SuTc 15 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HlEALTH for the year 1951 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 195 1 PUBLIC HEALTH COMMITTEE HIS WORSHIP THE MAYOR (Councillor FRANK WARREN, J. P.) Alderman F. C. LOHDEN, O. B. E. Councillor H.A. BENNETT Councillor J. SAUNDERS " J.L. GUTHRIE " D. SPARKS (Mrs)M. B. E. (Chairman) " L.J. HILL " E.P. TAWN " E. A. JAMES " A. G. TAYLOR " P.M. JOHNSON " KINGSLEY WILLIAMS PUBLIC HEALTH OFFICERS OF THE AUTHORITY Medical Officer of Health ENEAS J. MACINTYRE, M. D., D. P. H. Chief Sanitary Inspector CHARLES WILLIAM NEWBERY Certlf. R. S. I. Certlf.Meat and food. Certl f. S. I. Exam. Board. Deputy Chief Sanitary Inspector ARTHUR SYDNEY WILLIAMS Certlf. P. 8-I. Certlf.Meat and Food Assistant Sanitary Inspectors WALTER BLACK, D. F. A. Certlf.R. S. I. and & I. E.J.B. Certlf.Meat and Food JOHN ALWYN EVANS JONES Certlf. R. S. I. and S. I, E.J.B. Certlf.Meat and Food REGINALD WILLIAM NORMAN Certlf. R. S. I. and s.J.B. Certlf.Meat and Food KEMPTON HUDDLESTONE PRIOR Certlf. R, S. I. and S. I. E.J.B. Certlf.Meat and Food FRANK SUTCLIFFE Certlf. R. S. I. and S. I. E.J.B, Certlf. Meat and Food Public Analyst DANIEL D. MO I R,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 1951. The preliminary report of the Registrar General on the Census of April 1951 gives the population of the Borough as being 80, 664, composed of 36, 885 males and 43,779 females. His estimate at mid-year 1951, on which the statistics In this report are based, was 79,520. The general health of the community remained good. There was a fall In the birth rate from 12.6 per 1000 of population to 11.5 per 1000 of population, The death rate was stationary. The Infantile mortality rate was the lowest yet recorded. There was no maternal death. There was an Increase In the general Incidence of Infectious diseases. A severe epidemic of Measles occurred during the early months of the year. Simultaneously Influenza became prevalent. There were outbreaks of Dysentery during the Spring and Summer. Six cases of Poliomyelitis were notified. There was one case of Diphtheria. A Mass Radiography Unit visited the Borough in June and September. This service contributes towards the reduction of Tuberculosis and stimulates interest In the prevention of Illness. Good progress is being made towards the completion of the Council's Housing Programme within the Borough. During the year 101 flats and houses were completed, and 151 flats and houses were In course of erection. Schemes were In preparation for 62 flats and houses. The Council Is making every effort to promote the development of a site at Banstead to relieve the urgent need for houses. 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, and to the staff, I express my appreciation of the high standard of service. The water supply of the district maintained chemical and bacteriological purity. Effective control by daily sampling and 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, Ladles and Gentlemen, Your obedient Servant, ENEAS J. MACINTYRE 2 Medical Officer of Health. STATISTICS OF THE AREA 1950 1951 Area in acres 4338. 15 4338. 15 Registrar General's estimate of the Resident Population 81, 110 79, 520 Number of inhabited houses (end of Year) according to the Rate Book 23, 027 23, 171 Rateable Value and sum represented by a £903, 283 £910, 294 Penny Rate £3, 680 £3, 705 EXTRACTS FROM VITAL STATISTICS (Comparative of the Years 1950 and 1951) 1950 1951 England & Wales Total Male Female Total Male Female 1951 Live Births 1021 510 511 919 462 457 Legitimate 988 492 496 884 449 435 Illegitimate 33 18 15 35 13 22 Birthrate per 1000 of the Estimated Resident Population 12.6 11.5 15.5 Still Births 19 12 7 16 8 8 Legitimate 18 11 7 16 8 8 Illegitimate 1 1 - - - - Rate per 1000 total (live and still births) 18.2 17.1 22.9 Deaths 857 399 458 878 411 467 Death Rate per 1000 of the Estimated Resident Population 10.5 10.8 12.5 Deaths from Puerperal Sepsis 0 0 Other Puerperal Cause 0 0 Death Rate from Puerperal Causes per 1000 total (live and still births) 0.00 0.00 0.41 Deaths of Infants under one year of age All Infants per 1000 live births 26.44 11.96 29. 6 Legitimate Infants per 1000 legitimate live births 24.29 11.31 Illegitimate Infants per 1000 Illegitimate live births 90.90 . 22.22 3 Deaths 1950 1951 from Cancer 164 147 " Measles 0 1 " Whooping Cough 0 0 " Diarrhoea 3 3 Percentage of Deaths from certain causes to the total number of deaths. 1950 1951 Diseases of the heart and circulation 34.6 38.8 Cancer and malignant disease 19. 2 16.7 Diseases of the lungs (non-tuberculous) 8.2 9.6 Tuberculous diseases 1.6 2.2 Cerebral haemorrhage 15.4 11. 5 Congenital diseases 1.4 1.1 Suicide and violence 3.5 3.4 Diseases of the digestive system 1.3 2.1 Infectious diseases 1.9 3.2 Diseases of the kidney 2.9 1.7 Other defined diseases 10.0 9.7 Maternal Mortality. There was no death. The maternal mortality rate for England and Wales was 0.41 per 1000 total births. Infantile Mortality. The Infantile mortality rate was 11.96 per 1000 live births, compared with 26.44 per 1000 live births In 1950. There were eleven deaths of Infants under one year, compared with twenty-seven In 1950. 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 5 - - Prematurity 3 - - Pneumonia - - 1 Tracheo Bronchitis - - 1 Tuberculosis - - 1 Totals 8 - 3 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1951 M. F. Total 1 Tuberculosis, respiratory 12 4 16 2 Tuberculosis, other 2 1 3 3 Syphilitic disease 1 2 3 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal Infections - - - 7 Acute Poliomyelitis - - - 8 Measles 1 - 1 9 Other infective and parasitic diseases 1 1 2 10 Malignant neoplasm, stomach 7 11 18 11 Malignant neoplasm, lung, bronchus 15 8 23 12 Malignant neoplasm, breast - 18 18 13 Malignant neoplasm, uterus - 7 7 14 Other malignant and lymphatic neoplasms 40 41 81 15 Leukaemia, aleukaemia 1 3 4 16 Diabetes 3 - 3 17 Vascular lesions of nervous system 44 57 101 18 Coronary diseases, angina 67 49 116 19 Hypertension with heart disease 17 19 36 20 Other heart disease 59 99 158 21 Other circulatory disease 15 16 31 22 Influenza 9 13 22 23 Pneumonia 12 17 29 24 Bronchitis 26 25 51 25 Other diseases of respiratory system 4 - 4 26 Ulcer of stomach and duodenum 7 4 11 27 Gastritis, enteritis and diarrhoea 2 2 4 28 Nephritis and nephrosis 3 5 8 29 Hyperplasia of prostate 7 - 7 30 Pregnancy, childbirth, abortion - - - 31 Congeni tal malformations 7 3 10 32 Other defined and ill-defined diseases 35 46 81 33 Motor vehicle accidents 7 4 11 34 All other accidents 4 8 12 35 Suicide 3 4 7 36 Homicide and operations of war - - - Totals 411 467 878 5 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA New Legislation (1) Sutton and Cheam Corporation Act 1951. This Act received Royal Assent on the 1st August 1951. Apart from varying the terms upon which the sewage from certain areas Is disposed of by the Corporation, the Act confers further powers In regard to lands and makes further and better provisions for the health, local government finance and Improvement of the Borough. Chief among the public health provisions are powers In connection with public sewers and drains, closet accommodation, nuisance from domestic chimneys, nuisances from tipping of refuse, smoke from Industrial furnaces, discharge of steam waste gas, noise nuisance, offensive trades and nuisance from pigeons etc. Further powers are conferred with regard to food storage accommodation In dwelling houses, the slaughter of animals otherwise than for human consumption, registration of hawkers of food and their premises, the manufacture of Inedible fat and the making of byelaws as to meat for feeding animals. The powers relating to Infectious diseases Include entry Into premises In cases of notifiable disease, the furnishing of Information by occupiers of premises In cases of notifiable disease, restriction on attendance at schools or places of assembly, the exclusion of children from entertainments, stopping employment to prevent the spread of disease and the prohibition of Infectious tuberculous persons from handling food. Filthy or verminous premises or articles are further controlled and an amendment to Section 93 of the Public Health Act, 1936, makes it possible to speed up the procedure necessary to secure the repair of defective premises. (2) national Assistance (Amendment) Act, 1951. This Is an Act to amend Section 47 of the National Assistance Act, 1948 so as to expedite removal of persons In urgent need of care and attention to a hospital or to residential accommodation, by application to a Court of Summary Jurisdiction or to a Justice of the Peace. (3) The Public Health (Leprosy) Regulations, 1951. The regulations require medical practitioners to notify cases of Leprosy directly to the Chief Medical Officer of the Ministry of Health. This departure from normal practice Is designed to meet the special conditions arising from this disease. (4) The Puerperal Pyrexia Regulations, 1951,. The definition has been revised so as to conform with the advance of modern therapy. Medical Practitioners have received copies of the regulations. 6 Removal of Persons in need of Care and Attention The National Assistance Act 1948 (1) Section 47 A Court Order was secured and applied In February, 1951 for the removal of a woman, aged 83 years, senile, crippled, and living In Insanitary circumstances, to St. Heller Hospital, from which she was later transferred to a nursing home where she died. The National Assistance (Amendment) Act, -1951. (2) A Justice's Order was obtained and applied In November 1951, for the urgent removal of a man, aged 87 years, suffering from cancer and living In Insanitary circumstances, to St. Heller Hospital, where he died,, (3) A Justice's Order was obtained and applied In November 1951, for the urgent removal of a woman, aged 63 years, ill and living In Insanitary circumstances, to St. Heller Hospital, where she died of cancer. Burial and Cremation of the Dead The National Assistance Act, 1948. Section 50. Two burials were arranged under the powers granted to the Council by this section. Mortuary. Ninety five bodies were received and ninety five post mortem examinations were made. The mortuary premises which Include a three body refrigerated chamber, have been well maintained. 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, to which samples of milk, and Ice cream are sent, Is limited by the distance from the Borough. Clinics. Details of the 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 wood mansterne, 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 7 Samples of the raw and treated waters are examined dally by 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. 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 202.5 Ammonia, free 0.16 Ammonia, Albuminoid 0 Nitrogen In Nitrates 9. 308 Nitrogen In Nitrites 0 Oxygen absorbed In 4 hours at 27'C. 0.054 Chlorine In Chlorides 21.083 Hardness total (grains per gallon) 8.258 Bacteriological Results No. of Bacteria growing on Agar per ml. for 3 days at 20'C. 0 No. of Bacteria growing on Agar per ml. for 1 day at 37' C 0 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 detailed designs for the first stage of reconstruction at the Worcester Park Sewage Works are now nearing completion. It is hoped that work will commence before the end of 1952. On the main drainage system the ejectors at Elm Road are being replaced by a pumping station in Epsom Road. The pump wells are completed, but delays in the delivery of pipes and pumping machinery will prevent completion of the scheme until later in the year,. No other main drainage works have been carried out. 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 are in use. In the past twenty-three years, 159 premises, originally with cesspool drainage, have been connected to sewers, 8 SANITARY INSPECTION OF THE AREA Report of the Chief Sanitary Inspector under Article 27 of the Sanitary Officers (Outside London) Regulations 1935 (Pages 9 to 28) Record of Inspections and Notices Served Special Inspections: Interviews and advisory visits 1, 393 Reinspections 3, 487 Visits to works In progress 833 " Factories/Workplaces 435 " Bakehouses 35 " Outworkers premises 90 " Butchers, Grocers and other food premises 493 " Dairies and Milk Purveyors premises 27 " Ice Cream premises 158 " Stables/Passages/Pigsties/Ditches 56 " Restaurant/Cafe and School Canteen kitchens 78 " Premises re rodent Infestations 9, 652 " Tents/Vans/Sheds 5 " Cinemas/Theatres/Halls 16 " Premises re Infectious diseases 180 " " overcrowding and permitted numbers 351 " " food complaints (Shops and Houses) 320 " Barbers' and Hairdressers premises 75 " School and public conveniences 38 " Verminous houses 17 " Shops under the Shops Acts 401 " re the taking of Food and Drug samples 214 " " Bacteriological Milk/Water samples 105 " " samples of ice cream 126 " Smoke Observations 6 " under the Merchandise Marks Act 48 " " Rag Flock Acts 11 " to Licenced Public Houses 43 Miscellaneous visits 2, 801 Total 21, 494 Number of complaints received and investigated 642 Premises at which defects or nuisances were discovered 1, 650 Dwelling-houses surveyed for housing defects under the Public Health or Housing Acts 255 Number of defects or nuisances discovered 2,786 " " " remedied 2, 231 " " " in hand 230 " " " outstanding 325 Number of Informal notices served 1,218 9 Statutory Notices were served as under: Housing Act 1936 Sections 9 and 10 . (as amended by the Housing Act 1949) 46 Public Health Act 1936, Section 24 70 " " " 39 7 " " " 45 5 " " " 48 3 " " " 75 17 " " " 83 1 " " " 84 1 Total 150 Summary of Remedial Works and Sanitary Improvements Carried out Drainage and Sanitary Fittings. Number of houses and other premises redrained 9 Repairs and amendments to existing drains 112 Drains or gillies unstopped or cleansed (Involving 902 pranlses) 318 Sanitary fittings repaired/renewed/provided or cleansed 639 Water service plpes/clsterns/repalred, renewed or cleansed 15 Water, smoke and chemical tests applied 289 W.C. Apartments: W. C. Appartments provided 25 " lighted and/or ventilated 12 " provided with ventilated lobbies 3 " cleansed 33 Separate W.C. accommodation provided for the sexes 2 Structural Repairs or Improvements carried out: Number of roofs repaired or renewed 222 " guttering and rainwater pipes provided repaired, etc 145 " damp walls remedied 121 " brick, walls repointed, repaired or rerendered 74 " chimney stacks repaired or rebuilt 29 " yards paved or repaired 19 " sites of houses concreted 13 " floors relald or repaired 83 " windows/sills/sashcords repaired or renewed 275 " doors/thresholds provided or repaired 51 " staircases/handrails provided or repaired 9 " ranges/stoves/coppers renewed or repaired 44 " Miscellaneous Items 11 Cleansing: Number or rooms/passages/larders cleansed and/or repaired 279 " trade premises cleansed 42 " verminous houses disinfested for bugs/fleas 33 " premises sprayed for cockroaches/crickets/ wood beetles, etc, 42 " premises disinfected after various diseases 216 10 Various Number of offal bins provided 2 " dustbins provided 76 " accumulations of refuse and manure removed 29 " offensive ponds and ditches cleared " wasp nests destroyed 113 " miscellaneous Items 209 HOUSING 1. Inspection of Dwelling houses during the Year: (a) (1) Total number of dwelling-houses Inspected under the Public Health or Housing Acts 255 (11) Number of Inspections made for the purpose 706 (b)l Number of dwelling-houses found not to be In all respects reasonably fit for human habitation 131 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 46 (11) Number of dwelling-houses which were rendered fit after service of formal notices:- By owners 29 By Local Authority In default of owners 1 (b) Proceedings under the Public Health Act:- (1) Number of dwelling-houses In respect of which notices were served requiring defects to be remedied 12 (11) Number of dwelling-houses In which defects were remedied after service of formal notices:- By Owners 4 By Local Authority In defaults of owners 4 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936 N11 11 INSPECTION OF FACTORIES AND OTHER PREMISES (Factories Act 1937- 1948) Inspections made by Sanitary Inspectors for the purpose of provisions as to health Type of Premises Number on Register Inspections Notices, written and/or oral Factories without mechanical power 81 80 13 Factories with mechanical power 314 305 62 Other premises (excluding outworkers premises) 8 11 - Totals 403 396 75 Defects found in Factories and Other Premises under the Act Particulars refects found refects remedied Want of cleanliness 14 9 Inadequate ventilation 1 1 Overcrowding - — Unreasonable temperature - - Ineffective floor drainage Absence of thermometers 1 - Other nuisances 29 22 Sanitary Accommodation (a) insufficient 3 2 (b) Want of cleanliness 37 33 (c) Unsuitable or defective 18 16 d) Not separate for the sexes - - (e) Insufficient lighting In w.. C.'s 14 11 Totals 117 94 WORKPLACES - (Public Health Act, 1936) NUMBER OF Inspections Occupiers Written Notices prosecuted 39 Nil Nil SMOKE ABATEMENT The few chimneys attached to Industrial premises In the district have been kept under observation. After twelve months' delay In delivery the grit deposit gauges designed to measure the grit fall In the North of the Borough were received and placed In position for readings to be taken as and from the 1st January, 1952. 12 INSPECTION AND SUPERVISION OF FOOD (Food and Drugs Act, 1938) Sampling The following list Indicates the type and nature of the 240 formal and Informal samples submitted to the Public Analyst for analysis during the year: Article Number of samples examined Number of unsatisfactory samples Formal Informal Total Formal Informal Total Almonds (Ground) 2 2 Aspirin tablets 1 1 Aspirin tablets compound 1 1 Aspirin tablets (Junior) 1 1 1 1 Asthma tablets 1 1 Beef Juice 1 1 Beer (mild) 1 1 Beverage Powder 1 1 Biscuits (Choc-wafer) 1 1 Butter 2 2 Cake Decoration ("Sugar Strands") 1 1 1 1 Cake Mixture (Master Mix) 1 1 1 1 Capers In Vinegar 1 1 Cascara Fluid Extract 1 1 Celery Salt 1 1 Cheese 1 1 Cherries (Glace) 1 1 Cherries (Imitation) 1 1 1 1 Citric Acid 1 1 Coconut (Desiccated) 1 1 Coffee and Chicory 2 2 Coffee Extract 2 2 Coffee and Chicory Extract 1 1 Coffee and Chicory Essence 1 1 Confectionery (childrens cigarettes) 1 2 3 1 1 Cough Mixture 4 4 1 1 Cough Pellets 1 1 Cream (synthetic) 2 2 Cream Powder (synthetic) 1 1 Cream of Tartar 1 1 Date Puree 1 1 Extract (vegetable) 1 1 Flavouring \Lemon) 1 1 Flavouring (Almond) 1 1 Fruit Cake 2 2 1 1 Fruit Pudding 1 1 Gelatine 1 1 Glycerine and Borax 1 1 Gravy Browning 2 2 Gravy Powder 2 2 Herbal Pills 1 1 Horseradish 1 1 Ice Cream 48 48 2 2 Icing (soft) 1 1 Icing Sugar 1 1 Jam 3 3 Jelly Crystals 2 2 Jelly (Table). 3 3 Laxative tablets 1 1 Lemon Curd 2 2 Lemon,, Crystals 1 1 Lemonade Powder 1 1 Lemon Juice 1 1 Liquorice Powder 1 1 Carried forward: 1 119 120 1 8 9 13 Article Number of samples examined Number of unsatisfactory samples Formal Informal Total Formal Informal Total Brought forward 1 119 120 1 8 9 Meat (Potted) 1 1 Milk 24 24 Milk, food (Dried) 1 1 Milk. (Channel Island) 5 5 1 1 Milk (South Devon) 2 2 Milk (Evaporated) 1 1 Milk (whipping pound) 1 1 Mint (Jelly) 2 2 1 1 Mints (Digestive) 2 2 Mincemeat 1 1 Mint (dried) 1 1 Mint (Garden) 1 1 Nerve and Headache Powder 1 1 Olive Oil 1 1 Orange Squash 3 3 Paste (Anchovy) 1 1 Paste (Cod Poe) 1 1 Paste (Fish) 2 2 Paste (Meat) 1 1 Peel (Candled) 2 2 Pepper 1 1 Pepper condiment 1 1 Pepper (Ground White) 3 3 Pickle 1 1 Pie Steak 1 1 Preserve (Lime) 1 1 Puddings (Xmas) 2 2 Rice 2 2 Poll (Bread and Butter; 1 1 Sago (Creamola) 1 1 Salad Cream 2 2 Salt (Iodised) 1 1 2 1 1 2 Salmon Spread 1 1 Sausage (Preserved Beef) 2 2 Sausage (Beef) 7 1 8 Sausage (Pork) 3 3 Sausage Pork (cooked) 1 1 Sausage (Preserved Pork) 5 5 Sausages (tinned) 1 1 Sausage meat (Beef) 2 2 Sausage meat (Pork) 1 1 Soft drinks 8 1 9 Soup (Turtle) 1 1 Spread (Honey) 1 1 Spread (Anchovy) 1 1 Tablets (Digestive) 1 1 Tablets (Glucose) 1 1 Tablets (Sulphur) 1 1 Throat tablets 1 1 Tonic Food 1 1 Tonic (Children's) 1 1 Trifle paste 1 1 Vinegar (Malt) 1 2 3 1 1 Vinegar (Tarragona) 1 1 Wine (sweet) 1 1 Totals 66 174 240 3 11 14 14 The following details classify the type of Infringement or Irregularity and the action taken in relation to the fourteen unsatisfactory samples. Sample No. Article Infringement Action taken 1332 Aspirin Tablets (Junior) (Informal) Labelling Infringement Tablets contained In addition to aspirin Calcium Phosphate as an active constituent, but this was not disclosed on the label as., required by the Labelling of Food Order 1950 Manufacturer Warned The labels and packets were satisfactorily amended to conform with the requirements of the Labelling of Food I Order 1950 1336 Cherries (Imitation) "Chellies" (Informal) Sample contained 440 parts per million of Benzoic Acid contrary to the provisions of the Public Health etc. Preservatives in Food Regulations 1923 to 1948 Manufacturer Warned After prolonged correspondence the Manufacturers eventually agreed to withdraw from sale the domestic pack of "Chellles" 1369 Special Cough Mixture (Informal) Labelling Infringement The appropriate designation and quantitative particulars of each constituent or Ingredient were not written on the label as Is required by The Pharmacy and Medicines Act 1941 Retailer Warned The retailer (Chemist) admitted having failed to observe the requirements of the Pharmacy and Medicines Act and took Immediate steps to sure that future sales would be In order 1375 Cake Mixture "Master Mix" (Informal) Labelling Infringement Sample contained 35 per cent of sugar, but this was not specified as one of the Ingredients as is required by The Labelling of Food Order 1950 Manufacturer Warned It would appear that the packet In use had been printed for the unsweetened variety. New packets have now been printed which conform with The Labelling of Food Order 1950 1405 Mint Jelly (Informal) Article consisted of a viscous fluid which could be described as mint sauce but not as mint Jelly Manufacturer Warned This product had been prepared by a subsidiary company, The distributors agreed that the article was not mint Jelly and forthwith withdrew the remaining stocks from sale 15 Sample No. Article Infringement Action taken 1407 Ice Cream (Chemical) (Informal) Sample contained only 5½ per cent of milk solld6 other than fat Instead of not less than 7½ per cent as required by the Food Standards (Ice Cream) Order 1951 Manufacturer Warned The attention of the manufacturer was drawn to the deficiency of milk solids other than fat. A repeat sample proved satisfactory 1429 Vinegar (Malt) (Formal) Labelling Infringement The addition of 0.7 per cent of salt was not disclosed on the label Manufacturer Warned New labels were printed with a declaration that the malt vinegar contained salt and caramel 1437 Ice Cream (Chemical) (Informal) Sample contained 6¾ per cent of milk solids other than fat, Instead of not less than per cent as required by The Food Standards (Ice Cream) Order 1951 Manufacturer Warned The deficiency of milk solids other than fat was due to the use of an unsatisfactory alternative constituent Ingredient. A repeat sample proved satisfactory 1464 Salt Iodised (Informal) Labelling Infringement Sample contained 375 micrograms of Iodine per ounce, Instead of a minimum of 433 micrograms as declared on the label Manufacturer Warned The Informal sample showed a deficiency and the formal sample an excess of Iodine content per ounce. The manufacturers rightly A703 Salt Iodised (Formal) Sample contained 775 micrograms of Iodine per ounce Instead of not more that 723 micrograms as declared on the label assert that difficulty Is experienced In the mixing and migration of this article and the matter Is at present being vigorously Investigated by the trade in an endeavour to find a solution to the problem 1492 Cake Decoration "Sugar Strands" (Informal) Labelling Infringement The Ingredients of this article were not specified on the label as Is required by The Labelling of Food Order 1950 Manufacturers Warned The manufacturers agreed that the label did not conform to the requirements of the Labelling of Food Order 1950. As a result new labels have been printed and found to be satisfactory 16 Sample NO. Article Infringement Action taken 1496 Fruit Cake (Australian) (Informal) Contaminated with sand to the extent of 0.10 per cent thus causing a gritty taste. The sand was evidently Introduced Into this article by way of the fruit 'Retailer warned Retailer Informed of the sand contamination and the gritty taste. In reply It was stated that many tons of this cake had been sold without complaint, but In view of the report the matter was being taken up with the suppliers and pursued to the Country of origin A667 Confectionery "Children's Cigarettes" (Formal) This article was described on a slip Inside the container as a soft drink with Instructions to crush and stir up In water. Although this article might be described as a thirst quencher It certainly was not a soft drink and the directions were Impracticable. The statement specifying the Ingredients was not marked on or clearly legible through the outermost wrapper as Is required by the Labelling of Food Order 1950 Manufacturer Warned The sample failed to comply with the provisions of the Labelling of Food Order 1950 and the Soft Drinks Order 1947. As a result of prolonged negotiations with the firm's legal representatives the manufacture and distribution of these articles was discontinued A678 Milk: (Channel Island) (Formal) Sample contained 3.90 per cent of butter fat Instead of not less than 4.0 per cent according to the Milk (Control and Maximum Prices) (Great Britain) Order 1947 (The milk fat content of this sample conforms to the standard required by the Food and Drugs Act 1938) The deficiency was reported to the Ministry of Food (Milk Division) and the distributor with a view to enquiries being made at the source of production. Repeat sample No A689 taken In this district contained 4.1 per cent milk fat and was satisfactory 17 Sampling Observations. Of the 240 samples taken during the year 2.5 per cent were found to be other than genuine. This percentage figure excludes Informal samples repeated formally. The percentage for 1950 was 2.5 and for 1949, 2.13. Labelling Infringements In some form or another were found In 2.5 per cent of the total samples taken. The percentage for 1950 was 1.66, and for 1949 0.85. In view of the wide selection of articles sampled during the year it is worthy of note that the observations and Infringements reported upon by the Public Analyst have been relatively few In number and In the main of a generally minor character. Samples submitted during 1951 under the food and Drugs Act, 1938 and the Defence (Sale of Food) Regulations, 1943 Public Analyst's Comments. "Sampling has covered a wide range of foods and drugs, and particularly drugs of a 'proprietary' type which often Involves a lengthy and difficult analysis. The changing nature of adulteration continues to be reflected In the samples to which your Analyst has taken exception, and the relatively large number of labelling offences Is still apparent. It would be a serious reflection on the administration of the Food and Drugs Act and the ability of the Analyst If the gross adulteration which was rife In 1870 were still common today, but changing circumstances has necessitated changing laws and the law relating to the labelling of pre-packed foods for example, Is Just as Important In the world of today as the traditional requirements under the Food and Drugs Act. Most of the labelling offences which occur are due to thoughtlessness on the part of manufacturers or packers and to Ignorance of the law, but one cannot avoid thinking that In a few Instances Ingredients, which have to be specified, are omitted or put In the wrong order to deceive the public Into thinking they are getting a better article. All articles are subject to the fundamental requirements of the Food and Drugs Act In respect of Injurious substances, preservative, metallic and other comtamination and the general nature, substance and quality. Suitable tests are applied to all samples to ensure conformity with these requirements. A few comments on Individual food samples may be of general Interest. Ice Cream. The new standard for Ice cream, referred to In last year's report, came Into force on March 1st, 1951 It required a content of 5 per cent of fat, 7½ per cent of milk solids other than fat and 10 per cent of sugars of which 7½ shall be sucrose. The great majority of samples have conformed to requirements and only two taken In the Borough have shown a deficiency of milk solids. The average fat content of the samples taken during the year was 10.3 per cent, over twice the minimum requirement. There was every Indication beforehand that this minimum was being set too low and my results Indicate that the standard could be upgraded without hardship. 18 Sausages. The absence of a legal standard under the Food and Drugs Act or related Regulations Is considered by many to be a constant source of trouble In the way of action. In my experience, however, a minimum commercial quality for either beef or pork sausages constantly emerges as a result of traditional practice rather than as a result of maximum price standards and there has been no difficulty in establishing this quality to the satisfaction of the Courts, The substitution of up to 10 per cent of meat by an equivalent of milk, powder, which Is allowed by the Meat Products and Canned Meat Order, 1950, has not been popular and numerous complaints of bitter taste have arisen In connection with such sausages. Iodised salt. As a result of two samples taken In the Borough lt has been tacitly admitted that no guarantee of actual Iodine content of Individual packets can be made. It was suggested to the manufacturers that a declaration of a minimum content Instead of that of a wide range according to the present code of practice would be more practicable and more in line with the Labelling of Food Order," 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 1951, thirty hot water heaters and a number of washbasins were Installed In various food premises as a result of Informal action. Seventy eight Inspections were made Of restaurant kitchens, hotel kitchens and coffee stalls. Clean Food Bye laws - Section 15 These bye laws were made under Section 15 of the Food and Drugs Act 1938 by the Sutton and Cheam Council for securing the observance of sanitary and cleanly conditions and practises 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, have been In operation since July 1950. During the year eight Infringements of the bye laws were dealt with and applied mainly to open air trading of foodstuffs from street stalls and barrows, Loaf of Bread A loaf of bread purchased by a customer from a baker's shop was, upon examination, found to contain several short strands of tobacco. The matter was thoroughly Investigated and having regard to all the circumstances of the case a warning letter was addressed to the proprietor of the bakery. 19 MILK SUPPLY Food and Drugs (Milk Dairies and Artificial Cream Act 1950 Milk and Dairies Regulations 1949 The Milk (Special Designation) (Raw Milk) Regulations IPh9 The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1969 Routine Inspection of milk pasteuriser's, dealers and vendors premises has again revealed that the provisions of the various Regulations are generally well observed. The following licences to sell graded milks In the Borough were granted In 1951:- TYPE OF LICENCE Grade of Milk Dealers Supplementary Pasteuriser's Tuberculin Tested 11 8 - Tuberculin Tested (Past) 6 2 - Pasteurised 19 10 2 Sterilised 25 12 - Total 61 32 2 Examination of Milk Samples One hundred and two samples of milk were submitted for examination as follows:- Class of mine No. of sair®les taken Test applied Number of samples Passed Failed Pasteurised 62 Phosphatase 61 1 Methylene Blue 61 1 Sterilised 7 Turbidity 7 - Tuberculin Tested (Pasteurised) 17 Phosphatase 17 _ Methylene Blue 17 - Tuberculin Tested (Farm bottled) 16 Methylene Blue 14 2 TOTAL 102 4 It will be noted that all samples of Tuberculin Tested and Sterilised milks passed the prescribed tests. The failure of one Pasteurised milk sample and two Tuberculin Tested (Farm Bottled) Milk samples to pass the Methylene Blue Test was mainly due to the high atmospheric temperature at the time the samples were taken. It would appear that a further contributory cause In the case of the farm bottled milk was the delay between the time of production and delivery to the dairy. 20 These factors, although of a temporary nature, had an adverse effect upon the keeping qualities of the milk. It Is gratifying to report that the "follow up" samples of these milks were satis factory. The failure of one Pasteurised milk sample to pass the Phosphatase test occurred during the dismantling of the dairy plant, and the Installation of new machinery. During this period the milk was processed by another Company. It will be seen that a total of four samples only failed to pass the various tests In 1951, as compared with eleven In 1950. Biological Milk Samples, Eleven samples of Tuberculin Tested milk were taken and results showed that guinea pigs Inoculated with the milks failed to show any signs of a tuberculous Infection on post-mortem examination. ICE CREAM Registrations,. At the end of 1951, a total of 189 premises had been registered for the sale of Ice cream in accordance with Section 14 of the Food and Drugs Act 1938, and on six of these premises ice cream could be manufactured. It Is of Interest to note that the amount of Ice cream manufactured in the Borough has gradually diminished during the last year or so. At one factory the manufacture of Ice cream has practically ceased, whilst at another three premises the quantity now made is negligible. It would appear that the main cause for this change is an increasing public demand for the more popular and well-known brands of Ice cream. During the year sixteen new applications for registration of premises were received and granted as shown in the following table:- New New Year Registrations Year Registrations 1947 9 1950 27 1948 10 1951 16 1949 29 (A) - Bacteriological sampling of Ice Cream One hundred and twenty six samples of ice cream were taken for provisional grading and bacteriological examination. The following table shows the provisional gradings and percentages for the year 1951, and for comparative purposes the results of One hundred and four samples in 1950. 1951 1950 Grading of Samples Grading of Samples 94 Samples, Grade 1 - 74.60% 72 Samples, Grade 1 - 69.34% 25 " " 2 - 19.84% 16 " " 2 - 15.38% 5 " " 3 - 3.96% 12 " " 3 - 11.53% 2 " " 4 - 1.58% 4 " " 4 - 3.84% 126 Total 104 Total 21 It will be observed that the grading results In 1951arean Improvement even on the good results obtained In 1950 and favourably compare with the recommendations made by the Ministry of Health, which require that over a given period 50% of the vendors samples should fall Into Grade I, 80% into grades 1 or 2, not more than 20% into grade 3 and none Into Grade 4. In many instances the registration of premises for the sale of Ice cream is made on condition that pre packed ice cream only will be sold. The manufacturer is immediately notified if faecal coll are found to be present, and attention is drawn to low grade samples which have been placed in grades other than 1 or 2. Similar action is taken when ice cream samples persistently show the presence of conforms. It is gratifying to report that the bacterial purity of the ice cream sold In the Borough during the year has been maintained at a relatively high standard. The following table shows:- 1 2 3 4 5 6 Code NO. Of samples taken Number of samples sold Percentage results in each grade No. of samples with faecal coll present NO. Of samples with col1forms present Wrapped Loose 1 2 3 4 *A 2 - 2 100.00 - - - - 1 B 1 - 1 - - 100.00 - - 1 C 6 5 1 33.33 50.00 16.66 - - 1 D 1 1 - 100.00 - - - 1 1 *E 16 12 4 62.50 31.25 6.25 - - 11 F 4 2 2 75.00 25.00 - - - 3 *G 27 26 1 81.48 18.51 - - - 4 *H 20 20 - 80.00 20.00 - - - 2 *I 2 - 2 100.00 - - - - - *J 1 1 - 100.00 - - - - - *K 1 1 - 100.00 - - - - - *L 11 8 3 90.90 - 9.09 - - 1 *M 5 4 1 80.00 20.00 - - - 1 N 1 1 - 100.00 - - - 1 1 *O 9 - 9 66.66 - 11.11 22.22 - 6 *P 3 - 3 100.00 - - - - 2 Q 1 1 - 100.00 - - - - 1 R 3 3 - 66.66 33.33 - - - 1 *S 4 3 1 75.00 25.00 - - - 2 *T 5 5 - 40.00 40.00 20.00 - - - U 1 1 - 100.00 - - - - 1 *V 2 2 - 50.00 50.00 - - - 1 Total 126 96 30 2 41 22 During the year there were many changes in the suppliers of ice cream in the Borough, particularly so in regard to the smaller firms. As a result of these changes it is not possible in a number of cases to give the same code to the manufacturers as in the previous report for 1950. In those cases where the suppliers are the same they are denoted by an asterisk in the aforementioned table (B) Chemical Sampling of Ice Cream Fat and total solids The Food Standards (Ice Cream) Order 1951 which provides that ice cream must contain at least 5 per cent fat, 10 per cent sugar and 7½ per cent milk solids other than fat, came into operation on the first day of March 1951. The standard Is not Intended to apply to water ices sold as such or to "ice lollies". Forty eight samples of ice cream have been taken for an estimation of the chemical standard content and In two cases only did the Public Analyst report a deficiency of milk solids other than fat - 5½ per cent and 6f per cent respectively instead of the standard 7½ per cent. Follow-up samples were taken in each case and found to be satisfactory. It is worthy of note that the average fat content of the samples taken was 10.3 per cent fat as shown in the following table: - Producers Code Number of samples taken Average chemical standard Fat Percentage Total solids Percentage * A 2 10.6 33.2 B 1 11.2 38.0 *C 1 10.8 38.4 D 1 10. 1 39.0 E 1 8.2 37.6 *F 1 8.9 37.0 G 3 10.2 38.4 *H 4 11.2 37.2 *I 6 9.9 35.1 *J 6 11.2 37.2 K 2 13.7 33.2 *L 2 8.8 34.0 *M 2 10.5 36.6 *N 5 10.4 35.2 *O 1 10.5 40.0 *P 2 11.3 38.2 *Q 2 10.4 42. 1 *R 1 8.3 41.3 *S 5 10.4 36.8 Total and average 48 10.3 37.2 * Denotes a constant supplier and given the same code letter as for 1950 report 23 MEAT AND OTHER FOODS Food Shops. The fifty two 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. Action was taken in eleven cases where the sanitary conditions were not satisfactory, or certain contraventions of the Regulations existed. At the end of 1951, forty seven 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. In eighty nine cases the Insanitary or defective conditions found to exist In food shops, other than butchers shops, were satisfactorily dealt with. Unsound Food The following diseased and/or unsound meat and other foods have been surrendered and destroyed or, where suitable, utilised for pig food. Type of Food lbs Tins Bottles or Jars Number or Packets Bacon 129 - - - Biscuits 58 - - 119 Cereals /Macaroni - 3 - 9 Cheese - - - 389 Chickens - - - 2 Coffee/Cocoa - 13 - - Confectionery 88½ 1 - 76 Culinary Mixtures/Powders . 46½ 4 - 62 Figs - 12 - 84 Fish/Roes/Pastes 453 1,095 2 - Fruit Juices/Puree - 71 - - Fruit/Vegetables 70 863 46 - Geese - - - 18 Ham (Tinned) - 160 - - Jams/Marmalade/Syrup - 253 15 - Lemon Barley Powder - 59 - - Liver 27¼ - - - Meat (tinned) - 315 - - Meat (Imported) 135½ - - - Meat (Home killed) . 93 - - - Milk (tinned) - 220 - - Mincemeat - 1 1 3 Peas/Beans (tinned) - 247 - - Pork Pies - - - 3 Rabbits - 3 - - Salad Cream/Sandwich Spread - 10 44 - Sausages Beef/Pork 4 20 - - Soup/Pickle/Sauces . - 138 90 - Spaghetti - 7 - 20 Totals 1,104¾ 3,495 198 785 24 Slaughtering There is one licensed slaughterhouse in the district. No animals were slaughtered during the year. Slaughter of Animals Act 1933. Three licences to act as slaughtermen were granted in 1951. Bakehouses There are twenty four bakehouses in the district, and of these twenty two are provided with mechanical power. A good standard of cleanliness and sanitary condition generally obtained. Shops Acts 1934-1950. Four hundred and one 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. Schools. The sanitary condition and the water supply to the schools in the area were found to be satisfactory. Hairdressers and Barbers Premises. Seventy five Inspections were made under the Hairdressers or Barbers Byelaws, 1947, and revealed that the majority of the premises are well conducted and generally satisfactory. Nine cases of minor infringements of the Byelaws were discovered and remedied. LICENCED PREMISES OF PUBLIC ENTERTAINMENT Sixteen visits were made to licenced places of public entertainment in the district. They are mainly used for cinematograph shows, concerts, dancing and social functions. The sanitary arrangements were Inspected and a relatively good standard of cleanliness found to exist. Licenced Public Houses During the year an investigation was carried out into the general and sanitary conditions of the thirty six Licenced Public Houses in the Borough and a special report was presented to the Public Health Committee. Attention was primarily directed towards the available facilities for the washing and sterilisation of glasses, the adequacy of bar and cellar ventilation, and the general sanitary accommodation arrangements available to the public and the staff. The survey was launched by a communication being addressed to all the licensees, and the duty of carrying out the Investigation was delegated to one of the assistant sanitary Inspectors. The fullest co-operation was received from the licensees and the various brewery companies concerned. 25 The majority of the public houses are on the whole well maintained from a public health point of view, but in a few cases the conditions found to exist called for adverse comment. It is gratifying to report that since the completion of the investigation some improvements have already been carried out, and in the coming year it is hoped to deal with those cases where a practicable solution is considered possible. DISINFECTION AND DISINFESTATION Council Private Number of houses treated with Insecticide for bugs and fleas 13 20 Eleven school canteens were sprayed for files and moths. The Insecticides used were D.D.T. Municipal spray and Gammexane liquid spray. RODENT CONTROL - The Prevention of Damage by Pests Act, 1949 A - Surface Treatments (1) Nine thousand two hundred and ninety six visits were made during the year by the Podent Operators, and three hundred and fifty six by the Sanitary Inspectors to premises infested or possibly harbouring rats or mice. Five hundred and thirty nine premises were cleared of rats or mice and no major infestations were recorded. The work for the year is summarised as under:- Complaints received or cases discovered and investigated 590 Number of premises found to be infested 536 " where no evidence of rodents found 54 " cleared of rats or mice (including 105 previous year's cases) 539 " of premises still being treated at the year end 102 (2) The causes or sites of infestations at the five hundred and thirty six infested premises, were:- Keeping of poultry 138 " " pigs 1 Inside premises (under floors etc.) - rats 29 " " " " - mice 57 Buries, scrapes etc. In gardens, land etc. 198 Under or inside sheds 130 Defective drains 1 Accumulations of refuse etc. 2 Total 556 26 (3) Type of property found to be infested:- With Rats With Mice Total Council property 2 - 2 Dwelling houses 437 38 475 Business premises etc. 40 19 59 Total 479 57 536 (4) Summary of the type of premises and methods employed in clearing premises of rats and mice:- Dwelling houses (mainly in gardens) 476 Food shops and food premises 23 Non-food shops Waste land and building sites 11 Hospitals and schools 6 Factories and workplaces 4 Council premises Ditch 1 Miscellaneous 8 Total 539 Methods employed in clearing 539 premises of rats and mice. Poison baits 508 Trapping 32 Gassing 67 Pat and mouse proofing 12 Drains repaired 2 Accumulations removed 1 Other means 2 Total 624 B - Sewer Treatments (1) Second Maintenance Treatment (1950/51). The second maintenance treatment of soli-sewer-manholes found To be infested during the 10 per cent test baiting (1950/51) and all adjacent manholes was completed on the 2nd April, 1951 Prebaiting with damped sausage rusks was carried out on two consecutive days and the same bait base with 2½ per cent zinc Phosphide added was laid on the third day with the following results:- SECTION A C D E Total No. of Manholes Pre-balted 56 52 106 125 339 Complete Pre-balt Takes 10 14 12 29 66 Partial Pre-balt Takes 5 9 21 18 53 Percentage of takes (C and P. T.) 26.8 44. 2 32.0 37.6 35.1 No. of Manholes Poison Baited 16 27 36 37 136 The number of pre-balt takes shew a decrease of 19 per cent on the first maintenance treatment, and a proportional decrease in all sections of the soil-sewers. 27 (2) Test Baiting (1951-52). As previously, the Borough was divided Into five sections, and a test baiting of 10 per cent of the soil-sewer manholes was carried out during the month, of August. The test shewed a 5.6 per cent decrease In the number of bait takes as compared with the previous years's 10per cent test. The results achieved were as under:- SECTION A B C D E Total No. of Manholes Baited 32 16 52 72 81 253 Complete bait takes 7 - 18 7 7 39 Partial bait takes 7 - 4 5 6 22 Baits not taken 18 16 30 60 68 192 (3) First Maintenance Treatment (1951-52). The treatment was completed on the 12th September, 1951. Prebaiting with damped sausage rusks was carried out on two consecutive days, and the same bait base with 2½ per cent zinc Phosphide added was laid on the third day. 1 District B which shewed no takes in the 10 per cent test was again not baited. The total of the other four districts shewed a small increase in the number of pre-bait takes as compared with the previous maintenance treatments. The following is a tabulated summary of the results achieved. SECTION A C D E Total No. of Manholes Pre-baited 52 83 71 43 249 Complete Pre-bait takes 10 27 12 16 65 Partial Pre-bait takes 9 12 10 7 38 Percentage of takes (C and P. T.) 36.5 47.0 31.0 53.4 41.3 No. of Manholes Poison Baited 27 57 42 35 161 Key to Districts District "A" -Sutton - all roads south of the Sutton Station and east of Brighton Road. District "B" - Sutton and Cheam - All roads south of Mulgrave Road and Upper Mulgrave Road and west of Brighton Road. District "C" - Sutton - all roads east of the Railway and north from Sutton Station. District "D" - Cheam - all roads between London Road/Stonecot Hill and west of the Railway. District "E" - Worcester Park. 28 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Two thousand and eighty eight cases of infectious diseases were notified during the year 1951. This is an increase of one thousand two hundred and ten cases, due to a severe epidemic of Measles and a higher incidence of Whooping Cough, Dysentery and Pneumonia, Scarlet Fever. One hundred and ten cases were notified, a decrease of one hundred and five cases. The case rate was 1.38 per 1000 of population, compared with 1.11 per 1000 of population for England and Wales, The disease was generally mild. There was no death. Diphtheria. There was one case, a child aged three years, who had not been immunised against Diphtheria, The organism was of the mitis type Early diagnosis and early treatment ensured complete recovery This case is a warning that immunisation should not be rejected or deferred indefinitely. The case rate was 0.01 per 1000 of population, compared with 0.02 per 1000 of population for England and Wales. Diphtheria Antitoxin, Medical practitioners must be on guard against throat infectiouns being due to Diphtheria. Swabs for differential diagnosis must be taken before Penicillin or other antibiotics are administered. Otherwise the diagnosis is obscured. Early treatment with antitoxin is essential to prevent serious toxic effects. Diphtheria Immunisation. Immunisation has reduced the incidence and mortality of Diphtheria. In England and Wales notifications have fallen from 23,199 in 1944 to 699 in 1951, and in the same period deaths have been reduced from 934 to 34. These figures suggest that Diphtheria could be eliminated if immunisation was complete. To secure this objective it is vital that babies are immunised before their first birthday, and that children are re-inforced before entry to school or nursery school and re-lnforced again at the age of eight years. The position in this Borough is indicated by a survey at the end of 1951 of the state of immunisation of 1,067 babies born in 1950., This showed that 662. representing 62 per cent, had been immunised, 1.5 per cent of parents refused Immunisation 5 per cent were indifferent, 14 per cent intended to accept immunisation, and 10 per cent had left the district. The remainder included allergic children, two who had died, and the inaccessible The inactive well intentioned and the indifferent form the problem group who defer the rise of immunisation above the high percentage required for safety, During 1951, nine hundred and sixty-three children were immunised in the following age groups. Age Under 1 1-2 2-5 5-15 Total Numbers 39 624 159 141 963 29 At the end of the year, eleven thousand five hundred and forty-two children, representing 73.7 per cent of all children had been immunised. Of these, three thousand one hundred and five represents 54 per cent of the children under five years of age, and eight thousand four hundred and thirty seven represents 85.2 per cent of the children between five and fifteen years of age. The Clinics for Diphtheria Immunisation are as follows:- 1. At the Clinic, No. 1, Robin Hood Lane, Sutton, every Friday, at 2 p.m. 2. At the Clinic, Methodist Church Hall, Station Road, Belmont, every Thursday, at 1.30 p.m. 3. At the Clinic, Emmanuel Church Hall, Stonecot Hill, Sutton, every Monday, at 1.30 p.m. 4. At the Clinic, Parochial Rooms, The Broadway, Cheam, every Wednesday, at 1.30 p.m. 5. At the Clinic, Priory Crescent, Cheam, every Monday, at 1. 30 p.m. 6. At the Clinic, St. Oswald's Hall, Brocks Drive, North Cheam, the second and fourth Tuesday in each month, at 1.30 p.m. 7. At the Clinic, Jubilee institute, Maiden Green,Worcester Park, the first Monday in each month, at 1.30 p.m. Measles. A severe epidemic of Measles occurred during the first quarter of the year. One thousand four hundred and thirtythree cases were notified. Commencing in December 1950, the number of cases rose sharply throughout January to a peak in February, continued heavily through March and declined sharply in April. The highest concentration of infection was in the East, East Central, West Central and North East Wards. Twenty-three cases were removed to hospital. There was one death of a child aged three years from pulmonary complications. The case rate was 18.02 per 1,000 of population, compared with 14.07 per 1,000 of population for England and Wales. The severity of the epidemic is indicative of the coincidence of a highly virulent phase of the virus and the accumulation of susceptible children after relatively low incidence of Measles in preceding years. Infant school children and pre-school children were heavily involved. Twenty-four babies under one year of age were affected. The potency of Infection was high. The monthly distribution of cases is shown in the following table. January 358 May 48 September 1 February 445 June 19 October 4 March 393 July 7 November - April 151 August 7 December - 30 Measles must still be regarded as a serious infection. Despite the advantages of modern drugs in the prevention and treatment of pneumonia, there is the occasional case where through some inherent weakness in the response of the natural protective mechanism a fatal Bronchiolitis develops. Careful nursing during the febrile phase and careful convalescence are essential in all cases. Prevention depends on recognition of infection during the three or four days before the rash develops. The initial illness may seem to be only a minor indisposition. The child is often miserable and disinclined for food or play. There may be catarrh of the eyes nose or throat. This is the highly infectious phase and failure to recognise it leads to dissemination of infection. Children are frequently sent to school, or allowed to play in the streets or to go to the cinema in this phase of infection, which could more often be detected or at least suspected by more careful observation of minor indisposition in children and the Judicious use of the thermometer, a valuable household instrument during epidemics. Whooping Cough. Three hundred and fifty one cases were notified. This Is an Increase of one hundred and forty one cases. Prevalence was highest in January and February. The East and East Central Wards had the greatest Incidence. The case rate was 4.41 per 1,000 of population, compared with 3.87 per 1,000 of population for England and Wales, Eight cases were admitted to hospital. There was no death. The monthly incidence of notified cases is shown in the following table. January 56 July 43 February 58 August 44 March 29 September 22 April 40 October 11 May 21 November 1 June 21 December 5 Whooping Cough is a dangerous disease of infancy. The incidence of infection was highest among the Infant children and included twenty five babies under one year of age. The indefinite nature of the initial illness which may last for seven or even fourteen days before the characteristic whoop develops makes early diagnosis and the prevention of the spread of infection difficult. Early diagnosis may be helped by the use of cough plates cor eft throat swabs for the isolation of the bacillus. The new drug Chloromycetin can be valuable in treatment and prophylaxis if used in the early stages of infection. Ultimate control of the disease is likely to depend on the use of improved vaccines. Immunisation against Whooping Cough. During the year two hundred and twenty eight children were given injections against Whooping Cough. The material used was Pertussis 'S' Vaccine (suspended and alum precipitated). The alum precipitated type may predispose a muscle to paralysis in a person incubating 31 Poliomyelitis. Suspicion of this association arose in one case during the year. The use of the suspended vaccine is preferred as the injection is subcutaneous. Caution is necessary in giving injections during seasonal prevalence of Poliomyelitis. Recent trials of vaccines have shown that one prepared by an American method gives an improved standard of protection. Supplies of this vaccine are becoming available. Smallpox. No case was notified during the year. Prevention of Smallpox. Vaccination is voluntary and free of charge under the National Health Service. The percentage of babies under the age of one year vaccinated rose from 43.4 in 1950 to 55.8 in 1951. This increase in infant vaccination is an encouraging sign of public appreciation of the value of vaccination as a protective measure. The danger of the introduction of Smallpox into this country makes it necessary to sustain the basic immunity of the population. 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 1951. Age No. Vaccinated No. Re-Vaccinated Under 1 513 - 1 47 - 2 15 2 3 15 3 4 8 5 5-10 35 18 10-15 40 25 Over 15 10 321 Total 783 374 Puerperal Pyrexia. Six cases were notified in 1951, compared with five cases in 1950. The case rate was 6.42 per 1,000 total births, compared with 10.66 per 1,000 total births for England and Wales. Under the Puerperal Pyrexia Regulations 1951, the definition of Puerperal Pyrexia has been revised as meaning "any febrile condition occuring in a woman in whom a temperature of 100.4 Fahrenheit (38* Centigrade) or more has occurred within fourteen days after childbirth or miscarriage. 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. 32 Typhoid and Paratyphoid Fever One case of Paratyphoid Fever and two cases of Typhoid Fever were notified. All the cases were contracted abroad. The value of Chloromycetin in terminating the illness was impressive, but in two cases the clearance of infection was not accellerated. One case of Typhoid Fever had clinical relapse ten days after a course of Chloromycetin and bacteriological relapse after a second course. The liability to relapse of these infections ten to fourteen days after completion of a course of Chloromycetin has to be anticipated, and patients must be kept under close observation until this danger has passed. Dysentery. One hundred and six cases were notified. Of these twenty seven occurred within an institution for children. All were of the Sonne type. The cases occurred in a series of outbreaks in schools in the Sutton area. A high carrier rate among young symptom free children was found by bacteriological investigations. Dysentery is spread through school by the frequent contact of hands. The lack of warm water in schools for the washing of hands makes difficult the inculcation of this desirable hygienic practice. Food Poisoning No. of Outbreaks No. Of Cases No. of Deaths Organisms or Other Agents Food Involved 1 2 0 S. Typhi Murium Not ascertained 1 1 0 ” ” ” ” 1 1 0 ” ” Meat roll 1 1 0 ” ” Dried milk 1 l 0 ” ” Duck's egg (1) Two children suffered from gastro enteritis. The origin of infection was probably from the larder in a house subject to Infestation with mice. (2) A man who ate his mid-day meals in a cafe in another district was Infected. The cafe was found to be infested with mice. (3) A man who ate his mid-day meals in another cafe in another district was infected. The cafe was found to be infested with mice Seven other members of his household eating food at home remained well. (4) A baby, bottle fed, was probably infected through the mother, a carrier of infection, preparing the feed. (5) A young lady who developed gastro enteritis had eaten a lightly fried duck's egg, the only item of food likely to have caused the infection. All the cases were due to Salmonella Typhi Murium. This organism is carried by infected mice. It is conveyed to food by their excreta or dirts which are often overlooked as they may be hidden on or behind stored food. 33 Food in stores and larders must be moved frequently and examined carefully for any signs of infestation with mice. People who have even mild attacks of the infection may become unsuspecting carriers. In the duck. infection can pass through the oviduct to the egg. The need for the suppression of mice is evident. Duck's eggs must be boiled for ten minutes or otherwise completely sterilised by heat. The danger from the human carrier demands extreme vigilance from all engaged in the handling of food. To secure protection from pathogenic organisms the washing of hands, particularly after the use of the W. C., must become an established habit in homes and schools and a duty to the public of all who work in food premises. Cerebro Spinal Fever. No case was notified. Poliomyelitis. Six cases were notified in 1951, compared with twelve cases in 1950. Two were males aged five and thirtytwo years. Four were females aged 16, 18, 24 and 37 years. Four recovered completely. Two have mild residual paralysis. One of the patients, a student nurse, was resident in a Preliminary Training School for Nurses. it is the practice for students to record their own temperature daily as a routine method of training. The chart of the patient showed a mild temperature reaction on the probable day of infection, twelve days previous to the onset of illness. Three of five contacts showed a similar reaction to infection coinciding with the illness of the patient. Ten to fifteen days later these contacts had a rise of temperature corresponding to but11ower than the temperature curve of illness of the patient. This observation is of interest in indicating the possibility that such contacts, symptom-free, ambulant but mildly febrile, may be carriers of infection. Pneumonia. Of twenty nine deaths from all forms of Pneumonia, two were notified before death. The total number of notified cases arising in the district was sixty eight. Influenza. Influenza was prevalent in the first quarter of the year, and caused twenty two deaths, mostly in the elderly, and as a complication of other illness, Non-Notifiable Diseases School teachers reported one hundred and seventy six cases of Chicken Pox, ninety four cases of Mumps and forty one cases of German Measles. School notifications area useful indication of the prevalence of non-notifiable diseases and form a basis for consultation with the school medical officer. Scabies. There was a further decrease in the number of cases of Scabies. Six cases were treated, compared with seventeen cases in 1950. The number of attendances for treatment was eighteen, compared with forty two in 1950. Treatment is by bathing and the application of Benzyl Benzoate emulsion to the skin. 34 Lice. Twenty five cases were treated, the same number as in 1950. The number of attendances for treatment was seventy two. 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. 35 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1951. Disease Under 1 Age in Years Over 65 Totals Removed to Hospital Died * 1 2 3 4 5 10 15 20 35 45 Scarlet Fever - - 4 9 11 69 10 4 1 1 - - 109 47 - Diphtheria - - - 1 - - - - - - - - 1 1 - Smallpox - - - - - - - - - - - - - - - Typhoid Fever - - - - - 1 1 - - - - - 2 2 - Paratyphoid Fever - - - - - 1 - - - - - - 1 1 - Puerperal Pyrexia - - - - - - - - 6 - - - 6 - - Pneumonia - - - 1 1 3 3 3 9 7 22 19 68 7 29 Erysipelas - - - - - - - - - 1 2 1 4 1 - Dysentery - - 5 12 13 26 8 2 7 3 2 1 79 5 - Poliomyelitis - - - - - 1 - 2 2 1 - - 6 4 - Cerebro Spinal Fever - - - - - - - - - - - - - - - Measles 23 108 141 197 301 683 29 6 18 1 - 1 1408 18 1 Whooping Cough 24 31 30 44 51 145 4 1 5 3 2 6 346 4 - London Cases in the Downs Residential Nursery Scarlet Fever - - - - 1 - - - - - - - 1 1 - Dysentery - 8 3 2 - 1 - 12 1 - - - 27 27 - Measles 1 7 11 3 1 2 - - - - - - 25 5 - Whooping Cough 1 - 1 - 1 2 - - - - - - 5 4 * Under column "Died", all deaths, whether notified in the district or outside it, or not notified at all, are Included. 36 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 10157 8920 11335 12737 7401 7621 6608 5934 8807 79520 Scarlet Fever 12 8 15 35 5 21 4 5 4 109 1.37 1.11 Diphtheria - - - 1 - - - - - 1 0.01 0.02 Typhoid Fever - - - - - 1 1 - - 2 0.02 0.00 Paratyphoid Fever - - - - - - - 1 - 1 0.01 0.02 Smallpox - - - - - - - - - - 0.00 0.00 Puerperal Pyrexia - - - - - - - 5 1 6 - - Pneumonia 3 1 11 3 6 11 9 6 18 68 0.85 0.99 Erysipelas - - 2 1 - - - - 1 4 0.05 0.14 Dysentery 1 - 25 4 16 24 - 1 8 79 0.99 - Poliomyelitis - 1 1 3 - - - - 1 6 0.08 0.05 Cerebro Spinal Fever - - - - - - - - - - 0.00 0.03 Measles 54 45 244 207 207 213 117 356 165 1408 17.70 14.07 Whooping Cough 34 19 50 47 52 53 37 17 37 346 4.35 3.87 TOTALS 104 74 348 301 286 323 168 191 235 2030 37 TUBERCULOSIS On 31st December 1951, there were on the register nine hundred and eleven cases of Tuberculosis, of whom seven hundred and forty nine were Pulmonary cases and one hundred and sixty two non-Pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.20 per 1,000 of population, and for nonPulmonary Tuberculosis 0.04 per 1,000 of population. The total death rate for Tuberculosis was 0.24 per 1,000 of population, compared with 0.17 per 1,000 of population in 1950. Corresponding death rates for England and Wales were: Pulmonary 0.27 per 1,000 of population: non-Pulmonary 0.04 per 1,000 of population. The number of new cases of Pulmonary Tuberculosis was seventy four, compared with sixty five in 1950. The number of new cases of non-Pulmonary Tuberculosis was ten, compared with eleven in 1950. The increase in the number of new cases of Pulmonary Tuberculosis reflects the increasing use of modern diagnostic services. The objective of the campaign against Tuberculosis is to find and bring under control all infectious or potentially infectious cases of Pulmonary Tuberculosis and to prevent the development of new foci of infection by early treatment and complete cure. This can be attained by the extended use of Mass X-Ray supported by the protection of the susceptible by B.C.G. vaccination, advancing research and trial of new drugs, progressive improvement in housing and adequate accommodation in sanatoria. The suppression of non-Pulmonary Tuberculosis is being advanced by the introduction of "specified" areas where all milk is required to be either pasteurised or designated as has been the practice in this Borough for many years. The Tuberculosis Care Committee, under the chairmanship of County Alderman Miss Edith Hoole, has progressively developed the social service to patients and families in the Borough. Clothing, bedding, extra nourishment and the many other needs for reablement, have been generously provided. The scheme for holidays for children has been especially supported for its preventive and recreative value. The wide range of good work being done by this Committee deserves support and appreciation. The scheme for allowances to patients operated beneficially. 38 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 - - - - - - 1 1 1 1 1 1 - - - - 5 1 2 1 - l - 1 - 15 9 13 2 2 l - - - 25 10 5 - - 1 1 - - 35 5 5 1 - - 2 - - 45 10 1 - 2 2 - - - 55 6 - - - 4 - - - 65 and above 3 1 - - 3 1 1 - TOTALS 46 28 5 5 12 4 2 1 Notification of Tuberculosis Respiratory forms of death - Thirteen out of sixteen were notified. Other forms of death - Two out of three were notified. Mass Radiography A mass radiography unit visited the Borough on two occasions during the year. In June the unit was stationed at the Catholic Hall, Cheam Common Road, Worcester Park, and in September at the Public Hal1 Sutton. A total of five thousand six hundred and fifty eight persons attended for examination. The final results were as follows. Total X-Rayed No. of cases of active Pulmonary Tuberculosis No. of cases of arrested Pulmonary Tuberculosis Non- Tuberculous abnormalities WORCESTER PARK Males 606 3 23 32 Females 1050 - 41 31 Total 1656 3 64 63 Incidence per l,000 examined - 1.8 38.6 38.0 SUTTON Males 1653 8 66 117 Females 2349 6 103 19 Total 4002 14 169 136 Incidence Per l,000 examined - 3.5 42.2 33.9 39 The results lie within the range of expectation from random samples of the population. The figures might seem to indicate a lower incidence of undetected active Pulmonary Tuberculosis in Worcester Park, but these are random samples of population and deductions should not be made unless the groups are strictly comparable in size and composition. The importance of the figures lies in the detecting of seventeen cases of Pulmonary Tuberculosis, and the advantage to the patients and to the community thereby derived. The service is essentially preventive, and the interest and help of the Council in providing the Public Hall free of charge is highly advantageous, as is also the public service of the Catholic Church in permitting the use of the hall at Worcester Park. 40 CLINICS AVAILABLE FOB THE DISTRICT SUTTON AND BELMONT The Clinic. No. 1 Robin Hood Lane, Sutton Ante-Natal Clinic. Every Wednesday, at 9. 20 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. Vaccination against Smallpox, by appointment). SUTTON COMMON Emmanuel Church Hall Stonecot Hill, Sutton Infant Welfare Centre. Every Monday, at 1.30 p.m. (Including Diphtheria Immunisation. Vaccination against Smallpox, by appointment) CHEAM AND WORCESTER PARK The Parochial Rooms The Broadway, Cheam Infant Welfare Centre. Every Wednesday, at 1.30 p.m. (Including Diphtheria Immunisation) 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, 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. 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. Vaccination against Smallpox, by appointment) 41 SCABIES CLINIC St. Nicholas Road, Sutton Every Thursday, at 10 a.m. CHEST CLINIC St. Helier Hospital, Wrythe Lane, Carshalton (By appointment) Every Monday- Tuesday and Friday, at 9.30 a.m. Every Wednesday, at 2 p.m. Every second Wednesday in each month, at 6.30 p.m. (Old cases only) VENEREAL DISEASES CLINIC St. Helier Hospital, Wrythe Lane, Carshalton Kales 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. 42