Powder. 5 1 6 1 1 2 Cake Flour. 1 - 1 - - - Steamed Pudding Mixture 2 - 2 - - - Soya Flour. 1 - 1 - - - Pea Flour. 1 - 1 - - - Golden Raising Powder. 5 1 6 1 1 2 Self-Raising Flour. 6 1 7 1 1 2 Arrowroot. 1 - 1 - - - Beef Sausages. 1 3 4 - 2 2 Beef Susage Meat, 1 3 4 - - - Salami Sausage. 1 - 1 - - - Macaroni Cheese. 1 - 1 - - - Savouree. 1 - 1 - - - Pom Maehed Potatoes. 1 - 1 - - - Pickle. 1 - 1 - - - Beef & Vegetable Ex tract. 1 - 1 - - - Benergy Sandwich Spread 1 - 1 - - - Salmon & Shrimp Paste. 2 - 2 - - - Fish Paste. 1 - 1 - - - Salmon & Anchovy fish Paste. 1 - 1 - - - Smoked Herring Fish Pa ste . 1 - 1 - - - Verox Cubes. 1 - 1 - - - Beef Broth. 1 - 1 - - - Fruit Sauce, 4 - 4 - - - Mushroom Ketuchup. 1 - 1 - - - white Pepper. 2 - 2 - - - Salad Cream. 1 - 1 - - - Tomato Flavour Soup. 1 - 1 - - - Cayenne Pepper. 1 — 1 - - - Dorcester Sauce. 1 - 1 - - — Sage & Onion Stuffing. 3 - 3 - - - Cocoa. 1 - 1 - - - Carried forward. 79 82 161 3 6 9 (15)  NUMBER EXAMINED. NUMBER ADULTERATED ETC. Informal Formal Total. Informs Formal Total Brought forward. 79 82 161 3 6 9 Coffee. 1 - - - - - Mixed Spice. 1 - - - - - Ground Ginger. 2 - - - - - Ground Nutmeg. 2 — - - - - Caraway Seeds. 1 — i 1 - - - Malt Vinegar. 1 - 1 - - - Salad Oil 1 — "1 — - - Hydrogen Peroxide. - - - - - - Herbal Licorice Tablets 1 — 1 - - - Lung Syrup. 1 — 1 1 - - Bronchial & Catarrh Tablets. 1 - - - - - Cascara Sagrada Tablets. - 1 - 3 - - Vitamin Tonic. 1 - 1 - - - Blackcurrant Flavoured Cough Elixir. 1 - 1 - - - Borax & Honey. 1 - 1 - Nerve Tonic. 1 - 1 - - - Aspirin. 1 — 1 — - - Epsom Salts. 1 - 1 - - - Seidlitz Powder. 1 — 1 - - - Laxative Tablets. 1 — 1 - - - Campden Solution Tablets 1 - 1 1 - - Tincture of Iodine 1 - 1 - - - Bismuthated Magnesia Tablets. 2 - 1 - - - Compound Syrup of ara. 1 - 1 - - - Orange Flavouring. 1 - 1 - - - Strawberry Flavouring Essence. 1 - 1 - - - Almond Flavouring Essence. 1 - 1 - - - Ginger Wine Essence. 1 - 1 - - - Raspberry Flavouring Essence. 2 - 2 - - - Lime Flavoured Sulphur Tablets. 1 1 1 2 1 - - Food Flavouring Powder. Colouring Matter 1 - 1 - - - (Apple Green] 1 — 1 — - - Colouring Matter (Orange 1 - 1 - - - Synthetic Colouring. 1 - 1 - - - Lemonade Crystals. 4 — 4 — - - Orange Squash. 1 — 1 - - - Mineral Oil. 1 — 1 - - - Dessert Mould. 1 — 1 — - - Malt Chocolate Spread. 1 - 1 - - - Junket Powder. 1 - 1 - - - Gravy Powder. 1 - 1 - - - Saccharin Tablets. 1 - 1 - - - Table Jelly. 1 1 2 1 - - Table Jelly Crystals. 2 - 2 - - - Loaf of Bread. 1 - 1 - - - Total. 135 85 220 10 8 18 (16) Details of the eighteen unsatisfactory samples are as follows:- Sample No. Commodity. Infringement. Remarks. 724. Golden Raising Powder (Informal) Deficiency of available carbon dioxide. Followed up by Formal Sample No. A.355. A 355. Golden Raising Powder (Formal) Sample Vielded 5.7% of available carbon dioxide. Should yield not less than 6% of available carbon dioxide. Warning. Deterioration was due to lengthy storage in shop. Msnufacturer immediately withdrew old stocks and replaced with new. A 356. Beef Sausages (Formal) Infringement of The Meat Products and Canned Meat (Control and Maximum Prices) Order 1947. Warning. The Sutton & Cheam Food Control Committee, after careful consideration decided that the firm in question should be warned only. A 365. . Beef Sausages. (Formal) Infringement of the Ms at Products and Canned Meat (Control and Maximum Prices) Order, 1947. The Ministry of Food Enforcement Officer decided that on account of a technical point, it would not be advisable to take any further action in this case. 739. Lime Flavoured Sulphur Tablets. (Informal) Labelling Infringement. Followed up by Formal sample No. A 381. A 381. Lime Flavoured Sulphur Tablets. (Formal) Labelling Infringement. Tablet ingredients not sufficiently clear on label. Correspondence with the Manufacturers, resulted in new labels being printed, giving a full declaration of the tablet ingvedients. A 371. Milk. (Formal) Slight deficiency of milk solids other than milk fat contrary to the Sale of Milk Regulations 1939. Warning. Dairy man warned. A repeat formal sample was taken and on analysis found to be satisfactory. (17) Sample No. Commodity. Infringement. Remarks. 735. Cascara Sagrada Tablets. (Informal) Labelling Infringe- ment. The Pharmaceutical Society of Great Britain agreed that the tablets were incorrectly labelled. In April, 1947 the Court of Appeal aecided that as far as; Sec. 11 of the Pharmacy & Medicines Act, 1941 is concerned, it would appear that this preparation is not a substance recommended as a medicine within the meaning of the Act. In view of the above it was decided that no further action could at present be taken in these cases. A .378. Cascara Sagrada Tablets. (Formal) Labelling Infringe- ment .752. Cascara Sagrada Tablets. (Informal) Labelling Infringe- ment 753. Cascara Sagrada Tablets. (Informal) Labelling Infringe- ment 776. Campden Solution Tablets. (Informal) Label fails to comply with' Labelling of Food Order. Correspondence with the Ministry of Food revealed that inaccurate advice had been given to the Manufacturer, New labels are now being re-designed. 788. Self Raising Flour. (Informal) Deficiency of available carbon dioxide. Followed up by Formal Sample No. A.404. A.404. Self Raising Flour. (Formal) Self Raising Flour should yield not less than 0.40$ of available carbon. dioxide. This sample contained a deficiency of 62.5% of available carbon dioxide. PROSECUTION. The defendants were fined £5.0.0. with £15.15.0. costs 798. Baking Powder (Informal) Deficiency of available carbon dioxide. Followed up by Formal Sample No. A. 398. A 398. Baking Powder (Formal) Baking powder should yield not less than 8% of available carbon dioxide. This sample contained a deficiency of 56.25% of available carbon dioxide. PROSECUTION. The firm in question were fined £5,0.0. with £5.5.0. costs. (19) Sample No. Commodity. Infringement. Remarks. 805. Table Jelly. (Informal) Table Jelly of unsatisfactory setting qualities. A follow up formal sample (Ho.A405) was taken and on analysis proved to be satisfactory. 851. Lung Syrup. (Informal) Sample contained artificial syrup. The analysis result of this sample was received on 30th December, 1947. It is not yet possible to give a final result as negotiations with the firm concerned are still in progress. During 1947 it was again possible to maintain a satisfactory numerical standard, of sampling over a wide variety of commodities. Of the total samples 5.90% were found to be other than genuine, a very gratifying feature of the year's sampling. This percentage figure excludes informal samples repeated formally. Two successful prosecutions were instituted. MILK SUPPLY. There are 12 dairymen and 13 retail purveyors of milk in the district. Two persons whose premises are outside the district are also registered as retail purveyors. Routineinspection of premises has again revealed that the provisions of the Milk and Dairies Order, 1926, have boon generally well observed. The following Licences to sell graded milks were granted in 1947:- Grade of Milk. Type of Licence. Dealers' Supplementary. Tuberculin Tested. 10 1 Accredited - - Pasteurised. 12 2 MILK SAMPLES. 114 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 mins. Not decolourised in 30 mins. 90 89 1 11 79 (19) 2. Tuberculin Tested (Pasteurised) Milk. Number of Samples. Phosphatase Test. Methylene Blue (Reductase) Test Satisfactory Unsatisfactory Satisfactory Unsatis. factory 22 22 - 15 7 3. Tuberculin Tested Milk. Number of Samples. Coliform Test. Methylene Blue (Reductase) Test Negative Positive Satisfactory Unsa tisfactory. 2 1 1 1 1 The majority of the unsatisfactory bacteriological milk reports were received for samples taken during the months of June, July and August. During these months the weather was unusually warm with prolonged dryness. These conditions had an adverse effect on the keeping quality of milk, and was a matter of general concern to sampling authorities over a wide area. Repeat samples taken during the following months, September to December, when the weather was cooler, all proved satisfactory. In the one case of Tuberculin Tested milk shewing the presence of Coliform Bacilli the matter was taken up with the person concerned and a later repeat sample gave a negative result, ICE CREAM. At the end of 1947, 114 premis:s had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. On six of these premises ice cream could be manufactured. 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 1947 53 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. 60 cases of insanitary or defective conditions in food shops, other than butchers' shops, were dealt with. There is one licenced slaughter-house in the district. The only animals slaughtered during the year have been 6 pigs from pig clubs slaughtered under licences issued by the Ministry of Food. The following Table indicates the number of animals killed (20) inspected and found to be diseased. Cattle Excluding Cows. Calves. Sheep and Lambs Pigs. Number killed. - - - 6 Number inspected. - - - 6 All diseases except Tuberculosis. Whole carcasses condemned. Careasses of which seme - - - Nil part or organ was condemned - - - Nil Percentage of the number inspected affected with disease other than Tuberculosis . - - - Nil Tuberculosis only. Whole carcases condemned. - - - Nil Carcasses of which some part or organ was condemned. - - - Nil Percentage of the number inspected affected with Tuberculosis. - - - Nil The following diseased and/or unsound meat and other foods have been-surrendered and destroyed or, where suitable utilised for pig food:- Commodity. 1bs. Tins. Jars and Packets, Nos. Bacon. 9 - - - Beef. 3266 - - - Bread. 70 - - - Chiekens/Goslings, 126 - - - Cheese. 42½ 12 45 - Cocoa/coffee/tea/sugar . 20¾ 2 9 - Crumpets. mm - ■ - 2 650 Culinary Mixtures/ essences. 35 44 132 - Eggs/egg powder. - 2 - 1894 Fish/Tinned Fish. 3046½ 976 - - Flour (Loose & Paeke ted) 365 - - - Haggis. 36 - - - Marma lade/Jam/Syrup. - 158 16 - Meat & Fish pastes. - 197 9 - Meat pies. - - - 42 Milk. - 1131 - - Misce11aneous. 59¾ 105 - - Mutton. 606¾ - - - Oats/Puffed Wheat. - - 4 - Pork/Eeef Sausages. - 69 - - Prunes/Dates. 74 - - - Rabbits. 879 - - - (21) Commodity. Lbs. Tins . Jars and Packets. Nos. Suet. 18. — — — Semolina. 81 — — — Spaghetti. - 23 — — Saucey/Pickles. - 61 200 — Soups/extracts. - 145 8 — Sweets/Chocolates. 49½ — — 73 Tinned Meats. — 478 — — Tinned Fruits. — 211 — — Tinned/Raw vegetables. 229 460 1 — THE SLAUGHTER OF ANIMALS ACT, 1935. All animals slaughtered in the district have been stunned by means of a mechanically-operated instrument in accordance with the terms of this Act. Four persons were licenced to act as Slaughtermen during 1947. BAKEHOUSES. There are 26 Bakehouses, within the District and of these 22 are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obtained. RAT AND MOUSE REPRESSION RATS AND MICE (DESTRUCTION) ACT, 1919. * THE INFESTATION ORDER, 1945. A. SURFACE TREATMENT. During 1947, 6148 primary and subsequent visits were made in connection with rats or mice infested or suspected infested premises. No major infestations were recorded. 312 premises were satisfactorily cleared of rats or mice and the wcrk for the year is generally summarised below:- Total number of complaints received or cases discovered during the year 1947 376. Total number investigated 374 Total number of premises on which no evidence of infestation was found 51. Total number of premises found to be infested 326. Total number of premises cleared of rats or mice (including 71 premises cleared which were discovered during previous years) 312. (22) Cause of infestation at the 326 premises found to be infested during the year. Keeping of poultry etc, 110. Accumulations of refuse or debris 8. Harbourage under or in garden sheds etc, 90. Defective drains, 5, Inside premises (under floors etc) 86. Buries in gardens etc. 62. Source, untraced. 3. 364. Type of premises cleared Methods employed in clearing of rats or mice. the 312 premises of rats or mice. Dwelling-houses (mainly Poison baits. 296. in gardens) 265. Trapping, 41. Poodshops and food Gassing, 14. premises, 28 Rat & Mouse proofing, 3. Non-food shops and stores, 11. Drains repaired. 5. Factories & workplaces. 2. other means, 5, Offices. 1, Refuse Tips. 2. Miscellaneous. 3. 312, 364. B. SEVERS TREATMENT. (1) 10% TEST. A test beiting of 10% of the soil-sewer manholes in the Borough was completed on the 27th September, 1947. The test was carried out in relationship with the previously recorded surface rat infestations in the District. Very little evidence of any connection between surface end sewer infestations was revealed by the test. The Borough was divided into five sections and the results were as follows:- SECTION. NUMBER OF MANHOLES BAITED. COMPLETE BAIT: TAKES. PARTIAL BAIT TAKES. NO BAIT TAKES. A. 25 5 2 18 B. 60 1 - 59 C. 50 14 — 36 D. 47 9 2 36 E. 18 8 1 9 TOTAL. 200 37 5 158 (2) INITIAL SEVER TREATMENT. An initial treatment of the sewers found to be infested as the result of the 10$ test baiting was completed on the 16th November, 1947. Only those sections of sewers found to be infested during the 10% test were baited. Pre-baiting with damped sausage rusks was carried out on two consecutive days, and the same bait base with 2½% Zinc (23) Phosphide added was laid on the third day. The results are summarised as under:- SECTION NUMBER OF MANHOLES BAITED. UNPOISONSD PRE-BAITS LAID. POISONED BAITS. COMPLETE BA IT TAKES. PARTLiL BAIT TAKES. NO BAIT TAKES. LAID. A. 74. 4. - 70. 8. B. - - - — - C. 202. 14. 2. 186. 21. D. 193. 27. 8. 158. 40. E. 166. 42. 5. 119. 63. TOTAL. 635. 87. 15. 533. 132. (3) FIRST MAINTENANCE TREATMENT. The first maintenance treatment of those sewers found to be infested during the initial treatment was completed on the 27th November, 1947. Pre-baiting with damped bread-crumbs was carried out on two consecutive days, and the same bait-base with 10% Arsenicus Oxide added was laid on the third day with the following re suits:- SECTION NUMBER OF MANHOLES BAITED. UNPOISONED PRE-BAITS LAID. POISONED BAITS. COMPLETE BAIT TAKES . PARTIAL BAIT TAKES. NO BAIT TAKES. LAID. A. 10 1. — 9 1 B. - - - - - c. 32. 5. - 27. 5. D. 57. 5. - 52. 5. E. 71. — - 71. - TOTAL. 170. 11. - 159. 11. A second maintenance treatment will be commenced on th 1st March, 1948. SCHOOLS. The -sanitary condition and water supply of the Schools are satisfactory. ERADICATION OF BED BUGS. 51 bug-infested houses were dealt with as follows:- By the use of Insecticides. Thermatox. Hydrocyanic (H.C.N) Gas. Council Houses. 1. - - Other Houses. 50. - - (24) The work of disinfestation hag continued to be carried out upon the lines indicated in previous Reports. The Insecticide used was D.D.T. SHOPS ACT. One hundred and twentynine visits were made in connection with Section 10 of the Shops Act, 1934. INSPECTION OF SANITARY CONVENIENCES AT LICENCED PLACES OF PUBLIC ENTERTAINMENT. There are 19 licensed places of Public Entertainment in the Sutton & Cheam area. They are mainly used for cinematograph shows, music, dancing, whist drives, singing and socials. All the sanitary conveniences at these premises have been inspected, and found to be generally well maintained. A few minor defects were discovered, and action was taken for remedial work to be put in hand forthwith. INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Six hundred and twenty-four cases of infectious disease were notified during the year 1947, an increase of ten cases over the number in 1946: 226 were cases of Measles, and 149 were cases of Whooping Cough. The most important features were the high incidence of Poliomyelitis, and the low incidence of Diphtheria. SCARLET FEVER:- One hundred and seventy-two cases were notified, an increase of thirty-six cases. Ten of these were from an institution. The increase was due to an outbreak of infection in a school. The disease was generally mild. There was one death of an epileptic child aged 4 years, from fits induced by the infection. The case rate was 2.11 per 1000 of population compared with 1.37 per 1000 of population for England and Wales, DIPHTHERIA:- Two cases were notified compared with twenty-two in 1946. Both were adults. The case rate was 0.02 per 1000 of population compared with 0.13 per 1000 of population in England and Wales. There was no death. It is satisfactory to record that no case of Diphtheria occurred among children. This is in accordance with the general decline in incidence and fatality as a result of immunisation. The Diphtheria bacillus has not been eliminated. The number of carriers in the community is unaltered, and the virulent germ still lurks in our midst ready to penetrate any weakness in our armour of immunisation. It is well for parents to ensure that their children are immunised in early infancy, and reinforced regularly at intervals of not more than four years, DIPHTHERIA ANTITOXIN:- The early diagnosis of cases of Diphtheria, and their early treatment with Diphtheria Antitoxin are the greatest safeguards against mortality. Medical practitioners should administer large doses of antitoxin on suspicion of infection and while awaiting bacteriological confirmation of diagnosis. Otherwise, suspected cases should 25. be admitted to hospital at once for observation. Any delay in the administration of antitoxin gives time for the fixation of the dangerous 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:- Control over Diphtheria by immunisation is becoming effective, but there can be no relaxation in this fight. Over fourteen hundred babies are born into our population every year. To ensure complete success, all must have primary immunisation at Or before the first birthday. Protection rises after the primary injections and then gradually declines. Reinforcement is necessary every four years. If the child is to enter a nursery school, reinforcement is desirable at the age of 3 years. Every child should be reinforced before entering day school at the age of 5 years, and again at the age of 9 years. Diphtheria remains dangerous. Freedom from this infection must not engender any feelings of complacency. A high state of immunisation must be maintained. During the year 1947, eight hundred and twenty children were immunised against Diphtheria. The number immunised at the age of 1 year was 586, which represents 42 per cent of the babies reaching that age during the year, compared with 43 per cent for this age group in 1946. Four hundred and sixty-five children received reinforcing injections. The following table 3hows the distribution in age groups of children who received primary injections during the year. Under 1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 910 1011 11- 12 1213 1314 1415 Over 15 Total, 14 586 117 20 15 18 15 4l 15 6 4 - 3 1 2 - 820 At the end of the year, 10,227 children, representing 62.9 per cent of all the children, had been immunised. Of these, 2,588 represents 43.9 per cent of the children under five years of age, and 7,639 represents 73.7 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 age) 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) 26. MEASLES:- Two hundred and twenty-six cases were notified in 194-7, compared with two hundred and thirty-three cases in 1946, The case rate was 2.80 per 1000 of population, compared with 9.41 per 1000 of population for England and Wales, There was one death of a child aged 3 years from convulsions. The risks involved in infection by Measles are not always fully realised. Measles weakens the resistance of the body, and opens the way for other dangerous organisms which cause Bronchitis or Pneumonia. Careful nursing and careful convalescence are essential if complications are to be avoided. Children should be protected from infection by the isolation of any suspected case in the home. The slight primary catarrh of the nose, throat, and eyes, together with the child becoming miserable and disinclined for food or play should be the signal for precautions. Information of notifications of children under five years of age are 3ent 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. 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 Over 15 Total No, of Cases 9 14 22 25 26 49 27 15 12 7 2 2 2 3 1 10 226 WHOOPING COUGH:- One hundred and forty-nine cases were notified in 1947, compared with one hundred and forty-three in 1946, The case rate was 1.85 per 1000 of population, compared with 2.22 per 1000 of population for England and Wales, There was one death of a child aged 1 month from convulsions. Mortality from Whooping Cough falls most heavily on children under 1 year of age, for whom the disease is always serious, and to whom immunisation with vaccine is not applicable. The protection of young babies is rendered very difficult in many homes by the overcrowded conditions and lack of any room for the isolation of children who contract infection. Some prospect of treating Whooping Cough effectively in the early stages of the disease lies in the perfecting of new antibiotic drugs, active against the Bacillus Pertussis. A specific form of treatment for Whooping Cough would save many lives and reduce the infectivity of the disease. Immunisation by vaccine may help to raise the resistance of our uninfected children. 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 Over 15 Total No. of Cases 15 14 28 17 10 35 10 7 5 2 1 1 2 - - 2 149 i IMMUNISATION AGAINST WHOOPING COUGH:- The scheme of immunisation is restricted to children between the ages of 1 year and 5 years of the poorer inhabitants, to weakly children, and to children from overcrowded homes. During 1947, 209 children received injections, making a total of 412 children treated since the scheme was introduced in 1945, Since that date four children of the inoculated group have contracted Whooping Cough, Two have had severe attacks, and two mild attacks. The rate of 27, inci.dcnce in the inoculated group has been 1 in 103. The inoidanoe in the corresponding age group 1-5 years in the genral population during 1947 was 1 in 64. Thus there may be some reduction in incidence attributable to the vaccine. The malerial used is Bacillus Pertussis 'S' vaccine, 20 millions percent The dose given is 0,5 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 Floncules as a diluting agent and for combining immunisation against Diphtheria, This combination has been free from reactions. PUERPERAL PYREXIA Seven cases were notified in 1947, the same number as in 1946. The case rate was 4.74 per 1000 total births, compared with 7,16 per 1000 total births for England and Wales, The early notification of Puerperal Pyrexia is of primary imoortance in the prevention of maternal mortality. Medical practitioners should make the fullest use of the consultant, bacteriological, and hospital services provided by the Authority, and secure the immediate and effective isolation of any suspected case occurring in a maternity home. TYPHOID AND PARATYPHOID FEVERS:- One case of Typhoid Fever and one case of Paratyphoid Fever were notified. No source of infection was found in this Borough, Both cases recovered. DYSENTERY:- Three cases were notified in 1947, compared with thirty-five cases in 1946. Two were of the Flexner type and one of the Sonne type. The cases are a warning to all engaged in the handling and distribution of food that carriers exist and that scrupulous cleanliness of the hands of all parsons dealing with food is essential for the prevention not only of this disease, but of all enteric infections and other forms of food poisoning derived from dirty hands, FOOD POISONING:- During the year twenty-eight persons suffered from acule Staphylococcal food poisoning which could have been prevented by reasonable care on the part of manufacturers or purveyors of food. There were two outbreaks, one derived from cooked meat infected in a factory outside this Borough, and the other from a trifle prepared in a restaurant within this Borough. Symptoms were severe in some cases for 48 hours, and weakness lasted for over a week. Proprietors and managers of premises where food is prepared and distributed for human consumption must be made to realise their high responsibility to the general public, and to ensure that all persons employed in the handling of food give adequate care and attention to the cleanliness of their persons, clothing, and in particular to the proper cleansing of their hands, especially after defaecation, and before touching food, and that their premises and utensils are thoroughly cleansed to prevent bacterial contamination, and that refrigerators are used intelligently for the suppression of bacterial growth on foods, particularly during hot summer weather. An instructive circular in these terms, and calling attention to obligations under Section 13 of the Food and Drugs Act, 1938, was sent to all purveyors of food in the Borough. CEREPRO-SPINAL FEVER Four cases were notified. These were Sporacde and not interconnected. All were severe, and all recovered, 28 ANTERIOR POLIOMYELITIS:- Twenty-nine acute cases were diagnosed within the Borough between May and December 1947, Eight of these were abortive, and recovered without paralysis. Nineteen suffered from paralysis. Two died. Of the nineteen paralysed cases; five have recovered completely. Nine have slight residual weakness of one limb. Two have partial loss of function of one limbc Three are seriously disabled. Thus of the twenty-nine cases, twenty-two have recovered without serious disability, a satisfactory result which can be attributed to the excellent primary treatment given at Cuddington Isolation Hospital and subsequently in the orthopaedic departments of St. Helier Hospital and Sutton and Cheam Hospital, and which holds out the hope of considerable improvement in the more severe cases still under treatment. In the paralysed cases the main localisation of paralysis was as follows. Site Face R.Arm L.Arm Both Arms R. Leg L.Leg Both Legs Total No. of Cases 4 3 2 1 5 1 3 19 and the result of treatment was Recovered 3 1 - - 1 - - 5 Slight Weakness 1 2 1 1 3 1 - 9 Moderate Disability - - 1 - 1 - 2 Severe Disability - - - 7 - - 3 3 The principal focus of infection was in Sutton. It is probable that infection was introduced into this area early in July by an ambulant case in the early phase of illness. Fourteen cases occurred within the area of a square mile. Other smaller foci of infection were in an institution (5 cases) in the SouthWost Ward (5 eases) in the North Ward (2 cases) and in the Northwest Ward (2 cases). The group of cases in the Sutton area showed well defined circumferential spread, an unexplained feature of Poliomyelitis. Only in two instances were two cases diagnosed in one family. In general it was the exception for direct contacts of cases to fall ill with the disease. Only in two instances were two families affected in the same street. The sequence of infection was seldom ordered by association between families or proximity of dwellings. Bad housing or overcrowding did not appear to attract infection. Infection could not be traced to cinemas or swimming baths or crowded assemblies. No common infecting food factor was apparent. Where two oases did occur in one family it was the result of exceptionally close contact. The relative freedom from infection of direct contacts of cases suggests either that the dose of infection to produce the disease is very high, or that highly susceptible people are relatively few. It is possible that direct contacts who do not fall ill with the disease become potent carriers of infection, and set up a chain of infection through contact with other non-susceptibles until a highly susceptable person is encountered, It is known that the virus lies in the nasopharynx and in the bowel of infected persons, and the chain of contact infection may 29 be sustained by spray infections from the throat, or by food contaminated either by the hands'or by the breath of infectious carriers, or by an insect vector. It is possible that susceptibility may be related to some biological influence. No person over forty was a victim of the disease. Three of the eleven women of child bearing age who contracted the disease were pregnant. Severe fatigue, emotional instability and intercurrent infection were factors which appeared to predispose to infection, and precipitate illness. The age and sex distribution of the cases was as follows. Age 1-5 5-10 10-15 15-20 20-25 25-30 30-35 35-40 Total Males 3 0 3 0 1 2 2 0 11 Females 3 2 1 6 1 3 1 1 18 Total 6 2 4 6 2 5 3 1 29 The main deduction that can be made from this experience is that the control exercised over the movements of persons who have been in contact with a proved case of Poliomyelitis must be rigid and exercised before the chain of infection has been established, PNEUMONIA:- Of forty-two deaths occurring from all forms of Pneumonia, one case was notified previous to death. The total number of notified cases arising in the district was twenty-six, NON-NOTIFIABLE DISEASES:- School teachers reported seven cases of Mumps, one hundred and twenty-seven cases of Chicken v Pox, and one hundred and three 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 considerable reduction in the incidence of this parasitic infection of the skin. The treatment clinic in St. Nicholas Road, Sutton, operated efficiently under the care of Nurse James, and with voluntary help of Mrs, Berry, and dealt with sixty-three cases, compared with one hundred and sixty-eight cases in 1946, The number of attendances at the clinic was two hundred and thirty-four, compared with six hundred and twenty-five in 1946. The treatment Is by bathing and the application of Benzyl Benaoate emulsion to the skin, LICE:- There was a decrease in the number of cases of head lice treated at the clinic, Thirty cases were treated during the year, compared with sixty-seven cases in 1946, The number of attendances for treatment was seventy-five, compared with two hundred and fifty-four in 1946, 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 B,D.T. which helps to keep children free from infestation. \ 30 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1947 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 - - 5 14 7 76 42 7 5 5 1 - 162 93 1 Diphtheria - - - - - - 1 1 - - — 2 2 - Typhoid Fever - - - - - - - - - - - 1 1 1 - Para-typhoid 1 - - - - - - - - - - - 1 1 - Puerperal Pyrexia - - - - - - - - 4 3 - - 7 - - Pneumonia - - 2 1 - 1 1 - 2 5 10 4 26 1 42 Erysipelas - - - - - - - - 1 2 1 - 4 1 - Dysentery - - - - - 1 - - 2 - - - 3 1 - Poliomyelitis - 1 - 2 2 2 4 2 10 1 - - 24 21 2 Cerebro-spinal Fever 1 - - - - - 1 1 - 1 - - 4 4 - Measles 9 14 22 25 25 108 10 4 3 2 1 — 223 12 11 Whooping Cough 15 14 28 17 10 59 4 1 1 - - - 149 16 1 London Cases in the Downs Hospital, Scarlet Fever 2 4 2 - - 1 - 1 - - - - 10 10 - Poliomyelitis - 1 - - - - - 4 - - - - 5 5 - | Measles - — - - 1 2 - - - - - - 3 3 - Under Column "Died" all deaths, whether notified in the district or outside it, or not notified at all, are included, BACTERIOLOGICAL EXAMINATIONS The following examinations of specimens were made by direction of the Borough Council. Diphtheria Enteric Tuberculosis Positive Negative Positive Negative Positive Negative 1 94 4 31 6 26 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above table. 31 32. DISTRIBUTION OP NOTIFIABLE DISEASES IN WARDS DISEASE WARDS Case Rate per 1000 Populatn (Mid-Year) Case Rate per 1000 England & Wa1es N. N.W. N.E. W.C. E.C. E. S .W. S.E. S. Total Population 10487 9325 112 60 13137 7713 7866 6279 6073 8450 80590 Scarlet Fever 22 12 15 63 12 8 13 61 11 162 2.01 1.37 Diphtheria - - - - - - - 1 1 2 0.02 0.13 Typhoid 1 - - - - - - - - 1 0.01 0.01 Fara-typhoid - - - - 1 - - - - 1 0.01 0.02 Puerperal Pyrexia - - - - - - 2 4 1 7 - - Pneumonia 2 3 4 2 2 7 1 2 3 26 0.32 0.79 Erysipelas - - - 2 - 1 1 - - 4 0.05 0.19 Dysentery - - - 1 2 - - - - 3 0.04 - Poliomyelitis 2 2 - - 3 1 5 5 6 24 0.29 - Cerebro-spinal Fever 1 - - 1 1 - - - 1 4 0.06 0.05 Feasles 13 32 29 49 26 25 14 15 20 223 2.74 9.41 Whooping Cough 12 4 16 19 19 33 12 15 19 149 1.85 2.22 Total 53 53 64 137 66 75 48 48 62 606 TUBERCULOSIS On the 31st December 1947, there were on the Register 774 cases of Tuberculosis, of whom 621 were pulmonary cases and 153 non-pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.38 per 1000 of population, and for non-pulmonary Tuberculosis 0.09. The total death rate from Tuberculosis was 0.47 per 1000 of population compared with 0.34 per 1000 of population in 1946. The corresponding death rates for England and Wales in 1947 were: Pulmonary 0.47 per 1000 of population; non-Pulmonary 0.08 per 3.00 of population. Total rate. 0.55 per 1000 of population. The higher death rate may be reflection of the higher incidenoe during the war. There is always a time lag between higher incidence and higher mortality. The number of new cases of pulmonary Tuberculosis was 64 compared with 71 in 1946. The number of new cases of non-pulmonary tuberculosis was 6 compared with 9 in 1946. This is satisfactory, but mass radiography is revealing to us that a rise in the numbers diagnosed in the earliest stage of infection would be to our advantage. The overcrowded and unhealthy housing conditions at present react against any substantial reduction in incidence. The Sutton and Cheam Tuberculosis Care Committee continued to function as a social welfare committee dealing with every social influence affecting the patient and his family. The Committee enjoyed the close co-operation of the lady Almoner for Tuberculosis, whose fine work in the interests of the patients is worthy of the highest praise. The scheme of allowances continued to operate beneficially. The following table shows the 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 2 1 - 1 - - - 1 5 3 1 1 - 1 - — 1 15 9 20 - 1 2 2 - 1 25 7 3 - 2 2 - — 2 35 6 2 - - 2 4 - - 45 4 1 1 - 4 2 2 - 55 3 - - - 2 3 - - 65 and above 2 - - - 6 1 - - Totals 36 28 2 4 19 12 2 5 NOTIFICATION OF TUBERCULOSIS Respiratory Forms of Deaths - 25 out of 31 were notified. Other Forms of Death - 5 out of 7 were notified. 33. CIVIL AMBULANCE SERVICE This is the last full yearly report on the Ambulance Service which I shall have the pleasure of presenting to the Council. During the year 1947 the service operated satisfactorily. The total number of calls reached 1866, Consideration of the full daytime use of the two ambulances is now due, and is included in the proposals of the Surrey County Council under the National Health Service Act 1946, The staff under their Supervisor, Mr. F. Nazer, have given excellent service, and I would express my thanks to them for their constant loyalty and devotion to duty. The number of calls and types of call in 1947 are here compared with the calls in 1946, Accident Illnesss in Street Urgent Illness Non-urgent Illness Maternity Hospital Transport Total 1946 303 141 237 225 204 215 1325 '1947 364 147 290 398 215 391 1806 Of the 1806 calls, 542 were dealt with by the second ambulance, and 117 by mutual support from other districts: 359 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 28 15 36 41 25 39 14 59 49 58 364 Urgent 27 12 65 42 35 57 10 52 61 76 437 Non-Urgont 37 10 81 64 32 65 34 57 223 186 789 Maternity ' i CO 8 40 22 21 33 3 15 27 39 216 Totals 100 45 222 169 113 194 61 183 360 359 1806 The following table shows the number of calls per month in 1947 compared with the number of calls per month in 1946, Jan. Feb. Mar. Apr. May June. July. Aug. Sept. Oct. Nov. Dec. Total. 1946 105 109 103 103 87 97 98 116 97 105 133 172 1325 1947 167 154 176 159 143 160 143 124 133 128 147 - 172 1803 The following table shows the number of days in the year 1947 on which the number of calls varied from 0 to 16, Comparison is made with the year 1946. No, of calls per day 0 1 L 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1946 No, of days in year 11 58 41 88 57 40 29 24 7 7 1 2 - - - - - 1947 No. of days in year 5 18 42 50 51 57 _ 56 29 25 14 8 6 1 2 - - 1 34