SUTC 21 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1957 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 19 57 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR, (Alderman D. P. Thomas, J.P., C. C,) Alderman D. Sparks (Mrs.) M. B. E. " F. Warren " D, Webster (Miss) J..P. Councillor R. A. Beuzeval Councillor F.R, Muddle (Chairman) " D.M, Pettlngell (Mrs. " L, B. Blackler " A. Sullivan " A. W. Letts " A. G. Taylor 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 Cert. R. S. I., Cert, Meat & Food, Cert, S,I. Exam Board (until retirement on 31st October, 1957) ARTHUR SYDNEY WILLIAMS Cert. R. S. I., Cert. Meat & Food (from 1st November, 1957) Deputy Chief Public Health Inspector ARTHUR SYDNEY WILLIAMS Certo R, S.I., Cert. Meat & Food (until 31st October, 1957) REGINALD WILLIAM NORMAN Cert. R.S.I. and S. I.E.J.B., Cert. Meat & Food (from 1st November, 1957) Additional Public Health Inspectors JOHN BAMFORD Cert. R.S.I. and S. I.E.J.B., Cert. Meat & Food REGINALD WILLIAM NORMAN Cert. R.S.I. and S.I.E.J.B., Cert. Meat & Food (until 31st October, 1957) 1 Additional Public Health Inspectors (Continued) KEMPTON HUDDLESTONE PRIOR Cert.R.S.I. and S.I.E.J.B., Cert. Meat & Food CYRIL WILLIAM SOUTHERBY Cert. R.S.I. and S.I.E.J.B., Cert. Meat & Food FRANK SUTCLIFFE Cert. R.S.I. and S.I.E.J.B., Cert. Meat & Food Public Analyst DANIEL D. MOIR. M. Sc., F.R.I.C. Analytical and Consulting Chemist (Part-time) 2 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 1957. The general health of the community was good, despite the Impact of epidemics of Influenza and Measles. The estimated population showed an Increase of one hundred and forty. The birth rate Increased from 11.4 to 12.3 per thousand of population. The death rate rose slightly from 11.1 to 11.3 per thousand of population. The Infantile mortality rate was higher. There was no maternal death. There was an increased incidence of infectious diseases. Measles was epidemic during the Spring. A widespread epidemic of Influenza prevailed during the Autumn. Cases of Pneumonia increased. Whooping Cough was more prevalent. There were fewer cases of Scarlet Fever, Dysentery and Food Poisoning. Eleven cases of Poliomyelitis were notified. No case of Diphtheria occurred. A mass X-Ray Unit visited the Borough in July for two weeks with record attendances. There is increasing interest in this valuable diagnostic service. The Council's Housing Programme is limited by scarcity of sites. Consequently slum clearance is retarded. No new houses were completed during the year. At the end of the year seventy two houses or flats were planned or under construction. Sixty nine applications for subsidies for the building of houses in new towns were accepted. The work, of sanitation, of the prevention of nuisances and of the protection of food was efficiently carried out under the direction of the Chief Public Health Inspector (Mr. C. W. Newbery) and his successor (Mr. A.S. Williams) to whom I am indebted for their helpful collaboration. Work on the second stage of the reconstruction of the Worcester Park Sewage Works proceeded during the year. The water supply of the district maintained a high standard of chemical and bacteriological purity. Effective control by sampling and by chlorlnatlon was continued. I thank the Members of the Council for their advice and help during the year and I am indebted 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 3 STATISTICS OF THE AREA 1956 1957 Area in acres 4338.15 4338.15 Registrar General's estimate of the Resident Population 78,820 . 78,960 Number of inhabited houses (end of year) according to the Rate Book 23,438 23,692 Rateable value and sum represented by a £1,644, 647 £1,539,785 Penny Rate £6,677 £6,259 EXTRACTS FROM VITAL STATISTICS (Comparative of the Years 1956 and 1957) 1956 1957 England & Wales 1957 Total Male Female Total Male Female Live Births 903 490 413 970 493 477 16.1 Legitimate 867 470 397 939 478 461 Illegitimate 36 20 16 31 15 16 Birth Rate per 1000 of the Estimated Resident Population 11.4 12.3 Still Births 15 7 8 18 8 10 22.4 Legitimate 14 7 7 16 7 9 Illegitimate 1 - 1 2 1 1 Rate per 1000, total (live and still births) 16.3 18.2 Deaths 876 433 443 890 415 475 11.5 Death Rate per 1000 of the Estimated Resident Population. 11.1 11.3 Deaths from Sepsis 0 0 0.47 Other Maternal Causes 0 0 Death Rate from Maternal Causes per 1000 total (live and still births) 0.00 0.00 Deaths of Infants under one year of age All infants per 1000 live births 16.6 26.8 23.0 Legitimate Infants per 1000 legitimate live births 14.9 24.5 Illegitimate Infants per 1000 illegitimate live births 55.5 96.9 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1957 M. F. Total 1. Tuberculosis, respiratory 5 - 5 2. Tuberculosis, other - - - 3. Syphilitic disease 3 1 4 4. Diphtheria - - - 5. Whooping Cough - - - 6. Meningococcal infections - 1 1 7. Acute Poliomyelitis 1 1 2 8. Measles - - - 9. Other infective and parasitic diseases 3 1 4 10. Malignant neoplasm, stomach 12 16 28 11. Malignant neoplasm, lung, bronchus 33 5 38 12. Malignant neoplasm, breast - 18 18 13. Malignant neoplasm, uterus - 7 7 14. Other malignant and lymphatic neoplasms 48 48 96 15. Leukaemia, aleukaemla 6 - 6 16. Diabetes 1 3 4 17. Vascular lesions of nervous system 39 73 112 18. Coronary diseases, angina 81 49 130 19. Hypertension with heart disease 4 17 21 20. Other heart disease 54 104 158 21. Other circulatory disease 20 29 49 22. Influenza 3 7 10 23. Pneumonia 11 12 23 24. Bronchltls 21 14 35 25. Other diseases of respiratory system 4 3 7 26. Ulcer of stomach and duodenum 3 1 4 27. Gastritis, enteritis and diarrhoea 1 4 5 28. Nephritis and nephrosis 5 1 6 29. Hyperplasia of prostate 8 - 8 30. Pregnancy, childbirth, abortion - - 1 31. Congenltal malformations 6 2 8 32. Other defined and ill-deflned diseases 22 46 68 33. Motor vehicle accidents 8 2 10 34. All other accidents 6 8 14 35. Suicide 7 2 9 36. Homicide and operations of war - - - TOTALS 415 475 890 5 Mortality. The principal causes of death were diseases of the heart and circulation (52 per cent.) and cancer (22 per cent.). Deaths from cancer of the lung increased from thirty one to thirty eight. Deaths from coronary diseases decreased from one hundred and forty eight to one hundred and thirty. Deaths from accidents rose from twenty to twenty four, of which ten were due to motor vehicles. The results of epidemiological and statistical studies can be applied to the prevention of diseases and reduction of mortality. It is known that there is statistical correlation between smoking and cancer of the lung. There is evidence that the incidence of cancer of the lung is increasing. The significance of these findings should be recognised. A survey on the deaths of British doctors has shown that the death rate from cancer of the lung rose in proportion to the amount smoked and that the mortality rate from lung cancer was lower amongst those giving up smoking and diminished progressively with the increase in time during which smoking had been given up. DEATHS FROM CANCER OF THE LUNG, 1950 to 1957 1950 1951 1952 1953 1954 1955 1956 1957 Males 26 15 29 36 35 26 28 33 Females 3 8 7 3 3 6 3 5 Totals 29 23 36 39 38 32 31 38 Maternal Mortality. There was no maternal death. Infantile Mortality. There were twenty six deaths of Infants under one year in 1957, compared with fifteen deaths in 1956. The Increase was due mainly to prematurity and congenital defect. The Infantile mortality rate was 26.8 per thousand live births, compared with 23.0 per thousand live births for England and Wales. of the twenty six deaths, nineteen occurred in the neo-natal period within one month of birth, as is shown in the following table of causes and age groups. Causes of Death AGE GROUPS Under 1 month 1-3 months 3-12 months Prematurity 12 - 1 Congenital abnormality 5 1 2 Cerebral haemorrhage 2 - - Peritonitis - - 1 Pneumonia - 1 - Accident - - 1 Totals 19 2 5 6 GENERAL PROVISION OF PUBLIC HEALTH SERVICES FOR THE AREA NEW LEGISLATION The Colouring Matter in Food Regulations, 1957 These regulations which control the addition of colouring matter to food came into operation on 30th June, 1957. The Rent Act, 1957 This amending Act came into force on 6th July, 1957. Certain provisions relate to the control of rents and possession of houses. Local authorities are chiefly concerned with provisions relating to disrepair. The Housing Act, 1957 This is a consolidating Act (excepting finance) and slightly amends the law existing prior to 1st September, 1957, the date of operation of the Act. REMOVAL OF PERSONS IN NEED OF CARE AND ATTENTION The National Assistance Act, 1948 - Section 47 A Court Order obtained on 28th March, 1956 for the removal of a man, aged seventy four years, senile and infirm and living in insanitary conditions, to residential accommodation at "St. Andrews", Farnham, and renewed during 1956 in accordance with the Act, was again renewed by the Court on 20th February, 1957 and 22nd May, 1957. He died on 20th June, 1957. BURIAL AND CREMATION OF THE DEAD The National Assistance Act, 1948 - Section 50 Six burials were arranged under the powers granted to the Council by this Section. MORTUARY One hundred and fifty eight bodies were received and one hundred and fifty eight 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 7 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 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 188.75 Ammonia, free 0.18 Ammonia,. Albuminoid 0.00 Nitrogen in Nitrates 8.18 Nitrogen in Nitrites 0.00 Oxygen Absorbed 0.10 Chlorine in Chlorides 18.75 Hardness total (grains per gallon) 7.60 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. 8 DRAINAGE AND SEWERAGE Worcester Park Sewage Disposal Works. The work Oil Stage II of the Reconstruction Scheme has proceeded during the year and it is anticipated that the new Sludge Digestion tank will be in operation by Autumn, 1958. Design of succeeding Stages in the Reconstruction Scheme is proceeding. The effluent being discharged to the Beverley Brook con times to be of good quality. Sutton Sewage Disposal Works. These Works continue to discharge a good quality effluent to the Pylbrook. Flooding. The Borough Council have completed the new surface water sewer in Hamilton Avenue and Trafalgar Avenue and the Surrey County Council are proceeding with work of improvements to the Pylbrook at the rear of the properties in Hamilton Avenue. Design of the new surface water sewer in Matlock Crescent has been completed and work is to commence on the contract in February, 1958. The design of a relief surface water sewer for the lower portion of the High Street has been completed and financial authority is being sought. Refuse Collection and Scavenging. The collection and disposal of house re fuse 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 Accommodation. There are four premises with cesspools in use. Only two pall closets and two chemical closets are in use. In the past twenty nine 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 36 ) RECORD OF INSPECTIONS MADE AND NOTICES SERVED Visits Special Inspections: Interviews and advisory visits 1,439 Reinspectlon visits 3,481 Visits to works in progress 542 " Factories/Workplaces 524 " Bakehouses 39 " Outworkers premises 97 " Butchers/Grocers/Greengrocers/Fishmongers etc. 618 " Dairies/Milk Purveyors 28 " Ice Cream Premises (Manufacture and sale of) 129 " Restaurant/Cafe Kitchens, Dining Rooms etc. 139 " School/Industrial Canteen Kitchens 63 " Stables/Passages/Piggeries and Ditches 30 " Premises in connection with rodent control 5,765 " Cinemas/Theatres/Halls 11 " Hairdressers and Barbers Premises 74 " School and Public Conveniences 16 " Verminous Premises 12 " Shops under the Shops Act 255 " Licenced Public Houses 15 " Hospitals - spraying of kitchens 20 Visits re Infectious Diseases 82 " Food Poisoning Enquiries 2 " Food Complaints (request inspections) 87 " Overcrowding and permitted numbers 129 " Food and Drugs sampling 262 " Sampling of milk and water (Bacteriological) 125 " Sampling of ice cream (Bacteriological) 149 " Merchandise Marks Acts 263 " Rag Flock Act 4 " Pet Animals Act 10 " Heating Appliances (Fireguard Regulations) 5 " Atmospheric Pollution Gauges/Smoke observations 77 Miscellaneous visits 1,423 Total 15,915 Number of complaints received and investigated 437 Premises at which defects or nuisances were discovered 1,310 Dwelling-houses surveyed for housing defects under the Public Health or Housing Acts 51 Number of defects or nuisances discovered 1,991 " " " remedied 1,706 " " " in hand 109 " " " outstanding 176 Number of Informal notices served 798 10 STATUTORY NOTICES WERE SERVED AS UNDER. Housing Act 1936/1957 Sections 9 and 10 5 Public Health Act 1936, Section 24 70 " " " 39 4 " " " 45 2 " " " 75 3 Sutton and Cheam Corporation Act, 1951, Section 39 4 Sutton and Cheam Corporation Act, 1951, Section 42 1 Total 89 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT Drainage and Sanitary Fittings Number of houses and other premises redrained 8 " " " connected to soil and surface water sewers 2 Repairs and amendments to existing drains (1,359 feet laid) 59 Drains or gullies unstopped or cleansed (involving 929 premises) 312 Sanitary fittings repaired/renewed provided or cleansed 396 Water service pipes/cisterns/repaired renewed or cleansed 11 Water, smoke and chemical tests applied 161 W.C. Apartments W.C. Apartments provided 8 " lighted and/or ventilated 15 " provided with ventilated lobbies 5 " screened 1 " cleansed 32 Separate W,C. accommodation provided for the sexes 1 Structural Repairs or Improvements Carried Out Number of roofs repaired or renewed 56 " guttering and rainwater pipes provided repaired etc. 47 " damp walls remedied 23 " brick walls repointed repaired or re-rendered 25 " chimney stacks repaired or rebuilt 23 " yards paved or repaired 10 " floors relaid or repaired 33 " windows/cills/sashcords repaired or renewed 127 " doors/thresholds provided or repaired 13 " staircases/handrails provided or repaired 8 " ranges/stoves/coppers renewed or repaired 20 " food cupboards provided/ventilated Cleansing Number of rooms/passages/larders cleansed and/or repaired 82 " trade premises cleansed 61 " verminous premises disinfested for bugs/fleas 13 " premises sprayed for cockroaches/crickets/wood beetles etc. 34 " School Canteens/Kitchens sprayed for files and ants 10 " premises disinfected after various diseases 98 " Hospital kitchens sprayed 10 11 Various Number of dustbins provided 18 " accumulations of refuse removed 20 " wasp nests destroyed 81 " miscellaneous items 46 HOUSING Inspection of Dwelling-Houses during the Year:- (1) (a) Total number of dwelling-houses Inspected under the Public Health or Housing Acts 51 (b) Number of Inspections made for the purpose 262 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 33 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(Including 23 for 1956) 48 3. Action under Statutory Powers during the Year:- (A) Proceedings under Sections 9, 10 and 16 of the Housing Acts 1936-1957:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 5 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By Owners 2 (b) By Local Authority in default of owners (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 2 (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 - (2) Number of houses demolished as the result of informal action by the Local Authority 1 12 HOUSING REPAIRS AND RENTS ACT, 1954 No applications were received for 'Certificates of Disrepair' under this Act during 1957, but two applications for revocation of certificates issued in 1956 were received and granted. The following is a summary of the number of applications received for 'Certificates of Disrepair' under Section 26 from the 30th August 1954, (when the Act came into operation) until the 6th July 1957, when it was repealed by the Rent Act, 1957:- Number of applications for certificates of disrepair 19 Number granted 13 Number refused 5 Number withdrawn 1 Number of applications received for revocation of certificates, and granted 9 Number of certificates not yet revoked 4 RENT ACT, 1957 This Act came into operation on the 6th July 1957 and applies primarily to privately owned property let unfurnished as separate dwellings, but it also affects furnished lettings. The main effect of the Act was to free from rent control houses and flats with rateable values exceeding £40 in the Metropolitan Police District, and the City of London, or over £30 elsewhere in England and Wales, and to allow limited increases in the rents of houses and flats still under rent control. The Act has the general objective of enabling rented properties to be put in repair, of increasing the total stock of rented accommodation, and of securing a better use of existing housing accommodation. The following summary shews the number of applications received for 'Certificates of Disrepair' during the period 6th July to 31st December 1957:- Number of applications received 48 Number of decisions not to issue certificates Nil Number of applications withdrawn 3 Number of decisions to issue certificates 45 (a) in respect of some but not all defects 31 (b) in respect of all defects 14 Number of undertakings given by landlords under paragraph 5 of the First Schedule (Form K) 22 Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil Number of certificates of disrepair issued 12 13 INSPECTION OF FACTORIES AND OTHER PREMISES Factories Act 1937-1948 - (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 86 15 (2) Factories with mechanical power 307 334 56 (3) Other premises (excluding outworkers premises) 18 42 5 Total 381 462 76 2. Defects found in Factories and Other Premises under the Act:- Particulars Number of cases in which defects were found Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 17 14 - - Overcrowding - - - - Unreasonable Temperature 1 - - - Inadequate Ventilation - - - - Ineffective drainage of floor 1 1 - - Sanitary Conveniences (a) Insufficient 8 6 - - (b) Unsuitable or defective 48 36 - 5 (c) Not separate for the sexes - - - - Other offences against the Act (not including offences relating to outwork:) 1 1 - - Total 76 58 - 5 3. Outwork (Sections 110 and 111) Nature of Work No. of out-workers as recorded in the August list No. of cases of default in sending list to the Council Notices served Wearing apparel (Making etc.) 6 - - Umbrellas etc. 11 - - Lampshades 19 - - Total 36 - - 97 visits were made during the year to the homes of out-workers. 14 WORKPLACES- Public Health Act, 1936 Inspections Number of written and verbal notices Occupiers prosecuted 50 11 - CLEAN AlR ACT, 1956 Certain provisions of this Act, which included powers enabling Local Authorities to establish smoke control areas have been In operation since the beginning of 1957. The remaining provisions of the Act, not already covered by the Clean Air Act (appointed day) Order 1956, will come into operation on 1st June, 1958. After 1st June 1958 it will be an offence liable to a heavy penalty to emit dark smoke. This will apply equally to factories, shops and offices, house chimneys, the funnels of ships and railway engines. "Dark Smoke" is defined as smoke as dark as or darker than shade 2 on the Ringelmann Chart. The Act allows certain defences in the event of proceedings, for example, if it can be proved that dark smoke was solely due to lighting up a furnace from cold or to mechanical failure. In addition to the ban on dark smoke, the Clean Air Act will require a reduction in emissions of grit and dust from 1st June, and after that date all new furnaces Installed for burning pulverised fuel, or more than one ton an hour of other solid fuels, will have to be equipped with grit and dust arresting plant approved by the Local Authority. In the case of other new and existing furnaces, except for small domestic boilers, failure to take practicable steps to minimise grit and dust will be an offence. Smoke Abatement and Atmospheric Pollution. There are but few industrial chimneys in the Borough. No emission of dark smoke has been observed except in one case where dark smoke emitted from a hospital chimney was abated as a result of informal action, by the conversion of the plant from coal to oil fuel. Grit Deposit Measuring Gauges. In conjunction and With the co-operation of the Department of Scientific and Industrial Research, the grit deposit measuring gauges have been maintained and collected monthly for analytical examination of the contents. The following is a summary of the results obtained- 15 Gauge No.4 was removed early in March when building operations were commenced on the site, and reslted elsewhere on the 1st June, 1957. 16 Month Gauge No. 1 Gauge No. 2 Rainfall in Inches Total Solids (Tons per square mile) Rainfall in Inches Total Solids (Tons per square mile) January 1.61 11.93 1.69 9.54 February 2.83 8.92 2.93 10.20 March 0.67 8.95 - - April 0.25 9.95 - - May 1.30 11.26 - - June 1.30 12.76 - - July 2.51 10.20 - - August 3.25 7.66 - - September 2.62 11.23 - - October 1.65 7.16 - - November 2.02 7.33 - - December 1.94 10.54 - - TOTAL 21.95 117.89 4.62 19.74 Monthly Average 1.82 9.82 2.31 9.87 Gauge No. 2 was removed on the 1st March, 1957, due to redundancy on the cessation of gas production at the Sutton Gas Works. Month Gauge No. 3 Gauge No. 4 Rainfall in Inches Total Solids (Tons per square mile) Rainfall in Inches Total Solids (Tons per square mile) January 1.62 11.86 1.61 6.37 February 2.88 11.07 2.90 6.06 March 0.72 5.67 - - April 0.26 8.76 - - May 1.35 11.73 - - June 1.15 22.95 0.99 11.87 July 2.57 13.00 2.32 8.12 August 3.41 12.08 2.88 6.69 September 2.67 15.97 2.33 10.21 October 1.71 11.16 1.66 8.02 November 2.37 13.70 2.20 9.77 December 1.98 11.60 1.78 10.14 TOTAL 22.69 149.55 18.67 77.25 Monthly Average 1.89 12.46 2.07 8.58 INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1955 Sampling. During the year two hundred and sixteen samples (comprising fifty-one formal and one hundred and sixty-five Informal samples) were submitted to the Public Analyst for analysis as follows:- Type of Sample Number of Samples Examined Unsatisfactory Samples Formal Informal Total Formal Informal Total Ale - 1 1 - - - Almonds - ground 1 1 - - - Aniseed, Balsam of - 1 1 - - - Aspirin Spirit Liniment - 1 1 - - - Banana Flavour - 1 1 - - - Biscuits - 1 1 - - - Blackcurrant and Glycerine Pastilles - 1 1 - - - Blackcurrant Syrup - 1 1 - - - Butter 2 - - - - Cake Mixture - 4 - 1 1 Camphorated Oil - 1 1 - - - Cereal - 1 1 - - - Cheese Spread - 2 - - - Chicken and Ham Paste - 1 1 - - - Chicken - minced - 1 1 - - - Chlcklettes - 1 1 - - - Chocolate Drink 1 - 1 - - - Christmas Pudding - 1 1 - - - Coconut - desiccated - 1 1 - - - Coffee - 1 1 - - - " Instant - 1 1 - - - Coffee and Chicory - 1 1 - - - Cold Capsules - 1 1 - - - Confectionery - flour 1 - 1 - - - " - sugar - 10 10 - - - Cordial 2 1 3 - - - Cough Mixture - 4 4 - - - " Syrups - 4 4 - - - " Syrup - Cherry - 1 1 - 1 1 Cream - 3 3 - - - " - sterilised - 2 2 - - - Cucumbers - 1 1 - - - Currants - 1 1 - - - Diabetic Chocolate - 1 1 - - - Digestive Lozenges - 2 - - - Disinfectant - 1 1 - - - Drink Powder - 1 1 -- - - Dripping 1 - 1 - - - Figs, Syrup of - 1 1 - - - Flavouring Essence - 2 - - - Flour - Self Raising - 1 1 - - - Fruit - dried - 1 1 - 1 1 Gin 2 - - - - Glycerine of Thymol - 1 1 - - - Glycerine, Lemon Oil, Honey - 1 1 -- 1 1 Gum Pastilles - 1 1 - - - Haemorrhold Cream - 1 1 - - - Ice Cream - 6 - - - " Powder - 1 1 - - - Iodine Liniment - 1 1 - - - Jam - 2 - - - Jelly - 3 - - - Jelly - table - 1 1 - - - Kidney Cleansers - 1 1 - - - Carried forward 10 81 91 - 4 4 17 Type of Sample Number of Samples Examined Unsatisfactory Samples Formal Informal Total Formal Informal Total Brought forward 10 81 91 - 4 4 Lactagol - 1 1 - - - Lard 1 - 1 - - - Lemon Curd - 1 1 - - - Lemon Juice - - 2 - - - Lemonade Powder - 1 1 - - - Linseed and Honey Balsam - 1 1 - - - Liquid Apples - 1 1 - - - Liver Sausage 1 - 1 - - - Luncheon Meat - 1 1 - 1 1 Marzipan - - 2 - - - " Fruits - 1 1 - - - Meat Pudding - 1 1 - - - Meat Tenderlser - 1 1 - - - Meringue Powder - 1 1 - 1 1 Milk. 18 14 32 - - - " - Channel Island 12 - 12 - - - " - Evaporated - 1 1 - 1 1 " Shake Powder - 1 1 - 1 1 Mint Sauce - 1 1 - - - Mollasses Tablets - 1 1 - - - Mustard - French - 2 2 - 1 1 Nerve Tonic - 1 1 - - - Noodles - Egg - 1 1 - 1 1 Orange Drink 1 - 1 - - - Oranges - tinned - 1 1 - - - Olive Oil - 1 1 - - - Paste - 1 1 - - - Pastry Puff - 1 1 - - - Pate de Fole Truffle - 1 1 - - - Peas - 1 1 - - - Peel - mixed - 1 1 - - - Pepper - white - 3 3 - - - Phenslc Tablets - 1 1 - - - Piccalilli - 1 1 - - - Pork Roll - 1 1 - - - Quinine Tablets - 1 1 - - - Rennet - Essence - 2 2 - - - Rice Pudding - 1 1 - - - Salmon Spread - 1 1 - - - Sal-Volatile - 1 1 - 1 1 Sardines - 1 1 - - - Sausages - beef 2 - 2 1 - 1 " - Frankfurter - 1 1 - - - " - Meatless - 1 1 - - - " - Pork 2 1 3 - - - Shortening - 1 1 - - - Soup - 2 2 - - - Soup - Baby - 1 1 - - - Spice - 2 2 - - - Steak and Kidney Pudding - 1 1 - - - Stomach Tablets Herbal - 1 1 - 1 1 Taploca - 1 1 - - - Tea - 1 1 - - - Tomato Juice - 1 1 - - - " Puree - 1 1 - 1 1 " Soup - 1 1 - - - Tonic Tablets - 2 2 - - - Tranquillizer Tablets - 1 1 - - - Travel Sickness Tablets - 1 1 - - - Tumeric - ground - 1 1 - - - Turkey - minced - 1 1 - - - Vinegar 1 1 2 - - - Vitamin Capsules - 3 3 - - - Vitamin and Mineral Capsules - 1 1 - - - Whisky 3 - 3 - - - Wine - non alcoholic - 1 1 - - — TOTAL 51 165 216 1 13 14 18 The following details classify the type of Irregularity or Infringement, and the action taken In connection with the fourteen unsatisfactory samples:- Sample No, Article Sampled Type of Infringement Action taken and Remarks 2407 (Informal) Cake Mixture Labelling Infringement This article contained the Ingredients for making the basic cake, but not for the Icing and filling shewn In the Illustrated panel on the carton container. Cautioned The Manufacturers agreed to omit all Illustrations of Icing, decorations etc. from their advertising matter, and arranged for a new design and printing on the replacement cartons. 2305 (Informal) Cherry Cough Syrup Labelling Infringement This preparation contained the active constituents listed on the label which did not Include any reference to preparations of cherry bark or cherry laurel. The article was not entitled to the description "Cherry Cough Syrup". Cautioned. The Manufacturers maintained that the description of the basic Ingredients and the extracting process would be Inconveniently long for the space available on the label, but eventually agreed to alter the title to "Children's Wild Cherry Flavoured Cough Syrup". 2436 (Informal) Dried Fruit (Mixed) Labelling Infringement The label on the container of this article stated - "cleaned and processed ready for use"; but the mixed fruit was found to contain 0.05% of sand and other earthy matter. Cautioned. The retailer's remaining stock was returned to the wholesaler to be suitably dealt with. The packers agreed to reprint the cartons omitting the words "Ready for Immediate use" and any reference that the fruit had been cleaned. 2424 (Informal) Glycerin, Lemon Oil, Honey Labelling Infringement This preparation was described on the label as "Glycerin B.P., Lemon Oil B. P., Honey B. P.C., Ext. Ipecac. Llq. B. P.", but was found to consist of a compounded syrup containing a large proportion of sugar In addition to the main Ingredients specified In the title. Cautioned. The manufacturing chemist amended the label for this preparation to read "Syrup of Glycerin, Lemon Oil and Puriried Honey and Ext. Ipecac. Llq. B. P.", which the Public Analyst agreed was a reasonable description for the article. 2432 (Informal) Luncheon Meat The Luncheon Meat contained 72% of meat, whereas a reasonable minimum meat content Is considered to be 80%. Cautioned. The French manufacturers expressed surprise that the meat content was below 80% and maintained that It was manufactured In such a manner that the meat content should have been 80%. A further sample will be taken in due course. 19 Sample No. Article Sampled Type of Infringement Action taken and Remarks 2411 (Informal) Meringue Powder Labelling Infringement. The Ingredients of this article were specified on the label as "Ethyl Methyl Cellulose, Milk solids, Pure Egg White, Flavouring and Colouring", but no milk solids were detected, although there was evidence that the article had been prepared with about 1% of skimmed milk powder and a small proportion of dried egg albumen. Cautioned. The Manufacturers agreed to amend their labels, substituting the words "Skimmed Milk Powder" for the description "Milk solids". 2313 (Informal) MilkEvaporated (Full Cream) This article was found to contain 230 parts of tin per million, and Indicated excessive contamination due to prolonged storage, although a maximum figure of 250 parts of tin has been suggested as appropriate for canned foods In general, but as full cream evaporated milk Is used for feeding Infants it,was considered advisable not to offer this milk for general sale. The matter was taken up with the retailer, but It was found that only one case of this milk had been delivered and all the tins sold. The multiple firm was advised to Issue a directive to all branch shops outside the Borough to check any remaining stocks. 2375 (Informal) Milk. Shake Powder Labelling Infringement One of the Ingredients of this article was specified on the label as "vegetable stabiliser' but this term Is a generic and not a specified term and Is not In accordance with the requirements of the Labelling of Food Order. The Manufacturer agreed to omit the words "vegetable stabiliser". Eventually new labels were printed which complied with the Order. 2295 (Informal) MustardFrench This article had deteriorated through long storage and was unfit for human consumption. It was badly discoloured and possessed an objectionable smell and taste. Cautioned. Investigation revealed no further stocks available In the shop, as the 'line' had been discontinued. 2306 (Informal) NoodlesEgg The egg-noodles contained 1.5 per cent of egg yolk solids. There Is no legal standard for the egg content of noodles In this Country, but it would appear that a code of practise Is laid down by the Food Manufacturer's Federation Inc. and the Ministry of Food, which provides for a minimum egg solid content of not less than 3%. Cautioned. The manufacturers maintained that private analytical examination reports received gave In all instances a minimum of 4% egg yolk solids and could not account for the low figure of 1.5 per cent In this Instance. A repeat sample will be taken In due course. 20 Sample No. Article Sampled Type of Infringement Action taken and Remarks 2446 (Informal) Sal-Volatile This preparation was deficient in free ammonia to the extent of 22 per cent of the minimum prescribed by the British Pharmacopoeia. It contained 0.87% w/v of free ammonia Instead of a minimum of 1.12% w/v. Cautioned The retailer's remaining stock was returned to the Manufacturing Chemists who found that the NHg content was slightly lower than that found by the Public Analyst. This result confirmed the manufacturer's theory of faulty closures to the bottles, as the content figures after manufacture of the batch from which the retailer's delivery formed part, was 1.25% free ammonia. Further tests are being carried out to Improve the closures, and thus prevent evaporation. A984 (Formal) Sausagesbeef Labelling Infringement This sample was purchased as beef sausages, but analysis revealed It to be a sample of preserved beef sausages. The vendor was warned that the sausages were not labelled, or the prescribed notice exhibited to the effect that the sausages contained preservative. It was stated that due to redecoratlons being carried out at the premises, the prescribed notice had been mislaid, but that the oversight had now been rectified and a suitable notice exhibited. 2287 (Informal) Stomach Tablets, Herbal Labelling Infringement In the opinion of the Public Analyst the references to this article on the carton and In the accompanying literature might be liable to mislead the public as to the true nature of the tablets, as they were not antacid In the normal sense of the term. Cautioned The tablets contained a mixture of dehydrated vegetable Ingredients possessing no direct antacid properties. The acid-base balance of 6 tablets (dally dose) was equivalent to 43 mis. N/10 alkali which is the same as that of about ljozs. of raw carrots or celery. The manufacturers agreed there was some ambiguity in the wording of the descriptive matter, and proposed to modify the wording at the next printing of cartons and literature. 2294 (Informal) Tomato Puree Labelling Infringement The tomato puree contained 1.5% of added salt as an Ingredient, not specified on the label in accordance with the requirements of the Labelling of Food Order. Cautioned All remaining stocks were returned to the Importing wholesalers and the 'line' discontinued. 21 Sampling Observations. It will be seen from the detailed classification that of two hundred and sixteen samples taken during the year 2.30% were found to be other than genuine and labelling Infringements accounted for a further 4.16%, making a total of 6.46%. For comparative purposes the figures for 1956 were 2.32% and 1.86% respectively making a total of 4.18%. The pattern of sampling has followed that of previous years In that a wide range of commodltleshas been covered. Asatlsfylng result has emerged since the Infringements revealed were generally of a minor character and with the willing co-operation of retailers or manufacturers were quite readily adjusted. COMMENTS BY THE PUBLIC ANALYST ( Food and Drugs Act, 1955) The detailed worklngof the Act In respect of the Individual samples purchased and analysed Is adequately covered by the Chief Public Health Inspector's Report and I shall confine myself in these remarks to more general comments on certain aspects of enforcement as they appear to the Public Analyst, and as exemplified by the action taken on various samples during 1957. When the public analyst reports on a sample submitted to him as a result of routine sampling he usually does so after consideration of various principles laid down in the Act and after asking himself the following questlons:- 1. Is the article of the nature, substance.and quality demanded? 2. Is the article fit for human consumption? 3. Is the label on the article false or misleading? 4. Is the article (If pre-packed) correctly labelled? 5. Is there anything Injurious or potentially Injurious present? In answering the first four questions he must attempt to put himself into the same position (and state of mind) as the purchaser and this Is not always an easy matter. It has been contended time and time again that the public analyst Is no fit person to do this since he Is an expert on analysis only and his opinion on anything else Is not worth anything, Nothing is further from the truth since there Is no doubt that the public analyst goes to a very great deal of trouble to find out what the ordinary purchaser thinks, and in the course of years he develops a sixth sense which enables him, In the light of his analysis, to separate the 1 genuine' samples from the 'adulterated' with a fair degree of accuracy. However, the very fact that it is not easy to do this does make us cautious in alleging that an Importer, manufacturer, packer or retailer has committed what is 22 regarded by law as a criminal offence when he may be doing so in perfectly good faith and with no thought of prejudicing or misleading anybody. It is for this reason that the practice of negotiating with possible offenders in the first place is one which is becoming increasingly common and it is this practice which has been employed with great success in the Borough of Sutton and Cheam. The enforcing Authority is frequently faced both in and out of Court by the excuse that the alleged offence, when It relates to the sale of an article of inferior quality, cannot have been committed because there is no legal standard for the article concerned. It cannot be too frequently stressed that It has never been the policy In this country to create legal standards foralarge variety of foods and, although the number of standards is slowly increasing, it Is doubtful whether we shall ever cover in this way more than a few articles. Other foods have to be Judged on their merits and to a large extent on the basis of reputable commercial practice, and the fixing of standards for such foods has purposely been left If necessary to the local Courts to decide on such evidence as may be produced,, Fortunately it is rarely necessary to take matters as far as this, and in this Borough we have found that on the whole co-operation by manufacturers has been readily forthcoming. Where a large number o f manufacturers are Interested in establishing a reasonable standard of quality and description for the same article, there has been a tendency for Trade Organisations to take the matter up on behalf of individuals, and, In this way, following considerable pressure by the enforcing Authorities and by agreement with the Association of Public Analysts, it has been found possible In one or two Instances to arrive at an unofficial standard mutually satisfactory to both sides. Perhaps this tendency will develop In future years. There is one useful function of Food and Drug Sampling which is not always appreciated and that is the elimination of articles of food which have deteriorated through long storage in shopso The retailer still has a responsibility to turn over his stock, in such a way as to satisfy himself that the article he sells is of a satisfactory quality of freshness, and that It has not undergone deterioration as to render it no longer fit for sale. We are often able to draw a line here which, although It might not satisfy the fastidious, is a reasonable safeguard for the average purchaser. MILK SUPPLY food and Drugs Act, 1955 Milk and Dairies Regulations 1949-1953 The Milk (Special Designation) (Raw Milk) Regulations 19U9-195U The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations 1919-1953 The Borough of Sutton and Cheam Is a specified area for the purpose of the Milk (Special Designations) (Specified Areas) Order 1951, therefore all milk sold in the Borough is designated milk 23 All milk distributors In the area are licenced to use the special designation In relation to the milk retailed, and are granted a dealer's or supplementary licence for that purpose. Routine Inspection of milk pasteuriser's and distributors' 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 1957. Grade of Milk Dealers TYPE OF LICENCE Supplementary Pasteuriser's Tuberculin Tested 18 13 — Pasteurised 18 13 1 Sterilised 32 15 - TOTAL 68 41 1 CHEMICAL ANALYSIS OF MILK AND CREAM SAMPLES MILK Thirty formal and fourteen Informal samples of milk were taken for chemical analysis; all of which were found to be genuine. Twelve samples of Channel Island' milk contained satisfactory averages of 4.6% milk fat and 9.08% milk solids other than milk fat; and thirty-two other samples of milk contained satisfactory averages of 3.8% milk fat and 8.77% milk solids other than milk fat. The results were well above the minimum standard of 4% milk fat laid down In The Milk and Dairies (Channel Island and South Devon Milk) Regulations 1956; and of 3% milk fat and 8.5% milk solids other than milk fat required under The Sale of Milk Regulations 1939. CREAM Analysis of the five Informal samples of cream showed the double cream sample to contain 56% milk fat and the four single cream samples a satisfactory average of 23.6% milk fat. The minimum standards In relation to cream are as follows:'double cream' not less than 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. 24 ICE CREAM Ice Cream (Heat Treatment etc•) Regulations 19^7-1952 Registrations. During the year five applications for the registration of premises for the sale and storage of Ice cream were received and granted. At the end of 1957 a total of one hundred and fifty eight 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. EXAMINATION OF MILK SAMPLES (BACTERIOLOGICAL SAMPLES) One hundred and twenty-six samples of milk were examined as follows:- Class of Milk Number of samples examined Type of test applied Results Passed Failed Pasteurised 74 Phosphatase 74 - Methylene Blue 74 - Sterilised 10 Turbidity 10 - Tuberculin Tested Pasteurised 22 Phosphatase 22 - Methylene Blue 22 - Tuberculin Tested (Farm Bottled) 20 Methylene Blue 15 5 TOTALS 126 121 5 To comply with the Milk. (Special Designation) (Raw Milk:) Regulations, Tuberculin TestedMllkmust not decolourise Methylene Blue within 4½ hours If the sample Is taken during 1st May to 31st October, or wlthln 5½ hours If taken between the 1st November to 30th April. Of the total samples examined under these Regulations five samples of Hiberculin Tested (Farm Bottled) Milks failed to pass the prescribed test. Three of these samples were taken during the 4½ hours test period and decolourised Methylene Blue In from 1½ to 3½ hours, whilst the other two samples taken during the 5½ hours test period decolourised methylene blue In 4 hours and 5½ hours respectively. It Is the practise 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. 25 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 than 2.3 Lovibond blue units In the phosphatase test andmust not decolourise methylene blue In 30 minutes. Of the 96 samples examined under these Regulations not one failed the test. BACTERIOLOGICAL SAMPLING 0F ICE CREAM During the year seventy two samples of Ice cream were obtained for bacteriological examination and provisional grading. The following table shows the 1957 percentage results in each grade and for comparative purposes the results obtained in 1956. Grading of Samples 1957 Grading or Samples 1956 Grade 1 66 samples 91.67% Grade 1 92 samples 92.00% " 2 5 " 6.94% " 2 7 " 7.00% " 3 - - " 3 1 " 1.00% " 4 1 " 1.39% " 4 - - TOTAL 72 TOTAL 100 It is most gratifying to record that 98.61.% of the samples were placed in grades 1 and 2, none in grade 3 and only one in grade 4. The following table shows the average percentage and other details In connection with the samples obtained from individual manufacturers. Producers Code Number of samples taken Type of sample Average percentage in each grade Wrapped Loose Grade 1 Grade 2 Grade 3 Grade 4 A 10 10 - 100.00% - - - B 2 2 - 100.00% - - C 20 15 5 95.00% 5.00% - - D 18 16 2 88.89% 11.11% - - E 1 1 - 100.00% - - - F 8 8 - 87.50% 12.50% - - G x 4 - 4 75.00% 25.00% - - H x 5 - 5 80.00% - - 20.00% I 3 - 3 100.00% - - - J 1 - 1 100.00% - - - TOTAL 72 52 20 91.67% 6.94% Nil 1.39% x Denotes locally produced 26 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%. Six samples of locally produced Ice cream were submitted to chemical examination, and found to contain constituent percentages well above the prescribed standard, as under:- Sample No. Fat CONSTITUENT PERCENTAGES Milk, solids other than fat Sucrose Total Sugars 2299 6.6 12.9 13.8 13.8 2348 6.3 10.2 16.0 19.0 2368 6.7 7.7 13.9 17.9 2395 11.2 15.9 19.6 19.6 2396 7.8 12.2 15.7 15.7 2449 7.2 10.8 11.6 11.6 Average 7.6 11.6 15.1 16.3 ICE LOLLIES - BACTERIOLOGICAL EXAMINATION There is no prescribed standard for water ices or ice lollies sold as such, but as in former years it was decided to submit samples to a test similar to the one applied to ice cream. Twenty nine lollies were examined and found to be satisfactory. FOOD - FOOD HYGIENE REGULATIONS 1955-57 These regulations replace Section 13 of the Food and Drugs Act, 1938 (which dealt with precautions against contamination of food) and add a number of new provisions in respect of the hygienic handling of food and the construction and maintenance of premises, stalls, vehicles etc. where food is handled. They also replace regulations 19, 20 and 21 of the Public Health (Meat) Regulations, 1924 in respect of the transport and carrying of meat. The regulations lay down requirements in respect of (a) the cleanliness of food premises and stalls etc. and of apparatus and equipment, (b) the hygienic handling of food, (c) the cleanliness of persons engaged in the handling of food and of their clothing, and the action to be taken where they suffer from, or are carriers of, certain infections, (d) the construction of food premises, the repair and maintenance of food premises, stalls, vehicles etc., and the facilities to be provided, and (e) the temperature at which certain foods that are particularly liable to transmit disease are to be kept in food premises. 27 The Food Hygiene (Amendment) Regulations 1957 amend regulation 7 of the 1955 Regulations (which restricts the giving out of food for preparation or packing in domestic premises). The new regulation 7, which is to apply on the 1st June, 1958 permits the giving out of shrimps, prawns and onions for peeling on domestic premises if the premises are registered for the preparation of the food in question with the local authority under section 16 of the Food and Drugs Act, 1955, and certain other requirements are complied with. The following is a summary of the number of food premises in the Borough:- Bakehouses 15 Butchers (including one horseflesh shop) 56 Confectioners (sugar and flour) 161 Fishmongers/Stalls/Fried Fish Shops 34 General Stores/Shops 21 Greengrocers/Stalls/Stores 85 Grocers 143 Ice Cream (Manufacture and sale of) 158 Licenced Public Houses 35 Milk; Purveyors/Depots/Dairies 32 Restaurants/Cafes/Snack. Bars/Dining Rooms 67 School and Industrial Canteens/Kitchens/ Service Rooms 33 TOTAL 840 During the year 1,031 visits were made to food business premises, 95 notices were served in connection with the 231 infringements discovered as detailed in the following table:- Food Hygiene Regulations Contraventions Number of Infringements found In 1957 Number of Infringements rectified in 1957 including infringements discovered in 1956 but rectified in 1957 Regulation No. 5 4 4 " 6 14 60 " 8 13 47 " 9 7 14 " 10 1 3 " 12 1 - " 14 32 126 " 15 1 12 " 16 37 102 " 17 15 57 " 18 12 48 " 19 20 52 " 20 3 2 " 21 6 5 " 22 - 1 Carried forward 166 533 28 Food Hygiene Regulations Contraventions Number of Infringements found in 1957 Number of Infringements rectified in 1957 including infringements discovered in 1956 Cut rectified in 1957 Brought forward 166 533 Regulation No. 23 53 143 " 24 4 26 " 25 - 2 " 26 8 6 " 28 - 1 TOTAL 231 711 It is gratifying to record that the majority of the traders have shown a willing co-operation to comply with the requirements of the Regulations. This is revealed in the above table by the number of infringements rectified in the relatively short time the Regulations have been in force. Mention must also be made that the standard of hygiene in the various food premises and the cleanliness of the persons engaged in the handling of food is much improved. The following table shows the number of food premises registered by type of business, and the number of Inspections made. A. Section 16 - Food and 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 B C D Preserved Foods Milk Ice Cream Inspections Butchers 47 - - 132 Confectioners (Sugar and Flour) - 1 93 116 Fruiterers - - 4 10 General Shops/Stores - - 7 10 Grocers 15 24 46 177 Ice Cream (Manufacture) - - 3 15 Milk Depots/Dairies - 7 - 28 Sundry Premises -Newsagents etc. — - 5 8 TOTALS 62 32 158 496 29 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 lbs. Tins Bottles or Jars Nos. Bacon 44 - - - Beef (Home Killed) 348 - - - Beef (Imported) 130 - - - Chicken 3½ 2 - - Custard - 2 - - Eggs - - - 108 Fish - 44 - - Fish Paste/Creams - 3 - - Fish (Wet and Dry) 112 - - - Fruit/ Vegetables - 242 1 - Fruit Juices - 24 - - Ham /Gammon 43½ 23 - - J am /Marmalade/Syrup - 54 2 - Kidneys (Ox) 9 - - - Kidneys (Pig) 28 - - - Lamb (Home Killed) 86 - - - Livers (Lamb) 50 - - - Meat (Tinned) - 61 - - Melts (Pig) 56 - - - Milk/Cream - 11 - - Peas/Beans/Baked Beans - 118 - - Pork (Home Killed) 40 - - - Prunes 90 - - - Rice Pudding - 1 - - Salad Cream - 14 16 - Sausages - - - - Semolina 71 - - - Shrimps - 4 - - Soups/Pickles/Sauces - 17 2 - Spaghetti - 44 - - Steak. Pudding - 1 - - Sweet Corn - 1 - - Tongue (Ox) 6 - - - Tonic Food - 48 - - TOTALS 1,116} 714 21 108 SLAUGHTERING OF ANIMALS FOR HUMAN CONSUMPTION No animals were slaughtered within the Borough during the year. 30 SLAUGHTER OF ANIMALS ACT, 1933 One licence to act as slaughterman was granted in 1957. 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 be satisfactory. Thirty-nine primary visits of inspection made during the year resulted in six infringements being discovered and rectified. SHOPS ACT Two 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 are in the majority of cases satisfactory. SCHOOLS The sanitary conditions and the water supply to the Schools in the area are generally satisfactory. HAIRDRESSERS' AND BARBERS' PREMISES The sixty nine establishments in the Borough were inspected during the year and found to conform generally to the requirements of the Hairdressers and Barbers Bye-laws 1947. MERCHANDISE MARKS ACT Two hundred and sixty three 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. One application for renewal of Licence to store rag flock, was received and granted in 1957. 31 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. Ten visits of inspection were made during the year. Six licence renewal applications were received and granted during 1957. LICENCED PLACES OF PUBLIC ENTERTAINMENT There are nineteen licenced places of public entertainment In the Borough. They are used mainly for cinematograph shows, concerts, dancing and social functions. The general standard of cleanliness was good. LICENCED PUBLIC HOUSES Fifteen visits of inspection were made to the licenced public houses in the Borough. As a result of the Food Hygiene Regulations a considerable number of improvements have been carried out at many public houses. These include the provision of additional or improved sanitary conveniences, washbasins, hot water supply, improved ventilation to kitchens, bars and cellars, and the more general use of detergents and sterilising agents for the washing of utensils, beer pipe lines and pumps. HEATING APPLIANCES (FIREGUARDS) ACT, 1952 Five 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. No infringements of the Act were discovered. DISINFECTION AND D1SINFESTATION Council Houses Private Houses Other Premises Number of houses treated with insecticide for bugs and fleas 3 10 - 32 Ten school canteen kitchens and ten hospital kitchens were sprayed for flies, ants and moths. The insecticides used were Pybuthrin, Dieldrex, D. D. T , Municipal Spray and Garnmexane Liquid Spray. RODENT CONTROL The Prevention of Damage by Pests Act, 1949 A - Surface Treatments (1) 5,274 visits were made during the year by the Rodent Operator and 491 by the Public Health Inspectors to premises infested or possibly harbouring rats or mice. 523 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 561 Number of premises found to be infested 524 Number of premises where no evidence of rodents found 37 Number of premises cleared of rats or mice (including 80 previous year's cases) 523 Number of premises still being treated at the year end 81 (3) The cause or site of infestation at the 524 infested premises was:- Keeplng of poultry 15 Inside premises (under floors etc.)- rats 26 Inside premises (under floors etc.)- mice 62 Buries, scrapes etc. in gardens, land etc. 209 Under or inside sheds 205 Defective drains 9 Accumulations of refuse etc. 1 Source untraced - TOTAL 527 (4) Type of premises found to be Infested:- With Rats With Mice Total Council Property 15 3 18 Dwelllnghouses 416 15 431 Business Premises, etc. 30 31 61 Schools, Hospitals, Canteens, etc. 4 8 12 Land 2 - 2 TOTAL 467 57 524 33 (5) Summary of the type of premises and methods employed In clearing premises of rats and mlce:- Type of Premises Cleared Dwelllnghouses (mainly In gardens) 431 Food shops and food premises 31 Non-rood shops 12 Waste land and building sites 6 Hospitals and Schools 15 Factories and Workplaces 16 Council Premises (other than dwellings) 10 Miscellaneous 2 TOTAL 523 (6) Methods employed in clearing 523 premises of rats and mice- Warfarin and other Poison Baits 523 Trapping - Gassing 1 Rat and Mouse Proofing 1 Drains repaired 5 TOTAL 530 8 - Sewer Treatments (1) Treatment No. 22 - Second Maintenance Treatment (1956-1957) The second maintenance treatment of soil sewer-manholes in areas found to be infested during the previous treatment was completed on the 20th March, 1957. Prebaiting with damped sausage rusks with 0.25%paranitropherol added as a bait preservative was carried out on the first and fourth days and the same bait base with 2½% Zinc Phosphide added was laid on the eighth day with the following results:- SECTIONS TOTAL A B C D E Number of Manholes pre-baited 24 Not baited 94 92 34 244 Complete prebait takes 3 23 20 6 52 Partial prebait takes 5 29 12 9 55 Percentage of takes (C. and P.) 33.3 55.3 34.8 44.1 43.8 Number of manholes poison baited 11 62 35 20 128 The number of prebait takes shows an increase of 0.8% on the previous maintenance treatment. 34 (2) Test Baiting (1957-1958) 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 September. All the manholes baited were checked three days after the baits had been deposited, with the following results- SECTIONS TOTAL A B C D E Number of manholes baited 18 25 49 58 34 184 Complete bait takes 1 2 12 9 4 28 Partial bait takes - - - - - - Baits not taken 17 23 36 46 30 152 Baits washed off - - 1 3 - 4 (3) Treatment No. 23 - First Maintenance Treatment (1957-1958) This treatment was confined to the sections known to have been infested during the previous maintenance treatment together with sections proved to be infested by the annual 10% Test, and operations were completed on the 12th October, 1957. Prebaltlng with damped sausage rusks with 0.25% of paranltrophenol added as a bait preservative was carried out on the first and sixth days, and the same bait base with 2£% Zinc Phosphide added was laid on the ninth day; this procedure was adopted in respect of 209 of the total of 351 manholes treated, and the remaining 142 manholes were prebalted on the first and third days and poison baited on the fifth day. The following is a tabulated summary of the results achieved. SECTIONS TOTAL A B C D E Number of manholes prebaited 30 12 141 111 57 351 Complete prebait takes 8 - 44 33 17 102 Partial prebait takes 2 1 37 20 17 77 Percentage of takes (C. and P.) 33.3 8.3 57.4 47.7 59.6 51.2 Number of manholes poison baited 15 4 101 65 40 225 The number of prebait takes shows an increase of 7.4% on the previous maintenance treatment. 35 KEY TO SECTIONS Section "A" - Sutton - All roads south of the Sutton Station and east of Brighton Road. Section "B" - Sutton and Cheam - All roads south of Mulgrave Road and Upper Mulgrave Road and west of Brighton Road. Section "C" - Sutton - All roads east of the Railway and north from Sutton Station. Section "D" - Cheam - All roads between London Road/Stonecot Hill and west of the Railway. Section "E" - Worcester- Park. 36 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES Nine hundred and fifteen cases of infectious diseases were notified during 1957, compared with five hundred and six cases in 1956. This increase was due to a higher incidence of Measles, Whooping Cough and Pneumonia. There were decreases in Scarlet Fever, Dysentery and Food Poisoning. No case of Diphtheria was notified. A severe epidemic of Influenza occurred in the Autumn. Scarlet Fever. Fifty five cases were notified, a decrease often cases. Hie case rate was 0.70 per thousand of population, compared with 0.66 per thousand of population for England and Wales. The illness was generally mild. There was no death. Diphtheria. No case was notified. This records the value of immunisation. Diphtheria Antitoxin. The possibility Of Diphtheria must always be kept In mind in the differential diagnosis of infections of the throat. The early injection of antitoxin is the only effective treatment of Diphtheria. Swabs for diagnosis should be taken before any antibiotic is administered. Any suspected cases should be given antitoxin at once or admitted to isolation hospital for diagnosis and treatment. Diphtheria Immunisation. During this period when we are preoccupied with vaccination against Poliomyelitis, a high standard of immunity against Diphtheria must be maintained. Diphtheria is also a dangerous disease. The incidence has been remarkably reduced by immunisation. In 1948 there were three thousand five hundred and seventy five cases in England and Wales. In 1957 there were forty cases. Immunisation is safe, simple and effective. Every child should be immunised before the age of nine months. Reinforcement injections are necessary before entry to nursery school or day school and again at the age of eight to nine years. Immunisation is free of charge and can be arranged through the family doctor or at child welfare clinics. During 1957 seven hundred and ninety children were immunised and their ages at the dates of Immunisation were as follows:- Age: Under 1 1 2 3 4 5-9 10-14 Over 15 Total Number Immunised; 554 112 40 23 15 39 6 1 790 Six hundred and forty five children received reinforcing injections. A survey at the end of 1957 of the state of immunisation of nine hundred and three babies born in 1956 showed that six hundred and twenty nine, representing 69 per cent.,had been 37 immunised. Of the children under five years of age, two thousand eight hundred and fifteen, representing 60 per cent., had been immunised. Of the school children of five to fourteen years of age, six thousand and seventy two, representing 56 per cent., had been effectively Immunised by receiving primary or reinforcing injections within the past five years and two thousand eight hundred and ninety four, representing 26 per cent., who had been previously immunised, were in need of reinforcement. Measles. Six hundred and seventy seven cases were notified in 1957, compared with two hundred and seventy five cases in 1956. The case rate was 8.57 per thousand of population, compared with 14.09 per thousand of population for England and Wales. There was no death. Measles was epidemic from January to April and the incidence declined slowly to quiescence in September. The highest prevalence was in the West Central and North Wards. Two hundred and fifty six of the cases were Infants under five years of age, and fifteen were babies under one year. The monthly incidence of notified cases is shown in the following table- January 68 July 58 February 174 August 18 March 174 September 1 April 92 October - May 41 November 2 June 49 December - Epidemics of Measles recur at intervals of approximately two years. The infection spreads rapidly among susceptible children. There is always difficulty in recognising the early catarrhal signs of illness. Measles commences like a common cold with a rise of temperature, running of the nose, an occasional sneeze, watering of the eyes and a slight sore throat. The child is usually out of sorts and disinclined for food or play. After three to five days the rash appears. The catarrhal phase is highly infectious. Prevention of infection requires early recognition of the symptoms and early isolation. It is important that babies and weakly children should be protected from acquiring infection. Isolation should be continued until all symptoms and signs have disappeared. The danger of complications by secondary infection has been reduced by the Judicious use of Sulphonamides and antibiotics, but there is sometimes an exceptional child who reacts badly to this virus infection and careful nursing and careful convalescence are always necessary. The illness can be prevented or modified by the Injection of gamma globulin early in the incubation period. A small quantity is available to doctors for cases of special risk. Health visitors are informed of notified cases of children under five years of age so that they may give advice where necessary. 38 Whooping Coughs Eighty six cases were notified in 1957, compared with sixty six cases in 1956. The case rate was 1.09 per thousand of population, compared with 1.88 per thousand of population for England and Wales. There was no death. The general incidence was low. The highest prevalence was in the West Central and North East Wards. Thirty three of the cases were infants under five years of age and five were under one year. The monthly incidence of notified cases is shown in the following table- January 11 July 8 February 8 August 7 March 8 September 3 April 17 October - May 13 November 1 June 9 December 1 Whooping Cough is a serious infection in early infancy. The cough imposes a severe strain on the lung tissues. The danger of mortality is highest in the first three months of life and diminishes with age. Every effort should be made to protect babies and weakly infants from contact with infection. There has been a further improvement in the efficiency of vaccines which should give consistent and substantial protection. Immunisation should commence not later than three months of age. it is important that older susceptible children in the family should be immunised in order to protect the baby. Every child should be immunised before entry to school. During 1957 eight children who had received injections of vaccine since 1952 were notified as suffering from Whooping Cough. Five were assessed as slight and three as of moderate severity. in all these cases the frequency and severity of the cough was reduced. Health Visitors are informed of notified cases of children under five years of age so that they may give advice where necessary. 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 1957 seven hundred and sixty four children received immunising injections. The material used wasH. 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. One hundred and one children were given reinforcing injections during 1957. Small Pox. No case was notified. 39 Vaccination Against Small Pox. The speed of travel has increased the risk of Small Pox being imported. Our protection depends on vaccination. There is no drug which will cure the Illness. Vaccination in infancy provides a basal immunity which can be reinforced later with reduced reaction. The safest period for infant vaccination is three to six months of age. Vaccination is voluntary and free of charge and can be arranged through the family doctor or at the nearest Child Welfare Centre. in 1957 five hundredand thirty three babies undertheage of one year were vaccinated. The percentage of 56.9 compares with 53.7 in 1956 and 53.5 in 1955. The following table shows the number of vaccinations during 1957 Age Number Vaccinated Number Re-Vaccinated Under 1 533 - *1 38 1 2 27 1 3 7 5 4 11 2 5-9 37 30 10-14 18 18 Over 15 97 322 Totals 768 379 Puerperal Pyrexia Twenty three cases were notified in 1957, compared with eleven cases in 1956. Three were due to influenza. The revised definition of Puerperal Pyrexia in the Puerperal Pyrexia Regulations, 1951, made notiflable "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 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 is in operation. it has been estimated that there are about two hundred cases of Tetanus in England and Wales each year. The mortality is between 30 and 40 per cent. The bacillus is present in horse manure and in manured land. infection enters the body through contaminated wounds and abrasions which may be so slight as to escape notice. The object of immunisation is to prepare the tissues in advance to resist the Tetanus Bacillus. All who work in agriculture or in stables 40 should be immunised. Children are prone to abrasions and should be protected from the incidental risk of infection. At present it is a routine to inject anti-tetanic serum after wounds. This serum occasionally causes undesirable allergic reactions and its use can be avoided by precautionary immunisation with toxoid before injury. Immunisation requires three injections at monthly intervals. These can be combined with immunisation against Diphtheria and Whooping Cough. Immunisation must be sustained by reinforcement injection at the end of one year and thereafter at intervals not exceeding five years. A record of the dates of injection should always be carried on the person. During 1957 three hundred and ten children received primary injections. Food Poisoning. Four cases were notified in 1957, compared with fifteen cases in 1956. Two were adults and two were children. One case was due to Staphylococcal infection of cold roast duck. Two cases in one family were caused by Salmonella Typhlmurium. The source of infection was obscure. A child aged two years died from a combined infection of Salmonella Typhlmurlum and Staphylococcus. The source of infection was not ascertained. The occurrence of infections due to Salmonellae and Staphylococci in food continues to cause concern. No drug or antibiotic is specific against Salmonellae. Some types of Staphylococci have become resistant to certain antibiotics. Prevention of infection depends on scrupulous cleanliness in the production, storage, manufacture and distribution of food. The washing of hands after use of the W. C. is the most effective protectlve measure against intestinal carriers of infection. Early notification of cases of food poisoning is necessary so as to obtain the residue of suspected food for bacteriological examination. Dysentery. Fifteen cases were notified in 1957, compared with forty seven cases in 1956. All were of the Sonne type. Eleven of the cases occurred in an institution for children. The four district cases were sporadic. Sonne Dysentery is a highly infectious form of gastroenteritis. The infection is spread by faecal contamination of hands, objects, and, in particular, lavatory seats. Prevention depends on the washing of hands after use of the W. C. and on the efficient cleansing o f communal W.Cs. in schools and public places. Typhoid and Paratyphoid Fevers. No case was notified. Meningococcal infections. Two cases were notified. A woman aged seventy five years died from Meningococcal Septicaemia. A child aged nine months recovered from Acute Meningococcal Menlngltis. 41 This infection is endemic. Sporadic cases occur throughout the year. Prevalence is higher in the first quarter. Children under five years are the most susceptible age group. Cases are most numerous under the age of one year. Early diagnosis and prompt treatment wi th Sulphonamideare essential for the prevention of mortality. Poliomyelitis Eleven cases were notifled in 1957, compared with twelve in 1956. Six were paralytic and five non-paralytic. Four were adults and seven were children. Six were males and five were females. Of the paralytic cases, three recovered with slight weakness. A woman aged twenty nine years and a girl aged eight years have residual paralysis of one arm. Two deaths occurred. A man aged sixty four years died of Acute Polioencephalitis. A girl aged twelve years died from respiratory paralysis contracted in 1956. The object of Vaccination against Poliomyelitis is to reduce the incidence of paralysis and to prevent mortality. It is hoped that the immune bodies evoked by the vaccine will protect the nervous system from invasion by the virus. The incidence of cases may not be reduced. It is still necessary to emphasise the need for precautionary rest in any febrile condition which might be a reaction to infection. Tiredness predisposes to paralysis. Rest reduces the risk. Pneumonia. There were twenty three deaths from Pneumonia in 1957, compared with twenty four in 1956. influenza was a contributory cause in eight. Forty three cases of Pneumonia were notified in 1957, compared with twenty one in 1956. Twenty six were cases of influenzal Pneumonia. influenza. A severe epidemic of influenza due to a variant of Virus A occurred throughout the Borough in the Autumn. Sporadic cases were reported at the beginning of October. infection spread rapidly in schools and places of work. Hospital staffs were depleted. incidence reached a peak within two weeks. Decline was slow and cases continued to occur until the end of the year. The short period of invalidism prevented serious dislocation of public services. The acute phase lasted three or four days. Residual debility followed. Complication by Bronchitis was frequent. Cases of Pneumonia increased. Ten deaths were directly due to influenza. Non-Notifiab1e Diseases School teachers reported one hundred and forty five cases of Mumps, sixty six cases of Chicken Pox and fifty four cases of German Measles. School returns are a useful index of the prevalence of non-notifiable diseases and are a basis for consultation with the school medical officer. infestations. No case of Scabies or head lice was treated at the clinic during the year. 42 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1957 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 2 2 45 2 2 1 - - - 55 7 - Diphtheria - - - - - - - - - - ~ — - ~ Smallpox - - - - - - - - - — — — - - Typhoid Fever - - - - - - - - — - - — - - - Paratyphoid Fever - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 1 19 3 - - 23 ~ — Pneumonia - - - 1 3 1 2 5 - 16 14 42 6 23 Erysipelas " - - - - - - - 1 - - - 1 - — Dysentery 1 - - - - - - - 1 2 - — 4 - — Poliomyelitis - - 1 - 5 1 - 3 - 1 - 11 11 2 Meningococcal infection 1 - - - - - - - - — - 1 2 2 1 Post-Infectious Encephalitis - - - - - 1 - - 1 - - - 2 2 — Measles 15 42 65 61 71 393 20 5 2 1 - - 675 10 ~ Whooping Cough 5 1 10 4 13 44 5 — 3 1 — - 86 1 - London Cases in an institution Dysentery - 3 1 2 3 1 - 1 - - - - 11 10 - Pneumonia - 1 - - - - - - - - - — 1 - — Measles - 1 - — 1 — ~ ~ - — 2 1 * Under column "Died", all deaths, whether notified in the district or outside It, or not notified at all, are included. 43 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:- 9722 8606 11043 12105 7143 7764 7667 5984 8926 78960 Scarlet Fever 7 4 7 14 14 - 1 6 2 55 0.70 0.66 Diphtheria - - - - - - - - - - 0.00 0.00 Smallpox - - - - - - - - - - 0.00 0.00 Typhoid Fever - - - - - - - - - - 0.00 0.00 Paratyphoid Fever - - - - - - - - - - 0.00 0.01 Puerperal Pyrexia - - 1 - 1 - - 21 - 23 — — Pneumonia 4 5 9 7 2 7 3 3 2 42 0.53 0.73 Erysipelas - - - 1 - - - - - 1 0.01 0.08 Dysentery - 1 - - - - ' - 2 1 4 0.05 0.64 Poliomyelitis 1 - 2 3 - 3 2 - - 11 0.14 0.11 Meningococcal infection 1 - - 1 - - - - - 2 0.03 0.02 Post-infectious Encephalitis 1 - - - - - - 1 - 2 0.03 0.00 Measles 110 65 88 160 79 58 29 20 66 675 8.55 14.09 Whooping Cough 5 6 21 20 8 11 3 3 9 86 1.09 1.88 TOTALS 129 81 128 206 104 79 38 56 80 901 44 TUBERCULOSIS On 31st December 1957, there were on the register nine hundred and sixty cases of Tuberculosis, of whom eight hundred and forty six were Pulmonary and one hundred and fourteen nonpulmonary. in 1957 there were five deaths from Pulmonary Tuberculosis The death rate was 0.06 per thousand of population, the same as in 1956. There was no death from non-pulmonary Tuberculosis. For England and Wales the death rate for Pulmonary Tuberculosis was 0.10 per thousand of population and for non-pulmonary Tuberculosis 0.01 per thousand of population. The number of new cases of Pulmonary Tuberculosis was thirty two, compared with thirty four new cases in 1956. Until 1953 approximately seventy new cases were being notified annually. There has been a sharp decline in infection since the introduction o f new specific drugs and Improved surgical techniques. Residual foci of infection still persist, particularly among the middle aged and elderly and intensive search will be necessary to eliminate the disease. Tuberculosis can be cured by modern methods of treatment. The use of B. C. G. vaccine in adolescent children gives a high measure of protection. Five hundred and sixty two children received injections in 1957. The response rate was 73 per cent. Three new cases of non-pulmonary Tuberculosis were notified in 1957, compared with one new case in 1956. in fections of glands bones and Joints and serous membranes are caused by the human or bovine types of the bacillus. in this Borough all milk is designated or pasteurised. The Tuberculosis Care Committee is making a valuable contribution towards the well-being and reablement of patients. Early diagnosis has made it possible for many patients to be treated at home. Social and economic support for patients and families is necessary. Additional nourishment, clothing and bedding are provided. Grants are made towards occupational therapy. Holidays are provided for children, mothers and convalescent patients. The voluntary services of the members of the Committee are greatly appreciated. The Hon. Secretary is County Alderman Mrs. Margaret Walkden, J.P., 9, All Saints Road, Sutton. 45 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 1 - - - - - - - 15 6 2 - - - - - - 25 3 4 - 1 - - - - 35 3 2 1 - - - - - 45 - 2 1 - - - - - 55 7 - - - 3 - - - 65 and above 2 - - - 2 - - - TOTALS 22 10 2 1 5 - - - Notification of Tuberculosis Respiratory forms of death - Five out of five cases were notified. MASS RADIOGRAPHY A Mass Radiography Unit visited the Borough from 15th to 30th July 1957 and was stationed at the Public Hall, Sutton. Seven thousand, eight hundred and twenty five persons were examined. The results were as follows Total Examined No. of cases of active Pulmonary Tuberculous No. of cases of inactive pulmonary Tuberculosis Non-Tuberculous abnormalities Cancer of the Lung M. F. T. M. F. M. F. M. F. M. F. 3570 4455 7825 5 1 112 114 148 124 4 The incidence of Pulmonary Tuberculosis was 0.8 per thousand persons examined, compared with 1.2 per thousand in the area served by this X-Ray unit, which includes the County of Surrey. The findings are an index of infection in a sample of the population. They show the value of Mass Radiography in securing diagnosis and treatment. The incidence of cancer of the lung in this survey was 0.5 per thousand persons examined. If related to males only, there was incidence of 1.2 per thousand males examined. The finding of non-tuberculous abnormalities gives an opportunity for advice and treatment and the prevention of disablement. 46 CLINICS AVAILABLE FOR THE DISTRICT Methodist Church Hall, Station Road, Belmont infant Welfare Thursdays, 2 p.m. to 4 p.m. Minor Ailments (School Children) Thursdays, 1.30 p.m. to 2 p.m. The Clinic, Priory Crescent, Cheam Ante-Natal Mondays and Fridays, 9.30 a.m. to 12 noon. Mothercraft, and Relaxation Sxercises (Expectant Mothers) Thursday mornings, by appointment infant Welfare Mondays and Thursdays, 1.30 p.m. to 4 p.m. Minor Ailments (School Children) Wednesdays, 10.45 a.m. to 12 noon. Physiotherapy (Children) Tuesday afternoons, Thursday mornings, and Friday afternoons, by appointment. Dental (Mothers and Children) Mondays to Fridays, by appointment. The Parochial Rooms, The Broadway, Cheam infant Welfare Wednesdays, 1.30 p.m. to 4 p.m. The Clinic, Stonecot Hil1 , Sutton Ante-Natal Tuesdays, 9.30 a.m. to 12 noon. Mothercraft, and Relaxation Exercises (Expectant Mothers) Thursday mornings, by appointment. infant Welfare Mondays, Wednesdays and Fridays, 1.30 p.m. to 4 p.m. Minor Ailments (School Children) Wednesdays, 9.30a.m. to 10.30 a.m. Physiotherapy (Children) Friday mornings, by appointment. 47 The Clinic, 1, Robin Hood Lane, Sutton Ante-Natal Wednesdays, 9.30 a.m. to 12 noon. infant Welfare Tuesdays and Thursdays, 1.30 p.m. to 4 p.m. Minor Ailments (School Children) Mondays, 9.30 a.m. to 12 noon. Physiotherapy (Children) Monday and Thursday afternoons, by appointment. Ophthalmic (Children) Friday afternoons, by appointment. Dental (Mothers and Children) At 3, Robin Hood Lane, Sutton, Mondays to Fridays, by appointment. Wesley Hall , Ruskin Drive, Worcester Park infant Welfare Fridays, 2 p.m. to 4 p.m. Child Guidance Clinic, 25, Worcester Road, Sutton Child Guidance and Speech Therapy Mondays to Fridays, by appointment. Immunisation against Poliomyelitis, Diphtheria, Whooping Cough and Tetanus and Vaccination against Smallpox By appointment at Child Welfare Clinics or by arrangement with Family Doctors. SCABIES CLINIC St. Nicholas Road, Sutton. Every Thursday, at 10 a.m. CHEST CLINIC St. Helier Hospital, Wrythe Lane, Carshalton Mondays, Tuesdays and Fridays, at 9.30 a.m. Wednesdays, at 2 p.m. The second Wednesday in each month at 5 p.m. (By appointment) 48 VENEREAL DisEASES CLinIC St. Helier Hospital, Wrythe Lane, Carshal ton Males: Mondays, 4 p.m. to 6.30 p.m. Females: Wednesdays, 5 p.m. to 7 p.m. 49