SUTC 23 30R0UGH OF SUTTON AND CHEAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1959 INDEX Pages Ante-Natal Clinics 53-54 Area of District 4 Bakehouses 37 Bed Bugs 39 Births and Birth Rates 4 Causes of Death 5 Cesspools 12 Clean Air Act 18-21 Cleansing of Persons 48,54 Clinics and Welfare Centres 53-54 Closet Accommodation 12,42 Complaints 13 Cream 29 Deaths and Death Rates 4-6 Diphtheria 44-45, 49-50, 54 Disinfection and Dlslnfestation 39 Drainage and Sewerage 11-12, 14 Dysentery 48-50 Factories 18, 42, 43 Flooding 12 Food complaints 34 Food Hygiene Regulations 32-34 Food Poisoning 47 Food Unsound 36 Food Sampling 22-24 Hairdressers and Barbers 37 Head Lice 48,54 Health Education 8 Heating Appliances 38 House Refuse 12 Housing 2, 15-17 Ice Cream 30-31 Ice Lollies 31 Infantile Mortality 4, 6 Infectious Disease 44-50 Influenza 48 International Certificates of Vaccination 48 Laboratory Facilities 9 Licensed Public Houses 38 Maternal Mortality 4, 6 Maternity and Child Welfare Clinics 53-54 Measles 45, 49-50 Medical Examinations Meningococcal Infection 48-50 Merchandise Marks Act 37 Milk Supply 28 Mortuary Facilities 9 National Assistance Act 9 New Legislation Non-notifiable Diseases 48 Outworkers 18 Pest Destruction 39-41 Pet Animals Act 38 Places of Public Entertainment 38 Pneumonia 48-50 Poliomyelitis 48-50 Population 4 Public Health Committee 1 Puerperal Pyrexia 47, 49-50 Rag Flock 37 Rateable Value 4 Refuse Collection 12 Pent Act, 1957 17 Rivers and Streams 12 Rodent Control 39-41 Scabies 48-54 Scarlet Fever 44, 49-50 Schools 37 Shops Act Slaughter of Animals Act 37 Smallpox 46,49-50 Smoke Abatement 19 Staff 1 Swimming Baths 11 Tetanus Immunisation 47,54 Tuberculosis 51-52 Tuberculosis and Chest Clinic 54 Typhoid and Paratyphoid Fever 48-50 Vital Statistics 4 Water Supply 10-11 Whooping Cough 45-46, 49-50, 54 Workplaces 18 BOROUGH OF SUTTON AND CHEAM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1959 PUBLIC HEALTH COMMITTEE THE WORSHIPFUL THE MAYOR (Councillor F. W. Thompson, J.P., C.C.) Alderman D. Sparks (Mrs.) M.B.E. Alderman F. Warren Councillor G. Armstrong " R. A. Beuzeval (Chairman) " G. G. Burrlngton " E. Johnson (Mrs.) " A.W. Letts Councillor D.P. Madden " K.J. Martin " D.M. Pettlngell (Mrs.) 11 A. Sullivan " A. G. Taylor PUBLIC HEALTH OFFICERS OF THE AUTHORITY Medical Officer of Health John Craven Blrchall M. B., Ch.B., D. P.H. (Manor Park House, Manor Park Road, Sutton, Surrey. Vigilant 6603) Chief Public Health Inspector ARTHUR SYDNEY WILLIAMS Cert. P. S. I., Cert. Meat & Food Deputy Chief Public Health Inspector REGINALD WILLIAM NORMAN Cert. R. S. I. and S. I.E.J.B., Cert. Meat & Food Additional Public Health Inspectors JOHN BAMFORD Cert. R.S.I, and S. I.E.J.B., Cert. Meat & Food (Resigned on 12th July, 1959) HANDLEY LLEWELYN DAVIES Cert. R.S.I, and S. I.E.J. B., Cert. Meat & Food (Commenced Duties on 21st September, 1959) KEMPTON HUDDLESTONE PRIOR Cert. R. Sol. and S. I.E.J. B., Cert. Meat & Food CYRIL WILLIAM SOUTHERBY Cert. R.S.I, and 5. I.E. J.B., Cert. Meat & Food FRANK SUTCLIFFE Cert. R.S. I. and S. I.E.J. B., Cert. Meat & Food Publi c Analyst DANIEL D. MOIRM. Sc., F. R. I.C. Analytical and Consulting Chemist (Part-time) 1 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF SUTTON AND CHEAM Mr. Mayor, Ladles and Gentlemen, I have the honour to present to you the Annual Report on the health of the Borough for the year 1959. It has been prepared In accordance with Ministry of Health Circular 1/60. The general health of the Borough was good. The estimated population showed a decrease of thirty. The birth Pate was approximately the same at 13.0 per thousand of population (13.1 In 1958). The death rate decreased slightly from 12.3 to 12.02 per thousand of population. The Infant mortality rate was steady at 16.5 per thousand live births (16.4. In 1958), which compares very favourably with the national rate. There was no maternal death. There was an Increased Incidence of Infectious disease, mainly due to the biennial epidemic of Measles and to an Increase In the present generally mild type of Scarlet Fever. There was no case of Diphtheria and for the first year since 1944 there was no case of Poliomyelitis. A Mass Miniature Radiography Unit visited the Borough in June/July with satisfactory results. The Council's Housing Programme remains limited by scarcity of sites and consequently action on substandard housing Is retarded. Thirty one new houses and flats were completed during the year and one hundred and ten houses and flats were planned or under construction at the end of the year. Twenty six families Were transferred to New Towns and four to Frimley and Camberley during the year. Work on the second stage of the reconstruction of the Worcester Park. Sewage Works was completed during the year; meantime the design of subsequent stages IS proceeding. The water supply of the district was maintained at a high standard of chemical and bacteriological purity. During the drought water consumption rose to an all time peak. My thanks are due to the Water Engineer and Chemist for their collaboration. 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. A.S.Williams, to whom I am Indebted for his helpful collaboration and report. I am grateful for the excellent co-operation received from the County Staff at both County and District level, from Hospital and Laboratory staffs, and from the General Practitioners of the district. The same applies to my fellow Chief Officers and their staffs and also to the District Inspectors and clerical staff of the Health Department. 2 Finally, Mr. Mayor, Ladles and Gentlemen, I should like to express my thanks for the warm welcome given to my wife and myself and for the support you have given me during my first year of office. I am, Mr. Mayor, Ladles and Gentlemen, Your obedient Servant, JOHN C. BIRCHALL Medical Officer of Health. 3 STATISTICS OF THE AREA 1958 1959 Area In acres 4338.15 4338.15 Registrar General's estimate of the Resident Population 79,210 79,180 Number of inhabited houses (end of year) according to the Rate Book 24,626 24,995 Rateable value and sura represented by a £1, 554,114 £1,616,880 Penny Rate £6,313 £6,654 EXTRACTS FROM VITAL STATISTICS (Comparative of the Years 1958 and 1959) 19 5 8 19 5 9 England & Wales 1959 Total Male Female Total Male Female Live Births 1035 516 519 1033 527 506 Legitimate 1002 500 502 1006 518 488 Illegitimate 33 16 17 27 9 18 Birth Rate per 1000 of the Estimated Resident Population 1 13.1 (adjusted 13.1) . 13.0 (adjusted 13.4) 16.5 Still Births 9 5 4 14 7 7 Legitimate 9 5 4 14 7 7 Illegitimate 0 0 0 0 0 0 Rate per 1000 total (live and still births) 8.6 13.4 20.7 Deaths 971 461 510 952 440 512 Death Rate per 1000 of the Estimated Resident Population 12.3 (adjusted 12.05) 12.02 (adjusted 11.54) 11.6 Deaths from Sepsis 0 0 Other Maternal Causes 1 0 Death Rate from Maternal Causes per 1000 total (live and still births) 0.96 0.00 0.38 Deaths of Infants under one year of age All Infants per 1000 live births 16.4 16.5 22.0 Legitimate Infants per 1000 legitimate live births 14.5 16.9 Illegitimate Infants per 1000 Illegitimate live births 60.1 0.00 4 CAUSES OF DEATH IN THE BOROUGH OF SUTTON AND CHEAM DURING 1959 M. F. Total 1. Tuberculosis, respiratory 1 1 2 2. Tuberculosis, other - 1 1 3. Syphilitic disease 2 1 3 4. Diphtheria - - - 5. Whooping Cough - - - 6. Meningococcal infections 1 0 1 7. Acute Poliomyelitis - - - 8. Measles — — 9. Other infective and parasitic diseases - - - 10. Malignant neoplasm, stomach 9 7 16 11. Malignant neoplasm, lung, bronchus 33 11 44 12. Malignant neoplasm, breast 1 26 27 13. Malignant neoplasm, uterus - 3 3 14. Other malignant and lymphatic neoplasms 54 50 104 15. Leukaemia, aleukaemla 7 3 10 16. Dlabetes 2 5 7 17. Vascular lesions of nervous system 44 75 119 18. Coronary diseases, angina 96 55 151 19. Hypertension with heart disease 13 12 25 20. Other heart disease 35 101 136 21. Other circulatory disease 17 28 45 22. Influenza 7 12 19 23. Pneumonia 17 26 43 24. Bronchitis 39 16 55 25. Other diseases of respiratory system 3 6 9 26. Ulcer of stomach and duodenum 3 2 5 27. Gastritis, enteritis and diarrhoea 3 3 6 28. Nephritis and nephrosis 2 3 5 29. Hyperplasia of prostate 8 - 8 30. Pregnancy, childbirth, abortion - - — 31. Congenital malformations 5 4 9 32. Other defined and Ill-defined diseases 24 42 66 33. Motor vehicle accidents 6 6 12 34. All other accidents 2 9 11 35. Suicide 6 4 10 36. Homicide and operations of war - - - TOTALS 440 512 952 5 Mortality. The principal causes of death were diseases of the heart and circulation, 50 per cent, (as against 56 per cent, in 1958) and cancer, 21.4 per cent, (as against 17.6 per cent, in 1958). Deaths from cancer of the lung increased from thirty six to forty four and showed the highest Incidence ever to date in females. Deaths from coronary disease decreased from one hundred and eighty four to one hundred and fifty one. Deaths from accidents were twenty three, as In 1958, of which twelve were due to motor vehicles. Epidemiological and statistical studies have directed attention to factors which are contributory to constitutional diseases. There Is definite statistical correlation between the smoking of cigarettes and cancer of the lung. The risk of mortality can be reduced by abstinence from tobacco. The rise In female deaths Is not unexpected. DEATHS FROM CANCER OF THE LUNG, 1952 to 1959 1952 1953 1954 1955 1956 1957 1958 1959 Males 29 36 35 26 28 33 29 33 Females 7 3 3 6 3 5 7 11 Totals 36 39 38 32 31 38 36 44 Maternal Mortality. There was no maternal death. Infantile Mortality. There were seventeen deaths of Infants under one year in 1959, as In 1958. The Infantile mortality rate was 16.5 per thousand live births, compared with 22.0 per thousand live births for England and Wales. Of the seventeen deaths, eleven 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 1 month 1-12 months Prematurity 6 ... Congenital abnormality 3 3 Birth Injury 1 ... Broncho Pneumonia - 1 Other causes 1 2 Totals 11 6 6 NEW LEGISLATION (1) House Purchase and Housing Act 1959. This Act which came into force on 14th June 1959 enlarged the power of local authorities to make loans for the purchase of houses, made further provision for grants by local authorities towards the improvement of dwellings (the introduction of standard grants) and amended the existing law in respect of discretionary grants. (2) Factories Act 1959 An Act to amend the Factories Acts 1937 and 1948, and make further provision as to the health, safety and welfare of persons employed in factories or in premises or operations to which those Acts apply. It deals with the question of escape in case of fire particularly. This Act shall come into operation on such day as the Minister may by order appoint and different days may be appointed for different purposes of this Act. There were several regulations concerning food which include (3) The Milk and Dairies (General) Regulations 1959 The Regulations replace previous Regulations 1949 - 1954 with changes including matters concerned with registration and compensation and about notices served. Three are concerned with Ice Cream:(4) Food Standards (Ice Cream) Regulations 1959 (5) The Labelling of Food .(Amendment) Regulations 1959, and (6) Ice Cream (Heat Treatment etc.) Regulations 1959 all of which came into operation on 27th April 1959. (7) The Arsenic in Food Regulations 1959 came into operation on 10th August 1959 and lay down new standards for arsenic content. (8) The Condensed Milk Regulations 1959 came into operation on 26th June 1959 and provide for the sale of partly skimmed milk and consolidate previous regulations. (9) Housing (Underground Rooms) Act 1959 The date of operation of this Act was 14th June 1959. It lays down a standard of fitness for human habitation of underground rooms. 7 HEALTH EDUCATION (1) Home Safety As a member of the Sutton and Cheam Home Safety Committee and on their behalf your Medical Officer of Health organised a Home Safety Display in the Foyer of a local Theatre for ten days in April, which was opened by the Mayor. A Home Safety Quiz Competition was run in the local senior schools in connection therewith and the prizes were presented by Mr. I.B. Melman, the Theatre Manager, at the Saturday morning children's matinee. The Display was well attended and several schools sent parties of children on visits. A foreword to a Home Safety magazine produced by the Sutton and Cheam Home Safety Committee was also written. (2) Talks and Articles The Medical Officer of Health spoke to two Church Organisations on the "Work of the Health Department". The Chief Public Health Inspector gave a talk on the work of the Public Health Inspectors to a Boys Association and a talk on insects in food to a Boys Grammar School. One of the Assistant Public Health Inspectors gave a talk on "Hygiene in the Home" to a Co-operative Society group. The Medical Officer of Health also wrote five articles for a local Residents Association magazine, which dealt with Poliomyelitis Vaccination, Flies, Holidays, Immunisation in Children, and Accidents in the Home. The Chief Public Health Inspector gave a broadcast talk on the exceptional incidence of wasp infestation which occurred during the unusually warm Summer. (3) Poster Displays etc. Assistance was rendered to the Poliomyelitis Vaccination campaign run by the Divisional Medical Officer by the distribution of posters. A slide and film were also obtained and arrangements made to show them in three local cinemas. Posters were also displayed on Coughs and Sneezes and on various aspects of Home Safety. MEDICAL EXAMINATIONS One hundred and two medical examinations of staff were undertaken during the year, consisting of ninety for superannuation purposes and twelve sick pay cases for reports to the Establishment Committee. 8 NATIONAL ASSISTANCE ACT, 1948 Section 47 (Removal of Persons in Need of Care and Attention) No action was necessary under this Section of the Act. However, twenty old people were visited during the year as possibly in need of care and attention. Of these, three were admitted to hospital voluntarily for long term care. Three were admitted to hospital for temporary care to give guardians or relatives a holiday (two cases) or pending admission to Part III Accommodation. One old person was admitted direct to Part III Accommodation and two others were put on the waiting list for Part III Accommodation. One old lady on the waiting list for hospital died unexpectedly before admission. One old lady living alone refused all offers of assistance but was expected to require hospital admission before the end of the Winter 1959/60. One old lady who was physically handicapped and living in dilapidated property was rehoused into old aged persons accommodation. The remaining eight managed at home with varying types of assistance. Section 50 (Burial and Cremation of the Dead) Three burials were arranged under the powers granted to the Council by this Section. MORTUARY One hundred and sixty six bodies were received and underwent post mortem examination. The Mortuary premises, which Include a three body refrigerated chamber, have been well maintained. It is expected that work will be started on the building of the new Mortuary early next year. LABORATORI ES The Public Health Laboratory, Epsom, serves the Borough for bacteriological examinations. This service is supplemented by the use of the laboratories at Sutton and Cheam Hospital and St. Heller Hospital. Approximately one hundred and fifty specimens connected with infectious diseases were submitted to the laboratories during the year. 9 CLINICS Details of the clinics available in the district are given at the end of this report. (Pages 53 and 54) 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 the wells of the Sutton District Water Company is softened to under nine degrees of hardness. A high dose of chlorine in the form of chloramlne is administered to the water as a protective measure. Most of it is removed, later, leaving a small residual chloramlne to pass out to public distribution. Approximately thirty six gallons of water per person per day was supplied in 1959, of which approximately seven gallons was supplied to trade, and twenty nine gallons was used domestically. 1959 will be long remembered as the driest year for a very long time (possibly two hundred years for the country as a whole) and we were fortunate in our supply of water. Unrestricted supplies were maintained for all purposes without deterioration in quality, though naturally residents were requested to be careful in the watering of gardens. The rainfall was 34 per cent. below the standard average and the water consumption rose to its highest ever peak of consumption of almost seventeen million gallons per day as compared with an annual dally average of approximately nine and a half million gallons per day. Samples of the raw and treated waters are examined dally 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 190.55 Ammonia, free 0.08 Ammonia, Albuminoid 0.00 Nitrogen in Nitrates 8.16 Nitrogen in Nitrites 0.00 Oxygen Absorbed 0.10 Chlorine in Chlorides 17.70 Hardness total (grains per gallon) 8.07 10 Bacteriological Results No. of Bacteria growing on Agar, per ml. for 3 days at 20° C 1.8 No. of Bacteria growing on Agar per ml. for 1 day at 37° C. 0.06 Presence of Bacillus Coll in 100 ml. 0.00 Swimming Baths. There are two public swimming baths in Sutton and Cheam. The Maiden Road Baths, Cheam, was opened In 1938, and so is reasonably modern. It is open between April and September, and in winter it Is converted into a fine public hall. The Throwley Road Baths, Sutton, is much older and has changing cubicles round the sides of the bath. It is open all the year round. Maiden Road Baths Throwley Road Baths Both work on a continuous cycle of pressure filtration and chlorination, the actual water being emptied out once a year and the Baths being refilled with mains water. Records are kept at both Baths showing the number of bathers, water temperature and residual chlorine levels at various times during the day and from these it was clear that an adequate degree of chlorination was being maintained. Three samples were taken from each bath for bacteriological examination and showed a standard of purity as would be expected from a scrutiny of the records. In addition a new learner swimming bath was opened at Avenue Road County Primary School, Belmont Rise, Belmont during the year. It is 50 feet by 15 feet by 2 feet 9 inches to 3 feet deep, and holds 13,500 gallons. The cost was borne by money raised by the children and parents. A small pressure filtration plant and chlorinometer has been included. The pool will be subjected to sampling and check tests, commencing in 1960. DRAINAGE AND SEWERAGE Worcester Park Sewage Disposal Works. The Sludge digestion tank constructed under Stage II of the Reconstruction Scheme was brought into commission during the year and the cleaning out of the existing tank and the repair of the mechanism therein will be proceeding shortly. It is hoped that the full sludge disposal unit will be in operation by mid-1960. Maximum Clothes Accommodation Quantity of Water Treatment Cycle Time 312 150,000 gallons 3½ hours 250 70,000 gallons 3½ hours 11 The design of Stage III of the Reconstruction Scheme, which includes construction of a pumping and generating station, is proceeding and it is anticipated that work will commence during 1960. The effluent being discharged to the Beverley Brook is of reasonable quality. Sutton Sewage Disposal Works. These works discharge an effluent of reasonable quality to the Pylbrook. 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. Refuse disposal is by controlled tipping within the Borough. New arrangements have been made to tip outside the Borough next year. The work has been executed In a satisfactory manner. Closet Accommodation. There are three premises with cesspools in use and one with a septic tank. Two cesspools will definitely be abolished next year, owing to the extension of a sewer and a relief sewer. In the past thirty one years, one hundred and sixty one premises, originally with cesspool drainage, have been connected to sewers. Two pall closets and two chemical closets are in use at factory premises. Flooding. No major work on sewerage has been carried out during the year, but It is anticipated that during 1960 work will commence on the following Schemes:- Relief surface water sewer for a portion of the High Street, Sutton; relief surface water sewer In Morden Way; soil sewer in Cuddington Way and soil sewer from Ventnor Road to Downs Road, Belmont. Rivers and Streams. The streams within the Borough have been maintained in a satisfactory condition. 12 SANITARY INSPECTION OF THE AREA Report of the Chief Public Health Inspector under regulation 25 (20) of the Public Health Officers Regulations, 1959 (Pages 13 to 41) RECORD OF INSPECTIONS MADE AND NOTICES SERVED Visits Special Inspections: Interviews and advisory visits 1,225 Helnspectlon visits 2,051 Visits to works in progress 402 " Factories/Workplaces 536 " Bakehouses 18 " Outworkers premises 112 " ButchersVGrocers/Greengrocers/Flshmongers etc. 1,010 " Dairies/Milk Purveyors 32 " Ice Cream Premises (Manufacture and sale of) 118 " Restaurant/Cafe Kitchens, Dining Rooms etc. 107 " School/Industrial Canteen Kitchens 48 " Stables/Passages/Piggeries and Ditches 83 " Premises in connection with rodent control 5,701 " Cinemas/Theatres/Halls 16 " Hairdressers and Barbers Premises 81 " School and Public Conveniences 75 " Verminous Premises 43 " Shops under the Shops Act 436 " Licenced Public Houses 37 " Hospitals/Schools - spraying of kitchens 23 " Other premises - spraying for insect pests 63 Visits re Infectious Diseases 449 " Food Poisoning Enquiries 31 " Overcrowding and permitted numbers 241 " Food and Drugs sampling 244 " Sampling of milk and water (Bacteriological) 114 " Sampling of ice cream (Bacteriological) 166 " Merchandise Marks Acts 177 " Rag Flock Act " Pet Animals Act 12 " Heating Appliances (Fireguard Regulations) 19 " Atmospheric Pollution Gauo,es/Smoke observations 339 Miscellaneous visits 1,457 Total 15,469 Number of complaints received and Investigated 466 Premises at which defects or nuisances were discovered 1,142 Number of defects or nuisances discovered 1,645 " " " remedied l,351 " " " in hand 64 " " " outstanding 230 Number of Informal notices served 261 Statutory Notices were served as under:- Housing Act 1957 Sections 9 and 10 2 Public Health Act 1936, Section 24 15 " " " 39 1 " " " 75 2 Sutton and Cheam Corporation Act, 1951, Section 42 Total 21 13 SUMMARY OF REMEDIAL WORKS AND SANITARY IMPROVEMENTS CARRIED OUT Drainage and Sanitary Fittings: Number of houses and other premises redrained 2 Number of houses and other premises connected to soil and surface water sewers Repairs and amendments to existing drains (644 feet laid) 40 Drains or gullies unstopped or cleansed (involving 943 premises) 338 Sanitary fittings repaired/renewed provided or cleansed 238 Water service pipes/cisterns/repaired renewed or cleansed 11 Water, smoke and chemical tests applied 101 W. C- Apartments: W.C. Apartments provided 11 " lighted and/or ventilated 11 " provided with ventilated lobbies 3 " screened " cleansed and/or repaired 24 Separate W. C. accommodation provided for the sexes Structural Repairs or Improvements Carried Out: Number of roofs repaired or renewed 63 " guttering and rainwater pipes provided repaired etc. 52 " damp walls remedied 31 " walls repointed repaired or re-rendered 37 " chimney stacks repaired or rebuilt 5 " yards paved or repaired 9 " floors relaid or repaired 43 " windows/cills/sashcords repaired or renewed 110 " doors/thresholds provided or repaired 20 " staircases/handrails provided or repaired 5 " ranges/stoves/coppers renewed or repaired 14 " food cupboards provided/ventilated CI ean sing: Number of rooms/passages/larders cleansed and/or repaired 119 " trade premises cleansed 60 " verminous premises disinfested for bugs/fleas 28 " premises sprayed for cockroaches/crickets/wood beetles etc. 4 " premises disinfected after various diseases 276 " School Canteens/Kitchens sprayed for flies and ants 14 " Hospital kitchens sprayed 9 Various: Number of dustbins provided 35 " accumulations of refuse removed " wasp nests destroyed 465 " miscellaneous items 119 14 HOUSING 1. Inspection of Dwelling-Houses during the Year: (1) (a) Total number of dwelling-houses inspected under the Public Health or Housing Acts 156 (b) Number of inspections made for the purpose 729 (2) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 130 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 47 3 Action under Statutory Powers during the Year: (A) Proceedings under Sections 9, 10 and 16 of the Housing Act 195:- (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (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 10 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By Owners 8 (b) By Local Authority in default of owners 2 (C) Proceedings under Section 17 (1) of the Housing Act, 1957:- (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 3 15 4. Housing Act„ 1957 - Section 42 - Clearance Areas (A) 821-835 (odd) London Road, North Cheam A representation was made to the Borough Council on the 21st July 1959 in respect of 8 houses known as 821-835 (odd) London Road, North Cheam. These houses were considered to be unfit for human habitation, and the most satisfactory method of dealing with the conditions in the area was the demolition of all the buildings in that area. The owners had submitted proposals for the demolition and redevelopment of the sites In accordance with planning permission already obtained, provided the Borough Council were willing to undertake such re-housing of the tenants as may be required. It was decided to accept the proposals of the owners as satisfactory and they would, in due course, specify the times within which the redevelopment was to be carried out, having regard to the accommodation which the Borough Council would have available for re-housing the tenants. (B) 25 to 43 (odd) Maiden Road, Cheam It was reported to the Borough Council on the 27th October, 1959 that the property defined in the above-mentioned Clearance Area had been acquired by the Borough Council. 5. Housing Act, 1957 - Sections 16 and 17 17 and 19 Lingfield Road, Worcester Park The above-mentioned houses were considered on the 27th October, 1959 by the Borough Council as being unfit for human habitation and not capable at a reasonable expense of being rendered so fit. In accordance with Section 16 of the Housing Act, 1957 the appropriate Notice was served on the owners who indicated it was their intention to demolish the houses immediately the occupants had vacated the premises. This matter is still awaiting further consideration by the Borough Council mainly o* account of the special housing needs of the Invalid tenant. 6. Housing Act, 1957 - Part IV Overcrowding (a) (l) Number of dwellings overcrowded at the year end 40 (2) Number of families dwelling therein 85 (3) Number of persons dwelling therein (i.e. Equivalent number of adults)253 16 (b) Number of new cases of overcrowding reported during the year 10 (c) (1) Number of cases of overcrowding relieved 23 (2) Number of persons concerned in such cases (i.e. Equivalent number of adults) 125 (d) Particulars of any case In which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil These figures are Dased on tne Known cases of statutory overcrowding, and are obtained from cases discovered during routine inspections of dwellings, applications made for Council housing accommodation, and on information received in the Department, all of which have been checked by your Inspectoral Staff at the year end. During the year 241 visits were made to dwelling-houses In respect of overcrowding enquiries and permitted number of occupants. The 23 cases of overcrowding abated were relieved by the following means:- (a) Rehoused by the Borough Council 6 (b) Reduction in the number of occupants 6 (c) Other accommodation obtained on own initiative 11 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 lettlngs. 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' and for the cancellation thereof during the period 6th July 1957 to 31st December 1959:- 17 (A) Applications for Certificates of Disrepair From 1959 6.7.57 only to end of 1959 Number of applications received 138 12 " decisions not to issue certificates " applications withdrawn 8 " decisions to issue certificates 119 14 (a) in respect of some but not all defects 94 10 (b) in respect of all defects 25 4 Number of undertakings given by landlords under paragraph 5 of the First Schedule (Form K) 67 9 Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Number of certificates of disrepair issued (1 application withdrawn after service of Form J) 51 5 (B) Applications for Cancellation of Certificates Number of applications received 24 12 " objections to cancellation received 4 2 " certificates cancelled. 21 12 " objections to cancellation upheld 3 2 Number cancelled in spite of tenant'sobjection 1 1 PUBLIC HEALTH ACT, 1936 - WORKPLACES Inspections Number of written Occupiers and verbal notices prosecuted 40 2 FACTORIES ACT, 1937 - OUTWORK (Sections 110 and 111) One hundred and twelve visits were made during the year to the homes of outworkers residing in the Borough. CLEAN AIR ACT, 1956 The remaining provisions of the Act, not already covered by the Clean Air Act (appointed day) Order 1956, and 'The Dark Smoke (Permitted Periods) Regulations, 1958' came into operation on the 1st June, 1958. Section 1 of the Act prohibits, with certain exceptions, the emission of dark smoke from chimneys. A chimney is defined as including structures and openings of any kind from or through which smoke may be emitted (e.g. louvres in the roofs of buildings). The regulations permit the following: - (1) Not more than 10 minutes of dark smoke In the aggregate from any chimney In any period of 8 hours, or 14 minutes in 8 hours of soot-blowing is carried out within that 18 period. These periods are extended in the case of chimneys serving more than one furnace. (2) No continuous emission of dark smoke (other than that caused by soot-blowlng) shall exceed 4 minutes; and (3) No emission of black smoke (i.e. as dark or darker than shade 4 on the Rlngelmann Chart) shall exceed 2 minutes in the aggregate in any period of 30 minutes. In the case of proceedings for discharging dark smoke it would be a defence to prove that the emission was solely due (a) to the lighting of a furnace from cold, (b) to some failure of a furnace or of apparatus, and (c) to the use of unsuitable fuel when suitable fuel was unobtainable. Section 2 of the Act also provides a further defence available until 4th July 1963, if it can be proved that the emission of dark smoke was due to the nature of the building and equipment, and not due to failure of proper maintenance and it had not been practicable to alter or equip the building so as to enable it to be used for the purpose for which it was intended without the likelihood of contraventions of Section 1. Sections 5 to 9 relating to grit and dust from furnaces; Section 16 - abatement of smoke nuisances; and Section 19 relating to Railway Engines, also came into operation on the 1st June, 1958. Smoke Abatement and Atmospheric Pollution There are but few industrial chimneys in the Borough. Nine complaints of smoke emission were received and dealt with during the year, five of these were in respect of bonfires, three from boiler stacks attached to industrial premises, and one in respect of an incinerator. 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 samples collected monthly for analytical examination. The following is a summary of the results obtained during the year:- 19 MONTH Gauge No. 2 Gauge No. 6 Gauge No. 7 Rainfall in inches Total Solids (Tons per sq.mile) Rainfall in inches Total Solids (Tons per sq.mile) Rainfall in inches Total Solids (Tons per sq.mile) January 1.96 11.10 2.31 9.05 1.83 9.29 February 0.05 7.13 0.07 4. 94 0.06 4.83 March 2.16 10.97 2.53 8.89 2.17 7.72 April 1.97 11.14 2.42 9.36 2.00 6.83 May 1.09 10.04 1.01 8.75 0.77 8.22 June 0.75 10.51 1.33 11.46 0.42 9.58 July 1.61 10.83 1.63 9.46 1.01 6.73 August 0.93 6.93 1.34 8.33 1.28 6.57 September 0.05 8.26 0.13 8.27 0.04 6.23 October 2.03 8.12 2.15 13.11 2.07 5.73 November 3.51 11.60 3.89 21.83 3.15 10.07 December 3.57 9.24 4.54 9.22 3.19 7.79 Yearly Totals 19.68 115.87 23.35 122.67 17.99 89.59 Monthly Average 1.64 9.66 1.95 10.22 1.50 7.47 The Borough is adequately covered by the three grit deposit gauges which are sited roughly 1½ miles apart. DAILY MEAN CONCENTRATION OF SMOKE AND SULPHUR DIOXIDE A smoke filter and volumetric sulphur dioxide apparatus was installed in Manor Park House after consulting the Department of Scientific and Industrial Research as to the suitability of the site. A dally record has been kept, since the 1st November, 1958, of the amount of smoke or suspended matter and sulphur dioxide in the air. It has long been recognised that a distinction must be drawn between relatively coarse particles of solid matter which are quickly deposited by their own weight, and which comprise most of the particulate matter collected in the deposit gauge, and the very fine particles which settle slowly, if at all. These fine particles, commonly referred to as 'smoke', are less than about 20 microns (0.002 cm) In size and consist largely of carbonaceous matter, including tar, produced by the incomplete combustion of coal; some fine ash is also included. It is important to realise that little of this fine material is collected in the deposit gauge which in consequence gives no information about pollution by smoke. To obtain such information a smoke filter is necessary. 20 The following table gives a summary of the dally readings taken during the year 1959. Smoke (Milligrams per 100 cu.metres) Sulphur Dioxide (Parts per 100 million) Highest Dally Reading Lowest Dally Reading Average Dally Reading Highest Dally Reading Lowest Dally Reading Average Dally Reading January 129 1 31 54.1 0.2 12.4 February 100 2 21 37.1 2.4 10.6 March 28 T 9 12.7 1.0 4.6 April 15 T 4 11.5 0.8 3.6 May 8 1 3 10.2 1.4 4.0 June 3 T 1 5.9 0.4 2.2 July 3 T 1 6.3 0.5 1.9 August 3 T 1 4.1 0.2 1.9 September 10 1 3 9.9 1.2 4.5 October 14 Nil 4 9.0 0.5 2.8 November 78 1 15 30.1 1.2 6.5 December 31 1 5 17.8 1.1 3.7 Whole year 129 Nil 8 54.1 0.2 4.9 N. B. T = Trace Smoke Control Areas As regards the Clean Air Act, 1956, the Council decided to take no action until such time as the Minister of Housing and Local Government defines specifically the areas which are to be considered black areas. 21 INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1955 Sampling. During the year two hundred and eighteen samples (comprising fifty formal and one hundred and sixty-eight 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 Aspirin - Junior - 2 2 _ _ - Barbados Sugar - 1 1 - - - Beans - sliced - 1 1 - - - Biscuits - 1 1 - - - Blackcurrant Pie - 1 1 - - - Blackcurrant Syrup - 3 3 - - - Bombay Duck - 1 1 - - - Brandy Sauce - 1 1 - - - Breadcrumbs - 1 1 - - - Bun Flour - 1 1 - - - Caterpillars - roasted - 1 1 - - - Cayenne Pepper - 1 1 - - - Cheese Cake - 1 1 - - - Cherry Syrup - 1 1 - - - Chicken - boneless - 1 1 - - - Chicken Breast - 1 1 - - - Chicken - chopped - 1 1 - - - Christmas Pudding - 2 2 - - - Cochineal - 1 1 - - - Cocktail Sausages - 1 1 - - - Coffee Dessert - 1 1 - - - College Pudding - 1 1 - - - Confectionery - flour - 4 4 - 2 2 Confectionery - sugar - 10 10 - - - Cordial - 2 2 - - - Cornish Pasty - 1 1 - 1 1 Cough Mixture - 1 1 - - - Crab Meat - 1 1 - - - Crab Paste - 1 1 - - - Cranberry Sauce - 1 1 - - - Cream - 3 3 - - - Cream - Devon - 1 1 - - - Cream - Jersey - 1 1 - - - Cream - Sterilised - 2 2 - - - Cream - tinned - 1 1 - - - Crlspbread - 1 1 - - - Egg Rusks - 1 1 - - - Eldermlnt Drops - 1 1 - - - Evaporated Milk. - 2 2 - - - Frlzets - 1 1 - - - Fynnon Salts - 1 1 - - - Gees Llnctus Past. - 1 1 - - - German Mustard - 1 1 - - - Glucose - 1 1 - - - Glucose Tablets - 1 1 - - - Glycerin, Lemon and Honey Pastilles - 1 1 _ _ _ Glycerin, Lemon and Honey with Ipecacuanha - 1 1 - 1 1 Carried forward - 68 68 - 4 4 22 Type of Sample Number of Samples Examined Unsatisfactory Samples Formal Informal Total Formal, Informal Total Brought forward - 68 68 - 4 4 Goat Cheese - 1 1 - 1 1 Halibut Oil Capsules - 1 1 - - - Ham and Mushrooms in sauce - 1 1 - - - Hamburgers with gravy - 1 1 - - - Horseradish Sauce - 1 1 - - - Ice Cream - 15 15 - - - Instant Coffee - 1 1 - - - Instant Tea - 1 1 - - - Iodine Liniment - 1 1 - - - Iodine-Tincture. - 1 1 - - - Jam - 1 1 - - - Jam Sandwich Mix - 1 1 - - - Jelly - 2 2 - - - Junket Crystals - 1 1 - - - Ketchup, tomato - 1 1 - - - Laxative - 1 1 - - - Lemonade Powder. - 1 1 - - - Lemon Curd - 2 2 - - - Lemon Juice - 1 1 - - - Liquid Apples - 1 1 - - - Liver Puree - 1 1 - - - Luncheon Meat - 1 1 - - - Mace, powdered - 1 1 - - - Malt Vinegar, distilled - 1 1 - - - Marzipan Decorations - 1 1 - - - Mayonnaise - 1 1 - - - Meringue Powder. - 1 1 - - - Milk 30 13 43 - - - Milk - Channel Island 18 - 18 - - - Milk Shake In a Straw - 1 1 - 1 1 Mint, garden - 1 1 - - Mint Jelly - 1 1 - - - Mushrooms In Butter - 1 1 - - - Mushroom Ketchup - 1 1 - - - Onion Salt - 1 1 - - - Orange Juice - 1 1 - - - Orange Spread - 1 1 - - - Oyster Sauce - 1 1 - 1 1 Pain Relief Tablets - 1 1 - - - Paste - 1 1 - - - Pate de Fole - 1 1 - - - Peanut Butter - 1 1 - - - Pease Pudding - 1 1 - - - Peel, mixed - 1 1 - - - Pickle - 1 1 - - - Pineapple Juice - 1 1 - - - Pork Haslet - 1 1 - - - Pramatar - 1 1 - - - Pumpernickel - 1 1 - - - Raspberry Leaf Tablets - 1 1 - 1 1 Ravioli - 1 1 - - - Ravioli in Sauce - 1 1 - - - Rennet - essence of - 1 1 - - - Rice Pudding - 1 1 - - - Sardines - 1 1 - - - Sauce - 2 2 - - - Sausages - 1 1 - - - Sea Sickness Tablets - 1 1 - - - Seaweed Tablets - 1 1 - - - Slimming Formula - 1 1 - - - Carried forward 48 156 204 - 8 8 23 Type of Sample Number of Samples Examined Unsatisfactory Samples Formal Informal Total Formal Informal Total Brought forward 48 156 204 - 8 8 Soup Nuts - 1 1 - - - Soup Mix - 1 1 - - - Steakettes - 1 1 - - - Steak and Kidney Pudding - 1 1 - - - Table Dessert - 2 2 - - - Tarragon Powder - 1 1 - - - Tomato Juice Cocktail - 1 1 - - - Tonic Yeast - 1 1 - - - Toothache Tinct. - 1 1 - - - Tuna in Jelly - 1 1 - - - Vanilla Flavouring - 1 1 - - - Whisky 2 - 2 - - - Total 50 168 218 - 8 8 24 The following details classify the type of irregularity or infringement and the action taken in connection with the eight unsatisfactory samples:- Sample No. Article Sampled Type of Infringement Action taken and Remarks 2759 (Informal) Butter Drops Labelling Infringement The cake portion of this article contained no butter and the fat in the filling consisted of 3/5 ths butter-fat and 2/5other fat. Cautioned The manufacturers were informed of the infringement and the matter is being brought to the attention of the Joint Committee of Public Analysts and the various Bakery Trades Associations for considering a change of title. 2657 (Informal) Chocolate Cream Pastries The filling of this article consisted of a substance resembling cream, but consisted of 65% milk fat and 35% fat other than milk fat. Informed the Chief Public Health Inspector of Hove of the infringement, as the pastries were made and the Notice sent from a Hove bakery firm. A notice prominentlyexhibited in the shop stated "Only fresh pasteurised cream used in our pastries. No synthetic or imitation fillings". The Hove Borough Council subsequently, successfully prosecuted the bakers concerned in respect of selling 'Cream Meringues', 'Cream Sponge' and 'Cream Splits' which were not of the substance demanded, and for selling food containing a substance which resembled cream in appearance, but was not cream. 2764 (Informal) Cornish Pasty This article was not of the traditional shape and appearance of a cornish pasty, but resembled a meat and potatoe pie. The matter was brought to the attention of the bakers concerned, but had not been finalised at the year end. 2744 (Informal) Glycerin Lemon and Honey with Ipecacuanha Labelling Infringement This article contained about 25% v/v of sugar syrup, which was not stated in the title. Cautioned A more accurate description would have been ' Syrup' of Honey, Glycerin and Lemon with Ipecacuanha. The manufacturing chemists were informed of the infringement, but the matter was still under discussion at the year end. 2772 (Informal) Goat Cheese Labelling Infringement This article was made from a mixture of cows' and goats' milk in which the cows' milk preponderated. Cautioned The importers on being informed of the infringement immediately had new labels printed which read "Whey Cheese made from cows' and goats' milk and cream". 25 Sample No. Article Sampled Type of Infringement Action taken and Remarks 2626 (Informal) Milk Shake in a Straw Labelling Infringement The sample consisted of straws containing a compound colouring, flavouring and sweetening substance. The ingredients were not fully specified on the label. The manufacturers having previously agreed to arrange for the printing of new labels in order to comply with the requirements of the Order, and the retailer's stock having been delivered prior to this arrangement being made, it was decided to take no further action. 2748 (Informal) Oyster Sauce This article was found to contain 1,500 parts per million by weight of Benzoic Acid as an added preservative contrary to the Preservatives etc. in Food Regulations. Cautioned The importers had taken steps in 1958 to prevent the shipment concerned from being offered for sale, when Benzoic Acid was found in samples taken at that time, and stated that the retailer concerned with the sale of this article must have been overlooked. The retailer immediately withdrew from sale the remaining stock of Oyster Sauce. 2700 (Informal) Raspberry Leaf Tablets Labelling Infringement This article consisted of compound tablets of extracts of raspberry and senna leaves, the title of which did not indicate the true nature of the tablets. Cautioned The manufacturers readily agreed to change the description on the labels to "Raspberry Leaf Compound Tablets". 26 Sampling Observations It will be seen from the detailed classification that of two hundred and eighteen samples taken during the year 1.38% were found to be other than genuine and labelling Infringements accounted for a further 2.29% making a total of 3.67%. For comparative purposes the figures for 1958 were 4.98% and 2.71% respectively, making a total of 7.69%. 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 co-operation of retailers, importers and/or manufacturers were usually readily adjusted. Comments by the Public Analyst The public analyst, in performing his duties under the Food and Drugs Act, Is largely dependent on samples taken by sampling officers of a Food and Drugs Authority, and I have always found the initiative and co-operation of these officers In Sutton and Cheam to be particularly helpful in disclosing uncommon forms of adulteration and misdescription. This latter offence Is much more usual now than adulteration, which is usually taken to mean the substitution of part of an article of food by another substance which cannot readily be detected by the purchaser, such as, for example, the watering of milk, the mixing of margarine with butter and the 'dilution' of pepper with rice. Some offences fall into both categories and examples may be found in the eight articles of food (other than milk) which were reported against during the course of this year. No.2657 for instance (Chocolate Cream Pastries) Is both a misdescription under Section 6 and Section 47 of the Act and an adulteration since part of the milk fat has been mixed with some other fat. I am finding that the ordinary purchaser is less critical now of both adulteration and misdescription and It is becoming Increasingly difficult to prove prejudice under the time-honoured Section of successive Food and Drags Acts that "it is an offence to sell to the prejudice of the purchaser an article of food which is not of the nature or substance or quality demanded". With the advent of self-service stores, a demand for an article by name is rarely made and customers are willing to accept on sight lesser known articles of food of whose true nature they may only have a hazy idea. It is not always realised by those who have the responsibility for enforcing the Act that where a label applied to a food is false or likely to mislead, even if it does not mislead every customer or even a majority of customers, then offence is committed. In so far as the Analyst is responsible for expressing an opinion on such articles he cannot ignore such descriptions and labels without departing from principles of integrity and honesty which it would be wrong to forego. I obtained very little support for my opinion that a Cornish Pasty (Ref. Sample No.2764) is not a meat and potato pie, and that 27 the shape is equally Important to the Cornishman in Surrey, if not to the native of East Cheam. What is trivial to one purchaser may be a serious matter to another and I regard it as a wise maxim to Judge a label or description without regard to whether the food is of basic national importance and without being Influenced by the price paid. The offence is the same even if these other matters have to be taken into account in deciding what action ought to be taken. Any other course would only lead to names and descriptions losing their traditional meanings and the long term consequences would be serious. MILK SUPPLY Food and Drugs Act, 1955 Milk and Dairies (General) Regulations 1959 The Milk (Special Designation) (Raw Milk) Regulations 1949 to 1954 The Milk (Special Designation) (Pasteurised and Sterilised Milk. Regulations 1949 - 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. 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 1959:- Grade of Milk Dealers TYPE OF LICENCE Supplementary Pasteuriser's Tuberculin Tested 25 11 - Pasteurised 29 11 1 Sterilised 29 12 - TOTAL 83 34 1 CHEMICAL ANALYSIS OF MILK AND CREAM SAMPLES MILK Forty-eight formal and thirteen informal samples of milk were taken for chemical analysis; all of which were found to be genuine. Eighteen samples of 'Channel Island' and 'South Devon' milk contained satisfactory averages of 4.4% milk fat and 8.96% milk solids other than milk fat; and forty-three other samples of milk 28 contained satisfactory averages of 3.55% milk fat and 8.63% 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 Islands 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 eight informal samples of cream showed the one double cream sample to contain 49.2% milk fat and the seven single cream samples a satisfactory average of 23.1% 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. BACTERIOLOGICAL EXAMINATION OF MILK SAMPLES One hundred and sixteen samples of milk were examined as follows:- Class of Milk Number of samples examined Type of Test applied Results Passed Failed Pasteurised 73 Phosphatase 73 - Methylene Blue 73 - Sterilised 8 Turbidity 8 - Tuberculin Tested Pasteurised 12 Phosphatase 12 - Methylene Blue 12 - Tuberculin Tested (Farm Bottled) 23 Methylene Blue 20 3 TOTALS 116 113 3 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 and 30th April. Of the total samples examined under these Regulations three samples of Tuberculin Tested (Farm Bottled) Milk failed to pass the prescribed test. These samples were taken during the 4½ hours test period and decolourised Methylene Blue in 3 hours, 1 hour and 1½ 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. 29 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 and must not decolourise methylene blue in 30 minutes. The 85 samples examined under these Regulations were all found to be satisfactory. ICE CREAM Food and Drugs Act, 1955 Ice Cream (Heat Treatment etc.) Regulations, 1959 Food Standards (Ice Cream) Regulations, 1959 Reg i strat i ons During the year two applications for the registration of premises for the sale and storage of ice cream were received and granted. At the end of 1959 a total of one hundred and sixty-three 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. BACTERIOLOGICAL SAMPLING OF ICE CREAM During the year seventy-six samples of ice cream were obtained for bacteriological examination and provisional grading. The following table shows the 1959 percentage results in each grade and for comparative purposes the results obtained in 1958. Grading of Samples 1959 Grading of Samples 1958 Grade 1 71 samples 93.42% Grade 1 72 samples 97.30% " 8 4 samples 5.26% " 2 1 sample 1. 35% " 3 1 sample 1. 32% " 3 1 " 1.35% " 4 - " - " 4 - " - TOTAL 76 TOTAL 74 It is most gratifying to record that 98.68% of the samples were placed in grades 1 and 2, 1.32% 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. 30 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 13 13 - 100.00% - - - B 13 13 - 100.00% - - - C 13 13 - 100.00% - - - D 11 11 - 100.00% - - - E * 10 - 10 80.00% 20.00% - - F * 6 - 6 66.66% 16.67% 16.67% - G 5 - 5 80.00% 20.00% - - H * 5 3 2 100.00% - - - TOTAL 76 53 23 93.42% 5.26% 1.32% Nil * Denotes locally produced CHEMICAL SAMPLING OF ICE CREAM The Food Standards (Ice Cream) Regulations, 1959 came into operation on the 27th April 1959, and replaced the Order of 1953. The regulations prescribe amended standards for ice cream and for "Parev" (kosher) ice and introduce separate standards for dairy Ice cream (or dairy cream Ice or cream ice) and for milk ice. The standards for dairy ice cream and for milk ice provide that they shall contain no fat other than milk fat except such as may be Introduced by the use of any egg, any flavouring substance or any emulsifying or stabilising agent. The requirement in the 1953 Order that ice cream should contain not less than 10% of sugar is replaced by a provision that no type of ice cream shall contain any artificial sweetener. Alternative standards are prescribed for certain descriptions of ice cream containing fruit, fruit pulp or fruit puree. The standard of composition for ice cream is now as follows: - (a) Ice cream shall contain not less than 5% fat and 7½% milk. solids other than fat. (b) Ice cream containing any fruit, fruit pulp or fruit puree shall either conform to (a) above or, alternatively the total content of fat and milk solids other than fat shall be not less than 12½% of the whole including the fruit etc., and such total content of fat and milk solids other than fat shall include not less than 7½% fat and 2% milk solids other than fat. (c) Dairy Ice Cream, Dairy Cream Ice, or Cream Ice shall in each case contain not less than 5% milk fat and no other fat (except as mentioned in second paragraph above), and not less than 7½% milk solids other than fat. (d) Milk Ice or Milk Ice containing fruit, fruit pulp or fruit puree shall contain not less than milk fat and no other fat (save as mentioned in second paragraph above), and not less than 7% milk solids other than fat. 31 Five samples of ice cream were submitted to chemical examination prior to 27th April 1959 (when the standard for ice cream was not less than 5% fat, 10% sugar; and 7½% milk solids other than fat) and found to contain constituent percentages well above the prescribed standard as shewn below:- Sample No. Fat Constituent Percentages Total Sugars Milk; Solids other than fat Sucrose * 2637 12.0 11.1 13.8 13.8 * 2655 6.3 11.0 12.7 12.7 2656 12.3 12.3 16.9 16.9 * 2668 7.6 14.2 18.5 18.5 * 2669 7.9 10.6 16.3 16.3 Average 9.2 11.8 15.6 15.6 * Locally produced Ten samples of ice cream were submitted to chemical examination after the 27th April 1959, and also found to contain constituent percentages well above the prescribed standard, as under:- Sample No. Constituent Percentages Fat Milk Solids other than fat * 2684 6.7 11.4 * 2695 11.7 13.2 * 2696 8.6 10.7 * 2709 11.1 14.5 * 2710 6.2 10.0 * 2723 5.7 10.6 * 2724 10.2 12.3 2725 12.9 11.4 * 2753 11.4 13.8 * 2765 6.3 9.6 Average 9.1 11.7 * Locally produced ICE LOLLIES - BACTERIOLOGICAL EXAMINATION There is no prescribed standard for water ices or ice lollies sold as such, but as in former years ice lollle samples have been submitted to a test similar to the one applied to ice cream. Forty-one lollies were examined and found to be satisfactory. FOOD AND DRUGS ACT, 1955 FOOD HYGIENE REGULATIONS 1955-57 These regulations replace Section 13 of the Food and Drugs Act, 1938 (which dealt with precautions against contamination of 32 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. 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 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 compiled with. The following is a summary of the number of food premises in the 'Borough: - Bakehouses 13 Butchers (including one horseflesh shop) 55 Confectioners (sugar and flour) 177 Fishmongers/Stalls/Fried Fish Shops 29 General Stores/Shops 17 Greengrocers/Stalls/Stores 87 Grocers 131 Ice Cream (Manufacture and sale of) 163 Licenced Public Houses 34 Milk Purveyors/Depots/Dairies 41 Restaurants/Cafes/Snack Bars/Dining Rooms 66 School and Industrial Canteens/Kitchens/ Service Rooms 35 Other food premises 15 TOTAL 863 During the year 1,352 visits were made to food business premises, 72 notices were served in connection with the 134 infringements discovered as detailed in the following table:- 33 Food Hygiene Regulations 1955- 57 Number of Infringements found in 1959 Number of Infringements rectified in 1959, including infringements discovered in 1958, but rectified in 1959 Regulation No. 5 10 7 " 6 8 19 " 8 9 9 " 9 5 11 " 14 22 40 " 15 1 18 " 16 27 29 " 17 5 8 " 18 7 9 "19 8 8 " 20 1 - " 23 27 53 " 24 1 2 " 26 3 2 134 215 It is gratifying to record that the majority of the traders continue to show a willing co-operation to comply with the requirements of the Regulations. 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. Prosecut ions Food Hygiene Regulations, 1955 to 1957 No proceedings were taken during the year under the Regulations. Complaints Regarding Food Unfit for Human Consumption The following complaints were received and investigated during the year and advice given regarding various types of foodstuffs found to contain foreign matter. Grease in bread (4) Poppy head in frozen peas Dirty milk bottles (2) "Mould" on Jelly found to be cream of tartar crystals Mouldy sausages Fabric in bread roll "Dirt" in coconut candy found to be burnt sugar Metal foil in milk bottles (2) Mouldy pancakes Mouldy steak and kidney pie Mouldy packeted fish cakes (old stock) Wood shaving in milk bottle Lime deposits in chicken Mouldy wrapped loaf Glass in bread Glass in milk bottle Mouldy cornish pasties Suspected imported desiccated coconut, but found to be free of salmonella organisms on analysis Packed sausages gnawed by rodents 34 The general circumstances of the above did not warrant legal proceedings being taken. Each case was considered on its merits and appropriate warnings given where necessary. REGISTERED FOOD PREMISES 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 (General) Regulations 1959 C. Section 16 - Food and Drugs Act 1955 D. Number of inspections made A B C D Type of Registered Premises Preserved Foods Milk Ice Cream Inspections Butchers 47 - - 166 Confectioners (Sugar and Flour) - 1 96 190 Fruiterers - - 4 131 General Shops/Stores - - 7 7 Grocers 17 33 48 215 ice Cream (Manufacture) - - 3 8 Milk. Depots/Dairies — - 7 - 32 Sundry Premises - Newsagents etc. - - 5 24 64 41 163 773 35 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 Tubes Baby Food - 3 - - Beef, corned 75 8 - - Beef (Home Killed) 140 - - - Beef (Imported) 184 - - - Celery Hearts - 1 - - Chestnut Glace - - - 3 Cream - 3 - - Cream, salad - - 1 - Dates 41 - - - Fish - 76 - - Flour 60 - - - Fruit/Vegetables - 160 - - Gammon, cooked 54 - - - Ham and Chicken Galantine - 3 - - Ham/Shoulders 178¾ - - - Jam/Marmalade/Syrup/Honey - 5 4 - Jelly - 1 1 - Lamb (English) 32¾ - - - Lemon Curd - - 2 - Lemon, drink - - 1 - Livers (Lamb) 42½ - - - Livers (Ox) 9 - - - Meat - 7 - - Milk (Evaporated/Condensed) - 3 - - Mincemeat - 2 - - Mustard, French and Onion Salt - 3 - - Mutton, curried - 1 - - Orange Chip - 1 - - Peas/Beans/Baked Beans - 29 - - Peas Pudding - 2 - - Pork (English) 9 - - - Pork Roll, stuffed - 3 - - Puree - 2 - - Rice, creamed - 1 - - Snacks in Wine Sauce - 1 - - Soups/Pickles/Sauces - 21 10 - Tarragon (Mustard Flavour) - 1 - - Tomato Paste - 1 - - Tongue (Calf) - 1 - - Vitacup - 3 - - Whip, miracle - 1 - - TOTALS 826 343 19 3 36 Food and Drugs Act, 1955 Slaughterhouses Act, 1958 There are no licenced slaughterhouses within the Borough. Slaughter of Animals Act, 1958 One licence to act as slaughterman was granted in 1959 to the R. S. P. C. A. Inspector. Bakehouses There are thirteen 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. Eighteen visits of inspection were made during the year. Shops Act Four hundred and thirty-six 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. Hairdresser's and Barbers' Premises There are sixty-eight establishments in the Borough. Eightyone inspections were made during the year, and the premises generally were found to conform to the requirements of the Hairdressers and Barbers Bye-laws 1947. Merchandise Marks Act One hundred and seventy-seven visits were made to food premises under this Act. The infringements discovered were principally in connection with the marking of imported apples, tomatoes and dead poultry. Rag Flock and other Filling Materials Act, 1951 The intention of the Act is to secure the use of clean filling material in upholstered articles, and other articles which are stuffed or lined. 37 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 1959. 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. Twelve visits of inspection were made during the year. Six licence renewal applications and one new application for a licence were received and granted during 1959. Licenced Places of Public Entertainment There are eighteen 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 Thirty-seven visits of inspection were made to the 34 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 Nineteen 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. 38 Disinfection and Disinfestation Council Private Other Houses Houses Premises Number of houses treated with insecticide for bugs and fleas 8 20 - Fourteen school canteen kitchens and nine hospital kitchens were sprayed for files, ants and moths. The insecticides used were Pybuthrln, D.D.T. residual and municipal spray, Gammexane Liquid Spray, Zaldeclde M. Powder and Fumex Fumlgators. RODENT CONTROL The Prevention of Damage by Pests Act, 1949 A. Surface Treatments (1) Five thousand and sixteen visits were made during the year by the Rodent Operator and 685 by the Public Health Inspectors to premises infested or possibly harbouring rats or mice. Five hundred and seventy-six 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 590 Number of premises found to be infested 580 Number of premises where no evidence of rodents found 10 Number of premises cleared of rats or mice (including 93 previous year's cases) 576 Number of premises still being treated at the year end 97 (3) The cause or site of infestation at the 580 infested premises was:- Keeping of poultry 15 Inside premises (under floors etc.) - rats 33 Inside premises (under floors etc.) - mice 79 Buries, scrapes etc. in gardens, land etc. 282 Under or inside sheds 183 Defective drains 6 TOTAL 598 (4) Type of premises found to be infested:- With Rats With Mice Total Council Property 11 2 13 Dwelllnghouses 426 33 459 Business Premises. etc. 41 33 74 Schools, Hospitals, Canteens etc. 7 21 28 Land 6 - 6 TOTAL 491 89 580 39 (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) 456 Food shops and food premises 35 Non-food shops 15 Waste land and building sites 5 Hospitals and Schools 19 Factories and Workplaces 18 Council Premises (other than dwellings) 17 Miscellaneous 11 TOTAL 576 (0) Methods employed in clearing 570 premises of rats and mlce:- Warfarin and other Poison Baits 576 Rat and Mouse Proofing - Drains repaired 3 TOTAL 579 B. Sewer Treatments (1) Treatment Ho.26 Second Maintenance Treatment (1958-1959) The second maintenance treatment of soil sewer manholes in areas found to be infested during the previous treatment was completed on the 14th March 1959. Prebaiting with damped sausage rusks with 0.25% paranltrophenol added as a bait preservative was carried out on the first and sixth days and the same bait base with 2½% Zinc Phosphide added was laid on the ninth day with the following results:- SECTIONS ABODE TOTAL Number of Manholes prebaited 16 Not balted 63 84 74 237 Complete prebait takes 1 20 12 21 54 Partial prebait takes 1 4 6 18 29 Percentage of takes (C and P) 12.5 38.1 21.4 52.7 35.0 Number of manholes poison baited 4 31 25 45 105 The number of prebait takes shows a decrease of 2.1% on the previous maintenance treatment. 40 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 of Sutton Station. Section "D" - Chean - All roads between London Road, Stonecot Hill and west of the Railway. Section "E" - Worcester Park. (2) Treatment for year 1959-1960 The usual Test Baiting and First Maintenance Treatment (1959-1960) were not carried out by my Department, as in July 1959 the Ministry of Agriculture, Fisheries and Food approached the Council with a request that they should be permitted to carry out two experimental rat control treatments in parts of the Borough's sewers. Two separate poisons, sodium fluoracetate and fluoracetamide would be used, in the two areas chosen. On the 21st July, the Council gave it's approval of the scheme and on the 16th November the Ministry commenced the first stage of the treatments. This consisted of taking a census of the rat population feeding on wheat prebait at 30 selected manholes situated in each of the two areas of the Borough. The areas chosen for the experiments consisted of (a) the "Sutton Area" enclosed by the Carshalton and Cheam Road, the St. Heller and Wimbledon Branch line of the British Railways, All Saint's Road, Benhill Road, St. Barnabas Road and (b) the "Worcester Park Area" enclosed by London Road, Tudor Avenue, Sandrlngham Road, Lynwood Drive, Green Lane, Browning Avenue, Ebbisham Road, Burnham Drive. The result of this census showed that there were substantial numbers of rats infesting the sewers of the Worcester Park Area and to a lesser degree the sewers of the Sutton Area. It has been arranged for the first of the poison treatments to be carried out in January 1960 and the second treatment in March 1960 followed by a final census on the original 30 manholes of each area in April 1960. The outcome of this experiment is awaited with great interest. 41 APPENDIX ANNUAL REPORT OP THE MEDICAL OFFICER OP HEALTH IN RESPECT OP THE YEAR 1959 FOR THE BOROUGH OP SUTTON AND CHEAM IN THE COUNTY OF SURREY PRESCRIBED PARTICULARS ON THE ADMINISTRATION OF THE FACTORIES ACT, 1937 PART 1 OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number on Register Number of Occupiers prosecuted Inspections Written notices (1) (2) (3) (4) (5) (i) Factories in which Sections 1,2,3,4, and 6 are to be enforced by Local Authorities 51 55 4 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 317 324 18 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 21 35 7 - TOTAL 389 414 29 - 2. Cases in which DEFECTS were found (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases") Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 1 - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) 1 - - - - Inadequate ventilation (S.4) 1 1 _ - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 7 6 - - - (b) Unsuitable or defective 17 10 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 2 2 - - - TOTAL 29 19 - - - 42 PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Nature of Work Wearing apparel (Making etc., Cleaning and Washing Umbrellas etc. Lampshades Total No. of Outworkers in August list required by Section 110(1)(c) 30 12 47 89 No. of Cases of default in sending lists to the Council - - - - No. of Prosecutions for failure to supply lists - - - - No. of Instances of work in unwholesome premises - - - - Notices served - - - - Prosecutions - - - - 43 INCIDENCE OF AND CONTROL OVER INFECTIOUS DISEASES One thousand, seven hundred and thirty eight cases of Infectious diseases were notified during 1959, compared with two hundred and fifty five cases in 1958. Scarlet Fever. Two hundred and ninety four cases were notified In 1959 as against fifty nine in 1958. The case rate was 3.71 per thousand of population. The incidence was highest in the second and fourth Quarters, there being fifty six cases in the first Quarter, one hundred and three in the second Quarter, thirty one in the third Quarter, and one hundred and four in the fourth Quarter of the year. Three-fifths of the cases occurred in the age range five to ten years. The illness was generally mild and there were no deaths. Although Scarlet Fever can be a preventable disease, the present mildness of the condition, with earlier return to school, very often under three weeks, and no exclusion of contacts, renders prevention impossible. It is widely considered unnecessary to take more stringent action at present. Diphtheria. No case was notified during the year. The last case in Sutton and Cheam occurred in 1951. 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 admitted to isolation hospital at once for diagnosis and treatment. Diphtheria Immunisation. During the latter part of 1958 and In 1959 there were sizeable outbreaks of Diphtheria in the London area necessitating vigorous action to prevent spread, involving throat swabbing in schools. This is very near at hand and it behoves us in Sutton and Cheam to maintain or increase our diphtheria immunisation rate, which at present gives us no grounds for complacency. Diphtheria is still a danger. Immunisation is safe, simple and effective. Every child should be immunised before the age of twelve months, and if triple antigen is used, can be started as early as the third month. Reinforcing doses are required at first entry to school and again between the ages of eight and ten years. Immunisation is free of charge and can be arranged through the family doctor or at Child Welfare Clinics. During 1959 one thousand one hundred and thirty two 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: 625 204 29 8 13 53 - - 1132 Eight hundred and twenty one children received reinforcing lnjections. 44 A survey at the end of 1959 of the state of immunisation of the one thousand and thirty five babies born in 1958 showed that six hundred and eighty four, representing 66 per cent., had been immunised. Of the children under five years of age, three thousand and sixty, representing 63 per cent., had been immunised. Of the school children of five to fourteen years of age, four thousand five hundred and ninety, representing 44 per cent., had been effectively immunised by receiving primary or reinforcing injections within the past five years; and three thousand eight hundred and sixteen, representing 36 per cent., who had been previously immunised, were in need of reinforcement. Measles. Thirteen hundred and six cases were notified in 1959, compared with one hundred and thirty cases in 1958. The case rate was 16.49 per thousand of population. There was no death. One thousand and seventy one of the cases were notified during the first quarter of the year. The monthly incidence of notified cases is shown in the following table:- January 111 July 14 February 409 August 1 March 551 September 3 April 184 October 2 May 22 November 1 June 6 December 2 Measles cases must be kept out of school for ten days after the appearance of the rash and may then return if the child is sufficiently well to do so. Contacts are not excluded except the under fives, who should be excluded for fourteen days from the date of appearance of the rash in the last case in the home. However, all contacts should be carefully scrutinised dally before being allowed to go to school and should be excluded if suffering from a cough, cold, chill or red eyes. No child who is known for certain to have had the disease need be excluded. 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. Whooping Cough. Thirty cases were notified in 1959, compared with fourteen cases in 1958. The case rate was 0.38 per thousand of population. There was no death. Over half the cases were notified in the second quarter of the year. Sixteen of the cases were infants under five years of age and one was under one year. 45 The monthly incidence of notified cases is shown in the following table:- January 2 July 4 February - August 1 March 3 September 1 April 3 October - May 5 November 2 June 9 December - 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. The vaccines give substantial protection. Immunisation should commence not later than three months of age. Cases are excluded for twenty eight days from the beginning of the characteristic cough. Children under seven years should be excluded for twenty one days from the date of onset of a case in their home if they have not had the disease. 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 Coughs. 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 1959 one thousand and twenty nine 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, either separately or combined with immunisation against Diphtheria, or Diphtheria and Tetanus. Forty one children were given reinforcing injections during 1959. Smallpox. No case was notified. Vaccination against Smallpox. The speed Of travel has increased the risk of Smallpox 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. Vaccination is safest in infancy. Vaccination is voluntary and free of charge and can be arranged through the family doctor or at the nearest Child Welfare Centre. In 1959 six hundred and seventy seven babies under the age of one year were vaccinated. The percentage of 65.5 compares with 62.9 in 1958 and 56.9 in 1957. 46 The following table shows the number of vaccinations during 1959:- Age Number Vaccinated Number Re-Vaccinated Under 1 677 - 1 35 - 2 13 6 3 7 2 4 4 3 5-9 10 21 10-14 7 10 Over 15 47 249 TOTALS 800 291 Puerperal Pyrexia. Twenty two cases were notified in 1959, compared with twelve cases in 1958. Puerperal Pyrexia is "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". Tetanus. A scheme for the immunisation of children against Tetanus on request by parents is in operation. The Tetanus 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 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 for children. 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 1959 nine hundred and ninety two children received primary injections, and thirty five children received booster injections. Food Poisoning. Fifteen cases were notified in 1959, compared with three cases in 1958. Salmonella Typhimurium caused six cases and Salmonella Newport one case. In the remaining eight cases no organism was isolated. The sources of infection were obscure. The low incidence of infections due to Salmonellae and Staphylococci in food is satisfactory. 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 protective 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. No food handler should ever be allowed to return to work without bacteriological clearance. 47 Dysentery. Twelve cases were notified in 1959, compared with two cases in 1958. All were of the Sonne type. 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 of communal W.Cs. in schools and public places. It is most desirable that all cases of diarrhoea should be checked bacteriologlcally. Typhoid and Paratyphoid Fevers. No case was notified. Meningococcal Infections. Three cases were notified. All were in infants under one year of age. Two occurred in January in different parts of the Borough, and no connection could be traced. The third occurred in December. One of the January cases died. Poliomyelitis. No case was notified in 1959, which was the first year free from this infection since 1944. This was in spite of a hot dry Summer which has usually been associated with a higher incidence of this disease. It is probable that poliomyelitis vaccination has played a big part. During the year approximately nine thousand, seven hundred and sixty two persons were vaccinated against Poliomyelitis in the following groups. (1) Children 6 months to 15 years 2612 (2) Young people 15 to 26 years 6652 (3) Other priority groups 498 In addition, eight thousand, eight hundred and eighty persons received third injections. Pneumonia. There were forty three deaths from Pneumonia in 1959, compared with twenty seven in 1958. Sixty seven cases of Pneumonia were notified in 1959, compared with thirty four in 1958. Forty six were cases of Influenzal Pneumonia. Non-Notifiable Diseases. School teachers reported thirty two cases of Mumps, thirty two cases of Chicken Pox, nine cases of German Measles, and five cases of Glandular Fever. 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. Four cases of Scabies, seven cases of infestation by head lice and one case of pubic lice were treated during the year. The total number of treatments was thirty. International Certificates of Vaccination. Six hundred and eighty two International Certificates of vaccination were scrutinised and authenticated for six hundred and fourteen persons during the course of the year. 48 49 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING 1959 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 - 5 10 11 27 181 50 6 2 1 1 - 294 23 - Diphtheria - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - - Paratyphoid Fever - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 3 14 5 - - 22 - - Pneumonia 2 1 - - 1 4 2 2 7 10 22 16 67 6 43 Erysipelas - - - - - - - - - - 2 2 4 - - Dysentery 1 - - 2 1 4 1 1 - 1 - 1 12 - - Poliomyelitis - - - - - - - - - - - - - - - Meningococcal Infection 3 - - - - - - - - - - - 3 2 1 Post-infectious Encephalitis - - - - - - - - - - - - - - - Measles 31 96 133 131 163 703 42 2 4 1 - - 1306 9 - Whooping Cough 1 5 4 2 4 11 1 1 - 1 - - 30 1 - * Under column "Died", all deaths, whether notified in the district or outside it, or not notified at all, are included. 50 DISTRIBUTION OF NOTIFIABLE DISEASES IN WARDS Disease WARDS Case Rate per 1,000 population (Mid-year) N. N. W. N.E. W.C. E.C. E. S.W. S.E. S. TOTAL Population:- 9676 8670 10979 11842 7055 7860 7822 6129 9147 79180 Scarlet Fever 10 12 52 23 49 54 52 6 36 294 3.71 Diphtheria - - - - - - - - - 0.00 Smallpox - - - - - - - - - - 0.00 Typhoid Fever - - - - - - - - - - 0.00 Paratyphoid Fever - - - - - - - - - - 0.00 Puerperal Pyrexia - - 1 1 - - - 20 - 22 - Pneumonia 10 5 3 2 5 12 10 6 14 67 0.85 Erysipelas 2 - - - - 1 - - 1 4 0.05 Dysentery - - 5 1 - 2 - 3 1 12 0.15 Poliomyelitis - - - - - - - - - - 0.00 Meningococcal Infection 1 - - - - 1 - 1 - 3 0.04 Post-infectious Encephalitis - - - - - - - - - - 0.00 Measles 101 30 209 293 147 181 127 78 140 1306 16.49 Whooping Cough - - 8 - 2 15 1 2 2 30 0.38 TOTALS 124 47 278 320 203 266 190 116 194 1738 TUBERCULOSIS On 31st December 1959, there were on the register eight hundred and ninety cases of Tuberculosis, of whom seven hundred and eighty seven were Pulmonary and one hundred and three nonpulmonary. In 1959 there were two deaths from Pulmonary Tuberculosis, as against eight in 1958. The death rate was 0.025 per thousand of population, as against 0.10 in 1958. There was one death from non-pulmonary Tuberculosis, as against two in 1958. The death rate was 0.01 per thousand of population, as against 0.025 in 1958. For England and Wales the death rate for Pulmonary Tuberculosis was 0.08 per thousand of population and for nonpulmonary Tuberculosis 0.01 per thousand of population. The number of new cases of Pulmonary Tuberculosis was forty one, compared with thirty three new cases in 1958. Residual foci of infection still persist, particularly among the middle aged and elderly, and intensive search will be necessary to eliminate the disease. The use of B. C. G. vaccine in adolescent children gives a high measure of protection. Six hundred and twenty two children received injections in 1959, and thirty nine children were found to be Mantoux positive (5.9 per cent). The response rate was 71 per cent. Four new cases of non-pulmonary Tuberculosis were notified in 1959, the same as in 1958. The Tuberculosis Care Committee changed its name to the Sutton and Cheam Tuberculosis and Chest Care Committee during the year. This was necessary because the work of this valuable organisation was extended to promoting the well being and reablement of non tuberculous chest conditions in addition to their well established help to patients suffering from tuberculosis. The Committee provides additional nourishment, clothing and bedding. Grants are made to provide occupational therapy. Holidays are arranged for children, mothers and convalescent patients. The voluntary services of the members are highly appreciated. At the very end of the year the Committee learned that Mr. F.J. Stevens, A.M.I.A., Tuberculosis Almoner of Sutton Chest Clinic, would be leaving early next year to take up a new post. He will be badly missed, but takes with him the good wishes of the Committee. The Hon. Secretary is County Alderman Mrs. Margaret Walkden, 0. B. E., J. P., 9 All Saints Road, Sutton. The following table shows the new cases and deaths in age groups:- 51 AGE PERIODS NEW CASES DEATHS Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F 0 - - - - - - - - 1 1 - 2 - - - - - 5 - 1 - - - - - - 15 2 7 - - - - - - 25 6 4 - 1 - - - - 35 2 1 - - - - - 1 45 5 1 - 1 1 - - - 55 7 - - - - 1 - - 65 and above 2 2 - - - - - - TOTALS 25 16 2 2 1 1 - 1 Notification of Tuberculosis Respiratory forms of dearth - One out of two cases was notified. Other forms of death - The one case was notified. MASS RADIOGRAPHY A Mass Padlography Unit visited the Borough from 30th June to 17th July 1959 and was stationed at the Public Hall, Hill Road, Sutton. Five thousand, four hundred and eighty four persons were examined. The results were as follows:- Male Female Total Number of persons examined 2299 3185 5484 Pulmonary Tuberculosis: Cases requiring treatment and/or close clinic supervision 5 1 6 Cases requiring occasional clinic supervision 2 5 7 Primary lung cancer 1 - 1 The incidence of active Pulmonary Tuberculosis was 1.1 per thousand persons examined. 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. 52 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 Exercises (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 Hill, Sutton Ante-Hatal 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, 9.30 a.m. to 10.30 a.m. Physiotherapy (Children) Monday mornings, by appointment. 53 The Clinic, 1. Robin Hood Lane, Sutton Ante-Natal Wednesdays, 9.30 a.m. to 12 noon. Infant Welfare Tuesdays, Thursdays and Fridays, 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 ChiIdren) 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 Mondays to Fridays, by appointment. speech Therapy Tuesdays and Wednesdays, 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 AND CLEANSING 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 5.30 p.m. (By appointment) VENEREAL DISEASES CLINIC St. Helier Hospital, Wrythe Lane, Carshalton Males: Mondays, 4 p.m. to 6.30 p.m. Females: Wednesdays, 5 p.m. to 7 p.m. (Medical advice can be obtained on any day between the hours of 9 a.m. and 6 p.m.) 54