BED 2 BOROUGH OF BEDDINGTON AND WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1937. BOROUGH OF BEDDINGTON AND WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1937. TABLE OF CONTENTS. Public Health Committee 5 Maternity and Child Welfare Sub-Committee 5 Representatives on the Wandle Valley Joint Hospital Board 5 Representatives on the Wandle Valley Joint Sewerage Board 6 Staff of Public Health Department 6 Statistics and Social Conditions of the Area 9 Extracts from Vital Statistics 11 Vital Statistics: Area 12 Population 12 Births 12 Deaths 13 Birth and Death Rates in Wards 13 Registered Causes of Death 14 Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1937 15 Heart Disease and Diseases of the Circulatory System 16 Cancer 17 Violence 19 Maternal Mortality 20 Infantile Mortality 20 General Provision of Health Services for the Area: Laboratory Facilities 22 Ambulance Facilities 23 Nursing in the Home 23 Treatment Centres and Clinics 23 Hospitals 25 Disinfection 25 Maternity and Child Welfare: General Observations 25 Ante-natal and Post-natal Supervision 27 Maternity and Child Welfare Centres 28 Maternity Ward 29 Consultant Obstetrician 29 Home Help 29 Birth Control 29 Treatment: Orthopaedic 30 Dental 30 Minor Ailments 30 Provision of Milk and other Foods 31 Health Visiting 31 Child Life Protection 32 2 Sanitary Circumstances of the Area: Water Supply 32 Drainage and Sewerage 33 Rivers and Streams 33 Closet Accommodation 33 Public Cleansing 34 Sanitary Inspection of the Area. Statement of the Senior Sanitary Inspector for the Year, 1937: Dwelling Houses 35 Milk and Dairies 35 Meat and other Food 35 Factories and Workshops 36 Shops Act, 1934 36 Complaints 36 Infectious Disease and Disinfection 36 Rats and Mice (Destruction) Act 36 Increase of Rent (Restrictions) Act 36 Notices 36 Sanitary Improvements: Water Supply 37 Drains 37 Water Closets 37 Sinks 37 Yards 37 Dust Receptacles 37 Dampness 38 General Repairs, etc. 38 Milk and Dairies 38 Factories and Workshops 38 Bye-laws with respect to Nuisances 38 Smoke 38 Summary of work done during the year 39 Shops Act, 1934 40 Smpke Abatement 40 Swimming Baths 40 Eradication of Bed Bugs 40 Schools 41 Dairies 41 Milk (Special Designations) Orders 41 Slaughterhouses 42 Bakehouses 42 Other Food Preparing Places 42 Factories and Workshops 42 Housing: Housing Statistics: Inspection of Dwelling Houses 44 Remedy of Defects without service of Formal Notice 44 3 Action under Statutory Powers 44 Housing Act, 1936—Part IV—Overcrowding 45 Number of Houses and Flats erected during the year 45 Inspection and Supervision of Food: Milk 45 Meat 46 Food and Drugs (Adulteration) Act 46 Chemical and Bacteriological Examinations 47 Nutrition 47 Adoptive Acts and Bye-Laws 48 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 48 Incidence of Infectious Diseases in Age Groups and Wards 49 Cases of Infectious Disease notified, 1915-1937 50 Monthly Incidence of Infectious Disease 51 Scarlet Fever 52 Diphtheria 52 Enteric Fever 52 Erysipelas 52 Puerperal Fever and Puerperal Pyrexia 52 Opthalmia Neonatorum 53 Pneumonia 53 Acute Poliomyelitis 53 Dysentery 53 Cerebro-Spinal Fever 53 Non-notifiable Diseases 54 Tuberculosis 54 Prevention of Blindness 56 Cases admitted to Wandle Valley Joint Hospital 57 Miscellaneous: Examination of Employees 58 Propaganda 58 4 BOROUGH OF BEDDINGTON AND WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1937. Members: Councillor C. Derry, J.P. (The Mayor). Alderman H. B. Smalley (Deputy Mayor). Alderman H. A. Heath (Chairman). Alderman W. H. Lewis. Councillor H. J. W. Bliss, B.A. Councillor Mrs. V. M. Boyce. Councillor B. W. Brenner. Councillor F. G. Bryant. Councillor F. C. Elwood. Councillor Mrs. E. A. Lazenby, B.A. Councillor D. Mackay. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1937. Members: Alderman H. A. Heath (Chairman). Alderman H. B. Smalley (Deputy Mayor). Alderman W. H. Lewis. Councillor Mrs. V. M. Boyce. Councillor F. C. Elwood. Councillor Mrs. E. A. Lazenby, B.A. Co-opted Members: Mrs. F. Daw, Miss E. Hall, Mrs. M. Woods, B.A. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1937. Members: Councillor C. Derry, J.P. (The Mavor) Alderman G. Purser. Councillor H. D. Banks. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1937. Members: Councillor C. Derry, J.P. (The Mayor). Alderman W. M. Mellows. Alderman G. Purser. Councillor J. Vale. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. (commenced 1st April, 1937). *F. R. Edbrooke, M.B., Ch.B., D.P.H. (resigned 31st March, 1937). Assistant Medical Officer of Health:— *E. C. Loudon, M.B., Ch.B., D.P.H. (resigned 31st March, 1937). Assistant Medical Officer for Ante-Natal Clinic:— * Winifred M. Small, M.B., Ch.B. Consultant Obstetrician:— ^Leslie Williams, M.D., M.S., F.R.C.S. Senior Sanitary Inspector:— F. H. Lennard, A.M.I.S.E., M.R.S.I., M.S.I.A. Additional Sanitary Inspectors:— A. F. Leaney, M.R.S.I. G. J. T. Dean, M.R.S.I., M.S.I.A. (commenced 1st October, 1937). Health Visitors:— Miss M. Holman, S.C.M. Miss E. Turnbull, S.R.N., S.C.M. Clerks:— *S. E. Crisp, C.R.S.I, (resigned 31st March, 1937). W. A. Watts. Miss M. Frost. E. D. Evezard (commenced 1st October, 1937). "Part-time Officials. 6 Public Health Department, Town Hall, Wallington. To His Worship the Mayor, Aldermen and Councillors of the Borough of Beddington and Wallington. Ladies and Gentlemen, I beg to present my annual report for 1937. The period covered represents the nine months of the year in which I have held office as your first full-time Medical Officer of Health, and the three months previous which were covered by the service of my predecessor. The year under review from a public health standpoint was very satisfactory. Infectious disease notifications reached an extremely low level and the district was spared epidemics of any importance. In summarising the annual records it must be admitted, however, that this year, teeming as it was with major events of municipal interest, was not one in which (in some branches of the work at least) great achievements can be recorded in terms of statistics. Much of the work of the Public Health Committee concerned re-organisation and important decisions of principle, which, while laying the foundation of an efficient service for the future, cannot in this year of their inception be expected to produce notable results. The report represents in statistical form a record of the state of the health of the Borough during the past year. The general form recommended by the Minister of Health has been followed throughout and, in presenting the statistical tables, an effort has been made to incorporate more tables showing Ward distribution of relevant data. Much of the text has been curtailed and it is to be hoped that the tabular presentation of the main facts will be sufficient. 7 As this was the final year of the Urban District, a statistical review of Beddington and Wallington during the years in which it was an Urban District is presented in graph form. Some of the facts disclosed by the graph may be illuminating to many readers, particularly the stasis and lack of growth in the years immediately following the Great War. The graph shows that, in spite of a spectacular rise in the Birth Rate, the population of the district during these years actually diminished. Birth Rate, Population and Housing appear to have varied little until the year 1925. From that date, however, the growth, disclosed by the graph, has been remarkably rapid. It is to be anticipated that in 1938 the problem of housing will again engage the attention of the Council. The upward trend of population and the maintenance of the birth rate at a consistently high level will demand further expansion. We may all look forward to 1938, the first complete year of Borough status, with renewed confidence, and, as your new Medical Officer of Health, I feel sure that the important steps taken by the Council in 1937 in furthering Public Health Schemes for the Borough will bear a generous harvest in 1938. I wish to place on record my appreciation of the loyal service and valuable assistance I have received from all the members of my staff throughout the year. I have the honour to be, Ladies and Gentlemen, Your obedient servant, PATRICK J. O'CONNELL, Medical Officer of Health. July, 1938. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,048 Population, Census, 1931 26,249 Registrar-General's estimate of resident population for 1937 30,590 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1937 8,877 Rateable Value, December, 1937 £359,631 Sum represented by penny rate, December, 1937 £1,454 The year 1937 was memorable in many ways, but most of all by reason of the district, after many years of rapid growth, attaining full stature in this year and assuming Borough status. The Urban District of Beddington and Wallington was constituted in 1915 by an Order of the Surrey County Council, the area up to that time constituting part of the Croydon Rural District. By an order in Council, dated 20th August, 1937, H.M. King George VI granted a charter to Beddington and Wallington, which was presented on the 15th September, 1937, by the Lord Lieutenant of the County of Surrey. The Borough is bounded on the east by the County Borough of Croydon, to the north by the Borough of Mitcham, to the west by the Carshalton Urban District and to the south by the Urban District of Coulsdon and Purley. The character of the Borough, though it has been greatly developed and increased in population, has changed little in personality and charm. For the most part the district is still residential in character, the middle third being almost wholly so, while the southern third, although 9 including the landing ground of the Croydon Aerodrome, boasts some very fine residential property. Of recent years the northern third of the district has taken on a more industrial outlook, several large factories being developed there (radio engineering and manufacturing, chocolate making), in all giving work to about 15,000 people. This part of the district, while retaining some of the old-world associations inseparable from such places as Beddington Corner and Beddington Village, includes Beddington Park and the Croydon Sewerage Works. Some fine open spaces are to be found in various parts of the district, and much credit is due to the forethought and imagination which has prompted their development in recent years, and which, while robbing the beauty spots of none of their natural charm, has made them more accessible and hence more appreciated by the general public. The population of the district has increased steadily since 1925, and the growth of shopping centres, well planned and tastefully constructed, has been commensurate with other developments. Unemployment remains at a low level. 10 EXTRACTS FROM VITAL STATISTICS. Total. M. F. Birth Rate per 1,000 of the estimated resident population. Live Births—Legitimate 379 190 189 12.91 „ „ Illegitimate 16 10 6 Total 395 200 195 Rate per 1,000 total births. Still Births 16 9 7 38.93 Death Rate per 1,000 of the estimated resident population. Deaths 306 150 156 10.0 Rate per 1,000 (live and still) births. Deaths from Puerperal causes: — Puerperal Sepsis Nil — Other Puerperal causes 2 4.87 Death Rate of Infants under one year of age: — All Infants per 1,000 live births 58.23 Legitimate Infants per 1,000 legitimate live births 58.05 Illegitimate Infants per 1,000 illegitimate live births 62.5 Deaths from Cancer (all ages) 71 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 11 VITAL STATISTICS. Area. The area of the Borough is 3,048 acres, and of this the Croydon Aerodrome absorbs about 280 acres and the Croydon Sewage Works about 673 acres. Population. The Registrar-General's estimate of the resident population for the mid-year 1937 is 30,590, and the vital statistics in this report are based on that figure. An increase of 700 is shown over the figure for 1936, when the population for that year was estimated at 29,890 In 1915 there were 3,389 occupied houses, with an average of 4.0 persons per house. In 1937 there were 8,877 occupied houses, distributed as follows: — Beddington: — North Ward 2309 Central Ward 1356 South Ward ... 1587 5252 Wallington: — NorthWard 1420 Central Ward 1350 South Ward 855 3625 Total 8877 The average number of persons per house was 3.4. The number of persons in the Beddington Royal Female Orphanage, which is the only large residential institution in the district, was 132. Births,(a) Live Births.—The Registrar-General returns the number of births registered during 1937 as 395, of which 200 were males and 195 were females. This gives a live birth rate of 12.91 per 1,000 total population, compared with 13.5 in 1936 and 14.9 for England and Wales. Sixteen of the births were illegitimate, 10 males and 6 females. (b) Stillbirths.—The number of stillborn children registered in 1937 was 16 of which 9 were males and 7 were females. This gives a 12 stillbirth rate of 38.93 per 1,000 total births and 0.52 per 1,000 total population. Deaths. The Registrar-General gives the number of deaths registered as 306, of which 150 were males and 156 were females. Taking the estimated population figure of 30,590, the crude death rate for 1937 is 10.0 per thousand, compared with 9.9 for 1936. The corresponding figures for England and Wales for 1937 and 1936 are 12.4 and 12.1 respectively. The corrected death rate, i.e., the rate which would be arrived at if the age and sex constitution of the population of Beddington and Wallington was in the same proportion as the country as a whole, is 9.8. The Registrar-General's comparability factor for the adjustment of the death rate of Beddington and Wallington is 0.98. The birth and death rates for the Wards of the Borough are given below: — Ward. Population (Estimated). Live births. Birth rate. Deaths. Death rate (crude). Beddington : North 7387 117 15.8 65 8.8 Central 4799 64 13.3 40 8.3 South 4781 43 9.0 54 11.3 Wallington : North 5915 86 14.5 42 7.1 Central 4897 64 13.1 75 15.3 South 2810 21 7.5 30 10.7 The Borough: 30590 395 12.9 306 10.0 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar-General, gives the causes of deaths of residents in the Borough during 1937, and the next table the birth rate, general death rate, and the death rate for certain specified causes for the country as a whole, and for certain groups of the population, together with figures for notifiable infectious diseases. The rates for the Borough have also been included in this table for comparison purposes: — 13 Deaths occurring during the year 1937. Causes of Death. Males. Females. Total. All Causes 150 156 306 1. Typhoid and Paratyphoid Fevers — — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Influenza 5 8 13 7. Enchephalitis Lethargica — — — 8. Cerebro-spinal Fever — — — 9. Tuberculosis of Respiratory System 6 6 12 10. Other Tuberculosis Diseases 3 1 4 11. Syphilis 1 — 1 12. General Paralysis of the Insane, Tabes, etc 1 - 1 13. Cancer 35 36 71 14. Diabetes 2 — 2 15. Cerebral Haemorrhage 1 10 11 16. Heart Disease 33 36 69 17. Aneurysm — — — 18. Other Circulatory Diseases 5 13 18 19. Bronchitis 4 1 5 20. Pneumonia (all forms) 4 7 11 21. Other Respiratory Diseases 1 2 3 22. Peptic Ulcer 1 — 1 23. Diarrhoea, etc. (under 2 years) — — — 24. Appendicitis 1 — 1 25. Cirrhosis of Liver — — — 26. Other Diseases of Liver, etc — — — 27. Other Digestive Diseases 3 2 5 28. Nephritis 4 5 9 29. Puerperal Sepsis — — — 30. Other Puerperal Causes 2 -2 2 31. Congenital Causes, etc. 10 9 19 32. Senility 1 4 4 33. Suicide 2 2 4 34. Other Violence 17 3 20 35. Other defined causes 11 9 20 36. Causes ill-defined or unknown — — - Special Causes (included in No. 35): — Smallpox — — — Poliomyelitis — — — Polioencephalitis — — — Deaths of Infants under 1 year: — Total 14 9 23 Legitimate 13 9 22 Illegitimate 1 — 1 Live Births: — Total 200 195 395 Legitimate 190 189 379 Illegitimate 10 6 16 Stillbirths: — Total 9 7 16 Legitimate 9 6 15 Illegitimate — 1 1 Population (estimated mid-1937) 30590 14 Comparative crude birth rates, death rates, analysis of mortality, maternal death rates and case rates for certain infectious diseases in the year 1937:— England and Wales. 125 County Boro's and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Borough of Beddington and Wallington. Births— Rates per 1,000 Population. Live 14.9 14.9 15.3 13.3 12.91 Still 0.60 0.67 0.64 0.54 0.52 Deaths— All Causes 12.4 12.5 11.9 12.3 10.0 Typhoid and Paratyphoid Fevers 0.00 0.01 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.2 0.03 0.02 0.01 0.00 Scarlet Fever 0.1 0.01 0.01 0.01 0.00 Whooping Cough 0.04 0.04 0.03 0.06 0.00 Diphtheria 0.07 0.08 0.05 0.05 0.00 Influenza 0.45 0.39 0.42 0.38 0.42 Violence 0.54 0.45 0.42 0.51 0.78 Notifications— Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 2.33 2.56 2.42 2.09 2.18 Diphtheria 1.49 1.81 1.38 1.93 0.14 Enteric Fever 0.05 0.06 0.04 0.05 0.07 Erysipelas 0.37 0.43 0.34 0.44 0.10 Pneumonia 1.36 1.58 1.20 1.18 0.03 Deaths under 1 year Rates per 1,000 Live Births. of age 58 62 55 60 58.23 Deaths from hoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 0.00 Maternal Mortality— Puerperal Sepsis 0.97 Not available 0.00 Others 2.26 5.06 Total 3.23 5.06 Maternal Rates per 1.000 Total Births (i.e., Live and Still). Mortality— Puerperal Sepsis 0.94 Not available 0.00 Others 2.17 4.87 Total 3.11 4.87 Notifications— Puerperal Fever 13.93 17.59 11.52 4.15 2.43 Puerperal Pyrexia 14.34 4.87 15 The following table shows the principal causes of death with the rate per cent, of total deaths; — Cause of Death. Number of Deaths. Rate per cent. of Total Deaths. Pulmonary Tuberculosis 12 3.92 Cancer 71 23.20 Cerebral Haemorrhage 11 3.59 Heart Diseases 69 22.55 Other Circulatory Diseases 18 5.88 Pneumonia (all forms) 11 3.59 Nephritis 9 2.94 Suicide 4 1.31 Other forms of Violence 20 6.54 It will be seen that the causes ranking high amongst the deaths in the Borough are Cancer and Heart Disease. These causes together with Cerebral Haemorrhage and other circulatory diseases accounted for 169 deaths; followed by Pulmonary Tuberculosis, 12; Violence (including Suicide) 24; and Pneumonia, 11. HEART DISEASE AND DISEASES OF THE CIRCULATORY SYSTEM. Twenty-eight per cent. of the total deaths belonged to this group of cases. This is an inevitable consequence of having a great number of people of advanced age living in the district. In a great number of the cases the cause of death could be really described as senility, and this fact is borne out by the estimated age of death of the majority of the group. Seventy-six per cent. had attained the age of 65 years or over. 16 CANCER. The following table gives the ages, sex and localisation of the disease in the 71 cases in which death was attributed to this cause: — 20-30 years. 30-40 years. 40-50 years. 50-60 years. 60-70 years. 70-80 years. Over 80. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Jaw — — — — .— — — — 1 — — 1 — — 1 1 Oesophagus — — — — — — 1 — — — — — — — 1 — Lungs — 1 — — 1 1 2 — 3 1 — — — — 6 3 Larynx - - - - - - - - 1 - - - - - 1 — Stomach - - - - - - — 1 6 1 4 1 — — 10 3 Large Intestine — — 1 — — — — — — 1 2 — — 1 3 2 Liver - - - - - - - - - - 1 1 1 — 2 1 Pancreas - — — — — — — — 1 — 2 1 — — 3 1 Peritoneum - - - - - - - - - 1 - - - - 1 Urinary Bladder - - - - - - - — 1 1 1 — — — 2 1 Rectum - — — — 2 — — — — — 1 — — — 3 — Uterus - — — — — 1 — — 2 — — — — — 3 Ovary - — — — — 1 — 1 — 1 — 1 — — — 4 Breast - — — 1 — 2 — 1 — 6 — 4 — — — 14 Prostate - - - - - - - - 1 1 - - - 2 — Tongue - — — — — — — — — — 1 — — — 1 — Cervix - — — — — — — 1 — — — — — — — 1 Unknown - — — 1 — — — — — — — — — — — 1 Totals -" 1 1 2 3 5 3 4 14 14 13 9 1 1 35 36 An analysis of the table shows that there was a remarkable increase in the number of deaths from this cause in 1937 as compared with 1936. Another feature of the table is that, while Cancer of some part of the intestinal tract is still the most frequent type of case, the number of cases in which Cancer of the lung was diagnosed as the cause of death shows an increase. This may probably be accounted for by more reliable and accurate methods of diagnosis, but since males are more affected by the disease than females, occupational influence may also be a contributory factor. Cancer of the breast is still common in women, a total of 14 cases being recorded as compared with 9 last year, while the number of cases of Cancer of the uterus remains about the same. 17 The following table, which compares the actual death rate from Cancer in Beddington and Wallington with the corresponding rate for the whole country, shows how great the actual increase has been: — Year. Number of Deaths. Death Rate per thousand of population. Beddington and Wallington. England and Wales. 1915 15 0.97 1.22 1916 17 1.08 1.16 1917 21 1.27 1.19 1918 24 1.40 1.19 1919 21 1.23 1.18 1920 26 1.52 1.16 1921 21 1.30 1.21 1922 27 1.66 1.22 1923 35 2.14 1.26 1924 23 1.38 1.29 1925 36 2.15 1.33 1926 25 1.43 1.36 1927 41 2.28 1.37 1928 34 1.67 1.42 1929 22 1.00 1.43 1930 35 1.27 1.45 1931 39 1.48 1.48 1932 48 1.77 1.51 1933 50 1.79 1.52 1934 40 1.41 1.56 1935 40 1.37 1.58 1936 49 1.64 1.61 1937 71 2.32 1.63 Again, however, one finds that deaths attributed to this group are more common in the aged, and an analysis of the death returns shows that the majority had passed middle life and some were of really advanced age. It cannot be too strongly emphasized, that if deaths from this cause are to be reduced and the advantages of modern technique, both in diagnosis and treatment, are to be used to the full, advice must be sought in the very early stages of the disease. Delay is fatal, the earliest symptoms should be noted and the family physician consulted at once; only where this is done can a hopeful outlook be assured. 18 No discovery of outstanding importance in diagnosis or treatment was made in 1937, but a very steady advance was made in the application of those methods which have shown themselves of value in recent years. The constant and persevering research and collaboration of all workers in this field cannot help but result, in time, in the control of the ravages of this dread disease. If, however, the efforts of the research workers are to meet with the success they deserve, the active co-operation of the general public in placing themselves in the hands of the doctor in time is of the utmost importance. The Medical Officer of Health has undertaken the duties of local Medical Secretary to the British Empire Cancer Campaign, through which speakers can be secured to address meetings. VIOLENCE. Four deaths were recorded from Suicide. There were 20 deaths from other forms of violence, of these 17 were males and 3 females. It appears that 10 of these deaths occurred in an aeroplane crash in December, 1936, but were not registered till 1937, after the Coroner's inquest. Two infants perished from being accidentally suffocated by bed clothes. Both these cases were the subject of a Coroner's inquest, and the Medical Officer, as a result, issued a pamphlet on the subject of suitable sleeping arrangements for babies, which was circularised at the Council's Infant Welfare Centres. Five deaths of Wallington residents due to road accidents occurring within the Borough took place in 1937. Three deaths of Wallington residents occurred in roads outside the Borough. Whilst appreciating that the problem of road accidents is one of national importance, as a Borough we must make every effort to ensure safety on our own roads and thus contribute our share towards National Safety. 19 MATERNAL MORTALITY. Two deaths in women directly associated with childbirth occurred during the year, giving a maternal mortality rate of 4.87 per 1,000 live and stillbirths as compared with 3.23 for England and Wales. The rate appears unduly high for a district of this type, but as the figures dealt with are very small the rate does not really give a true impression of the facts. Both patients were under the care of their own doctors. The first, aged 34 years, died as a result of a pulmonary embolism, due to a thrombosis of the internal saphenous vein. She was delivered prematurily at the 34th week of a stillborn child. The second patient, aged 31 years, suffered from kidney disease during the ante-natal period and died, after delivery, as a result of complications due to this cause. The child was stillborn. In neither case was the patient seen by the consultant appointed by the Council, either before or during her confinement. One of the patients attended the Ante-Natal Clinic. INFANTILE MORTALITY. The number of deaths registered during the year in infants under one year of age was 23 (14 males and 9 females), all but one being in legitimate children. This gives an infantile mortality rate of 58.23 per 1,000 live births, as compared with 39 in 1936 and 58 for England and Wales. 20 The following table gives the age and cause of death of each infant who died: — No. Age. Cause of Death. 1. Newly Born Asphyxia, probably caused by a woollen shawl in which child was wrapped. 1. 2 hours Inanition. Premature birth. 1. 2 hours Congenital debility. Delivered by cæsarean section. 2 hours Prematurity. 12 hours 5. 1 day 1 day 1 week 1. 1 day Convulsions. Cerebral compression, pressure on the head during parturition. 1. 1 day Cardiac failure. Primary respiratory failure. Immaturity of development. 1. 1 day Cyanosis. Imperfect delivery. Premature birth. 1. 1 day Inanition. Premature birth. Albuminuria of pregnancy in mother. 2. 2 days Prematurity. Multiple birth (twins). 1. 3 days Erythro-blastic anaemia. 1. 6 days Partial atelectasis. Pyloric stenosis. Peritonitis following laparotomy. 1. 1 week Atelectasis. Premature birth and ante-natal uterine haemorrhage. 1. 1 week Heart failure. Sclerona neonatorum. 1. 8 weeks Asphyxia. Suffocation by bedclothes while sleeping with mother. 1. 3½ months Cardiac failure. Asphyxia due to being suffocated by clothes covering the cot. 1. 4 months Marasmus. Pink disease. Secondary colitis. 1. 4 months Bronchial pneumonia. Gastro enteritis, following operation for hare lip. 1. 9 months Primary thrombosis of superior longitudinal sinus. Fifteen, or 65.2 per cent., of the deaths occurred in the first week of life; 18, or 78.3 per cent., occurred in the first month; and 5, or 21.7 per cent., from the second to the twelfth month. The infantile mortality in the different Wards is given below: — Beddington: — North 11 Central 1 South 2 Wallington: — North 1 Central 5 South 3 21 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. There have been no changes in the arrangements for the examination of swabs, sputa and other pathological material:— Specimens examined. Totals. Positive. Negative. Diphtheria—Routine examinations. Swabs for local practitioners 137 - 137 Tuberculosis—(Sputa) 57 5 52 194 5 189 In May the Council approved the Medical Officer of Health's scheme for the provision of a laboratory in the Town Hall for the examination of samples of water and milk. This was thought to represent the most economical way in which to meet the ever-increasing demand for more analyses. Subsequent events have shown how wise was this decision, and although the laboratory did not come into operation until the 18th October (before the water-borne Croydon Typhoid outbreak) the following tables of the analyses carried out up to the close of the year are a record of work of the utmost importance in the preservation of the health of the people of Beddington and Wallington:— Samples. Outside Laboratories. 1st January to 17th October. M.O.H.'s Laboratory. 18th October to 31st December. Water:— Chemical analyses 5 — Bacteriological analyses 20 20 Milk:— Bacteriological examinations 51 13 Specimens which cannot be examined adequately in the laboratory are sent to the Counties Public Health Laboratories, 91, Queen Victoria Street, London, and some pathological specimens are sent to the Pathological Laboratory at the Croydon General Hospital. 22 AMBULANCE FACILITIES. Infectious Cases. Two motor ambulances have been provided by the Wandle Valley Joint Hospital Board. Ceneral and Accident Cases. The ambulance available for general and accident cases is under the control of the Carshalton, Beddington and Wallington Fire Protection and Ambulance Committee. In 1938 a new Ambulance Service will be provided by the Council operating from the new Fire Station in Belmont Road. The Council on the 29th June, 1935, undertook responsibility for any expenses incurred by the Police, or other persons, in the provision of an ambulance for the removal of cases of accidents occurring in the Borough. NURSINC IN THE HOME. This service is undertaken mainly by the staff of the Beddington and Wallington District Nursing Association and their work in the Borough is greatly appreciated. During the year the District Nurses attended 1,174 cases, including 78 maternity and 80 midwifery patients. TREATMENT CENTRES AND CLINICS. Maternity and Child Welfare Centres:— Centre. When held. Voluntary Helpers. Beddington Village, Second and fourth Mrs. Jennings. Village Hall. Monday of month, Mrs. Mountney. 2-4 p.m. Mrs. Lewes Sayer. Bandon Hill, First and third Tues- Mrs. Moor. Methodist Hall, day of month, 2-4 Mrs. Philips. Sandy Lane. p.m. Mrs. Street. Mrs. Heley. Elm Grove, First and third Wed- Mrs. Buck. Elm Grove Hall, nesday of month, Mrs. Jackson. Butter Hill. 2-4 p.m. Wallington, Second and fourth Mrs. Beale. Baptist Hall, Wednesday of Mrs. Blake. Queen's Road. month, 2-4 p.m. Mrs. Cowper. Mrs. Daw. Mrs. James. Mrs. Jeffrey. Mrs. Mellows. Mrs. Shaw. Hackbridge, Second and fourth Mrs. Brightwell. Labour Hall, Thursday of month, Mrs. Thomas. York Street. 2-4 p.m. Ante-natal and Post-natal Clinic, The Nurses Home, Fridays, 2-4 p.m. 57, Montagu Gardens. 23 TUBERCULOSIS. The treatment of cases of Tuberculosis is under the control of the Surrey County Council, who provide both sanatorium and dispensary treatment. The two dispensaries available for residents of the Borough are situated at Mitcham and Sutton, the sessions being held as follows:— Mitcham (Western Road):— First, third and fifth Tuesday of month at 1.30 p.m. Each Thursday at 1 p.m. and fourth Thursday at 5.30 p.m. Sutton (Public Hall, Church Road):— Every Wednesday at 2 p.m. Third Wednesday of month at 5.30 p.m. IMMUNISATION ACAINST DIPHTHERIA. The Council in May approved a scheme of immunisation whereby patients could be treated by the Medical Officer of Health at his Town Hall premises, free of charge. Such treatment was commenced in November, when the laboratory facilities became available. No cases completed their treatment during the year under review, but at the end of the year 12 patients were attending and will be reported on in 1938. SCHOOL CLINICS. The local education authority is the Surrey County Council, who provide the medical services for the school children of the Borough. VENEREAL DISEASES CLINICS. The Surrey County Council is the responsible authority for Venereal Diseases in the area and is a member of the London and Home Counties Scheme. The arrangements provide for the free diagnosis and treatment of these diseases at the Croydon General Hospital, at clinics established at the Royal Surrey County Hospital, Guildford, at the East Surrey Hospital, Redhill, and at hospitals under the London and Home Counties Scheme. 24 HOSPITALS. infectious Cases. Cases of infectious disease occurring in the Borough are admitted to the Wandle Valley Joint Isolation Hospital, Beddington Corner. Small-pox. By arrangement with the County Council, cases of Small-pox are admitted to the Small-pox Hospital at Clandon. Ceneral and Accident Cases. Cases from this area are admitted to the Carshalton, Beddington and Wallington (War Memorial) Hospital, Carshalton, and to the General Hospital, Croydon. Public Assistance Hospitals. The Public Assistance Hospitals serving this area are situated at Epsom and Kingston. Maternity Cases. Under an agreement between the Council and the Carshalton, Beddington and Wallington (War Memorial) Hospital, a very limited number of maternity cases are admitted upon the recommendation of the Medical Officer of Health. Maternity cases are also admitted to the Public Assistance Hospitals. DISINFECTION. The disinfection of houses has been undertaken by the Council during the year and the Wandle Valley Hospital Board have continued to co-operate in the disinfection of bedding, etc. When residents request disinfection which is not essential in the interests of the public health, this is undertaken upon a payment of 10s. per load for bedding, etc., and 5s. for the first room and 2s. 6d. for each additional room as applied to house disinfection. MATERNITY AND CHILD WELFARE. The Council is the responsible authority for this important section of the work. The ever-increasing significance of measures, both national and local, to prevent undue risks in childbirth and to prevent ill-health in mothers and infants cannot be over-emphasized. All Ministers of Health within recent years have appreciated the importance of this factor in maternal life, and in April, 1937, Sir Kingsley Wood presented to Parliament his Report on an Investigation 25 into Maternal Mortality. This was followed in May by Circular 1622, addressed by the Minister to all Maternity and Child Welfare Authorities. The Circular represents the considered opinion of the Minister on the action and re-organization which Maternity and Child Welfare Authorities should take to bring their Maternity and Child Welfare service up to the standard shown to be essential from the findings of the Report. The Circular is likely to be the standard of reference on Maternity and Child Welfare schemes as far as they relate to maternity work for some time to come. The Public Health Committee gave the Circular preliminary consideration at more than one meeting, and appointed a special subcommittee to consider the Circular in more detail. The principal points to which the Medical Officer of Health has drawn the attention of the Council, points in which the Maternity and Child Welfare scheme of the Borough is deficient in the light of the Circular, are as follows: — (a) Insufficient Maternity and Ante-natal beds. (b) No provision of Consultant Ante-natal clinics. (c) No provision of Consultant Post-natal clinics. These are all matters for consideration in 1938, and as in each case co-operation between the local authority and the general practitioners is most necessary, the discussions will be directed to this end, representative members of the medical profession in the locality being present at the meetings. An analysis of the births allocated to the Borough is appended, from which it will be seen that the demand for institutional delivery is increasing, the number delivered in hospitals and nursing homes in 1937 being actually greater than those delivered in their own homes:— Total notified (live and still) births 404 Births in the Home 186 Attended by doctor and maternity nurse 102 „ Nursing Association midwife 79 „ Private midwife 5 Births in Institutions 201 At private Nursing Homes 45 At Carshalton (War Memorial) Hospital 59 At Epsom and Kingston Hospitals 27 Outside Institutions 70 By Registrar iq By transferred notifications 7 26 The District Nursing Association midwives continue to perform yeoman service, their work being materially increased in 1937 as the result of the operations of the Midwives Act, 1936. In spite, however, of the excellent home midwifery service thus provided in the Borough, the further growth of small houses, flats and blocks of flats increases the difficulty of carrying out good midwifery in the home. This results in an ever-increasing demand for institutional deliveries. We have been assured by the Surrey County Council and the Minister of Health that the number of beds to be provided at the new St. Helier Hospital will meet this need in 1940 (December). If, however, it can be shown that the need is not satisfied, the Council may contemplate further provision of maternity beds for Beddington and Wallington in some manner to be approved by the Minister of Health. ANTE-NATAL CLINIC. Ante-natal Clinics are held weekly (since 1st October, 1937) with an average attendance of about 21 pregnant women. The Clinic is housed in the Nurses' Home, Montagu Gardens, where very good accommodation is rented by the Council from the District Nursing Association. Ante-natal and Post-natal Attendances, 1937. Council Cases. Nursing Association Cases. Total. No. of clinics held 41 Total number of women who attended during the year 200 No. of first attendances, ante-natal 81 80 161 No. of re-attendances:— Ante-natal 296 347 643 Post-natal 17 55 72 No. of consultations with Medical Officer 394 482 876 Average attendance per session 21.4 27 During the year 200 expectant mothers attended the Clinic, as compared with 184 in 1936. This represents approximately 50 per cent, of the total notified births (live and still) which occurred in the Borough during 1937. The total number of attendances made at the 41 sessions was 804, as compared with 744 in 1936. POST-NATAL CLINIC. Post-natal cases are seen as they present themselves at the antenatal clinic and it is estimated that about 45 per cent. of the cases seen at the ante-natal sessions return for post-natal examinations after their confinement. This figure is relatively small, but it is anticipated that when consultant post-natal clinics are inaugurated, the attendances will increase. Dr. Winifred Small continues to act as Ante-natal Medical Officer and her services have been greatly appreciated. MATERNITY AND CHILD WELFARE CENTRES. There has been no change since the previous year in the days on which sessions are held. The following table shows the attendances for 1937 at the five Centres maintained by the Council:— don Hill. ton. Elm Grove Hackbridge Walling ton. Totals, 1937. Number of sessions held 24 23 23 24 23 117 Infants:— No. of new cases under 1 year 95 62 33 45 66 301 No. of re-attendances 952 536 441 402 573 2904 No. of new cases over 1 year 23 24 16 12 23 98 No. of re-attendances 748 686 445 581 674 3134 Total attendance of infants 1818 1308 935 1040 1336 6437 Average attendance of infants per session 76 57 41 43 58 55 Mothers attending 1611 1139 850 793 1151 5544 Total attendance 3429 2447 1785 1833 2487 11981 Average total attendance per session 143 106 78 76 108 102 28 During the year the total number of attendances made by the children at the Centres was 6,437 as compared with 5,485 in 1936, an increase of 952. Approximately 76 per cent. of the babies whose births were registered as occurring within the Borough attended one or other of the Centres. MATERNITY WARD. Throughout the year the arrangements between the Council and the Carshalton, Beddington and Wallington (War Memorial) Hospital for the reception of maternity cases remained the same. The following table gives particulars of the cases admitted under the Council's scheme during the year:— Cases admitted 32 For medical reasons 15 For unsuitable home conditions 17 Normal confinements 21 Abnormal confinements 11 Twenty-eight cases were referred from the Ante-natal Clinic and 4 by private practitioners. CONSULTANT OBSTETRICIAN. The Consultant Obstetrician to the Council is Mr. Leslie Williams, M.D., M.S., F.R.C.S., but during the year 1937 his services were not called upon. HOME HELP. No change was made during the year in the Council's scheme, whereby a Home Help is provided on application, to assist in domestic duties during confinements occurring in the homes of residents. A Home Help was provided in 14 cases during the year. BIRTH CONTROL. The Council have made arrangements for women who need information on birth control, on the grounds of health, to attend a voluntary centre at Croydon. During 1937 15 women from the Borough attended this clinic. 29 TREATMENT. Orthopaedic. Patients who attend the Centres and require treatment for orthopaedic defects are referred by the Medical Officer of Health to the Orthopaedic Department of the Croydon General Hospital. During the year 7 cases (defects of the feet, bow legs, knock knees, etc.) received treatment. Dental. During 1937 19 cases were referred for treatment under the Councils' scheme as follows:— Referred for Treatment. Received Treatment. Extractions. Fillings. Dentures. Full upper and lower. Full upper. Full lower. Expectant mothers 5 4 26 — — — 1 Nursing mothers 6 4 12 — 3 1 1 Children under 5 years 8 5 17 2 — — — 19 13 55 2 3 1 2 Minor Ailments. Fifty-one cases were referred from the Maternity and Child Welfare Centres to the under-mentioned Hospitals during the year:— Carshalton, Beddington and Wallington (War Memorial) Hospital 8 Croydon General Hospital 34 Great Ormond Street Hospital 5 The Wilson Hospital, Mitcham 2 The London Hospital 1 Infants' Hospital, Vincent Square 1 The conditions requiring treatment were:— Tonsils and Adenoids 15 Nævus 8 Circumcision 4 Dental defects 2 Orthopaedic defects 7 Hernia 5 Eye conditions 2 Other conditions (vomiting, nervous condition, Asthma etc.) 8 30 PROVISION OF MILK AND OTHER FOODS. The following table shows the number of families which were in receipt of assisted milk supply under the Council's scheme during the year:— Cases on 1st Jan., 1937. New Cases during 1937. Cases discontinued. Cases on 31st Dec., 1937 Milk free 18 33 20 31 Milk at quarter cost 19 14 13 20 Milk at half cost 8 8 6 10 Total 45 55 39 61 In addition, in certain cases, concentrated foods or drugs are provided free or at reduced price. Further, when in the opinion of the Medical Officer of Health it is considered necessary, infant foods are supplied to mothers at cost price. HEALTH VISITINC. Two full-time Health Visitors, who work under the supervision of the Medical Officer of Health, are employed. The following is a summary of the work carried out during the year:— Home visiting. Visits to expectant mothers:— No. of first visits 96 No. of re-visits 110 Total 206 Visits to infants:— No. of first visits to infants under 1 year 370 No. of re-visits to infants under 1 year 987 No. of visits to infants 1-5 years 2278 Total 3635 Public Health Act (Child Life Protection):— No. of visits paid 51 Other visits:— Infantile mortality 10 Puerperal Fever 1 Puerperal Pyrexia 4 Ophthalmia Neonatorum 1 Stillbirths 10 Whooping Cough 1 Tuberculosis 62 Maternity, Home Help, Milk and Dental Scheme 240 Miscellaneous 21 Unsuccessful 262 663 Total visits, 1937 4504 Total visits, 1936 3927 31 Attendances at clinic sessions. Maternity and Child Welfare Centres 224 Ante-natal and Post-natal Clinics 41 Total 265 Interviews at office 596 CHILD LIFE PROTECTION. The Senior Health Visitor is the authorised Child Life Protection Visitor for the Borough. She reports:— Number of persons who were receiving children for reward at the end of the year 5 Number of children on the register at the end of the year 14 Number of children who died during the year Nil During the year 51 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLY. During the year 15 samples of water from the main district supply (Sutton District Water Company) were submitted for analyses. Medical Officer of Health's Laboratory. Other Laboratories. (Since 18th October.) 3 12 In no case was the legal standard of hardness exceeded and the samples, taken as a whole, conformed to the accepted standards of a pure and wholesome water supply. Several private wells are in use in the district and have been the subject of investigation by the Medical Officer of Health from time to time during the current year. It was found necessary to discontinue the use of two private wells situated in the Borough. The premises involved have been using the public water supply following this action. 32 The remaining private wells, used for the most part by large manufacturing firms, proved on examination in 1937 to be delivering a water conforming to accepted standards. □ RAINACE AND SEWERAGE. The Council's soil and storm water drainage systems have been extended during the year to meet the requirements of building estates in course of development. The Eastern Area Surface Water Drainage Scheme was completed during 1937 at a cost of approximately £13,000, thus obviating the flooding previously experienced on the roads at Beddington. The new sewer in Beddington Park to drain the tennis pavilion, tea chalet and cricket pavilion and cottages was also completed during the year and cesspools were demolished. The Wandle Valley Joint Sewerage Board have laid a new main outfall sewer, commencing in London Road, just beyond the boundary of this Borough, and the whole of the flooding in the Beddington Corner area of the district has been removed. It is anticipated that during the coming year the sewer in Woodmansterne Lane will be extended in order to drain adequately the existing cottages on the smallholdings. This will abolish the earth closets at present in use. Negotiations are proceeding for the proper drainage into the main sewer of Messrs. G. Payne's factory and Croydon Cricket Club's pavilion and the pavilions in Hillcrest Road, and it is contemplated that works will be commenced in 1938 for this purpose. RIVERS AND STREAMS. All watercourses within the Borough receive constant supervision. In accordance with the usual practice, the River Wandle was cleaned out from the Croydon Borough boundary to Mitcham, all silt, tree branches and obstruction being removed, while considerable lengths of camp sheeting were provided to maintain the banks. CLOSET ACCOMMODATION. Practically the whole of the area is on the water carriage system, draining into the public sewers. 33 A very few isolated dwelling-houses remained on a conservancy method at the end of the year, but it is contemplated extending the sewerage of the Borough in 1938, which will bring the method of disposal up to date. At the end of 1937 there were approximately 20 earth closets and 6 cesspools within the Borough. There are, in addition, a number of chemical closets which are provided chiefly for use on sports grounds. PUBLIC CLEANSINC. A weekly collection of house refuse throughout the Borough is carried out by direct labour under the supervision of the Borough Engineer and Surveyor. The refuse is deposited on a site within the district. The type of receptacle in use throughout the Borough is the portable galvanised iron covered dustbin. The Council do not undertake the removal of the contents of earth closets and cesspools. The occupiers of the premises concerned carry out the work in a satisfactory manner. SANITARY INSPECTION OF THE AREA. The following statement by the Senior Sanitary Inspector gives statistics as to the number of complaints received, inspections made, defects remedied, and other work carried out by the Sanitary Inspectors. In October, 1937, a second Additional Sanitary Inspector was appointed. 34 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1937. DWELLINC-HOUSES. Number of inspections of dwelling-houses 846 Number of inspections recorded under Housing Regulations 160 MILK AND DAIRIES. Number of cowkeepers on register 1 Number of retail purveyors of milk on register 52 Number of dairy premises on register 10 Number of inspections of premises 48 Defects or infringements of Acts and Orders discovered and remedied 10 Number of samples of milk taken for bacteriological examination 64 Number of licences to sell graded milk issued:— Tuberculin Tested 11 Accredited 1 Pasteurised 9 Pasteurisers' Establishments 2 23 MEAT AND OTHER FOOD. Number of slaughterhouses on register (licensed) 1 Number of visits to slaughterhouse 7 Number of animals killed at slaughterhouse:— Sheep — Pigs 3 Calves — Cattle, other than Cows — Cows 3 Number of carcases, with offal, inspected at slaughterhouse 3 Number of condemnations at slaughterhouse:— Whole carcases Nil Organs Nil Number of visits to other food-preparing places 286 Number of defects found and remedied 4 Unsound food destroyed:— Fish 98 lbs. (Unwholesome). 35 FACTORIES AND WORKSHOPS. Number of factories and workshops on register 126 Number of inspections of factories and workshops 218 Number of inspections of workplaces 18 Number of defects discovered and remedied 14 Number of bakehouses on register (one underground) 12 SHOPS ACT, 1934. Number of visits to shops re sanitary accommodation, ventilation and temperature 208 Heating facilities provided 12 Ventilation provided 2 COMPLAINTS. Complaints of nuisances received during the year were due to the following causes:— Defects in dwelling-houses 59 Stoppages in drains 22 Defects in drains or water closets 3 Accumulations of refuse 10 Smoke 2 Insect Pests 6 Burning of refuse 2 Miscellaneous 16 120 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 121 Number of rooms disinfected 141 Lots of bedding and clothing disinfected 126 RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints or requests for advice received 48 Number of visits to premises 241 INCREASE OF RENT (RESTRICTIONS) ACTS. Number of certificates issued Nil NOTICES. Number of informal notices served (including verbal intimations) 557 Number of statutory notices served (Public Health Acts) 38 36 SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 11 Water pipes and fittings repaired or renewed 26 Water cisterns cleansed 3 Drains. Drains re-laid or repaired 29 Drains unstopped and cleansed 70 Intercepting traps renewed 7 Intercepting traps provided with rodeye stoppers 21 Manholes provided or repaired 40 Manholes cleansed 9 Ventilation pipes repaired or renewed 26 Ventilation pipes provided 6 Soil pipes repaired or renewed 3 Gullies renewed or cleansed 14 Gully kerbs and channels repaired 13 New soakaways constructed 17 Rainwater pipes disconnected from drain 6 Water Closets. New water closets constructed 7 New pans fixed to water closets 14 Dirty pans cleansed 3 Flushing cisterns repaired or renewed 22 Flush pipes and pan joints repaired or renewed 17 Seats repaired 23 Closed-in seats abolished 11 Walls, floors, etc., repaired 22 Light and ventilation provided 5 Doors repaired or renewed 8 Sinks. Sinks renewed or repaired 12 Waste pipes repaired or renewed 22 Yards. Yards newly paved or repaired 14 Yards cleansed 2 Dust Receptacles. New portable galvanised iron dustbins provided 170 37 Dampness. Damp-proof courses provided or repaired 11 Roofs repaired 112 Rainwater gutters repaired or renewed 68 Rainwater downspouts repaired or renewed 23 Windows, sills and doors made weatherproof 103 External walls repaired, re-pointed or rendered 84 Earth banked against house walls removed 4 External walls treated with waterproofing solution 31 General Repairs, Etc. Rooms cleansed 143 Walls, ceilings and floors repaired 76 Floors repaired 18 Stoves repaired or renewed 29 Coppers repaired or renewed 7 Doors repaired or renewed 8 Windows repaired 38 Windows provided with new sashcords 38 Staircases repaired 4 Rooms provided with means of ventilation 5 Food stores ventilated or provided 2 Ventilation provided under floors 19 Chimneys repaired 46 Overcrowding abated 5 Refuse removed 7 Number of premises disinfested from bed bugs 7 Milk and Dairies. Unregistered purveyors of milk registered 6 Contraventions of Milk (Special Designations) Order remedied 3 Premises cleansed 1 Factories and Workshops. Defects remedied 14 Byelaws with respect to Nuisances. Accumulations of manure or other offensive refuse removed or covered 2 Receptacles for manure renewed or repaired 2 Smoke. Nuisances abated 1 38 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 846 Number of re-inspections and visits to works in progress 3717 Number of miscellaneous visits and inspections 857 Number of visits to dairies and cowsheds 48 Number of visits to factories, workshops and workplaces 236 Number of inspections of shops 208 Number of visits to watercress beds 10 Number of visits to slaughterhouse 7 Number of visits to food stores 286 Number of visits to stables and yards 74 Number of visits to market gardens, etc. 36 Number of visits to fried fish shops 12 Number of visits to urinals 34 Number of visits to piggeries 1 Number of visits re infectious diseases 121 Number of visits to streams 18 Number of visits re rats 241 Number of visits re smoke abatement 12 Number of complaints of nuisances received and investigated 120 Number of preliminary notices served 557 Number of statutory notices served 38 Number of interviews re nuisances, etc. 636 Number of water tests applied to drains 85 Number of smoke tests applied to drains 87 Number of rooms disinfected 141 Number of lots of bedding and clothing disinfected 126 Number of samples of drinking water taken 45 Number of samples of swimming bath water taken 1 Number of milk samples taken 64 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. 39 SHOPS ACTS, 1934. Under this Act 208 inspections were made during 1937, and in 14 cases action was necessary in regard to ventilation and temperature. SMOKE ABATEMENT. It was not found necessary to take formal action to abate nuisances arising from the emission of smoke during the year, but 1 case was dealt with informally. SWIMMING BATHS. There is only one swimming bath in the district, that being situated at, and owned by, the Royal Female Orphanage, Beddington. In addition to the residents of the Orphanage, it is used by a Swimming Club, and by children from elementary and other schools. During the year a number of visits were paid and one sample was taken of the water, which is chlorinated, and which proved to be satisfactory. ERADICATION OF BED BUCS. During the year bed bugs were found to exist in 2 Council houses and in 5 other houses. The premises were disinfested either by the tenant or owner of the affected house or by the Council. The latter has not, so far, employed a contractor to carry out disinfestation. The methods employed for freeing infested houses of bed bugs are either:— 1.—Where only a few bugs are found, the tenant of the house concerned is given advice and required to carry out remedial measures, in certain circumstances liquid insecticide and a sprayer being provided, or 2.—Where the infestation is such that the tenant is unlikely to achieve a satisfactory result, disinfestation is carried out by the staff of the Council. In these cases, usually entailing the treatment of rooms, the picture rails, architraves, skirtings and similar fittings which harbour bugs, are removed or loosened, and, where practicable, subjected to the flame of a blow lamp, the rooms being sprayed subsequently with liquid insecticide. No occasion arose during the year for the fumigation and treatment of furniture or bedding, but a steam disinfecting plant is available for the treatment of bedding and clothing, if required. 40 As a matter of routine, all vacated Council houses are inspected, and disinfestation, if necessary, is carried out before re-occupation of the premises. Where possible, the homes of prospective tenants of Council houses are visited so that action can be taken, if necessary, to ensure that no infested articles are moved into houses free from vermin. SCHOOLS. School Closure. On no occasion during the year was a School closed by the Local Sanitary Authority on account of the prevalence of Infectious Disease amongst the scholars. As in the case of the Public Elementary Schools, notice is given to the Head Teachers of all private schools in the event of the pupils suffering from, or having been in contact with, Infectious Disease. The advice of the Medical Officer of Health as to further action is available should this be requested, and disinfection is provided when required. Medical Inspection. The medical inspection of the Public Elementary School children is carried out by the Education Department of the Surrey County Council. Water Supply and Sanitary Condition. All the Public Elementary Schools in the district have been inspected from time to time. They are all supplied with water from the public mains and connected with the sewers. RECULATED TRADES: DAIRIES. There are 10 registered premises within the district, this being 2 less than last year. Only one cowkeeper now remains on the register. During the year 48 visits of inspection were paid, and cleansing of premises was required in one instance. MILK (SPECIAL DESIGNATIONS) ORDERS. During the year the Council granted the following number of licences under the above-named Orders:— Tuberculin Tested 11 Accredited 1 Pasteurised 11 41 SLAUGHTERHOUSES. There is only one Slaughterhouse within the district, this being licensed annually. During the year only 3 animals were slaughtered at the premises. BAKEHOUSES. There are 12 Bakehouses in the district, one being underground. The premises were visited periodically, but no unsatisfactory conditions were found to exist. OTHER FOOD PREPARINC PLACES. During the year 286 visits were paid to other food preparing places within the district. The conditions found were generally satisfactory. FACTORIES AND WORKSHOPS. There are 126 Factories and Workshops in the district. The following tables give details of inspections made and defects found, as supplied by the Senior Sanitary Inspector:— 1. Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary. Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries) 181 2 — Workshops (Including Workshop Laundries) 37 — — Workplaces (Other than Outworkers' premises) 18 — — Total 236 2 — 42 2. Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts— Want of cleanliness 1 1 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 4 4 — — Sanitary Accommodation— (a) Insufficient — — — — (b) Unsuitable or defective 9 9 — — (c) Not separate for sexes — — — — Other Offences 1 — 1 — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) Total 15 14 1 — 43 HOUSING. As stated in previous reports, a large proportion of the houses in the Borough are very good class dwellings, while the majority, having been built during the last 25 years, are in very good condition and well spaced. HOUSING STATISTICS. 1. Inspection of Dwelling-houses during the year. (1) (a) Total number of Houses inspected for housing defects (under Public Health or Housing Acts) 834 (b) Number of inspections made for the purpose 846 (2) (a) Number of Dwelling-houses (included under head (1) above) inspected and recorded under the Housing Consolidated Regulations, 1925 160 (b) Number of inspections made for the purpose 160 (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 the preceding sub-head) found not to be in all respects reasonably fit for human habitation 471 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 464 3. Action under Statutory Powers during the year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of Dwelling-houses in respect of which notices were served requiring repairs — (2) Number of Dwelling-houses which were rendered fit after service of formal notices:— (a) By owners — (b) By Local Authority in default of owners — B. Proceedings under the Public Health Acts: — (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 31 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 31 (b) By Local Authority in default of owners — 44 C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of Dwelling-houses in respect of which Demolition Orders were made — (2) Number of Dwelling-houses demolished in pursuance of Demolition Orders — D. Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 4. Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of Dwelling-houses overcrowded at the end of the year 8 (ii) Number of families dwelling therein 9 (iii) Number of persons dwelling therein 66 (b) Number of new cases of overcrowding reported during the year 2 (c) (i) Number of cases of overcrowding relieved during the year 5 (ii) Number of persons concerned in such cases 36 (d) Particulars of any cases in which Dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of the overcrowding Nil (e) Any other particulars in respect to overcrowding conditions it is desirable to report Nil Number of Houses and Flats erected during the year:— By the Council Nil By other persons 301 INSPECTION AND SUPERVISION OF FOOD. MILK. Ungraded. Samples of milk were taken throughout the district, and in the great majority the results of examination were satisfactory. Unfortunately, there is no standard of bacterial cleanliness for ordinary milk, but it is of interest to compare the results of examinations made during 1937 with the standard formerly required for Grade A milk. This milk had not to exceed 200,000 organisms per c.c., nor have any coliform bacillus present in 0.01 c.c. 45 The following is a summary of the results of the 14 samples taken:— Total Count. Under 200,000 per 1 c.c. 11 Over 200,000 per 1 c.c. 3 14 Coliform Bacillus. Absent from 0.1 c.c. 8 „ „ 0.01 c.c. 3 „ „ 0.001 c.c. 2 „ „ 0.0001 c.c. 1 14 Craded Milk. The following samples were taken during the year:— Tuberculin Tested 2 Pasteurised 48 50 Seven samples of pasteurised milk were found not to comply with the bacteriological standard prescribed by the Milk (Special Designations) Order. The samples of tuberculin tested milk were satisfactory. Tubercle Bacilli. Twenty-three samples of milk were examined microscopically for the presence of acid-fast bacilli. A negative result was obtained in each case. MEAT. The carcases of all animals slaughtered in the Borough are inspected by the Sanitary Inspectors before being placed on the market. FOOD AND DRUGS (ADULTERATION) ACT, 1928. The duties under the above-named Act are carried out in this district by the Surrey County Council. The following numbers of samples have been collected from this area during the year:— 46 Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. Convic tions. Formal. Informal. Total Formal. Informal. Total Milk 26 1 27 1 - 1 - - Cream - - - - - - - - Butter 2 - 2 - - - - - Cheese - - - - - - - - Margarine - - - - - - - - Lard - - - - - - - - Meat 2 - 2 - - - - - Flour - - - - - - - - Tea - - - - - - - - Coffee - - - - - - - - Cocoa - - - - - - - - Sugar - - - - - - - - Sausages 3 - 3 1 - 1 1 1 Confectionery and Jam 2 - 2 1 - 1 - - Sausage Meat 1 - 1 - - - - - Wine - - - - - - - - Beer - - - - - - - - Spirits 1 - 1 - - - - - Drugs - - - - - - - - *Other articles 1 - 1 - - - - - Totals 38 1 39 3 - 3 1 1 *Details of other articles— Shredded Beef Suet 1 - 1 - - - - - CHEMICAL AND BACTERIOLOGICAL EXAMINATIONS. During the year samples of water and milk have been submitted to the following Chemists for the above examinations:— Messrs. Rideal, Rideal & Sciver. The Counties Public Health Laboratories. NUTRITION. This subject formed part of the Council's activities in the National Health Campaign outlined in this report under the heading of propaganda. Lectures and cookery demonstrations on suitable diet for infants and young children were given during the autumn. 47 ADOPTIVE ACTS AND BYELAWS. The following Acts have been adopted:— Public Health Acts (Amendment) Act, 1890, Parts I, II and III. Public Health Acts (Amendment) Act, 1907, Parts I to VI and VIII to X. Private Street Works Act, 1892. Local Government and Other Officers' Superannuation Act, 1922. Public Health Act, 1925. Public Libraries Acts, 1892-1919. Small Dwellings Acquisition Acts, 1899-1923. The following Byelaws are in force:— Byelaws with respect to New Streets and Buildings. Byelaws under Section 2 of the Public Health (Smoke Abatement) Act, 1926. Byelaws with respect to Public Parking Places for Vehicles. Rules with respect to Allotment Gardens. Byelaws with respect to Pleasure Grounds. Byelaws with respect to Advertisements. Miscellaneous Byelaws made by the Surrey County Council with respect to good rule and government. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1937, the number removed to hospital and the number of deaths attributed to these diseases:— Disease. Number Notified. Removed to Hospital. Deaths. Scarlet Fever 65 59 - Diphtheria 4 4 - Erysipelas 3 1 - Enteric Fever 2 1 - Puerperal Fever 1 1 - Puerperal Pyrexia 2 2 - Ophthalmia Neonatorum 1 1 - Pneumonia 1 - 11* Acute Anterior Poliomyelitis 1 1 - Dysentery 1 - - Totals 81 70 11 *Includes deaths from all forms of Pneumonia. 48 Cases of Infectious Disease notified during the year 1937. Disease. At all ages. Number of Cases Notified. Total cases notified in Cases removed to Hospital. Deaths At Ages—Years. each Ward. Under 1 Year. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Beddington. Wallington. North. Central. South. North. Central. South. Scarlet Fever 65 - - 1 3 6 30 12 2 7 4 - - 25 8 9 16 6 1 59 - Diphtheria 4 1 - - - - 3 - - - - - - 3 - 1 - - 4 - Enteric Fever 2 - - - - - 1 1 - - - - - - - 1 1 - 1 - Erysipelas 3 - - - - - - - - - - 1 1 1 - 2 - - 1 - Puerperal Fever 1 - - - - - - - - - - - - - - - 1 - 1 - Puerperal Pyrexia 2 - - - - - - - - - - - - - - - 1 - 2 - Ophthalmia Neonatorum 1 1 - - - - - - - - - - - - - - - - 1 - Pneumonia 1 - - - - - - - - - - - - - - - - - - *11 Acute 1 Poliomyelitis 1 - - - - - - - - - - - - - - - - - - - Dysentery 1 - - - - - 1 — — — — — — — — - - 1 - - Totals 81 2 — 1 3 6 35 14 2 9 6 2 1 30 8 14 17 10 2 70 11 *Includes all forms. The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections:— The following table shows the history of infections from the date of the inception of the Urban District until Borough status was attained in the year under review:— Cases of Infectious Disease notified in each year, 1915-1937. Disease. 1915 (nine mths.) 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Small Pox - - - - - - - - - - - - - 1 - - - - _ - - - - Scarlet Fever 39 16 8 34 62 67 74 59 28 15 33 34 33 58 59 68 60 51 59 78 94 53 65 Diphtheria 14 24 9 23 43 47 34 19 40 15 12 16 70 21 17 12 16 14 17 33 22 13 4 Enteric Fever 1 1 - 1 3 5 1 - 6 1 - — 4 39 1 1 1 1 - - 1 2 2 Erysipelas 6 9 4 3 4 5 8 4 4 2 7 3 3 9 11 15 12 6 6 6 7 6 3 Poliomyelitis 1 - - - 2 - - - - - - - - - - - - - - - 1 - 1 Ophthalmia Neonatorum 1 - - 1 - 2 - — — — 1 1 — 2 — 2 — 1 — 1 — 1 1 Puerperal Fever - 1 - - 1 - 2 - 2 — — — — 2 2 — 1 1 — 1 1 1 1 Puerperal Pyrexia - - - - - - - - - - - 1 1 4 3 2 3 2 1 3 1 — 2 Measles — 87 241 158 39 - - - - - - - - - - - - - - - — - Cerebro Spinal Meningitis — — — 1 — — 1 — — 1 — — — 1 — — 1 — — — — — — Pneumonia — — — — 16 3 8 4 5 9 2 5 14 19 20 13 16 36 42 15 4 2 1 Malaria — — — — 6 4 — — — — — — — — 1 — — - — — — — — Chicken Pox — — — — 3 — — — 6 3 - - - - - - - - - - - - - Dysentery - - - - - - 1 - - - - - - - - - - - - - - - 1 Encephalitis Lethargica - - - - - - 1 — 3 1 - - - - - - - - - - - - - Tuberculosis Pulmonary 17 16 22 27 18 16 15 12 18 18 18 13 21 14 21 18 31 28 17 17 23 18 20 Other Forms 6 8 4 4 — — 3 1 6 — 5 3 8 6 9 5 1 3 5 3 7 6 4 Totals 85 162 288 252 197 149 148 99 118 65 78 76 154 176 144 136 142 143 147 157 161 102 105 50 The monthly incidence of Infectious Disease, 1937. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 1 8 2 7 12 6 8 3 4 4 5 5 65 Diphtheria 3 - - - - 1 - - - - - - 4 Enteric Fever — 1 - - - - - - - - 1 — 2 Erysipelas — — 1 — 1 — — 1 — — — — 3 Puerperal Fever - - - - - 1 - - - - - - 1 Puerperal Pyrexia - - - - - - - - 2 - - - 2 Ophthalmia Neonatorum - - - - - 1 - - - - - - 1 Pneumonia — — 1 — — — — — — — — — 1 Acute Poliomyelitis - - - - - - - 1 - - - - 1 Dysentery - - - - - - - - - - - 1 1 Totals 4 9 4 7 13 9 8 5 6 4 6 6 81 SCARLET FEVER. This disease still continues mild in character and complications and sequelae are less prevalent. The monthly incidence of the disease shows that the seasonal prevalence reached a peak in May (12 cases notified). The total number of cases notified, however (65), is relatively low, and the disease cannot be said to produce much invalidism in the Borough. No deaths were recorded from Scarlet Fever during the year. DIPHTHERIA. From the table on page 50 the incidence of Diphtheria will be seen to be the lowest on record. Only four notified cases occurred during the year. All the cases were removed to hospital and recovered. ENTERIC FEVER. Two cases of this group of disease were notified. One was nursed in the Wandle Valley Isolation Hospital and had an uninterrupted recovery. This case was directly associated with the unfortunate epidemic of Typhoid which occurred in Croydon during the year, and as a neighbouring Borough in such close association with Croydon we were extremely fortunate in having no other case from that source. While the Croydon epidemic was at its height, local practitioners were supplied with anti-typhoid immunising serum, and several made use of this facility to protect contacts and persons whose work brought them into Croydon. ERYSIPELAS. Three cases were notified in 1937 as compared with 6 in the previous year. One of the cases was admitted to hospital. No deaths resulted from this disease. PUERPERAL FEVER AND PUERPERAL PYREXIA. Notifications received under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, were as follows:— Puerperal Fever 1 Puerperal Pyrexia 2 52 Since October 1st, 1937, when the Public Health Act, 1936, came into force, separate notifications of Puerperal Fever has been abolished and conditions of raised temperature occurring after childbirth are now notifiable as Puerperal Pyrexia. Two patients were admitted to Queen Charlotte's Hospital under the Council's arrangement, where, under treatment with the new technique for dealing with such cases, both made an uninterrupted recovery. In no case was the Council's appointed consultant obstetrician called in. OPHTHALMIA NEONATORUM. One case of this disease was notified during 1937 and was treated in a London County Council Hospital. Recovery occurred, the vision being unimpaired. PNEUMONIA. One case of primary Pneumonia was notified under the Public Health Acts. Eleven deaths from all forms of Pneumonia were registered during the year, most of these being in patients of advanced years. ACUTE POLIOMYELITIS. One case, in a girl aged 14 years, was seen by the Medical Officer of Health in consultation was a private practitioner and removed to University College Hospital. This patient, although suffering from widespread paralysis at first, has improved greatly, but was still under treatment at the close of the year for some residual paralysis of the lower limbs. DYSENTERY. One case of this complaint was notified; the patient recovered. CEREBRO-SPINAL FEVER. No cases of this disease were reported during the year. 53 NON-NOTIFIABLE DISEASES. Returns from the local education authority keep the department informed of the incidence of these diseases in children attending the elementary schools. From this and other sources (although the information so obtained may be an under-statement) it will be seen that the incidence of the following diseases was relatively light during the year:— Measles 48 Mumps 11 Chicken-Pox 142 Whooping Cough 97 TUBERCULOSIS. There were 24 new cases notified during the year. The following table gives the number of new cases notified during the past five years:— New Cases. 1933 1934 1935 1936 1937 M. F. M. F. M. F. M. F. M. F. Pulmonary 9 8 13 4 12 11 9 9 10 10 Non-Pulmonary 2 3 1 2 2 5 4 2 2 2 Totals 11 11 14 6 14 16 13 11 12 12 The annual case rate for Pulmonary Tuberculosis per 1,000 of population for 1937 was .65 compared with .61 for 1936. The annual case rate for Non-Pulmonary Tuberculosis per 1,000 of population for 1937 was .13 compared with .20 for 1936. The Registrar-General returns the number of deaths which occurred from Tuberculosis in 1937 as 16. The following table gives the number of deaths from this disease during the past five years:— Deaths. 1933 M. F 1934 M. F. 1935 M. F. 1936 M. F. 1937 M. F. Pulmonary 7 7 3 4 10 7 12 12 6 6 Non-Pulmonary 1 — 1 1 3 2 3 — 3 1 Totals 8 7 4 5 13 9 15 12 9 7 54 It will be seen from the foregoing table that 16 deaths were registered as due to Tuberculosis, of which 12 were Pulmonary and 4 NonPulmonary. The figures correspond to a death rate per 1,000 of population of .39 for Pulmonary Tuberculosis and .13 for Non-Pulmonary Tuberculosis. Of the 16 deaths which occurred, 5 were in unnotified cases, i.e., 31 per cent. of the total Tuberculosis deaths. Four of the unnotified deaths were of residents who died outside the area and came to notice by inward transfers. Investigations as to the reasons for omissions of notifications are made at the request of the County Medical Officer of Health, and the information obtained is forwarded to him. The following table, compiled from local records, shows the number of new cases of Tuberculosis notified during the year, together with the deaths at various age periods:— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1 and under 5 - - - - - - — - 5 and under 10 - - 1 — — — - — 10 and under 15 — — — — — - — 15 and under 20 — 3 1 1 — — 1 - 20 and under 25 1 2 — — 1 1 — — 25 and under 35 5 3 — 1 3 1 1 - 35 and under 45 2 1 — — 1 1 — — 45 and under 55 2 1 — — 1 2 1 — 55 and under 65 — — — — — 1 — — 65 and upwards - - - - - - - - Totals 10 10 2 2 6 6 3 — The new cases were distributed amongst the Wards as follows:— Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 2 6 1 6 4 1 Non-Pulmonary 1 1 — 1 1 — Totals 3 7 1 7 5 1 55 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 57 such examinations were made. Treatment for cases of Tuberculosis is under the control of the Surrey County Council, who provide both sanatorium and dispensary treatment. The Tuberculosis After-Care Committee, which commenced activity in 1935, continued its good work during 1937, assisting a number of Tuberculosis patients and their dependents in various ways. At the end of the year 157 cases in the Borough remained on the register. Public Health (Prevention of Tuberculosis) Regulations, 1925. On no occasion during the year was it necessary for the Council to take steps under the regulations. Public Health Act, 1925, Section 62, and Public Health Act, 1936, Section 172. No action was necessary under these sections during the year. PREVENTION OF BLINDNESS. The Authority for administering the various provisions of the Acts dealing with blind persons is the Surrey County Council. No special scheme for the Borough, apart from the general provisions by the Surrey County Council quoted above, has been prepared under Section 176 of the Public Health Act, 1936. For children of pre-school age, an arrangement has been made with the London County Council by which children suffering from Ophthalmia Neonatorum are admitted for treatment to a London County Council Hospital. Other visual defects in this group are seen by the Ophthalmic Surgeon at the Croydon General Hospital under an arrangement between the local authority and the authorities of the Croydon General Hospital. 56 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to the Hospital during 1937. Disease. Bedding- Coulsdon and Purley. Merton and Morden. Mitcham. ton and Walling- ton. cases deaths cases deaths cases deaths cases deaths Diphtheria 4 - 10 — 28 4 98 2 Scarlet Fever 59 - 48 — 115 181 — Typhoid Fever 1 - 13 1 1 1 — — Erysipelas 1 - 2 — 1 — 8 — Tonsilitis 1 - 5 2 — 7 — Measles 2 - 1 — 3 — 3 — Whooping Cough 1 — — - 3 — 6 — Rubella — - 1 — 2 — 5 — Other Diseases. Influenza - - - - - - 1 — Impetigo — — — — 2 — 1 — Cerebro-Spinal Meningitis — - — — 1 1 — — Pneumonia - - - - - - 2 — Meningitis-Tubercular - - - - - - 1 1 Mumps — - 2 — 2 — 2 — Farunculosis-Ansemia - - 1 — — — — — Puerperal Fever - - 1 — - — — — Nephritis 1 - - - - - - - Liver Abscess from Amoebic Dysentery - - - - - - 1 1 Rhinitis and Bronchitis - - — - - - 5 — Adenitis - - - — 1 — 1 — Cellulitis of Ankle - - - — 1 — — — Otitis Media - - - — 1 — 1 — Chicken Pox - - - — 3 — 1 — Anterior Poliomyelitis - - 2 — 1 — 1 — Septic Burn of Foot - - - - - - 1 — Septicaemia - - - - - - 1 — Totals 70 — 86 1 167 6 327 4 57 MISCELLANEOUS. EXAMINATION OF EMPLOYEES. Since 1st April, 1937, the Medical Officer of Health has undertaken the examination of all new staff for admission to the Council's Superannuation Scheme. Seven candidates were examined and all were found suitable to enter the scheme. PROPAGANDA. Public health propaganda engaged the attention of the Council during the latter part of the year, the Council co-operating to the full in the Surrey County Council's Health Campaign. This campaign, organised and conducted by the Central Council for Health Education, is being run in conjunction with the National Health Campaign inaugurated by the Prime Minister in his broadcast address on September 30th. The object of the campaign is to stimulate the nation to a more vigorous health consciousness and to obtain a wider use of the health services provided by local authorities. So far the meetings held have been very well attended and up to date the campaign in Wallington has been an unqualified success. 58 triLCIAM FILE. Ltd.. 78. WOODCOTE ROAD. WALUNOTON.