SUTC 16 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1952 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 52 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR, (ALderman Klngsley Williams, J.P.) Alderman F. C. LOHDEN, 0. B. E. " W. T. VENTON " F. WARREN Councillor H.A. BENNETT " L. B. BLACKLER " J. L. GUTHRIE " D. M. JOHNSON Councillor F. R. MUDDLE " D. SPARKS (Mrs) M. B. E. (Chairman) " A. G. TAYLOR " F. E. W. TOZER 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. Certlf.Meat and Pood. Certif. S. I. Exam. Board Deputy Chief Sanitary Inspector ARTHUR SYDNEY WILLIAMS Certlf. R. S. I. Certif.Meat and Food Assistant Sanitary Inspectors WALTER BLACK, D. P. A. Certif. R. S. I. and S. I.E.J.B. Certif.Meat and Food JOHN ALWYN EVANS JONES Certif. R. S. I. and S. I.E.J. B. Certif.Meat and Food REGINALD WILLIAM NORMAN Certif. R. s. I. and S. I.E.J.B. Certif.Meat and Food KEMPTON HUDDLESTONE PRIOR Certif. R. s. I. and S. I.E.J. B. Certif.Meat and Food FRANK SUTCLIFFE Certif.R. S. I. and S. I.E.J.B. Certif.Meat and Food Public Analyst DANIEL D. MOIR, M. Sc., F. R. I. C. Analytical and consulting Chemist (part-time) 1 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SUTTON AND CHEAM Mr. Mayor, Ladles and Gentlemen, I have the honour to present to you the Annual Report on the health of the Borough for the year 1952. The health of the community was good. The birth rate fell from 11.5 per thousand of population to 10.79 per thousand of population. The death' rate was stationary at 10.8 per thousand of population. The infantile mortality rate was low. There were two maternal deaths. The general incidence of infectious diseases was lower. Measles was epidemic during March. Six cases of Poliomyelitis were notified. There was no case of Diphtheria. A Mass Radiography Unit visited the Borough in August and again proved of great value in the detection of early disease and the prevention of illness. The Council's housing programme progressed. During the year 103 flats and houses were completed and 63 flats and houses were in course of erection. Schemes were in progress for 47 flats and houses. In November preparation of the site at Banstead for the erection of 200 houses was commenced. 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) who has constantly endeavoured to promote progress in hygiene and housing, and to whom, and to the members of the staff I would express my appreciation of their services. 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 1951 1952 Area in acres 4338.15 4338.15 Registrar General's estimate of the Resident Population 79,520 79,300 Number of inhabited houses (end of year) according to the Rate Book 23,171 22,760 Rateable value and sum represented by a £910,294 £917,050 Penny Rate £3,705 £3,740 EXTRACTS FROM VITAL STATISTICS (Comparative of the Years 1951 and 1952) 1951 1952 England & wales 1952 Total Male Female Total Male Female Live Births 919 462 457 876 454 422 Legitimate 884 449 435 844 435 409 Illegitimate 35 13 22 32 19 13 Birthrate per 1000 of the Estimated Resident Population 11.5 10.79 15.3 Still Births 16 8 8 16 5 11 Legitimate 16 8 8 16 5 11 Illegitimate - - - - - - Rate per 1000 total (live and still births) 17.1 17.8 22.6 Deaths 878 411 467 886 440 446 Death Rate per 1000 of the Estimated Resident Population 10. 8 10.8 11.3 Deaths from Sepsis 0 1 Other Maternal Causes 0 1 Death Rate from Maternal Causes per 1000 total (live and still births) 0.00 2.24 0.72 Deaths of Infants under one year of age All Infants per 1000 live births 11.96 18.26 27.6 Legitimate Infants per 1000 legitimate live births 11.31 17.77 Illegitimate Infants per 1000 illegitimate live births 22.22 31. 25 3  1951 1952 Deaths from Cancer 147 172 " Measles 1 1 " Whooping Cough 0 0 " Diarrhoea 3 2 Percentage of Deaths from certain causes to the Total Number of Deaths 1951 1952 Diseases of the heart and circulation 38.8 39.0 Cancer and malignant disease 16.7 19.4 Diseases of the lungs (non-tuberculous) 9.6 8.0 Tuberculous diseases 2.2 2.1 Vascular lesions of the nervous system 11.5 14.2 Congenital diseases 1. 1 0.9 Suicide and violence 3.4 2.7 Diseases of the digestive system 2.1 1.7 Infectious diseases 3.2 0.9 Diseases of the kidney 1.7 0.9 Other defined diseases 9.7 10.2 Maternal Mortality. There were two deaths. One was from obstructed labour due to contracted pelvis and one from septicaemia following abortion the cause of which was not ascertained at the inquest. The maternal mortality rate was 2.24 per thousand total births, compared with 0.72 for England and Wales. Infantile Mortality. The infantile mortality rate was 18.26 per thousand live births, compared with 11.96 per thousand live births in 1951. There were sixteen deaths of infants under one year, compared with eleven In 1951. Of the sixteen deaths, twelve 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 Deaths Under 1 month AGE GROUPS 1-3 months 3-12 months Congenital Abnormality 7 1 1 Prematurity 4 - - Pneumonia - 1 - Asphyxia 1 - - Bronchiolitis - - 1 Totals 12 2 2 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 195 2 M. F. Total 1 Tuberculosis, respiratory 11 6 17 2. Tuberculosis, other 2 - 2 3 Syphilitic disease 2 1 3 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal infections - - - 7 Acute Poliomyelitis - - - 8 Measles - 1 1 9 Other Infective and parasitic diseases - - - 10 Malignant neoplasm, stomach 19 7 26 11 Malignant neoplasm, lung, bronchus 29 7 36 i2 Malignant neoplasm, breast - 16 16 13 Malignant neoplasm, uterus - 9 9 14 Other malignant and lymphatic neoplasms 41 44 85 15 Leukaemia, aleukaemia 4 - 4 16 Diabetes 1 3 4 17 Vascular lesions of nervous system 49 77 126 18 Coronary diseases, angina 68 47 115 19 Hypertension with heart disease 8 12 20 20 Other heart disease 59 108 167 21 Other circulatory disease 16 28 44 22 Influenza 3 1 4 23 Pneumonia 17 13 30 24 Bronchitis 30 13 43 25 Other diseases of respiratory system 5 2 7 26 Ulcer of stomach and duodenum 6 3 9 27 Gastritis, enteritis and diarrhoea 1 1 2 28 Nephritis and nephrosis 7 1 8 29 Hyperplasia of prostate 10 - 10 30 Pregnancy, childbirth, abortion - 2 2 31 Congenital malformations 3 5 8 32 Other defined and ill-defined diseases 36 28 64 33 Motor vehicle accidents 1 4 5 34 All other accidents 8 2 10 35 Suicide 4 5 9 36 Homicide and operations of war - - - Totals 440 446 886 5 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA NEW LEGISLATION The Public Health (Tuberculosis) Regulations, 1952 These Regulations revoke the Public Health (Tuberculosis) Regulations, 1930, and make similar provision for the notification of tuberculosis modified to accord with the structure and administration of the services now being provided under the National Health Service Acts. REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION The national Assistance Act, 1918 - Section 47 The national Assistance (Amendment) Act, 1951. No action was taken under this Section during the year 1952. BURIAL AND CREMATION OF THE DEAD The national Assistance Act, 1948 - Section 50 Four burials were arranged under the powers granted to the Council by this section. MORTUARY Ninety-four bodies were received and ninety-four 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. 6 SANITARY CIRCUMSTANCES OF THE AREA Water Supply. The water supply is mainly derived from the deep wells in the chalk of the Sutton District water Company, situated at Sutton, Cheam and Woodmansterne. A small area in the North Ward is supplied by the Metropolitan water Board. The water from all wells of the Sutton District Water Company is softened to nine degrees of hardness. Chlorine is applied in the form of chloramine as a protective measure. 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 samples are examined in rotation by the District Councils in the area of supply. The supply from all sources has been satisfactory in quality and quantity. All the dwelling houses have a direct supply from the public mains. Below is the average of monthly analyses. Chemical Results in Parts per Million Average Total Solids 194.583 Ammonia, free 0.17 Ammonia, Albuminoid 0 Nitrogen in Nitrates 8.708 Nitrogen in Nitrites 0 Oxygen Absorbed 0.075 Chlorine in Chlorides 19.583 Hardness total (grains per gallon) 7.8 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 Coli 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 the reconstruction at the Worcester Park Sewage Works are now before the Ministry of Housing and Local Government for approval with a view to the work being started at an early date. On the main drainage system the new Pumping Station at Epsom Roadlsnow In operation replacing the old ejector station. Plans are In hand for Increasing the capacity of the ejector station at Relgate Avenue. It Is hoped to commence the construction of a relief surface water sewer In Wellesley Road (East) In the spring of 1953. 7 Refuse Collection and Scavenging. The collection and disposal of house refuse and salvage, together with the scavenging of public highways is carried out under the supervision of the Borough Engineer and Surveyor. The work, has been executed in a satisfactory manner. Rivers and Streams. The streams within the Borough have been maintained in a satisfactory condition. Closet Accommodation. There are eight premises with cesspools in use. Some six pall closets and one privy are in use. In the past twenty-four 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 1,167 Reinspection visits 3,337 Visits to works in progress 898 „ Factories and Workplaces 499 „ Bakehouses 42 „ Outworkers' premises 127 „ Butchers, grocers and other food premises 470 „ Dairies and milk purveyors 37 „ Ice Cream premises 147 „ Stables, passages, piggeries and ditches 32 „ Restaurant, cafe, school canteen kitchens 137 „ Premises re rodent infestations 7,330 „ Tents, vans, sheds 19 „ Cinemas, Theatres, Halls 14 „ Premises re. infectious disease enquiries 240 „ re. overcrowding and permitted numbers 1,004 „ re. food complaints (Request Inspections) 295 „ Hairdressers and Barbers premises 78 „ School and public conveniences 32 „ Verminous houses 13 „ Shops under The Shops Acts 583 „ Licenced Public houses 32 „ Atmospheric pollution gauges, smoke observations 83 „ Premises - Food and Drugs Act sampling 154 „ „ - Bacteriological Milk/Water sampling 99 „ „ - Bacteriological Ice Cream sampling 111 „ „ - Merchandise Marks Acts 140 „ „ - Rag Flock Acts 7 „ „ - Pet Animals Act 11 Miscellaneous visits 2,826 Total 19,964 Number of complaints received and investigated 502 Premises at which defects or nuisances were discovered 1,433 Dwelling-houses surveyed for housing defects under the Public Health or Housing Acts 225 Number of defects or nuisances discovered 2,502 „ „ „ remedied 1,865 „ „ „ in hand212 „ „ „ outstanding 425 Number of informal notices served 945 9 STATUTORY NOTICES WERE SERVED AS UNDER: Housing Act 1936 Sections 9 and 10 32 (as amended by the Housing Act 1949) Public Health Act 1936, Section 24 10 „ „ „ 39 1 „ „ „ 45 2 „ „ „ 75 8 Total 53 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT Drainage and Sanitary Fittings. Number of houses and other premises redralned 4 Repairs and amendments to existing drains 91 Drains or gullies unstopped or cleansed (involving 701 premises) 257 Sanitary fittings repaired/renewed/provided or cleansed 553 Water service pipes/cisterns/repaired, renewed or cleansed 10 Water, smoke and chemical tests applied 296 W.C. Apartments: W.C. Apartments provided 19 " lighted and/or ventilated 24 " provided with ventilated lobbies 7 " cleansed 49 Separate W.C. accommodation provided for the sexes 4 Structural Repairs or Improvements Carried Out: Number of roofs repaired or renewed 171 " guttering and rainwater pipes provided repaired, etc. 98 " damp walls remedied 88 " brick walls repolnted, repaired or re-rendered 61 " chimney stacks repaired or rebuilt 7 " yards paved or repaired 17 " sites of houses concreted 2 " floors relaid or repaired 71 " windows/sills/sashcords repaired or renewed 200 " doors/thresholds provided or repaired 48 " staircases/handrails provided or repaired 6 " ranges/stoves/coppers renewed or repaired 44 " Miscellaneous items 2 Cleansing: Number of rooms/passages/larders cleansed and/or repaired 220 " trade premises cleansed 58 " verminous rooms dlslnfested for bugs/fleas 16 " premises sprayed for cockroaches/crickets/ wood beetles, etc. 42 " premises disinfected after various diseases 241 " Canteens sprayed for flies and ants 12 Various: Number of offal bins provided 10 " dustbins provided 61 " accumulations of refuse and manure removed 33 " offensive ponds and ditches cleared 1 " wasp nests destroyed 145 " Miscellaneous items 288 10 HOUSING 1. Inspection of Dwelling-houses during the Year: (1) (a) Total number of dwelling-houses inspected under the Public Health or Housing Acts 225 (b) Number of inspections made for the purpose 647 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 199 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 136 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 32 (2) Number of dwelling-houses which were rendered fit after service of formal notices: - By Owners 11 By Local Authority in default of owners 2 (b) Proceedings under the Public Health Act:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- By Owners 1 By Local Authority in default of owners 2 (c) Proceedings under Sections 11 and 13 of the Housing Act 1936 (1) Number of houses demolished as the result of informal action by the Local Authority 6 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 73 80 7 Factories with mechanical power 323 350 44 Other premises (excluding outworkers premises) 14 30 5 Total 410 460 56 Defects found in Factories and Other Premises under the Act Particulars Defects found Defects remedied Want of cleanliness 8 8 Inadequate ventilation 3 3 Overcrowding - - Unreasonable temperature - - Ineffective floor drainage 3 3 Absence of thermometers - - Other nuisances 12 11 Sanitary Accommodation - (a) Insufficient 2 1 (b) Want of cleanliness 15 14 (c) Unsuitable or defective 10 10 (d) Not separate for the sexes - - (e) Insufficient lighting in W. C.'s 3 2 Totals 56 52 WORKPLACES - Public Health Act, 1936 NUMBER OF Inspections 39 Written Notices 5 Occupiers prosecuted - SMOKE ABATEMENT The few chimneys attached to industrial premises in the district have been kept under observation. Eighty-three visits were made in connection with the location, collection and renewal of the grit deposit gauges which were placed in position on the 1st January 1952. An assessment of the total solids including ash is being obtained and results collated over a period in order to ascertain the full extent of the problem in the north end of the Borough. 12 INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1938 Sampling. During the year 183 formal and informal samples were submitted to the Public Analyst for analysis as follows:- Article Number of samples examined Number of unsatisfactory samples Formal Informal Total Formal In formal Total Almonds (Ground) 1 1 Almond Paste 1 1 Apples (Liquid) 1 1 Asthma Tablets 1 1 Bicarbonate of Soda 2 2 Biscuits 2 2 Black Pudding 1 1 Borax 1 1 Cakes 1 1 Cake Decoration 1 1 Cake Flour Mixture 1 1 Cheese Spread 1 1 Cherries Glace 1 1 Chocolate Drink 1 1 Cinnamon 1 1 Coconut 1 1 Coffee 1 1 Coffee and Chicory J. 1 Coffee Instant 1 1 Colouring (Sap Green) 1 1 Cordial 1 1 Cornflour 1 1 Cornish Pasties 2 2 Cough Mixture 1 1 Crab (dressed) 1 1 Cream of Tartar 2 2 Essence 4 4 Flour 1 1 Flour (Pea) 1 1 Gelatine 2 2 Ginger 2 2 Glauber salts 1 1 2 1 1 Glucose Tablets 1 1 Glycerine 1 1 Ice Cream 1 8 9 1 1 2 Ice Cream Mix 1 1 Ice Lollie 1 1 Isinglass 1 1 1 1 Jam Diabetic 1 1 Jam Raspberry 1 1 1 1 Jelly Crystals 4 4 1 1 Juice Grape 1 1 Juice Tomato 1 1 Lard 1 1 Laxative Fruit 1 1 Lemonade Crystals 4 4 Lemon Curd 1 1 Lemon Juice 1 i Liver sausage 2 2 Liquid Paraffin 1 1 Carried forward: 5 70 75 1 5 6 13 Article Number of samples examined Number of unsatisfactory samples Formal In formal Total Formal Informal Total Brought forward 5 70 75 1 5 6 Luncheon Sausage 2 2 Macaroni 1 1 1 1 Malted Milk 1 1 Manual ade 2 2 * Marshmallow Creme 1 1 Meat Paste 1 1 Meat Pies 1 1 Meat and Vegetable 1 1 Meringue Powder 1 1 1 1 Milk 17 2 19 Milk (Channel Island) 7 7 Mincemeat 1 1 Mince Pies 1 1 Mint (Dried) 1 1 Mousse (Strawberry) 1 1 Mushrooms in Butter 1 1 Oatcakes 1 1 Olive Oil 1 1 Orange Squash 1 1 Paste (Fish) 3 3 Paste (Meat) 1 1 Pastilles 1 1 Pastry Mix 1 1 Pastry/Pasties 2 2 Peanut Butter 1 1 Pepper 5 5 Pepper Paprika 2 2 Pepper White 2 2 Pineapple Slices 1 1 Port 1 1 Salad Cream 1 1 Sausages; Beef 7 7 1 1 Sausages Beef (Preserved) 1 1 Sausages Pork 10 1 11 2 2 Sausages Pork (Preserved) 2 2 1 1 Sausage Meat (Pork) 1 1 Sausage Rolls 2 2 Sherbet Fountain 1 1 1 1 Soup (kidney) 1 1 Spice 1 1 Squash Fruit 1 1 Steak Pie 1 1 Suet 2 2 1 1 Suet (Shredded) 1 1 Sulphur Tablets 1 1 Syrup Golden 1 1 Syrup of Figs 1 1 Tapioca 1 1 1 1 Tea 1 1 Tomato Ketchup 1 1 Tonic Tablets 1 1 Tonic Tablets (Iron) 1 1 Welsh Rarebit 1 1 Witch Hazel 1 1 1 1 Totals 52 131 183 5 11 16 14 The following details classify the type of irregularity or infringement and the action taken in relation to the unsatisfactory samples. Sample No, Article Infringement Action Taken 1518 Sherbet Fountain (Informal) Labelling Infringement Name and address of the packer, and the deslgnation of each ingredient not clearly legible on the wrapper. Manufacturer Warned Wrapper paper too absorbent causing printers ink to run. New labels printed and found to be satisfactory. A716 Sausages (Pork.) (Formal) Sample deficient in meat to the extent of 41 per cent. PROSECUTION Under the Food and Drugs Act, 1938. Defendant fined £5 with £3.3s. 0d. costs, A721 Sausages (Beef) (Formal) Deficient in meat to the extent of 14 per cent. Manufacturer Warned A736 Sausages (Pork) (Preserved) (Formal) Contained 60 per cent of meat instead of the minimum of 65 per cent. Manufacturer Warned A746 Sausages (Pork) (Formal) Contained 56 per cent of meat instead of a minimum of 65 per cent. PROSECUTION Food and Drugs Act 1938, Defendant fined £5 with £2. 2s. 0d. costs. 1524 Glauber's Salts (informal) General deterioration of article through efflorescence. Sample about half as strongweight for weight as Glaubers Salts B. P. Manufacturer Warned Loss of weighs due to the inadequate protection afforded by the cardboard container Follow up formal sample (No A735) was taken and found to be satisfactory. 1586 Jelly Crystals (Informal) Oonta5ned 79.5 per cent of sugar, instead of a minimum of 84 per cent. Manufacturer Warned All stocks in this area withdrawn from sale. 1592 Jam Raspberry (Informal) Contained 68' 2 per cent of soluble solids instead of a minimum of 68.5 per cent. Retailer Warned 1591 Suet (Informal) Contained 81.9 per cent of fat instead of a minimum of 83 per cent. Manufacturer Warned 1559 Isinglass (Informal) Labelling Infringement Sample contained gelatine derived probable from both animal and fish sources. In view of the many issues involved the matter was referred to the Ministry of Food, Food Standards and Labelling Division, to re-open and take up with he Manufacturers the question of declaration of ingredients on the label. 15 Sample No. Article Infringement Action Taken 1569 Ice Cream (Cold Mix) (Informal) Contained 2.7 per cent of fat instead of not less than 5 per cent. Manufacturer Warned The Manufacturer/Retailer admitted making a "mix" with insufficient fat content. The fat content A751 Ice Cream (Cold Mix) (Formal) Contained 3.1 per cent of fat instead of not less than 4 per cent. of ice cream was officially reduced to 4 percent prior to the taking of formal sample (A751). A further sample proved to be satisfactory and contained over the requisite amount of fat. 1596 Witch Hazel (Informal) Labelling Infringement Sample described on label as Distilled Extract of Witch Hazel with Aqua Hamamelidis B. P.C. Manufacturer Warned Explanation given that obsolete type of label had been used on bottle. Newly printed label submitted Tor examination found to be in order. 1617 Tapioca Dessert (Informal) Labelling Infringement Contained 40 per cent sugar and starch respectively Condition of article very poor, the sugar and starch having congealed together into a hard mass. Proportion of Tapioca (20%) was far less than that of potato. Misdescription of article Manufacturer Warned Total stocks withdrawn from sale in this area. 1620 Meringue Powder (Informal) Labelling Infringement Ingredients incorrectly stated on the label in accordance with the Labelling of Food Order 1952. Sample almost devoid of the aroma and flavour of coffee Manufacturer Warned Specimen labels containing revised wording as to the respective flavouring basis submitted for examination and found to be in order. 1631 Macaroni (Informal) Labelling Infringement Sample consisted of Arrowroot and not Macaroni. Retailer Warned The retailer admitted that in order to make the commodity more attractive the arrowroot had been placed in cellophane bags marked "Aberdeen Macaroni". Sampling Observations. Of the 183 samples taken during the year 4.91 per cent were found to be other than genuine. This percentage figure excludes informal samples repeated formally. in 1951 the percentage figure was 2.5 per cent. Labelling infringements in some form or another were found in 3.27 per cent of the total samples taken. In 1951 the percentage figure was 2.5 per cent. 16 Two successful prosecutions were instituted during the year in connection with meat deficiencies in pork sausages, and warning letters were issued to ten manufacturers and two retailers in connection with other types of infringements. Having regard to the wide variety of articles sampled it will be seen that the observations and infringements reported upon by the Public Analyst have in the main been of a minor character. Public Analyst's Comments. The pattern of sampling and the type of adulteration has followed much the same course as in previous years. Sausages deficient in meat, ice cream deficient in fat and shredded suet deficient in fat are not unusual occurrences and these common articles of food are rightly given prominence in sampling. It is however with the pre-packed article of a semi-luxury nature that false or misleading labels and incorrect descriptions are likely to arise and the wide range of foodstuffs and drugs covered in the year's sampling has revealed one or two such cases. Perhaps the most interesting mis-description from the Analyst's point of view was that of the sale of gelatine under the name isinglass, the excuse for which was backed by a patent of the mid nineteenth century and two law cases of the 1890's. My research at the Patent Office served to expose the weakness of this claim. Labels and descriptions of two other samples in particular illustrate the dislike of some manufacturers of pre-packed articles to call a spade a spade. Tapioca Dessert (Sample No. 1617) contained only 20 per cent of tapioca as compared with 40 per cent of potato starch. As a general principle in these and other similar cases it seems to me that the name of the article of food should bear some relation to a major and not a minor constituent. Again, in this and in another article of food (Meringue Powder, Sample No. 1620) potato starch was euphemistically described as processed farina, Such terms are contrary to the letter and the spirit of the Labelling of Pood Order, 1950, and should be discouraged by all possible means. FOOD AND DRUGS ACT, 1938 Precautions to be taken in rooms where food intended for sale is prepared or stored Section 13 of the above Act requires that there shall be provided within reasonable distance of the room suitable washing basins and a sufficient supply of soap, clean towels, and both hot and cold water for the use of the persons employed in the room. One hundred and thirty-seven visits of inspection were made under this section to restaurants, cafes and hotel kitchens and 17 to dining rooms, snack bars and coffee stalls. During 1952 twenty-one water heaters were installed in food premises. One hundred and seventy-five such heaters have been provided during the past four years. CLEAN FOOD BYELAWS - Section 15 Byelaws 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. The infringements discovered during the year were mainly of a minor character, except in the case of one baker using an unsatisfactory bread delivery van. CLEAN FOOD - Dogs in Food Premises During August, notices and explanatory letters were distributed to food establishments in the Borough regarding the admittance and control of dogs in food premises. There was a willing and ready response on the part of most retailers to exhibit the Notices. 18 MILK SUPPLY Food and Drugs (Milk Dairies and Artificial Cream) Act 1950 Milk and Dairies Regulations 1949 The Milk (Special Designation) (Raw Milk) Re gulations 1949 The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949 Routine inspection of milk pasteuriser's and distributor's premises reveals that the provisions of the various Regulations are generally well observed. The following licences to sell graded milks in the Borough were granted in 1952:- Grade of Milk TYPE OF LICENCE Dealers Supplementary Pasteuriser's Tuberculin Tested 9 10 - Tuberculin Tested (Past) 9 - Pasteurised 19 11 2 Sterilised 35 12 - 72 33 2 Examination of Milk Samples. One hundred and eighteen samples of milk were submitted for examination as follows:- Class of milk No. of samples examined Test applied Number of Samples Passed Failed Pasteurised 64 Phosphatase 64 - Methylene Blue 64 - Sterilised 7 Turbidity 7 - Tuberculin Tested (Pasteurised) 15 Phosphatase 15 - Methylene Blue 14 1 Tuberculin Tested (Farm Bottled) 32 Methylene Blue 25 7 118 All Pasteurised and Sterilised Milks passed the prescribed Tests. One Tuberculin Tested (Pasteurised) sample and seven Tuberculin Tested (Farm Bottled) samples failed to pass the Methylene Blue Test. Once again it would appear that the main contributing factors to the failures were the high atmospheric temperature when the samples were taken and the period between the time of production and delivery of the farm bottled milk. 19 BIOLOGICAL MILK SAMPLES (Farm Bottled Milk) Eleven samples of Tuberculin Tested Milks were taken for biological examination. In all cases the guinea pigs inoculated with the milks failed to show any signs of a tuberculous infection on post mortem. ICE CREAM Registrations. At the end of 1952, a total of 182 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. The quantity of ice cream manufactured in the Borough still continues to decline. During the year thirteen new applications for the registration of premises for the sale of ice cream were received and granted. (A) Bacteriological Sampling of Ice Cream One hundred and two samples of ice cream were taken for provisional grading and bacteriological examination. The following table shows the provisional grading percentages for the year 1952 and for comparative purposes the results obtained from samples in 1951. 1952 Grading of samples 1951 Grading of samples Grade 1 63 Samples 61.76 Grade 1 94 Samples 74.60 " 2 30 " 29.41 " 2 25 " 19.84 " 3 6 " 5.88 " 3 5 " 3.96 " 4 3 " 2.94 " 4 2 " 1.58 102 " 126 " 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 results achieved 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 1, 80% into Grades 1 or 2, not more than 20% into Grade 3 and none into Grade 4. 20 (B) - The following table shows the percentage grading results for each Manufacturer:- Code No. of samples taken Number of samples sold Average Percentage results in each Grade Faecal Coli present Conforms present Wrapped Loose 1 2 3 4 A 4 - 4 75.00 25.00 - - 1 B 2 - 2 - 100. 00 - - - 1 C 1 - 1 100.00 - - - - - D 18 13 5 55.55 38.88 - 5.55 - 6 E 21 20 1 90.47 9.52 - - - 2 F 22 21 1 45.45 36.36 18.18 - - 2 0 1 - 1 100.00 - - - - - H 2 2 - 50.00 50.00 - - - - I 1 1 - 100.00 - - - - 1 J 6 4 2 50.00 50.00 - - - - K 3 - 3 33.33 33.33 - 33 33 - 3 L 4 3 1 75.00 25.00 - - - 1 M 1 1 - 100.00 - - - - - N 7 7 - 57.14 28.57 14.28 - - 1 O 2 2 - 100.00 - - - - 1 P 3 3 - 33.33 66.66 - - - - ft 2 2 - 50.00 - - 50.00 - 1 R 1 - 1 - 100.00 - - - - S 1 1 - 100.00 - - - - - Totals 102 80 22 61.76 29.41 5.88 2.94 - 20 It is gratifying to note that the above results show a complete absence of faecal coll and that conforms were present in only 20 samples. In 1951, 2 samples contained faecal coli and 41 contained conforms. (C) - Chemical Sampling of Ice Cream Fat and Total Solids. The Food Standards (Ice Cream) Order 1951 was amended in July 1952. The minimum fat content is now 4 per cent Instead of 5 per cent and milk solids other than fat 5 per cent instead of per cent, A total of eight samples were taken under the above Orders,, In one case only did the Public Analyst report a deficiency of fat. The Manufacturer was informed and a repeat sample taken showed a fat content well above the prescribed standard. 2 1 (D) - The following table shows the average fat content and the milk solids, other than fat, percentages in the samples taken. Producers code Number of samples taken Average Chemical Standard Fat percentage Milk solids other than fat A 2 9.2% 10.6% B 2 9.3% 8.8% C 1 10.6% 8.6% D 1 13.8% 7. 5% E 2 4.8% 8.3% 8 9.5% 8.7% (E) . Ice Lollies (Chemical and Bacteriological Examinations ) 1. Chemical. The Food Standards (Ice Cream) Orders do not apply to water Ices sold as such, or to Ice lollies. The production of Ice lollies In the Borough Is Increasing whereas the manufacture of Ice cream Is diminishing. In order to ascertain the possible effect of the use of bakellte moulds In the manufacture of lollies, a sample was submitted to the Public Analyst for examination, but no evidence was found of harmful Impurities arising from the use of these moulds. 2. Bacteriological. Ice Lollies are In popular demand with school children. In view of this, and In the absence of a prescribed standard, It was considered advisable that samples of lollies should be submitted to a bacteriological test similar to the one applied to ice cream. It Is gratifying to record that all of the twenty-six samples taken for this purpose were placed in provisional Grade I, and further that none contained faecal coll, and In four cases only were conforms found to be present. MEAT AND OTHER FOODS Food Shops. The fifty-four butchers shops (Including two horseflesh shops) within the Borough have been Inspected and observation kept upon the vehicles used for the conveyance of meat. In general the provisions of the Public Health (Meat) Regulations have been well observed. 22 Remedial action was taken In eleven cases where the sanitary conditions were not satisfactory, or certain contraventions of the Regulations existed. At the end of 1952, forty-eight butchers shops had been registered in accordance with Section 14 of the Food and Drugs Act 1938 and applied mainly for the manufacture of sausages only. Another seven premises were similarly registered for the preparation of potted, pressed, pickled or preserved food intended for sale. Eighty cases of Insanitary or defective conditions found to exist In food shops other than butchers shops were remedied. PROSECUTION Contaminated Beef Sausages. A successful prosecution was instituted against a firm of butchers for selling beef sausages contaminated with mouse droppings. Proceedings were taken under the Ftiod and Drugs Act 1938 and a fine of £20 was Imposed with £7.7s. Od. costs. 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 Baby/Invalid Foods _ 17 _ _ Beef/Mutton 2, 164¼ - - - Biscuits/Wafers 27 n - 4 Bread/Flour - - - 19 Cereals/Puddings/Mixtures - 44 3 86 Cheese - 9 - 230 Chickens - - - 2 Coffee/Coffee Extract - 1 3 - Confectionery 56¾ 6 - 21 Cornish Pasties - - - 8 Fish/Paste/Creams 158 160 3 - Fruit Julces/Puree - 82 3 - Fruit/Vegetables 60 1383 76 101 Ham 24 51 - - Ice Cream Powder. - 7 - - J am/Marmalade/Syrup - 154 93 - Meat Pastes - 9 1 - Meat (Tinned) - 616 - - Milk (Tinned) - 52 - - Mincemeat - 2 - — Nuts/Sliced Coconut - 5 - - Oats/Rlce/Barley/Corn - 3 - 87 Offal/Minced Meat 145 - - Pork/Pork Butts 129| 10 - - Rabbits - 1 - - Salad Creams/Spread - 9 - - Sausages (Beef/Pork) 92½ 29 - - Carried forward 2857¼ 2650 182 558 23 Type of Food lbs Tins Bottles or Jars Number of Packets Brought forward 2,857¼ 2650 182 558 Soups/Pickles/Sauces - 26 18 - Splces/Junket/Bovrll - 8 3 3 Synthetic Cream Powder - 8 - - Tapioca/Spaghetti 87 1 - - Tea 7¼ - - 7 Totals 2,951± 2693 203 568 Slaughtering, No animals were slaughtered during the year in the one licenced Slaughterhouse In the district Slaughter of Animals Act, 1933 TWO licences to act as slaughterman were granted In 1952 Bakehouses, There are twenty-three bakehouses In the Borough and of these twenty two are provided with mechanical power In the majority of cases the standard of cleanliness and sanitary condition Is generally good Forty-two visits of Inspection were made In 1952 and the fifteen Infringements discovered were rectified Shops Act, 1950 (Section 38) Five hundred and eighty-three visits were made to various premises under the Shops Act and resulted In the discovery of eighteen Infringements The arrangements made for the health and comfort of the shop workers are generally satisfactory Schools The sanitary condition and the water supply to schools In the area are generally satisfactory Hairdressers and Barbers Premises Seventy-eight Inspections were made to the sixty-nine establishments In the Borough under the Hairdressers and Barbers Byelaws 1947 which resulted In the discovery of five Infringements only Merchandise Marks Acts One hundred and forty visits were made to food premises under the above Acts The eight Infringements observed were mainly in connection with the marking of Imported apples and tomatoes Rag Flock and Other Filling Materials Acts 1951 An Act to secure the use of clean filling materials In upholstered articles and other articles which are stuffed or lined and for purposes connected therewith came into force on 1st November, 1951 The Act provides that certain premises have to be registered by the Local Authority on payment of a registration fee and certain other premises have to be licenced by the Local Authority to store rag flock on payment of the statutory fee During 1952 twelve applications for registration and four for licences were received and granted 24 Pet Animals Act, 1951. This Act which came Into operation on 1st April,, 1952 provides that no person shall keep a pet shop except under the authority of a licence granted by the Local Authority in accordance with the provisions of the Act and on payment of a fee not exceeding ten shillings. Nine licence applications were received and granted during 1952. LICENCED PLACES OF PUBLIC ENTERTAINMENT Fourteen visits were made to licenced places of public entertainment. These are mainly used for cinematograph shows, concerts, dancing and social functions. Action was taken in five cases to rectify certain minor defects, but in general the standard of cleanliness was good. LICENCED PUBLIC HOUSES In 1951, an exhaustive Investigation was carried out into the general sanitary and hygienic conditions of the thirty-six Public Houses in the Borough and a special report was presented to the Public Health Committee. It is recorded with satisfaction that during 1952 many Improvements have been carried out at several premises, particularly is this so in the provision of constant hot water supplies by various means; the use of detergents and sterilising agents for the washing of utensils; the Installation of additional w. C.'s, urinals, baths, washbasins and other matters of considerable sanitary and hygienic importance. It is hoped that with the continued co-operation of the brewery companies and the licensees together with a relaxation of, building licence restrictions to show further progress in the coming year. DISINFECTION AND DISINFESTATION Council Private Number of houses treated with insecticide for bugs and fleas 5 8 . Twelve school canteens were sprayed for flies, ants 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) Six thousand six hundred and eighty-eight visits were made during the year by the Rodent Operators and six hundred and 25 forty-two by the Sanitary Inspectors to premises Infested by or possibly harbouring rats or mice. Four hundred and thirty-seven premises were cleared of rats or mice, and no major Infestations were recorded. (2) The work, for the year Is generally summarised as under: - Complaints received or cases discovered and Investigated 468 Number of premises found to be Infested 410 Number of premises where no evidence of rodents found 58 Number of premises cleared of rats or mice (Including 101 previous year's cases) 437 Number of premises still being treated at the year end 76 (3) The cause or site of Infestation at the four hundred and ten Infested premises was:- Keeplng of poultry 77 Inside premises (under floors etc) - rats 27 " " " mice 45 Buries, scrapes etc. In gardens, land etc. 117 Under or Inside sheds 147 Defective drains 2 Accumulations of refuse etc. 1 Total 416 (4) Type of property found to be lnfested:- Wlth with Total Rats Mice Council property 4 2 6 Dwell lnghouses 337 16 353 Business premises etc. 26 25 51 Total 367 43 410 (5) Summary of the type of premises and methods employed In clearing premises of rats and mlce;- Type of Premises cleared Dwelling houses (mainly In gardens) 377 Food shops and food premises 22 Non- food shops 7 Waste land and building sites 4 Hospitals and Schools 5 Factories and workplaces 11 Council Premises 6 Piggery 1 Miscellaneous 4 26 Total 437 Methods employed In clearing 437 premises of rats and mice, Poison baits 414 Trapping 19 Gassing 57 Rat and Mouse proofing 8 Accumulations removed 1 Other means 2 501 B - SEWER TREATMENTS (1) Second Maintenance Treatment (1951-1952). The second maintenance treatment of soil sewer-manholes found to be Infested during the 10% test baiting (1951-52) and all manholes In the sections affected was completed on the 15th March, 1952. Prebaitlng with damped sausage rusks was carried out on two consecutive days and the same bait base with 2£% Zinc Phosphide added was laid on the third day with the following results:- SECTIONS A C D E Total Number of Manholes prebalted 42 78 89 91 300 Complete prebalt takes 3 32 14 3 52 Partial prebalt takes 1 3 3 15 22 Percentage of takes (C and P.T.) 9.5 44.8 19.1 19.7 24.6 Number of manholes poison baited 10 46 27 40 123 The number of pre-bait takes shew a decrease of 16.7% on the previous maintenance treatment. (2) Test Baiting (1952-53). The Borough was divided Into five sections, as in previous tests, and a test baiting of 10% of the soll-sewer manholes was carried out during the month of August, The percentage of takes was a little higher than in the 10% test of last year. The following Is a tabulated summary of the results achieved: - SECTION A B C D E Total Number of manholes baited 25 31 48 65 32 201 Complete bait takes 16 2 5 21 5 49 Partial bait takes 2 1 4 5 - 12 Baits not taken 7 28 39 39 27 140 (3) First Maintenance Treatment (1952-53). This treatment was confined to the areas known to have been Infested during the previous maintenance treatment together with the whole of the areas proved to be Infested by the annual 10% Test. It entailed baiting a much larger number of soil sewer manholes than In previous treatments and resulted in a higher number of takes. 27 However, the whole of the infested sections were so thoroughly treated that it is hoped the next maintenance treatment will show an improvement. The following is a tabulated summary of the results achieved. SECTIONS A B C D E Total Number of manholes prebaited 98 31 118 250 103 600 Complete prebalt takes 5 8 12 37 15 77 Partial prebalt takes 20 5 19 55 21 120 Percentage of takes (C. and p.T) 25.5 41.9 26.2 36.8 34.9 32.8 Number of manholes poison baited 41 23 43 114 46 267 KEY TO SECTIONS Section "A" - Sutton - all roads south of the Sutton Station and east of Brighton Road Section "B" - Sutton and Cheam - All roads south of Mulgrave Road and Upper Mulgrave Road and west of Brighton Road. Section "C" - Sutton - all roads east of the Railway and north from Sutton Station. Section "D" - Cheam - all roads between London Road/stonecot Hill and west of the Railway. Section "E" - Worcester Park. 28 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Eight hundred and seventeen cases of Infectious diseases were notified during the year 1952, a decrease of one thousand two hundred and seventy one cases. There was a lower Incidence of Measles, Whooping Cough and of Dysentery. Scarlet Fever. One hundred and twenty four cases were notified, an Increase of fourteen cases. The case rate was 1-56 per thousand of population compared with 1-53 per thousand of population for England and Wales. The disease was generally mild. There was no death. Diphtheria, No case was notified In 1952 compared with one case In 1951. Diphtheria Is still a serious danger to the unlmmunlsed child. Diphtheria Antitoxin The possibility of Diphtheria must always be considered In the differential diagnosis of infections of the throat. Early diagnosis and early treatment with antitoxin are essential for the prevention of mortality. Swabs for diagnosis should be taken before antibiotics are administered. Antibiotics may kill the diphtheria bacillus and so obscure diagnosis, but they will not neutralise toxin. Antitoxin should be given on suspicion of the disease. Otherwise the patient should be admitted to hospital for observation and treatment. Diphtheria Immunisation, In 1944 there were In England and Wales twenty three thousand, one hundred and ninety nine cases of Diphtheria and nine hundred and thirty four deaths. In 1952 there were three hundred .and seventy five cases and thirty two deaths. It can be assumed that Immunisation Is saving approximately nine hundred lives, mostly of children, each year. Therefore the campaign must be pressed forward and reorganised so as to reduce and eliminate the persisting residual mortality. Babies can be Immunised safely at the age of 9 months and Immunisation can and should be completed before the first birthday. At present the preponderance of Immunisation of babies Is carried out between the ages of one and two years. This delay leaves a large number of babies unnecessarily at risk for several months, a first objective Is to secure the Immunisation of 75 per cent of all babies before the first birthday. A survey at the end of 1952 of the state of Immunisation of nine hundred and fifty babies born In 1951 showed that five hundred and eighty one, representing 61 per cent, had been Immunised, but of these only 31 per cent had been Immunised before the first birthday. It Is Important that mothers should arrange for the Immunisation of their babies at nine months of age. All Infants should be reinforced before entry to nursery school or day school. All school children should be reinforced between the ages of eight and nine years. 29 In the absence of cases of Diphtheria there Is a tendency to defer, to be well lntentloned but Inactive, or to refuse to believe In the need for Immunisation. Several outbreaks In other places In recent years affecting children who have not been Immunised are sharp reminders that Diphtheria still kills. Immunisation Is voluntary but parents have an obligation to protect their children, and to co-operate In the elimination of the disease. During 1952, eight hundred and thirty children were Immunised and their ages at the date of Immunisation were as follows: - Age Under 1 1 2 3 4 5-9 10-14 Over 15 Total Numbers 292 341 55 14 11 100 15 2 830 At the end of the year eleven thousand, eight hundred and five children representing 75*4 per cent of all children had been Immunised. Of these two thousand eight hundred and ninety eight represents 50 per cent of the children under five years of age and eight thousand nine hundred and seven represents 89*9 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, the first and third Friday In each month, at 2 p.m. 2. At the Clinic, Methodist Church Hall, Station Road, Belmont at Infant welfare session, every Thursday, at 2 p.m. 3. At the Clinic, Emmanuel Church Hall, stonecot Hill, Sutton, at Infant Welfare Session, 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, at Infant welfare Session, every Monday and Thursday, at 1.30 p.m. 6. At the Clinic, St. Oswald1 s Hall, Brocks Drive, North Cheam at Infant Welfare Session, every Friday, at 1.30 p.m. 7. At the Clinic, Jubilee Institute, Maiden Green, Worcester Park, at Infant welfare Session, the first Monday In each month, at 1, 30 p.m. Measles. Five hundred and fourteen cases were notified in 1952 compared with one thousand four hundred and thirty three In 1951. a period of quiescence for seven months followed the severe epidemic of the spring of 1951. a secondary and smaller epidemic wave rose sharply during February and March 1952, declined slowly and persisted until July. The case rate was 6-48 per thousand of population compared with 8*86 per thousand of population for England and Wales. There was one death of a child aged 4 years from toxaemia and acute dilatation of the stomach, a rare complication of acute infections. 30 The monthly Incidence of notified cases Is shown in the following table:- January 2 July 61 February 47 August 17 March 136 September - April 75 October 8 May 89 November 8 June 58 December 13 The toxic effects of Measles can be serious In the occasional case where the tissues fall to react to the Infection. Measles Is caused by a virus and there Is no specific drug. The sulphonamldes and antibiotics have proved of great value In the prevention and treatment of secondary Infections which cause pneumonia and middle ear disease. Prevention or attenuation of the Illness can be achieved by the Injection of gamma globulin early In the Incubation period, but the supply of this serum Is very limited and has to be restricted to contacts who are especially at risk.. Prevention of Infection Is still mainly dependent on early diagnosis and early Isolation. The early catarrhal phase of the Illness lasts for four days before the rash appears and Is a highly Infectious period. There Is catarrh of the eyes, nose or throat The child Is disinclined for food or play. A slight rise of temperature will confirm suspicion of Infection. Immediate action at this stage with restriction from going to school or cinema or from playing In the street can save many other children from infection. The careful nursing and careful convalescence of all cases of Measles are essential. Whooping Cough. Sixty seven cases were notified. This Is a decrease of two hundred and eighty four cases. Prevalence was low throughout the year. The case rate was 0*84 per thousand of population compared with 2-61 per thousand of population for England and wales. There was no death. The monthly Incidence of notified cases is shown In the following tables- January 4 July 12 February 2 August 5 March 6 September 5 April 2 October 7 May 10 November 10 June 3 December 1 Whooping Cough must be regarded as a dangerous disease of Infancy. While the risk of mortality diminishes with age there Is always the danger of damage to the tissues of the lung and Impairment of functional power. The problem of reducing mortality lies mainly In preventing Infection during the first year of life. Vaccines are not applicable In the early months of high mortality, but their use for the Immunisation of Infants and younger shcool children who usually bring Infection Into the home would help to protect the susceptible baby. The drug Chloromycetin 31 will often diminish the Illness If given In the early phase of cough before the 1 whoop' develops, and will reduce the lnfectlvlty of a patient and help to protect Immediate contacts. Early diagnosis can be assisted by the use of cough plates or pharyngeal swabs for Identification of the Infection. Careful nursing and careful convalescence of cases of Whooping Cough are always necessary. Immunisation against Whooping Cough, Improved Vaccines are now available for the prevention of Whooping Cough. In August 1952 the Surrey County council Introduced a scheme for the Immunisation of children under 5 years. In 1952, three hundred and seventy four children received Immunising Injections. The material used is H. Pertussis suspended Vaccine (20,000 million bacilli per c.c.). Three injections of 1 c.c. are given at monthly Intervals. The Injections are given subcutaneously to minimise the risk of muscle Irritation which can predispose a muscle to paralysis In children who are Incubating Poliomyelitis. Small Pox. No case was notified. Vaccination. Vaccination gives effective protection against an all Pox. The speed of travel and the growing number of travellers have Increased the danger of the introduction of Snail Pox. Vigilance and preparation are necessary. Infant vaccination provides a basic Immunity which reduces the risk of mortality and facilitates revacclnatlon In later years. In 1952 the percentage of babies vaccinated under one year was 53*2 compared with 55*8 per cent in 1951. All babies should be vaccinated between three and six months, the safest age for vaccination. The service Is free of charge, and easily available through medical practitioners and clinics. The following table shows the number of vaccinations during 1952. Age No. Vaccinated No. Re-Vacclnated Under 1 466 - 1 31 - 2 11 - 3 11 - 4 7 2 5-10 20 11 10-15 16 14 Over 15 56 180 Total 618 207 Puerperal Pyrexia. Sixteen cases were notified in 1952 compared with six In 1951. The Increase Is a response to the revised definition of Puerperal Pyrexia In the Puerperal Pyrexia Regulations 1951 which made notifiable any febrile condition occurring In a woman In whom a temperature of 100,4* Fahrenheit (38' Centigrade) or more has occurred within fourteen days after childbirth. The case rate was 17.82 per thousand total births compared with 17.87 per thousand total births for England and Wales. 32 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 effective isolation of any suspected case occurring In a nursing home. Typhoid and Paratyphoid Fever, One case Of Typhoid Fever was notified. The patient, a woman aged 21 years, who had arrived on holiday suffering from early symptoms was Immediately removed to hospital. Her recovery was complete. There was no secondary case. Dysentery. Forty three cases were notified compared with one hundred and six cases In 1951. Twenty seven cases occurred within an Institution for children. All were of the Sonne type, which Is endemic, and produces outbreaks of Infectious gastro enteritis. The Intensity of the Illness varies from mild abdominal discomfort to severe diarrhoea. Mild ambulant cases are frequently the carriers of Infection. Food handlers who suffer In any degree from symptoms of gastro enteritis have a duty to attend their doctor and to ensure by bacteriological examination that they are free from Intestinal Infection. Food Poisoning. Twenty cases were notified and ten were ascertained as a result of Investigations. There were three outbreaks of three, five and thirteen cases and nine single cases. The sources of Infection of ten cases were outside the Borough. No. of No. of No. of Organisms or Pood Involved Outbreaks Cases Deaths other agents 1 5 - s. Enterltldls Not ascertained 1 3 - S. Typhi Murium Tinned salmon sandwiches 1 13 - Staphylococcus Aureus Cheese souffle The largest outbreak of thirteen cases occurred In a residential home and was due to bacterial overgrowth of a cheese souffle 'kept warm' for eight hours. The keeplng'warm for a prolonged period of any food which may be a good medium for the growth of bacteria Is dangerous. Of the nine single cases seven were due to S. Typhi Murium, one to S. Orlenberg and In one case the organism was not Identified. In six the exact food Involved could not be ascertained, but In three, steak pie, pineapple Juice, and fruit melba, were related to Infection. The occurrence of these cases of food poisoning emphasises the need for meticulous care by all who handle and prepare food. Those who sell cooked meats and other foods which will not be subjected to heat treatment In the home must learn to avoid touching these foods unnecessarily with their hands. TheByelaws require the protection of food from any form of contamination. The washing of hands particularly after the use of the w.C. is the most Important protective measure against dangerous Intestinal Infections. 33 Cerebro Spinal Fever. NO case was notified. Poliomyelitis. Six cases were notified, the same number as in 1951. All were paralytic. Two recovered. One case, a girl aged four years, has severe residual paralysis of arms and legs. Two boys aged eight and four years have weakness of the right hand. One female adult has weakness of the right leg. The case rate was 0.08 per thousand of population compared with 0.09 per thousand of population for England and Wales. Poliomyelitis has become established as a serious annual epidemic disease. The Incidence rises during the early summer and maintains a high level during late summer and autumn. Sporadic cases occur during the winter and spring. Typically, Poliomyelitis has three phases. The first is a mild febrile Illness often with headache and sore throat. The second is a period of remission of symptoms which may last for a few hours or a few days. The third is the acute meningeal phase with high temperature, headache, pain In the neck and muscular aches. The period of remission of symptoms Is the most deceptive feature of the disease. It Is necessary for people to take heed of minor febrile illness during the seasonal prevalence of Poliomyelitis and to rest and to restrict social contacts until fully recovered. It is probable that infection is spread by mild ambulant cases in the first phase of illness. In those cases who suffer paralysis there is always hope of a gradual and considerable recovery. Modern methods of treatment are enabling many who were severely paralysed to lead useful lives, and their happiness has been greatly enhanced by the excellent social work of the Infantile Paralysis Fellowship. Pneumonia. Of thirty deaths from Pneumonia four were notified previous to death. The total number of notified cases was forty one compared with sixty eight in 1951. The number of deaths from respiratory diseases showed a sharp rise following the dense fog of the first week-end of December 1952. Infestations. Two cases of Scabies and sixteen cases of Infestation by lice were treated. The number of attendances at the clinic for treatment was seventy two. This compares with six cases of Scabies and twenty five cases with lice, and ninety attendances for treatment in 1951. Non-Notifiable Diseases. School teachers reported four hundred cases of Chicken Pox, three hundred and sixty four cases of Mumps and two hundred and three cases of German Measles. School notifications are a useful Indication of the prevalence of non-notifiable diseases and form a basis for consultation with the school medical officer. 34 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1952 . 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 _ 1 2 14 13 77 12 3 1 _ 1 _ 124 47 _ Diphtheria - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - 1 - - - 1 1 - Paratyphoid Fever - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - - 14 2 - - 16 - - Pneumonia - 1 1 2 - - 1 1 2 8 14 11 41 4 30 Erysipelas - - - - - - - - - 1 3 1 5 - - Dysentery - - 2 - 1 4 - 3 4 1 - 1 16 - - Poliomyelitis - - - - 2 1 - - 2 1 - - 6 5 - Cerebro spinal Fever - - - - - - - - - - - - - - - Measles 7 46 37 49 66 232 10 3 3 3 ~ - 456 11 1 Whooping Cough 4 3 12 4 11 33 " " " " 67 2 London Cases in the Downs Residential Nursery Dysentery 4 9 6 3 2 _ _ 2 1 _ _ - 27 23 - Measles 6 19 20 5 6 1 1 58 24 * Under column "Died", all deaths, whether notified In the district or outside It, or not notified at all, are included. 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:- 9981 9098 11454 12807 7288 7633 6478 5707 8854 79300 Scarlet Fever 9 7 26 26 14 23 7 9 3 V 124 1.56 1.53 Diphtheria - - - - - - - - - 0.00 0.01 Typhoid Fever - - 1 - - - - - - 1 0.01 0.00 Paratyphoid Fever - - - - - - - - - 0.00 0. 02 Smallpox - - - - - - - - - 0.00 0.00 Puerperal Pyrexia - ~ 1 - - •-* - 14 1 16 - — Pneumonia 1 3 4 4 3 17 2 - 7 41 0.52 0.72 Erysipelas 2 - - - 1 - - 2 - 5 0.06 0.14 Dysentery 1 1 3 6 - 3 - - 2 16 0.20 — Poliomyelitis 1 - - 4 - - - - 1 6 0.08 0.09 Cerebro Spinal Fever - - - - - - - - - - 0.00 0.03 Measles 64 27 63 78 74 57 20 20 53 456 5.75 8.86 Whooping Cough 13 4 18 7 10 8 3 1 3 67 0.84 2.61 Totals 91 42 116 125 102 108 32 46 70 732 36 TUBERCULOSIS On 31st December 1952 there were on the register nine hundred and thirty cases of Tuberculosis, of whom seven hundred and seventy four were Pulmonary cases and one hundred and fifty six non-pulmonary cases. The death rate from Pulmonary Tuberculosis was 0.21 per thousand of population and 0.03 per thousand of population for non-pulmonary Tuberculosis. The total death rate was 0.24 per thousand of population, the same as In 1951. The corresponding death rates for England and Wales In 1952 were similar. The number of new cases of Pulmonary Tuberculosis was seventy, compared with seventy four In 1951. The number of new cases of non-pulmonary Tuberculosis was three, compared with ten In 1951. Considerable progress has been made In recent years In the treatment of Tuberculosis by new drugs and antibiotics and by surgery. Expectation of cure Is higher and suppression of infection more effective. Mass X-Ray Is helping to find early cases and to search out hidden foci of Infection. Prevention by B.C.G. vaccine has a wide field of application as yet untouched. Progressive Improvement In housing Is essential for the reduction of Infection. A reduction In non-pulmonary Tuberculosis Is being achieved by the Tuberculin testing of dairy herds and by the Introduction of "specified" areas where all milk Is required to be pasteurised or designated, as has been the practice In this Borough for many years. The Tuberculosis Care Committee has given substantial help during the year to many patients and to many families. Clothing, bedding, extra nourishment and many other needs for reablement have been liberally provided. The scheme for holidays for children has been supported. The work of the members of this voluntary committee Is greatly appreciated. The scheme for allowances to patients has operated beneficially. 37 The following table shows the new cases and deaths In age groups. AGE PERIODS NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - - - - - - - - 1 2 1 - - - - - - 5 2 2 1 - - 1 1 - 15 10 11 - - - - - - 25 7 7 - 1 1 3 - - 35 7 5 - - 2 1 - - 45 6 1 - 1 1 - - - 55 6 1 - - 5 - - . - 65 and above 1 1 - - 2 1 1 - TOTALS 41 29 1 2 11 6 2 0 Notification of Tuberculosis Respiratory forms of death - All seventeen cases were notified Other forms of death - Neither case was notified. MASS RADIOGRAPHY A mass radiography unit visited the Borough from 25th August to 12th September 1952. A total of three thousand nine hundred and sixty four persons attended for examination. The final results were as follows. Total No., of cases of No of cases of Non-Tuberculous X-Rayed active Pulmonary arrested Pulmonary abnormalities Tuberculosis Tuberculosis Males 1463 2 77 74 Females 2501 6 82 73 Total 3964 8 159 147 Incidence per 1,000 examined 2.0 40.1 37.0 The Incidence of 2.0 cases per thousand examined lies within the range of expectation for random samples of the population, and compares with an average for the County of 2.1. The finding of other abnormalities of the chest gives an opportunity for early advice and treatment. The visits of the unit are valuable In stimulating public Interest In the use of modern scientific advances for the preservation of health. It Is notable that the attendances of women outnumbered those of the men by nearly two to one. It Is hoped that the example and Influence of mothers and wives will encourage a larger attendance of adolescent and adult male members of the community. 38 CLINICS AVAILABLE FOR THE DISTRICT SUTTON AND BELMONT The Clinic, No. 1, Robin Hood Lane, Sutton Ante Natal Clinic. Every Wednesday, at 9,30 a.m. (By appointment) Infant Welfare Centre. Every Tuesday and Thursday, at 1.30 p.m. Diphtheria Immunisation Clinic. The first and third Friday In each month, at 2.0 p.m. Vaccination against Smallpox. By appointment. Methodist Church Hall, Station Road, Belmont Infant Welfare Centre, Every Thursday, at 2.0 p.m. (Including Diphtheria Immunisation. Vaccination against Smallpox, by appointment) SUTTON COMMON Emmanuel Church Hall, Stoneoot 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 2.0 p.m. (Including Diphtheria Immunisation from 1.30 to 2.0 p.m. Vaccination against anallpox, by appointment) 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. Vaccination against Smallpox, by appointment) St. Oswald's Hall, Brocks Drive, North Cheam Infant Welfare Centre. Every Friday, at 1.30 p.m. (Including Diphtheria Immunisation, 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) 39 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 5 p.m. (Old cases only) VENEREAL DISEASES CLINIC St. Helier Hospital, Wrythe Lane, Carshalton Males Every Monday, from 5 p.m. to 7 p.m. Females Every Wednesday, from 5 p.m. to 7 p.m. Every Friday, from 1.30 p.m. to 3.30 p.m. 40 ' s - . .