Library I SUTC 20 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1956 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR (Alderman W.L. Hasted, J.P.) Alderman D. Sparks (Mrs,) M.B.E. " F. Warren " D.Webster (Miss) J.P. Councillor R.A. Beuzeval Councillor R.S. Oliver „ L.B. Blackler „ D.M. Pettingell (Mrs.) „ A.W. Letts „ A. Sullivan „ F.R. Muddle „ A. G„ Taylor (Chairman) PUBLIC HEALTH OFFICERS OF THE AUTHORITY Medical Officer of Health ENEAS J. MACINTYRE. M.D., D.P.H. Chief Public Health Inspector CHARLES WILLIAM NEWBERY Certlf. R.S.I., Certlf. Meat & Food. Certif. S.I, Exam. Board Deputy Chief Public Health Inspector ARTHUR SYDNEY WILLIAMS Certif. R.S.I. Certif. Meat & Food Additional Public Health Inspectors JOHN BAMFORD Certlf. R.S.I., and S.I.E.J, B., Certif. Meat & Food (Commenced Duties on 20th August, 1956) REGINALD WILLIAM NORMAN Certlf. R.S. I.. and S. I.E.J.B., Certif. Meat & Food KEMPTON HUDDLESTONE PRIOR Certlf. R.S.I. and S.I.E.J. B., Certif. Meat & Food CYRIL WILLIAM SOUTHERBY Certlf. R.S.I. and S.I.E.J.B., Certif. Meat & Food (Commenced Duties on 6th April, 1956) FRANK SUTCLIFFE Certlf. R.S.I. and S.I.E.J.B.. Certif. Meat & Food Public 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 Gentleman, I have the honour to present to you the Annual Report on the health of the. Borough for the year 1956. The general health of the community was good. The estimated population showed an increase of one hundred and forty. The birth rate was stationary at 11.4 per thousand of population. The death rate rose from 10.4 to 11.l per thousand of population. The Infantile mortality rate remained low. There was no maternal death. The incidence of infectious diseases was lower. Measles and Whooping Cough were less prevalent. There was an increase in Scarlet Fever, Dysentery and Food Poisoning. Twelve cases of Poliomyelitis were notified. No case of Diphtheria occurred. The number of new cases of Pulmonary Tuberculosis again declined. A Mass X-Ray Unit visited Worcester Park in March with beneficial results and stimulated interest in the prevention of diseases of the chest. There is a continuing need for the better housing of many families. During the year one hundred and twelve flats or houses were occupied and plans for a further thirty nine flats or houses were in course of preparation. At the end of the year eight hundred and forty nine families had been accommodated in new houses, flats and prefabricated bungalows since the end of the war. The work of sanitation, of the prevention of nuisances and of the protection of food was carried out efficiently under the direction of the Chief Public Health Inspector (Mr. C.W. Newbery) to whom, on his impending retirement, I wish to express my thanks for his invaluable contribution to the health of the Borough and for our long and happy association. The first stage in the reconstruction of the Worcester Park Sewage works was completed during the year and a greatly improved effluent was achieved. The water supply of the district maintained a high standard of chemical and bacteriological purity. Effective control by sampling and by chlorinatlon was continued. I thank 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. STATISTICS OF THE AREA 1955 1956 Area in acres 4338,15 4338,15 Registrar General's estimate of the Resident Population 78,680 78,820 Number of inhabited houses (end of year) according to the Rate Book. 23,370 23,438 Rateable Value and sum represented by a Penny £950,420 £1,644,647 Rate £3,927 £6,677 EXTRACTS FROM VITAL STATISTICS (Comparative of the years 1955 and 1956) 1955 1956 England & Wales 1956 Total Male Female Total Male Female Live Births 893 486 407 903 490 413 Legitimate 869 475 394 867 470 397 Illegitimate 24 11 13 36 20 16 Birth Rate per 1000 of the Estimated Resident Population 11.4 11.4 15.7 Still Births 18 9 9 15 7 8 Legitimate 17 9 8 14 7 7 Illegitimate 1 - 1 1 - 1 Rate per 1000 total (live and still births) 19.7 16.3 23.0 Deaths 815 394 421 876 433 443 Death Rate per 1000 of the Estimated Resident Population 10.4 11.7 11.7 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 0.56 Deaths of Infants under one year of age All infants per 1000 live births 19.9 16.6 23.8 Legitimate Infants per 1000 legitimate live births 19.6 14.9 Illegitimate Infants per 1000 Illegitimate live births 0.0 55.5 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1956 M. F. Total 1. Tuberculosis, respiratory 4 1 5 2. Tuberculosis, other - - - 3. Syphilitic disease 1 1 2 4. Diphtheria - - - 5. Whooping Cough - - - 6. Meningococcal infections - - - 7. Acute Poliomyelitis - - - 8. Measles - - •- 9. Other Infective and parasitic diseases 1 1 2 10. Mallgiant neoplasm, stomach 10 6 16 11. Malignant neoplasm, lung, bronchus 28 3 31 12. Malignant neoplasm, breast - 20 20 13. Malignant neoplasm., uterus - 6 6 14. Other malignant and lymphatic neoplasms 44 34 78 15. Leukaemia, aleukaemia 2 1 3 16. Diabetes 2 3 5 17. Vascular lesions of nervous system 46 74 120 18. Coronary diseases, angina 87 61 148 19. Hypertension with heart disease 9 15 24 20. Other heart disease 50 99 149 21. Other circulatory disease 17 22 39 22. Influenza 1 4 5 23. Pneumonia 12 12 24 24. Bronchitis 46 19 65 25. Other diseases of respiratory system 4 4 8 26. Ulcer of stomach and duodenum 6 4 10 27. Gastritis, enteritis and diarrhoea 3 3 6 28. Nephritis and nephrosis 7 1 8 29. Hyperplasia of prostate 10 - 10 30. Pregnancy, childbirth, abortion - — - 31. Congenital malformatlons 1 2 3 32. Other defined and ill-defined diseases 31 31 62 33 Motor vehicle accidents 4 3 7 34. All other accidents 4 9 13 35. Suicide 3 4 7 36. Homicide and operations of war - - - TOTALS 433 443 876 5 Mortality. The number of deaths increased from eight hundred and fifteen to eight hundred and seventy six. The principal causes of death were diseases of the heart and circulation (41.1 per cent) and Cancer (17.6 per cent). Deaths from Bronchitis increased from thirty five to sixty five. There were one hundred and forty eight deaths from coronary diseases, an increase of ten. Twenty deaths were due to accidents. Seven were related to motor vehicles. Deaths from digestive diseases rose from eleven to eighteen. Epidemiology as a science is applicable to the study of constitutional diseases and accidents. The results of research can be applied to prevent premature death. Many of the stresses which cause coronary diseases, digestive diseases and mental illness could be avoided and many accidents could be prevented by measures based on epidemiological studies. The cause of cancer is unknown but contributory factors could be eliminated., There is statistical correlation between cancer of the lung and the smoking of cigarettes. The significance of this finding requires wide recognition. DEATHS FROM CANCER OF THE LUNG 1950 to 1956 1950 1951 1952 1953 1954 1955 1956 Males 26 15 29 36 35 26 28 Females 3 8 7 3 3 6 3 Total 29 23 36 39 38 32 31 Maternal Mortality. There was no maternal death. The maternal mortality rate for England and Wales was 0.56 per thousand total births. Infantile Mortality. The infantile mortality rate was 16.6 per thousand live births, compared with 19.0 per thousand live births in 1955. There were fifteen deaths of infants under one year, compared with seventeen deaths in 1955, Of the fifteen deaths, thirteen occurred in the neo~natal period within one month of birth, as is shown in the following table of causes and age groups. AGE GROUPS Causes of Death Under l month 1-3 months 3-12 months Congenital Abnormality 3 1 1 Prematurity 8 - - Cerebral Haemorrhage 2 - — TOTALS 13 1 1 6 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA NEW LEGISLATION The Clean Air Act, 1956 Certain provisions of the Act relating to the installation of new furnaces, the height of chimneys of buildings other than residences, shops and offices, smoke control areas, pollution from colliery spollbanks, research, publicity and the making of building Bye-laws, came Into force on 31st December, 1956. REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION The National Assistance Act, 1948 - Section 47 A Court Order was obtained on 28th March, 1956 and applied on 24th May 1956 for the removal of a man, aged seventy four years, senile and infirm, living in insanitary conditions and in need of care and attention, to residential accommodation provided by the Surrey county Council at “st. Andrews", Farnham, for a period of three months. The delay in applying the Order was due to his obstruction and to necessary consideration for his age and infirmity. The Court Order was renewed on 15th August and 21st November, 1956. BURIAL AND CREMATION OF THE DEAD The National Assistance Act, 1948 - Section 50 Three burials were arranged under the powers granted to the Council by this Section. MORTUARY One hundred and seventy one bodies were received and one hundred and seventy one 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. 7 SANITARY CIRCUMSTANCES OF THE AREA Water Supply. The water supply is mainly derived from the deep wells in the chalk of the Sutton District Water Company, situated at Sutton, Cheam and woodmansterne. A small area in the North Ward Is supplied by the Metropolitan Water Board, The water from all wells of the Sutton District Water Company is softened to nine degrees of hardness. Chlorine is applied in the form of chloramine as a protective measure. Samples of the raw and treated waters are examined daily by the laboratory at the Sutton works. Samples are also examined at monthly intervals by the Company's Consultant Analyst, and monthly samples are examined in rotation by the District Councils In the area of supply. The supply from all sources has been satisfactory in quality and quantity. All the dwelling houses have a direct supply from the public mains. Below is the average of monthly analyses. Chemical Results in Parts per Million Average Total Solids 190,83 Ammonia, free 0.13 Ammonia, Albuminoid 0.00 Nitrogen in Nitrates 7.55 Nitrogen in Nitrites 0.00 Oxygen Absorbed 0.13 Chlorine in Chlorides 18.75 Hardness total (grains per gallon) 8.13 Bacteriological Results No, of Bacteria growing on Agar per ml. for 3 days at 20° C 2 No. of Bacteria growing on Agar per ml. for 1 day at 37° C 0 Presence of Bacillus Coll in 100 ml. 0 Swimming Baths. Satisfactory control over residual Chlorine and pH has been maintained in the two swimming baths. Two samples taken at peak periods of attendance gave satisfactory chemical and bacteriological results. DRAINAGE AND SEWERAGE Worcester Park Sewage Disposal WorkS. During the year the work on Stage 1 of the Scheme for the reconstruction of the Worcester Park Sewage works was completed, as a result of which a greatly improved effluent is now being discharged to the Beverley Brook, 8 The work on stage II of the scheme which includes the construction of an additional sludge digestion tank. is to commence in March 1957 and should be completed by early 1958. The design of succeeding stages in the scheme is proceeding. Sutton Sewage Disposal Works. These works continue to discharge a good quality effluent to the Pylbrook. Flooding. As a result of statistics obtained following the mid-summer storms the Surrey County Council are proceeding with improvements to the Pylbrook at the rear of properties in Hamilton Avenue and the Borough Council are embarking upon an improvement in their surface water sewer in Hamilton Avenue and Trafalgar Avenue. Similar investigations are proceeding with a view to relieving surface water conditions of the lower portion of Sutton High Street. 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. Subject to the remarks regarding the Pylbrook under "Flooding" above, the streams within the Borough have been maintained in a satisfactory condition. Closet Accoramodation. There are four premises with cesspools in use. Some two pall closets and two chemical closets are in use. in the past twenty eight years, one hundred and sixty one premises originally with cesspool drainage have been connected to sewers. 9 SANITARY INSPECTION OF THE AREA Report of the Chief Public Health Inspector under Article 27 of the Sanitary Officers (Outside London) Regulations 1935/1951 (Pages 10 to 32 ) RECORD OF INSPECTIONS HADE AND NOTICES SERVED Visits Special Inspections: Interviews and advisory visits 1,626 Reinspection visits 2,733 Visits to works In progress 621 " Factories/Workplaces 403 " Bakehouses 17 " Outworkers premises 94 " Butchers/Grocers/Greengrocers/Fishmongers etc. 694 " Dairies/Milk Purveyors 38 " Ice Cream Premises (Manufacture and sale of) 264 " Stables/Passages/Plggerles and Ditches 51 " Restaurant/Cafe Kitchens, Dining Rooms etc. 115 " School/Industrial canteen Kitchens 44 " Premises in connection with rodent control 6,077 " Tents/Vans/Sheds 9 " Cinemas/Theatres/Halls 20 " Hairdressers and Barbers Premises 66 " School and Public Conveniences 64 " Verminous Premises 11 " Shops under the Shops Act 455 " Licenced Public Houses 14 " Hospitals - spraying of kitchens 9 " re Infectious Diseases 132 " Food Poisoning Enquiries 14 " Food Complaints (request inspections) 87 " Overcrowding and permitted numbers 116 " Food & Drugs Act sampling 303 " Sampling of milk and water (bacteriological) 105 " Sampling of Ice cream (bacteriological) 306 " Merchandise Marks Acts 275 " Rag Flock Act 6 " Pet Animals Act 18 " Heating Appliances (Fireguard) Regulations 12 " Atmospheric Pollution Gauges/Smoke Observations 85 Miscellaneous visits 1,326 Total 16,210 Number of complaints received and investigated 631 Premises at which defects or nuisances were discovered 1,892 Dwelling-houses surveyed for housing defects under the Public Health or Housing Acts 128 Number of defects or nuisances discovered 2,590 " " " remedied 1,620 " " "in hand 644 " " „ outstanding 326 10 Number of informal notices served 1,116 STATUTORY NOTICES WERE SERVED AS UNDER: Housing Act 1936 Sections 9 and 10 (as amended by the Housing Act 1949) 3 Public Health Act 1936, Section 24 18 „ " "39 1 " „ " 75 2 " " "92 2 Total 26 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT Drainage and Sanitary Fittings Number of houses and other premises redrained 11 Number of houses and other premises connected to soil and surface water sewers - Repairs and amendments to existing drains 101 Drains or gullies unstopped or cleansed (involving 1248 premises) 403 Sanitary fittings repaired/renewed provided or cleansed 337 Water service pipes/cisterns/repaired renewed or cleansed 22 Water, smoke and chemical tests applied 186 W.C. Apartments W. C. Apartments provided 14 " ligated and/or ventilated 1 " provided with ventilated lobbies 9 " cleansed 18 Seperate W. C. accomodation provided for the sexes 2 Structural Repairs or Improvements Carried Out Number of roofs repaired or renewed 59 " guttering and rainwater pipes provided repaired etc. 79 " damp walls remedied 23 " Brick walls repolnted repaired or re-rendered 51 " chimney stacks repaired or rebuilt 27 " yards paved or repaired 15 " floors relald or repaired 15 „ windows/cills/sashcords repaired or renewed 163 " doors/thresholds provided or repaired 28 " staircases/handrails provided or repaired 6 " ranges/stoves/coppers renewed or repaired 27 " Food cupboards provided/ventilated 2 Cleansing Number of rooms/passages/larders cleansed and/or repaired 83 „ trade premises cleansed 9 " vennlnous premises dlsinfested for bugs/fleas 11 " premises sprayed for cockroaches/crickets/wood beetles etc. 18 " premises disinfected after various diseases 123 " School Canteens/Kitchens sprayed for files and ants 10 " Hospital kitchens sprayed 9 11 Various Number of dustbins provided 21 " accumulations of refuse and manure removed 22 " wasp nests destroyed 43 „ miscellaneous items 34 HOUSING 1 Inspection of Dwelling-Houses during the Year: (1) (a) Total number of dwelling-houses inspected under the Public Health or Housing Acts 128 (b) Number of inspections made for the purpose 283 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 65 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 68 (including 37 for 1955) 3 Action under Statutory Powers during the Year. (A) Proceedings under Sections 9, 10, and 16 of the Housing Acts 1936-1949:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notlces:- (a) By Owners 1 (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 3 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners 3 (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 Four applications for Certificates of Disrepair were received during 1956, two were granted and two refused. 12 INSPECTION OF FACTORIES AND OTHER PREMISES Factories Act 1937-1918- (Part I of the Act) 1. Inspections made by Public Health Inspectors for the purpose of provisions as to healths:- Type of Premises Number on Register Number of Inspections Notices, written and/or oral (1) Factories without mechanical power 56 56 21 (2) Factories with mechanical power 315 292 43 (3) Other premises (excluding workers premises) 55 55 13 TOTAL 426 403 77 2 Defects found in Factories and Other Premises under the Act:- Partlculars Number of cases In which defects were found Found Remedied Re terred To H.M. Inspector By H.M. Inspector want of cleanliness 29 26 - 3 Overcrowding - - - - Unreasonable Temperature - - - - Inadequate Ventilation 1 - - - Ineffective drainage of floor - - - Sanitary Conveniences- (a) Insufficient 8 7 - 1 (b) Unsuitable or defective 26 19 - 2 (c) Not separate for the sexes 1 1 - - Other offences against the Act (not including offences relating to outwork) 28 20 - - TOTAL 93 73 - 6 WORKPLACES - Public Health Act, 1936 Inspections Number of Written Occupiers and Verbal Notices prosecuted 55 13 Nil SMOKE ABATEMENT There are but a few industrial chimneys in the Borough. No emission of black smoke has been observed. In conjunction and co-operation with the Department of Scientific and Industrial Research the grit deposit measuring gauges have been maintained. 13 INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1955 Sampling. During the year two hundred and fifteen samples (comprising fifty six formal and one hundred and fifty nine informal samples) were submitted to the Public Analyst for analysis as follows:- Type of Food sampled Number of samples examined Unsatisfactory samples Formal Informal Total Formal Informal Total Apples - liquid - 1 1 - - - Apricots - dried - 1 1 - - - Beans with sausages - 1 1 - - - Bicarbonate of soda - 1 1 - - - Biscuits - 2 2 - - - Black Puddings - 1 1 - 1 1 Blancmange - 1 1 - - - Blood Tonic - 1 1 - - - Brandy 1 - 1 - - - Butter - 3 3 - - - Butter-Rum - 1 1 - 1 1 Cake decoration - 1 1 - - - Castor Oil - 1 1 - - - Cheese Spread - 3 3 - - - Chemical Food - 1 1 - 1 1 Chicken Galantine - 1 1 - - - Chlcklettes - 1 1 - - - Chilblain Tablets - 1 1 - - - Christmas Pudding - 1 1 - - - Clnammon - 1 1 - - - Cochineal - 1 1 — - - Codeine Tablets - 1 1 — — - Confectionery - Chocolate - 4 4 - 1 1 Confectionery - Sugar - 7 7 - - — Cooking Oil - 1 1 — - - Cordial - 2 2 - - - Cough Medicine - 1 1 - - - Cream - 2 2 - - - Cream - double - 2 2 - - - Curry Powder - 1 1 - - - Drinking Crystals - 1 1 - - - Dripping 6 1 7 1 - 1 Evaporated Milk - 1 1 - - — Faggots - 1 1 — — — Fish Cakes - 1 1 - - — Flavouring Essence - 1 1 - - - Flour - self-raising - 1 1 - - - Frlzets - 1 1 - - - Fruit juice Cocktail - 1 1 - - - Gelatine - 1 1 - - - Gingerbread - 1 1 — - - Glycerine Lemon & Honey - 1 1 - 1 1 Glycerine Lemon & Honey Balsam - 1 1 - - - Glycerine of Thymol - 1 1 - — - Guava Jelly - 1 1 — — Haliborange - 1 1 - - — Herbal Medicine — 1 1 - — — Herbs - Mixed - 1 1 - - - Carried forward: 7 64 71 1 5 6 14 Type of Food sampled Number of samples examined Unsatisfactory samples Formal Informal Total Formal Informal Total Brought forward 7 64 71 1 5 6 Honey - 1 1 - - - Ice Cream - 10 10 - - - Ice Lollies - 3 3 - - Icing Sugar - 2 2 - - - Instant Pudding - 1 1 - - Iron jelloids - 1 1 - - Jam - 2 2 - - - Jelly - 4 4 - - Lard 1 — 1 - - - Lemon Curd - 1 1 - - - Lemonade Crystals - 3 3 - - - Liquid Paraffin - 1 1 - - - Liver Sausage - 1 1 - - - Margarine 2 - 2 - - - Marzipan 3 1 4 - - Mayonnaise - Tarragon - 1 1 - - - Milk 17 7 24 - - - Milk - Channel Island 15 - 15 " - - Milk - South Devon 1 - 1 - - Milk - "Warm" 3 - 3 1 — 1 Mincemeat 1 3 4 - - - Mint in Vinegar - 1 1 - - - Mustard - Continental - 1 1 - - - Nerve Tonic - 1 1 - - - Olive Oil - 1 1 - - - Orange Drink 1 - 1 - - - Paste - 5 5 - - Peanuts - Chocolate - 1 1 - Peas - Processed - 1 1 - - - Peel - 1 1 - - Pep-up Tablets - 1 1 - - - Pepper - white - 2 2 - - - Pickle - 1 1 - - - Pickling Spice - 1 1 - - - Pie Steak - 1 1 - - - Pie Steak & Kidney - 1 1 - - - Pine Linctus - 1 1 - - Pork - Minced - 1 1 - - Prophylactic Tablets - 1 1 - - - Raisin Chocolate - 1 1 - - Rennet - 1 1 - - - Rice - Creamed - 1 1 - - - Rice - flaked - 1 1 - - - Rice - ground - 1 1 - - - Rose - Hip Syrup - 2 2 - - - Salmon relish - 1 1 - - - Salmon Spread - 1 1 - - - Sauce - 1 1 - - - Sausage - Pork 1 - 1 - - - Savoury Spread - 1 1 - - - Sherry - 1 1 - - - Sleep Tablets - 1 1 - - - Steak & Kidney Pudding - 2 2 - 1 1 Strawberry flavouring - 1 1 - - - Suet - 2 2 - - - Sugar - Demerara - 1 1 - - - Table Dessert - 1 1 - - - Tapioca - 1 1 - - - Tea - 3 3 - - - Tenderising Salt - 1 1 - - - Carried forward 52 153 205 2 6 8 15 Type of Food sampled Number of samples examined Unsatisfactory samples Formal Informal Total Formal Informal Total Brought forward 52 153 205 2 6 8 Tomato Juice - 1 1 - - - Tonic - 1 1 - - - Vermicelli - Milk Chocolate - 1 1 - 1 1 Vinegar - 1 1 - - - Vitamin Capsules - 1 1 - - - Whisky 4 - 4 - - - Yeast Tablets — 1 1 - - - TOTALS 56 159 215 2 7 9 The following details classify the type of irregularity or infringement, and the action taken in connection with the nine unsatisfactory samples. Sample No. Article Sampled Type of Infringement Action Taken 2137 (Informal) Black Pudding. This article was slightly contaminated with a green lye diffusing inwards from the skin. Cautioned. The use of the dye was discontinued and the manufacturer's sucessfully experimented with a dye obtained from another source. A repeat sample proved satisfactory. 2149 (Informal) Butter Rum (Cumberland) Labelling Infringement. The butter contained spice (nutmeg) an ingredient not specified on the label in accordance with the requirements of the Labelling of Food Order Cautioned. The manufacturers were apparently unaware that the small quantity of nutmeg used should be declared in the list of ingredients and made arrangements to include the word "nutmeg" on the next supply of caps. 2161 (Informal) Glycerine Lemon and Honey Labelling Infringement This article was described as Glycerine Lemon and Honey, but the formula printed on the label in small type and in Latin abbreviations included 50% of Syrup of Tolu, therefore the title was not considered a satisfactory one for a cough mixture. Cautioned. The manufacturers agreed satisfactorily to amend the description of this article and at the same time to improve the formula of the preparation. 16 Sample No. Article Sampled Type of Infringement Action Taken 2303 (Informal) Chemical Food Labelling Infringement This preparation conformed to the standard of the British Pharmaceutical codex, but it was labelled as prepared according to the formula of the British Pharmacopoeia. This statement is misleading in that chemical Food is no longer included in the British Pharmacopoeia. Caution The Pharmacy Superlnten dent acting on behalf of the retailers admltt ed the error, and requested the drug company who supplied the Chemical food to amend future labels. A947 (Formal) Dripping The dripping contained 2.3% of free fatty acids and was slightly rancid. Cautioned. It would appear that a certain amount of stale fat had been mixed with the fresh fat prior to rendering. A repeat sample proved satisfactory. 2207 (Informal) Steak and Kidney Pudding This article was of poor quality as regards composition and meat content. It consisted of a meat pudding containing minced meat and gravy thickened with cereal filler. The meat content expressed on the whole pudding and calculated as meat containing 15% of tat was 16%. Cautioned. Steak and Kidney Pudding should consist of recognisable pieces of steak and kidney in gravy and not minced meat. The manufacturers admitted the mixture was "fine" as difficulty was experienced when using larger pieces of steak and kidney through a filler. A repeat sample taken revealed the filling to be satisfactory, although the proportion of meat In the whole pudding could, with advantage, be increased. 2265 (Informal) Milk: Chocolate Fourrt Pineapple and Cream Labelling Infringement The front panel of the wrapper of this article was illustrated with five whirls of whipped cream with pieces of pineapple on top and bore the description Pineapple and cream. The filling contained sugar pineapple concentrate, 25% of fats other than milk fat and about 30% of dried milk, but no cream. The description and label were consldered as misleading. The chocolate is manufactured in England in conjunction with an Associate Company in Switzerland. The manufacturers are giving serious thought and consideration to the points raised by the Public Analyst and a satisfactory conclusion is expected in the near future. 17 Sample No. Article Sampled Type of Infringement Action Taken A965 (Formal) "Warm" Milk. This sample contained 2.3% of milk fat and 9.08% of milk solids other than milk fat as Judged by the sale of Milk Regulations 1939. The sample was deficient in milk fat - the deficiency corresponding to the abstraction of 23% of milk fat . The minimum limit of the above named Regulations for milk fat is 3%. Cautioned. The sample was purchased at a Caffe which had recently changed hands. One of the partners admitted that she had removed a little cream for a trifle and further stated that she was unaware of the Regulations as to the sale of milk at a Caffe as it was a beverage for which they were seldom asked. A warning was issued as the abstraction did not appear to be intentional and an assurance received that the offence would not be repeated. 2273 (Informal) Milk Chocolate Vermicelli Analysis revealed the sample to be cake decorations prepared with cornflour, sugar, skimmed milk powder and margarine or similar fat. Milk chocolate is prepared with full-cream milk powder and the use of skimmed or partly skimmed milk powder is a form of adulteration. This article therefore is not entitled to the description "Milk Chocolate vermicelli". Cautioned. The manufacturers were told that the basic description of the article should be cake decorations and that no exception would have been taken if the article had been sold as Chocolate Vermicelli cake decorations. it was further suggested that the outstanding stocks held by the manufacturers could be used up by the adoption of a description of this nature in any future sales. The amount of stock held by the retailers was negligible and it was stated the "line" would not be renewed at present. Sampling Observations. it will be seen from the detailed classification that of two hundred and fifteen samples taken during the year 2.32% were found to be other than genuine and labelling infringements accounted for a further 1.86%, making a total of 4.18%. 18 For comparative purposes the figures for 1955 were 3.52% and 2.2% respectively making a total of 5.72%. The pattern of sampling has followed that of previous years in that a wide range of commodities has been covered. A satisfying result has emerged since the infringements revealed were generally of a minor character and with the willing cooperation of retailers or manufacturers were quite readily adjusted. COMMENTS BY THE PUBLIC ANALYST (Food and Drugs Act, 1955) In my notes for 1955, I referred to the passing of the Food and Drugs Act, 1955, (which came into force on the 1st January 1956) and said that it would be interesting to see how the new Act was working in a years time. Some alterations and additions of particular interest to the public analyst which have been brought about by the new Act are as follows:- (a) Control of the preparation and sale of injurious foods and adulterated drugs is extended and the cumulative effects of consuming food containing injurious substances may now be taken into account. (b) The sale to the prejudice of the purchaser of a food or drug not of the nature, substance or quality demanded has been strengthened by the removal of two former defences, one applying to food or drugs the subject of a patent and the other to proprietary medicines. (c) The Ministries concerned with the operation of this Act are given widely extended powers to make Regulations to require, prohibit or regulate the addition of substances to foods, to regulate the composition of foods, and to control processes or treatment in the preparation of food. At the same time, the Ministries are instructed that they shall have regard to the desirability of restricting, so far as practicable, the use of substances of no nutritional value. (d) The Ministries are also given powers to make Regulations as to the labelling, marking or advertising of food intended for sale and as to the descriptions which may be applied to such foods. (e) Wider control is applied to the sale of reconstituted cream and imitation cream, and a description which includes the word "cream" (whether or not aspart of a composite word) may not now be used in relation to any substance which resembles cream, but is not cream, or to any article of food containing such a substance. 19 Some of the above changes will not bear fruit immediately, but the Pood Standards committee of the Ministry of Agriculture, Fisheries and Food produced a number of Reports n 1956 which, if adopted and translated into Regulations, will have a direct influence on the work, of the public analyst in future years. It is now proposed to allow the use of certain antioxidants in foods in restricted quantities. These substances tend to delay rancidity in fats and, as such, are classed as preservatives, tut under the Preservatives Regulations now in force their use would be illegal. A Report has also been issued on Colouring Matters in Food, and it has been recommended that a permitted list of about 30 synthetic colours be allowed and that all other colours except certain colours of natural origin be forbidden, Similarly a Report on the use of emulslflers, stabilisers and similar substances in foods also recommends a short permitted list of harmless substances to the exclusion of others which may not be so. The Flour Regulations which came into force in September 1956 prescribed certain compulsory additions to flour including chalk (14 oz. to the sack), the two vitamins aneurln and nicotinamide, and iron. It is the duty of Food and Drugs Authorities to enforce such Regulations as these, and all this means additional work for the public analyst. I foresee a period of very great activity which will require the maximum co-operation between the Ministry, Food and Drugs Authorities and the public analyst. There is little necessary by way of comment on the examination of the samples already noted by the Chief Public Health inspector. The samples to which exception has been taken are very varied in character and show the wisdom of intelligently covering a wide field, a practice which has been pursued with similar success for many years in this Borough. The problems of labelling and description of foods and of drugs are by no means easy, and most of the offences committed by manufacturers and packers are unintentional. It is gratifying to find in most cases a ready desire to co-operate and to ensure that there can be no possibility of misleading the public as to the nature, substance or quality of the article being sold. The misleading advertising of articles is one which is more difficult to bring under control and it is hoped that in due course advantage will be taken of the changes in the law which allow of positive Regulations being made to apply to advertisements as well as labels. 30 MiLK SUPPLY Food and Drugs Act 1955 Milk and Dairies Regulations 1949-1953 The Milk (Special Designation) (Raw Milk) Regulations 1949-1954 The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1949-1953 Routine inspection of milk pasteuriser s and purveyor'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 1956:- Grade of Milk TYPE OF LICENCE Dealers Supplementary Pasteuriser's Tuberculin Tested 10 11 - " " (Pasteurised) 7 - - Pasteurised 18 11 1 Sterilised 32 12 - TOTALS 67 34 1 EXAMiNATiON OF MILK SAMPLES (BACTERIOLOGICAL SAMPLES/ One hundred and ten samples of milk were examined as f ollows:- Class of Milk Number of samples examined Test applied Results Passed Failed Pasteurised 72 Phosphatase 72 - Methylene Blue 72 - Sterilised 5 Turbidity 5 - Tuberculin Tested (Pasteurised) 14 Phosphatase 14 - Methylene Blue 13 1 Tuberculin Tested (Farm Bottled) 19 Methylene Blue 13 6 TOTALS 110 103 7 To comply with the Milk. (Special Designation) (Raw Milk.) Regulations, Tuberculin Tested Milk must not decolourise Methylene Blue within 4½ hours if the sample is taken during 1st of May to 31st October, or within 5½ hours if taken between the 1st November to 30th April. Of the total samples examined under these Regulations six samples of Tuberculin Tested (Farm Bottled) Milks failed to pass the prescribed test. Five of these samples were taken during the 4½ hours test period and decolourised Methylene Blue in from 2½ to 4½ hours, whilst the other sample taken during the hours test period decolourised methylene blue in 4½ hours. 21 It is the practice immediately to notify failures of farm bottled milk to the dairy company concerned so that the matter may be taken up with the responsible producers as speedily as possible. To comply with the Milk (Special Designation)( Pasteurised) and sterilised Milk) Regulations, Tuberculin Tested (Pasteurised and Pasteurised Milk must not give a reading of more that 2.3 Lovibond blue units in the phosphatase test and must not decolourise methylene blue in 30 minutes. Of the total samples examined under these Regulations one sample of Tuberculin Tested (Pasteurised) Milk failed the test and decolourised methylene blue in 10 minutes. A repeat sample proved satisfactory. CHEMICAL ANALYSIS OF MILK AND CREAM SAMPLES MILK Thirty six formal and seven informal samples of milk were taken for chemical analysis. The samples contained satisfactory averages of 3.6% milk fat and 8.7% milk solids other than fat, with the exception of one sample of "Warm Milk" which contained 2.3% milk fat instead of 3%. Excluding the exception the results are above the minimum standard of 3% milk fat and 8.5% milk solids other than fat laid down in The Sale of Milk Regulations. CREAM Analysis of the four informal samples of cream showed the double cream samples to contain a satisfactory average of 50% milk fat and the single cream 24.5% milk fat. The minimum standards in relation to cream are as follows:double cream - not less that 48% by weight of milk fat, and other creams described as single cream, pouring cream, coffee cream, fruit cream, or as any other description of cream, not less than 18% by weight of milk fat. BIOLOGICAL MILK SAMPLES (FARM BOTTLED MILK) Seven samples of Tuberculin Tested Milk were taken for biological examination with negative results ICE CREAM ice Cream (Heat Treatment etc.) Regulations 1947-1952 RegIstratIons. At the end of 1956 a total of one hundred 22 and forty one premises had been registered for the sale of ice cream in accordance with Section 16 of the Food and Drugs Act 1955 and on three of these premises ice cream could be manufactured. During the year eleven applications for the registration of premises for the sale and storage of ice cream were received and granted. BACTERIOLOGICAL SAMPLING OF ICE CREAM During the year one hundred samples of ice cream were obtained for bacteriological examination and provisional grading.. The following table shows the 1956 percentage results in each grade and for comparative purposes the results obtained in 1955 1956 Grading of Samples 1955 Grading of Samples Grade 1-92 samples - 92.00% Grade 1-68 samples - 79.06% " 2-7 " - 7.00% " 2-7 " - 8.13% " 3-1 " - 1.00% "3-7 "8.13% " 4 - Nil " - Nil "4-4 " - 4.65% TOTAL 100 TOTAL 86 It is most gratifying to record that ninety nine per cent of the samples were placed in grades 1 and 2, one per cent only in grade 3 and none in grade 4. The following table shows the average percentage and other details in connection with the samples obtained from individual manufacturers. Code Number of samples taken Type of sample Average Percentage in each grade Wrapped Loose Grade 1 Grade 2 Grade 3 Grade 4 A X 8 - 8 100- 00% - - - B X 2 2 - 100.00% - - - C 14 13 1 100.00% - - - D 22 19 3 95.45% 4.54% - - E 19 18 1 100.00% - - - F 2 - 2 100.00% - - - G 1 1 - 100.00% - - - H X 17 - 17 70.58% 23.53% 5. 88% - I 4 4 - 75.00% 25.00% - - J 1 1 - 100.00% - - - K 1 - 1 100.00% - - - L 3 3 - 66.66% 33.33% - - M 2 - 2 100.00% - - - N 4 - 4 100.00% - - - TOTALS 100 61 39 92.00% 7.00% 1.00% Nil X Denotes locally produced. 23 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%. The following table shows that the ten samples submitted to a chemical examination contained average constituent percentages well above the prescribed standard. Producers Code Number of samples Fat Constituent Percentages Milk solids other than fat Sucrose Total sugars A X 1 11.7% 9.6% 13.00% 13.00% A X 1 11.0% 9.7% 13.30% 13.30% B 1 11.5% 9.5% 13.6% 17.9% C 1 11.8% 14.1% 14.4% 14.4% C 1 9.9% 11.5% 18.2% 18.2% D 1 11.2% 12.6% 13.3% 13.3% E X 1 5.4% 14.7% 15.9% 15.9% E X 1 7.1% 7.9% 15.2% 20.4% F 1 18.2% 8.7% 14.5% 14.5% G 1 10.0% 10.7% 17.9% 17.9% TOTALS 10 10.7% 10.9% 14.9% 15.8% X Denotes locally produced ICE LOLLIES- BACTERIOLOGICAL AND CHEMICAL EXAMINATION There is no prescribed standard for water ices or ice lollies sold as such, but it was decided as in former years to submit samples to a test similar to the one applied to ice cream. Bacteriological Examination. Twenty one lollies were examined and found to be satisfactory. Chemical Examination. Three samples were examined for possible metallic contamination arising from the use of certain types of moulds, but no harmful Impurities were detected as a result of using such moulds. FOOD - FOOD HYGIENE REGULATIONS 1955-56 These Regulations take the place of Section 13 of the Food and Drugs Act, 1938 and came into force on the first day of January, 1956, with the exception of certain provisions which operated from the first day of July. 1956, and the restrictions on the preparation and packing of food in or about domestic premises which are postponed until the first day of January, 1958. The Regulations add a number of new provisions in respect of the hygenlc handling of food, and the construction and maintenance of premises, stalls, vehicles etc. where food is 24 handled. These also replace Regulations 19, 20, and 21 of the Public Health (Meat) Regulations 1924 in respect of the transport and carrying of meat. The following table is an analysis of the food premises in the Borough. Number Bakehouses 15 Butchers (including one horseflesh shop) 56 Confectioners (sugar and flour) 157 Fishmongers/stalls/Fried Fish Shops 33 General stores/Shops 21 Greengrocers/Stalls/Stores 77 Grocers 138 Ice Cream (Manufacture and sale of) 141 Licenced Public Houses 35 Milk. Purveyors/Depots/Dalrles 38 Restaurants/Cafes/Snack Bars/ Dining Rooms 65 School/Industrial Canteens/Kitchens/Servlce Rooms 44 The Number of food premises inspected slncethe Regulations came into force are given in the following table, also the number of infringements found, remedied, in hand, or outstanding at the end of the year and the number of notices involved. Premises Infringements Remedied in Hand Outstanding Notices Inspected found end of 1956 Served verbal 352 1008 261 455 292 243 109 The following table shows in detail the infringements found in connection with each regulation. Regulation Number Regulation Requirement Number of Infringements found 5 Food business not to be carried on at unsanitary premises 1 6 Cleanliness of equipment etc. 84 8 Food to be protected against contamination 56 9 Personal cleanliness 13 10 Carrying and wrapping etc. of open rood 2 14 Sanitary conveniences 207 15 Water supply to be provided 10 16 Wash-hand basins to be provided 138 17 First aid materials to be provided 74" 18 Accommodation for clothing etc. ... 77 19 Facilities for washing food and equipment 70 20 Lighting of food rooms 5 21 Ventilation of food rooms 6 22 Food room not to communicate with sleeping place 1 23 Cleanliness and repair etc. of food rooms 221 24 Accumulation of refuse etc. 38 25 Temperature at which certain foods to be kept 2 26 General requirements as to stalls 2 28 Water supply to stalls 1 TOTAL 1008 25 In view of the relatively short time that the Food Hygiene Regulations have been in force, it is too early to attempt anything in the nature of a complete assessment of their working and success, but it can be stated that good progress has already been made both in regard to the number of food premises insnected and the number of infringements remedied and in hand as shown in a previous table The following table shows the number of food premises registered by type of business, and the number of inspections made. A. Section 16 - Food & Drugs Act, 1955. B. Milk and Dairies Regulations 1949-1954 C. Ice Cream (Heat Treatment etc.) Regulations 1947-1952 and D. Number of inspections made. Type of Registered Premises A Preserved Foods B Milk. C Ice Cream D Inspections Butchers 48 - - 127 Confectioners (Sugar and Flour) - - 94 184 Fruiterers - - 2 9 General Shops/Stores 2 1 8 32 Grocers 10 26 30 195 Ice Cream (Manufacture) - - 3 11 Milk Depots/Dairies - 8 - 38 Sundry Premises - Newsagents etc. - - 4 3 TOTALS 60 35 141 599 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 condemned 1bs. Tins Bottles or Jars Almonds (Ground) 5½ - - Apple rings (dried) 30 - - Beef (Home Killed) 46½ - - Beef (Imported) 221¼ - - Biscuits 400 - - Chicken - 1 - Currants 32 - - Fish (Tinned) - 28 - Fish (Wet and Dry) 291¼ - - Fruit Juices - 30 - Carried forward 1026½ 59 - 26 Type of food condemned lbs Tins Bottles or Jars Brougit forward 1026½ 59 - Fruit Salad (dried) 150 - - Fruit/Vegetables (Tinned) - 160 4 Grapes 15 - - Ham 20¾ - - Jam/Marmalade/Syrup - - 18 Kidneys (Ox) 5 - - Kidneys (Pig) 27 - - Lard 12 - - Livers (Lamb) 18 - - Macaroni - 1 - Margarine 67 - - Meat-Tinned - 48 - Milk/Cream (Tinned) - 75 - Mutton (Home Killed) 25 - - Offal-plucks 48 - - Peas/Beans (Tinned) - 17 - Pork (Home Killed) 34 - - Potatoes 336 - - Sausages (Tinned) - 5 - Soups/Pickles/Sauces - 12 2 Sugar 38 - - Sweetbreads 14½ - - Tongue(Ox) 3½ 2 - Turkey 17 - - TOTALS 1857¼ 379 24 SLAUGHTERING OF ANIMALS FOR HUMAN CONSUMPTION No animals were slaughtered within the Borough during the year. SLAUGHTER OF ANIMALS ACT, 1933 One licence to act as slaughterman was granted in 1956. BAKEHOUSES There are fifteen bakehouses in the Borough, all of which are provided with mechanical power. The standard of cleanliness and the sanitary conditions in the majority of cases were found to he satisfactory. Seventeen primary visits of inspection made during the year resulted in seven infringements being discovered and rectified. SHOPS ACT Four hundred and fifty five visits were made to various premises under the Shops Act and revealed that the arrangements made for the health and comfort of the shop workers were in the majority of cases satisfactory. 27 SCHOOLS The sanitary conditions and the water supply to the schools in the area are generally satisfactory. HAIRDRESSERS AND BARBERS PREMISES The sixty-six establishments in the Borough were inspected during the year. The general standard prevailing is good, as instanced by the discovery of only four minor infringements of the Hairdressers and Barbers Byelaws 1947. MERCHANDISE MARKS ACT Two hundred and seventy five visits were made to food premises under this Act. The infringements discovered were principally 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. 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. Two applications for licence renewals to store rag flock were received and granted in 1956. Six primary visits of inspection were made during the year to the 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 oh payment of a fee not exceeding ten shillings. Eighteen visits of inspection were made during the year. Seven licence renewal applications were received and granted during 1956. LICENSED PLACES OF PUBLIC ENTERTAINMENT There are twenty licenced places of public entertainment in the Borough. They are used mainly for cinematograph shows, concerts, dancing and social functions. Three minor defects were found and rectified. The general standard of cleanliness was good. 28 LICENSED PUBLIC HOUSES Fourteen visits of inspection were made to the licenced public houses in the Borough. Further substantial and varied improvements are still being carried out 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 Twelve visits were made during the year 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. One infringement of the Act was discovered and rectified. DISINFECTION AND DISINFESTATI ON Council Houses Private Houses Other Premises Number of houses treated with insecticide for bugs and fleas 3 8 - Ten school canteen kitchens and nine hospital kitchens were sprayed for flies, ants, moths and cockroaches. The Insecticides used were Pybuthrln, Dleldrex, D.D.T., Municipal spray and Gammexane Liquid Spray. RODENT CONTROL The Prevention of Damage by Pest Act, 19U9 A - SURFACE TREATMENTS (1) Five thousand three hundred and fifty six visits were made during the year by the Rodent Operator and seven hundred and twenty one by the Public Health inspectors to premises Infested or possibly harbouring rats or mice. Five hundred and two premises were cleared of rats or mice and no major infestations were recorded. (2) The work for the year is generally summarised as under:- 29 Complaints received or cases discovered and Investigated 535 Number of premises found to be infested 504 Number of premises where no evidence of rodents found 31 Number of premises cleared of rats or mice (including 69 previous year's cases) 502 Number of premises still being treated at the year end 76 (3) The cause or site of infestation at the five hundred and four infested premises was:- Keeplng of poultry 29 Inside premises (tinder floors etc.) - rats 19 Inside premises (under floors etc.) - mice 44 Buries, scrapes etc. in gardens, land etc 219 Under or inside sheds 191 Defective drains 7 Accumulations of refuse etc Source untraced 1 TOTAL 510 (4) Type of premises found to be infested:- With Rats with Mice Total Council property 11 - 11 Dwellinghouses 405 24 429 Business premises etc 32 16 48 Schools, Hospitals, Canteens etc. 7 6 13 Land 3 — 3 TOTAL 458 46 504 (5) Summary of the type of premises and methods employee In clearing premises of rats and mlce:- Type of Premises cleared Dwellinghouses (mainly in gardens) 423 Food shops and food premises 36 Non-food shops 5 Waste land 1 Hospitals and Schools 6 Factories and Workplaces 15 Council Premises 11 Miscellaneous 5 TOTAL 502 30 (6) Methods employed in clearing five hundred and two premises of rats and mice:- warfarln and Poison Baits 499 Trapping 1 Gassing 3 Rat and Mouse Proofing 2 Drains repaired 7 Other means 2 TOTAL 514 B - SEWER TREATMENTS (1) Treatment No. 20 - Second Maintenance Treatment (1955-1956) The second maintenance treatment of soil sewer-manholes in areas found to be infested during the previous treatment was completed on the 24th March, 1956. Prebaltlng with damped sausage rusks was carried out on two consecutive days and the same bait base with 2½% Zinc Phosphide added was laid on the third day with the following results:- SECTIONS A B C D E Total Number of Manholes pre-balted 70 Not Baited 87 66 66 289 Complete prebalt takes 3 11 1 5 20 Partial prebalt takes 14 19 24 19 76 Percentage of takes (C.&P.) 24.2 34.4 37.8 36.3 33.2 Number of manholes poison baited 24 40 37 37 138 The number of prebalt takes shows an Increase of 5% on the previous maintenance treatment. (2) Test Baiting (1956-1957) The Borough was divided into five sections, as in previous tests, and a test baiting of 10% of the soil-sewer manholes in areas previously cleared or thought not to be infested was carried out during the month of August. All the manholes baited were checked three days after the baits had been deposited, with the following results:- S E C T I 0 N S A B C D E Total Number of manholes baited 14 21 53 66 34 188 Complete bait takes - - 8 5 5 18 Partial bait takes 1 - 1 - 1 3 Baits not taken 13 21 44 59 27 164 Baits washed off - - - 2 1 3 31 (3) Treatment No, 21 - First Maintenance Treatment (1956-1957) This treatment was confined to the sections known to have been infested during the previous maintenance treatment together with sections proved to he infested by the annual 10% test, and operations were completed on the 29th September, 1956. Prebalting with damped sausage rusks with 0.25% of paranltrophenol added as a bait preservative was carried out on the first and fifth days, and the same bait base with 2½% Zinc Phosphide added was laid on the tenth day. This extended method of treatment proved tobe most satisfactory, and shewed a higher percentage of complete bait takes than in several of the previous treatments. Use of paranltrophenol will be made in all future treatments, as it was found that no moulds formed on the baits even after being left ten days in the sewer manholes. The following is a tabulated summary of the results achieved:- SECTIONS A B C D E Total Number of manholes prebaited 62 Not baited 90 87 77 316 Complete prebalt takes 6 27 34 19 86 Partial prebalt takes 3 19 25 3 50 Percentage of takes (C. & P.) 14.5 51.1 67.8 28.5 43.0 Number of manholes poison baited 12 68 65 29 174 The number of prebait takes shows an increase of 9.8% on the previous maintenance treatment. N.B. It was not necessary to bait Section B since there were no bait takes during the 10% Test Baiting Treatment. (4) KEY TO SECTIONS Section "A" - Sutton - All roads south of the Sutton Station and east of Brighton Road. Section "B" - Sutton & 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 32 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Five hundred and six cases of infectious diseases were notified during 1956, compared with one thousand two hundred and eighty eight cases in 1955. This decrease was mainly due to a lower prevalence of Measles and Whooping Cough. There was an increase of Dysentery, Food Poisoning and Scarlet Fever. Twelve cases of Poliomyelitis were notified. One case of Typhoid and one of Paratyphoid Fever occurred. There was no case of Diphtheria, Scarlet Fever. Sixty five cases were notified, an increase of six cases. The case rate was 0.82 per thousand of population, compared with 0.74 per thousand of population for England and Wales. The illness was generally mild. There was no death. Diphtheria. No case was notified. Continued freedom from this dangerous Infection depends on the completeness of immunisation. Diphtheria Antitoxin. The early diagnosis and early treatment of Diphtheria are essential to prevent mortality. Antitoxin is the only effective treatment and should be given on suspicion of infection. Otherwise any suspected case should be admitted to hospital at once for observation and treatment. Swabs for the diagnosis of Diphtheria must be taken before any antibiotic is administered. Diphtheria imraunisation. Every child in every family requires the protection given by immunisation. Diphtheria has been suppressed but not eliminated. During 1956 fifty one cases occurred in England and Wales. Parents are rightly eager to protect their children against prevalent diseases, but should not forget that Diphtheria still lurks in the background and must be kept under control while attacks on other infections are being launched. Diphtheria immunisation is still saving many lives and much disablement. All babies should be immunised before the age of nine months. Infants should receive reinforcing injections before they enter nursery school or day school. School children should be reinforced at the age of eight years. Immunisation is free of charge to every child either through the family doctor or at the nearest Child Welfare Clinic, During 1956 nine hundred and ninety five 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: 647 190 26 22 26 81 3 - 995 33 A survey at the end of 1956 of the state of immunisation of eight hundred and ninety three babies born in 1955 showed that five hundred and ninety two representing 66 per cent, had been immunised. Of the children under five years of age, two thousand six hundred and eighty seven, representing 59 per cent, had been immunised- Of the school children of five to fourteen years of age, six thousand seven hundred and ninety two, representing 61 per cent, had been immunised and sufficiently reinforced and two thousand four hundred and eighty three, representing 22 per cent, previously Immunised. required further reinforcement. During 1956 one thousand seven hundred and sixty nine reinforcing injections were given. Measles. Two hundred and seventy five cases were notified in 1956, compared with one thousand and thirty nine cases in 1955. The case rate was 3.49 per thousand of population, compared with 3.59 per thousand of population for England and Wales. There was no death, After the severe epidemic in the Spring and Summer of 1955 there was a period of quiescence until the end of that year. During 1956 the incidence was relatively low but sporadic cases and small localised outbreaks occurred. The greatest prevalence was from May to July and the highest numbers of cases were in the East and South wards. One hundred and twelve of the cases were infants under five years of age and eight were babies under one year. The monthly incidence of notified cases is shown in the following table. January 11 July 65 February 28 August 30 March 9 September 1 April 11 October 1 May 38 November 7 June 45 December 29 Measles is caused by a virus. There is no specific drug or vaccine. The illness can be severe The danger of complications by secondary infections has been reduced by the timely and selective use of antibiotics. Babies and weakly children should be protected from acquiring the infection. Some parents regard the infectivity of Measles with undue complacency to the detriment of others. Prevention depends on recognition of the early catarrhal symptoms which are present for three or four days before the rash appears and on early isolation which should continue until symptoms and signs have completely disappeared. Careful nursing and careful convalescence are essential. The Illness can be prevented or modified by the injection of gamma globulin early in the incubation period. A limited quantity of gamma globulin is available for cases where there is special risk Whooping Cough. Sixty six cases were notified in 1956, compared with one hundred and sixteen cases in 1955. The case 34 rate was 0.84 per thousand of population compared with 2,07 per thousand of population in England and Wales. There was no death. The general incidence was low. The highest prevalence was in the East and South west Wards. Thirty two of the cases were infants under five years of age and one was under one year. The monthly incidence of notified cases is shown in the following table. January 9 July 10 February 1 August 7 March 18 September 2 April 4 October 2 May 3 November 1 June ... 9 December - Whooping Cough is a serious infection in infancy. There is danger of mortality in young babies and weakly infants. Every effort should be made to give protection by avoidance of infection and by immunisation, injections of vaccine should be commenced at the age of three months. infants should be immunised or reinforced before they enter nursery school or day school. The vaccine will prevent or modify the illness in a majority of cases. During 1956 nine children who had received injections of vaccine were notified as suffering from Whooping Cough. Eight were assessed as slight and one as of moderate severity. Spasmodic cough in an immunised child should arouse suspicion of infection. Diagnosis can be assisted by the use of cough plates or pharyngeal swabs. immunisation against Whooping Cough. Immunisation against Whooping Cough is available free of charge for children under five years of age. either through the family doctor or at Child Welfare Clinics. In 1956 eight hundred and eighty 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. Two hundred and thirty six children were given reinforcing injections during 1956. Small Pox. No case was notified. Vaccination against Small Pox. The speed of the aeroplane has greatly increased the risk, of the introduction of Small Pox into this country. Small Pox is a very serious illness. There is no specific remedy. Vaccination is the only safeguard Every baby should be vaccinated at the age of three to six months. Vaccination in infancy provides a basic immunity which can be reinforced later with reduced rislc of severe reaction. A service is available free of charge through medical practitioners and Child Welfare Clinics. 35 In 1956 four hundred and eighty five babies under the age of one year were vaccinated. The percentage of 53.7 compares with 53.5 in 1955 and 54.3 in 1954. The following table shows the number of vaccinations during 1956. Age Number Vaccinated Number Re-Vaccinated Under 1 485 - 1 31 - 2 11 2 3 6 7 4 7 - 5-9 14 17 10-14 9 13 Over 15 45 232 Totals 608 271 Puerperal Pyrexia. Eleven cases were notified in 1956 compared with nineteen in 1955. 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 of suspected infection occurring in a maternity or nursing home. Tetanus. A scheme for the immunisation of children against Tetanus on request by parents was introduced in August, 1956. The protection given by the primary course of injections of Tetanus Toxoid is not permanent and should be reinforced at the end of one year and thereafter within five year periods. The objective is to reduce the risk, of mortality from tetanus and to avoid the need for injection's of antitetanlc serum, to which some people are allergic, as a prophylactic in cases where a wound is possibly infected. Thirty seven children received injections of Tetanus Toxoid in 1956. Dysentery. Forty seven cases were notifled in 1956, compared with five cases in 1955. All were of the Sonne type. Thirty of the cases occurred in an institution for children. Of the seventeen district cases five acquired infection outside the Borough. Two were infected by a visitor from another district. A group of three cases were infected by one carrier. Four carriers were detected and treated. 36 Sonne Dysentery is a highly infectious form of gastroenteritis. The illness is often severe butmild transient attacks are frequent and often disregarded. Faecal Infection is conveyed directly from hand to hand or indirectly by the fouling of objects or food. The washing of hands after the use of the W. C. and before handling food is the most important protective measure. Typhoid and Paratyphoid Fevers. One case Of Typhoid Fever and one case of Paratyphoid Fever occurred. Both recovered. A boy aged thirteen years developed Typhoid Fever after accidental immersion in a sewage tank in another district. A woman aged fifty four years, a private nurse, contracted paratyphoid Fever, Type 3.A. No local source of infection was found. A notice served, under the Public Health (Infectious Diseases) Regulations, 1953, on a woman, aged forty two years, a cook., who is a carrier of Salmonella Paratyphosus B, Type 1, requiring her to refrain from engaging in any occupation connected with the handling of food or drink for human consumption, was continued. The infection persists. Compensation was paid in accordance with the Regulations during 1956. Food Poisoning. Fifteen cases were notified in 1956, compared with seven cases in 1955. All were single cases and widely distributed. There was no apparent connection between the cases. No common sources of infection were discovered. Two were infected outside the Borough. Six were adults, three were school children and six were infants. Ten of the cases occurred during May and June. Thirteen of the cases were caused by Salmonella Typhlmurlum, one by Salmonella Thompsonl and one by Staphylococcus. There was one death from an acute attack, a woman aged seventy four years. Foods involved included reheated stew, cold ham, salad, sausage rolls, and duck's eggs. Mice were a possible source of infection in two cases. in ten cases the exact source of infection was not ascertained. During investigations four carriers were detected and treated. Salmonella Typhlmurlum was the most frequent cause of food poisoning. Mice are the original source of this infection. The danger of contamination of food during production, storage and distribution demands constant efforts to secure their destruction or exclusion from contact with food. Meat and egg products which are not subjected to sufficient heat for sterilisation are principal vehicles of infection. Salad vegetables and fruit maybe contaminated by rodents and should be thoroughly washed. The egg of the duck is always suspect and should not be used to prepare lightly cooked foods. Boiling for fifteen minutes is necessary for sterilisation of the egg. The human carrier has opened up new channels of infection from food shops, restaurants and canteens. The Food Hygiene Regulations require a very high standard of cleanliness frcmall Who are engaged in the handling of food. The wash hand basin is the most important item of equipment in the food shop. The 37 washing of hands after the use of the W.C. is our principal protection against the intestinal carrier of Salmonellae. Meningococcal Infections. NO case was notified. Poliomyelitis. Twelve cases were notified in 1956, compared with sixteen cases in 1955. Nine were paralytic and three non-paralytic. Three were adults and nine were school children. Four sporadic cases occurred during the Summer. In November and December there was an outbreak of eight cases in Cheam and Worcester Park. Two schools had two cases. One school was closed for a week before the Christmas Holidays. One case occurred in a hospital and the children's ward was closed for two weeks. There were two cases in one family. Of the paralytic cases, one, a girl aged twelve years, had severe general paralysis involving the muscles of respiration and died in March 1957. Two boys aged five and six years have paralysis affecting both legs. A girl aged six years has weakness of one arm and one leg. A woman aged thirty years and a boy aged ten years have weakness of one arm. Three have recovered. The paralysis which occurs in some cases of Poliomyelitis is a matter of serious concern. It is hoped to reduce the number of paralytic cases by protective vaccination. It is necessary to recognise that minor febrilei illness may be a prelude to Poliomyelitis and that early precautionary rest reduces the risk of paralysis. Headache, sore throat, aches and pains associated with malaise and fever are significant of virus infection and require restin bed. Cases of mild reaction to infection are liable to spread infection and due precautions should be taken. During the year two hundred and thirty children received injections of Poliomyelitis Vaccine. Pneumonia. Of twenty four deaths from Pneumonia, three were notified before death. The total number of notified cases was twenty one compared with twenty nine in 1955. Infestations. No case of Scabies or head lice was treated at the clinic during the year. Non-notifiable Diseases. School teachers reported two hundred and sixty three cases of Chicken Pox, one hundred and forty six cases of German Measles and nineteen cases of Mumps. School returns areauseful indication of the prevalence of nonnotifiable diseases and form a basis for consultation with the school medical officer. 38 39 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1956 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 - 2 5 1 - 46 6 3 1 - 1 - 65 14 - Diphtheria - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - Typhoid Fever - - - - - - 1 - - - - - 1 1 - Paratyphoid Fever - - - - - - - - - - 1 - 1 1 - Puerperal Pyrexia - - - - - - - - 10 1 - - 11 - - Pneumonia - - - 1 1 5 - - 2 2 1 9 21 4 24 Erysipelas - - - - - - - - - - 3 2 5 1 - Dysentery 1 - 2 - 1 3 2 1 5 - 2 - 17 5 - Poliomyelitis - - - - - 6 3 - 2 1 - - 12 11 - Meningococcal infection - - - - - - - - - - - - - - - Post-infectious Encephalitis - - - - - 1 - - - - - - 1 1 - Malaria (contracted abroad) - - - - - - - - 1 - - - 1 1 - Measles 7 15 22 31 31 142 14 - 6 - 1 - 269 5 - Whooping Cough 1 4 10 6 11 31 3 - - - - - 66 1 - London Cases in an Institution Dysentery - 6 11 6 3 1 - 2 1 - - - 30 30 - Measles 1 2 2 - 1 - - - - - - - 6 6 - *Under column "Died", all deaths, whether notified in the district or outside it, or not notified at all, are included. 40 DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS (District Cases) Disease WARDS Case Rate per 1,000 population (Mid-year) Case Rate per l,000 England and Wales N. N.W. N.E. W.C. E. C. E. S.W. S.E. S. TOTAL Population:- 9719 8654 11008 12171 7160 7766 7469 5971 8902 78820 Scarlet Fever 4 6 13 19 3 8 6 2 4 65 0.82 0.74 Diphtheria - - - - - - - - - - 0.00 0.00 Smallpox - - - - - - - - - - 0.00 0.00 Typhoid Fever - - 1 - - - - - - 1 0.01 0.00 Paratyphoid Fever - - - - - - - 1 - 1 0.01 0.01 Puerperal Pyrexia - - - 1 1 - - 9 - 11 - - Pneumonia 2 2 8 2 1 2 2 - 2 21 0.27 0.59 Erysipelas - - - 3 - - 2 - - 5 0.06 0.10 Dysentery 1 2 - 2 3 - 5 3 1 17 0.22 1.09 Poliomyelitis 1 3 2 3 - 1 2 - - 12 0.15 0.07 Meningococcal infection - - - - - - - - - - 0.00 0,03 Post-infectious Encephalitis - - - 1 - - - - - 1 0.01 Malaria (contracted abroad) - - - 1 - - - - - 1 0.01 - Measles 9 7 42 5 32 55 28 37 54 269 3.41 3.59 Whooping Cough 6 2 8 5 5 17 12 11 - 66 0.84 2.07 TOTALS 23 22 74 42 45 83 57 63 61 470 TUBERCULOSIS On 31st December 1956, there were on the register nine hundred and sixty one cases of Tuberculosis, of whom eight hundred and forty four were Pulmonary and one hundred and seventeen non-Pulmonary cases. The total death rate for Tuberculosis was 0.06 per thousand of population. This compares with 0, 05per thousand of population In 1955. The death rate for Pulmonary Tuberculosis was 0.06 and for non-Pulmonary Tuberculosis 0,00 per thousand of population. For England and Wales the rate for Pulmonary Tuberculosis was 0.11 and for non-Pulmonary Tuberculosis 0.01 per thousand of population. The number of new cases of Pulmonary Tuberculosis was thirty four compared with fifty cases in 1955, This considerable decllne suggests a reduction of infection. Continued progress depends on the intensive search for early cases, the elimination of foci of infection, particularly among the middle aged and elderly and concurrent protection of the adolescent by B. C. G. Vaccination. One new case of non-Pulmonary Tuberculosis was notified, compared with six cases in 1955. Infections of glands, bones and Joints and serous membranes are caused by bovine or human types of the bacillus. Bovine infection is being eliminated from dairy herds. In this Borough all milk is pasteurised or designated. The scheme for the protection of school children at the age of thirteen years by B.C.G. Vaccine had an average response of 70 per cent. Five hundred and fifty four children received injections. The Tuberculosis Care Committee is giving valuable service in combating the social and economic conditions which retard the recovery of the patient and endanger the welfare of the family. Many patients are now being treated at home and require social care. Additional nourishment, clothing and bedding are provided. Grants are made to encourage occupational therapy. Children, mothers and convalescent patients are given restful holidays. The many and varied needs of the patient and family are considered with sympathy and understanding. The voluntary services of the members of the Committee are highly appreciated. The Hon. Secretary is County AldermanMrs. Margaret Walkden, J.P , 9, All Saints Road, Sutton. The following table shows the new cases and deaths In age groups. 41 ACE PERIODS NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - - - - - - - - 1 - - - - - - - - 5 - - - - - - - - 15 2 1 - - - - - - 25 4 4 1 - 1 1 - - 35 2 5 - - - - - - 45 7 1 - - - - - - 55 5 - - - 3 - - - 65 and above 2 1 - - - - - - TOTALS 22 12 1 - 4 1 - -- Notification of Tuberculosis Respiratory forms of death - Four out of five cases were notified. MASS RADIOGRAPHY A Mass Radiography Unit visited the Borough from 5th to 15th March 1956 and was stationed at the Cooperative Hall, Longfellow Road, Worcester Park. Two thousand and sixty five persons were examined. The results were as follows:- Total Examined No. of cases of active Pulmonary Tuberculosis No. of cases of inactive Pulmonary Tuberculosis Non-Tuberculous abnormalities M. F. T. M. F. M. F. M. F. 726 1339 2065 1 2 24 27 15 21 The incidence of active Pulmonary Tuberculosis was 1.5 per thousand persons examined. This is within the range of expectation for an urban area. The average incidence in the County of Surrey was 1.2 per thousand persons examined. Mass Radiography is making a valuable contribution towards the eradication of Tuberculosis by the detection of early disease and by revealing hidden foci of infection. Greater use of the service should be made by those who have not been previously examined and men should be encouraged to attend in greater numbers. The finding of non-Tuberculous abnormalities gives an opportunity for early treatment and the prevention of disablement. 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. Infant Welfare Centre. Every Tuesday and Thursday, at 1.30 p.mo (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 The Clinic, Stonecot Hill, Sutton Ante Katal Clinic. Every Tuesday, at 9.30 a.m. Infant Welfare Centre. Every Monday, Wednesday and Friday, 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 Katal Clinic. Every Monday and Friday, at 9.30 a.m. Infant Welfare Centre. Every Monday and Thursday, at 1.30 p.m. (Including Diphtheria and Whooping Cough Immunisation and Vaccination against Smallpox). Wesley Hall, Ruskin Drive. 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. 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. Holier Hospital, Wrythe Lane, Carshalton Males Every Monday, from 4 p.m. to 6,30 p.m. Females Every Wednesday, from 5 p.m. to 6 p„m. 44 '