Library SUTC 17 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1953 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 53 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR (Alderman Kingsley Williams, J„P.) Alderman F, C. LOHDEN, 0, B. E. „ F, WARREN „ D. WEBSTER (Miss) J.P, Councillor H. A. BENNETT „ J, L, GUTHRIE „ D. M. JOHNSON „ F. K, MUDDLE Councillor D.M. PETTINGELL (Mrs) „ 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 Food. Certif. S. I. Exam. Board Deputy Chief Sanitary Inspector ARTHUR SYDNEY WILLIAMS Certlf. R. S. I. Certlf.Meat and Food Assistant Sanitary inspectors WALTER BLACK, D.P.A. Certlf. R. S. I. and S.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.I.E.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 Publ i c Analyst DANIEL D. MOIR, M. Sc., F. R, I, C. Analytical and Consulting Chemist (part-time) 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 1953, The health of the community was good. There was a rise In the birth rate from 10.8 to 11.8 per thousand of population. The death rate fell from 10.8 to 9.9 per thousand of population. The Infantile mortality rate was low There was no maternal death. There was a fall in the death rate for Tuberculosis, The general incidence of infectious diseases was higher. Measles and Whooping Cough were epidemic in March, An outbreak of Dysentery occurred in June, Fifteen cases of poliomyelitis were notified. There was no case of Diphtheria, A Mass Radiography Unit visited the Borough in August with beneficial results. Further progress was made in the Council's Housing Programme, During the year sixty three houses and flats were completed and two hundred and twenty three were in course of erection. Schemes were in progress for one hundred and forty five houses. The work of general sanitation, of the prevention of nuisances and of the protection of food was carried out efficiently, In March a Clean Food Exhibition was successfully organised and presented under the auspices of the Council. I wish to express to the Chief Sanitary Inspector (Mr. C.W. Newbery) and to the staff 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 chlorinatlon 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 Medical Officer of Health. 2 STATISTICS OF THE AREA 1952 1953 Area In acres 4338.15 4338.15 Registrar General's estimate of the Resident Population 79,300 79,040 Number of Inhabited houses (end of year) according to the Rate Book 22,760 22,887 Rateable Value and sum represented by a £917,050 £925,454 Penny Rate £3,740 £3,776 EXTRACTS FROM VITAL STATISTICS (Comparative of the Years 1952 and 1953) 1952 1953 England & Wales 1953 Total Male Female Total Male Female Live Births 876 454 422 938 481 457 Legitimate 844 435 409 908 465 443 Illegitimate 32 19 13 30 16 14 Birthrate per 1000 of the Estimated Resident Population 10.8 11. 8 15.5 Still Births 16 5 11 17 14 3 Legitimate 16 5 11 17 14 3 Illegitimate - - - - - - Rate per 1000 total (live and still births) 17. 8 17.8 22.4 Deaths 886 440 446 782 375 407 Death Rate per 1000 of the Estimated Resident Population 10.8 9.9 11.4 Deaths from Sepsis 1 0 Other Maternal Causes 1 0 Death Rate from Maternal Causes per 1000 total (live and still births) 2.24 11.7 0. 76 Deaths of Infants under one year of age All Infants per 1000 live births 18.3 11.7 26.8 Legitimate Infants per 1000 legitimate live births 17.8 12. 1 Illegitimate Infants per 1000 Illegitimate live births 31.2 0.00 3  1952 1953 Deaths from Cancer 172 149 " Measles 1 0 " Whooping Cough 0 0 " Diarrhœa 2 1 Percentage of Deaths from certain causes to the total number of deaths 1952 1953 Diseases of the heart and circulation 39.0 37.4 Cancer and malignant disease 19.4 19.2 Diseases of the lungs (non-tuberculous) 8.0 9.7 Tuberculous diseases 2.1 1.8 Vascular lesions of the nervous system 14.2 14.1 Congenital malformations 0.9 0.3 Suicide and violence 2.7 3.6 Diseases of the digestive system 1.7 2.2 Infectious diseases 0.9 2.0 Diseases of the kidney 0.9 1.9 Other defined diseases 10.2 7.8 Maternal Mortality. There was no maternal death. The maternal mortality rate for England and Wales was 0.76 per thousand total births. Infantile Mortality. The infantile mortality rate was 11.7 per thousand live births, compared with 18,. 3 per thousand live births in 1952. There were eleven deaths of Infants under one year, compared with sixteen in 1952. Of the eleven deaths, four occurred in the neo-natal period, within one month of birth, as is shown in the following table of causes and age groups. Causes of Death Under 1 month AGE GROUPS 3-12 months 1-3 months Congenital Abnormality 1 - 1 Prematurity 2 - - Cerebral Haemorrhage 1 - - Pneumonia - 2 3 Nephritis - 1 - Totals 4 3 4 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1953 M. F. Total 1 Tuberculosis, respiratory 10 1 11 2 Tuberculosis, other 3 - 3 3 Syphilitic disease 1 - 1 4 Diphtheria - - - 5 Whooping Cough - - - 6 Menlngococcal infections - - - 7 Acute Poliomyelitis 1 - 1 8 Measles - - - 9 Other Infective and parasitic diseases - 1 1 10 Malignant neoplasm, stomach 7 9 16 11 Malignant neoplasm, lung, bronchus 36 3 39 12 Malignant neoplasm, breast - 16 16 13 Malignant neoplasm, uterus - 5 5 14 Other malignant and lymphatic neoplasms 33 40 73 15 Leukaemia, aleukæmia - 1 1 16 Diabetes 4 2 6 17 Vascular lesions of nervous system 47 63 110 18 Coronary diseases, angina 66 44 110 19 Hypertension with heart disease 8 11 19 20 Other heart disease 36 87 123 21 Other circulatory disease 18 23 41 22 Influenza 6 7 13 23 Pneumonia 12 18 30 24 Bronchitis 27 16 43 25 Other diseases of respiratory system 1 2 3 26 Ulcer of stomach and duodenum 6 2 8 27 Gastritis, enteritis and diarrhoea 1 2 3 28 Nephritis and nephrosis 5 4 9 29 Hyperplasia of prostate 6 - 6 30 Pregnancy, childbirth, abortion - - - 31 Congenital malformations - 2 2 32 Other defined and ill-defined diseases 26 35 61 33 Motor vehicle accidents 2 3 5 34 All other accidents 5 7 12 35 Suicide 7 2 9 36 Homicide and operations of war 1 1 2 Totals 375 407 782 5 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA NEW LEGISLATION The Public Health (Infectious Diseases) Regulations, 1953 These Regulations revoke The Public Health (Infectious Diseases) Regulations 1927. They continue the requirement to notify Malaria, Dysentery, Acute Primary Pneumonia and Acute Influenzal Pneumonia; prescribe action to be taken In relation to Malaria, Typhus Fever and Relapsing Fever; and amplify precautionary measures against Food Poisoning. REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION The national Assistance Act„ 1948 - Section 47 A Court Order was obtained and applied in December 1953 for the removal to St. Anne's, Redhill, of a woman aged 74 years, senile infirm, living in insanitary circumstances and in need of care and attention. 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 One hundred and eleven bodies were received and one hundred and eleven 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 chloramlne as a protective measure. Samples of the raw and treated waters are examined daily by the laboratory at the Sutton Works. Samples are also examined at monthly intervals by the Company's Consultant Analyst, and monthly 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 195.00 Ammonia, free 0.18 Ammonia, Albuminoid 0 Nitrogen in Nitrates 8.18 Nitrogen in Nitrites 0 Oxygen Absorbed 0.09 Chlorine in Chlorides 18.08 Hardness total (grains per gallon) 8.08 Bacteriological Results No. of Bacteria growing on Agar per ml. for 5 days at 20° C 1 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. Approval to the first Stage of the reconstruction of Worcester Park. Sewage Works has been received from the Ministry of Housing and Local Government and it is anticipated that a contract for the work will be let and the work commenced in April, 1954. Alterations to the Sewage Ejector Station at Reigate Avenue to increase the capacity have been completed. The surface water relief sewer in Wellesley Road (East) was completed in the early part of 1953 and on the occasions of subsequent rainstorms no trouble was experienced in this vicinity. 7 Refuse Col1ect1 on 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 25 years, 160 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 30) RECORD OF INSPECTIONS MADE AND NOTICES SERVED Visits Special Inspections: Interviews and advisory visits 1,093 Reinspection visits 3,021 Visits to works in progress 681 " factories and workplaces 490 " Bakehouses 37 " Outworkers premises 142 " Butchers, grocers and other food premises 605 " Dairies and Milk Distributors 35 " Ice Cream Premises (manufacture and sale of) 178 " Stables, passages, piggeries and ditches 34 " Restaurant, cafe kitchens, dining rooms 93 " School and Industrial kitchens Z1 " Premises re. rodent control 9,101 " Tents, Vans and sheds 16 " Cinemas, Theatres and Halls 19 " Premises re, infectious diseases 162 " re. Food poisoning enquiries 14 " " re. Food complaints (Request Inspections) 250 " " re. overcrowding and permitted numbers 416 " Hairdressers and Barbers premises 70 " School and public conveniences 39 " Verminous premises 21 " Shops under the Shops Acts 443 " Licenced Public Houses 23 " Atmospheric pollution gauges, smoke observations 106 " Premises - Food and Drugs Act sampling 184 " " Bacteriological Milk/Water sampling 99 " " Bacteriological Ice Cream sampling 174 " " Merchandise Marks Acts 104 " " Rag Flock Acts 13 " " pet Animals Act 8 Miscellaneous Visits 2,370 Total 20,068 Number of complaints received and Investigated 574 Premises at which defects or nuisances were discovered 1,371 Dwelling-houses surveyed for housing defects under the Public " " "Health or Housing Acts 150 " " " Number of defects or nuisances discovered 1,931 " " " remedied 1,557 " " "In hand 179 " " " outstanding 195 Number of Informal notices served 831 9 STATUTORY NOTICES WERE SERVED AS UNDER: Housing Act 1936 Sections 9 and 10 (as amended by the Housing Act 1949) 35 Public Health Act 1936, Section 24 19 „ „ „ 42 1 „ „ „ 45 2 „ „ „75 2 Total 59 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT Drainage and Sanitary Fittings Number of houses and other premises redrained 7 Number of houses and other premises connected to soli and surface water sewers 2 Repairs and amendments to existing drains 70 Drains or gullies unstopped or cleansed (Involving 953 premises) 318 Sanitary fittings repaired/renewed/provided or cleansed 354 Water service pipes/eistems/repaired, renewed or cleansed 5 Water, smoke and chemical tests applied 228 W. C. Apartments: W. C. Apartments provided 17 " lighted and/or ventilated 13 " provided with ventilated lobbies 3 cleansed 29 Separate W. C, accommodation provided for the sexes 4 Structural Repairs or improvements Carried outs Number of roofs repaired or renewed 143 " guttering and rainwater pipes provided repaired, etc 61 " damp walls remedied 69 " brick walls repointed, repaired or re-rendered 32 " chimney stacks repaired or rebuilt 11 " yards paved or repaired 17 " sites of houses concreted 1 " floors relaid or repaired 52 " windows/cills/sashcords repaired or renewed 190 " doors/thresholds provided or repaired 29 " staircases/handrails provided or repaired 11 " ranges/stoves/coppers renewed or repaired 50 " Miscellaneous Items 7 Cleansing Number of rooms/passages/larders cleansed and/or repaired 198 " trade premises cleansed 44 " verminous premises disinfested for bugs/fleas 21 " premises sprayed for cockroaches/crickets/wood beetles etc. 27 " premises disinfected after various diseases 188 " Canteens sprayed for files and ants 8 Various; Number of offal bins provided " dustbins provided 34 " accumulations of refuse and manure removed 25 " offensive ponds and ditches cleared 1 " wasp nests destroyed 53 " miscellaneous Items 55 10 HOUSING 1„ Inspection of Dwel1ing-Houses during the Year; (1) (a) Total number of dwelling-houses Inspected under the Public Health or Housing Acts 150 (b) Number of Inspections made for the purpose 319 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 137 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 107 3. Action under Statutory Powers during the Years (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 35 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- By Owners 16 By Local Authority In default of owners 2 (b) Proceedings under the Public Health Acts- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:By Owners By Local Authority In default of owners 1 (c) Proceedings under Sections 11 and 13 of the Housing Act 1936 (1) Number of houses demolished as the result of formal action by the Local Authority 4 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 70 85 19 factories with mechanical power 325 337 34 Other premises (excluding outworkers premises) 65 68 8 Totals 460 490 61 Defects found in Factories and Other Premises under the Act Particulars Defects found Defects remedied Want of cleanliness 6 5 Inadequate ventilation 2 1 Overcrowding - - Unreasonable temperature - - Ineffective floor drainage - - Absence of thermometers - - Other nuisances 10 10 Sanitary Accommodation - (a) Insufficient 4 3 (b) Want of cleanliness 12 12 (c) Unsuitable or defective 12 12 (d) Not separate for the sexes 1 1 (e) Insufficient limiting in W.C. S 4 1 Totals 51 45 WORKPLACES - Public Health Act, 1936 NUMBER OF Occupiers Inspections written Notices Prosecuted 68 8 SMOKE ABATEMENT Observations have been kept upon the chimneys of the few premises likely to give rise to smoke nuisance. No black smoke contraventions were observed but, in order to deal with moderate emissions, the chimney at one sawdust consuming furnace has been rebuilt and heightened and work of a similar character to a laundry boiler chimney is in hand. The Corporation has maintained four grit deposit gauges and the results of monthly analyses are being collated. Results are furnished also to the Department of Scientific and Industrial Research. INSPECTION AND SUPERVISION OF FOOD Food, and Drugs Act, 1938 Sampling, During the year 212 formal and Informal samples were analysed by Che Public Analyst, as follows: - Type of sample Samples examined Unsatisfactory samples Formal Informal Total Formal Informal Total Almonds, ground 1 1 Almond mixture 1 1 Aspirin 1 1 Baking Powder 1 1 Banana Curd 1 1 Blackcurrant Juice 1 1 Blanc Mange 2 2 Cake 1 1 Cake (Chocolate Roll) 1 1 - 1 1 Cake Flour 1 1 Camphorated Oil 1 1 Caramels (Butter Content) 1 1 - 1 1 Caraway Seeds 1 1 Celery Salt 1 1 Cheese Spread 3 3 Chemical Food 1 1 - 1 1 Chocolate Drink 1 1 Chutney, Tomato 1 1 Cloves, ground 1 1 Coconut, desiccated 1 1 Coffee and Chicory Essence 3 3 Coffee and Chicory Extract 1 1 Coffee and Chicory Powder 3 3 Coffee Spread 1 1 Cold Capsules 1 1 Colour (Food) 1 1 Condensed Milk 1 1 Cordial 1 1 1 Cordial (Lime) 1 - 1 Cough Mixture 1 1 Cough Syrup 1 1 Cream (Double) 5 5 Cream Powder 1 1 Cream (Single) 3 3 Cream (Sterilised) 3 3 Cream of Tartar 1 1 Curry Powder 2 2 Custard Flavouring 1 1 Decorations (Edible) 1 1 Deodorant Tablets 1 1 Dripping 2 2 Essence (Almond) 1 1 Extract (Meat) 1 1 Eye Lotion 1 1 Flavour (Lemon) 1 1 Flour (Self-Raising) 1 1 French Dressing 1 1 Gelatine Powder 1 1 Ginger 1 1 Ginger Conserve 1 1 Carried forward: 2 66 68 - 3 3 13 Type of Sample Samples examined Unsatisfactory samples Formal Informal Total Formal Informal Total Brought forward: 2 66 68 - 3 3 Honey 1 1 Ice Cream 12 12 Ice Cream Powder 1 1 Ice Lolly 2 2 J am 3 3 Jelly (table) 5 5 Ketchup Tomato 2 2 Lemon Cheese 1 1 Lemon Juice 1 1 Lemonade Powder 4 4 Loaf (Veal and Ham) 1 1 Liquid paraffin 1 1 Liver Tablets 1 1 Marmalade 4 4 Marzipan 1 1 Meat Extract 1 1 Milk 31 3 34 2 - 2 Mint Jelly 1 1 Mint Sauce 2 2 Mustard (German) 1 1 Nuts (Mixed) 1 1 Olive Oil 1 1 Paste (Meat) 2 2 Peas 1 1 Pepper 1 1 Pepper Compound 1 1 Pepper White 4 4 Peppermint Lozenges 1 1 - 1 1 Pie (Pork) 1 1 Pie (Steak and Kidney) 1 1 Pudding (Milk) 1 1 Rice Flaked 1 1 Saccharin Tablets 1 1 Salt (Gravy) 1 1 Sauce 2 2 Sausages (Beef) 4 - 4 Sausages (Pork) 9 1 10 2 - 2 Spice Pickling 1 1 Suet 3 3 Suet (Beef) 1 1 Sweets 13 13 - 2 2 Teething Powders 1 1 Throat Lozenges 1 1 Tomato Juice Cocktail 1 1 Tonic Nerve 1 1 Vegetable and Meat Extract 1 1 Vinegar 1 1 Vinegar (Cider) 1 1 Vitamin Syrup 2 - 2 Vitamin Tablets 1 - 1 Welsh Rarebit 1 1 Wine (Ginger) 1 - 1 Wine (Orange) 1 — 1 Totals 51 161 212 4 6 10 14 The following details classify the type of irregularity or infringement and the action taken in relation to the unsatisfactory samples. Sample No and date taken Article Infringement Action taken A 769 9.1.53 Pork Sausages (Formal) Sample contained 60% of meat Including fat. Pork sausages of ordinary commercial quality contain not less than 65% of meat Including fat. Manufacturer Warned Deficiency stated to be due to "bad mixing". A 777 6.2.53 Pork Sausages (Formal) Sample contained 60% of meat including fat. Pork Sausages of ordinary commercial quality contain not less than 65% of meat including fat. Butcher Warned Error admitted in calculating the meat content for the "mix". (The Canned Corned Meat (Prices) Order 1953 which removed earlier provisions prescribing maxlmuir prices and minimum meat content for sausages and sausage meat from the 1st March 1953 was taken into account in deciding to Issue warnings In the above cases). A 806 A 807 3. 9.53 Milk (Formal These samples taken In course of delivery were both deficient in milk solids other than fat to the extent of 3%. The freezing point test did not Indicate the presence of added water. The milk fat percentages were well above the required standard. Producer Warned "Appeal to the cow" samples were taken by the Local Authority in whose area the producer farm is situated. 1632 31.12. 52 Sweets (Czechovaklia) (Informal) Sweets were of low quality and so malodorous as to be repulsive Warning Retailer immediately agreed to discontinue purchasing the "line". The Ministry of Food were informed and the complaint was taken up with the Czechoslovak Commercial Attache who stated there would be a very considerable improvement in the manufacture of these fruit bon bons in the future. A later sample taken from another source (No. 1672) showed an improvement in quality. 15 Sample No and date taken Article Infringement Action Taken 1670 12. 2. 53 Chocolate Roll Flavour (Informal) Sample contained 1.6% of chocolate as dry fat-free cocoa matter instead of not less than 4%. In view of the many conflicting issues involved regarding the use of and the import of the term "Flavour" when used in connection with this type of article and the prior approval given by the Ministry of Food no further action was taken in this case. 1673 8.4.53 caramels (Butter content) (Dutch Product) (Informal) Sample devoid of butter fat. Contained 12.3% of hardened coconut oil. Retailer Warned Vendor genuinely under the impression that the caramels contained butter. Show card indicated caramels had butter content. Immediately withdrawn upon representation. 1773 3. 11.53 Butter Cream Fudge. (Irish product) (Informal) Sample contained 2.3% of butter fat, instead of not less than 4%. Retailer Warned Unaware that under the terms of a code of practice agreed between the Ministry of Food and the Chocolate and Sugar Confectionery trade where the word "butter" or a synonym is used without qualification in the description of sugar confectionery that the butter fat content of the products shall not be less than 4%. Should further supplies be obtained the sweets will not be described as Butter Cream Fudge. 1779 3.11. 53 Peppermint and Glucose Lozenges (Informal) Sample contained only a fifth of the proportion of Peppermint Oil stated in the formula. Warning The distributors assert, and it is agreed, that some loss in peppermint oil is to be expected during manufacture and storage of this article. The manufacturers state that alterations are being made both in the production and packlng of this product to avoid the loss of oil. 1783 9. 12. 53 Chemical Food (Informal) This sample which was taken on 9.12. 1953 bore a label which stated that the Chemical Food had been prepared according to the British Pharmacopoeia. Chemist Informed The retailer was told that the British Pharmacopoeia 1948 ceased to have effect on 1st September 1953 and that Chemical Food is not now included in the British Pharmacopoeia. 16 Sampling Observations. Of the two hundred and twelve samples taken during the year 2.83 per cent were found to be other than genuine, and labelling infringements in some form of another accounted for a further 1.88 per cent. For comparative purposes the respective figures for 1952 were 4.91 and 3.27 per cent. Having regard to the wide variety of articles sampled it will be seen that the observations made and the infringements reported by the Public Analyst have in the main been of a generally minor character. Comments by the Public Analyst. The general relaxation of restrictions on the sale of food, the revocation of price control orders and rationing orders has continued throughout the year, and it has become increasingly necessary to maintain the quality of foodstuffs at a level certainly not less than that required by the various control orders previously in force. Sometimes this has been done by re-enacting previous standards in new Food Standards Orders but in other cases it has been left to Food and Drugs Authorities to establish a standard based on commercial quality. The wide range of foodstuffs sampled by the Borough's Sampling Officers is thus invaluable in providing a basis for the Analyst's Judgment of quality and in ensuring the maintenance of a reasonable standard. An example of the successful stand which Analysts and Food and Drugs Authorities have made followed the revocation of the Meat Control Order. It was then forecast that the quality of sausages would fall badly, but in practice the average meat content has risen and I have experienced no case of a deficiency much below the earlier legal standard of 50 per cent meat content for beef and 65 per cent for pork. This year has also seen the publication of a new British Pharmacopoeia which includes numerous new drugs and eliminates many old favourites. As an example of the latter, Parrlsh's Chemical Food is no longer "Official" in the Pharmacopoeia. During the year the Labelling of Food Order has been revised and consolidated, but the important feature requiring the specification of the ingredients of pre-packed food remains unchanged. As in other years attention has been paid to ensuring that foods are as free as possible from metallic contamination. During the summer, ice lollies received much public interest in the press as being liable to this form of contamination, but samples taken, in the Borough were free from objection. There is perhaps one other item of particular interest arising out of the year's sampling. The use of the term "butter" in describing confectionery has rightly been condemned unless a proportion of butter has been used in the manufacture. This subject has previously received official comment in a Ministry of Food Circular where a general standard of 4 per cent butter fat 17 content has been suggested, except where the description "flavoured" is used in conjunction with butter. In the latter case, presumably the actual butter fat content may be reduced to a mere trace without offending, but your Analyst does not personally feel that the modification "flavoured" is sufficient indication to the purchaser of the virtual absence of butter. The same argument has been used in connection with chocolate swiss rolls, but does the description "swiss roll, chocolate flavour" really convey to the purchaser the impression that no chocolate or cocoa has been used In the recipe? MILK SUPPLY Food and Drugs (Milk Dairies and Artificial Cream) Act, 1950 Milk and Dairies Regulations 1949-1953 The Milk (Special Designation) (Raw Milk) Regulations 1949 The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949-1953 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 1953:- Dealers TYPE OF LICENCE Pasteuriser's Supplementary TUberculin Tested 9 10 - Tuberculin Tested (Past) 9 - - Pasteurised 19 11 2 Sterilised 35 12 — Totals 72 33 2 Examination of Milk Samples, One hundred and twenty three 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 62 2 Methylene Blue 64 - Sterilised 7 Turbidity 7 - Tuberculin Tested (pasteurised) 16 Phosphatase 16 - Methylene Blue 16 - Tuberculin Tested (Farm Bottled) 36 Methylene Blue 32 4 Total 123 Totals 117 6 18 It will be seen that of the one hundred and twenty three samples examined all passed the prescribed tests, except two pasteurised and four Tuberculin Tested samples, The failure of the two pasteurised milk, samples to pass the phosphatase test was due to a temporary technical fault at the processing dairy. The contributing factors to the failure of the four Tuberculin Tested (farm bottled milk) to pass the methylene blue test were the high atmospheric temperatures when the samples were taken and the apparent delay between the time of production and delivery to the milk depot. Repeat samples taken in due course were satisfactory. One dairy company has erected new and much enlarged premises to replace an out of date and inadequate building and plant. A modern H. T. S. T pasteurising plant and completely new bottle and churn washing machinery have been installed. Improved laboratory facilities have been provided Colour tests and the normal prescribed tests were satisfactory from the outset and have so remained. CHEMiCAL MILK AND CREAM SAMPLES Thirty one formal and two informal milk and cream samples have been taken for chemical analysis, The samples contained satisfactory averages of 3.7 per cent milk fat and 8.7 per cent of milk solids other than milk fat. These results are above the minimum standard of 3 per cent milk fat and 8.5 per cent milk solids other than fat laid down in the Sale of Milk Regulations. In the case of cream, four samples of double cream gave an average milk fat content of 49.7 per cent and four samples of single cream an average of 23 per cent. BIOLOGICAL MILK SAMPLES (FARM BOTTLED MILK) Twelve samples of Tuberculin Tested Milk were taken for biological examination. In all cases the guinea pigs inoculated with the milks failed to show any signs of tuberculous infection on post mortem. ICE CREAM Ice Cream (Beat Treatment etc°) Regulations 1947-1952 Registrations- At the end of 1953a total of one hundred and eighty seven 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. 19 The quantity of ice cream manufactured in the Borough continues to decline. At the present time a small amount is made at only three premises. During the year five new applications for the registration of premises for the sale of ice cream were received and granted. BACTERIOLOGICAL SAMPLING OF ICE CREAM Ninety eight samples of ice cream were taken at various premises for provisional grading and bacteriological examination. The following table shows the provisional grading percentages for the year 1953 and for comparative purposes the results obtained from one hundred and two samples In 1952. 1953 1952 Grading of Samples Grading of Sables Grade 1 82 samples 83.67% Grade 1 63 samples 61.76% " 2 6 " 6.12% " 2 30 " 29.41% " 3 8 " 8.16% " 3 6 " 5.88% " 4 2 " 2.04% " 4 3 " 2.94% 98 Samples 102 Samples It will be seen that the bacterial purity of the ice cream sold in the Borough has been maintained at a relatively high standard. The following table shows the percentage grading results for each manufacturer Code No. of samples taken Type of samples taken Percentage results in each Grade Faecal Coll present Conforms present Wrapped Loose 1 2 3 4 A X 5 - 5 100, 00 - - - - 3 B X 1 - 1 - - 100.00 - - 1 C X 1 - 1 100. 00 - - - - 1 D 14 10 4 85.71 7.14 7.14 - - 3 E 18 17 1 94.44 5. 55 - - - 4 F 21 20 1 95. 22 4. 76 - - - 3 G 2 - 2 100.00 - - - - 1 H 2 2 - 100.00 - - - - 1 I 4 - 4 25.00 - 75.00 - - 3 J 4 2 2 100.00 - - - - 3 K 3 3 - 75.00 25.00 - - - 2 L 3 3 - 100.00 - - - - 1 M 2 2 - 50.00 - 50.00 - - 1 N 5 5 - 100. 00 - - - - - o 7 6 1 71.42 14.28 14.28 - - 3 P 3 3 - 66. 66 - 33.33 - - 2 Q 3 - 3 - 33.33 - 66.66 - 3 Totals 98 73 25 83.67 6.12 8.16 2.04 Nil 35 X Denotes locally produced. 20 It is gratifying to record that the above results show a complete absence of faecal coll. A similar result was obtained n 1952, CHEMICAL SAMPLING OF ICE CREAM The Flood Standards (Ice Cream) Order 1953 restored from the 1st June 1953 the standard which had been in force before July 1952 and is now fat 5 per cent, sugar 10 per cent and milk solids other than fat per cent. Twelve samples were taken for chemical examination and in no case did the Public Analyst report a deficiency of fat. Producers Code Number of Samples Flat Sample constituent percentages Milk solids other than fat Sucrose Total solids A X 2 16.5% 7.6% 13.9% 13.9% 9.3% 8.7% 10.3% 16.6% B 2 10.1% 8.5% 10.5% 11.5% 8. 6% 8.3% 14.4% 18.5% C 2 11.4% 9.4% 8.9% 13.3% 10.4% 6.9% 12.1% 16.5% D 1 9.7% 6.5% 11.5% 18.5% E X 1 8.9% 16.2% 11.3% 12.5% F X 1 7.6% 8.8% 12.7% 14.8% G 1 10.2% 9:5% 13.0% 15.8% H 1 10.1% 9.0% 11.0% 15.7% I 1 9.2% 8.4% 14.4% 16.8% Average % 12 10.1% 8.9% 12.0% 15.3% X Denotes locally produced ICE LOLLIES - CHEMICAL AND BACTERIOLOGICAL EXAMINATION 1, Chemical. The Food Standards (Ice Cream) Orders do not at present apply to water ices sold as such or to ice lollies. The production of ice lollies in the Borough is Increasing. Two informal samples of ice lollies were examined by the Public Analyst for evidence of metallic contamination arising from the use of certain types of moulds, but no harmful impurities were found as a result of using these moulds. 2. Bacteriological. In view of the absence of a prescribed standard and the ever increasing demand for ice lollies by school children, it was considered advisable as in the previous year to submit samples to a bacteriological test similar to the one applied to ice cream. 21 Twenty one samples were examined and all placed in provisional Grade I, none contained faecal coli and in two 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 and offal. In general the provisions of the Public Health (Meat) Regulations have been well observed. Remedial action was taken in seven cases where the sanitary conditions were not satisfactory, or certain contraventions of the Regulations existed. Forty eight butchers premises are registered in accordance with the Food and Drugs Act, 1938, Section 14. The registrations are mainly for the manufacture of sausages. A further eight food premises are registered, six of which are for the preparation of potted, pressed, pickled or preserved foods, one for the manufacture of Jam and one under Section 34 as a wholesale dealer in margarine. Eighty seven cases of insanitary of defective conditions found to exist in food shops other than butchers shops were remedied. Food Premises. The following table shews the number and type of food premises in the Borough and the number of primary inspections made. Type of Food premises Number Inspections Bakehouses 21 37 Butchers (including two horseflesh shops) 54 130 Confectioners (Sugar and flour) 135 144 Dairies and Milk Distributors 41 35 Dining Rooms/Snack Bars/Coffee Stalls 10 13 Fishmongers/Fried Fish 37 57 General shops and multiple stores 36 43 Grocers 119 127 Greengrocers/Stalls 84 104 Ice Cream (Sale of) 187 178 Licenced public houses 36 23 Restaurants/Cafes, 64 80 22 Registered Food Premises. The following table shews the number and type of food premises registered under the Food and Drugs Act, 1938 and/or the Milk and Dairies Regulations, 1949. A - Number of premises registered under the Food and Drugs Act, for the preparation or manufacture of preserved foods and as wholesale dealer In margarine. B - Number of premises registered under the Milk and Dairies Regulations 1949 for the heat treatment of milk and/or as Distributors of Milk. C - Number of premises registered under Section 14 Food and Drugs Act 1938 for the manufacture, sale and/or storage of Ice cream. Premises A B. C (By type) Preserved Foods Milk Ice Cream Grocers 7 - 20 Grocers (Milk Distributors) - 30 6 Dairies - 2 - Milk Depots - 6 - Batchers 48 - - General Shops/Multiple Stores - 3 12 Fruiterers/Greengrocers 1 - 4 Confectioners (Sugar and Flour) - - 101 Cafes/Restaurants/Dining Rooms - - 38 Ice Cream Manufacturers - - 3 Sundry Premises - - 3 Totals 56 41 187 Clean Food Byelaws - Section 15. The 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 now been In operation since July 1950. The few Infringements discovered during the year were mainly of a minor character. Clean Food - Dogs in Food Premises. During August 1952 printed notice cards were distributed to all the food establishments In the Borough, regarding the control and admittance of dogs in such premises. There is no doubt as to the success of the campaign as revealed by the comparatively few complaints now received in connection with this type of nuisance. 23 HEALTH AND FOOD EXHIBITION The Council organised a Health and Food exhibition In the Public Hall during the period 17th to 21st of March. Within the limits of the accommodation available the story of how food poisoning outbreak.es usually occur was admirably explained by means of cinematograph films, pictorial exhibits and suitable pamphlets. Food traders and their staffs were Invited to attend a special afternoon session, when short descriptive talks on food matters were given by the Medical Officer of Health and the Chief Sanitary Inspector. A brochure was prepared and widely distributed prior to the Exhibition. It contained brief references to matters of vital Importance In connection with health and food problems, as they affect the general public, the trader, and In addition It drew attention to the part played by the Public Health Officers In their fight against diseases which arise from food and drink Infections. Simple rules were also given to food handlers on the necessity for care in personal hygiene, the care and suitability of wearing apparel, the hygiene of catering establishment kitchens and last, but not least, the home larder. The Exhibition also ably presented the latest methods employed In the constant battle against Infestations of rats, mice and many kinds of food insect pests. It is a matter for regret that the number of adults attending this widely advertised Exhibition did not come up to expectations. However, it is pleasing to record that the Interest, enthusiasm, and keenness shewn by the organised groups of school children and members of various youth organisations who attended amply rewarded the labour of those responsible for the organisation and presentation of the Exhibition. The valuable assistance of the Ministries of Agriculture and Fisheries and Food is acknowledged. 24 UNSOUND FOOD The following diseased and/or unsound meat and other foods have been surrendered and destroyed of, where suitable, utilised for pig food. Type of Food lbs Tins , Bottles or Jars, Number or Packets Apples 45 - - - Baby Foods - - 43 - Beef (Home Killed) 599½ - - - Beef/Mutton (Imported) 577 - - - Cereals - 12 - 88 Cheese/Butter - - 1 12 Coffee - 8 11 - Confectionery/Biscuits 4½ 5 - 265 Culinary Mixtures - 132 - - Dates - - - 6 Eggs - - - 132 Fish (Tinned) - 211 - - Fish (Wet and Dry) 490 - - - Fruit Juices/Puree - 313 - - Fruit/Vegetables 462 961 28 5 Ham 76½ 9 - - Ice Cream/Powder - 1 - 1392 Jam/Marmalade/Syrup/Honey - 141 30 - Lemonade Powder/Crystals - 82 - - Meat (Offal) 95 8 - - Meat/Fish Pastes/Creams - 29 4 - Meat (Tinned) - 114 - - Milk/Cream (Tinned) - 117 - - Mincemeat - 7 15 - Mint Jelly/Relish/Bovril - - 34 - Mustard/Salt - - 3 1 Mutton (Home Killed) 113½ - - - Nuts (Mixed) - - - 39 Peas/Beans - 238 - - Pies - - - 47 Pork (English) 30¾ - - - Puddings - 83 - - Rabbits - 2 - - Sausages 150½ 12 - 38 Semolina/Sago/Tapioca/Barley 23½ 55 14 31 Soups/Pickles/Sauces - 34 34 48 Swiss Rolls/Cakes/Sponges 26 4 - 557 Totals 2693½ 2578 217 2661 SLAUGHTERING No animals were slaughtered during the year In the one licenced slaughterhouse In the district. SLAUGHTER OF ANIMALS ACT, 1933 One licence to act as slaughterman was granted In 1953. 25 BAKEHOUSES There are twenty one bakehouses in the Borough, of these twenty are provided with mechanical power. The standard of cleanliness and the sanitary conditions in the majority of cases were found to be satisfactory. Thirty seven visits of inspection during the year resulted in seven infringements being discovered and rectified. SHOPS ACTS Four hundred and forty three visits were made to various premises under the Shops Acts and revealed that the arrangements made for the health and comfort of the shop workers are in the majority of cases satisfactory. SCHOOLS The sanitary conditions and the water supply to the Schools in the area are generally satisfactory. HAIRDRESSERS AND BARBERS PREMISES The sixty nine establishments in the Borough were inspected during the year. The general standard prevailing is good, as revealed by the discovery of only five infringements of the Hairdressers and Barbers Byelaws 1947. MERCHANDISE MARKS ACT One hundred and four visits were made to food premises under this Act. The infringements discovered were mainly in connection with the marking of imported apples and tomatoes. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The intention of the Act is to secure the use of clean filling materials in upholstered articles, and other articles which are stuffed or lined. The Act provides for the registration of certain premises by the Local Authority on payment of a registration fee and the licensing of certain other premises on payment of a statutory fee. Three applications for renewal licences to store rag flock were received and granted in 1953. The registration of the ten premises in the Borough having already been carried out in 1952. Thirteen visits of inspection were made during the year. 26 PET ANIMALS ACT, 1951 This Act came into operation on 1st April 1952 and 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. Eight renewal licence applications were received and granted during 1953. LICENCED PLACES OF PUBLIC ENTERTAINMENT There are twenty two licenced places of public entertainment in the Borough. They are used mainly for cinematograph shows, concerts, dancing and social functions. Action was taken to rectify five minor defects found, but in general the standard of cleanliness was good. LICENCED PUBLIC HOUSES It will be recalled that in 1951 an exhaustive investigation was carried out into the general sanitary and hygienic conditions to be found at the thirty six public houses in the Borough when a special report was presented to the Public Health Committee. It is gratifying to record that since the completion of the survey, and particularly during 1953 a substantial number of varied improvements have been carried out. These include such items as the provision of additional W„ C. accommodation, urinals, baths, washbasins, constant hot water and the supplying of detergents and sterilising agents for the washing of utensils, glasses and beer pipe lines. These improvements have in the main been made possible by the cordial and close co-operation of the Brewery Companies and most of the licensees, together with some assistance from a relaxation of building licence restrictions. DISINFECTION AND DlSINFESTATION Council Private Other Houses Houses Premises Number of houses treated with Insecticide for bugs and fleas - 18 3 Eight school canteens were sprayed for flies, ants and months. The insecticides used were D.D.T., Municipal Spray and Gammexane Liquid Spray. 27 RODENT CONTROL The Prevention of Damage by Pests Act, 1949 A - Surface Treatments (1) Eight thousand six hundred and seventeen visits were made during the year by the Rodent Operators and four hundred and eighty four by the Sanitary Inspectors to premises infested or possibly harbouring rats or mice. Four hundred and fifteen 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 472 Number of premises found to be infested 434 Number of premises where no evidence of rodents found 38 Number of premises cleared of rats or mice (including 70 previous year's cases) 415 Number of premises still being treated at the year end 92 (3) The cause or site of Infestation at the four hundred and thirty four Infested premises was:- Keeping of poultry 70 Inside premises (under floors etc.) - rats 26 Inside premises (under floors etc.) - mice 43 Buries, scrapes etc. in gardens., land etc. 182 Under or inside sheds 134 Defective drains 1 Accumulations of refuse etc 4 Total 460 (4) Type of property found to be infested:- With Rats With Mice Total Council property 8 1 9 Dwelling houses 346 20 366 Business premises etc. 31 19 50 Schools, Hospitals, Canteens, etc. 6 3 9 Totals 391 43 434 (5) Summary of the type of premises and methods employed in clearing premises of rats and mice:- Type of Premises cleared Dwelling-houses (mainly in gardens) 355 Food shops and food premises 23 Non-food shops 15 Waste land 1 Hospitals and Schools 4 Factories and Workplaces 8 Council Premises 3 Miscellaneous 6 Total 415 28 Methods employed in clearing four hundred and fifteen premises of rats and mice. Poison baits 398 Trapping 16 Gassing 17 Rat and Mouse proofing 3 Accumulations removed 2 Other means 2 Total 438 B - Sewer Treatments (1) Second Maintenance Treatment (1952-1953) The second maintenance treatment of soil sewer-manholes in areas known to be infested from the previous treatment and those sections found to be infested during the annual 10 per cent test baiting (1952-53), was completed on the 11th March 1953. Pre — baiting 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:- SECTIONS A B C D E Total Number of Manholes prebaited 91 36 85 227 99 538 Complete prebait takes 1 2 5 9 9 26 Partial prebait takes 7 3 23 59 16 108 Percentage of takes (C. and P.) 8.8 13.9 32.9 29,9 25.2 24 9 Number of manholes poison baited 10 11 39 95 36 191 The number of pre-bait takes shew a decrease of 7.9 per cent on the previous maintenance treatment. (2) Test Baiting (1953-54). The Borough was divided into five sections, as in previous tests, and a test baiting of 10 per cent of the soil-sewer manholes in areas cleared or thought not to be infested was carried out during the month of August. The following is a tabulated summary of the results:- SECTIONS A B C D E Total Number of manholes baited 10 16 82 40 55 203 Complete bait takes - - 3 2 - 5 Partial bait takes 2 1 5 - 1 9 Baits not taken 8 15 74 38 54 189 (3) First Maintenance Treatment (1953-54). This treatment was confined to the areas known to have been Infested during the previous maintenance treatment together with sections proved to be infested by the annual 10 percent Test, and operations were completed on the 30th September, 1953. 29 Prebaiting with damped bread-rusks was carried out on two consecutive days and the same bait base with l0 percent Arsenious Oxide added was laid on the third day. The following is a tabulated summary of the results achieved:- SECTIONS A B C D E Total Number of manholes prebaited 29 43 82 168 60 382 Complete prebait takes 2 1 17 12 9 41 Partial prebait takes 3 - 20 11 3 37 Percentage of takes (C. and P.) 17.2 2.3 45.1 13.6 20.0 20.4 Number of manholes poison baited 24 42 42 140 48 296 The number of pre-bait takes shew a further decrease of 4.5 per cent on the previous maintenance treatment. 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 30 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES One thousand, two hundred and fifty two cases of Infectious diseases were notified during the year 1953, an Increase of four hundred and thirty five cases. There was a higher prevalence of Whooping Cough, Measles, Pneumonia, Dysentery, Poliomyelitis and Scarlet Fever. Scarlet Fever. One hundred and thirty cases were notified, an Increase of six cases. The case rate was 1.64 per thousand of population, compared with 1.39 per thousand of population in England and Wales. The high incidence was due to outbreaks in schools. The disease was generally mild. There was no death. Diphtheria. No case was notified in 1953. Diphtheria remains a danger to children who have not been immunised. Diphtheria Antitoxin, It is still necessary for doctors to give very serious consideration to the possibility of Diphtheria in the differential diagnosis of throat infections. Early diagnosis and early treatment with antitoxin are essential for the prevention of mortality. Antitoxin should be injected on suspicion of the disease, or the case admitted to hospital for observation and treatment. Diphtheria Immunisation. The success achieved by immunisation is shown by a comparison of the cases and deaths in 1944 and 1953 in England and Wales. Year Cases Deaths 1944 23199 934 1953 240 24 The residual incidence and mortality will persist until complete immunisation of a high percentage of children is achieved. Protection is proportionate to the number of children who are immune. Immunisation in infancy is not sufficient to protect a child throughout the schooldays. The immunity wanes with the passage of time and the child will become susceptible unless reinforcement injections to revive immunity are given every four years up to the age of nine. There is unnecessary delay in bringing babies for immunisation. Parents are losing that sense of urgency which prevailed in the early days of the campaign when Diphtheria was prevalent. Delay creates a period of risk for the baby or infant. Every baby should have been immunised before the first birthday. The course of primary injections should begin at the age of nine months. Reinforcement injections at the age of five and nine years are essential. 31 During 1953 seven hundred and twenty four children were immunised and their ages at the date of immunisation were as follows. Ags: Under l 1 2 3 4 5-9 10-14 Over 15 Total Number: 230 347 29 19 14 78 7 - 724 A survey at the end of 1953 of the state of immunisation of eight hundred and seventy six babies born in 1952 showed that four hundred and seventy eight, representing 55 per cent had been immunised. Of the children under five years of age two thousand seven hundred and forty, representing 47 per cent had been immunised. Of the school children of five to fourteen years of age, seven thousand two hundred and forty eight, representing 73 per cent had been immunised and sufficiently reinforced and one thousand seven hundred and twenty seven, representing 17 per cent previously immunised required further reinforcement. During 1953 one thousand seven hundred and eighty one reinforcing injections were given, 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 the 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. Oswald's Hall, Brocks Drive, North Cheam at Infant Welfare Session, every Friday, at 1.30 p.m. 7. At the Clinic, Wesley Hall, Cheam Common Road, Worcester Park at Infant Welfare Session, every Friday, at 2 p.m. 8. 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. Six hundred and nineteen cases were notified, an increase of one hundred and five cases. The disease was epidemic from January to April and thereafter declined 'towards quiescence. The case rate was 7.83 per thousand of population compared with 12.36 per thousand of population for England and Wales. There was no death. 32 The monthly incidence of notified cases is shown in the following table. January 69 July 23 February 96 August 2 March 230 September - April 118 October - May 36 November - June 28 December 17 The protection from infection of babies, infants and of weakly children should be regarded as important. Older children are better able to withstand the illness but there is always an occasional child who reacts poorly to the infection and care in nursing all cases from the onset is essential, Secondary infection is liable to occur in a weakened child and to give rise to Pneumonia, The sulphonamide drugs and penicillin have greatly reduced this danger, Early medical advice should be sought so as to avoid complications. The prevention of infection depends on recognition of the early symptoms. These begin three or four days before the rash appears. The child is catarrhal in the eyes, throat and nose and is out of sorts, Irritable or listless. In this phase observation in bed until medical advice is obtained is the best policy. The child may be infectious and should be prevented from going to school or cinema or playing in the streets. Complete isolation in the home is often very difficult and sometimes impossible but some reduction of contact can usually be achieved. Whooping Cough. Three hundred and eight cases were notified in 1953 compared with sixty seven cases in 1952. Prevalence was highest in March and April, declined slowly and persisted throughout the year. The case rate was 3.89 per thousand of population, compared with 3.58 per thousand of population for England and Wales. There was no death. The monthly incidence of cases is shown in the following table. January 16 July 24 February 28 August 12 March 52 September 12 April 62 October 14 May 30 November 18 June 31 December 9 Whooping Cough is now regarded as the most serious infectious disease of early infancy. The risk of mortality is highest during the first three to six months from birth and diminishes progressively with age. Older children who have been debilitated by other illness are also at risk. The cough is always a severe strain even in the robust child. Prevention depends on recognition of the early symptoms and early isolation of the patient. The drug Chloromycetin is effective in reducing infectivity and can eliminate the bacillus from the throat. Earl y diagnosis can be 33 assisted by the use of cough plates or pharyngeal swabs for the identification of the bacillus. The cough increases gradually over seven or even fourteen days before the characteristic whoop occurs. Medical advice is desirable so that suitable drugs can be prescribed to reduce the strain on the lungs and to minimise the danger of complication. Careful nursing and careful convalescence are essential. Immunisation against Whooping Cough. Immunisation by protective vaccines is now available free of charge for children under five years through the family doctor or at Child Welfare Clinics. In 1953 four hundred and sixty three 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. Immunisation against Diphtheria and Whooping Cough can be combined and is increasingly popular. The injections are given subcutaneously to avoid irritation of muscle which might lead to selective paralysis in children incubating Poliomyelitis. The vaccines are effective and can prevent or greatly modify the illness. Small Pox. No case was notified. Vaccination against Small Pox. The voluntary response to infant vaccination has been good. Five hundred babies under the age of one year were vaccinated. The percentage of 53.3 compares with 53.2 in 1952. infant vaccination provides a basic immunity in the population and is a necessary precaution against Small Pox. The risk of mortality from Small Pox is reduced and re-vaccination in later years is more likely to be free from severe reaction and complication. Outbreaks of Small Pox can occur suddenly. Vaccination against Small Pox is a wise precaution and the only sure protection. All babies should be vaccinated between three and six months, the safest age for vaccination. The service is free of charge and available through medical practitioners and clinics. The following table shows the number of vaccinations during 1953. Age No. Vaccinated No. Re-Vaccinated Under l 500 - 1 30 - 2 12 - 3 17 2 4 6 3 5-9 10 15 10-14 5 13 Over 15 49 176 Totals 629 209 Puerperal Pyrexia. Twenty two cases were notified in 1953 compared with sixteen cases in 1952. A revised definition of Puerperal Pyrexia In the Puerperal Pyrexia Regulations, 1951 made notifiable "any febrile condition occurring in a woman in whom a temperature of 100.4 Fahrenheit (38 Centigrade) or more has 34 occurred within fourteen days after childbirth or miscarriage". The stricter control over mild pyrexia is reflected in a higher number of notifications. The case rate was 23.03 per thousand total births compared with 18.23 per thousand total births for England and Wales. The early notification of Puerperal Pyrexia is of primary importance in the prevention of maternal mortality. Medical Practitioners should make the fullest use of the consultant, bacteriological and hospital services and ensure the effective isolation of any case suspected of infection and occurring in a maternity or nursing home. Typhoid and Paratyphoid Fever. No Case was notified within the Borough. Five symptom free excretors of Bacillus Paratyphosus B. were found among children who attend Green Lane School, Worcester Park, where an outbreak of nine cases of Paratyphoid Fever in pupils residing in adjoining districts occurred in November. Eleven- symptom free excretors were found in adjoining districts. The outbreak was due to infection of food of carrier origin. The spread of the outbreak was prevented by the early detection and treatment of cases and of symptom free excretors. In the extensive investigations there was close co-operation between the district Medical Officers of Health, the School Medical Officer, the Medical Practitioners of the area, the Public Health Laboratory Service, the teachers and the parents of the children. Dysentery. Sixty cases were notified compared with forty three cases in 1952. Fifty eight were of the Sonne type. Eight cases occurred within an institution for children. Of these two were of the Flexner type. An outbreak of sixteen cases occurred between the 3rd June and 13th June and was attributable to a carrier in a food shop. Secondary infections continued until the 27th July, involving a school and a nursery school. There were thirteen sporadic cases of obscure origin, three of whom contracted infection outside the Borough. Sonne Dysentery is endemic and the control of the unknown carrier will only become effective when the habit of washing hands after the use of the W. C. and before handling food is generally adopted and strictly applied. Food Poisoning. Nine cases were notified and two were recorded following investigations. Four were involved in an outbreak, the source of which was not ascertained, following a reception held outside the Borough. There were seven single cases of whom three acquired Infection elsewhere. No. of Outbreaks No. Of Cases No. of Deaths Organism or Agent Food Involved 1 1 _ S. Typhi Murium Not ascertained 1 1 - Staphylococcus Cold roast pork 1 1 - S. Typhi Murium Cold roast beef 1 1 - S. Typhi Murium Duck's egg 1 4 - S. Typhi Murium Not ascertained 1 1 - S. Typhl Murium Not ascertained 1 1 - S. Typhi Murium Steak pie 1 1 - Staphylococcus Cheese 35 Nine cases were infected with Salmonella Typhi Murium, the commonest pathogenic organism found in the bowel in cases of food poisoning. Infection causes an attack of enteritis usually seuere but sometimes so mild as to be disregarded. The organism tends to persist in the bowel for several weeks and exceptionally infection of the gall bladder produces a chronic carrier. It is important that food handlers should recognise the possible significance of even mild diarrhoea and seek bacteriological investigation, The protection of food depends on the scrupulous washing of hands after use of the W.C. by all who are engaged in the handling of food Salmonella Typhi Murium is an infection of mice and has been conveyed to man by food contaminated by their dirts. Mice foul the layerings of ducks and ducks' eggs are a frequent source of infection. It has been estimated that ducks' eggs are the probable cause of infection in one out of three of the outbreaks recorded as being due to Salmonella Typhi Murium, Information on sporadic cases is less complete but in one out of twenty five cases ducks' eggs are suspected. There is danger in using ducks' eggs to prepare uncooked or lightly cooked food such as mayonnaise, custards, custard fillings and meringues, for not only will the degree of heat fall to kill the organism but will stimulate its growth, Ducks' eggs eaten fried poached, or lightly boiled or in omelettes will not be sufficiently heated to kill Salmonella, Boiling for at least ten minutes is required. No ducks eggs either alone or mixed with hens eggs should be used except for the preparation of food requiring a long period of cooking at a high temperature,. Mice can contaminate food in storage, in the shop and in the kitchen. The eradication of mice is necessary to secure safety from infection, Salad vegetables and raw fruit which may have been fouled by birds, animals or by handling, are a possible undisclosed source of intestinal infections and should be washed very thoroughly before eating. Two cases were due to Staphylococcus Aureus, the common organism of the skin which can multiply on food and produce a toxin causing severe intestinal irritation. Staphylococci are conveyed to food from unwashed hands, from infected uncovered abrasions, from utensils contaminated by handling or by flies, and by sneezing from the nostrils where they are present in the hair follicles. Clean hands can be Infected by touching the face or nostrils. One main objection to the smoking of cigarettes by food handlers is that the fingers are brought into close proximity with the lips and nostrils. Staphylococci flourish on food which is warm and near to body heat. Roast meat which is to be eaten cold must be cooled rapidly through the danger range of temperature and must be stored in a very cool place. Cold meats exposed to summer temperatures provide a good medium for growth. The sale of cold meats requires scrupulous cleanliness and cool storage at all times. Cold cooked meats should be eaten on the day of purchase unless they can be stored at home in a refrigerator. The problem of bacterial food poisoning would be quickly reduced if a self imposed discipline of hand washing after use of 36 the W. C. and before handling food was accepted and applied by all food handlers, Cerebro Spinal Fever, No case was notified. Poliomyelitis. Fifteen cases were notified compared with six cases in 1952. Nine were paralytic. Of these four recovered completely. A boy of ten years died of Acute Bulbar Paralysis. A girl of seventeen years has severe paralysis affecting the legs. Three cases have residual paralysis. A girl of seven years recovered completely from partial paralysis of the Diaphragm after treatment in an iron lung. All the non-paralytic cases recovered. Poliomyelitis has been recognised as a spray infection from the throat and nose. It is now known that in addition the. virus multiplies in the bowel of the patient and it is probable that faecal contamination plays an important part in the spread of the disease. In our everyday lives there is a constant passage of faecal organisms by hand to hand exchange and through contact with handled objects and food. The washing of hands after use of the W. C. is as essential a precautionary measure against the spread of Poliomyelitis as it is against Food Poisoning. There is new knowledge that the virus enters the blood stream from the bowel. It is hoped that the production of antibodies in the blood by the use of vaccines may prevent the entry of the virus to the nervous system. The path of entry is not yet clear. Research on vaccines is proceeding and, although promising, is still in the experimental stage. It is known that excessive emotional or physical fatigue facilitate the passage of the virus and that rest is protective. Any mild febrile illness suggestive of an infection should be treated with caution during the season of prevalence of Poliomyelitis. The hospitals are doing excellent work in reducing disablement. The supporting social service of the Infantile Paralysis Fellowship is giving hope and happiness to many patients. Pneumonia. Of thirty deaths from Pneumonia one was notified before death. The total number of notified cases was eighty eight compared with forty one in 1952. Influenza was prevalent during the first quarter of the year and sixty eight cases of Influenzal Pneumonia were notified. infestations. Five cases of Scabies and ten cases of infestation by lice were treated The number of attendances at the clinic for treatment was fifty five. This compares with two cases of Scabies and sixteen cases with lice and seventy two attendances for treatment In 1952. Non-Notifiable Diseases, School teachers reported forty nine cases of Chicken Pox, twenty nine cases of Mumps and fifty eight cases of German Measles. School notifications are a useful indication of the prevalence of non-notlflable diseases and form a basis for consultation with the school medical officer. 37 GO to NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1953 Disease AGE IN YEARS TOTALS Removed to Hospital Died * Under 1 1 2 3 4 5 10 15 20 35 45 Over 65 Scarlet Fever - 1 5 11 12 80 13 5 2 - - - 129 40 - Diphtheria - - - - - - - - - — - — - - - Small Pox - - - - - - — — - - — - - - Typhoid Fever - - - - - - - — - - - - - - - Para typhoid never - - - - - - - — — — — - - - - Puerperal Pyrexia - - - - - - - 1 16 5 - - 22 — - Pneumonia 1 1 2 - 1 2 1 3 9 9 29 27 85 1 30 Erysipelas - - - - - - - - - 8 2 10 3 l Dysentery 1 2 1 3 3 19 4 4 5 3 4 3 52 2 - Poliomyelitis - - 1 1 - 6 5 1 1 - - - 15 12 1 Cerebro Spinal Fever - - - - - - - - - - — — - - Measles 13 39 54 68 78 341 12 2 7 - 1 - 615 8 - Whooping Cough 14 16 25 38 41 161 3 2 4 - 3 - 307 5 - London Cases in the Downs Residential Nursery Scarlet Fever - - 1 - - - - - - - - - 1 1 - Pneumonia - - 2 - 1 - - — - - — - 3 - - Dysentery - 4 2 1 1 - - - - - - - 8 4 - Measles 2 - 1 - 1 - - — — — — - 4 1 - Whooping Cough - - 1 - - - - - - - - - 1 - - * Under column "Died" all deaths, whether notified in the district or outside it or not notified at all, are included 39 DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS = (District Cases) DISEASE WARDS Case Rate per 1, 000 population (Mid-year) Case Rate per 1000 England and Wales N. N. W. N. E. W.C. E. C. E. S.W. S.E. S. TOTAL Population:- 9890 9048 11382 12757 7154 7785 6637 5613 8774 79040 Scarlet Fever 15 8 22 19 5 21 15 14 10 129 1.63 1.39 Diphtheria - - - - - - - - - - 0.00 0.01 Typhoid Fever - - - - - - - - - — 0.00 0.00 Paratyphoid Fever - - - - - - - - — — 0.00 0.01 Small Pox - - - - - - - - - - 0.00 0.00 Puerperal Pyrexia - - 1 - - - - 21 - 22 - — Pneumonia 1 5 10 - 6 23 6 10 24 85 1.07 0.84 Erysipelas - 1 1 4 1 2 - - 1 10 0.12 0. 14 Dysentery 3 - 12 18 9 4 3 2 1 52 0.65 — Poliomyelitis 1 - 5 3 - 1 2 - 3 15 0.18 0.11 Cerebro Spinal Fever - - - - - - - - — — 0.00 0.03 Measles 45 31 109 99 40 105 40 75 71 615 7.78 12.36 Whooping Cough 59 27 29 37 28 51 16 21 39 307 3. 88 3. 58 Totals 124 72 189 180 89 207 82 143 149 1235 TUBERCULOSIS On 31st December 1953 there were on the register nine hundred and sixty six cases of Tuberculosls of whom eight hundred and seventeen were Pulmonary cases and one hundred and forty nine non-Pulmonary cases. The total death rate from Tuberculosis was 0.17 per thousand of population, compared with 0.24 per thousand of population in 1958. The death rate for Pulmonary Tuberculosis was 0.14 and for non-Pulmonary Tuberculosis 0.03 per thousand of population. The corresponding rates for England and Wales were Pulmonary Tuberculosis 0.18 and non-Pulmonary Tuberculosis 0.02 per thousand of population. The number of new cases of Pulmonary Tuberculosis was seventy four compared with seventy in 1952. It is of interest to record the numbers of notified cases of Pulmonary Tuberculosis since 1944, a peak, year of war time infections. Year; 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 Cases: 86 71 71 64 50 69 65 74 70 74 The post war decline in notifications proceeded until 1949 when a rise commenced coincident with the introduction of Mass X - Ray and with the inception of the National Health Service giving free access of patient to doctor. The suppression of Pulmonary Tuberculosis will depend on the finding of as many early cases as possible, on their effective treatment so as to reduce the number of foci of infection, and on progress in the provision of good housing to eliminate those social factors which predispose to infection. Cases of non-Pulmonary Tuberculosis are either of bovine or human origin. The danger of bovine infection has been greatly reduced 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 gives advice and help on all social problems related to the disease. Many patients and families in the Borough have been cared for by the provision of clothing and extra nourishment, by the payment of fares to enable relatives to visit Sanatoria, by grants to enable occupational therapy to be continued at home, and by participating in the County Scheme for holidays for children. The service given is highly confidential and cannot be fully publicised, but deserves recognition and support. The work of the members of this voluntary Committee is greatly appreciated. The Hon. Secretary is County Alderman Mrs. Margaret Walkden, J.P., 9, All Saints Road, Sutton. 40 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 - 5 1 5 1 - - - - - 15 12 7 - 1 - - - 25 5 9 1 - - - 1 - 35 8 10 - 2 3 1 1 - 45 7 1 - - 4 - - - 55 7 - - - 1 - - - 65 and above 1 - - - 2 - - - TOTALS 42 32 2 4 10 1 3 - Notification of Tuberculosis Respiratory forms of death - Ten out of eleven cases were notified Other forms of death - One out of three cases was notified MASS RADIOGRAPHY A mass radiography unit visited the Borough from 24th August to 18th September. 1953. A total of five thousand six hundred and sixty 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 a Tuberculosis NonTuberculous abnormalities Males 2115 2 75 76 Females 3553 7 115 70 Total 5668 9 190 146 Incidence per 1,000 examined - 1.6 33.5 25.8 The incidence of 1.6 per thousand persons examined in the Borough compares with 2,0 per thousand in 1952, The average incidence in the County in 1953 was 1,7 per thousand persons examined compared with 2o 1 in 1952. The figures suggest a tendency to decline in the number of undetected cases of active Pulmonary Tuberculosis in the community. A reduction in the number of notified cases would provide confirmation, but this is not yet evident The need for continuing the search for early cases of Tuberculosis is obvious and there is great advantage in finding other abnormalities of the chest which will respond to early advice and treatments Mass Radiography is making a valuable contribution in the reduction of Tuberculosis 41 CLINICS AVAILABLE FOR THE DISTRICT SUTTON AND BELMONT The Clinic, Ho. 1„ Robin Hood Lane, Sutton Ante Natal Clinics 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 Small Pox, By appointment. Methodist Church Hall, Station Road, Belmont Infant Welfare Centre. Every Thursday, at 2,0 p,m, (Including Diphtheria Immunisation, Vaccination against Small Pox, 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 Small Pox, 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 Small Pox, 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 Small Pox 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 Small Pox, by appointment) Wesley Hall, Cheam Common Road. Worcester Park Infant Welfare Centre. Every Friday, at 2 p.m. (Including Diphtheria Immunisation. Vaccination against Small Pox, 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 Small Pox, by appointment) 42 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. 43