LIBRARY BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1950 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1950 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR COUNCILLOR MISS DOROTHY WEBSTER J. P. Alderman F.C. Lohden, O. B.E. COUN W. H CLEAVE COUN . D. SPARKS, (Mrs; M. B. E „ E.A. JAMES „ E..P TAWN „ W M. R. KING „ F. E. W. TOZER „ D. H. MANNING „ F. WARREN „ J. C. ROBERTSON C C. „ 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 Ch ef Sanitary Inspector ARTHUR SYDNEY WILLIAMS Certif R S. I. ,Certif Meat & Flood. Assistant Sanitary Inspectors; WALTER BLACK D. P. A. Certif R.S, I and S. I. E. J. B. Certif Meat & Flood JOHN ALWYN EVANS JONES Certif R.S. I. and S.I. E.J. B Certif Meat & Flood REGINALD WILLIAM NOMAN Certif. R.S.I. and S. I.E.J. B. Certif Meat & Flood KEMPTON HUDDLESTONE PRIOR Certif. R.S. I. and S.I.E.J. B, Certif Meat & Flood FRANK SUTCLIFFE Certif R.S. I. and S. I. E.J. B. Certif Meat & Food Public Analyst DANIEL D. MOIR M. S.c., 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 1950. The services provided under the National Health Service Act; 1946 became more defined in form and improved in co-ordination The general health of the community was good,, The birth rats fell from 13,2 per 1000 of population to 12.6 per 1000 of population. The death rate rose from 9 8 to 10.5 per 1000 of population. The infantile mortality rate was low at 26 per 1000 live births. There was no maternal death. There was no unusual incidence of infectious disease. Twelve cases of Poliomyelitis occurred. There was no case of Diphtheria. No case of Food Poisoning was notified A Mass Radiography Unit visited the Borough in September and again contributed to the early diagnosis of Pulmonary Tuberculosis. Deficiency in housing accommodation remained a matter for serious concern. During the year sixty flats and houses were completed and one hundred and forty-seven flats and houses were in course of construction. Schemes were in preparation for one hundred and fifty-seven flats and houses. The acquisition and development of a site in Banstead Jointly with other authorities, proceeded slowly. The work of general sanitation, of the prevention of nulsances and of the protection of food was carried out efficiently under the direction of the Chief Sanitary Inspector (Mr, C.W. Newbery) whose work on housing has been of the highest value. 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 co-operation. I am Mr.Mayor,Ladies and Gentlemen, Your obedient Servant, ENEAS J. MACINTYRE, Medical Officer of Health. 2 STATISTICS OF THE AREA. 1949. 1950. Area in Acres 4338., 15 4338.15 Registrar General's Estimate of the Resident Population 81,260 81,110 Number of inhabited houses(end of year)according to the Rate Book 22,951 23,027 Rateable Value and sum represented by £902,059 £903,283 a Penny Rate £3,665 £3, 680 EXTRACTS FROM VITAL STATISTICS (comparative of the years 1949 and 1950) 1949 1950 England and Vales Total Male Female Total M ale female 1950 Live Berths 1074 565 509 1021 510 511 Legitimate 1024 538 486 988 492 496 Illegitimate 50 27 23 33 18 15 Birth Rate per 1,000 of the Estimated Resident Population 13.2 12. 6 15.8 Still Births 23 14 9 19 12 7 Legitimate 22 13 9 18 11 7 Illegitimate 1 1 - 1 1 - Rate per 1.000 total (live and still births) 20.9 18.2 22.6 Deaths 796 373 423 857 399 458 Death Rate per 1,000 of the Estimated Resident Population 9 .8 10.5 11. 8 Deaths fromPuerperal Sepsis 0 0 Other Puerperal Causes 1 0 Death Rate from Puerperal Causes per 1,000 total (live and still births) 0.91 0.00 0.72 Deaths of Infants under one year of age- All Infants per 1,000 live births 21.42 26.44 29.8 Legitimate Infants per 1,000 legitimate live births 19.53 24.29 Illegitimate Infants per 1,000 illegitimate live births 60. 00 90.90 3  1949 1950 Deaths from Cancer 143 164 „ „Measles 0 0 „ „ Whooping Cough 0 0 „ „ Diarrhoea 2 3 Percentage of Deaths from certain causes to the total number of Deaths 1949 1950 Diseases of the heart and circulation 35. 5 34.6 Cancer and malignant disease 18.0 19.2 Diseases of the lungs (non-tuberculous) 9.4 8.2 Tuberculous diseases 2.9 1.6 Cerebral haemorrhage 11.0 15.4 Congenital diseases 2.1 l.4 Suicide and violence 3.5 3.5 Diseases of the digestive system 4.4 1.3 Infectious diseases 2.1 1.9 Diseases of the kidney 2.3 2.9 Other defined diseases 8.8 10.0 Maternal Mortality: There was no death. The maternal mortality rate for England and Wales was 0.72 per 1,000 total births. Infantile Mortality: The infantile mortality rate was 26.44 per 1,000 live births compared with 21.42 per 1,000 live births in 1949. There were twenty-seven deaths of infants under one year, compared with twenty-three in 1949. Of the twenty-seven deaths, twenty-four occurred in the neo-natal period, within one month of birth, as is shown in the following-table of causes and age groups:- Causes of Death Age Groups Under 1 month 1-3 months 3-12 months Congenital Abnormality 11 1 - Prematurity 7 - - Pneumonia 2 1 - Cerebral Haemorrhage 2 - - Gastro Enteritis - 1 - Icterus 2 — - Total 24 3 - 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1950 M. F. Total 1 Tuberculosis respiratory 10 4 i4 2 Tuberculosis, other - - - 3 Syphilitic disease 2 5 7 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal infections - - - 7 Acute Poliomyelitis - 1 1 8 Measles - - - 9 Other infective and parasitic diseases 2 2 4 10 Malignant neoplasm, stomach 10 13 23 11 Malignant neoplasm, lung, bronchus 26 3 29 12 Malignant neoplasm, breast 1 14 15 13 Malignant neoplasm, uterus - 3 3 14 Other malignant and lymphatic neoplasms 37 57 94 15 Leukaemia, aleukaemla - 3 3 16 Diabetes 1 2 3 17 Vascular lesions of nervous system 51 81 132 18 Coronary disease, angina 55 52 107 19 Hypertension with heart disease 7 17 24 20 Other heart disease 55 82 137 21 Other circulatory disease 15 14 29 22 influenza 2 2 4 23 Pneumonia 12 14 26 24 Bronchitis 27 10 37 25 Other diseases of respiratory system 5 2 7 26 Ulcer of stomach and duodenum 1 4 5 27 Gastritis, enteritis and diarrhoea 2 1 3 28 Nephritis and nephrosis 8 6 14 29 Hyperplasia of prostate 11 - 11 30 Pregnancy, childbirth, abortion - - - 31 Congenital malformations 4 8 12 32 Other defined and ill-defined diseases 41 42 83 33 Motor vehicle accidents 5 2 7 34 All other accidents 7 9 16 35 Suicide 2 5 7 36 . Homicide and operations of war - - - Totals 399 458 857 5 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA Legilsation. NATIONAL ASSISTANCE ACT, 1948 SEC 47 REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION A Court Order was secured and applied in March 1950, for the removal of a woman, aged 62 years suffering from mental depression and living in insanitary circumstances to residential accommodation provided by the Surrey County Council at St Anne' s Home Redhill After the period of three months prescribed, the patient was allowed to return to her home but in December she relapsed in health and cleanliness and was persuaded to enter residential accommodation at The Oaks Dorking Road Epsom where she remains voluntarily SEC. 50. BURIAL OR CREMATION OF THE DEAD Three burials were arranged under the powers granted to the Corncll by this section Laboratories Arrangements were continued for the use of the laboratory at Sutton and Cheam Hospital which has provided an essential Public Health service, The use of the Public Health Laboratory at Epsom is limited by the distance from the Borough, Mortuary During 1950 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 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 chloramlne as a protective measure Samples of the raw and treated waters are examined daily by the laboratory at the Sutton Works Samples are also examined at monthly Intervals by the Company's Consultant Analyst. and monthly 6 samples are examined in rotation by the District Councils in the area of supply, The supply from all sources has been satisfactory in quality ana 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. 189. 58 Ammonia, free 0.232 Ammonia, Albuminoid 0. Nitrogen in Nitrates 6.82 Nitrogen in Nitrites 0. Oxygen absorbed in 4 hours at 27° C. 0.004 Chlorine in Chlorides 17.75 Hardness total (grains per gallon) 8.36 BACTERIOLOGICAL RESULTS No. of Bacteria growing on Agar per ml. for 3 days at 20° C. 5.08 No. of Bacteria growing on Agar per ml. for 1 day at 37° C. 0.08 Presence of Bacillus Coll in 100 ml. 0 Drainage and Sewerage No major new construction works have been carried out at either of the sewage disposal works but a Public Enquiry was held in February 1950 into the proposals for the reconstruction of Worcester Park. Sewage Works. Approval in principle to this scheme has now been given and it is hoped to proceed before the end of 1952 with the first stage of the works including new primary settlement tanks, additional percolating filters and new humus tanks No major works have been carried out in connection with the main drainage system except that a length of surface water sewer in Gander Green Lane near the Cheam Wells of the Sutton District Water Company has been relald in cast iron pipes. 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. 7 Closet Accommodation There are eight premises with cesspools in use Some six pail closets and one privy are in use in the past 22 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 25) Record of Inspections and Notices Served. Special Inspections Interviews and advisory visits 1,620 Reinspectlons 3,705 Visits to works in progress 1,073 „Factories/Workplaces 272 „ Bakehouses 32 „ Outworkers premises 76 „ Butchers, Grocers and other food premises 391 „Dairies and Milk Purveyors Premises 20 „ Ice Cream Premises 122 „ Stables/Passages/Pigstles/Ditches 24 „ Restaurant/Cafe and School Canteen kitchens 85 „ Premises re: rodent infestations 7,117 „ Tents/Vans/Sheds 5 „ Cinemas/Theatres/Halls 17 „ Premises re: infectious diseases 239 „ Premises re overcrowding and permitted numbers 408 „ Premises re. food complaints (Shops and Houses) 247 „ Barbers and Hairdressers Premises 61 „ School and public conveniences 38 „ Verminous houses 15 „ Shops under the Shops Acts 240 „ re the taking of Food and Drug Samples 191 „ re: the taking of Bacteriological Milk/Water Samples 93 „ re: the taking of Bacteriological Samples of icecream 100 „ re: Smoke Observations 2 Miscellaneous Visits 2,590 Total 18,783 Number of complaints received and investigated 663 Premises at which defects or nuisances were discovered 1,906 Dwelling-houses surveyed for housing defects under the Public Health or Housing Acts 310 Number of defects or nuisances discovered 2,782 „ „ „ remedied 2.116 „ „ „ in hand 124 outstanding 542 Number of informal notices served 1,294 Statutory Notices were served as unders:Housing Act 1936 Sections 9 and 10 (as. amended by the Housing Act 1949) 33 Public Health Act 1936, section 24 40 „ „ „ „ 39 12 „ „ „ „ 45 4 „ „ „ „ 75 10 8 Total 99 Summary of Remedial Works and Sanitary Improvements carried out Drainage and Sanitary Fittings Number of houses and other premises redralned 23 Number of houses and other premises connected to soil and surface water sewers 1 Repairs and amendments to existing drains . 129 Drains or gullies unstopped or cleansed 302 Sanitary fittings repaired/renewed/provided or cleansed 734 Water service pipes/cisterns/repaired. renewed or cleansed 13 Water, smoke and chemical tests applied 468 W. C. Apartments:- W. C. Apartments provided 11 „ lighted and/or ventilated 22 „ provided with ventilated lobbies 7 „ cleansed 72 Separate W.C. accommodation provided for the sexes 2 Structural Repairs or Improvements carried outs:- Number of roofs repaired or renewed 202 „ guttering and rainwater pipes provided repaired etc., 154 „ damp walls remedied 89 „ brick walls repointed, repaired or re-rendered 100 „ Chimney stacks repaired or rebuilt , 31 „ yards paved or repaired 18 „ sites of houses concreted 4 „ floors relaid or repaired 149 „ windows/sills/sashcords repaired or renewed 349 " doors/thresholds provided or repaired 62 " staircases/handrails provided or repaired 23 " ranges/stoves/coppers renewed or repaired 66 " Miscellaneous Items 28 CIeansing:- Number of rooms/passages/larders cleansed and/or repaired 518 " trade premises cleansed 46 " verminous houses dlslnfested for bugs/ fleas 57 " premises sprayed for cockroaches/crickets/wood beetles etc. 53 " premises disinfected after various diseases 319 Var i ouss- Number of offal bins provided 3 " dustbins provided 157 " accumulations of refuse and manure removed 42 " premises cleared of rats and mice 434 11 offensive ponds and ditches cleared 1 " wasp nests destroyed 34 " miscellaneous Items 185 9 HOUSING 1. Inspection of Dwelling-houses during the Year:- (1) (a) Total number of dwelling-houses inspected under the Public Health or Housing Acts 248 (b) Number of inspections made for the purpose 853 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 122 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 106 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 33 (2) Number of dwelling-houses which were rendered fit after service of formal notices :- (a) By Owners 17 (b) By Local Authority in default of owners 3 (B) Proceedings under the Public Health Act ;- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 16 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners 7 (b) By Local Authority in default of owners 7 (c) Proceedings under Sections 11 and 13 of the Housing Act 1936. (a) Number of dwelling-houses in respect of which Demolition Orders were made, 4 (b) Number of dwelling-houses demolished in pursuance of Demolition Orders FACTORIES ACT 1937-1948 Inspection of Factories and other Premises Inspections made by Sanitary Inspectors for the purpose of provisions as to Health- Number of Type of Premises inspections Notices,written and/or Oral. Factories with mechanical power 220 38 Factories without mechanical power 65 13 Premises (other than out-workers premises) 19 2 Total 304 53 10 Defects Found in Factories and other premises Under the Acts- Partoiculars Number of Defects Found Remedied Want of cleanliness 4 4 Inadequate ventilation - - Overcrowding - - Unreasonable temperature - - Ineffective floor drainage - - Absence of thermometers 4 2 Insuffient lighting in W. C. Apartments 5 4 Other nuisances 13 10 Sanitary Accommodation - (a) Insufficient 3 - (b) Want of cleanliness 24 22 (c) Unsuitable or defective 16 12 (d) Not separate for the sexes - - Total 69 54 PUBLIC HEALTH ACT, 1936 - WORKPLACES Number of Inspections Written Notices Occupiers Prosecuted 19 2 - The following list indicates the nature of the 240 formal and Informal samples submitted for analysis during the year Article Number of samples examined. Number of unsatisfactory samples. Formal Informal Total Formal Informal Total Almonds ground 2 2 Almond Rock 1 1 1 l Almonds sliced 1 1 Apple Puree 1 1 1 l Apple Toffee 1 1 Baking Powder 1 1 Beans in Tomato 1 1 Bicarbonate of Soda 1 1 Brawn - Pork 1 1 Carried forward 1 9 10 1 1 2 SMOKE ABATEMENT The few chimneys attached to industrial premises in the district have been kept under observation. During the year two smoke and grit nuisances were detected and abated as a result of informal action. in 1951 grit deposit gauges will be installed to measure the grit fall in the north of the Borough, INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1933 - Samplin 11 Article Number of samples examined. Number of unsatisfactory samples. Formal Informal Total Formal Informal Total Brought forward 1 9 10 1 1 2 Cake & Pudding Mixture 1 1 Calves feet Jelly 1 1 Cascara Sagrada Tablets 1 1 Chocolate Spread 1 1 Chutney Fruit 1 1 Chutney Tomato 1 1 Coconut in Syrup 1 1 Cochineal Colouring 1 1 Cocoa Mild 1 1 Cocoa Desslcated 2 2 Coffee & Chicory Essence 2 2 Colouring 1 1 Cornflour 1 1 Crab Paste 1 1 Cream of Tartar 1 1 Curd Lemon 1 1 Curry Powder 1 1 Custard Powder 3 3 Dandelion Coffee Essence 1 1 Dessert Crystals 1 1 Dessert Powder 1 1 Dessert Tablets 1 1 Digestive Tablets 1 1 Fig Pudding 2 3 Fish Cakes 1 1 Flavouring 1 1 Fudge Nut 1 1 Gelatine Dessert 2 2 Ginger Flavour 1 1 Health Salts 1 1 Honey 5 5 Ice Cream 31 31 1 1 Jam (Apple & Blackcurrant) 2 2 Jelly Crystals 6 6 Jelly Table 5 5 Ketchup-Tomato 2 2 Llnctus 1 1 Laxative Fruit. 1 1 Lemonade Crystals 3 3 Lemonade 1 1 Lemon Powder 1 1 Lemonade Powder 1 1 Maralyn Milk 1 1 Marmalade 1 1 Marmalade Orange 1 1 Milk 41 41 Milk (Condensed) 1 1 Milk Whipping Compound 1 1 Mincemeat 4 4 Carried forward 42 113 155 1 2 3 12 Article Number of samples examined Number of unsatisfactory samples. Formal Informal Total Formal Informal Total Brought forward 42 113 155 1 2 3 Mint Sauce 1 1 Mustard Mix 1 1 Orange Conserve 1 1 Paraffin Liquid 2 2 Paste (fish) 2 2 Paste ,'Meat) 1 1 Pastry Mixture 1 1 Peanut-Butter 1 1 Peas-Processed 4 4 Peel-Candied 3 3 Peel-cut mixed 1 1 Pectin fruit 1 1 Pepper 1 1 Pepper Compound 5 5 Peppei-Ground (white) 2 2 Peppermints 1 1 Pills-Kidney & Bladder 1 1 Pudding-Xmas 2 2 Sage 1 1 Sage & Onion Stuffing 1 1 Salad Cream 3 3 Sandwich Spread 1 1 Sauce 1 1 Sausage (preserved) Beef 1 1 Sausage Beef Tinned 1 1 Sausage (preserved) Pork 1 1 1 1 Sausage (Beef) 1 1 Sausage (Pork) 3 3 Scone Mixture 1 1 1 1 Soft Drinks 1 1 Soup-Noodle 1 1 Soup Tinned Vegetable 1 1 Soya Paste Substitute 1 1 Sponge Mixture 1 1 Squash-Grapefruit 1 1 Squash-Lemon 1 1 Squash-Orange 1 2 3 Suet Beef Shredded 1 1 1 1 Suet-Shredded 1 4 5 2 2 Syrup Spread 1 1 Tapioca Dessert 2 2 Tea Extender Tablets 1 1 Thyme 1 1 Tomato Puree 1 1 Tomato Juice 1 1 Tonic 1 1 Tonic Blood Renewer 1 1 Tonic Food - Red Bone Marroe with Malt and Chemical food 1 1 1 1 Carried Forward 51 176 227 2 7 9 13 Article Number of samples examined , Number of unsatisfactory samples- Formal Informal Total Formal Informal Total, Brought Toward 51 176 227 2 7 9 Tonic Syrup 1 1 Tonic Tablets-Chlorophyll 1 1 Vegetable Extract 3 Vinegar (Malt) 1 1 1 1 Vitamin B 1 1 Whisky 4 4 Yeast Dried 1 1 Yeast Tablets 1 1 Total 55 185 240 2 8 10 Details of the ten unsatisfactory samples are as follows:- Sample No. Article Infringement Action taken. A615 All Almond Rock. (Formal) Labelling infringement Article contained 5% of peanuts instead of "All Almonds" as described on the label. Manufacturer Warned 1175 Apple Puree (Informal) Labelling Infringement Contained Saccharin, the presence of which was not disclosed on the labels also contaminated with mould. Manufacturer warned. Stocks withdrawn from sale. Mould due to stock being old. A628 Pork Sausage (Formal) Labelling Infringement Contained preservative. Retailer asserted that the label containing the declaration had become de tached Retailer warned. 1174 Sweetened Scotch Scone Mixture (Informal) Article had objectionable smell and taste, Rancidity of fat. Manufacturer warned, Wi thdrawn from sale Rancidity probably due to lengthy storage. 1232 Shredded Beef Samples contained 78.6 Manufacturer 1287 Suet (Informals) and 79.1% of fat respectively, instead of not less than 83% by weight of fat. warned. A follow up sample No A643 contained a fat content above the required standard 1191 Red Bone Marrow with malt and chemical food. (Informal) Labelling Infringement Misleading label and dosage discrepancies. Representations made to manufacturers, who agreed that a change of label was desirable. New labels were printed. 14 Sample Article Infringement Action Taken. No, 1288 Ice Cream (Chemical Sample) (Informal) Contained 3. 3% of fat, and was not of ordinary commercial quality Manufacturer warned. Admitted error in amount of fat used A follow up sample revealed a fat content above the interim standard of 5% fat 1294 Shredded Suet (Informal) Deficiency of fat content; 81,8% instead of not less than 83% fat. Manufacturer warned. 1158 Vinegar (Malt) (Informal) Contained 0,9% of added salt, which is not a natural ingredient of malt vinegar The Ministry of Food has in certain cases allowed the addition of salt to malt vinegar without declaration on the label. No further action taken on this sample. Sampling Observations Of the 240 samples taken during the year 2, 5% were found to be other than genuine. This percentage figure excludes informal samples repeated formally. The percentage for 1949 was 2.13% Labelling infringements in some form or another were found in 1.66% of the total samples taken. The percentage for 1949 was 0 .85%. A most gratifying feature of the year's sampling is reflected in the fact that the observations of ana infringements reported upon by the Public Analyst were mostly of a minor character. General Observations by the Public Analyst Samples submitted during 1950 under the Food and Drugs Act, 1938 and the Defence(Sale of Food) Regulations, 1943 The usual wide range of sampling has been maintained throughout the year with the result that a number of unusual commodities have been investigated as well as a large variety of the common foodstuffs and medicines 15 Of the less usual articles it may r.e of interest to mention a few such as s- Shredded Coconut in syrup - a tinned article consisting of coconut in shreds packed in a small quantity of a light syrup. This otherwise excellent article would not keep once it was opened, and the contents of the large tin would have to be used within two or three days- Essence of Dandelion Coffee - which, although clearly stated on the label contained besides dandelion essence, a very considerable proportion of coffee essence. Anybody expecting a caffeine- free drink would therefore be disappointed,, Milk whipping compound - Two or three of these have come on the market during the last year They are designed to make a sort of mock cream with milk and they contain both synthetic emulsifiers and thickeners as well as gums obtained from natural sources. The growing use of new synthetic chemical substances in foods is something which will have to be watched very carefully from a medical and public health point of view Tea Extender Tablets - an ingenious article simulating the natural properties of tea and containing added caffeine and colouring matter For those who like this type of article these tablets did fulfil the purpose implied in their description. Red bone marrow with malt & chemical food - This proprietary tonic contained relatively such small quantities of red bone marrow and malt that its virtue rested almost entirely with the chemical food (more commonly known as Parrlsh's Food). Exception was taken to the description with the successful outcome indicated elsewhere. Of the more common articles of food two require special mention. Ice Cream - The average fat content has rapidly increased during the year and the minimum of per cent, fixed by the Ministry of Food as a condition of supply of raw materials was soon shown to be far below the average commercial quality of the ice cream on sale to the public. As a result it was possible to take exception to a sample showing only 3. 3 per cent. of fat and to suggest 5 or even 6 per cent. of fat as a reasonable minimum limit. in fact the average fat content of the 31 samples submitted during the year was 8. 9 per cent„ To conform with the actual quality of much of the ice cream on sale during the latter part of the year the Ministry has now made a much more comprehensive legal standard including limits for fat, sugars, sucrose and milk solids This comes into force in March, 1951. Malt Vinegar - For several years much of the malt vinegar on sale, particularly that sold as a prepacked article in bottles has contained an addition of between 0.8 and 1 per cent of salt. This 16 was commenced during the war and was stated to reduce the tendency to decomposition and to be a temporary expedient until sufficient pasteurising plant could be obtained Your Analyst has always taken the view that salt is not a natural ingredient of malt vinegar and that its inclusion without declaration was an offence. However manufacturers were for some reason loth to make this declaration and the Ministry of Food Issued them with a special dispensation permitting the addition of salt to vinegar without disclosure With the coming into force in November, 1950 of the new Labelling of Food Order, authority to make this dispensation lapsed and manufacturers are now required to list added salt as an ingredient of this commodity It is notable that little is now heard of "pasteurisation and it would appear that salt is likely to become a permanent addition to much of what was previously known as malt vinegar FOOD AND DRUGS ACT, 1938 - Section 13 (i) Precautions to be taken in rooms where food intended for sale is prepared or stored. This section requires that there shall be provided in or within reasonable distance of the room suitable washing basins, and a sufficient supply of soap, clean towels, and clean water both hot and cold, for the use of persons employed in the room, During 1950, 58 instantaneous hot water heaters and a number of wash basins were installed in a variety of food premises as a result of informal action by the inspectorial staff. FOOD AND DRUGS ACT, 1938 - Section 15 Clean Food Bye-laws. The above bye-laws made under Section 15 of the Food and Drugs Act 1938 by the Corporation for securing the observance of sanitary and cleanly conditions and practices in connection with the handling wrapping and delivery of food sold or intended for sale for human consumption and in connection with the sale or exposure for sale in the open air of food intended for human consumption, came into operation on 24th July 1950. Since the adoption of the bye- laws a few minor infringements have already been observed but in general She results achieved and the working of the bye-laws will not be known until the expiration of the present experimental period MILK SUPPLY Milk and Dairies Regulations 1949 The Milk {Special Designation) (Raw Milk) Regulations, 1 9 49 The Milk (Special Designation) Pasteurised and Sterilised Milk Regulations, 1949 Routine inspection of milk pasteuriser's, dealers and 17 vendors 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 1950 Grade of Milk. Dealer' s Type of Licence Supplementary Pasteuriser-s Tuberculin Tested 17 6 - Tuberculin Tested(Past) - 1 - Pasteurised 19 9 2 Sterilised 21 9 - Total 57 25 2 Examination of Milk Samples One hundred and nine samples of milk were submitted for examination as follows Class of Milk. Number of samples taken Appropriate test applied Number of Passed samples Failed Pasteurised 77 Phosphatase 77 - Sterilised 10 Methylene Blue 73 4 Turbidity * 10 - Tuberculin Teste (Pasteurised) d 12 Phosphatase 12 - Methylene Blue 12 - Tuberculin Teste (Farm Bottled) d 10 Methylene Blue 3 7 Total 109 11 It will be noted that all the Pasteurised and Tuberculin Tested (Pasteurised) Milks passed the phosphatase test and the sterilised milks the turbidity test. The failure of eleven samples to pass the methylene blue test was mainly due to the high atmospheric temperature at the time the samples were taken and in the case of one producer of Tuberculin Tested (Farm Bottled) milk to the delay between the time of production and delivery to the customer These factors had an adverse effect upon the keeping qualities of the milk. However, when further samples were taken the results proved to be satisfactory. ICE CREAM l. Registrations. At the end of 1950„ 173 premises had been registered in accordance with Section 14 of the Food and Drugs Act 1938. On six of these premises ice cream could be manufactured. During the last year or so there has been a marked increase in the number of applications for permission to sell Ice cream as shown by the following table 18 Year Number of applications. 1946 7 1947 9 1948 10 1949 29 1950 27 2. Samplings (Bacteriological) During the year 104 samples of ice cream were taken for provisional grading ana bacteriological examination. The following table shows the provisional gradlngs and percentages for the year 1950, and for comparative purposes the results of 155 samples taken in 1949. A COMPARATIVE TABLE - PROVISIONAL GRADING. 1950 Grading of Samples 1949 Grading of Samples 72 Samples: Grade 1 - 69.23% 93 Samples: Grade I - 60.00% 16 „ „ 2 - 15.38% 25 „ „2-163.12% 12 „ „ 3 - 11. 53% 28 „ „ 3 - 18. 06% 4 „ „ 4-3.84% 9 „„ 4 - 5.08% 104 Total 155 Total 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, It will be observed that the 1950 provisional grading results show an improvement on the results obtained in 1949 A ertaln amount of credit for this progressive change is due to the fact that in many instances the granting of registration certificates for the sale of ice cream is made on condition that only pre-packed ice cream may be sold at those premises. In order to maintain a high degree of bacteriological purity it is the practice immediately to notify the dealer if faecal coli are found to be present in the ice cream and he is also Informed if samples are placed in grades other than 1 or 2. It is gratifying to report that the result of this practice is reflected in the usually improved results obtained when further samples are taken 19 BACTERIOLOGICAL SAMPLING OF ICE CREAM B The following general table shows A. Code designation for each producer of Ice cream. B. Number of samples taken from each producer C. Number of samples sold wrapped or loose D. Provisional grading percentage results. E. Number of samples with faecal coll present, F. Number of samples with coliforms present. A B C D E F Producer's Code. No. taker from each producers No. Of samples sold Results of samples in each grade. No. with faecal coll No. with coilforms Wrapped Loose 1 2 3 4 % % % % A 2 - 2 100 - - - - - B 1 - 1 100 - - - - - C 2 - 2 50 - 50 - - - D 3 3 - 66. 66 33.33 - - - - E 8 6 2 87.5 12.5 - - - - F 3 - 3 33.33 - 33. 33 33. 33 2 2 G 20 20 - 90.00 10.00 - - - 1 H 16 16 - 87.5 12. 5 - - - - I 2 - 2 100 - - - - - J 1 1 - 100 - - - - - K 1 1 - - 100 - - - - L 3 3 - 100 - - - - - M 13 7 6 61.53 23.07 15. 38 - - 7 N 1 1 - - 100 - - - 1 O 6 4 2 66.66 16. 66 - 16.66 1 4 P 7 - 7 - 28.57 57.14 14.28 1 6 Q 1 1 - 100 - - - - - R 1 - 1 - 100 - - - - S 7 3 4 14.28 14.28 57.14 14,28 2 5 T 3 3 - 100 - - - - 1 U 1 - 1 100 - - - - 1 V 2 2 - 100 - - - - - TOTAL 104 71 33 6 28 C- SAMPLING ; CHEMICAL : (Fat and total solids) During the latter part of the year It was decided that In addition to the bacteriological examination of Ice cream, samples should also be taken for chemical examination. Thirty one samples were taken for this purpose and submitted to the Public Analyst for analysis, Two samples from a local producer failed to show a 5% fat content, but a follow up sample contained 5,3% of fat. 20 The following table shows:- A Producer's code. B Number of samples taken from each producer C Average chemical standard. Producer's code Number of samples taken Average Fat chemical standard Total solids A 1 10.8% 30.6% B 1 9.4% 34.5% C 2 8.3% 29.9% D 3 3 9% 34.8% E 1 11.1% 32.7% F 2 7.2% 33.8% G 1 7.3% 31.9% H 3 10.7% 34.2% I 3 9.6% 35.2% J 2 10.3% 38.0% K 1 7.6% 32.6% L 1 7.4% 32.3% M 2 9.6% 35.5% N 2 10.5% 37.0% O 1 13.0% 40.1% P 1 8.8% 37.1% Q 1 10.2% 38.0% R 1 9.2% 35.5% S 2 9.0% 35.3% Total and average 31 8.9% 34.6% HEAT AND OTHER FOODS 1.Foodshops. The fifty-five butchers shops within the Borough have been inspected and observation kept on the vehicles used for the conveyance of meat, with the result that it has been found that the provisions of the Public Health (Meat) Regulations have been generally well observed. Necessary action was taken in 12 cases where the sanitary conditions were not satisfactory, or certain contraventions of the Regulations existed. At the end of 1950, 51 premises had been registered in accordance with Section 14 of the Food and Drugs Act, 1938,, The majority of the registered premises are concerned with the manufacture of sausages only, 88 cases of insanitary or defective conditions in food shops other than butchers shops were dealt with. 2. Shops Act 1934 - 1950 240 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. 21 3 Slaughtering. There is one licensed slaughterhouse in the district No animals were slaughtered during the year. 4. Slaughter of Animals Act, 1933 Three licences to act as slaughtermen were granted MEAT AND OTHER FOODS 5 Unsound Food. 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 20½ 1 - - Beef/Mutton (Home Killed) 415 - - - Beef/Mutton (Imported) 1171¾ - - - Butter/Fat ¾ 2 1 11 Cakes/Chocolate Spread/ Confectionery 55¼ 2 - 80 Cereals 3½ 29 - 10 Coffee - 2 - - Corn on the Cob/Chestnuts 12 5 - - Culinary Mixtures - 9 73 533 Dates/Figs/Prunes/Dried Fruit 81¼ - 162 Dressed Crab 18½ - - - Eggs - - - 3,901 Fish Pastes and Creams - 43 37 - Fish (Tinned etc.) - 522 9 - Fish (wet) 708 - - - Flour (Loose and packeted) 27 - - 7 Fruit Juices/Jellies/Puree - 91 - 2 Ham 31¾ 7 - - Ice Cream - - - 5 Marmalade/Syrup/Jam/Honey – 162 9 - Milk (Tinned) - 324 - - Offal/Pork Pies 52 – - 45 Pickles/Sauces/Soup/Salad Creams – 97 137 148 Peas/Beans 50 150 - – Proprietary Articles - 2 8 166 Puddings - 74 - - Rabbits 86 1 - - Sausages Tinned/Sausage Meat t 28 5 - - Spaghetti - 36 - 11 Tinned Fruit and Vegetables 52½ 514 16 - Tinned Meats/Pastes 7 395 3 - Whalemeat Steak — 1 – – Totals 2,820¾ 2474 293 5,081 22 BAKEHOUSES There are 25 bakehouses within the district, and of these 23 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 HAIRDRESSERS AND BARBERS PREMISES Sixty one inspections were made, and revealed that the majority of the premises are well conducted and generally satisfactory. Eleven cases of minor infringements of the bye-laws were discovered and rectified. LICENSED PREMISES 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 DISINFECTION AND DISINFESTATION Council Houses Private Houses Number of houses treated with insecticide for bugs and fleas 6 24 The insecticides used were D.D.T. Municipal Spray and Gammexane liquid spray. THE PREVENTION OF DAMAGE BY PESTS ACT 1949 RODENT CONTROL A. Surface Treatments. (1) 6 799 visits were made during the year by the Rodent Operators and 318 by the Sanitary Inspectors to premises infested or possibly harbouring rats or mice. 434 premises were cleared of rats or mice, and no major infestations were recorded. The work for the year is generally summarised as under:- Complaints received or cases discovered and investigated 517 Number of premises found to be infested 457 23 Number of premises where no evidence of rodents found 60 " " " cleared of rats or mice (including 79 previous year's cases) 434 " " " still being treated at the year end 109 (2) The cause or site of infestations at the 457 infested premises was:- Keeping of poultry 110 Inside premises (under floors etc.)- rats 26 " " " " "- mice 94 Under or inside sheds 99 Buries scrapes etc. in gardens, land etc. 156 Defective drains 8 Accumulation of refuse etc . 2 Total 495 (3) Summary of the type of premises and methods employed in clearing premises of rats and mice:- Type of premises cleared No. Methods employed in clearing 434 premises of rats and mice No. Dwellinghouses (mainly in gardens) 379 Poison Baits 413 Food shops and Food premises 20 Trapping 23 Hotels 2 Gassing 7 Non food shops and stores 4 Factories and workplaces 12 Rat and mouse proofing 9 Offices 2 Hospitals: Day Nursery; Schools 8 Council premises 5 Drains repaired 8 Miscellaneous 2 Accumulations removed 1 Other means 4 Total 434 Total 465 B. Sewer Treatments. (I) Second Maintenance Treatment (1949-50) The second maintenance treatment of soil sewers-manholes found to be infested during the 10% test baiting carried out in July 1949 was completed on the 10th March, 1950. Prebaltlng with damped sausage rusks was carried out on two consecutive days and the same bait base with 2½% Zinc Phosphide was laid on the third day with the following results:- Unpoisoned pre-baits Borough divided into 5 sections Number of manholes pre baited Complete bait takes laid Partial bait takes Baits not taken No. of manholes poison baited. A.C.D.E. (minus section B) 191 48 10 133 66 24 The number of pre-bait takes was practically the same as in the first maintenance treatment. (2) 10% Test Baiting (1950-5I) As previously, the Borough was divided into five sections, and a test baiting of 10% of the soil-sewer manholes was carried out during the month of September The test shewed a 7% increase in the number of bait takes as compared with the previous year's 10% test The results achieved were as under:- District Number of manholes baited Complete bait takes Partial bait takes Baits not taken A 22 10 1 11 B 25 - - 25 C 53 11 1 41 D 69 14 7 48 E 46 16 4 26 Total 215 51 13 151 First Maintenance Treatment (1950-51) The treatment was completed on the 1st November 1950 Prebaiting 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- District B which shewed no takes in the 10% test was not baited The other four Districts shewed a substantial increase in the number of prebait takes as compared with the previous treatments. The known kill was very satisfactory and a decrease in the number of takes is anticipated in the treatment which will be commenced in March 1951 The following is a tabulated summary of the results achieved:- District No. of manholes prebaited Complete pre-bait takes Partial pre-bait takes Percentage of takes (C & P.T.) No. of holes poison baited A 56 23 4 48.2 27 C 52 26 7 63.4 35 D 106 30 20 47.1 59 E 122 50 22 59.0 105 Total 336 129 53 54.1 226 KEY TO DISTRICT District "A" - Sutton - All roads south of the Sutton Station and east of Brighton Road. 25 District "B"- Sutton and Cheam - All roads south of Mulgrave Road and Upper Mulgrave Road and west of Brighton Road. " "C" - Sutton - all roads east of the Railway and north from Sutton Station. " "D" - Cheam - all roads between London Road/Stonecot Hill and west of the Railway " "E" - Worcester Park. 26 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Eight hundred and seventy eight cases of infectious diseases were notified during the year 1950. This is an increase of fifty nine cases which is due to an epidemic of mild dysentery within an institution, and an Increase in the number of cases of Scarlet Fever There was a lower incidence of Measles, Twelve cases of Poliomyelitis were notified, an increase of six cases. Again there was no case of Diphtheria No case of food poisoning was notified. Scarlet Fever. Two hundred and fifteen cases were notified, an increase of forty eight cases The higher prevalence arose from a series of outbreaks in schools and the persistence of infection in crowded classrooms The case rate was 2 64 per 1000 of population compared with 1.50 per 1000 of population for England and Wales The disease was generally mild. There was no death. Diphtheria. No case was notified during 1950 This Is the fourth year during which no child within the age group subject to Immunisation has suffered from Diphtheria The case rate for England and Wales was 0.02 per 1000 of population It Is appropriate at a time when there is a tendency for immunisation to decline to remind people of the saving in lives and disability which has resulted from immunisation Ten years ago, in 1940. there were thirty two cases and three deaths in this Borough. Diphtheria Antitoxin. The absence of cases of Diphtheria is likely to lead to a loss of familiarity with diagnosis among the younger generation of medical practitioners, and to a loss or the urgency of seeking medical advice and treatment for throat conditions among the younger generation of mothers There Is also a danger in the decline in the taking of swabs from throats for bacteriological diagnosis before treatment is prescribed or applied Swabs from throats in any degree suspicious of Diphtheria must be taken before Penicillin is used Otherwise diagnosis is obscured. Penicillin destroys the Diphtheria bacillus, but does not neutralise the toxins Early diagnosis and early treatment with antitoxin are essential for the prevention of mortality Antitoxin should be administered in large doses on suspicion of infection and while awaiting bacteriological confirmation of diagnosis. Otherwise suspicious cases should be sent to hospital for observation and treatment. Diphtheria Immunisation. During the year there was a decrease in the number of children immunised against Diphtheria This may have been due partly to complacency in the absence of Diphtheria, but there was also a reaction to a published report of a possible association between the localisation of paralysis in Poliomyelitis and the site of Intramuscular injection. Realisation of the consequences of a recurrence of epidemic diphtheria make it essential to continue and to sustain immunisation with proper safeguards. This can be done by adjusting 27 the timing and method of injection so as to avoid any possible association of injection and paralysis From January to May, the interepldemlc period for poliomyelitis, is a safe period . for immunisation,, During the Summer and Autumn subcutaneous injection can be preferred to and replace intramuscular injection, and alum free non irritant forms of toxoid can be used safely throughout the year, Otherwise, there is no need to limit immunisation against Diphtheria. Medical practitioners are in a position to advise and to exercise discretion when necessary It is desirable that the immunisation of all babies should be carried out before the first birthday, and that reinforcing injections should be applied before the child enters a nursery school or day school, and again at the age of 8 or 9 years. A close check is kept on the state of immunisation of new entrants to schools and reinforcing injections are given at schools. During the year 1950, seven hundred and forty two children were immunised against Diphtheria. The number immunised at the age of one year was four hundred and eighty three which represents 45 per cent of the babies reaching that age during the year compared with 55 per cent for this age group in 1949. One thousand seven hundred and forty four children received reinforcing infections. The following table shows the distribution in age groups of children who received primary injections during the year. Under 1 38 Brought forward 724 1-2 483 9-10 4 2-3 88 10-11 - 3-4 18 11-12 12 4 - 5 25 12-13 1 5-6 23 13-14 - 6-7 27 14-15 1 7-8 8 Over 15 - 8-9 14 Total 742 Carried forward 724 At the end of the year ten thousand five hundred and v seventy three children representing 64.2 per cent of all children had been immunised. Of these three thousand and seventy two represents 50.5 per cent of the children under 5 years and seven thousand five hundred and one represents 72.3 per cent of the children between five and fifteen years of age. The Clinics for Diphtheria immunisation are as follows:- 1. At the Public Hall, No. 1, Hill Road, Sutton. Every Friday, at 2 p.m. 2, At the Clinic, 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 Thursday, at 1.30 p.m. 28 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 1.30 p.m. 6. At the Clinic, Jubilee Institute, Maiden Green, Worcester Park, The first Monday in each month, at 1.30 p.m. Measles. Three hundred and eighteen cases were notified, a decrease of forty nine cases The incidence rose during the Spring and early Summer, and declined during the Autumn In December there was a sharp rise presaging epidemic conditions in 1951 Eight cases were admitted to hospital There was no death The case rate was 3.92 per 1000 of population compared with 8.39 per 1000 of population for England and Wales The monthly distribution of cases is shown in the following table:— January 5 Brought forward 154 February 6 July 8 March 25 August 17 April 50 September 3 May 31 October 3 June 37 November 28 December 105 Carried forward 154 Total 318 Measles should still be regarded as one of the more serious infections of childhood There is no specific drug The provision of temporary immunity by serum is limited in application The antibiotics and sulphonamides control secondary infections and reduce the danger of complications. The debilltating effect of the illness is severe Careful nursing during the acute febrile phase and careful convalescence are very important Prevention depends mainly on the early isolation of the child during the catarrhal phase which exists for three or four days before the rash appears. The illness begins with catarrh of the nose, throat and eyes. The child is miserable and disinclined for food or play. A raised temperature is an important index of infection Mothers should seek early medical advice to confirm diagnosis and to avoid dangerous 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. Whooping Cough. Two hundred and ten cases were notified, a decrease of nine cases Prevalence was higher during August. The case rate was 2,59 per 1000 of population compared with 3.60 per 1000 of population for England and Wales. Eleven cases were admitted to hospital with respiratory complications. There was no death. 29 The monthly incidence of notified cases is shown in the following table:- January 1 Brought forward 44 February 1 July 15 March 1 August 53 April 7 September 20 May 17 October 10 June 17 November 31 December 37 Carried forward 44 Total 210 Whooping Cough is the most dangerous infection of infancy. The damage which is liable to be done to the tissues of the lungs by the intensity of the cough, the liability of the weakened lung tissues to secondary infection and the strain applied to the heart and circulation, make the prevention or early termination of this illness a matter of great importance Prevention of infection in homes and schools is made difficult by the indefinite nature of the symptoms in the early catarrhal phase which may last for 7 to 14 days before the whoop is defined Cough plates to detect the organism can be helpful in diagnosis The new drug Chloromycetin is proving useful in the prevention of mortality in babies and weakly children, and in the reduction of infection among older children in homes where babies are at risk. There is still a need for a safe and effective vaccine to reduce the incidence of 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. During the year, one hundred and sixty six children received a course of injections of Whooping Cough Vaccine, making a total of 1,197 children treated since 1945. Ten cases notified during the year had received injections during the past five years, giving an incidence among the immunised no less than in the general child population. The material used was Pertussis S Vaccine/20 million bacilli per c. c. Recent large scale trials have proved that the vaccines in use up to the present have been variable and of uncertain immunising value, but that one vaccine manufactured according to a new specification of American origin is of high immunising power and worthy of general use Unfortunately, colncidently with this important discovery, a report was published of a positive correlation between injection of certain forms of alum precipitated vaccine and paralysis of muscle in Poliomyelitis It was necessary to proceed cautiously during the Summer and Autumn and to defer injections of Whooping Cough vaccine until the interepidemic period of Poliomyelitis. January to May. At the end of the year arrangements were made to use this new vaccine, which marks a definite advance towards the prevention of Whooping Cough. 30 Small Pox. No case was notified during the year Prevention of Small Pox. Vaccination is voluntary, and free of charge under the National Health Service The percentage of babies under the age of one year vaccinated during the year rose from 33 7 in 1949 to 43.4 in 1950. This shows a growing appreciation of the need for this protection The danger of the introduction of Small Pox into this country increases with the growing facility and speed of travel, and the increasing numbers of travellers Vaccination is a safeguard Parents should ensure that babies are vaccinated between three and six months of age, the safest period for vaccination The following table shows the numbers of vaccinations during 1950:- Age Number Vaccinated Number reVaccinated Age Number Vaccinated Number reVaccinated Under 1 466 - Brought fwd. 526 17 1 17 3 8 6 1 2 14 1 9 2 1 3 4 4 10 3 - 4 7 4 11 5 - 5 8 2 12 3 1 6 7 3 13 4 2 7 3 - 14 2 1 Carried fwd. 526 17 Over 15 41 157 Total 592 180 Puerperal Pyrexia. Five cases were notified in 1950 compared with four cases in 1949 The case rate was 4 80 per 1,000 total births compared with 5.81 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, bacteriological, and hospital services, and ensure the immediate and effective isolation of any suspected case occurring in a nursing home Typhoid and Paratyphoid Fever. One unusual case of prolonged Typhoid Fever occurred The infection was discovered post mortem in october. The history of the case was of chronic illness dating back to January The patient refused to see a doctor until her legs became paralysed and she was admitted to hospital as a case of paraplegia There was a strong suspicion that the infection was acquired through eating mussels Two cases of Paratyphoid Fever were notified One a boy of five years, contracted the infection while on holiday in another district The infection of the other case, a girl of seventeen years, was obscure, No source was found within the district. Dysentery. Sixty four cases were notified Of these, fifty eight occurred within an institution for children. All were 31 mild and of the Sonne type. Food Poisoning. No case was notified. This reflects a satisfactory standard of hygiene in food premises and in homes during the year Those who handle food for sale must be constantly on the alert to ensure cleanliness of hands and of utensils, and to secure protection of food from dust, files, and vermin, and in all respects to meet the requirements of the Byelaws relating to the handling of food, Cerebro-Spinal Fever. There was one acute case of meningitis in a young adult who recovered completely. Poliomyelitis. Twelve cases were notified in 1950, compared with six cases in 1949. Seven cases recovered without paralysis Two children aged three and seven years have residual weakness of one leg Two men suffered paralysis of both legs. One is severely disabled. One adolescent girl died. in addition, two men contracted paralysis of both legs while temporarily resident in other districts and are severely disabled. The orthopaedic departments of local hospitals give excellent service in restoring function to weakened limbs, and the Surrey Voluntary Association for the care of Cripples is ever ready to give material and moral support when necessary. Pneumonia. Of twenty six deaths from all forms of pneumonia, one was notified before death. The total number of notified cases arising in the district was forty two. Non-Notifiable Diseases. School teachers reported one hundred and twenty three cases of Chicken Pox, twelve cases of Mumps, and eleven cases of German Measles School notifications are a useful Index of the prevalence of non-notifiable diseases, and form a basis for consultation with the school medical officer Scabies. There was a 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 seventeen cases, compared with twenty six in 1949 The number of attendances at the clinic was forty two, compared with ninety in 1949. 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 five cases were treated compared with fifty cases in 1949. The number of attendances for treatment was ninety, compared with one hundred and sixty in 1949. 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 33 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1950. Disease Under 1 year 1 yr. 2 yrs. 3 yrs 4 yrs 5 yrs. 10 yrs 15 yrs 20 yrs. 35 yrs. 45 yrs 65 yrs. Totals Removed to hospital D i e d * Scarlet Fever 1 3 5 19 23 146 9 5 2 1 1 - 215 113 - Diphtheria - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - 1 1 1 1 Paratyphoid Fever - - - - - 1 - 1 - - - - 2 2 - Puerperal Pyrexia - - - - - - - - 4 1 - - 5 - - Pneumonia - 2 - 5 1 3 5 5 3 2 7 9 42 2 26 Erysipelas - - - - - - - - - 1 3 3 7 3 - Malaria - - - - - - - - - 1 - - 1 1 - (contracted abroad Dysentery - - 1 1 - 1 — - 2 1 - - 6 - - Poliomyelitis - - - 1 1 3 1 4 2 - - - 12 10 1 Cerebrospinal Fever _ - - - - - - - 1 - - - 1 1 - Measles 5 26 25 33 43 173 7 2 2 1 - - 317 7 - Whooping Cough 18 16 25 24 36 80 2 2 2 2 1 - 208 9 - London Cases in the Down Nursery: Dysentery - 13 16 13 3 - - 11 1 1 - - 58 58 - Measles - - - - - 1 - - - - - - 1 1 - Whooping Cough - - - 2 - - - - - - - - 2 2 - *Under column "Died", all deaths, whether notified in the district or outside it, or not notified at all, are included 34 DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS (District Cases) DISEASE WARDS Case Rate per 1,000 population (Mid-year) Case Rate per 1000 England and Wales N. N.W. N.E. W.C. E.C. E. S.W. S.E. S. Total Population 10419 9160 11318 13078 7573 7745 6719 6074 9024 81110 Scarlet Fever 33 20 33 51 23 24 4 10 17 215 2.64 1.50 Diphtheria - - - - - - - - - - 0.00 0.02 Typhoid Fever - - 1 - - - - - - 1 0.01 0.00 Para-typhoid Fever - - 1 - - - - - 1 2 0.02 0.01 Smallpox - - - - - - - - - - 0.00 0.00 Puerperal Pyrexia a- - - - - - - 5 - 5 - - Pneumonia 3 1 6 1 6 8 4 5 8 42 0.51 0.70 Erysipelas - 2 - - - 1 2 - 2 7 0.08 0.17 Malaria - - - - - 1 - - - 1 0.01 - Dysentery - 1 - 3 - - 1 1 - 6 0.07 - Poliomyelitis 1 2 2 1 1 1 1 2 1 12 0.15 0.18 Cerebrospinal Fever - - 1 - - - - - - 1 0.01 0.03 Measles 49 34 31 13 23 35 30 42 60 317 3.90 8.39 Whooping Cough 11 8 19 12 19 25 23 49 42 208 2.56 3.60 Totals 97 68 94 81 72 95 65 114 131 817 TUBERCULOSIS On 31st December 1950 there were on the register eight hundred and seventy two cases of Tuberculosis, of whom seven hundred and seven were pulmonary cases and one hundred and sixty five non-Pulmonary cases The death rate from Pulmonary Tuberculosis was 0.17 per 1000 of population, and for nonPulmonary Tuberculosis was 0.00. The total death rate for Tuberculosis was 0.17 per 1000 of population, compared with 0.49 per 1000 of population in 1949 Corresponding death rates for England and Wales in 1950 were Pulmonary 0 31 per 1000 of population; non-Pulmonary, 0.04 per 1000 of population; total rate, 0.35 per 1000 of population The number of new cases of Pulmonary Tuberculosis was sixty five compared with sixty nine in 1949 The number of new cases of non-pulmonary Tuberculosis was eleven, compared with six in 1949. The continued decline in the death rate from Tuberculosis is satisfactory and is in keeping with the progressive stabilisation of domestic and social conditions after the upheaval of war The scientific advances achieved in mass radiography and protective vaccination are bound to exert an influence on the incidence of infection, but can only be fully effective if they are coupled with improved housing conditions and adequate accommodation in Sanatoria and hospitals The continued occurrence of cases of non-Pulmonary Tuberculosis calls for complete control of the milk supply of the country by pasteurisation or designation Within this Borough all milk sold is efficiently pasteurised or designated The Tuberculosis Care Committee has continued to give comfort and support to many patients, In addition to the provision of clothing bedding and extra nourishment, the Committee has been able to give substantial help in the provision of holidays for children who are contacts of the disease, and to contribute towards the reablement of many patients, The valuable work of Mr. Stevens the Almoner for Tuberculosis, has been greatly appreciated 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 Pulmonary Non-Pulmonary Deaths Pulmonary Non-Pulmonary 0 M F M F M F M F 1 1 - - - - - - - 5 2 1 2 - - - - - 15 8 19 1 4 - 1 - - 25 10 7 1 1 3 1 - - 35 5 4 1 - 2 - - - 45 4 - - 1 2 - - - 55 2 - - - 1 - - - 65 and above 2 - - - 2 2 - - Totals 31 31 5 6 10 4 - - NOTIFICATION OF TUBERCULOSIS Respiratory forms of death - Eight out of fourteen were notified. Other forms of death - None was notified MASS RADIOGRAPHY A Mass Radiography Unit of the South-West Metropolitan Regional Hospital Board visited the Public Hall, Sutton, from 28th August to 15th September, 1950, Two thousand eight hundred and eighty eight persons attended for examination. The final results were as follows:- Males Females Total X-Rayed 1274 1614 Pulmonary Tuberculosis, active 6 5 Pulmonary Tuberculosis, inactive 42 50 Abnormalities (non-Tuberculous) 36 39 These figures show that approximately four persons per 1000 of population were found to have active pulmonary Tuberculosis, The ratio is higher than in previous surveys, particularly for males, but is within the expectation from random samples of the population. Ninety-two cases were found with inactive Tuberculosis, showing the frequency of spontaneous healing The finding of nonTuberculous abnormalities of the heart and lungs gives opportunity for early and appropriate treatment The finding of early Tuberculosis of the lungs by mass radiography is contributing towards a reduction of Tuberculous infection in the community, 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 Parchil Rooms The Broadway, Cheam. INFANT WELFARE CENTRE Every Wednesday, at 1.30 p.m. including Diphtheria Immunisation the first Wednesday in each month, at 1.30 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 Thursday, 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 l.30 p.m. (including Diphtheria immunisation the second and fourth Tuesday in each month at 1.30 p.m. Vaccination against Smallpox, by appointment 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) 37 SCABIES CLINIC St. Nicholas Road Sutton. Every Thursday, at 10 a.m. CHEST CLINIC (by appointment) St. Helier Hospital, Wrythe Lane, Carshalton. Every Monday, at 9 30 a.m. Every Tuesday at 9.30 a.m. Every Wednesday at 2 p.m. Every Friday, at 9.30 a.m. Every second Wednesday in each month at 5.30 p.m. (Old cases only) VENEREAL DISEASES CLINIC St. Helier Hospital, Wrythe Lane, Carbhalton. Males. Every Monday, from 5 p.m. to 7 p.m. Females. Every Wednesday, from 5 p.m. to 6 p.m. Every Friday, from 2 p.m. to 3 p.m. 38 .