BED 30 Health Report for 1923 FOR THE BEDDINCTON AND WALLINGTON URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH WALLINGTON : William Pile, Ltd., 19 & 21, Manor Road. 3 Urban District Council of Beddington and Wailington. Ladies and Gentlemen, I beg to present my 26th Annual Report on the Health Conditions prevailing in Beddington and Wailington during the year 1923, which has been, on the whole, a very healthy period. 1 am greatly indebted to all the Members of the Council and to all its Officials for their ready help at all times, and to the Public Health staff I am grateful for their loyal and excellent assistance. I am, Ladies and Gentlemen, Your obedient Servant, C. M. FEGEN, Medical Officer of Health; 24, London Road, West Croydon. 4 Urban District Council of Beddington and Wallington. PUBLIC HEALTH COMMITTEE. Chairman: Mrs. B. W. THOMAS, B.A. MRS. F. BRYANT. MR. A. E. BENNETTS. MR. A. DAW. MR. E. C. T. LANDON. MR. S. C. MILLER. Mr. J. NOBLE. MR. W. C. CLIFFORD-SMITH, O.B.E., J.P. MR.W. G. STORER, J.P. Mr. F. A. W. TAYLOR. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Mrs. THOMAS, B.A. MRS. BRYANT. MR. CLIFFORD-SMITH, MR. DAW. O.B.E., J.P. MR. LANDON. MR. STORER, J.P. MR. NOBLE. MRS. HOLDF.N. Mrs. CLIFFORD-SMITH. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. Mrs. THOMAS. MR. J. NOBLE. MR. CLIFFORD-SMITH. STAFF. Medical Officer of Health: C. M. FEGEN, D.P.H., &c. Assistant Medical Officer of Health: P. N. CAVE, D.P.H., &c. Sanitary Inspector: F. H. LENNARD, M.R.S.I. Health Visitor: MISS M. HOLMAN, C.M.B. Clerks: S. E. CRISP, C.R.S.I. Miss M. C. BULLOCK. 5 GENERAL STATISTICS. Area (acres), 3,029. Population (1923), 16,340. Number of inhabited houses (1923), 4,248. Rateable Value, ,£146,942. Sum represented by a penny rate,£615. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births:— Total. M. F. Legitimate 218 118 100 Illegitimate 3 3 Birth Rate, 13.5. Deaths, 172. Death Rate, 10.5. Number of women dying in, or in consequence of, childbirth: — From Sepsis 1 From other causes 1 Deaths of infants under one year of age:— Per 1,000 Legitimate Births 50 Per 1,000 Illegitimate Births 333 Total 49 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 3 6 HEALTH REPORT FOR 1923. AREA AND POPULATION. The Urban District of Beddington and Wellington has a total area of 3,029 acres, and is divided into six wards. The number of occupied houses in the District was: In 1916 3834 In 1917 3861 In 1918 3867 In 1919 3873 In 1920 3870 In 1921 3948 In 1922 4081 In 1923 4248 The number of houses in the respective Wards was : Beddington North 655 Beddington Central 569 Beddington South 753 1977 Wallington North 625 Wellington Central 999 Wallington South 647 2271 The average number of persons occupying each house was 3.8. The estimated population for 1923 was 16,340. 7 The following Table will show the age distribution at the time of the 1921 Census:- Age (last birthday). Males. Females. 0—4 562 535 5—9 662 700 10-14 619 803 15-19 629 752 20-24 438 734 25—29 427 668 30—34 459 709 35—39 580 796 40—44 631 796 45-49 500 653 50-54 453 530 55—59 333 414 60-61 268 315 65—69 210 291 70-74 125 214 75—79 88 132 80 -84 33 76 85—89 12 26 90 94 4 5 95 and over — The following particulars as to the chief occupations of the Beddington and Wallington residents are extracted from the Census report for 1921:— Occupation. Males. Females. Agricultural occupations 321 19 Metal workers 328 8 Electrical apparatus makers, fitters, etc. 111 1 Workers in skins, leather goods makers 134 18 Workers in wood, etc. 155 7 Paper workers, printers, etc. 100 22 Builders, bricklayers, etc. 180 — Painters and decorators 101 — Transport workers 338 30 Commercial and financial occupations 872 178 Public administration and defence 256 72 Professional occupations 267 228 Persons employed in personal service 102 1114 Clerks, draughtsmen, typists, etc. 835 387 Total unoccupied and retired 863 5381 8 VITAL STATISTICS. Births. The number of Births registered during the year as belonging" to the District was 221, of which 121 were males and 100 were females, as against 232 last year. The Birth Rate for the year was 13.5 per thousand of population, as against 14.3 last year. The Birth Rate in England and Wales in 1923 was 19.7 per thousand of population, as against 20.6 last year. The number of illegitimate births occurring in the District during the year was 3, giving a percentage of total births of 1.3, as against 3.4 last year. REGISTERED BIRTHS AND BIRTH RATES. Ward. Estimated Population. Births. Birthrates. Male Female. Totals. Beddington— North 2430 22 22 44 18.1 Central 2370 1??? 14 26 10.9 South 2250 11 17 28 12.4 Wallington— North 2880 25 25 50 17.3 Central 4020 25 17 42 10.4 South 2390 9 5 14 5.8 Births occurring outside District. 17 — 17 Totals 16340 121 100 221 13.5 DEATHS. Exclusive of those deaths which occurred in Public Institutions situated within the District, but belonging to other districts, the deaths registered amounted to 172. In this number are included those deaths which were transferred by the Registrar-General of persons who had died outside, but who belonged to this District. The number of these deaths was 44. These deaths chiefly occurred at the Workhouse, Workhouse Infirmary, and General Hospital at Croydon; the County Asylums at Brookwood or Netherne; the Cottage Hospital at Carshalton; and the Wandle Valley Joint Hospital Board's Hospital at Beddington Corner. 9 The mortality corresponds to a death rate of 10.5 per thousand of population, as against 9.9 last year. The Death Rate in England and Wales for 1923 was 11.6, as against 12.9 last year. INFANTILE MORTALITY. The number of infants who died under one year of age was 11, as against 14 last year, the Infantile Mortality Rate being 49 per thousand births, as against 60 last year. The Infantile Mortality Rate for England and Wales was 69. CAUSES OF DEATHS. The Deaths registered during 1923 included : 1 from Influenza (1) 12 from Tuberculosis (8) 35 from Cancer (27) 24 from Heart Disease (18) 16 from Respiratory Diseases (25) No Deaths occurred from Measles and Whooping Cough, and for the second year in succession there were no deaths from either Scarlet Fever or Diphtheria. The figures in brackets refer to last year. The following Table shows the Birth Rate, Death Rate and Infant Mortality Rate for each of the years 1915-1923, together with the Rate for England and Wales. Year. Birth Rate. Beath Kate. Infantile Mortality Rate Beddington and Wallington England and Wales. Beddington and Wallington England and Wales. Beddington and Wallington England and Wales. 1915 14.5 21.8 11.4 15.1 71 110 1916 14.8 21.6 10.5 14.0 79 91 1917 13.4 17.8 11.1 14.4 72 97 1918 12.3 17.7 11.5 17.6 47 97 1919 12.7 18.5 10.8 13.8 73 89 1910 17.9 25.4 8.7 12.4 52 80 1921 15.5 22.4 9.9 12.1 72 83 1922 14.3 20.6 9.9 12.9 60 77 1923 13.5 19.7 10.5 11.6 49 69 10 ZYMOTIC DEATH RATE. The Zymotic Death Rate is a term commonly applied to the rates of Deaths occurring from the seven principal Zymotic complaints, viz., Small Pox, Scarlet Fever, Diphtheria, Whooping Cough, Diarrhoea, and " Fever which latter term includes Typhus, Typhoid (Enteric) and Puerperal Fevers. During the year 1923, the number of deaths from these complaints numbered 4, the Zymotic Death Rate, therefore, being 0.24 per thousand of population. The deaths from Phthisis numbered 12. This gives a Phthisical Death Rate of 0.73 per thousand of population. The following Table shows the number of Deaths and the rate per cent. of total deaths from each specified cause: Cause of Death. Number. Percentage Rate. Influenza 1 0.58 Tuberculosis of respiratory system 12 6.97 Other tuberculous diseases 1 0.58 Cancer, malignant disease 35 20.34 Diabetes 1 0.58 Cerebral Haemorrhage 19 11.04 Heart disease 24 ???3.95 Arterio-sclerosis 10 5.81 Bronchitis 8 2.90 Pneumonia 9 5.23 Other respiratory diseases 2 1.10 Ulcer of stomach or duodenum 1 0.53 Diarrhoea, Ac. 3 1.74 Appendicitis 2 1.16 Cirrhosis of Liver 1 0.58 Nephritis 4 2.32 Puerperal sepsis 1 0.58 Diseases and accidents of parturition 1 0.58 Congenital debility, malformation and premature birth 6 3.43 Suicide 3 1.74 Other deaths from Violence 4 2.32 11 Birth-rate, Death-rate, and Analysis of Mortality during the Year 1923. - Birthrate per 1,000 Total, Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 Years). Total Deaths under One Year. England and Wales 19.7 11.6 0.01 0.00 0.14 0.03 0.10 0.07 0.22 0.44 7.7 69 105 County Boroughs and Great Towns, including London. 20.4 11.6 0.01 0.00 0.15 0.03 0.12 0.09 0.22 0.40 9.9 72 157 Smaller Towns (1921 Adjusted Populations 20,000— 50,000). 19.8 10.6 0.01 — 0.19 0.02 0.10 0.06 0.21 0.38 6.4 69 London 20.2 11.2 0.01 0.00 0.08 0.02 0.09 0.13 0.17 0.45 10.2 60 Beddington and Wallington 13.5 10.5 0.00 0.00 0.00 0.00 0.00 0.00 0.06 0.24 13.5 49 12 INFECTIOUS DISEASE. The year 1923 has been a satisfactory one from the point of view of the incidence of Infectious Disease. 1915 (9 months) 1916 1917 1918 1919 1920 1921 1922 1923 Scarlet Fever 39 16 8 34 62 67 74 59 28 Diphtheria 14 24 9 23 43 47 34 19 40 Typhoid Fever 1 1 - 1 3 5 1 — 6 Erysipelas 6 9 4 3 4 5 8 4 4 Poliomyelitis 1 — — — 2 — — — — Opthalmia Neonatorum 1 — — 1 — 2 — — — Puerperal Fever - 1 - — 1 — 2 — 2 Measles - 87 241 158 39 — — — — Cerebro Spinal Meningitis - - - 1 — — 1 — — Pneumonia - - - — 16 3 8 4 5 Malaria - - - — 6 4 — — — Chicken Pox - — — — 3 — — — 6 Dysentery — — — — — — 1 — - Encephalitis Lethargica — — — — — — 1 — 3 Tuberculosis Pulmonary 17 16 22 27 18 16 15 12 18 Other forms 6 8 4 4 — — 3 1 6 Total 35 162 288 252 197 149 148 99 118 13 Reference to Table I., at the end of the Report, will show : — Firstly, cases notified in the District, with ages of incidence, and the nature of the Infectious Disease; Secondly, the total number of cases and the nature of the disease in each Ward; Thirdly, the number of cases removed to the Isolation Hospital. SCARLET FEVER. A very large decrease in the number of cases of Scarlet Fever notified took place, viz., 28 as against 59 last year. Of the 28 cases 9 occurred at the Royal Female Orphanage. Twenty-two cases were removed to the Isolation Hospital. No deaths were registered as occurring from Scarlet Fever. DIPHTHERIA. Although an increase of cases of Diphtheria occurred, viz., 40 as against 19 last year, there were 26 cases which occurred amongst the inmates of the Royal Female Orphanage. Excluding these cases there were only 14 cases occurring within the District. During the year the whole of the inmates and staff of the Orphanage were swabbed, and a bacteriological examination was made from the nose and throat of each individual. A number were found to have the Diphtheria bacilli, and were removed to the Hospital for treatment. Swabs, numbering 97, were also sent by medical men practising in the District, and were examined by Dr. Cave at the Isolation Hospital. Thirty-seven cases were removed to the Isolation Hospital. I am glad to say that again this year no deaths were registered as occurring from this complaint. 14 PUERPERAL FEVER. Two cases were notified, both of which unfortunately had a fatal termination. One patient was removed to the Isolation Hospital, and was found to be suffering also from Tubercular Bronchopneumonia. TYPHOID FEVER. Six cases were notified, all of which were Para-typhoid Fever. Owing to a number of cases also occurring in neighbouring Districts, an investigation was made by a Medical Inspector of the Ministry of Health. A possible source of infection was traced, and shortly after no further cases occurred. None of the cases were removed to Hospital. All cases recovered. CHICKEN POX. Owing to cases of Small Pox occurring in other Districts, it was deemed advisable for Chicken Pox to be made a compulsory notifiable disease for six months, to come into force on the 13th October. During the period of the year it was so in force 6 cases were notified. I am glad to state that no case of Small Pox occurred in this District, although on several occasions I was called in to examine a suspicious case. ENCEPHALITIS LETHARGICA. Three cases occurred, two families being affected. Two of the cases were removed to the Isolation Hospital. All the patients recovered. TUBERCULOSIS. During the year 24 new cases of Tuberculosis were notified, of which 18 were pulmonary and 6 were other forms of Tuberculosis. Sanatorium and dispensary treatment is carried out by the Surrey County Council. 15 To assist in the early diagnosis of cases, specimens of sputum are examined bacteriologically at the Wandle Valley Joint Hospital—free of charge. During the year Dr. Cave examined 18 specimens. The Health Visitor paid 31 visits to the homes of patients notified as suffering from Tuberculosis. Disinfection at the home is carried out after death, on a patient's admission to an Institution, and on other occasions as are necessary. TUBERCULOSIS. Age—Periods New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M F M F M F M F Under 1 year - - - - - - - - 1 and under 5 years — — 1 — — — 1 — 5 to 10 years — — — 1 — — — — 10 to 15 „ - - - - - - - - 15 to 20 „ 2 — — 1 — — — — 20 to 25 „ 3 3 - 1 — 2 - - 25 to 35 „ — 4 — 1 2 2 - — 35 to 45 „ 1 3 1 — — — — - 45 to 55 „ 1 1 — — 2 2 — — 55 to 65 „ — — — — 2 — — — 65 years and upwards - - - - - - - - Total 7 11 2 4 6 6 1 — The cases were distributed amongst the following Wards: Localisation. Total Beddington. Wallington. North Central South North Central South Pulmonary 18 3 4 3 3 4 1 Non-Pulmonary 6 3 - - - 3 - HEALTH VISITOR. Miss Holman, the Health Visitor, has carried out all her duties in a very efficient manner. 16 During the year she has paid the following visits:— Number of visits to homes where children have been born 117 Number of revisits re Births 1368 Number of visits re Tuberculosis 31 Number of Ante-natal visits 14 Number of visits re Deaths under one year of age 5 MATERNITY AND CHILD WELFARE. The Infant Welfare work in Beddington and Wallington shows most encouraging results. The attendance at the four Centres has been very good, and I feel sure that the children, and the mothers too, have largely benefited by their attendance, and the help afforded them. It will be seen that 13 children have been sent for treatment to the Carshalton Cottage Hospital under the Council's arrangement with that Hospital, while 3 have been sent to various London Hospitals, and 8 cases have been sent to Consultants. In two instances, the efforts of your Health Visitor and myself to secure permanent benefit for children have had to be supplemented bv the willing and most helpful co-operation of the local Officer of the National Society for the Prevention of Cruelty to Children, with most gratifying results. In two cases I have been able to secure the use of the ambulance of the National Society for the Prevention of Cruelty to Children, to take mothers with their children up to London for consultations, thus rendering easy the necessary consultation for the benefit of the children. Your Health Visitor's work is deserving of the highest appreciation, and the results of her work is evidenced by the high esteem she is held in by all parents. 17 Name of Centre. Voluntary Helpers. Number of Sessions Held. Total number of children on books, 31st Dec., 1923. Attendance. Average Attendance Number of Children sent for Treatment. Children sent to Consultants. Adults. Children. To Carshalton Hospital. To other Institutions. Hackbridge Mrs. Crouch 23 81 646 698 30 8 — 2 Mrs. Holden Mrs. Wright Bandon Hill Miss Brander 23 55 292 357 16 3 — 4 Miss Champness Mis. Jeffrey Wallington Mrs. Clifford-Smith 23 77 513 546 24 2 1 2 Mrs. Noble Beddington Village — 11 12 54 69 6 — — — 18 MEDICAL INSPECTION OF SCHOOL CHILDREN. The Medical Inspection of School Children is carried out by the Education Department of the Surrey County Council. The Medical Officer of Health is called in on occasions to examine children suspected to be suffering from infectious or contagious disease. SCHOOLS. Visits are paid to Schools in the District in order to see that the sanitary arrangements, etc., are satisfactory, and also, at other times, when necessary, special visits were made. The following Table shows the number of visits, etc., paid during the year:— Number of ordinary and special visits to Schools 10 Certificates given for school attendance purposes 30 Home visits to individual children 80 Schools disinfected 2 During the year the following Schools were closed on the recommendation of the Medical Officer of Health, owing to the prevalence of Infectious Disease:— Bandon Hill Infants' from 16th March to 29th March, for Measles. Hackbridge Infants' from 10th September to 6th October, for Whooping Cough. Bandon Hill from 22nd November to 23rd November, for disinfection of the class-rooms. AMBULANCE FACILITIES. Two motor ambulances are provided for the removal of persons suffering from Infectious Disease to the Isolation Hospital. HOUSING, &c. Number of new houses erected during the year:— (a) Total 121 (b) With State assistance under Housing Acts, 1919 or 1923:— (i) By Local Authorities — (ii) By other bodies or persons — 19 1. Unfit Dwelling Houses. Inspection. (1) Total number of Dwelling Houses inspected for housing defects (under Public Health or Housing Acts) 351 (2) Number of Dwelling Houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 110 (3) Number of Dwelling Houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of Dwelling Houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 258 2. Remedy of Defects Without Service of Formal Notices. Number of defective Dwelling Houses rendered fit in consequence of informal action by the Local Authority or their Officers 237 3. Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning Act, 1919:— (1) Number of Dwelling Houses in respect of which Notices were served — 2) Number of Dwelling Houses which were rendered fit:— (a) By Owner — (b) By Local Authority in default of Owners — (3) Number of Dwelling Houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close — B. Proceedings under Public Health Acts. (1) Number of Dwelling Houses in respect of which Notices were served requiring defects to be remedied 21 (2) Number of Dwelling Houses in which defects were remedied :— (a) By Owners 21 (b) By Local Authority in default of Owners — 20 C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909:— (1) Number of representations made with the view to making of Closing Orders — (2) Number of Dwelling Houses in respect of which Closing Orders were made — (3) Number of Dwelling houses in respect of which Closing Orders were determined, the Dwelling Houses being rendered fit — (4) Number of Dwelling Houses in respect of which Demolition Orders were made — (5) Number of Dwelling Houses demolished in pursuance of Demolition Order — 21 REPORT on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—Inspection of Factories, Workshops and Workplaces, Including Inspections made by Sanitary Inspectors. Premises (1) No. of. Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory laundries). 30 1 - Workshops (inoluding Workshop laundries) 68 3 - Work places (other than outworkers premises included in part 3 of this report). — — — Total. 98 4 — 2.—Defects found in Factories, Workshops and Workplaces. Particulars. (1) Number of defects. Number of Proseoutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector (4) Nuisances under Public Health Acts, including those specified under Sections 2, 3, 7 and 8 of the Factory and Workshop Act remediable under The Public Health Acts- Want of cleanliness 2 2 - — Other Nuisances 5 6 — — Sanitary accommodation unsuitable or defective 7 7 - — Total. 14 14 — — 22 3.—Homework. Nature of Work. (1) Outworkers Lists, Section 107. Sending in twice a year. Sending in once a year. Notices served on Occupiers as to keeping °r sending lists. (8) Prosecutions. (9&10) Lists. (2) Outworkers. [lists. (5) Outworkers. Contractors (3) Workmen. (4) Contractors (6) Workmen. (7) Wearing Apparel (making). 2 — 1 2 — 2 — — Total. 2 — 1 2 — 2 — — 4.—Registered Workshops. Workshops on register at end of year. (1) Numbers (2) Tailors and Dressmakers 12 Bootmakers 8 Carpenter's and Builder's Workshops 8 Workshop Bakehouses 5 Motor and Cycle Repairers 5 Blacksmiths and Wheelwrights 5 Upholsterers 3 Other Trades 11 Total number of Workshops on Register 57 23 5.—Other Matters. Class. (1) Number. (2) Mutters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 123, 1901) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other 4 Underground Bakehouses (s. 101) in use at the end of the year 1 24 SALE OF FOOD AND DRUGS ACTS. The Sale of Food and Drugs Acts is administered in this District by the Surrey County Council. The following Table shows the number of samples examined during the year from this District. Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convictions. Formal Informal Total Formal Informal Total Milk 53 3 56 10 1 11 6 2 Cream .. .. .. .. .. .. .. .. Butter .. .. .. .. .. .. .. .. Cheese .. .. .. .. .. .. .. .. Margarine .. .. .. .. .. .. .. .. Lard .. .. .. .. .. .. .. .. Bread .. .. .. .. .. .. .. .. Flour(Self-Raising) .. .. .. .. .. .. .. .. Tea .. 1 1 .. .. .. .. .. Coffee (Extract) .. 1 1 .. .. .. .. .. Cocoa .. .. .. .. .. .. .. .. Sugar .. .. .. .. .. .. .. .. Mustard .. .. .. .. .. .. .. .. Confectionery and Jam .. .. .. .. .. .. .. .. Pepper .. .. .. .. .. .. .. .. Wine .. .. .. .. .. .. .. .. Beer .. .. .. .. .. .. .. .. Spirits .. .. .. .. .. .. .. .. Drugs .. .. .. .. .. .. .. .. Other articles .. 1 1 .. .. .. .. .. Totals 53 6 59 10 1 11 5 2 appendices. 26 TABLE I. CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1923. Diabase. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages—Years. Beddington. Wallington. Under 1 year. 1 and under 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and over. North. Central. South. North. Central. South. Scarlet Fever 28 .. .. .. 1 1 8 10 1 3 3 1 .. 11 8 2 3 2 2 22 Diphtheria 40 1 .. 1 .. 1 6 22 4 4 1 .. .. 26 1 .. 6 6 1 37 Pneumonia 5 .. .. .. .. .. .. .. .. 1 2 i 1 1 1 .. 1 2 .. .. Erysipelas 4 .. .. .. .. .. .. .. 1 .. 1 2 .. 1 .. .. 1 2 .. 3 Puerperal Fever 2 .. .. .. .. .. .. .. .. 2 .. .. .. .. 1 .. 1 .. .. 1 Encephalitis Lethargica 3 .. .. .. .. .. 1 1 1 .. .. .. .. .. .. .. .. 2 1 2 Typhoid Fever 6 1 1 .. .. .. 3 .. .. .. 1 .. .. 1 .. .. 1 3 1 .. Chicken Pox 6 .. .. .. .. .. 2 3 1 .. .. .. .. 2 2 2 .. .. .. .. Totals 94 2 1 1 1 2 20 36 8 10 8 4 1 42 13 4 13 17 5 65 The above figures include 9 Scarlet Fever and 26 Diphtheria cases which occurred in the Royal Female Orphanage. 27 TABLE II. DEATHS REGISTERED DURING THE CALENDAR YEAR 1923, CLASSIFIED BY AGE AND CAUSE. Cause of Deaths. 1 Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. 2 3 4 6 6 7 8 9 10 All Ages. Under 1. 1 & under 2. 2 & under 5. 5 & under 15. 15 & under 25. 25 & under 45. 45 & under 65. 65 & upwards. Influenza 1 .. .. .. .. .. .. .. 1 Tuberculosis of the Respiratory System 12 .. .. .. .. .. 3 6 .. Other Tuberculous Diseases 1 .. 1 .. .. .. .. .. .. Cancer, malignant diseases 35 .. .. .. .. 1 2 18 14 Diabetes 1 .. .. .. .. .. 1 .. .. Cerebral Hœmorrhage, etc. 19 .. .. .. .. .. .. 4 15 Heart Disease 24 .. .. .. .. 1 2 5 16 Arterio-sclerosis 10 .. .. .. .. .. .. .. 10 Bronchitis 5 .. .. 1 .. .. .. 4 Pneumonia (all forms) 9 .. .. .. 1 1 1 1 5 Other respiratory diseases 2 .. .. .. .. .. .. .. 2 Ulcer of stomach or Duodenum 1 .. .. .. .. .. .. 1 .. Diarrhoea, etc. (under two years) 3 1 2 .. .. .. .. .. .. Appendicitis and Typhlitis 2 .. .. .. 1 1 .. .. .. Cirrhosis of Liver 1 .. .. .. .. .. .. 1 .. Acute and Chronic Nephritis 4 .. .. .. .. .. .. 2 2 Puerperal Sepsis 1 .. .. .. .. .. 1 .. .. Other accidents and diseases of Pregnancy and Parturition 1 .. .. .. .. .. 1 .. .. Congenital Debility and Malformation. Premature Birth 6 6 .. .. .. .. .. .. .. Suicide 3 .. .. .. .. .. 1 2 .. Other Deaths from Violence 4 .. .. 1 1 .. 1 1 .. Other Defined Diseases 27 4 .. .. .. 1 1 7 14 All Causes 172 11 3 1 4 8 14 48 83 28 ISOLATION HOSPITAL. The Wandle Valley Joint Hospital, which is situate at Beddington Corner, serves the Urban Districts of Beddington and Wellington, Coulsdon and Purley, Merton and Morden, and Mitcham. The Hospital was first opened at the beginning of March, 1899, when 28 beds were provided, viz., 10 beds for Scarlet Fever cases, 10 beds for Diphtheria cases, 4 beds for Typhoid Fever cases, and 4 beds for doubtful cases. In 1904 a contract was entered into by the Croydon Rural District Council to considerably extend the accommodation, and in June, 1905, an additional Scarlet Fever pavilion for 22 beds was completed. The hand laundry was converted into a steam laundry, and an additional dormitory was provided in the administrative block. A further enlargement in 1910 included a cubicle block for 12 patients and also quarters for a resident Medical Officer. Further accommodation was provided in 1922 by the erection of another cubicle block for 16 beds. The nominal number of beds now available is 78, but on many occasions a larger number of patients are being treated. Since the Hospital was opened 8,825 patients have been admitted. The number of patients admitted last year, together with the number of deaths and the case mortality, is :— 29  Cases. Deaths. Case Mortality, (per cent.) Scarlet Fever 230 2 0.86 Diphtheria 136 4* 2.94 Pneumonia 1 — 0.00 Puerperal Fever 3 1† 33.33 Typhoid Fever 1 1 100.00 Erysipelas 6 — 0.00 Measles 1 — 0.00 Encephalitis Lethargica 2 - 0.00 Influenza 1 — 0.00 Tuberculosis 20 2 10.00 Total 401 10 2.49 *One patient died from Nephritis. †Patient died from Tubercular-Broncho-Pneumonia. Bacteriological Laboratory. The Hospital is provided with a bacteriological laboratory, and during the year Dr. Cave has made the following examinations : — Number of swabs examined for Diphtheria 1147 Number of specimens of Sputa 122 This work was divided amongst the constituent Authorities and amongst the patients at the Hospital as shown by the following Table: — Swabs for Diphtheria. Sputa. Beddington and Wallington 97 18 Coulsdon and Purley 93 29 Mitcham 157 27 Hospital Cases 800 48 30 Patients admitted to Hospital during 1923. District. Scarlet Fever. Diphtheria. Pneumonia. Puerperal Fever. Tyhoid Fever. Erysipelas. Tuberculosis. Measles. Encephalitis Lethargica. Influenza. Totals. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Beddington and Wallington 22 .. 37 .. .. .. 1 1* .. .. 3 .. .. .. 1 .. 2 .. .. .. 66 1 Coulsdon and Purley 35 1 23 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 59 2 Mitcham 107 .. 35 .. .. .. 2 .. 1 1 1 .. .. .. .. .. .. .. 1 .. 147 1 Merton and Morden 54 1 39 3‡ 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 95 4 Caterham 11 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 13 .. Carshlton 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. i .. Surrey .. .. .. .. .. .. .. .. .. .. .. .. 20 2 .. .. .. .. .. .. 20 2 Total. 230 2 136 4 1 .. 3 1 1 1 6 .. 20 2 1 .. 2 •• 1 •• 401 10 J One patient died from Nephritis. * Patient died from Tubercular-Broncho-Pneumonia. 31 ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE YEAR 1923. To the Medical Officer of Health. Sir,— In compliance with the provisions of the Sanitary Officers Order, 1922, I beg to submit the following" statement showing the number of inspections made and the work carried out in the administration of the Public Health Acts, Housing Acts, Bye-laws, etc., in the District during the year 1923. DWELLING HOUSES. The total number of dwelling houses inspected during the year was 351, of which number, 110 were inspections made in accordance with the Housing (Inspection of District) Regulations, 1910. Of the total, 93 houses were found to be reasonably fit for human habitation and free from nuisance. The detects discovered during the inspections numbered 1,150, and are shown classified in the following Table : — Defective water fittings 17 Defects in drains and drainage fittings 184 Defects in water closets 68 Defective sinks and waste-pipes 23 Defective paving of back yards 19 Dampness, defective roofs, etc. 196 Defective internal walls and ceilings 158 Dirty internal walls and ceilings 253 Defective windows, broken sash-cords, etc. 99 Defective dustbins 72 Other defects or nuisances 61 Total 1150 DAIRIES, COWSHEDS AND MILKSHOPS. The number of producers and purveyors of milk on the registers at the end of the year was 21 : — Producers and Wholesale Purveyors of Milk 6 Retail Purveyors of Milk 15 32 The number of cowsheds in use in the District was 5, and the number of dairy premises 12. One hundred and four visits were paid to these premises during the year, and the undermentioned defects or infringements of the Regulations were discovered and remedied : — Defective drain 1 No ashpit accommodation 1 Uncovered milk vessels 2 The cowsheds were visited each quarter of the year by the Veterinary Surgeon (R. Thrale, Esq., M.R.C.V.S.), appointed by the Council, and the average number of cows examined was 107. During the year the Council granted three licences authorising the sale of " Certified " Milk. SLAUGHTERHOUSE AND MEAT AND FOOD INSPECTION. There is one slaughterhouse in the District, which is licensed annually. The slaughterhouse was frequently visited during the year but no infringements of the Byelaws dealing with slaughterhouses were observed. The Bye-law making compulsory the stunning of animals by means of a mechanically-operated instrument is in force in the District. The number of visits paid to the slaughterhouse and other premises for the purpose of inspecting the meat and other foods deposited thereon was 348. The meat destroyed during the year as being unfit for human consumption amounted to 54 lbs. BAKEHOUSES. There were 9 bakehouses in use in the District, one being underground. Thirty visits were paid to these premises during the year, and the under-mentioned defects were discovered and remedied : — Defects in drainage and drain fittings 2 Lime-washing required 1 FACTORIES AND WORKSHOPS. A statement with reference to factories and workshops is included in the Report of the Medical Officer of Health. 33 INFECTIOUS DISEASE AND DISINFECTION. Number of visits paid to premises on occurrence of Infectious Disease 127 Number of reports sent to Medical Officer of Health 68 Number of notices sent to schools (excluding scholars from attendance) 30 Number of rooms disinfected 95 Lots of bedding and clothing disinfected 88 COMPLAINTS. Eighty-two complaints were received during the year, and were due to the following causes : — Defects in dwelling houses 30 Choked drains 17 Accumulations of offensive refuse 7 Animals kept so as to be a nuisance 6 Rats 5 Defective dustbins 3 Miscellaneous 14 Total 82 All the complaints received prompt attention. INCREASE OF RENT (RESTRICTIONS) ACTS. No applications were received for certificates under these Acts. RATS AND MICE (DESTRUCTION) ACT, 1919. Forty-nine visits were paid to premises where rats were prevalent. In addition to this number, inquiries were made during routine inspections of premises, and advice given where necessary. Certain structural defects which encouraged the entry of rats into premises were remedied. BYE-LAWS. Three infringements of the bye-laws dealing with nuisances were dealt with during the year, and were due to deposits of manure. 34 NOTICES. In connection with the nuisances and defects discovered, notices as under were served during the year : — Informal notices served (including verbal intimations) 264 Statutory notices served Sec. 94, P.H. Act, 1875 (Nuisances) 20 Sec. 36, P.H. Act, 1875 (Dustbins) 4 24 Total 288 DETAILS OF DEFECTS REMEDIED AND SANITARY IMPROVEMENTS EFFECTED DURING THE YEAR. Water fittings repaired 17 Drains relaid or repaired 36 Drains unstopped and cleansed 26 Soil pipes and ventilating pipes repaired or renewed 48 Manholes newly constructed or repaired 30 Gullies renewed or cleansed 34 New stoppers fixed in rodeyes of interceptors 11 Water-closet walls, floors and roofs repaired 23 New pans fixed to water-closets 12 Flushing cisterns to water-closets repaired or renewed 24 Flush pipes and pan joints repaired or renewed 12 Glazed stoneware sinks provided 13 Waste pipes from sinks, etc., repaired or renewed 26 New dustbins provided 75 Yards paved or paving repaired 18 Roofs and gutters repaired 122 Damp-proof courses fixed 10 External walls repaired 24 Internal walls repaired 146 Rooms cleansed 243 Windows repaired 136 Fireplaces repaired 54 Offensive accumulations of refuse removed 15 Miscellaneous defects remedied 14 Total *1169 *Including 83 defects outstanding at end of 1922. The number of defects outstanding at the end of 1923 was 85. 35 SUMMARY OF WORK DONE DURING THE YEAR. Number of houses inspected 351 Number of visits to works in progress and re-inspections 987 Number of visits to schools 10 Number of miscellaneous visits and inspections 240 Number of visits to dairies, cowsheds and milkshops 104 Number of visits to factories and workshops 99 Number of visits to slaughterhouse and food stores 348 Number of visits to piggeries 28 Number of visits to stables 86 Number of visits to urinals 21 Number of visits re infectious disease 127 Number of visits re rats 49 Number of complaints received and investigated 82 Number of preliminary notices served 264 Number of statutory notices served 24 Number of interviews re nuisances, etc. 156 Number of tests applied to drains 210 Number of rooms disinfected 95 Number of lots of bedding and clothing disinfected 88 Number of water samples taken 80 Total number of defects and nuisances discovered 1171 Total number of defects and nuisances remedied *1169 including 83 outstanding at end of year 1922. I am, Sir, Yours obediently, F. H. LENNARD, M.R.San.i., Sanitary Inspector. - Diphtheria. - — No. of Cases per 100,000. — - Scarlet Fever.— No of Cases per 100,000.- -Tuberculosis. - — No of Cases per 100,000 -