S4TC 13 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the Medical Officer of Health For the Year 1949. William Pile. Ltd., Printers. 46-50 High Street, Sutton. BOROUGH OF SUTTON AND CHEAM. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1949. PUBLIC HEALTH COMMITTEE. HIS WORSHIP THE MAYOR (Alderman W. D. MILNE, J.P.). Alderman F. C. LOHDEN, O.B.E. Coun. E. E. BLANE (Mrs.). Coun. J. C. ROBERTSON, C.C. „ E. A. JAMES. „ D. SPARKS (Mrs.), M.B.E. „ W. M. R. KING. „ F. E. W. TOZER. „ D. H. MANNING. „ F. WARREN. „ J. NICHOLSON. „ KINGSLEY WILLIAMS (Chairman). PUBLIC HEALTH OFFICERS OF THE AUTHORITY. Medical Officer of Health: ENEAS J. MACINTYRE, M.D., D.P.H. Chief Sanitary Inspector: CHARLES WILLIAM NEWBERY, Certif. R.S.I., Certif. Meat & Food, Certif. S.I. Exam. Board. Deputy Chief Sanitary Inspector: ARTHUR SYDNEY WILLIAMS, Certif. R.S.I., Certif. Meat & Food. Assistant Sanitary Inspectors: WALTER BLACK, D.P.A., Certif. R.S.I. and S.I.E.J.B., Certif. Meat & Food. JOHN ALWYN EVANS JONES, Certif. R.S.I. and S.I.E.J.B., Certif. Meat & Food, (commenced duties 17/1/1949). 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. Public Analyst: DANIEL D. MOIR, M.Sc., F.R.I.C., Analytical and Consulting Chemist (part-time). 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 1949. The initial phase in the development of the National Health Service was completed. Medical practice became adjusted to new conditions and new relationships. Divisional administration of the personal health services of the County Council was established advantageously. Welfare services were co-ordinated and improved. The deficiency of hospital accommodation for the chronic sick and aged continued, but was greatly relieved by the arduous and efficient domiciliary work of the district nurses, and by the active help given by voluntary organisations in the Borough. The general health of the community was good. The birth rate fell from 14.8 per 1,000 of population to 13.2 per 1,000 of population. The death rate was slightly lower, at 9.8 per 1,000 of population. The infantile mortality rate of 21 per 1,000 live births is the lowest yet recorded. The maternal mortality rate remained low. One case of Smallpox occurred. Six cases of Poliomyelitis were notified. Otherwise there was no exceptional incidence of infectious disease. A Mass Radiography Unit visited the Borough in August, and again proved the value of this service in the early detection of disease and in the prevention of illness. Housing remained the most serious problem. Many families continued to live in overcrowded and unhealthy homes. During the year, 22 flats were completed and 41 houses and 36 flats were under construction. Schemes were in course of preparation for 79 houses and 111 flats. At the end of the year there were 2,606 applicants on the waiting list. The need for additional building sites outside the Borough was established. The work of general sanitation, of the prevention of nuisances, and of the protection of food, was carried out efficiently under the direction of the Chief Sanitary Inspector (Mr. C. W. Newbery), to whom I am indebted for his constant collaboration on all matters affecting the public health. 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 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-operation. I am, your obedient Servant, ENEAS J. MACINTYRE, Medical Officer of Health. 2 STATISTICS OF THE AREA. 1948. 1949. Area in Acres 4338.15 4338.15 Registrar General's Estimate of the Resident Population 81,320 81,260 Number of inhabited houses (end of year) according to the Rate Book 22,857 22,951 Rateable Value and sum represented by a Penny Rate £897,257 £902,059 £3,670 £3,658 EXTRACTS FROM VITAL STATISTICS (comparative of the years 1948 and 1949). 1948 1949 England and Wales 1949 Total Male Female Total Male Female Live Births 1203 591 612 1074 565 509 Legitimate 1151 564 587 1024 538 486 Illegitimate 52 27 25 50 27 23 Birth Rate per 1,000 of the Estimated Resident Population 14.8 13.23 16.7 Still Births 21 13 8 23 14 9 Legitimate 20 13 7 22 13 9 Illegitimate 1 — 1 1 1 — Rate per 1,000 total (live and still births) 17.2 20.9 22.6 Deaths 806 382 424 796 373 423 Death Rate per 1,000 of the Estimated Resident Population 9.9 9.8 11.7 Deaths from— Puerperal Sepsis 0 0 Other Puerperal Causes 1 1 Death Rate from Puerperal Causes per 1,000 total (live and still births) 0.82 0.91 0.82 Deaths of Infants under one year of age— All Infants per 1,000 live births 28.26 21.42 32.0 Legitimate Infants per 1,000 legitimate live births 26.07 19.53 Illegitimate Infants per 1,000 illegitimate live births 76.92 60.00 3 1948. 1949. Deaths from Cancer 136 143 „ „ Measles 0 0 „ „ Whooping Cough 0 0 „ „ Diarrhoea 1 2 Percentage of Deaths from certain causes to the total number of Deaths— 1948. 1949. Diseases of the heart and circulation 35.0 35.5 Cancer and malignant disease 16.9 18.0 Diseases of the lungs (non-tuberculous) 9.9 9.4 Tuberculous diseases 4.0 2.9 Cerebral haemorrhage 11.3 11.0 Congenital diseases 3.3 2.1 Suicide and violence 4.2 3.5 Diseases of the digestive system 4.0 4.4 Infectious diseases 0.9 2.1 Diseases of the kidney 3.0 2.3 Other defined diseases 7.5 8.8 Maternal Mortality. There was one death from Toxaemia. The maternal mortality rate was 0.91 per 1,000 total births. The rate for England and Wales was 0.82 per 1,000 total births. Infantile Mortality. The infantile mortality rate was 21.42 per 1,000 live births, compared with 28.26 per 1,000 live births in 1948. There were twenty-three deaths of infants under one year, compared with thirty-four in 1948. Of the twenty-three deaths, fourteen occurred in the neo-natal period, within one month of birth, as is shown in the following tabje of causes and age groups:— Causes of Death Age Groups Under 1 month 1-3 months 3-12 months Congenital Abnormality 6 — 2 Prematurity 4 — — Broncho-Pneumonia 1 1 2 Cerebral Haemorrhage 2 — — Gastro enteritis — — 1 Encephalitis — — 1 Meningitis — — 1 Asphyxia — 1 — Pyaemia 1 — — Total 14 2 7 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1949. M. F. Total l Typhoid and paratyphoid fevers — 2 Cerebrospinal fever — — — 3 Scarlet Fever — — — 4 Whooping Cough — — — 5 Diphtheria — — — 6 Tuberculosis of respiratory system 14 6 20 7 Other forms of Tuberculosis 2 1 3 8 Syphilitic diseases 3 2 5 9 Influenza 4 7 11 10 Measles — — — 11 Acute poliomyelitis and polioencephalitis — — — 12 Acute infective encephalitis — 1 1 13 Cancer of buccal cavity—(Esophagus (M) and Uterus (F) 5 5 10 14 Cancer of stomach and duodenum 14 6 20 15 Cancer of breast — 18 18 16 Cancer of all other sites 54 41 95 17 Diabetes — 3 3 18 Intracranial vascular lesions 30 58 88 19 Heart disease 112 131 243 20 Other diseases of circulatory system 15 25 40 21 Bronchitis 16 17 33 22 Pneumonia 15 13 28 23 Other respiratory diseases 11 2 13 24 Ulcer of stomach or duodenum 4 2 6 25 Diarrhoea under 2 years 1 1 2 26 Appendicitis 1 — 1 27 Other digestive diseases 10 13 23 28 Nephritis 4 14 18 29 Puerperal Sepsis — — 30 Other maternal causes — 1 1 31 Premature birth 3 1 4 32 Congenital malformations, birth injuries and infantile diseases 8 5 13 33 Suicide 8 2 10 34 Road traffic accidents 7 1 8 35 Other violent causes 5 6 11 36 All other causes 27 41 68 337 423 796 5 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA. Legislation. National Assistance; Act, 1948. Sec. 47. Removal of Persons in Need of Care and Attention. A Court Order was secured and applied in November, 1949, for the removal of a woman, aged 68 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 has elected to remain voluntarily in the home, and has improved in health. Sec. 50. Burial or Cremation of the Dead. Two 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. Additional service has been provided at the Public Health Laboratory, Epsom, but its use is limited owing to the distance from the Borough. Mortuary. During 1949, seventy-seven bodies were received, and seventy-seven post mortem examinations were made. The mortuary premises and equipment, which includes a threebody refrigerated chamber, have been well maintained. Clinics. Details of clinics available in the district are given at the end of this report. 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 nine degrees of hardness. Chlorine is applied in the form of chloramine as a protective measure. 6 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. CHEMICAL RESULTS IN PARTS PER MILLION AVERAGE Total solid residue dried at 180°C. 202.9 Ammonia, free 0.141 Ammonia, Albuminoid 0 Nitrogen in Nitrates 7.3 Nitrogen in Nitrites 0 Oxygen absorbed in 4 hours at 27°C. 0.016 Chlorine in Chlorides 17.3 Hardness total (grains per gallon) 8.46 BACTERIOLOGICAL RESULTS No. of Bacteria growing on Agar per ml. for 3 days at 20°C. 1.3 No. of Bacteria growing on Agar per ml. for 1 day at 37°C. 0.08 Presence of Bacillus Coli in 100 ml. 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 conjunction with the main drainage system, except for a length of storm water relief sewer in Langley Park Road, Sutton. A scheme for the major reconstruction of the Worcester Park Sewage Works is in course of preparation and the Public Enquiry has been held. 7 Refuse Collection and Scavenging. The collection and disposal of house refuse and salvage, together with the scavenging of public highways, is carried out under the supervision of the Borough Engineer and Surveyor. The work has been executed in a satisfactory manner. Rivers and Streams. The streams within the Borough have been maintained in a satisfactory condition. Closet Accommodation. There are eight premises with cesspools in use. Some six pail closets and one privy are in use. In the past 21 years, 159 premises, originally with cesspool drainage, have been connected to sewers. SANITARY INSPECTION OF THE AREA. Report of the Chief Sanitary Inspector under Article 27 of the Sanitary Officers (Outside London) Regulations, 1935 (pages 8 to 26). Record of Inspections and Notices Served. Special Inspections, Interviews on Premises and Advisory Visits 1,680 Re-inspections 4,556 Works in Progress 1,756 Visits to Factories/Workplaces 376 „ Bakehouses 34 „ Outworkers' Premises 66 „ Slaughterhouses 1 „ Butchers, Grocers and other Food Premises 360 „ Dairies and Milkshops 26 „ Ice Cream Premises 105 „ Stables/Passages/Pigsties/Ditches 44 „ Restaurant and Cafe Kitchens 61 „ Premises re Rats and Mice Infestations 5,692 „ Tents/Vans/Sheds 10 „ Cinemas/Theatres/Halls 16 „ Premises re Infectious Diseases 249 „ Premises re Overcrowding and Permitted Numbers 375 „ Premises re Food Complaints (Shops and Houses) 320 „ Barbers and Hairdressers Premises 73 „ Public and School Conveniences. 23 „ Verminous Houses 22 „ Shops under the Shops Acts 369 Visits re taking of Food and Drug Samples 196 „ „ Bacteriological Samples of Milk/Water 52 „ „ Bacteriological Samples of Ice Cream 161 „ Smoke Observations 4 Miscellaneous Visits 2,744 Total 19,371 8 Complaints received and investigated 687 Premises at which defects or nuisances were discovered 1,715 Dwellinghouses surveyed for housing defects under the Public Health or Housing Acts 368 Defects or nuisances discovered 2,276 „ „ remedied 1,914 „ „ in hand 31 „ „ outstanding 331 Informal Notices served 976 Statutory Notices were served as under:— Housing Act, Sections 9 and 10 52 Public Health Act, Section 24 48 „ „ „ „ 39 24 „ „ „ „ 45 7 „ „ „ „ 56 „ „ „ „ 75 17 „ „ „ „ 83 1 „ „ „ „ 84 1 Total 151 Summary of Remedial Works and Sanitary Improvements Carried Out. Drainage and Sanitary Fittings: — Number of houses and other premises re-drained 22 Number of houses and other premises connected to soil and surface sewers 7 Repairs and amendments to existing drains 187 Drains or gullies unstopped and cleansed 224 Sanitary fittings repaired, renewed, provided or cleansed 833 Water service pipes/cisterns repaired, renewed or cleansed 22 Water, smoke and chemical tests applied 521 W.C. Apartments:— W.C. apartments provided 16 „ „ lighted and/or ventilated 31 „ „ provided with ventilated lobbies 7 „ „ cleansed 76 Separate accommodation provided for the sexes 7 Structural Repairs or Improvements:— Roofs repaired or renewed 210 Guttering and rainwater pipes provided, repaired, etc. 127 Damp walls remedied 110 Brick walls re-pointed, repaired or re-rendered 64 Chimney stacks repaired or rebuilt 21 Yards paved or repaired 24 Sites of houses concreted 3 Floors relaid or repaired 117 Windows/cills repaired or renewed 357 Doors/thresholds provided or repaired 50 Staircases/handrails provided or repaired 26 Ranges/stoves/coppers repaired or renewed 82 Miscellaneous 41 Cleansing:— Rooms/passages/larders, etc., cleansed and/or repaired 444 Trade premises cleansed 85 Verminous houses disinfested for bugs/fleas 47 9 Premises sprayed for flies/crickets/cockroaches 35 Premises disinfected after various diseases 239 Various:— Offal bins provided 10 Dustbins provided 202 Accumulations of refuse and manure removed 39 Premises cleared of rats and mice 311 Offensive ponds and ditches cleansed 4 Wasp nests destroyed 317 Miscellaneous 99 HOUSING. 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected under the Public Health or Housing Acts 368 (b) Number of inspections made for the purpose 871 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 191 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 171 3. Action under Statutory Powers during the Year:— (A) Proceedings under Sections 9, 10 and 16 of the Housing Acts, 1936-1949:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 52 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners 21 (b) By Local Authority in default of Owners 7 (B) Proceedings under the Public Health Act:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 9 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 5 (b) By Local Authority in Default of Owners 2 (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936 nil 10 FACTORIES ACT, 1937-1948. Inspection of Factories and Other Premises 1. Inspections made by Sanitary Inspectors for the Purposes of Provisions as to Health:— Type of premises Number of Inspections Notices, written and/or oral Factories with Mechanical Power 269 54 Factories without Mechanical Power 130 18 Premises (other than outworkers premises) 11 1 Total 410 73 2. Defects Found in Factories and Other Premises under the Act:— Particulars Number of defects Found Remedied Want of cleanliness 14 13 Inadequate ventilation — — Overcrowding 2 2 Unreasonable temperature — — Ineffective floor drainage 1 1 Absence of thermometers 1 1 Insufficient lighting in W.C. Apartments 18 14 Other nuisances 25 23 Sanitary Accommodation— (a) Insufficient 4 3 (b) Unsuitable or defective 27 25 (c) Not separate for the sexes — — Totals 92 82 11 PUBLIC HEALTH ACT, 1936—WORKPLACES. Inspections Number of:— Written Notices Occupiers Prosecuted 11 1 — SMOKE ABATEMENT. The few chimneys attached to industrial premises in the district have been kept under observation. During the year three smoke and grit nuisances were detected and abated without the need for formal action. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act, 1938—Sampling. The following table indicates the nature of the 234 formal and informal samples submitted for analysis during the year 1949:— Article Number of Samples Examined Number of Unsatisfactory Samples Formal formal Total Formal Informal Total Apple Juice .... 1 1 .... .... .... Arrowroot .... 1 1 .... .... .... Artificial Cochineal .... 1 1 .... .... .... Aspirin Tablets .... 1 1 .... .... .... Baking Powder .... 2 2 .... .... .... Beer .... 1 1 .... .... .... Bicarbonate of Soda .... 1 1 .... .... .... Brandy 3 .... 3 .... .... .... Bread Crumbs .... 1 1 .... .... .... Cake Flour Mixture .... 1 1 .... .... .... Candied Peel .... 1 1 .... .... .... Cereoca .... 1 1 .... .... .... Cheese (Goats) .... 1 1 .... .... .... Chocolate Spread .... 1 1 .... .... .... Chutney Mango .... 1 1 .... .... .... Cinnamon & Quinine .... 1 1 .... .... .... Coffee: Coffee Extract .... 3 3 .... .... .... Coffee & Chicory Essence .... 5 5 .... .... .... Coffee & Chicory .... 1 1 .... .... .... Carried forward 3 25 28 .... .... .... 12 Article Number of Samples Examined Number of Unsatisfactory Samples Formal Informal Total Formal Informal  Brought forward 3 25 28 .... .... .... Coffee Concentrated Powder .... 2 2 .... .... .... Corn Flour .... 2 2 .... .... .... Cooking Fat .... 1 1 .... .... .... Cough Mixture: Syrup .... 3 3 .... .... .... Crab Paste .... 1 1 .... .... .... Cream of Tartar .... 1 1 .... .... .... Custard Powder .... 5 5 .... .... .... Curry Powder .... 1 1 .... .... .... Dessert Mould .... 1 1 .... .... .... Epsom Salt Tablets .... 1 1 .... .... .... Essence of Anchovies .... 1 1 .... .... .... Fig Pudding .... 1 1 .... .... .... Fillet of Anchovies .... 1 1 .... .... .... Flour (Self Raising) .... 2 2 .... .... .... Fritter Mixture .... 2 2 .... .... .... Fruit Pectin Relish .... 2 2 .... .... .... Fruit Preserving T ablets .... 1 1 .... .... .... Gelatine .... 1 1 .... .... .... Gin 1 .... 1 .... .... .... Ginger (Ground) .... 1 1 .... .... .... Glycerine & Honey .... 1 1 .... .... .... Grapefruit, Orange, Lemon Squash 2 1 3 .... .... .... Gravy Powder .... 1 I .... .... .... Ground Pimento .... 1 1 .... ........ .... Herring Spread .... 1 1 .... .... .... Indigestion Tablets .... 1 1 .... .... .... Jams (Various) .... 4 4 .... .... .... Jelliblock 2 2 4 2 2 4 Jellytine .... 1 1 .... .... .... Koray .... 1 1 .... .... .... Laxative Tablets .... 1 1 .... .... .... Lemonade Crystals .... 1 1 .... .... .... Lemonade Flavouring .... 1 1 .... .... .... Linseed Compound .... 1 1 .... .... .... Liquorice Powder .... 1 1 .... .... .... Lung Tonic .... 1 1 .... .... .... Mac-Rice .... 1 1 .... .... .... Malt Extract .... 1 1 .... .... .... Malt Extract Tablets .... 1 1 .... .... .... Malted Milk .... 1 1 .... .... .... Marinated Mussels .... 1 1 .... .... .... Meat Paste .... 1 1 .... .... .... Milk 61 5 66 .... .... .... Milk, Sweetened Condensed .... 1 1 .... .... .... Minced Meat .... 2 2 .... .... .... Mixed Cut Peel .... 1 1 .... .... .... Mustard .... 2 2 .... .... .... Nutmeg (Ground) .... 1 1 .... .... .... Carried forward 69 93 162 2 2 4 13 Article Number of Samples Examined Number of Unsatisfactory Samples Formal Informal Total Formal Informal Total brought forward 69 93 162 2 2 4 Oatmeal Medium .... 1 1 .... .... .... Oats Rolled .... 1 1 .... .... .... Olive Oil .... 4 4 .... .... .... Onion Powder .... 1 1 .... .... .... Pancake Mixture .... 1 1 .... .... .... Paraffin (Medicinal) .... 1 1 .... .... .... Pastry Mixture .... 2 2 .... 1 1 Peas (Tinned) .... 2 2 .... .... .... Pepper (White) .... 1 1 .... .... .... Pinapple Syrup .... 1 1 .... .... .... Port Wine—Non Alcoholic .... 1 1 .... .... .... Rennett, Essence of .... 2 2 .... .... .... Restorative Tonic .... 1 1 .... .... .... Rum 1 .... 1 .... .... .... Saccharin Tablets .... 2 2 .... .... .... Sage .... 1 1 .... .... .... Salad Cream 2 3 5 1 1 2 Salad Dressing .... 1 1 .... .... .... Sandwich Spread .... 1 1 .... .... .... Sausages (Beef) 1 .... 1 .... .... .... Sausage Meat 2 .... 2 .... .... .... Sausage Luncheon .... 1 1 .... .... .... Sauce Chutney: Fruit .... 2 2 .... .... .... Seidlitz Powders .... 1 1 .... .... .... Shredded Wheat .... 1 1 .... .... .... Sild .... 1 1 .... .... .... Slimming Tablets .... 1 1 .... .... .... Soya Flour .... 1 1 .... .... .... Soup .... 2 2 .... .... .... Spaghetti & Cheese .... 1 1 .... .... .... Sultanas .... 1 1 .... .... .... Suet Shredded .... 1 1 .... .... .... Sulphur Lozenges .... 1 1 .... .... .... Sweetened Fat .... 2 2 .... .... .... Sweet Almond Oil .... 1 1 .... .... .... Syrup of Figs .... 1 1 .... .... .... Syrup of Hypophosphite .... 1 1 .... 1 1 Throat Tablets .... 1 1 .... .... .... Tomato : Mushroom Ketchup .... 3 3 .... .... .... Tomato Spread .... 1 1 .... .... .... Tomato Soup (Concentrated) .... 2 2 .... 1 1 Tonic Food .... 1 1 .... .... .... Vinegar (Malt) .... 1 1 .... 1 1 Vitacup .... 1 1 .... .... .... Whisky ....6 .... 6 .... .... .... Xmas Pudding .... 3 3 .... .... .... Yeast Tablets .... 1 1 .... .... .... Total 81 153 234 3 7 10 14 Details of the ten unsatisfactory samples are as follows:— Sample No. Commodity Infringement Action taken 986 Salad Cream (Informal) Excessive amount of edible vegetable oil and deficiency of egg yolk solids Sample repeated by taking formal sample No. A526 A526 Salad Cream (Formal) Slight excess of edible vegetable oil and deficiency of egg yolk solids According to the requirements of the Food Standards (Salad Cream and Mayonaise Order 1945) the sample had a slight excess of edible vegetable oil, and a deficiency of egg yolk solids. Having regard to the investigations being conducted into the quantitative constituents of this foreign product, and the analytical methods of determining the egg yolk solid content, it was decided no further action be taken. 1059 Syrup of Hypophosphite (Informal) Labelling Infringement (Deficiency of iron) Warning. Upon representation the Manufacturers withdrew all stocks for investigation. They later stated that the preparation was deficient in solution of iron hypophosphite and the constituent had been made and supplied to them in bulk a considerable time ago. The label contained a printer's error. 1020 Vinegar (Malt) (Informal) Labelling Infringement The sample contained a small amount of added salt. The Ministry of Food has under certain circumstances temporarily permitted a special dispensation regarding the addition of salt without declaration on the label. 1077 Pastry Mixture (Informal) Excess of Salt Warning. The proportion of salt to flour was excessive. All stocks withdrawn from sale and warning given. 15 Sample No. Commodity Infringement Action taken 1100 Concentrated Tomato Soup (Informal) Excessive proportion of tin per lb. Warning. The sample contained 2.3 grains of tin per pound, whereas Tinned Tomato Soup should not contain more than 2 grains of tin per pound. A repeat sample No. 1102 was taken and found to be satisfactory. The attention of the Whole saler was drawn to the generally rusty condition of the stock, resulting in the total withdrawal from sale of this salvaged commodity. 1123 1124 A593 A594 Jelli - Blocks Raspberry and Lemon flavour (Two Informal and two Formal Samples) Constituent deficiencies (Soluble solids and sugar) The Public Analyst reported that the informal and formal samples contained varying deficiencies of soluble solids and sugar. After due consideration the Council on the advice of the Town Clerk decided no further action be taken on these samples under the Food Standards (Table Jellies) Order 1949. Sampling Observations. Of the total samples taken during the year 2.13 per cent. were found to be other than genuine. This percentage figure excludes informal samples repeated formally. The percentage for 1948 was 4.97. Labelling infringements in some form or another were found in only 0.85 per cent. of the total samples. The percentage for 1948 was 2.26. A most gratifying feature of the year's sampling is reflected in the fact that observations and infringements reported upon by the Public Analyst were mostly of a minor character. General Observations by the Public Analyst. Sampling throughout the year covered a wide range of articles and the gradually increasing variety of foods on the market during 1949 is reflected by the appearance of such items as fillets of anchovies, concentrated coffee powder, marinated mussels, sweetened fat. almond oil and goats 16 cheese. Certain brands of pre-packed foods from foreign countries and from the Commonwealth have come in for some criticism both in the Borough and other parts of Surrey. For example, salad creams Nos. 986 and A526, of Dutch origin, were found to be deficient in egg yolk solids, and although this deficiency is alleged to be due to a partial decomposition and not to wilful adulteration, it is noticeable that the brands of British manufacture are almost without exception satisfactory. Similarly pastry mixture No. 1077 contained excess of salt, and concentrated tomato soup of French origin was contaminated with tin. The samples included one of Syrup of Iron Hypophosphite which contained only 50 per cent. of the amount of iron declared on the label. This would appear to have been a careless error either of calculation or measurement, since all the other active constituents were accurately dispensed. Finally, samples of Jelli-Block (two informal and two formal) were reported against on the grounds that, although they were in effect Jelly Table Tablets, they did not conform to the legal standard in respect of sugar and soluble solids content. A wide sampling programme such as is indicated by the above figures serves to remind shopkeepers, wholesalers, manufacturers and importers alike of their duty to ensure that foods and drugs are of the nature, substance and quality demanded, and free from any misleading descriptions. FOOD AND DRUGS ACT, 1938—Section 9. Prosecutions. (1) Coloured Cake Decoration Mixture. In December, 1949, a customer bought a small quantity of coloured cake decoration mixture which is commonly known as " hundreds and thousands " at a local shop. When sprinkling the mixture over a custard, she noticed it contained numerous small beetles. Official examination revealed the mixture to be heavily infested with active and inactive beetles in various stages of development. The beetles were of the type known as the " drug store beetle " and the " spider beetle." As a result of further investigation, the Company was successfully prosecuted on three counts for selling, exposing for sale, and depositing for the purpose of sale, cake decoration mixture which was unfit for human consumption. The cases were heard in February, 1950, and the firm was fined £15 (£5 on each summons) and 25/- costs. 17 (2) Bread Containing Mouse Droppings. In November, 1949, evidence of mouse contamination was found in a loaf of "Bermaline" bread purchased by a customer from a local baker's shop. The contamination was found to be due to mouse droppings in the loaf substance, and this was confirmed by laboratory tests. The case was heard in February, 1950, and resulted in the Company being fined £25 with 10/- costs. FOOD AND DRUGS ACT, 1938—Section 13 (i). Precautions against Contamination of Food. The above Section requires there shall be provided in or within reasonable distance, suitable washing facilities, a supply of soap, clean towels, and both hot and cold water for the persons employed. It is gratifying to note that during 1949, sixty-six instantaneous hot water heaters have been installed in the various food establishments, as the result of informal action. MILK SUPPLY. Milk and Dairies Regulations, 1949. The Milk (Special Designation) (Raw Milk) Regulations, 1949. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. These Regulations came into force on 1st October, 1949, and re-enact with amendments The Milk (Special Designations) Regulations, 1936 to 1948, and provide for a new special designation—" Sterilised Milk." Routine inspection of premises has again revealed that the provisions of the various Regulations are generally well observed. The following licences to sell graded milks were granted in 1949:— Grade of Milk Type of Licence Dealer's Supplementary Pasteuriser's Tuberculin Tested 17 7 — Tuberculin Tested (Past.) — 1 — Pasteurised 19 12 2 Sterilised 17 10 — Total 53 30 2 18 Examination of Milk Samples. Seventy-six samples of milk were submitted for examination as follows :— 1. Pasteurised, Heat Treated and Sterilised Milk. Number of Samples Phosphatase Test Methylene Blue Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory 66 66 — 61 5 2. Tuberculin Tested (Pasteurised) Milk. Number of Samples Phosphatase Test Methylene Blue Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory 10 10 — 8 2 The failure of seven samples to pass the Methylene Blue Test was due to the high atmospheric temperature when the samples were taken in the month of September. Samples taken in the previous month and the following month were satisfactory. 3. Glass in School Milk. Complaints were received that the bottled milk delivered to a school by a local dairy contained varying amounts of glass particles. Swift action was taken thoroughly to examine and investigate the actual processing of milk at the dairy. A hidden fault was discovered in the mechanism of the milk bottle filling machine. The defect was immediately rectified by renewal of the defective metal valve. Further tests at the dairy and school proved the milk to be free from the presence of glass. ICE CREAM. 1. Registrations. At the end of 1949, 147 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938. On five of these premises ice cream could be manufactured. 19 2. Sampling. During the year, 155 samples of ice cream were taken for provisional grading and bacteriological examination. The following table shows the provisional gradings and percentages for the 1949 samples, and for comparative purposes the results of 46 samples taken in 1948:— A. Comparative Table—Provisional Grading (19491948). 1949 Grading of Samples 1948 Grading of Samples 93 samples placed in Grade 1 =60.00% 16 samples placed in Grade 1 =34.78% 25 „ „ „ „ 2=16.12% 4 „ „ „ „ 2= 8.69% 28 „ „ „ „ 3 = 18.06% 17 „ „ „ „ 3 = 36.95% 9 „ „ „ „ 4 =5.08% 9 „ „ „ „ 4 = 19.56% 155 46 The Ministry of Health recommend that over a given period 50% of the vendors' samples should fall into Grade 1, 80% into Grades 1 or 2, not more than 20% into Grade 3 and none into Grade 4. The gradings obtained in 1949 compare favourably with the recommended standard for ice cream. B. Comparative Table—Presence of Faecal Coli and/ or Coliforms (1949-1948). Grade of Sample Percentage of samples with fa:cal coli present Percentage of samples with Coliforms present 1949 1948 1949 1948 1 1.29% — 1.93% 6.52% 2 — 2.17% 4.51% 4.52% 3 1.93% — 9.03% 28.26% 4 2.58% 2.17% 5.16% 17.39% The 1949 figures show a general improvement in the bacterial purity of samples as compared with the 1948 results. When a sample is placed in Grade 3 or 4 the vendor is notified accordingly. Generally speaking, it is found that this practice creates a desire on the part of most vendors to attain a higher grading for future samples. Repeat samples are taken to discover the cause for low grade results and advice is given where necessary. 20 In many instances when the results have been poor, the vendors have refused further supplies from the producers concerned, thereby terminating the sale of bacteriologically inferior ice cream in the district. It is gratifying to report that the ice cream trade is generally co-operative and anxious to provide a product which receives a high grade report. MEAT AND OTHER FOODS. 1. Foodshops. The fifty-five 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 generally been well observed. Necessary action was taken in 13 cases where the sanitary conditions were not satisfactory, or certain contraventions of the Regulations existed. At the end of 1949, 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. 126 cases of insanitary or defective conditions in food shops, other than butchers' shops, were dealt with. 2. Slaughtering. There is one licensed slaughterhouse in the district. One pig only was slaughtered during the year, and a section of udder weighing 51bs. was condemned as unfit for human consumption due to mammitis. 3. Unsound Food. 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 Bottles or Jars Packets or Numbers Bacon 21¾ 4 - - Beef 930 — — — Bread 168 — — — Cake, Sponge 71½ — — 12 Cheese 38¾ — — 64 Cocoa Coffee Sugar, Tea 2 2 6 — Culinary Mixtures Essences — 29 1 97 Dried Fruit 242 1 — — Eggs — — — 1385 Fat (Prepared) — 1 — 34 Fish, Wet Tinned 1852 147 8 — Flour, Loose Packeted 3 — — 1 Fruit, Fresh 50 — — — Ice Cream — — — 8 Jelly Crystals Powder — 2 — — Marmalade Jam Syrup — 100 38 37 Meat, Fish Pastes — 1270 10 — Meat Pies 15 — — 2 Milk, Tinned — 410 — — Mutton, Lamb 320¾ — — — Oats Cereals — 1 — 67 Offal 184 — — — Pork 5 — - - Pork and Beef Sausages 50 12 - - Proprietary Foods — 1 1 — Rabbits 424 16 — 20 Sauces Pickles Salad Cream — 4 322 — Soups — 76 4 2 Spaghetti — 13 — — Sweets Chocolate 37¾ — — — Tinned Fruits Juices — 289 7 — Tinned Raw Vegetables 266 315 1 — Tinned Meat 15 227 — — Whale Steak — 1 — — Total 4696 2921 398 1729 SLAUGHTER OF ANIMALS ACT, 1933. Four licences to act as slaughtermen were granted. 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. SCHOOLS. The sanitary condition and the water supply of the schools in the area were found to be satisfactory. 22 DISINFECTION AND DISINFESTATION. Council Houses Private Houses Number of houses treated with insecticide for bed bugs and fleas 11 36 The insecticides used were D.D.T. Municipal Spray and Gammexane Liquid Spray. SHOPS ACT, 1934. 369 visits were made to various types of premises in connection with Section 10 of the Shops Act, 1934. The arrangements made for the health and comfort of the shop workers are generally satisfactory. The co-operation of the various traders is reflected in the number of sanitary improvements carried out without having to take formal action. HAIRDRESSERS AND BARBERS PREMISES. Seventy-three inspections were made, and revealed that the majority of the premises are well conducted and generally satisfactory. In thirteen cases minor infringements of the byelaws were discovered and rectified. LICENCED PLACES OF PUBLIC ENTERTAINMENT. There are nineteen licenced places of public entertainment in the district. These are mainly used for cinematograph shows, concerts, dancing and social functions. The sanitary arrangements have been inspected and a relatively good standard of cleanliness found to exist. 23 RAT AND MOUSE REPRESSION Rats and Mice (Destruction) Act, 1919 The Infestation Order, 1943. A. (1) Surface Treatment. During 1949, 5,692 visits were made in connection with rat or mouse infested or suspected premises. No major infestations were recorded. 311 premises were cleared of rats or mice, and the work for the year is generally summarised as follows :— Complaints received or cases discovered and investigated 395 Premises where no evidence of infestation found 53 Number of premises found to be infested 342 Premises cleared (including 49 for previous year) 311 (2). Cause of Infestation at the 342 Infested Premises. Keeping of poultry 95 Accumulations, refuse, etc. 4 Under garden sheds 82 Defective drains 6 Inside premises, floors, etc 91 Gardens 91 Source untraced 1 Total 370 (Duplication of source in some cases.) (3). Types of premises cleared Methods employed in clearing the 311 premises of rats or mice Dwellinghouses (mainly in gardens) 265 Poison Baits 304 Trapping 7 Food Premises 21 Gassing 5 Non-Food Premises and stores 5 Rat and Mouse Proofing 3 Factories and Workplaces 4 Repairing of Drains 4 Offices 2 Other Means (Necessary to duplicate methods in some cases) 1 Hospitals, Nursing Homes 1 Sports Grounds, Waste land 8 Schools 3 Miscellaneous 2 Total 311 Total 324 24 B. Sewers Treatment. (1). Second Maintenance Treatment (1948-1949) (Completed March, 1949). The second maintenance treatment of sewers found to be infested during the 10% test baiting carried out in July, 1948, has been satisfactorily carried out. Pre-baiting with damped bread crumbs was done on two consecutive days and the same bait base with 10% Arsenious Oxide added was laid on the third day with the following results Borough divided into 5 sections Number of manholes pre-baited Unpoisoned pre-baits laid Number of manholes poison baited Complete bait takes Partial bait takes Baits not taken A.B.C.D.E. 119 9 1 109 15 These figures show a 50% improvement on the first maintenance treatment, which produced 16 complete and 4 partial pre-bait takes. (2). 10% Test Baiting (1949-1950) (Completed July, 1949). As previously, the Borough was divided into five sections, and a test baiting of 10% of the soil sewer manholes carried out in relation to previously recorded surface infestations. The test revealed there is little evidence to support any connection between surface and sewer infestations. Results as follows:— Borough divided into 5 sections Number manholes baited Complete bait takes Partial bait takes Baits not taken A.B.C.D.E. 201 35 9 157 The number of complete and partial bait takes is higher than in the 1948 10% test. Increase found to be in Sections D and E. 25 (3) First Maintenance Treatment (1949-1950) (Completed September 1949). Pre-baiting with damped sausage rusks was carried out on two consecutive days and the same bait base with 2\°7o Zinc Phosphide added was laid on the third day, with the following results:— Borough divided into 5 sections Number of manholes pre-baited Unpoisoned pre-baits laid Number of manholes poison baited Complete bait takes Partial bait takes Baits not taken A.B.C.D.E. 191 52 5 134 102 The table shows an increase in the number of pre-baits taken as compared with the results of previous maintenance treatments, but compares favourably with the 10% test baiting results. The increase in the sewer rat population is probably due to the very dry summer weather of 1949. The second maintenance treatment will be commenced in February, 1950. INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Eight hundred and nineteen cases of infectious disease were notified, a decline of four hundred and fifty-five cases. Points of special interest were the occurrence of a case of Smallpox, a higher number of sporadic cases of Poliomyelitis, an increased prevalence of Scarlet Fever and of Whooping Cough, a fall in the number of cases of Measles, and the absence of notified cases of Diphtheria and of Dysentery. Scarlet Fever. One hundred and sixty-seven cases of Scarlet Fever were notified, an increase of fourteen cases. The disease was generally mild. There was no death. The case rate was 2.06 per 1,000 of population, compared with 1.63 per 1,000 of population for England and Wales. The higher prevalence is related to outbreaks in schools, and the persistence of infection in crowded classrooms. Diphtheria. No case was notified during 1949. It is satisfactory to record, that during the past three years no child within the age groups subject to immunisation has suffered from Diphtheria. The case rate for England and Wales was 0.04 per 1,000 of population. 26 Diphtheria Immunisation. Under the National Health Service immunisation has become a family service provided by the family doctor, and attendance at public clinics has tended to decline. The medical practitioners now notify the Medical Officer of Health of each child immunised by them, and henceforth statistics of the numbers immunised should be more accurate. The success of immunisation is due to the fine spirit of co-operation of parents. Success must not breed complacency. Diphtheria is still dangerous. Carriers still exist in our midst. The diphtheria bacillus awaits an opportunity to break through any weakness in our defences. Every baby should be immunised at or before the first birthday. Every child should be reinforced before entering nursery school or day school and again at the age of eight to nine years. A close check is being kept on the state of immunisation of new entrants to schools and reinforcing injections are given at schools. During the year 1949, nine hundred and ninety children were immunised against Diphtheria. The number immunised at the age of one year was 665, which represents 55 per cent. of the babies reaching that age during the year, compared with 49 per cent, for this age group in 1948. One thousand nine hundred and seventy-six children received reinforcing injections. The following table shows 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 1112 1213 1314 1415 Over 15 Total 42 665 125 44 25 24 22 9 9 3 2 10 2 4 1 3 990 At the end of the year, 10,250 children, representing 62.2 per cent. pf all the children, had been immunised. Of these, 3,030 represents 48.7 per cent. of the children under five years of age, and 7,220 represents 70.5 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, Methodist Church Hall, Station Road, Belmont. The first Thursday in each month, at 1.30 p.m. 3. At the Clinic, Priory Crescent, North Cheam. Every Monday, at 1.30 p.m. 27 4. At the Clinic, St. Oswald's Hall, Brocks Drive, North Cheam. The second and fourth Tuesday in each month, at 1.30 p.m. 5. At the Clinic, Parochial Rooms, The Broadway, Cheam. The first Wednesday in each month, at 2 p.m. 6. At the Clinic, Jubilee Institute, Maiden Green, Worcester Park. The first Monday in each month; at 1.30 p.m. Measles. A rise in the incidence of Measles in December, 1948, continued in 1949, reaching a peak in April, and thereafter declining slowly towards quiescence at the end of the year. Three hundred and sixty-seven cases were notified in 1949, compared with eight hundred and ninety-four cases in 1948. Eleven cases were admitted to hospital complicated by Bronchitis or Broncho Pneumonia. There was no death. The case rate was 4.52 per 1,000 of population, compared with 8.95 per 1,000 of population for England and Wales. The monthly distribution of cases is shown in the following table:— Jan. Feb. March April May June Tuly Aug. Sept. Oct. Nov. Dec. Total 36 33 47 85 38 36 49 19 9 7 6 2 367 Measles is caused by a virus, and is a serious infection for which no specific drug has yet been discovered. The danger of complications by secondary infections has been reduced by the use of Sulphonamides and Penicillin, but the need for careful nursing and careful convalescence continues. Infection is most potent during the early catarrhal phase for three or four days before the rash develops. Spread of infection is most often due to a failure to recognise this early phase during which the child has catarrh of the nose, throat and eyes, and is miserable and disinclined for food or play. The temperature is raised, and the judicious use of a thermometer at this stage may help the mother to decide to restrain the child from contact with other children until diagnosis is confirmed by the appearance of the rash. Medical advice should be sought so as to avoid complications. Information of notifications of children under five years of age is sent to Health Visitors in order that advice may be given where necessary. A leaflet of advice is sent to the home of every notified case. 28 Whooping Cough. Two hundred and nineteen cases were notified, an increase of sixty-two cases. The prevalence was high from January to March. The case rate was 2.69 per 1,000 of population, compared with 2.39 per 1,000 of population for England and Wales. Thirteen cases were admitted to hospital with respiratory complications. There was no death. The monthly incidence of notified cases is shown in the following table :— Jan. Feb. March April May June July Aug. Sept. Oct. Nov. Dec. Total 50 58 56 22 13 8 6 5 1 — — — 219 Whooping Cough is now the most dangerous infection of infancy. The catarrhal phase starts like the common cold, with coughs at first single and later grouped, and may last for seven to fourteen days before the 'whoop' develops. This phase is highly infectious, and the difficulty of early diagnosis makes prevention of infection difficult in homes and schools. The new antibiotic drug, Chloromycetin, gives hope of having a curative effect on Whooping Cough, and when subjected to final trials, and available in quantity, may help to resolve many of the problems related to the disease. Information of notifications of children under five years of age is sent to all Health Visitors in order that help and advice may be given where necessary. A leaflet of advice is sent to the home of every notified case. Immunisation against Whooping Cough. Three hundred and forty-eight children received a course of injections during the year, making a total of 1,031 immunised since 1945. Three cases notified during the year had received injections. The value of this form of immunisation is still under review. It has been established that a degree of immunity is produced. The most efficient and least reactive type of vaccine has yet to be determined. The material used during the year was Bacillus Pertussis 'S' Vaccine, 20 million bacilli per c.c. When combined with Toxoid Antitoxin Floccules (T.A.F.) for immunising against Diphtheria, and injected subcutaneously, there were no reactions. Smallpox. One case of Smallpox occurred in April. The patient, a young man aged 20 years, a passenger contact from S.S. "Mooltan," developed a mild febrile prodromal illness 29 on Thursday, 7th April, and was confined to his room under observation. On Sunday, 10th April, a macule and a papule were noted on his forehead. Two macules were present on his back. A diagnosis of Smallpox was confirmed by Dr. Marsden, Consultant to the Ministry of Health. The patient was removed to Clandon Isolation Hospital. Subsequently scrapings from a minute pustule were examined at the Central Public Health Laboratory, Colindale, and showed a pure growth of the virus of Smallpox. The patient had been vaccinated in 1944 and again on 2nd April before disembarking, but too late to prevent the virulent infection from manifesting itself. The rash was highly modified and abortive, and the patient recovered rapidly without further constitutional disturbance. All known direct contacts were vaccinated. Appropriate disinfection was carried out. No secondary cases arose. Prevention of Smallpox. Vaccination is a voluntary measure. It is essential that people should have a basic immunity established in infancy, reinforceable as circumstances of travel or contact in later life may require. With the rapidity of modern transport and the increasing number of travellers, there can be no guarantee that Smallpox will not intrude into any home at any time. The abortive case with little or no rash can escape detection with dire consequences to the unvaccinated. There has been a general tendency for infant vaccination to decline. Parents should ensure that babies are vaccinated between three and six months of age, the safest period for vaccination. The following table shows the number of vaccinations during the year 1949:— Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Over 15 Total Number Vaccinated 404 37 15 10 8 7 6 5 6 5 8 5 1 7 6 46 576 Number ReVaccinated — 2 2 5 4 2 4 5 6 5 5 12 5 9 9 231 306 Puerperal Pyrexia. Four cases were notified in 1949, compared with two cases in 1948. The case rate was 3.63 per 1,000 total births, compared with 6.31 per 1,000 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, 30 bacteriological and hospital services provided by the Authority and ensure the immediate and effective isolation of any suspected case occurring in a maternity home. Typhoid and Paratyphoid Fever. There was one case of Paratyphoid Fever, a school child, who contracted the disease in another area. Dysentery. No case of Dysentery was notified. This is satisfactory and suggests a higher standard of cleanliness and care in the handling of food. Food Poisoning. No. of Outbreaks. No. of Cases. No. of Deaths. Organisms or Other Agents. Fond Involved. 1 5 0 B. Coli Tongue. 1 35 0 Staphylococcus. Minced Meat. 1 1 0 B. Typhi Murium. Duck's Egg. (1) Five persons suffered from gastro-enteritis after a meal of tongue cooked at home. Examination of a residue of the food showed a growth of B. Coli indicative of contamination after cooking. The illness conformed to the type associated with Staphylococcus Aureus, the toxins of which are heat resistant. (2) Five members of the staff and thirty school children suffered from mild transient attacks of sickness and diarrhoea after eating a school meal of re-heated minced meat. Action was taken to avoid repetition of the occurrence. (.3) A patient suffering from symptoms of Appendicitis was admitted to hospital. Examination of his stools revealed the presence of B. Typhi Murium. The infection was attributable to the eating of a duck's egg twelve hours before onset. Ducks' eggs must be very thoroughly cooked to avoid the danger of infection. The need for constant care by all who are engaged in the handling of food is indicated by the continued occurrence of cases of food poisoning. At the end of the year consideration was given to the adoption of Model Byelaws related to the handling of food. These require that standards of cleanliness which are reasonable and necessary for the protection of food should be maintained in food premises. 31 While emphasis is laid on the control of food premises and on the responsibilities of those who serve food in shops, canteens and restaurants, the liability for contamination to occur in private households must not be overlooked. Some household larders are unsuitable for prolonged storage, and some are stocked with little regard to hygiene. The household refrigerator has limitations and to some people gives a false sense of security. Cerebro spinal Fever. One case, a boy of six, was notified. He recovered quickly after treatment in hospital. Poliomyelitis. Six cases were notified. All were children. Two boys, aged 9 and 11½ years, recovered without paralysis. A baby girl, aged 11 months, has residual paralysis of the left arm. Two girls, aged 5 and 6 years, recovered with slight weakness of the back muscles. A girl, aged 7 years, has paresis of both legs and remains in hospital. Pneumonia. Of twenty-eight deaths occurring from all forms of Pneumonia, seven were notified before death. The total number of notified cases arising in the district was fifty. Non-notifiable Diseases. School teachers reported one hundred and forty-two cases of Chicken Pox, three hundred and thirty-five cases of Mumps, and four cases of German Measles. School notifications are a useful index of the prevalence of non-notifiable diseases, and form a basis for consultations with the school medical officer. 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 twenty-six cases, compared with fifty-one in 1948. The number of attendances at the clinic was ninety, compared with one hundred and forty-eight in 1948. The treatment is by bathing and the application of Benzyl Benzoate emulsion to the skin. Lice. There was an increase in the number of cases of head lice. Fifty cases were treated, compared with twenty cases in 1948. The number of attendances for treatment was one hundred and sixty, compared with eighty-four in 1948. 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. 32 BACTERIOLOGICAL EXAMINATIONS. The following examinations of specimens were made at Laboratories :— Diphtheria Enteric Tuberculosis Positive Negative Positive Negative Positive Negative — 18 — 6 1 15 Diphtheria swabs are also taken by the School Nurses and sent to the County Laboratory; these are not included in the above table. NOTIFIABLE DISEASES (Other Than Tuberculosis) DURING 1949. Disease Under 1 year 1 year 2 years 3 years 4 years 5 years 10 years 15 years 20 years 35 years 45 years 65 years Totals Removed to Hospital *Died Scarlet Fever — 1 14 11 18 96 19 2 2 3 1 — 167 103 — Diphtheria - - - - - - - - - - - - - - - Smallpox - - - - - - - - 1 - - - 1 1 — Typhoid Fever - - - - - - - - - - - - - - - Para-typhoid Fever - - - - - 1 - - - - - - 1 1 — Puerperal Pyrexia - - - - - - - - 4 - - - 4 - - Pneumonia 1 — 1 — — 2 3 1 4 4 19 14 49 1 28 Erysipelas - - - - - - - - - - 1 2 3 1 - Dysentery - - - - - - - - - - - - - - - Poliomyelitis 1 — — — — 4 1 — — — — 6 6 — Cerebrospinal Fever - - - - - 1 - - - - - - 1 1 — Measles 9 41 43 60 55 137 9 6 6 — 1 — 367 11 — Whooping Cough 15 20 31 27 29 81 9 1 2 2 1 1 219 13 — London Cases in the Downs Nursery Pneumonia - 1 - — — - - - — - - - 1 1 - * Under column "Died," all deaths, whether notified in the district or outside it, or not notified at all, are included. 33 DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS. (District Cases.) DISEASE WARDS Case Rate per 1,000 Population (Mid-Year) Case Rate per 1,000 England and Wales N. N.W. N.E. W.C. E.C. E. S.W. S.E. S. Total Population 10455 9198 11307 13123 7631 7751 6728 6066 9001 81260 Scarlet Fever 25 44 16 22 20 11 10 9 10 167 2.C6 1.63 Diphtheria — — — — — — — — — — 0.00 0.04 Typhoid Fever - - - - - - - - - - 0.00 0.01 Para-typhoid Fever - - - - 1 - - - - 1 0.01 0.01 Smallpox - - - - - - 1 - - 1 0.01 0.00 Puerperal Pyrexia - - - - - 1 — 2 1 4 — — Pneumonia 1 1 6 2 12 12 3 5 7 49 0.60 0.80 Erysipelas — — 1 — — 1 — 1 — 3 0.04 0.19 Dysentery - - - - - - - - - - 0.00 — Poliomyelitis 1 — 1 — 1 1 — 2 — 6 0.07 0.13 Cerebrospinal Fever — — — — — — — — 1 1 0.01 0.02 Measles 17 20 58 90 46 44 32 20 40 367 4.52 8.95 Whooping Cough 9 22 35 41 43 25 13 12 19 219 2.69 2.39 Totals 53 87 117 155 123 95 59 51 78 818 34 TUBERCULOSIS. On the 31st December, 1949, there were on the Register 833 cases of Tuberculosis, of whom 678 were Pulmonary cases and 155 non-Pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.25 per 1,000 of population, and for non-Pulmonary Tuberculosis 0.04 per 1,000 of population. The total death rate for Tuberculosis was 0.29 per 1,000 of population, compared with 0.39 per 1,000 of population in 1948. Corresponding death rates for England and Wales in 1949 were: Pulmonary, 0.40 per 1,000 of population; nonPulmonary, 0.05 per 1,000 of population; total rate, 0.45 per 1,000 of population. The number of new cases of Pulmonary Tuberculosis was 69, compared with 50 in 1948. The number of new cases of non-Pulmonary Tuberculosis was 6, compared with 13 in 1948. The death rate from Tuberculosis has shown a gradual decline since 1945, and the rate for 1949 is the lowest recorded. The proportion of new pulmonary cases being diagnosed in the early stages of illness is steadily increasing, and the prospect of cure is enhanced by modern methods of treatment. The progressive reduction of infection is dependent on housing development, and the provision of more adequate accommodation in hospitals and sanatoria for the treatment of early cases. The occurrence of cases of non-pulmonary Tuberculosis is a constant reminder that general control of the National milk supply by pasteurisation or designation is urgently necessary. Within this Borough all milk sold is already efficiently pasteurised or designated. The Tuberculosis Care Committee continued the valuable work of helping patients to overcome social and domestic difficulties, and had particular satisfaction in being able to participate in the Surrey Scheme to provide holidays for children who are contacts of the disease. The Committee was greatly helped by the energy and interest of Mr. Stevens, the Almoner for Tuberculosis. The Scheme for allowances to patients operated beneficially. 35 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 3 2 - — — 1 — 5 3 3 1 - - - - - 15 9 14 — 1 2 — — — 25 10 6 1 1 2 3 — — 35 5 3 — — 4 2 1 — 45 3 3 — — 3 — — — 55 2 1 — — 1 — — — 65 and above 2 — — — 2 1 — 1 Totals 36 33 4 2 14 6 2 1 NOTIFICATION OF TUBERCULOSIS. Respiratory forms of deaths, 18 out of 20 were notified. Other forms of death, 0 out of 3 was notified. MASS RADIOGRAPHY. A Mass Radiography Unit of the South-West Metropolitan Regional Hospital Board visited the Public Hall, Sutton, from 29th August to 15th September, 1949. Two thousand four hundred and twenty-five persons attended for examination. The final results were as follows:— Males. Females. Total X-Rayed 1,046 1,379 Pulmonary Tuberculosis, active 4 2 Pulmonary Tuberculosis, inactive 39 41 Abnormalities (non-Tuberculous) 61 52 The figures conform to general experience that two or three people in every thousand of the adult population are suffering from early unrecognised active Pulmonary Tuberculosis. The frequency of Tuberculosis with spontaneous healing is shown by the finding of 80 cases of arrested disease. The finding of non-tuberculous abnormalities of the heart and lungs gives opportunity for appropriate treatment and for adjustment of ways of life to relieve disability. At present the service can only deal with a sample of the population, but the educational influence, in preparation for the more general application of the service in the future, justifies regular visits of the Unit. 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. (Including Diphtheria Immunisation the first Thursday in each month, at 1.30 p.m. Vaccination against Smallpox, by appointment.) CHEAM AND WORCESTER PARK DISTRICT. The Parochial Rooms, The Broadway, Cheam. Infant Welfare Centre. Every Wednesday, at 2 p.m. (Including Diphtheria Immunisation the first Wednesday in each month, at 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, at 1.30 p.m. Vaccination against Smallpox, by appointment.) St. Oswald's Hall, Brocks Drive, North Cheam. Infant Welfare Centre. Every Friday, at 1.30 p.m., and the second and fourth Tuesday in each month, at 1.30 p.m. (Including Diphtheria Immunisation the second and fourth Tuesday in each month, at 1.30 p.m. Vaccination against Smallpox, by appointment.) 37 Jubilee Institute, Maiden Green, Worcester Park. Infant Welfare Centre. Every Monday and Thursday, at 1.30 p.m. (Including Diphtheria Immunisation the first Monday in each 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. (By appointment.) St. Helier 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 cases only). VENEREAL DISEASES CLINIC. St. Helier 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. 38