SUTC 12 BOROUGH OF SUTTON AND CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948. borough of sutton and cheam. annual report of the MEDICAL OFFICER OF HEALTH For the Year 1948. PUBLIC HEALTH COMMITTEE HIS WORSHIP THE MAYOR (ALDERMAN W. T. VENTON, J.P.) Alderman F.C. Lohden, O. B. E. Coun, E.E.Blane (Mrs.) Coun. F.E.Smyth (Mrs.) J.P. " d.h.Manning. " d.Sparks (Mrs.) M.B.E. " J.Nicholson. " W.C.Wallia. " J.C.Robertson, " f. Warren. Coun, Kingsley Williams. (Chairman) PUBLIC HEALTH OFFICERS OF THE AUTHORITY. MEDICAL OFFICER OF HEALTH. ENEAS J. MACINTYRE, M.D. D.P.H. CHARLES SANITARY INSPECTOR. CHARLES WILLIAM NEWBERY. Certif. R.S.I., Certif. Meat & Food, Certif. S.I. Exam. Board. DEPUTY CHIEF SANITARY INSPECTOR. ARTHUR SYDNEY WILLIAMS. Certif. R.S.I. Certif. Meat & Food. ASSISTANT SANITARY INSPECTORS. WALTER BLACK, P.P.A. Certif. R.S.I, and .I.E.J.B. Certif. Meat & Food. PETER EVERT KINTON. Certif. R.S.I. and S.I.E.J.B., Certif. Meat & Food, (Resigned 6.6.1948.) 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 SUTCLIFFE. Certif, R.S.I. and S.I.E.J.B., Certif. Meat & Food. 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 1948, The National Health Service Act, 1946, came into operation on 5th July, 1948, and at the end of the year proposals for the reorganisation of the personal health services were under consideration. Simultaneously, the National Assistance Act, 1948, containing important provisions for the care of the aged, became operative. The administration of the environmental, sanitary, and epidemiological services was not affected by these major legislative changes. During the year 1948, the general health of the community was good. There was a fall in the birth rate from. 17.9 per 1000 of population to 14,8 per 1000 of population. The death rate was lower. The infantile mortality rate of 28 per 1000 live births was a new low record for the Borough. The maternal mortality rate remained low. An epidomic of Measles occurred during the Spring and early Summer. Otherwise there was no unusual incidence of infectious diseases. The child population, within the age groups subject to immunisation, was free from Diphtheria, The first visit to the Borough of a Mass Radiography Unit in April, 1948, confirmed the value of this service for the detection of early disease of the chest, and for the prevention of chronic ill-health. The deficiency of housing accommodation continued to be the most adverse influence affecting the public health. At the end of the year there were 3,750 applicants on the waiting list. The serious discomfort being endured by some of these families calls for early relief, from local, regional, or national housing resources. Encouraging progress was made on the Council's schemes for permanent houses. Twenty-two permanent houses were completed and occupied, and thirty-nine houses were under construction. 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 also given valuable service in promoting the provision of temporary housing accommodation, in sustaining the habitability of houses, and preserving 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. I thank 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-operation. I am, Kr. Mayor, Ladies and Gentlemen, Your obedient Servant, ENEAS J. MAC INTYRE Medical Officer of Health. (3) STATISTICS OP THE AREA 1947 1948 Area in Acres 4358.15 4338.15 Registrar General's Estimate of the Resident Population 80,590 81,320 Number of inhabited houses (end of year) according to the Rate Book 22,306 22,857 Rateable Value and sum represented by a Penny Rate £901,065 £3,685 £897,257 £3,670 EXTRACTS PROM VITAL STATISTICS COMPARATIVE OP THE YEARS 1947 AND 1948 Total 1947 Male Female Total 1948 Male Female England & Wales 1948 Live Births 1446 753 693 1203 591 612 Legitimate 1380 717 663 1151 564 587 Illegitimate 66 36 30 52 27 25 Birth Rate per 1000 of the Estimated Resident Population 17.9 14.8 17.9 Still Births 30 15 15 21 13 8 Legitimate 27 12 15 20 13 7 Illegitimate 3 3 - 1 - Rate per 1000 total (live and still births) 20.3 17.2 23.0 Deaths 886 435 451 806 382 424 Death Rate per 1000 of the Estimated Resident Population 10.9 9.9 10.8 Deaths from Puerperal Sepsis 1 0 Other Puerperal Causes 0 1 Death rate from Puerperal Causes per 1000 total (live and still births) 0.68 0.82 0.86 Deaths of Infants under one year of ago All Infants per 1000 live births 30.43 28.26 34.0 Legitimate Infants per 1000 legitimate live births 29.0 26.07 Illegitimate Infants per 1000 illegitimate live births 60.6 76.92 (4)  1947 1948 Deaths from Cancer 148 136 „ „ Measles 1 0 „ „ Whooping Cough 1 0 „ „ Diarrhoea 0 1 Percentage of Deaths from certain causes to the total number of deaths. Diseases of the heart and circulation 31.5 35.0 Cancer and malingant disease 16.7 16.9 Diseaases of the lunds (non tuberculous) 12.5 9.9 Tuberculous diseases 4.3 4.0 Cerebral haemorrhage 12.0 11.3 Congenital Diseases 3.7 3.3 Suicide and Violence 3.6 4.2 Diseases of the digestive system 4.0 4.0 Infectious diseases 2.4 0.9 Diseases of the kidney 2.1 3.0 Other defined diseases 7.2 7.5 MATERNAL MORTALITY:-There was one death from Toxaemia of pregnancy and Chronic Interstitial Nephritis. The maternal mortality rate was 0.82 per 1000 total births. The rate for England and Wales was 0.86 per 1000 total births. INFANTILE MORTALITY:- The infantile mortality rate was 28.26 per 1000 live births. compared with 30.43 per 1000 live births in 1947. The rate for England and Wales was 34 per 1000 live births. There were thirty-four deaths of infants under one year. compared with forty-four in 1947. Of the thirty-four deaths. twenty-seven occurred in the neo-natal period. within one month of birth. as is shown in the following table of causes and age groups. Age Groups Causes of Death Under 1 month 1-3 months 3-12 months Congenital Abnormality 16 - - Permaturity 7 - - Broncho-Pneumonia - l 1 Cerebral Haemorrhage 2 - - Asphyxia 2 1 2 Cerebro Spinal Meningitis - - 1 Gastro enteritis - 1 - 27 3 4 (5) CAUSES OF DEATH IN THE BOROUGH OP SUTTON AND CHEAM DURING 1948. M. F. Total 1 Typhoid and paratyphoid fevers - 1 1 2 Cerebro-spinal fever 1 - 1 3 Scarlet Fever - - - 4 Whooping Cough - - - 5 Diphtheria - - - 6 Tuberculosis of respiratory system 19 11 30 7 Other forms of tuberculosis 1 1 2 8 Syphilitic diseases 3 2 5 9 Influenza - - - 10 Measles - - - 11 Acute poliomyelitis and polioencephalitis - - - 12 Acute infective encephalitis - - - 13 Cancer of buccal cavity Oesophagus (M) and Uterus (F) 8 8 16 14 Cancer of stomach and duodenum 14 7 21 15 Cancer of breast - 13 13 16 Cancer of all other sites 50 36 86 17 Diabetes - 3 3 18 Infracranial vascular lesions 33 58 91 19 Heart disease 106 143 249 20 Other diseases of circulatory system 11 22 33 21 Bronchitis 17 14 31 22 Pneumonia 18 15 33 23 Other respiratory diseases 12 4 16 24 Ulcer of stomach or duodenum 7 3 10 25 Diarrhoea under 2 years 1 - 1 26 Appendicitis 3 1 4 27 Other digestive diseases 7 7 14 28 Nephritits 13 11 24 29 Puerperal Sepsis - - - 30 Other maternal causes - 1 1 31 Premature birth 3 4 7 32 Congenital malformations, birth injuries and infantile diseases 9 11 20 33 Suicide 8 5 13 34 Road traffic accidents 3 3 6 35 Other violent causes 5 10 15 36 All other cases 30 30 60 382 424 806 (6) GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA LEGISLATION Bye-laws Bye-laws as to the business of Hairdreseor and Barber became operative on 1st January, 1948. National Health Servioe Act, 1946. Sec, 26. Vaccination and Immunisation, The Council approved that the Medical Officer of Health for the Borough should act as agent for the County Medical Officer of Health in the administration of these servioes as from 5th July, 1948, Sec. 27, Ambulanoe Services, The Council's Ambulance Service was transferred to the administrative control of the Surrey County Council on 5th July, 1948. Naticnal Assistance Act, 1948, Sec, 47, Removal of persons in need of care and attention. A Court Order was secured and applied in November, 1948, for the removal of a woman, aged 60 years, suffering from mental depression and living in insanitary circumstances, to residential accommodation provided by the Surrey County Council at The Oaks, Dorking Road, Epsom, After the period of three months prescribed, the patient was discharged is being recovered and fit to lead a normal life, but the return to her former environment has reacted unfavourably, Sec. 50, Burial or cremation of the dead. Five burials were arranged under the powers granted to the Council by this section, LABORATORIES Arrangements were continued for the use of the laboratory at Sutton and Cheam Hospital, which has provided an efficient and convenienc Public Health Laboratory service for many years. Supplementary service has been provided at the Public Health Laboratory, Epsom, but its use is limited owing to the distance from the Borough, MORTUARY During 1948, ninety-six bodies were received, and ninety-six post mortem examinations were made. The mortuary premises and equipment, which includes a three body refrigerated chamber, have been well maintained, CLINICS Details of Clinics available for the district are given at the end of this Report, (7) 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 degress 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 chomist 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. CHEMICAL RESULTS IN PARTS PER 100,000 AVERAGE Total solid residue dried at 180° c. 18.46 Ammonia, free 0.0111 Ammonia, Albuminoid 0 Nitrogen in Nitrates 0.766 Nitrogen in Nitrites 0 Oxygen absorbed in 4 hours at 27° C. 0.0038 Chlorine in Chlorides 1.792 Hardness total (grains per gallon) 7.58 BACTERIOLOGICAL RESULTS No. of Bacteria growing on Agar per c.c. for 3 days at 20° C. 1.5 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 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 Sewage Works or in connection with the main drainage system, A scheme for the major reconstruction of the Worcester Park Sewage Works is in course of preparation, REFUSE COLLECTION AND SCAVENGING. The colloction and disposal of house refuse and salvage, together with the scavenging of publio 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 9 premises with cesspools in use. Some 6 pail closets and 1 privy are in use. In the past twenty years 158 premises, originally with cesspool drainage, have been oonneoted to sewers. (8) 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 the Report of the Chief Sanitary Inspector on Sanitary circumstances, Housing, Food Supply, etc. (pages 9 to 26 ) continues to be condensed. RECORD OF INSPECTIONS AND NOTICES SERVED. Number. Special Inspections; interviews on premises and advisory visits 1,721. Re-inspections 4,085. Visits to works in progress 1,536. Visits to Factories (with or without power) and workplaces 297. Visits to Bakehouses (with or without power) 28. Visits to Outworkers premises 44. Visits to Slaughterhouses 2. Visits to Butchers, Grocers and other food premises 364. Visits to Dairies and Milk Shops 14. Visits to Ice Cream promises 97. Visits to Stables, Passages, Pigstyes 25. Visits to Restaurant and Cafe Kitchens 51. Visits to Premises re rats and mice infestations 5,879. Visits to Tents, Vans, Shods etc 5. Visits to Cinemas, Theatres, Halls etc. 18. Visits to Premises re infectious diseases 162. Visits to Premises re overcrowding and Permitted Numbers 623. Visits to Premises re food complaints (shops and private houses) 388. Visits to Harbors' and Hairdressers' premises 87. Visits to Public and School Conveniences 37. Visits and re-visits to Verminous Houses 67. Visits and re-visit's under the Shops Acts 302. Visits re taking of Food and Drug Samples 147. Visits re Bacteriological sampling of milk, water etc. 77. Visits re Bacteriological sampling of ice cream 62. Visits re Smoke observations 8. Miscellaneous Visits 2,623. 18,749. Premises at which defects or nuisances were discovered 1,603. Dwellinghouses surveyed for housing defects under Public Health or Housing Acts 345. Defects or nuisances discovered 2,788. Defects or nuisances remedied 1,936. Defects or nuisances in hand 153. Defects or nuisances outstanding 699. Informal Notices served 970. Statutory Notices served:- Housing Act, Sees. 9 & 10 40. Public Health Act, Sec. 24. 54. Public Health Act, Sec. 39. 26. Public Health Act, Sec. 48. 3. Public Health Act, Sec. 45. 7. Public Health Act, Sec. 93. 3. Public Health Act, Sec. 75. 18. Total 151. Complaints received and investigated 710. (9) SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT. DRAINAGE AND SANITARY SITTINGS, Number of houses and other premises redrained 17 Number of houses and other premises connected to soil sewers 3 Repairs and amendments to existing drains 163 Drains or gullies unstopped and cleansed 305 Sanitary fittings repaired, renewed, provided or cleansed 830 Water service pipes and/or cisterns, repaired, renewed or cleansed 41 Water, smoke and chemical tests applied 436 W.C. APARTMENTS. W.C. Apartments provided 8 W.C, Apartments lighted and/or ventilated 13 Ventilated lobbies to W.C. Apartments provided 5 Separate accommodation for the sexes provided 3 W.C, Apartments cleansed 64 STRUCTURAL RE' AIRS OR IMPROVEMENTS. Roofs renewed or repaired 316 Guttering and rainwater pipes provided, repaired etc. 163 Damp walls remedied 110 Brickwalls repointed, repaired or rendered 66 Chimney stacks repaired or rebuilt 30 Yards paved or repaired 18 Sites of houses concreted 7 Floors relaid or repaired 174 Windows and/or cills repaired or renewed 139 Doors and thresholds provided or repaired 57 Staircases, and/or handrails provided or repaired 22 Ranges, stoves and coppers repaired or renewed 96 Miscellaneous 165 CLEANSING. Rooms, passages, larders etc. cleansed repaired 473 Trade premises cleansed 98 Verminous houses disinfested for bugs, fleas 44 Premises sprayed for flies, crickets, cockroaches etc. 90 Premises disinfected after various diseases 241 Miscellaneous 92 Offal bins provided 2 Dustbins provided 1ll Accumulations of refuse and manure removed 33 Premises cleared of rats and/or mice 351 Offensive ponds and ditches cleansed 1 Wasp nests destroyed 113 SMOKE ABATEMENT. The few chimneys attached to industrial premises in the district have been kept under observation. During the year seven smoke and grit nuisances were detected and abated without the need for formal action. (10) FACTORIES ACT 1937 1. INSPECTION OF FACTORIES AND OTHER PREMISES Inspections made by Sanitary Inspectors For purposes of provisions as u health Premises (1) Inspect ions (2) Number of Occupiers Prosecuted (4) Notices Written & Oral (3) Factories with Mechanical power 219 33 — Factoriea with out Mechanical Power 103 27 - Other Premises (other than Outworkers' premises 3 - - Total 325 60 - 2. DEFECTS FOUND IN 'FACTORIES AND OTHER PREMISES UNDER THE ACT Particulars (1) Number of defects Number of defects in respect of which prosecutions were instituted (6) Found (2) Remedied (3) Referred t o H. M. Inspector (4) Referred by H.M. Inspector (5) Want of cleanlinoas 16 15 - - - Inadequate ventilation 2 2 - — - Overorowding - - - - - Unreasonable Temperature - - - - - Ineffective drainage of floors - - - - - Absence of Thermometers - - - - - Absence of suitable lighting in W.C.Apartmerits 4 1 - - - Other nuisances 72 59 1 - - Carried forward: 94 77 1 - - (11) Particulars (1) Number of defects Number of defects in respect of which prose cut ions were instituted (6) Found (2) Remedied (3) Referred to H.M. Inspector (4) Referred by H.M. Inspector (5) Brought forward: 94 77 1 - - Sanitary Accommodation (a) Insufficient 2 - - 1 - (b) Unsuitable or defective 9 8 - 2 - (c) Not separate for the sexes 2 1 - - - Totals 107 86 1 3 - 3. 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 3 - - HOUSING 1. INSPECTION OF DWELLING-HOUSES DURING THE YEAR:- (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 345 (b) Number of inspections made for the purpose 1,049 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 214 (12) 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 63 3. ACTION UNDER STATUTORY POWERS DURING TEE YEAR:- A. Proceedings under Sections 9,10 and 16 of the Housing Act, 1936:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 40 (2) Number of dwollinghousos Which were rendered fit after service of formal notices:- (a) By Owners 22 (b) By Local Authority in default of Owners 4 B. Proceedings under Public Health Act (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 11 (2) Number of dwelling-houses in which defects were remedied after service of 'formal notices:- (a) By Owners 10 (b) By Local Authority In default of Owners — C. Proceedings under Sections 11 and 13 of the Housing Act,1936:- Nil (13) INSPECTION AND SUPERVISI ON OF FOOD. Food & Drugs Act, 1958. The following table indicates the nature of the 221 formal and informal samples submitted for analysis during the year 1948. Article, Number of samples examined. Number of unsatisfactory samples. Formal Informal . Total Formal Informal Total Adexoline Tablet Capsules 1 1 Apple Sauce 1 1 Baking Powder 3 3 Barley Crystals 1 1 Bicarbonate of Soda 2 2 Black Pudding 1 1 Brandy 1 1 Butter 1 1 Cake Decorations 1 1 Cake Mixture 1 1 Campden Solution Tablets 1 1 1 1 Catarrh & Bronchial Syrup 1 1 Cheese (Alpine) 1 1 Chocolate Spread 1 1 Chunx (Sweets) 1 1 Chutney 1 1 Cinammon (Ground) 1 1 Cocoa 1 1 Cod Liver Oil 1 1 Cod Liver Roe Paste 2 2 Coffee 1 1 Coffee Essence 1 1 Coffee & Chicory Extract 2 2 Compound (Glycerine & Honey) 1 1 Cooking oil 1 1 2 1 1 2 Cough Mixture 1 1 Cough Pastilles 1 1 Culinary Oil 1 1 Custard Powder (Dutch) 1 1 Curry Powder 2 2 Digestive Mixture 1 1 Dyspepsia Tablets 1 1 Effervescing Powder 1 1 Epsom Salts 1 1 Fish Cake (Fried) 1 1 Fish Pastes 4 4 Flavouring Essences 4 4 2 2 Flour (Self Raising) 4 4 Formamint Tablets 1 1 Fruit Sauce 1 1 Gee's Linctus 1 1 Gelatine 1 2 3 1 1 2 Gin 1 1 Ginger (Ground.) 1 1 1 1 Glycerine & Lemon Balsam 1 1 Golden Raising Powder 1 1 Grape Juice 1 1 Horseradish Cream 1 1 Hydrogen Peroxide 1 1 Indigestion Tablets 1 1 Carried forward: 5 63 68 2 6 8 (14) Article. Number of samples examined. Number of unsatisfactory samples. Formal Informal Total Formal Informal Total Brought forward 5 63 68 2 6 8 Influenza Mixture 1 1 Jams (Various) 1 5 6 Junket (Rennet) 1 1 Ka-fat 1 1 1 1 Lemonade Crystals 1 1 Lemon Drink Crystals 1 1 Lemon Linctus 1 1 1 1 Lemonade Powder (Suckers) 1 1 Lemonade Powder 2 2 Lime Flavour Compound 1 1 Liver Tone Tablets 1 1 Liviar 1 1 Lung Syrup 2 2 2 2 Malt Extract Tablets 1 1 Malted Milk Powder 1 1 1 Milk 75 75 9 9 Mint 1 1 Mustard Cream 1 1 Mustard Sauce 1 1 Olive Oil 1 1 Orafin Laxative 1 1 1 1 Paraffin (Medicinal) 1 1 Paste of Dates 1 1 Pepper (White) 1 1 Potato Powder 1 1 Pudding Mixtures 5 5 1 1 Quinine (Ammoniated Tincture) 2 2 1 1 Rum 1 1 Saccharin Tablets 2 2 Sage 1 1 Salad Cream 1 1 Salad Oil 2 2 Sauce 4 4 Sausages (Beef) 1 1 Scone Mixture 2 2 1 1 Seidlitz Powder 1 1 Serocalcin 1 1 Soup (Oxtail: Celery) 2 2 Sponge Mixture 1 1 Sulphur Tablets, (Flavoured) 2 2 1 1 Sweetening Tablets 1 1 Sweephat 1 1 Sweets 1 1 Syrup Laxative 1 1 Table Jelly 1 1 2 Tablets for Anaemia 1 1 Teaseed Oil for Salad 2 2 Tonic Food 1 1 Vinegar (Malt) 2 2 Vinegar (non-brewed) 1 1 Whiskey 5 5 Yeast (Dried) 1 1 Total: 91 130 221 13 13 26 (15) Details of the twenty six unsatisfactory samples are as follows:- Sample No. Commodity Infringement Remarks 858 Scone Mixture (Informal) Mixture slightly iufosted with inseecs Warning Iengthy storage in shop had caused deterioration. Remaining stocks withdrawn from sale and destroyed 860 Pudding Mixture (Informal) Grub Infestation Warning Examination of remaining stocks failed to reveal further infestation 867 Horseradish Cream (Informal) Contaminated with iron from metal cap of bottle Warning Contamination due to lengthy storage in shop. Remainder of stocks found to be rusty and were destroyed 870 Lemon Linctus (Informal) Labelling Infringement Quantitative particulars of the active ingredients not clearly legible through being over printed on the label design. The formula is clear of the design on the now labels A434 A442 Lung Syrup (Formal) Lung Syrup (Formal) Labelling Infringemnt Labelling Infringement Repeat of informal sample No .851 (taken in December 1947) Legal opinion advised against taking further action on these samples 879 Gelatine (unformal) Slightly excess- . ive amount of Zinc Followed up by formal sample No.A443 A443 Gelatine (Formal) Low jelly strength Warning Deterioration due to old stock having been kept loose. Manufacturers now supply a pre-pack Which conforms to regulation requirements (16) Sample No. Commodity Infringement Re marks A454 A459 A460 A469 A472 A481 A482 A483 A487 Milk (formal) Deficiency of milk fat These unsatisfactory samples arise from the taking of eighteen formal milk samples in course of delivery from eighteen churns of five producers# Individual samples revealed a varying deficiency in milk fat, but the average milk fat bulk figure from the whole consignment was above the minimum standard of 3 per cent. At a later date ten repeat formal samples were taken and all proved satisfactory, except one, which was slightly deficient in milk fat (N0.A472). As in the previous case the bulk milk fat figure was above the required standard. An adjoining Authority took up the question of "appeal to the cow" samples, as the farm is situated in that area. 892 Sulphur Tablets Line Flavoured (Informal) Labelling Infringement Warning Sample taken from stock having an old label. Manufacturers agreed to replace old stock with cartons bearing a full declaration label. 932 934 Strawberry Flavouring (Informal) Blackcurrant Flavouring (Inf ormal; Extensive Mould growths Warning Deterioration due to long shop storage. Remainder of stock withdrawn from sale and destroyed. 944 Campden Solution Tablets (Informal) Deficiency of 2 per cent of sulphur dioxide preservative • Warning in view of the small deficioncy of sulphur dioxide a warning letter was addressed to the manufacturers. (17) Sample No. Commodity Infringement Remarks 950 Ka-Fat Informal) External wrapper contaminated with mould Warning to Retailer No. further stock In shop when visited. 957 Ammoniated Tincture of Quinine (Informal) \ Deficiency and excess of constituent ingredients due to ineffsctive screw cap to bottle Warning Public Analyst stated the constituent variation was due to long steruge. Manufacturers withdrew old stock from sale and replaced with a new type of pack. 962 Mineral Oil (For cooking) (Informal) Resembled light liquid paraffin A repeat formal sample was taken (No. A501). A501 Cooking Oil (Formal) Consisted of mineral oil of the nature of light liquid paraffin The Legal Department advised against taking further action on this sample. The retailer voluntarily withdrew the remaining stocks from sale. 972 Orafin Laxative (Informal) Labelling Infringement Warning The sample was taken from stock bearing an old type of label. New stocks,with amended labels, have now been supplied by the Manufacturers. observations During 1948 it was again possible to maintain a satisfactory numerical standard of sampling over a wide variety of commodities. Of the total samples taken during the year 4,97 per cent were found to be other than genuine. Thin percentage figure excludes informal samples repeated formally. Labelling infringements in some form or another were found in 2.26 per cent of the total samples. A most gratifying feature of the year's sampling is reflected in the fact that the observations and infringements reported upon by the Public Analyst were mostly of a minor character. Effervescing Drink Powder As a result of a private complaint, alleging that a certain drinking powder contained harmful properties, an informal sample of effervescing drink powder was submitted to the Public Analyst for analysis. The Public Analyst reported that no foreign ingredient of a harmful or irritant nature could be detected in the sample. (18) 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. Routine inspection of premises has again revealed that the provisions of the Milk and Dairies Order 1926, have been generally well observed. The following licences to sell graded milks were granted in 1948:- Grade of Milk Type of licence Dealers' Supplementary Tuberculin Tested 13 2 Pasteurised 13 2 BACTERIOLOGICAL MILK SAMPLES 83 samples of milk were submitted for bacteriological examination as follows:- 1. Pasteurised, Heat Treated and Sterilized Milk Number of Samples Phosphatase Test Methylene Blue (Reductase) Test Satisfactory Unsatisfactory Decolourised in less than 30 minutes Not docolourised in 30 minutes 72 72 — 5 67 2. Tuberculin Tested (Pasteurised) Milk Number of Samples Phosphatase Test Methylene Blue (Reductase) Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory 11 11 - 9 2 The seven unsatisfactory bacteriological milk samples were taken towards the end of July. During this period the weather was very warm and dry. These conditions had??? an adverse effect on the keeping qualities of the milk, and no doubt caused the failure to pass the Methylene Blue Test. During the following month, when the weather was cooler, the repeat bacteriological milk samples taken proved satisfactory. (19) PROSECUTION . Successful proceedings wore instituted against a firm of dairymen for delivering milk in a bottle containing foreign matter to a private consumer. The defendants wore fined £5 with special costs amounting to £3.3.0. ICE CREAM At the end of 1948, 117 promises had been registered in accordance with Section 14 of the Food & Drugs Act 1938. On five of these premises ice cream could be manufactured. ICE CREAM SAMPLING During tho year 46 samples of ice cream wore taken for bacteriological examination. The following table shows the provisional grading results as reported by the Bacteriologis:- 16 samples placed in Grade 1 4 „ „ „ „ 2 17 „ „ „ „ 3 9 „ „ „ „ 4 46 Total In all cases the Manufacturer.. or the Dealer has been notified of the sample grading result. This procedure has created a desire on the part of the producers and dealers to adopt more stringent measures, in order to produce a bacteriologically free product and thus attain higher gradings. MEAT AND OTHER FOODS The 55 Butchers shops within the Borough have been inspected, and observation kept upon tho vehicles used for the convoyance 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 13 cases where the sanitary conditions were not satisfactory, or certain contraventions of the Public Health (Meat) Regulations 1924 existed. At the end of 1948, 47 premises had been registered in accordance with Section 14 of the Food & Drugs Act 1938. The majority of the registered premises are concerned with the manufacture of sausages only. 103 cases of insanitary or defective conditions in food shops, other than butchers' shops, were dealt with. There is one licenced slaughterhouse in the district. The only animals slaughtered during the year have boon 3 pigs from pig clubs slaughtered under licences issued by the (20) Ministry of Food. The following table indicates the number of animals killed, carcases inspected and condemned. Cattle excluding cows Cows Calves Sheep and lambs Pigs Number killed — — — — 3 Number inspected — — — — 3 All diseases except Tuberculosis Whole carcases condemned — — — — Nil Carcases of which some part or organ was condemned — — — — Nil percentage of the number inspected affected with disease other than Tuberculosis — — — — Nil Tuberculosis only Whole carcases condemned — — — — Nil Carcases of which some part or organ was condemned — — — — Nil Percentage of the number inspected affected with Tuberculosis — — — — Nil Imported Corned Beef Early in tho year a particular pack of corned beef was distributed to various shops in this district. On examination the corned beef appeared to be affected with metallic contamination. Swift action was taken for the submission of samples to the Public Analyst for chemical examination and rtocks were temporarily withdrawn from sale . The public Analyst confirmed metallic contamination of the corned beef, with the result that the Ministry of Pood caused the total withdrawal from sale of thi3 particular pack. (21) The following diseased and/or unsound meat and other foods have been surrendered and destroyed or, where suitable, utilised for pig food:- Commodity lbs Tins Jars or Packets Number Bacon 19½ 10 - - Beef 817½ - - - Bread/Biscuits 2 - 2 - Butter ½ - - - Cheese 12½ 1 9 - Chickens/Giblets 50 2 - - Cocoa/Coffee/Tea/Sugar 98 1 6 - Culinary Mixtures/Essences 68 38 160 - Eggs/Egg Powder - 3 3 1,169 Fish/Tinned Fish 4,298 1,276 1 - F1our/Loose/Packeted 84 - 15 - Je11ies/Crystals/powders - 3 9 - Marmalade/Jam/Syrup - 225 21 - Meat /Fish Pastes - 206 24 - Meat Pies - - - 19 Milk (Tinned) - 498 - - Mutton/Imp or ted/Tinned 15 12 - - Oats/Puffed Wheat/Cereals 59 1 26 - Orange/Grape Fruit Juice - 48 2 - Ox Liver 49 - - - Pork/Beef Sausages 64¼ 2 - - Pressed Maws 61½ - - - Prunes/Dates/Figs 153 _ 7 - Proprietary Foods - 7 - - Rabbits 42 22 ~ - Rusks - - 5 - Sauces/Pickles/Vinegar 1 53 150 - Soups/Extracts - 148 38 - Spaghetti - 23 17 - Sweets/Chocolates 122¾ - 21 - Tinned fruits - 225 13 - Tinned/Raw Vegetables 25½ 355 20 - Tinned Meats/Brawn 26½ 477 35 Totals: 6,069½ 3,636 584 1,188 THE SLAUGHTER OF ANIMALS ACT, 1933 All animals slaughtered in the district have been stunned by means of a mechanically operated instrument in accordance with the terms of the Act. 4 persons were licenced to act as slaughtermen during 1948. BAKEHOUSES There are 26 bakehouses within the district and of these 24 are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obtained. (22) RAT AND MOUSE REPRESSION. RATS AH) LUCE (DESTRUCTION) ACT, 1919. THE INFESTATION ORDER, 1943. A. SURFACE TREATMENT. During 1948, 5,879 primary and subsequent visits were made in connection with rats or mice infested or suspected infested premises. No major infestations were recorded. 351 premises were satisfactorily cleared of rat3 or mice and the work for the year is generally summarised below:- Total number cf complaints received or cases discovered during the year 1948 338 Total number investigated 336 Total number of premises on which no evidence of infestation was found 27 Total number of premises found to be infested 309 Total number of premises cleared of rats or mice (including 93 premises cleared which were discovered during previous years) 351 Cause of infestation at tho 309 premises found to be infested during the year. Keeping of poultry etc. 90 Accumulations of refuse or debris 2 Harbourage under or in garden sheds etc. 77 Defective drains 5 Inside premises (under floors etc.) 76 Buries in gardens etc. 90 Source untraced 1 341 Type of premises cleared of rats or mice. Dwelling-houses (mainly in gardens) 297 Foodshops and food premises. 30 Non-food shops and stored 7 Factories & workplaces 3 Offices 1 Hospitals/nursing homes 3 Miscellaneous 10 351 Methods employed in clearing the 351 premises of rats or mice. Poison baits. 336 Trapping 40 Gassing 16 Rat & Mouse Proofing 2 Drains repaired 7 Other means 6 407 B. SEWERS TREATMENT. 1. Second Maintenance Treatment (1947-48) The second maintenance treatment of those 9ewers found to be infested during the Initial Treatment carried out in September, 1947 was satisfactorily completed on the 10th March, 1948. Pre-baiting with damped sausage-rusks was carried out on two consecutive days, and the same bait base with 2½% Zinc Phosphide added was laid on the third day with the following results:- (23) Section. No. of manholes prebaited. Unpoisoned Pre-baits laid. No. of manholes poison baited. Complete bait takes. Partial bait takes. Baits not taken. A 10 2 1 7 5 B - - - - - C 32 2 - 30 5 D 57 2 1 54 4 e 71 i - 70 3 Total 170 7 2 161 17 These figures shew an improvement on the first maintenance treatment which produced 11 complete takes of prebait and no partial takes. 2. 10% Test (1948-49). A test baiting of 10% of the soil-sewer manholes in the Borough was again carried out and completed on the 14th July, 1948. The test was carried out in relationship with the previously recorded surface rat infestations in the Borough. Again very little evidence of any connection between surface and sewer infestations was revealed by the test. The Borough was divided into five sections and the results were as follows:- Section. No. of manholes baited. Complete Bait takes. Partial Bait takes. Baits not taken. A 24 3 - 21 B 60 1 - 59 C 55 13 - 42 D 47 4 - 43 E. 18 - - 10 Total 204 21 - 183 It is interesting to note that the number of bait-takes is 50% less than in the 1947 10% Test, and Section E, which then shewed a 50% take, is now clear of infestation. 3. First Maintenance Treatment (1948-49). The first maintenance treatment of those sewers found to be infested during the 10% Test was completed on the 25th September, 1948. Pre-baiting with damped sausage rusks was carried out on two consecutive days, and the same bait base with Zino Phosphide added was laid on the third day with the following results:- (24) Section. No. of manhole s prebaited. Unpoisoned baits laid. No. of manholes poison baited. Complete bait takes. Partial bait takes. Baits not taken. A 18 3 - 15 8 B 10 - - 10 - C 65 11 - 54 18 D 24 2 4 18 10 Total. 117 16 4 97 36 A second maintenance treatment will be commenced on the 29th February, 1949, when the bait used will be 10% Arsenious Oxide and damped bread crumbs. SCHOOLS. The sanitary condition and water supply of the schools are satisfactory. ERADICATION OF BED BUGS. 41 bug infested houses were dealt with as follows:- By the use of Insecticides. Hydrocyanic Gas. (H.C.N) Council Houses. 11. - Other Houses. 30 - The work of disinfection and disinfeststion has continued to be carried out upon the lines indicated in previous reports. The insecticides used were D.D.T. and Gammexane. SHOPS ACT, 1954. 302 visits were made in connection with. Section 10 of the Shops Act, 1934. From action taken it is gratifying to report that an increasing number of food premises have and are being fitted with instantaneous water heaters. These provide a constant supply of hot water, thus enabling employees to wash their hands, as and when required before serving the public with food-stuffs. The Inspectorial Staff of the Public Health Department is constantly vigilant of the necessity to observe and if necessary enforce the taking of all hygienic precautions in the various processes of food manufacture, storage and distribution. The general co-operation of all connected with food supplies is much appreciated. HAIRDRESSERS AND BARBERS PREMISES. The byelaws in connection with the business of hairdressers (25) and barbers premises made in 1947 came into operation on 1st January, 1948. The byelaws were made for the purpose of securing cleanliness of the premises, and for the cleanliness and sterilization of the instruments, towels end other materials used in the business. During 1948, eightyseven visits were made to the sixtyseven Hairdressers and Barbers premises. Inspection revealed that the majority of the premises are well conducted, and a generally good standard maintained. Twenty notices were served, mostly for minor infringements of the byelaws. LICENCED PLACES OF PUBLIC ENTERTAINMENT. INSPECTION OF SANITARY CONVENIENCES. There are nineteen licenced places of public entertainment in the district. These are mainly used for cinematograph shows; concerts; dancing; whist drives and social functions. The sanitary conveniences at all these premises have been inspected, and a relatively good standard of cleanliness found to exist. In one case extensive alterations were carried out to the building, in order to increase the insufficient sanitary accommodation available for the sexes. At eleven premises minor defects were discovered and remedied. INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES One thousand two hundred and seventy-four cases of infectious diseases were notified during the year 1948, This is an increase of six hundred and fifty cases over the number in 1947, and is accounted for by an epidemic of Measles during the Spring and early Summer, There were eight hundred and ninety-four cases of Measles during the year. Two cases of Poliomyelitis of moderate severity occurred. There were two cases of Diphtheria, a reminder of the persistence of this dangerous disease. Three cases of Cerebro Spinal Fever were notified, SCARLET FEVER:- One hundred and fifty-three cases were notified, a decrease of nineteen cases. The disease wa3 generally mild. There was no death. The case rate was 1.88 per 1000 of population, compared with 1.73 per 1000 of population in England and Wales, DIPHTHERIA:- Two cases were notified. One, a child aged 5 months, had a severe attack and recovered without disability. An immunised carrier in the family was cleared of infection. The other case, an adult, had a mild attack, Tho source of infection was not discovered. No child within the age groups subject to Immunisation suffered from Diphtheria. These cases show the tendency for the incidence of the disease to move to age groups outside the present range of immunisation. They indicate the need for constant vigilance in diagnosis. The oase rate was 0.02 per 1000 of population, compared with 0.08 per 1000 of population for England and Wales. (26) DIPHTHERIA ANTITOXIN:- Early diagnosis and early treatment with Antitoxin remain 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 be admitted to hospital at once for observation. Diphtheria Antitoxin is free of cost to all patients under the National Health Service. DIPHTHERIA IMMUNISATION:- The absence of cases of Diphtheria within tho age groups subject to immunisation demonstrates the value of this service. Immunisation against Diphtheria is tho greatest co-operative effort in preventive medicine that the nation has ever undertaken. There can be no relaxation. The presence of cases outside tho protected age groups, and the persistence of carriers of tho infection are warnings of danger. Every parent must join in this effort for security from Diphtheria. To ensure complete success every baby must have primary immunisation not later than the first birthday. Reinforcement injection is necessary every four years. If the child is to enter a nursery school, roinforcement is desirable at the age of three years. Every child should bo reinforcod before entry into day school, and again before reaching the ago of nine years. A high state of immunisation must be maintained. During the year 1948, one thousand one hundred and seventy-four children were immunised against Diphtheria. The number immunised at the age of one year was 715, which represents 49 per cent of the babies reaching that age during the year, compared with 42 per cent for this age group in 1947. One thousand one hundred and seventy-six children received reinforcing injections. The following table shows the distribution in ago 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 9- 10 l0ll 11-12 1213 1314 1415 Over 15 Total 34 715 198 36 31 30 29 21 8 16 23 28 2 1 1 1 1174 At the end of the year, 9,991 children, representing 60,97 per cent of all the children, had been immunised. Of these, 2,939 represents 46.82 per cent of the child-en under 5 years of age, and 7,052 represents 69.75 per cent of the children between 5 and 15 years of ago. 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 Monday, at 1.30 p.m. 3. At the Clinic, St. Oswald's Hall, Brocks Drive, North Cheam, Every second and fourth Tuesday in the month, at 1.30 p.m. 4. At the Clinic, Parochial Rooms, The Broadway, Cheam, Every Wednesday, at 1.30 p.m. 5. At the Clinic, Jubilee Institute, Maiden Green, Worcester Park# Every first Monday in the month, at 1.30 p.m. (27) MEASLES:- Measles became epidomic during March, April and May, and declined slowly during the Summer months to a state of quiescence in October and November, but a secondary rise in incidence occurred during December. Eight hundred and ninetyfour cases were notified, compared with two hundred and twentysix cases in 1947. Eighty-six cases were from an institution. Thirty-nine cases were admitted to hospital. Twenty-one were complicated by Pneumonia, Bronchitis or other infections. There was no death. The case rate was 10,98 per 1000 of population, comparod with 9,34 per 1000 of population for England and Wales, The monthly distribution of cases is shown in the following table. Jan. Fob. March April May June July Aug. Sept. Oct. Nov. Dec. Total 2 58 235 223 119 71 69 44 14 5 5 49 894 The age groups of notified cases are shown in the following table. Age:- Undor 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Over 15 Total. NO. of Cases:- 24 99 114 112 110 203 131 33 10 13 6 4 2 3 24 894 Measles tends to become epidemic in alternate years, the intensity of the epidemic depending on the number of susceptible children, the density of tho population, and the opportunities for contact at home and in school. Measles is a serious illness which lowers the vitality of the body and renders the patient vulnerable to secondary infections, and consequent complications by Pneumonia, Bronchitis, and middle ear disease, Tho danger from these complications has been reduced by the use of Sulphonamide drugs and Penicillin, but the debilitating effects of the illness still demand careful nursing and careful convalescence. Timely medical advice should be sought before complications have become established, and it is to be hoped that the facilities for medical advice provided by the National Health Service will be used by mothers for the protection of their children. Prevention of infection depends on the early isolation of suspected cases, and this can only be achieved by the recognition of the early catarrhal signs. The slight primary catarrh of the nose, throat and eyes, together with the child becoming miserable and disinclined for food and play, should be signals for precautions. Mothers should try to interpret the possible significance of minor signs of ill health in their children, and should recognise the social duty to protect others from infection both within the family and outside. Mild cases of Measles or of any other infection should be restrained from contact with other children. Information of notifications of children under five years of age is sent to Health Visitors in order that advice and help may be given where necessary. A leaflet of advice is sent to the homo of every notified case. (28) WHOOPING COUGH:- One hundred and fifty-seven cases were notified, compared with one hundred and forty-nine cases in 1947. Fifteen of the cases were from an institution. The case rate was 1.93 per 1000 of population, compared with 3,42 per 1000 of population for England and Wales, Seven cases were admitted to hospital. There was no death. Whooping Cough is a prolonged and debilitating illness liable to complication by Pneumonia and Bronchitis with subsequent impairment of the function of the lungs. Every effort should be made to protect babies and young children from infection until they are old enough to withstand the stresses of the disease. Progress is being made in research aimed at finding a specific drug for the cure of the disease, and the value of vaccines for immunisation is being estimated, but until a specific drug or a completely effective vaccine are available, the main prospect of prevention lies in the early isolation of suspected cases. The early catarrhal stage of Whooping Cough resembles a persistent catarrhal cold. There is a harsh cough which is at first single, and later groupod. Finally tho cough is paroxysmal with a terminal 'whoop'. In infants the illness may be confined to the catarrhal stage. There may be no 'whoop'. Vomiting after coughing is very suggestive of Whooping Cough, Any suspicion of the disease demands precautions against the spread of infection. Suspected cases should not be allowed by their parents to mix with other children, nor allowed to travel on buses, or visit shopping centres and places of public resort. In cases of doubt, medical advice should be sought beforo a child is given liberty of action, and in severe cases early medical advice will prevent complications. Information of notifications of children under five years of age is sent to all Health Visitors in order that advice and help may be given where necossary. A leaflet of advice is sent to the home of every notified case. Tho age groups of notified cases are shown in the following table. Age:- Under 1 l 2 3 4 5 6 7 8 9 10 11 12 13 14 Over 15 Total No of Cases:- 11 19 25 30 2l 26 13 2 3 2 - 1 - - - 4 157 IMMUNISATION AGAINST WHOOPING COUGH:- The scheme of immunisation against Whooping Cough is restricted to children between the ages of 1 year and 5 years, to weakly children, and to children from overcrowded homes. During 1948, two hundred and seventy-one children received a course of injections, making a total of six hundred and eighty-three children immunised since 1945, During 1948, fifteen of this group contracted Whooping Cough, at intervals of time varying from three months to three years from the time of injection. Of these, two had severe attacks, six had moderate attacks, and seven had slight attacks. Normally there is wide variation in the severity of Whooping Cough which makes it difficult to assess the value of ameliorative immunisation. In some cases there was alteration in the character of the 'whoop' and reduction in the severity of the cough, which might bo attributable to the vaccine. There was no indication of reduction of incidence of the disease in the immunised group. The hope of even slight ameliorative effect justifies perseverance, (29) Large scale national research now in progress will evaluate the process and determine the most effective form of vaccine and dosage. The material used was Bacillus Pertussis 'S' Vaccine, 20 million bacilli per c.c. The dose given is 0.5 c.c. in four doses, three at weekly intervals and the fourth a month later. It has been found convenient and satisfactory to combine the vaccine with Toxoid Antitoxin Floccules as a diluting agent and for combining Immunisation against Diphtheria, The combination has been free from reactions, PREVENTION of SMALLPOX:- Vaccination against Small Pox is now a voluntary measure, but infant vaccination must be sustained if we are to maintain a relative immunity in the population against the introduction of Small Pox, a risk not to be ignored. The safe period for the vaccination of babies is between 3 months and 6 months of age, and a high responsibility lies with parents to ensure that their babies are vaccinated either by arrangement with their own doctor or at a Child Welfare Clinic, The service is free of charge under the National Health Service, Vaccination against Small Pox is a necessary routine measure of protection for all babies. The following table shows the number of vaccinations from 5th July, 1948 to 31st December, 1948. Age:- Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Over 15 Total Number Vaccinated:- 161 12 13 1 3 1 1 2 - - 1 1 - 2 - 10 198 Number reVaccinated:- _ - 1 - - 4 _ - 1 - - 3 - 2 - 39 50 PUERPERAL PYREXIA:- Two cases were notified in 1948, compared with seven eases in 1947, The case rate was 1.63 per 1000 total births, compared with 6,89 per 1000 total births for England and Wales. The early notification of Puerperal Pyrexia is of primary importance in the prevention of maternal mortality. Medical practitioners should make the fullest use of the consultant, bacteriological and hospital services provided by the Authority, and secure the immediate and effective isolation of any suspected case occurring in a maternity home. TYPHOID AND PARATYPHOID FEVERS:- One case of Paratyphoid Fever, a child resident in an institution, was notified. There was one death from Paratyphoid Fever of an aged woman resident, in an institution outside the Borough# No source of infection was found within the Borough. DYSENTERY:- Thirty-seven cases of Sonne Dysentery were notified# Thirty of these were from institutions. This compares with three cases notified in 1947, The disease is endemic in this area, and the presence of carriers calls for the most scrupulous care by all engaged in the handling of food. The chain of infection can' only be broken by clean hands. Mild cases suffering only from slight abdominal discomfort or transient diarrhoea may transmit severe aircacks to others. Bacillary Dysentery can now be effectively controlled by the use of Sulphonamide drugs, but for the prevention of this and of other gastrointestinal infections, the washing of hands, particularly after the use of lavatories, by all engaged in the handling of food, is essential, (30) FOOD POISONING:- No. of Outbreaks No. of Cases No. of Deaths Organisms or other agents Foods involved 1 100 0 B. Coli & Staphylooooci Salad 1 3 0 B. Typhi Murium Various 1 4 0 Staphylococcus Aureus Cold roast mutton 1 1 0 Staphylococcus Aureus Brawn Total: 4 108 0 (1) One hundred children suffered from gastro-enteritis after a mid-day meal in a school canteen. The water in an outside storage tank was found to be contaminated, and the illness was due to salad washed in this water. Immediate steps were taken by the Education Authority to rectify this. These cases emphasise the duty plaoed on those responsible for communal feeding to ensure the maximum safety of food from infection, (2) A family of three suffered from gastro-enteritis due to Bacillus Typhi Murium derived from mouse infestation of a larder. The mouse sometimes carries this organism, which can cause severe and sometimes fatal illness. All practicable steps should bo taken to suppress mice and to protect larders and food stores against infestation, (3 & 4) The Staphylococcus is commonly found on the skin of the hands and is easily transmitted to food if hands arc not thoroughly washed. Under favourable conditions of temperature and moisture the Staphylococcus Aureus will multiply rapidly on many foods and can produce a powerful toxin which is a severe gastrointestinal irritant. The need for constant vigilance by all concerned with the handling and preparation of food is demonstrated by the occurrence of these cases. Infection can only be prevented by scrupulous cleanliness, CEREBRO SPINAL FEVER:- Three cases were notified. Those were sporadic with no interconnection. There was one death of a baby aged 5 months from a severe attack. POLIOMYELITIS:- Two cases were notified. One, a boy of 10 years has residual paralysis of the right leg and remains in hospital under treatment. The other, a female adult, has recovered with slight residual weakness of the muscles of the shoulders and arms, PNEUMONIA:- Of thirty-three deaths occurring from all forms of Pneumonia, one was notified previous to death. The total number of notified cases arising in the district was thirteen, NON-NOTIFIABLE DISEASES:- School teachers reported three hundred and seventy-four oases of Chicken Pox, one hundred and ninety-four cases of Mumps, nineteen cases of German Measles, and six oases of infective jaundice. School notifications are a useful index of the prevalence of non-notifiable diseases, and form a basis for consultations with the school medical officer. (31) SCABIES:- There was a further 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 dealt with fifty-one cases, compared with sixty-three cases in 1947. The number of attendances at the clinic was one hundred and forty-eight, compared with two hundred and thirty-four in 1947. The treatment is by bathing and the application of Benzyl Benzoate emulsion to the skin. LICE:- There was a decrease in the number of cases of head lice. Twenty cases were treated, compared with thirty cases in 1947. The number of attendances for treatment was eighty-four, compared with seventy-five in 1947. The treatment of head lice is by cleansing and the application of lethane oil to the scalp. 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 2 90 7 15 3 14 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above table. (32) NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1948 Disease Under 1 Year 1 Year 2 Years 3 Years 4 Years 5 Years 10 Years 15 Years 20 Years 35 Years 45 Years 55 Years Totals Removed to Hospital * Died Scarlet Fever — 5 5 10 20 78 19 4 7 3 1 — 152 94 — Diphtheria 1 — — — — — — — 1 — — — 2 2 — Typhoid Fever — — — — _ — — — _ _ _ _ _ _ _ Para-typhoid Fever _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 Puerperal Pyrexia _ _ _ _ _ _ _ _ 1 1 _ _ 2 _ _ Pneumonia 1 _ _ 1 1 _ _ _ 1 2 3 4 13 3 33 Erysipelas _ _ _ _ _ _ _ _ 1 3 5 1 10 5 - Dysentery _ 1 — 1 _ 4 _ _ 2 _ _ 1 9 3 _ Pol1omye1itis — _ _ _ _ _ 1 _ 1 _ _ _ 2 1 _ Cerebro Spinal Fever 1 _ _ _ 1 _ _ _ 1 _ _ _ 3 3 1 Measles 22 76 74 94 109 390 21 5 13 4 _ _ 808 28 _ Whooping Cough 11 19 19 22 20 46 1 1 1 2 _ _ 142 4 _ London Cases in the Downs Hospital. Scarlet Fever _ _ 1 _ _ _ _ _ _ _ _ _ 1 1 Para -typhoid Fever __ 1 _ _ _ _ _ _ _ _ _ _ 1 1 Dysentery 3 7 14 3 _ _ _ 1 _ _ _ _ 28 20 Measles 2 23 40 18 1 _ _ 2 _ _ 1 _ 86 11 Whooping Cough _ _ 6 8 1 _ _ _ _ — _ _ 15 3 x Under Column "Died" all deaths, whether notified in the district or outside it, or not notified at all, are included. (33) (34) DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS (DISTRICT CASES) 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 10558 9227 11325 13186 7690 7823 6686 6077 8748 81320 Scarlet Fever 28 9 24 38 14 13 5 5 16 152 1.88 1.73 Diphtheria 1 - - 1 — - - — — 2 0.02 0.08 Typhoid Fever - — — — — — — — — — 0.00 0.01 Para-typhoid Fever - - - — — — — — — — 0.00 0.01 Puerperal Pyrexia - - - — — — — 2 — 2 — — Pneumonia 1 — 2 — — 7 — — 2 13 0.16 0.73 Erysipelas - - 1 1 1 1 — 3 3 10 0.12 0.21 Dysentory - 1 1 4 _ — — — 3 9 0.11 — Poliomyelitis 1 - — — — — 1 — — 2 0.02 0.04 Cerebro Spinal Fever 2 - 1 — — — _ — — 3 0.03 0.03 Measles 101 56 59 184 106 98 52 68 84 808 9.92 9.34 Whooping Cough 10 11 35 16 27 14 9 6 14 142 1.75 3.42 Totals 144 78 123 244 148 133 67 84 122 1143 TUBERCULOSIS On the 31st December, 1948, there wore on the Register 787 cases of Tuberculosis, of whom 632 were Pulmonary cases and 155 non-pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.37 per 1000 of population, and for non-pulmonary Tuberculosis 0.02 per 1000 of population. The total death rate for Tuberculosis was 0.39 per 1000 of population, compared with 0.47 per 1000 of population in 1947, Corresponding death rates for England and Wales in 1948 were: Pulmonary 0,44 per 1000 of population; non-pulmonary 0.06 per 1000 of population. Total rate: 0,50 per 1000 of population. The number of new cases of Pulmonary Tuberculosis was 50, compared with 64 in 1947, The number of now cases of non-pulmonary Tuberculosis was 13, compared to 6 in 1947. The reduction in the number of new oases of Pulmonary Tuberculosis is satisfactory, and may indicate a tendency towards decline in incidence of the disease, but this is unlikely to be accellerated until there is a substantial improvement in housing conditions, and in facilities for early treatment in sanatoria. The number of cases of non-pulmonary Tuberculosis is higher. These cases are mostly of bovine origin, and confirm tho need for legislation for the general compulsory pasteurisation of all undesignated milk. Within this Borough all milk sold is already efficiently pasteurised or designated. The Tuberculosis Care Committee continued to expand its field of endoavour to help and to encourage many patients and their families to overcome social and domestic difficulties. In this the Committee have been greatly helped by the energy, understanding and sympathy of the Lady Almoner for Tuberculosis, Miss Tayler. The scheme for allowances to patients operatod beneficially. The following table shows the new cases and deaths in age groups. Age Periods Now Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 — — — 1 — — — — 1 — — — — — — _ — 5 2 1 2 1 — — — 1 15 6 9 3 — 2 4 — — 25 6 6 1 3 2 3 — — 35 6 5 — 1 4 3 — — 45 3 2 — — 5 1 1 — 55 3 — 1 1 5 — — — 65 and above 1 — — — 1 _ — — Totals 27 23 6 7 19 11 1 1 NOTIFICATION OF TUBERCULOSIS Respiratory Forms of Deaths - 25 out of 30 were notified. Other Forms of Death - 2 out of 2 were notified. (35) MASS RADIOGRAPHY A Mass Radiography Unit of the Surrey County Council was stationed at the Public Hall, Sutton, from 31st March to 17th April, 1948. Three thousand five hundred and seventy-six persons attended for examination. The final results were as follows, 1. Newly discovered cases of active Pulmonary Tuberculosis (a) Requiring Sanatorium treatment 4 (b) Requiring observation at Chest Clinic 4 2. Cases of arrested Pulmonary Tuberculosis 62 3. Other abnormalities (a) Cardio vascular 14 (b) Non-Tuberculous Chest conditions 38 These figures confirm the general experience with Mass Radiography that two or three people in every thousand of the adult population are suffering from early unreoognised active Pulmonary Tuberculosis. The frequency of Tuberculous infection with spontaneous healing is shown by the finding of sixty-two cases of arrested disease. The finding of other abnormalities of the heart and lungs gives an opportunity for appropriate treatment and for adjustment of ways of life to prevent future disability. The advantages of this'service to the individual and to the community are apparent. (36) CLINICS AVAILABLE FOR THE DISTRICT SUTTON and BELMONT DISTRICT THE PUBLIC HALL, 1, HILL ROAD, SUTTON. Ante-Natal Clinic - Every Monday, at 1.30 p.m. and every Wednesday, at 9.30 a.m. (By appointment) Infant Welfare Centre - Every Tuesday and Thursday, at 1.30 p.m. Diphtheria Immunisation Clinic - Every Friday, at 2 p.m. Vaccination against Smallpox - By appointment. METHODIST CHURCH HALL, STATION ROAD, BELMONT. Infant Welfare Centre - Every Thursday, at 1.30 p.m. CHEAM and WORCESTER PARK DISTRICT THE PAROCHIAL ROOMS. THE BROADWAY, CHEAM. Infant Welfare Centre - Every Wednesday, at 2 p.m. (including Diphtheria Immunisation from 1.30 p.m. to 2 p.m.) THE CLINIC, PRIORY CRESCENT, CHEAM. Ante-Natal Clinic - Every Monday and Friday, at 9.30 a.m. (By appointment) Infant Welfare Centre - Every Monday and Thursday, at 1.30 p.m. (Including Diphtheria Immunisation every Monday from 1.30 p.m. to 2 p.m. Vaccination against Smallpox - by appointment) ST. OSWALD'S HALL. BROCKS DRIVE. NORTH CHEAM. Infant Welfare Contre - 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 Tuesday, at 1.30 p.m. : Vaccination against Smallpox - by appointment) JUBILEE INSTITUTE, MALDEN GREEN, WORCESTER PARK. Infant Welfare Contre - Every Monday and Thursday, at 1.30 p.m. (Including Diphtheria Immunisation every first Monday in the month, at 1.30 p.m. : Vaccination against Smallpox - by appointment) SCABIES CLINIC St, Nicholas Road, Sutton, Every Thursday, from 10 a.m. to 12 noon. CHEST CLINIC St. Holler Hospital, Wr'ytho Lane, Carshalton. (By appointment) 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 cases only) VENEREAL DISEASES CLINIC St. Heller Hospital, Wrythe Lane, Carshalton. Males - Every Monday, from 5 p.m. to 7 p.m. Females - Every Wednesday, from 5 p.m. to 7 p.m. Every Friday, from 1.30 p.m. to 3.30 p.m. (37)