SUTC18 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1954 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 54 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR (Alderman D.P. Sullivan, J.P.) Alderman D. SPARKS (Mrs.) M.B.E. " F. WARREN » D. WEBSTER (Miss) J.P. Councillor R.A. BEUZEVAL " D.M. JOHNSON " F. R. MUDDLE " A. N. PERRY Councillor D.M. PETTINGELL (Mrs.) " A. G. TAYLOR (Chairman) " 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 Certlf. R. S. I., Certlf.Meat and Food. Certlf.S. I. Exam. Board Deputy Chief Sanitary Inspector ARTHUR SYDNEY WILLIAMS Certlf.R S.I. Certlf.Meat and Food Assistant Sanitary Inspectors KENNETH HUGH HALSTEAD Certlf. R. S.I, and S.I.E.J.B., Certlf.Meat and Food ('Commenced Duties 10th May, 1954) JOHN ALWYN EVANS JONES Certlf. R. S. I. and S.I.E.J.B., Certlf.Meat and Pood 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 Ftiod FRANK SUTCLIFFE Certlf. R.S.I. and S.I.E.J.B., Certlf.Meat and Food Publ i c Anal yst 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 1954, the twenty first report since Incorporation in 1934, This period of twenty one-years Is of historical Interest In the development of the Public Health services In the Borough. It Includes the early years of adjustment to Increasing population, the static years of war and the post war years of resettlement Notable advances in the sanitary, medical and social services occurred, The efficiency of the basic Public Health services was secured. Water supply has been safeguarded by chlorlnatlon Milk supply has been protected by pasteurisation and designation The services for the disposal of sewage, surface wate- and refuse have been Improved and modernisedAmenities have been preserved and enhanced, The medical services were extended and reorganised, St Heller Hospital was opened. Well equipped clinics were established Free medical treatment became available for all. Medical research evolved new methods for the prevention, diagnosis and treatment of disease. New drugs and antibiotics became available against septic Infections, Typhoid Fever and Tuberculosis Mass X-Ray was popularised. Immunisation suppressed Diphtheria. Vaccines against Whooping Cough and against Tuberculosis were introduced. Greater social security has been provided. Organised Welfare Services have been developed and voluntary organisations have given generous support. Responsibility has been assumed for the care of the sick the crippled and the aged, These advances are reflected in the wellbeing of the people. During 1954 the general health of the community was good,. No major epidemics occurred. The general incidence of infectious diseases was low The birth rate rose from 11.8 to 12.1 per thousand of population The death rate rose from 9.9 to 10.2 per thousand of population, The Infantile mortality rate remained low. There was no maternal death. There was a further decline In the death rate from Tuberculosis, A Mass X-Ray Unit visited the Borough on three occasions and again assisted in the prevention of disease The Council's Housing Programme continued to progress. Daring the year one hundred and seventy six houses were occupied and ninety five houses were in course of erection, Schemes were In progress for ninety four houses. At the end of the year six hundred and eighty four families had been accommodated in new houses- flats and prefabricated bungalows since the end of the war. 3 The general work of 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 maintained a high standard of service. I wish to express my appreciation to him and to the staff of the department. The water supply of the district reached a high degree of chemical and bacteriological purity. Effective control by dally sampling and by chlorlnation 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. 4 STATISTICS OF THE AREA 1953 1954 Area In acres 4338.15 4338.15 Registrar General's estimate of the Resident Population 79,040 79,200 Number of Inhabited houses (end of year) according to the Rate Book 22,887 23,100 Rateable Value and sum represented by a £925,454 £940,735 Penny Rate £3,776 £3,859 EXTRACTS FROM VITAL STATISTICS (Comparative of the Years 1953 and 1954) 1953 1954 England & Wales 1954 Total Male Female > Total Male Female Live Births 938 481 457 959 484 475 Legitimate 908 465 443 919 466 453 Illegitimate 30 16 14 40 18 22 Birth Rate per 1000 of the Estimated Resident Population 11.8 12.1 15.2 Still Births 17 14 3 14 6 8 Legitimate 17 14 3 13 5 8 Illegitimate - - - 1 1 - Rate per 1000 total (live and still births) 17.8 14.3 23.4 Deaths 782 375 407 809 390 419 Death Rate per 1000 of the Estimated Resident Population 9.9 10.2 11.3 Deaths from Sepsis 0 0 Other Maternal Causes 0 0 Death Rate from Maternal Causes per 1000 total (live and still births) 0.00 0.00 0.69 Deaths of Infants under one year of age All Infants per 1000 live births 11.7 18.7 25.5 Legitimate Infants per 1000 legitimate live births 12.1 19.5 Illegitimate Infants per 1000 illegitimate live births 0.0 0.0 5  1953 1954 Deaths from Cancer 149 176 Measles 0 0 " Whooping Cough 0 0 " Diarrhoea 1 2 Percentage of Deaths from certain causes to the total number of deaths 1953 1954 Diseases of the heart and circulation 37.4 37.5 Cancer and mallgiant disease 19.2 21.8 Diseases of the lungs (non-tuberculous) 9.7 9.9 Tuberculous diseases 1.8 1.0 Vascular lesions of the nervous system 14.1 14.4 Congenital malformations 0.3 0.6 Suicide and violence 3.6 2.8 Diseases of the digestive system 2.2 1.6 Infectious diseases 2.0 0.5 Diseases of the kidney 1.9 1.4 Other defined diseases 7.8 8.5 Maternal Mortality. There was no maternal death. The maternal mortality rate for England and Wales was 0.69 per thousand total births, infantile Mortality The Infantile mortality rate was 18.7 per thousand live births, compared with 11.7 per thousand live births in 1953. There were eighteen deaths of Infants under one year, compared with eleven In 1953. Of the eighteen deaths, fourteen occurred In the neo-natal period, within one month of birth, as is shown In the following table of causes and age groups. Causes of Death AGE GROUPS Congenital Abnormality Under 1 month 1-3 months 5-12 months 4 - 1 Prematurity 8 - - Cerebral Haemorrhage 1 - - Pneumonia - 1 - Nephritis - 1 - Asphyxia 1 1 - Totals 14 3 1 6 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1954 M. F. Total i Tuberculosis, respiratory 4 2 6 2 Tuberculosis, other 2 - 2 3 Syphilitic disease - - - 4 Diphtheria - - - 5 Whooping Cough - - - 6 Meningococcal infections - 1 1 7 Acute Poliomyelitis - - - 8 Measles - - - 9 Other Infective and parasitic diseases - 1 1 10 Mallgiant neoplasm, stomach 10 7 17 11 Mallgiant neoplasm, lung, bronchus 35 3 38 12 Mallgiant neoplasm, breast - 20 20 13 Mallgiant neoplasm, uterus - 6 6 14 Other mallgiant and lymphatic neoplasms 51 38 89 15 Leukaemia, aleukaemla 4 2 6 16 Diabetes 1 1 2 17 Vascular lesions of nervous system 29 88 117 18 Coronary diseases, angina 75 51 126 19 Hypertension with heart disease 7 15 22 20 Other heart disease 42 82 124 21 Other circulatory disease 14 17 31 22 Influenza 1 1 2 23 Pneumonia 12 8 20 24 Bronchitis 33 17 50 25 Other diseases of respiratory system 6 2 8 26 Ulcer of stomach and duodenum 9 2 11 27 Gastritis, enteritis and diarrhoea - 2 2 28 Nephritis and nephrosis 6 5 11 29 Hyperplasia of prostate - - - 30 Pregnancy, childbirth, abortion - - - 31 Congenital malformations 5 - 5 32 Other defined and ill-defined diseases 30 39 69 33 Motor vehicle accidents 6 1 7 34 All other accidents 8 6 14 35 Suicide - 2 2 36 Homlcide and operations of war - - - Totals 390 419 809 7 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA NEW LEGISLATION The Slaughterhouses Act, 1954 An Act to make local authorities responsible for the time being for securing that adequate slaughterhouse facilities are available locally; to explain and amend the law with respect to the provision by local authorities of public slaughterhouses and generally to control the licensing, regulation and restriction of private slaughterhouses. The Slaughter of Animals (Amendment) Act, 1954 This Act mainly Implements the recommendation of the Committee of Enquiry into the Slaughter of Horses. It deals with the licensing of premises, Regulations for securing humane conditions, licensing of slaughtermen and the Instantaneous slaughtering on stunning of animals. The Food and Drugs Amendment Act,, 1954 Apart from Section 28 dealing with restriction of private slaughterhouses, this Act does not come into force until a date appointed by the Minister of Food. On this date It is anticipated that this Act, together with other akin legislation, will be consolidated and that new Food Hygiene Regulations will come into operation simultaneously. The Housing Repairs and Rents Act, 1954 This Act makes further provision for the clearance and redevelopment of areas of unfit housing accommodation; and for securing or promoting the reconditioning and maintenance of houses. It amends the existing enactments and deals with houseslet- ln-lodglngs, rent control, etc. The Puerperal Pyrexia (Amendment) Regulations, 1954 The form of notification is amended to Include information on the cause of pyrexia,, 8 REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION The national Assistance Act, 1948 - Section 47 Extension of a Court Order was obtained on 17th March, 1954 for the retention in St. Anne's, Redhill, of a woman aged 74 years. No further action was necessary in this case owing to her increased infirmity, 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 bodies were received and one hundred 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, has Increased but is limited by the distance from the Borough. CLINICS Details of the clinics available in the district are given at the end of this report. SANITARY CIRCUMSTANCES OF THE AREA Water Supply. The water supply Is mainly derived from the deep wells in the chalk of the Sutton District Water Company, situated at Sutton, Cheam and 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 9 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 187.42 Ammonia, free 0.14 Ammonia, Albuminoid 0 Nitrogen in Nitrates 7.76 Nitrogen in Nitrites 0 Oxygen Absorbed 0.04 Chlorine in Chlorides 18.00 Hardness total (grains per gallon) 7.76 Bacteriological Results NO. of Bacteria growing on Agar per ml. for 3 days at 20°c. 3 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 Work. is proceeding on the first stage of the reconstruction of Worcester Park Sewage Disposal Works, and it is anticipated that stage one of the scheme will be complete before the end of 1955. Preparation for the succeeding stages of reconstruction are now in hand. A surface water relief sewer In Stoneleigh Avenue and Sandringham Road was completed during the year, since when no complaints of flooding have been received from this area. 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 four premises with cesspools in use. Some six pall closets are in use. In the past twenty six years. one hundred and sixty one premises. originally with cesspool drainage,, have been connected to sewers. 10 SANITARY INSPECTION OF THE AREA Report of the Chief Sanitary Inspector under Article 27 of the Sanitary Officers (Outside London) Regulations 1935/1951 (Pages 11 to 31) RECORD OF INSPECTIONS HADE AND N0TICES SERVED Visits Special Inspections: Interviews and advisory visits 1,267 Reinspection visits 2,595 Visits to works in progress 536 " Factories and Workplaces 488 " Bakehouses 32 " Outworkers' premises 140 " Butchers, grocers and other food premises 590 " Dairies and Milk Distributors 33 " Ice Cream Premises (manufacture and sale of) 175 " Stables, passages, piggeries and ditches 37 " Restaurant, cafe kitchens, dining rooms 105 " School and industrial canteen kitchens 52 " Premises re. rodent control 9,072 " Tents, Vans and Sheds 7 " Cinemas, Theatres and Halls 21 " Premises re. Infectious diseases 111 ""re. Flood poisoning enquiries 6 " " re. Food complaints (Request inspections) 200 " " re. overcrowding and permitted numbers 279 " Hairdressers1 and Barbers' premises 68 " School and public conveniences 46 " Verminous premises 10 " Shops under the shops Act 465 " Licenced Public Houses 21 " Atmospheric pollution gauges, smoke observations 99 " Premises - Flood and Drugs Act Sampling 171 " " - Bacteriological Milk/Water Sampling 109 " " Bacteriological Ice Cream Sampling 151 " " re. Merchandise Marks Acts 246 " " re. Rag Flock Acts 10 " " re. Pet Animals Act 11 " " re. Heating Appliances (Fireguards Regulatlons) 31 Miscellaneous Visits 1,964 Total 19,148 Number of complaints received and investigated 504 Premises at which defects or nuisances were discovered 1,320 Dwelling-houses surveyed for housing defects under the Public Health or Housing Acts 121 Number of defects or nuisances discovered 1,710 " " " remedied 1,386 " "" in hand 198 " " " outstanding 126 Number of informal notices served 722 11 STATUTORY NOTICES WERE SERVED AS UNDER; Housing Act 1936 Sections 9 and 10 18 (as amended by the Housing Act 1949) Public Health Act 1936, section 24 57 " " " 39 4 " " " 45 1 " " " 58 1 " " " 75 3 Total 64 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT Drainage and Sanitary Fittings Number of houses and other premises redralned 2 Number of houses and other premises connected to soil and surface water sewers 2 Repairs and amendments to existing drains 52 Drains or gullies unstopped or cleansed (involving 842 premises) 282 Sanitary fittings repalred/renewed/provlded or cleansed 332 Water service plpes/clstems/repalred, renewed or cleansed 11 Water, smoke and chemical tests applied 163 W.C. Apartments W. C. Apartments provided 17 " lighted and/or ventilated 8 " provided with ventilated lobbies 4 " cleansed 19 Separate W.C. accommodation provided for the sexes 3 Structural Repairs or Improvements Carried Outs Number of roofs repaired or renewed 92 " guttering and rainwater pipes provided, repaired, etc. 63 " damp walls remedied 42 " brick walls repolnted, repaired or re-rendered 15 " chimney stacks repaired or rebuilt 28 " yards paved or repaired 7 " floors relald or repaired 30 " wlndows/cills/sashcords repaired or renewed 223 " doors/thresholds provided or repaired 17 " staircases/handrails provided or repaired 6 " ranges/stoves/coppers renewed or repaired 31 " Miscellaneous items 1 Cleansing: Number of rooms/passages/larders cleansed and/or repaired 145 " trade premises cleansed 44 " verminous premises dlslnfested for bugs/fleas 10 " premises sprayed for cockroaches/crickets/wood beetles etc. 23 " premises disinfected after various diseases 138 " Canteens sprayed for files and ants 9 Various: Number of dustbins provided 49 " accumulations of refuse and manure removed 24 " offensive ponds and ditches cleared 1 " wasp nests destroyed 78 " miscellaneous items 46 12 HOUSING 1. Inspection of Dwelling-Houses during the Years (1) (a) Total number of dwelling-houses inspected under the Public Health or Housing Acts 121 (b) Number of inspections made for the purpose 247 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 103 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 91 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 16 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By Owners 11 (b) By Local Authority in default of owners 1 (B) Proceedings under the Public Health Act: (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 6 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By Owners 4 (b) By Local Authority in default of Owners - (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 - HOUSING REPAIRS AND RENTS ACT. 1954 This Act came into operation in September 1954 and makes further provision for the clearance and re-development of areas of unfit housing accommodation, for securing or promoting the reconditioning and maintenance of houses and otherwise to amend 13 the enactments relating to housing and the exercise of certain powers relating to land and rent control. During the period September to December 1954, eight applications for certificates of disrepair were received, seven were granted and one withdrawn. INSPECTION OF FACTORIES AND OTHER PREMISES Factories Act 1937-1948 1. Inspections made by Sanitary Inspectors for the purpose of provisions as to health: Type of Premises Number on Register Number of Inspections Notices, written and/ or oral (1) Factories without mechanical power 60 76 13 (2) Factories with mechanical power 328 351 31 (3) Other premises (excluding outworkers premises) 78 61 11 Totals 466 488 55 2 Defects found in Factories and Other Premises under the Act: Particulars Number of cases in which defects were found Referred Found Remedied TO H.M. Inspector By H.M. Inspector Want of cleanliness 7 5 - - Overcrowding - - - - Unreasonable temperature - - - - Inadequate Ventilation - - - - Ineffective drainage of floor 1 1 - - Sanitary Conveniences - (a) Insufficient 8 6 - - (b) Unsuitable or defective 9 8 - - (c) Not separate for the sexes - - - - Other offences against the Act (not including offences relating to outwork) 35 28 1 1 Total 60 48 1 1 WORKPLACES - Public Health Act, 1936 Inspections Number of Written Occupiers and Verbal Notices prosecuted 61 ... 11 SMOKE ABATEMENT The grit deposit gauges have been maintained in the North end of the Borough 14 No Instances of black smoke from the few industrial chlmnles have been observed. INSPECTION AND SUPERVISION OF FOOD Food and Drugs Acts, 1938 to 1954 Sampling. During the year two hundred and seven samples (comprising forty four formal and one hundred and sixty three informal samples) were analysed by the Public Analyst as follows:- type of Food sampled Number of samples examined Unsatisfactory samples Formal Informal Totals Formal Informal Totals Almonds - ground - 1 1 - 1 1 Artificial colour - 1 1 - - - Blackcurrant Syrup - 1 1 - - - Bone and Nerve Liniment - 1 1 - - - Boraclc Acid Powder - 1 1 - - - Butter 5 2 7 - - - Butterscotch - 1 1 - 1 1 Cake - 1 1 - - - Cake Mixture - 1 1 - - - Calamine Lotion - 1 1 - - - Cascara Sagrada - 1 1 - - - Cheese Spread - 1 1 - - - Chicken (Livers and Meat) - 1 1 - - - Chicken Minced - 1 1 - - - Citric Acid - 1 1 - - - Coconut, desiccated - 1 1 - - - Coffee - 1 1 - - - Coffee and Chicory Essence - 2 2 - - - Coffee and Chicory Extract - 1 1 - - - Cooking Fat - 1 1 - - - Cordial- Ginger 1 - 1 - - - Cough Mixture - 1 1 - - - Cream - 7 7 - - - Cream of Tartar - 1 1 - - - Creme - Marshmallow 1 1 - - - Custard Powder - 2 2 - 1 1 Dripping - 1 1 - - - Embrocation - 1 1 - - — Energy Tablets - 1 1 - - - Eye Lotion - 1 1 - - - Flavour - Almond - 1 1 - - - Flavour - Rum - 1 1 - - - Flour - Self Raising - 1 1 - - - Gargle - 1 1 - - - Ginger - 1 1 - - - Glauber's Salts - 1 1 - - - Glucose Tablets - 1 1 - - - Gravy Salt - 1 1 - - ~ Halibut Oil Capsules - 1 1 - - - Honey - 1 1 - - ~ Ice Cream (Chemical) - 11 11 - - — Ice - Frig. - 1 1 - - - Jam - 3 3 - - — Jelly (table) - 2 2 - 1 1 Lard - 1 1 - - Lemons - 1 1 - - — Lemon Curd - 1 1 - - Lemonade Powder - 1 1 - - - Liquid Paraffin - 1 1 - - — Lollies (Sweets) - 2 2 - - — Margarine - 7 7 - 1 1 Margarine - Vegetarian - 1 1 - - - Carried forward: 6 80 86 - 5 5 15 Type of Food sampled Number of samples examined unsatisfactory samples Formal Informal Totals Formal Informal Totals Brought forward: 6 80 86 - 5 5 Marzipan 1 3 4 - 1 1 Milk 23 4 27 - - - Milk - South Devon 2 - 2 - - - Milk - Channel Island 5 - 5 - - - Milk - Condensed - 1 1 - - - Mint Sauce - 1 1 - - - Mouthwash - 1 1 - - - Nutmegs - 1 1 - - - Ointment - Carbolic - 1 1 - - - Ointment - Zinc - 1 1 - - - Oranges - 1 1 - - - Orange Juice - 3 3 - - - Paste - Anchovy - 1 1 - - - Paste - Fish - 1 1 - - - Pasties - Cornish - 1 1 - - - Pastilles - Throat - 2 2 - - - Pate - 2 2 - - - Peanut - Kernels - 1 1 - - - Peas - 2 2 - - - Pepper - 2 2 - - - Pepper Cayenne - 1 1 - - - Pepper White - 1 1 - - - Phosphates Tonic - 1 1 - - - Pie Filling - 1 1 - - - Pie - Ham and Egg - 1 1 - - - Relish Savoury - 1 1 - 1 1 Rennet Essence - 1 1 - 1 1 Saccharine Tablets - 1 1 - - - Sardines - 1 1 - - - Sauce - 1 1 - - - Sauce - Melba - 1 1 - - - Sausages - Beef - 1 1 - - - Sausages - Continental - 1 1 - - - Sausages - Pork 3 - 3 - - - Seldlltz Powder - 1 1 - - - Sherbet Suckers - 1 1 - - - SOUP - 3 3 - - - Soup Mix - 2 2 - - - Spice Mixed - 1 1 - - - Spice Pickling - 1 1 - - - Sponge - 1 1 - - - Steak - Stewed - 1 1 - - - Sugar - 1 1 - - - Sugar - Pieces - 1 1 - - - Sugar - Tinted - 1 1 - - - Sweets - 15 15 - - - Tannic Acid Glycerine - 1 1 - - - Tannic Acid Lotion - 1 1 - - - Tapioca - 1 1 - - - Tartaric Acid - 1 1 - - - Tarts - 1 1 - - - Tomato Juice - 1 1 - - - Tonic Pills (Iron) - 1 1 - 1 1 Turkey Minced - 1 1 - - - Vinegar - 1 1 - - - Whisky 4 - 4 - - - Witch Hazel - 1 1 - - - Zinc Cream - 1 1 - - - Zinc Sulphate Lotion - 1 1 - - - Totals 44 163 207 - 9 9 16 The following details classify the type of irregularity or infringement and the action taken In connection with the unsatisfactory samples. Sample NO. Article Sampled. Infringement Action taken 1794 (Informal) Rennet Essence The sample was of an Inferior quality, and did not form a Junket when prepared according to the printed directions. Virtually useless for the purpose for which it was sold. Warning given regarding the necessity for the periodical examination of stocks liable to deterioration. through prolonged storage. This commodity had been in the shop for over three years. Nine remaining bottles were withdrawn from sale. 1803 (Informal) Relish Savoury The sample of Savoury Relish was of inferior quality. It had deteriorated through age, was not palatable and had developed off-flavours. Warning given regarding the necessity for the periodical examination of stocks liable to deterioration through prolonged storage. The sample was taken from stock admitted to be at least two years old. No remaining stocks on premises. 1819 (Informal) Custard Powder Sample submitted on account of complaint that the powder had a 'carbolic' smell. Public Analyst reported that the objectionable smell and taste were associated with the flavourings used and not as a result of contamination with soap or other impurity. Few remaining packets withdrawn from sale. 1843 (Informal) Iron Tonic Pills (Blaud's) Labelling Infringement The pills had been prepared in the traditional manner in accordance with the British Pharmacopoeia 1948, but Blaud's Pills have been deleted from the current British Pharmacopoeia 1953 and therefore not correct to refer to them on the label as B.P Labels changed to conform with the observations made by the Public Analyst. 1849 (Informal) Marzipan Sample contained 12% of ground almonds. Marzipan is basically a mixture of ground almonds and sugars. A reasonable minimum content of ground almonda is 20%. Retailer admitted that a small amount of fondant was sometimes mixed with the marzipan to make It "easier to work" and it was possible that the "mixture" had been sent in error to the branch shop from which the sample was taken. A further sample was taken and found to be satisfactory. 17 Sample No. Article Sampled Infringement Action taken 1874 (informal) Vitaminised Margarine Sample contained 2.750 parts per million of boron preservative which is 10% in excess of the prescribed maximum proportion allowed in the Public Health (Preservatives etc. in Food) Amendment Regulations 1953. The sample was also slightly rancid. Complete withdrawal of all remaining stocks in various branch shops. 1885 (Informal) Butterscotch Labelling Infringement Sample contained 3.7% of butter-fat. Under the code of practice agreed Between the Ministry of Food and representatives of the chocolate and sugar confectionery trade, where the word "Butter" or a synonym is used without qualification in the description of sugar confectionery, the butter-fat content of the products shall not be less than 4%. The manufacturers had included well over 4% of dairy butter - the ingredient mentioned on the label - but had not allowed for the normal moisture and sal't content of butter, which reduces the actual butter-fat content to only about 84% of the butter used. It was stated on behalf of the manufacturers that all possible steps would be taken in future to ensure a satisfactory product. 1917 (Informal] Ground Almonds This sample contained 10% of sugar. It was stated that the ground almonds had been stored in a container which previously contains sugar, and this may account for the presence of sugar in the sample. 1936 (Informal) Table Jelly The Jelly failed to satisfy the setting test, and did not produce a clear Jelly sweet owing to the presence of a small quantity of organic debris and miscellaneous dirt.. Due to certain variations between the declared minimum net weight on the packages and the actual weight of the contents of the informal and repeat samples, the Public Analyst found it was not possible to fulfil the requirements of the Food Standards (Table Jellies) Order in carrying out the setting test. This difficulty will no doubt be overcome when the Food and Drugs Amendment Act 1954 comes into force, as it will then be possible to submit complete packages or containers as formal samples. 18 Sampling Observations. It will be seen from the detailed classification that of the two hundred and seven samples taken during the year 2.89 per cent were found to be other than genuine, and minor irregularities accounted for a further 1. 44 per cent, making a total of 4, 33 per cent. For comparative purposes the figures for 1953 were 2.83 per cent and 1.88 per cent respectively with a total of 4.71 per cent. Having regard to the wide variety of articles sampled it is gratifying to record that the observations and infringements reported by the Public Analyst have in the main been of a generally minor character. Comments by the Public Analyst. Food and Drugs Act and Relevant Regulations andOrders, 1954 "There is a special function of the Public Analyst which is exemplified by several samples which I have had occasion to report against during the course of the year. The nature or quality of an article can be assessed in a number of different ways and a particular food can fall so low in quality that it ceases to be of the minimum standard acceptable by the Public. This falling off innature or quality can be due to deterioration on storage, to the use of unsuitable ingredients, or to the inclusion of a deficiency or excess of a particular incredient. All three of these factors can result in Justifiable complaints and the Public Analyst (by virtue of his special training) can often safeguard the interests of the public by anticipating this falling off in quality and thereby preventing future sale to the prejudice of the purchaser. No fewer than five of the nine 'adulterated' samples this year were found to fall to reach a reasonable minimum of quality. The essence of rennet did not make a proper Junket, the savoury relish was quite unpalatable due to staleness, the custard powder had a soapy taste due to an unsuitable flavouring, the margarine was slightly rancid, and the table Jelly crystals did not make a Jelly that would set properly. Again, quantitative standards of quality only exist for a restricted number of foods and for others the case for a minimum is Judged by ordinary commercial practice, tradition, and what the purchaser expects to get. Ultimately this question has to be put to the test by asking magistrates to adopt a certain standard, but that put forward by a public analyst, as a reasonable minimum, is often accepted without much dispute. This year has been the passing into law of the Food and Drugs (Amendment) Act, 1954, which will provide means for stricter control of the addition of chemical substances to foods and of general hygiene in relation to the preparation of food." 19 MILK SUPPLY Food and Drugs Acts 1938 to 1954 Milk and Dairies Regulations 1949-1953 The Milk (Special Designation)(Raw Milk) Regulations 1949 to 1954 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 1954:- Grade of Milk TYPE OF LICENCE Dealers Supplementary Pasteuriser's Tuberculin Tested 10 11 _ Tuberculin Tested (Pasteurised) 8 1 _ Pasteurised 19 11 1 Sterilised 35 12 _ Totals 72 35 1 Examination of Milk Samples One hundred and twenty Six samples of milk were examined as follows:- Class of Milk Number of samples examined. Test applied Results Passed Filled Pasteurised 64 Phosphatase 64 - Methylene Blue 64 - Sterilised 11 Turbidity 11 - Tuberculin Tested (Pasteurised) 15 Phosphatase 15 - Methylene Blue 15 - Tuberculin Tested (Farm Bottled) 36 Methylene Blue 33 3 Totals 126 123 5 In order to comply with the Milk. (Special Designation) (Raw Milk) Regulations 1949 to 1954, Tuberculin Tested Milk, must not decolourise Methylene Blue within 4½ hours if the sample is taken from 1st May to 31st October, or within 5½ hours if taken from 1st November to 30th April. It is pleasing to report that of the one hundred and twenty six samples taken only three failed to pass the prescribed tests. Two of these samples were taken during the 4½ hour test 20 period, and decolourised methylene blue in three hours and four hours respectively. The other, taken during the five hour period, decolourised methylene blue in 4½ hours. In the case of farm bottled milk. it is the practice immediately to notify the proprietors of the dairy of any failure, and they in turn take the matter up with the responsible producers. During the year the pasteurisation of milk ceased at one of the two pasteurising dairies in the Borough and the plant has been removed. CHEMICAL ANALYSIS OF MILK AND CREAM SAMPLES Thirty formal and four informal milk samples have been taken for chemical analysis. The milk samples contained satisfactory averages of 3.7 per cent milk fat and 8.8 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. Seven informal samples of cream submitted for analysis were found to be satisfactory. BIOLOGICAL MILK SAMPLES (FARM BOTTLED MILK) Eleven samples of Tuberculin Tested Milk were taken for biological examination. In all cases the guinea pigs inoculated with the milk failed to show any signs of tuberculous infection on post mortem. ICE CREAM Ice Cream (Heat Treatment etc.) Regulations 1947-1952 Registrations. At the end of 1954 a total of one hundred and eighty six 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. At the present time only a small amount is made at two premises. Durliig the. year seven applications for the registration of premises for the sale of ice cream were received and granted. 21 BACTERIOLOGICAL SAMPLING OF ICE CREAM One hundred and six samples of ice cream were taken for bacteriological examination and provisional grading. The following table shows the percentage results for the various grades in 1954, and for comparative purposes the result obtained from the ninety eight samples taken in 1953:- 1954 1953 Grading of Samples Grading of Samples Grade 1 81 samples 76.41% Grade 1 82 samples 83.67% " 2 12 " 11. 32% " 2 6 " 6.12% " 3 8 " 7.54% " 3 8 " 8.16% " 4 5 " 4.71% " 4 2 " 2.04% 106 samples 98 samples The bacterial purity of the ice cream sold in the Borough has been maintained at a relatively high standard. The following table shows the grading percentages and other details in connection with the samples obtained from individual manufacturers:- Code Number of Samples taken Number of Samples sold Percentage in each Grade Wrapped Loose 1 2 3 4 A X 15 - 15 60.00% 20.00% 6.66% 13.33% B X 1 1 - 100.00% - - - C 13 10 3 100.00% - - - D 20 19 1 100.00% - - - E 20 15 5 80.00% 20.00 % - - F 2 - 2 100.00% - - - G 2 2 - 100.00% - - - H 13 2 11 30.76% 23.07% 30.76% 15.38% I 5 - 5 60 00% - 20.00% 20.00% J 2 1 1 50.00% 50.00% - - K 1 1 - 100.00% - - - L 1 1 - 100.00% - - - M 4 3 1 100.00% - - - N 1 1 - - 100.00% - - 0 4 4 - 50.00% - 50.00% - P 2 - 2 100.00% - — — TOTAL S 106 60 46 76.41% 11.32% 7.54% 4.71% X Denotes locally produced. CHEMICAL SAMPLING OF ICE CREAM The Food standards (Ice Cream) Order 1953 prescribes (with certain 'exceptions) the following standard for ice cream:Fat 5%: Sugar 10%: and Milk Solids other than fat 7½%: 22 The following table shows that eleven samples were submitted to the Public Analyst for analytical examination. The results reveal that the average constituent percentages were well above the required standard. Producers Code Number of Samples Fat Sample constituent percentages Milk solids other than fat Sucros Total solids A X 1 10.6% 11.5% 13.00% 13.0% B 2 9.2% 10.1% 15.7% 17.2% C 2 10.4% 8.7% 14.1% 17.9% D 3 8.8% 11.8% 12.7% 14.0% E 1 11.9% 10.6% 15.3% 16.3% F 1 8.6% 9.7% 13.9% 19.3% G 1 11.9% 6.2% 13.0% 17.2% Averages 11 10.2% 9.8% 13.9% 16.4% X Denotes locally produced ICE LOLLIES - BACTERIOLOGICAL EXAMINATION The Food Standards (Ice Cream) Orders do not prescribe a standard for water ices or ice lollies sold as such. In view of the absence of such a standard and the increasing public demand for ice lollies, it was considered advisable as in former years to submit various samples of ice lollies to a bacteriological test similar to the one applied to ice cream. Fifteen samples were examined and all were placed in provisional Grade 1. MEAT AND OTHER FOODS Food Shops, The fifty five 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 twelve cases where the sanitary conditions were not satisfactory, or certain contraventions of the Regulations existed. Forty eight butchers' premises are registered in accordance with Section 14 of the Food and Drugs Act i938 mainly for the manufacture of sausages. A further eight food premises are registered in connection with the preparation of potted, pressed, pickled or preserved foods. 23 Ninety one cases of insanitary or defective conditions found to exist in food shops other than butchers shops were remedied. 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 Primary Inspections Bakehouses 18 32 Butchers (including two horseflesh shops) 55 96 Confectioners (Sugar and flour) 145 148 Dairies and Milk Distributors 32 33 Dining Rooms/Snack Bars/Coffee Stalls 7 13 Fishmongers/Fried Fish 35 52 General shops and multiple stores 26 30 Grocers 133 138 Greengrocers/Stalls 89 119 Ice Cream (Sale of) 186 175 Licenced public houses 36 21 Restaurants/Cafes 67 105 Totals 829 962 The following table shows the number and type of food premises registered under the Food and Drugs Act 1938 to 1954. A - Number of premises registered under the Food and Drugs Act, for the preparation or manufacture of preserved foods. B - Number of premises registered under the Food and Drugs Act and the Milk and Dairies Regulations 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 Floods Milk Ice Cream Grocers 9 3 24 Grocers (Milk Distributors) - 27 8 Dairies - 4 3 Milk Depots - 4 - Butchers 48 - - General Shops/Multiple Stores - 4 10 Frulterers/Greengrocers - - 5 Confectioners (Sugar and Flour) - - 87 Cafes/Restaurants/Dining Rooms - - 40 Ice Cream Manufacturers - - 6 Sundry Premises - - 3 57 42 186 24 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 six infringements discovered during the year were of a minor character. 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 Apricots (Dried) 27½ - - - Beans/Peas - 150 12 - Biscults/Ryvita 4 2 - 13 Cereals 26 8 - 32 Cheese/Butter 7 1 5 37 Chickens - - - 12 Coffee/Chicory Essences - 3 - - Confectionery 9 4 - 103 Culinary Mixtures/Powders - 3 5 24 Dates - - - 2 Drinking Chocolate - 3 3 2 Eggs - 1 - 360 Fish (Tinned) - 110 - - Fish (Wet and Dry) 214½ - - - Flour - - - 4 Fruit Juices/Purees - 25 5 - Fruit/Vegetables 38½ 822 7 - Ham 27¼ 14 - - Hors d'oeuvres - 16 - - Jam/Marmalade/Syrups - 89 20 - Jellies/Crystals - 4 - 2 Liver/Kidneys 207½ 2 - - Meat (Home Killed) 924¾ - - - Meat (Imported) 940 - - - Ox Tall/Suet 39 - - 13 Pies - - - 33 Puddings - 9 6 3 Rennet/Pastes (Fish and Meat) - 32 4 - Sausages 43 2 - - Soups/Pickles/Sauces - 47 15 - Spaghetti - 13 - - Tinned Meats 3½ 73 - - Tinned Milk/CreaM — 94 ~ - Totals 2511½ 1527 82 640 25 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 1954. BAKEHOUSES There are eighteen bakehouses in the Borough, of which seventeen are provided with mechanical power. The standard of cleanliness and the sanitary conditions in the majority of cases were found to be satisfactory. Thirty two primary visits of inspection during the year resulted in six infringements being discovered and rectified. SHOPS ACT Four hundred and sixty five visits were made to various premises under the Shops Act and revealed that satisfactory arrangements for the health and comfort of the shop workers were made with few exceptions. SCHOOLS The sanitary conditions and the water supply to the Schools in the area are generally satisfactory. HAIRDRESSERS' AND BARBERS' PREMISES The sixty four establishments in the Borough were inspected during the year. The general standard prevailing is good, as revealed by the discovery of only eight minor infringements of the Hairdressers and Barbers Byelaws 1947. MERCHANDISE MARKS ACT Two hundred and forty six visits were made to food premises under this Act. The infringements discovered were mainly in connection with the marking of imported apples, tomatoes, and Imported dead poultry. 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. 26 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 of licences to store rag flock, were received and granted in 1954. Ten primary visits of inspection were made during the year to the nine registered premises in the Borough. 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 applications for renewal of licences were received and granted during 1954. 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 four minor defects found. The general standard of cleanliness was good. LICENCED PUBLIC HOUSES Twenty one visits of inspection were made to licenced public houses in the Borough. Originating from the complete survey of public houses made in 1951, many further substantial and varied improvements have been carried out to individual houses in the form of reconstructlonal work, the provision of additional sanitary conveniences, baths, washbasins, hot water supply and also the more general use of detergents and sterilising agents for the washing of utensils, glasses, beer pipe lines and pumps. HEATING APPLIANCES (FIREGUARDS) ACT 1952 The Heating Appliances (Fireguards) Regulations 1953 made under the above Act, came into operation in October 1953. The Regulations apply to any heating appliance - gas fire, electric fire, or oil burner - of a type which is so designed that it is suitable for use in a dwelling house or other residential premises. 27 The Regulations require that every appliance shall be fitted with a guard which is robustly made and of such construction and fitting that it satisfies the prescribed tests. Thirty one visits were made to premises which sold heating appliances. This involved the carrying out of numerous tests on the many types and designs of heaters offered for sale. In one case only were the guards found not to comply with the Regulations and in this instance the manufacturers withdrew all stocks from sale. DISINFECTION AND DlSINFESTATION Council Houses Private Houses Other Premises Number of houses treated with insecticide for bugs and fleas 3 7 - Nine 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 Treatment (1) Eight thousand five hundred and fourteen visits were made during the year by the Rodent Operators and five hundred and fifty eight by the Sanitary Inspectors to premises infested or possibly harbouring rats or mice. Four hundred and eighty four 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 515 Number of premises found to be infested 486 Number of premises where no evidence of rodents found 29 Number of premises cleared of rats or mice (including 92 previous year's cases) 484 Number of premises still being treated at the end of the year 107 28 (3) The cause or site of infestation at the four hundred and eighty six infested premises was:- Keeping of poultry 68 Inside premises (under floors etc.) - rats 17 Inside premises (under floors etc.) - mice 65 Buries, scrapes etc. in gardens, land etc. 183 Under or inside sheds 168 Defective drains 5 Accumulations of refuse etc. 3 Total 509 (4) of property found to be infested:- With Rats With Mice Total Council property 5 - 5 Dwellinghouses 400 40 440 Business premises etc. 17 12 29 Schools, Hospitals, Canteens etc. 3 7 10 Land 2 — 2 Total 427 59 486 (5) Summary of the type of premises and methods employed in clearing premises of rats and mice:- Type of Premises cleared Dwellinghouses (mainly in gardens) 428 Food shops and food premises 16 Non-food shops 6 Waste land 3 Hospitals and Schools 10 Factories and Workplaces 10 Council Premises 8 Miscellaneous 3 Total 484 Methods employed in clearing four hundred and eighty four premises of rats and mice. Poison baits 476 Trapping 11 Gassing 18 Rat and Mouse Proofing 5 Accumulations removed 1 Other means 5 Total 516 29 B - Sewer Treatments (1) Treatment No. 16 - Second Maintenance Treatment (1953-1954) The second maintenance treatment of soli 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 (1953-54) was completed on the 17th March, 1954. Prebaiting with damped sausage rusks was carried out on two consecutive days and the same bait base with 2½ per cent Zinc Phosphide added was laid on the third day with the following results:- SECTIONS A B C D E Total Number of Manholes prebaited 17 6 82 86 31 222 Complete prebait takes 1 - 7 3 6 17 Partial prebait takes 1 - 13 3 8 25 Percentage of takes C. and P.) 11.7 - 24.4 6.9 45.1 18.9 Number of manholes poison baited 5 - 29 14 18 66 The number of prebait takes shew a further decrease of 6.0 per cent on the previous maintenance treatment. (2) Test Baiting (1954-55) 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 previously 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 13 25 70 62 30 200 Complete bait takes 5 - - 8 5 18 Partial bait takes 1 - - 4 1 6 Baits not taken 7 25 70 50 24 176 (3) Treatment No. 17 - First Maintenance Treatment (1954-55) 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 per cent Test, and operations were completed on the 9th October, 1954. 30 Prebaiting with clamped bread-rusks was carried out on two consecutive days and the same bait base with 10 per cent Arsenious Oxide added was laid on the third day. The following is a tabulated summary of the results:- SECTIONS A B C D E Total Number of Manholes prebaited 54 Not baited. 57 102 67 280 Complete prebait takes 8 10 10 10 38 Partial prebait takes 5 11 6 8 30 Percentage of takes (C. and P.) 24.0 36.8 15.6 26.8 24.2 Number of manholes poison baited 27 31 27 25 110 The number of prebait takes shews a slight increase of 3.8 per cent on the previous maintenance treatment. N. B. It was not necessary to bait Section B since there were no prebait takes on two previous treatments. KEY TO SECTIONS Section "A" - Sutton - all roads south of 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. 31 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Four hundred and twenty five cases of infectious diseases were notified during 1954. a decrease of eight hundred and twenty seven cases. There was a lower incidence of Measles, Whooping Cough, Scarlet Fever, Pneumonia, Dysentery and Poliomyelitis. Three cases of Cerebro Spinal Fever occurred. Scarlet Fever, Eighty two cases were notified, a decrease of forty eight cases. The case rate was 1.04 per thousand of population, compared with 0.96 per thousand of population for England and Wales. The disease was generally mild. There was no death. Diphtheria No case was notified in 1954, One adult carrier was detected and treated. Diphtheria is still dangerous. Diphtheria Antitoxin. The early diagnosis and early antitoxin treatment of Diphtheria are essential to prevent mortality. On suspicion of infection the patient must be given antitoxin at once or admitted to hospital forthwith for observation and treatment. The toxin quickly becomes fixed in muscle and nerve tissue with serious results. The urgent need for antitoxin treatment of Diphtheria must always be remembered. Diphtheria immunisation Immunisation has provided a high degree of safety from Diphtheria, but there is still a residual incidence and mortality as is shown in the following statistics for England and Wales. Year Cases Deaths 1944 23,199 934 1954 182 9 A very large number of lives have been saved by immunisation. It should be possible to eliminate incidence and mortality by a cooperative effort. Every parent has a duty to secure the primary immunisation of the baby before the first birthday and to ensure that immunisation is sustained by reinforcing injections before the child enters nursery school or day school. Further reinforcement is necessary at the age of eight to nine years. Immunisation is available to every child, free of charge, either through the family doctor or at the nearest Child Welfare Clinic During 1954 nine hundred and fifty 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 Number: 355 382 35 27 20 122 7 2 950 A survey at the end of 1954 of the state of immunisation 32 of nine hundred and thirty eight babies born in 1953 showed that five hundred and seventeen, representing 55 per cent, had been immunised. Of the children under five years of age, two thousand six hundred and ninety, representing 57 per cent, had been immunised. Of the school children of five to fourteen years of age, seven thousand and six, representing 65 per cent had been immunised and sufficiently reinforced and two thousand and fifty three, representing 19 per cent, previously immunised required further reinforcement. During 1954 one thousand eight hundred and sixty one reinforcing injections were given. Measles One hundred and seventy cases of Measles were notified, a decrease of four hundred and forty nine cases. A minor epidemic occurred from January to April. The case rate was 2.15 per thousand of population, compared with 3.32 per thousand of population for England and Wales. There was no death. The monthly incidence of notified cases is shown in the following table. January 75 July 6 February 36 August 7 March 20 September 2 April 19 October - May - November 1 June 2 December 2 Measles is caused by a virus against which there is no specific drug. The Sulphonamldes and Penicillin have reduced complications from secondary infections. There is always a danger that an occasional child may fall to react adequately to the infection and careful nursing and careful convalescence are necessary, The young baby and the weakly child should be protected frcm acquiring infection, The illness can be prevented or greatly modified by injecting Gamma Globulin early in the incubation period A limited quantity of Gamma Globulin is available for cases where there is a special risk. Whooping Cough. Eighty one cases were notified in 1954, compared with three hundred and eight cases in 1953 There was a low prevalence throughout the year. The case rate was 1.02 per thousand of population, compared with 2.39 per thousand of population for England and Wales- There was no death. The monthly incidence of notified cases is shown in the following table. January 10 July 2 February 8 August 8 March 4 September 8 April 4 October 6 May 4 November 13 June 12 December 2 33 Whooping Cough is now the most serious infectious disease of early infancy-, There is always a danger of mortality in very young or weakly babies. The residual effects of infection are liable to cause impairment of the lungs and the physical development of the child may be retarded. A vaccine which will prevent or modify the illness is now available. The immunisation of babies should be commenced at the fourth month of age and can be combined with Diphtheria immunisation. Parents should ensure that all infant children in the family are immunised against Whooping Cough at once and that any child about to enter school is immunised before entry. If immunity of the children in the infant schools can be achieved the spread of Whooping Cough will be reduced and babies will be more secure from infection in the homes. A modified attack of Whooping Cough in an immunised child is often difficult to diagnose. The child can transmit infection while the cough persists. If contact with Whooping Cough is known or suspected it is a wise precaution to isolate the child for a few days until the cough disappears. Immunisation against Whooping Cough. immunisation against Whooping Cough is available free of charge for children under five years of age, through the family doctor or at Child Welfare Clinics. in 1954 seven hundred and five children received immunising injections. The material used was 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. Small Pox. No case was notified Vaccination against Small Pox. The voluntary response to infant vaccination should be greatly increased. Vaccination in infancy between the third and sixth month of age, is safe and provides a sound basic immunity which can be reinforced by revacclnatlon at a later age without undue reaction. It would be advantageous to introduce a scheme for the revacclnatlon of school children when a higher percentage of primary vaccinations in infancy is attained. The defences against Small Pox must be strengthened and the opportunity is offered to mothers to raise the number of infant vaccinations to a high level. The service is free of charge and is available through medical practitioners and Child Welfare Clinics. in 1954 five hundred and fifteen babies under the age of one year were vaccinated. The percentage of 54, 3 compares with 53.3 in 1953 and 53,2 in 1952. 34 The following table shows the number of vaccinations during 1954. Age No, Vaccinated No. Re-Vaccinated Under 1 515 - 1 33 - 2 11 - 3 12 1 4 9 2 5-9 13 7 10-14 7 9 Over 15 43 178 Totals 643 197 Puerperal Pyrexia- Fifteen cases were notified in 1954, compared with twenty two cases in 1953. The 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 occurred within fourteen days after childbirth or miscarriage". The early notification of Puerperal Pyrexia is of primary importance in the prevention of maternal mortality. Medical practitioners should make the fullest use of the consultant, bacteriological and hospital services and ensure the effective isolation of any case suspected of infection and occurring in a maternity or nursing home. Typhoid and Paratyphoid Fever. No case was notified. Dysentery. Twenty four cases were notified in 1954, compared with sixty cases in 1953. Twenty two were of the Sonne type and were sporadic. Two were of the Flexner type. One was related to an outbreak outside the Borough and the other to residence abroad. Sonne Dysentery is a highly infectious form of gastro enteritis, and is spread by faecal contamination of hands and food. Many of the cases are mild and transient, but some are severely prostrated. The possibility of this infection should always be considered in mild cases of diarrhoea, particularly in food handlers. Prevention lies in the thorough disinfection of w„Cs. and in the thorough washing of hands before the preparing or eating of food. Food Poisoning. Ten cases were notified. All were sporadic. Five contracted infection outside the Borough. 35 Seven were due to Salmonella Typhi Murium and one to Staphylococcus Aureus. No. of Cases NO. Of Deaths Organism or Agent Food involved 1 - Not ascertained Not ascertained 1 - S. Typhi Murium Not ascertained 1 - S. Typhi Murium Not ascertained 1 - S. Typhi Murium Duck's egg 1 - S. Typhi Murium Meat pasty 1 - S. Typhi Murium Not ascertained 1 - S. Typhi Murium Saveloys 1 - S. Typhi Murium Meat Pie 1 - Staphylococcus Aureus Roast. Turkey 1 - Not ascertained Pork luncheon meat The occurrence of cases of Food Poisoning is a reminder of the need for constant care in the handling and storage of food. The frequency of cases is an index of faulty handling or the careless exposure of food to bacterial contamination. Particular attention must be paid to those foods which are to be eaten without further cooking, Processed or cooked meats are the source of a high proportion of cases, They must be protected by indirect handling with clean instruments, covered to prevent contamination and kept cold to inhibit bacterial growth. Slow cooling and the keeping of cooked foods overnight in a warm kitchen create conditions favourable to bacterial growth. The danger from duck's eggs, which may contain Salmonella Typhi Murium, must be emphasised. These should only be used in the preparation of foods which require prolonged cooking at high temperatures. They must be boiled for fifteen minutes to give absolute safety. This type of infection has Its origin in mice and the elimination of mice from food stores. shops and kitchens is essential for the prevention of food poisoning. in man the carrier state can follow even mild infection. It is Important that workers in food shops who suffer from mild gastro enteritis should have tests to ensure that they are free from infection. The washing of hands after the use of the W.C. is the simplest and most effective measure against the infection of food by intestinal organisms. The care of the hands includes the care of the nails and the clean covering o f abrasions which may easily become infected with Staphylococci from the skin or nose. Staphylococcus is a common organism of the skin of the hands and of the nostrils and can produce a powerful toxin in food which causes severe gastro enteritis. Food must be protected from all sources of contamination. This demands a high standard of control and supervision. Cerebro Spinal Fever. Three cases were notified during the Autumn in 1954 The first was a visitor aged twenty years, who took seriously 111 after arrival and recovered with treatment. The second was a child aged 4½ years with a congenital defect of the heart, who recovered temporarily but died subsequently 36 The third was an infant of fifteen months, who died from an acute fulminating attack within twelve hours of onset. There was no evidence of interconnection.' Cerebro Spinal Fever is due to the Meningococcus and is a severe infection with danger of mortality. There are seasonal rises in the incidence of cases and of carriers. Early treatment with Sulphonamlde is essential. Poliorayelitis. Two cases were notified in 1954, compared with fifteen cases in 1953. one was a boy aged seven years with paralysis of the left arm. The other was a girl aged eighteen years with paralysis of the muscles of the back. Both recovered. A considerable advance has been made in our knowledge of the virus of Poliomyelitis. Medical research gives a prospect of an efficient vaccine which will produce Immunity and prevent paralysis. Until a safe vaccine is available we must adopt preventive measures to avoid infection and protective measures to reduce the risk of paralysis. It is known that the infection is inhaled and ingested and that multiplication of the virus occurs in the pharynx and in the bowel. It has been estimated from investigations that forty per cent of direct contacts with cases carry infection in the bowel. Some abortive cases with very mild Illness are not recognised as Poliomyelitis and contacts may be unaware of their infection. Therefore very strict cleanliness is necessary to reduce the transference of faecal contamination. Contacts of known or suspected cases should avoid over exertion and secure adequate sleep. Tiredness, either physical or emotional, predisposes to illness and to paralysis. Minor illness occurring in a person who has had contact with Poliomyelitis requires rest in bed until recovery. Pneumonia. Of twenty deaths from Pneumonia three were notified before death. The total number of notified cases was thirty nine compared with eighty eight in 1953. infestations. Eleven cases of Scabies and eight cases of infestation by lice were treated. The number of attendances at the clinic for treatment was fifty six. This compares with five cases of Scabies and ten cases with Lice and fifty five attendances for treatment in 1953. Non-Notifiable Diseases. School teachers reported two hundred and twenty three cases of Chicken Pox, two hundred and seventy six cases of Mumps and two cases of German Measles. School notifications are a useful indication of the prevalence of non-notiflable diseases and form a basis for consultation with the school medical officer. 37 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1954 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 4 10 6 51 10 - - - - - 82 24 - Diphtheria - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - — - Typhoid Fever - - - - - - - - - - - - - - - Paratyphoid Fever - - - - - - - — - — - - - - Puerperal Pyrexia - - - - - - - - 12 3 - - 15 - - Pneumonia - - - - - 5 - - 3 8 13 9 38 3 20 Erysipelas - - - - - - - - - 1 7 1 9 2 - Dysentery 1 1 - 2 1 4 2 1 6 2 - 1 21 4 - Poliomyelitis - - - - - 1 - 1 - - - - 2 1 - Cerebro Spinal Fever - 1 - - 1 - - - i - - - 3 3 1 Measles 3 9 11 17 11 105 11 - 2 1 - - 170 3 - Whooping Cough 5 5 7 8 17 35 1 1 1 - 1 - 81 4 - London Cases in the Downs Residential Nursery Pneumonia - - 1 — - - - - - - - - 1 - - Dysentery - 1 1 - - - - 1 - - - - 3 3 - *Under column "Died", all deaths, whether notified in the district or outside it, or not notified at all, are included. 38 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:- 9820 9021 11308 12631 7167 7777 6927 5730 8819 79200 Scarlet Fever 11 8 12 13 8 8 8 6 8 82 1.04 0.96 Diphtheria - - - - - - - - - - 0.00 0.00 Smallpox - - - - - - - - - - 0.00 0.00 Typhoid Fever - - - - - - - - - - 0.00 0.00 Paratyphoid Fever - - - - - - - - - - 0.00 0.00 Puerperal Pyrexia - - 1 - - - 14 - 15 - - Pneumonia 2 2 4 4 3 7 8 4 4 38 0.48 0.59 Erysipelas 3 1 1 1 2 1 - - - 9 0.11 0.12 Dysentery - 2 3 3 1 5 3 1 3 21 0.27 - Poliomyelitis - - - 1 - - 1 - - 2 0.03 0.04 Cerebro Spinal Fever - 1 - 2 - - - - - 3 0.04 0.03 Measles 10 13 28 2 9 37 31 7 33 170 2.15 3.32 Whooping Cough 20 4 5 5 13 10 7 4 13 81 1.02 2.39 Totals 46 31 54 31 36 68 58 36 61 421 39 TUBERCULOSis On 31st December 1954 there were on the register nine hundred and thirty six cases of Tuberculosis, of whom seven hundred and ninety seven were Pulmonary cases and one hundred and thirty nine non-Pulmonary cases. The total death rate from Tuberculosis was 0.11 per thousand of population, compared with 0.17 per thousand of population in 1953. The death rate for Pulmonary Tuberculosis was 0. 08 and for non-Pulmonary Tuberculosis 0 03 per thousand of population. The corresponding rates for England and Wales were Pulmonary Tuberculosis 0,16 and nonPulmonary Tuberculosis 0.02 per thousand of population. The number of new cases of Pulmonary Tuberculosis was sixty one, compared with seventy four in 1953. This reduction in the number of new cases may indicate a lessening of infection. The intensive work of the Chest Physicians at Clinics and with Mass Radiography Units is achieving success in the diagnosis of early cases which can be cured and new drugs and advances in chest surgery are reducing the lnfectlvlty of more advanced cases. Seven cases of non-Pulmonary Tuberculosis were notified, compared with six in 1953. These cases represent infections of glands, bones and Joints, and serous membranes. They are caused either by the bovine or human type of bacillus. The incidence of bovine infections has been greatly reduced by pasteurisation and designation of milk. A scheme for protective B. C. G. Vaccination against Tuberculosis for school children at the age of thirteen years was introduced in 1954. The response was good. It is important that the adolescent who is most liable to the acute pneumonic type of the disease should be protected by B.C.G. Vaccine. Elimination of the disease is dependent on progressive improvement in housing and social conditions. The Tuberculosis Care Committee has continued to give help to many patients and many families in the Borough. Extra nourishment, comforts and clothing are very important to those whose incomes are reduced by Illness. During recovery patients need encouragement and support. Relatives are helped to visit patients regularly by payment of fares. The children are given holidays. Grants are made to enable convalescent patients to continue occupational therapy or to provide training in new occupations suitable to their disability. Tuberculosis is often a long illness requiring prolonged treatment before cure is effected. The help given by the Care Committee removes anxieties and accelerates cure. The services of the members are highly 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 - - - - - - - - 5 - - 2 1 - - - - 15 12 14 - 1 - - - - 25 8 6 - - - 1 1 - 35 1 5 - - - - - - 45 4 2 - 2 1 1 - - 55 2 4 - - 3 - - - 65 and above 3 - 1 - - - 1 - TOTALS 30 31 3 4 4 2 2 - Notification of Tuberculosis Respiratory forms of death - Five out of six cases were notified. Other forms of death - None out of two cases was notified. MASS RADIOGRAPHY A Mass Radiography Unit visited the Borough on three occasions during 1954. The Unit was stationed at Elmcroft Pavilion, London Road, North Cheam, from 6th May 1954 to 28th May 1954, at North Cheam Baptist Church Hall, Ridge Road, Sutton Common, from 29th June 1954 to 9th July 1954 and at Sutton Public Hall from 12th July 1954 to 30th July 1954. A total of seven thousand two hundred and four persons were examined. The final results were as follows. Total X-Rayed No. of cases of active Pulmonary Tuberculosis No. of cases of arrested Pulmonary Tuberculosis NonTUberculous abnormalities M. F. T. M. F. M. F. M. F. North Cheam 1194 1822 3016 - - 37 41 43 42 Sutton Common 222 320 542 - - 16 19 11 11 Sutton 1538 2108 3646 3 5 82 98 56 47 TOTAL 2954 4250 7204 3 5 135 158 110 100 The incidence of active Pulmonary Tuberculosis was 1.1 per thousand persons examined in the Borough in 1954, compared with 1.6 in 1953. The average incidence in the County of Surrey in 1954 was 1.2 per thousand persons examined, which compares with 1.7 in 1953. The figures suggest a continuing tendency for the number of undetected cases to decline. It is difficult to make deductions from single random samples of the population. In the Sutton survey the incidence was 2.2 per thousand persons examined. 41 A relatively high incidence in one area indicates a need for regular surveys,, The finding of non-Tuberculous abnormalities gives an opportunity for early advice and treatment and the avoidance of illness. Mass X-Ray is a valuable diagnostic and preventive service. 42 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. (Including Diphtheria and Whooping Cough immunisation and Vaccination against Smallpox). Methodist Church Hall. Station Road Belmont Infant Welfare Centre. Every Thursday, at 2.0 p.m. (Including Diphtheria and Whooping Cough immunisation and Vaccination against Smallpox). SUTTON COMMON Emmanuel Church Hall Stonecot Hill, Sutton Infant Welfare Centre. Every Monday, at 1.30 p.m. (including Diphtheria and Whooping Cough immunisation and Vaccination against Smallpox). CHEAM AND WORCESTER PARK The Parochial Rooms The Broadway, Cheam Infant Welfare Centre Every Wednesday, at 1.30 p.m. (Including Diphtheria and Whooping Cough immunisation and Vaccination against Smallpox). The Clinic- Priory Crescent Cheam Ante Natal Clinic, Every Monday and Friday, at 9.30 am. (By appointment). Infant Welfare Centre Every Monday and Thursday, at 1.30 p.m. (including Diphtheria and Whooping Cough Immunisation and Vaccination against Smallpox). St Oswald's Hall, Brocks Drive North Cheam Infant Welfare Centre, Every Friday, at 130 p.m (Including Diphtheria and Whooping Cough Immunisation and Vaccination against Smallpox). Wesley Hall. Cheam Common Road Worcester Park Infant Welfare Centre Every Friday, at 2,0 p.m. (Including Diphtheria and Whooping Cough Immunisation and Vaccination against Smallpox). 43 SCABIES CLINIC St. Nicholas Road, Sutton Every Thursday, at 10 a. m, CHEST CLINIC St. Heller 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 Hales 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. 44