BED3 BOROUGH OF BEDDINGTON AND WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1938. BOROUGH OF BEDDINGTON AND WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1938. 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 13 Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1938 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 22 Nursing in the Home 23 Treatment Centres and Clinics 23 Hospitals 25 Disinfection 26 Maternity and Child Welfare: General Observations 26 Ante-natal and Post-natal Supervision 27 Maternity and Child Welfare Centres 28 Maternity Ward 29 Consultant Obstetrician 30 Home Help 30 Birth Control 30 Treatment: Orthopædic 30 Dental 30 Minor Ailments 31 Provision of Milk and other Foods 31 Health Visiting 32 Child Life Protection 32 2 Sanitary Circumstances of the Area: Water Supply 33 Drainage and Sewerage 34 Rivers and Streams 34 Closet Accommodation 35 Public Cleansing 35 Sanitary Inspection of the Area. Statement of the Senior Sanitary Inspector for the Year, 1938: 36 Dwelling Houses 36 Milk and Dairies 36 Meat and other Food 36 Factories and Workshops 37 Shops Act, 1934 37 Complaints 37 Infectious Disease and Disinfection 38 Rats and Mice (Destruction) Act 38 Increase of Rent (Restrictions) Act 38 Notices 38 Sanitary Improvements: Water Supply 38 Drains 38 Water Closets 39 Sinks 39 Yards 39 Dust Receptacles 39 Dampness 39 General Repairs, etc. 39 Milk and Dairies 40 Food Premises 40 Factories 40 Shops 40 Bakehouses 40 Bye-laws with respect to Nuisances 40 Smoke 40 Summary of work done during the year 40 Shops and Offices 42 Camping Sites 42 Smoke Abatement 42 Swimming Baths 42 Eradication of Bed Bugs 42 Schools 43 Dairies 43 Milk (Special Designations) Orders 44 Slaughterhouses 44 3 Bakehouses 44 Other Food Preparing Places 44 Factories and Workshops 44 Housing: Housing Statistics: Inspection of Dwelling Houses 46 Remedy of Defects without service of Formal Notice 46 Action under Statutory Powers 46 Housing Act, 1936—Part IV—Overcrowding 47 Number of Houses and Flats erected during the year 47 Inspection and Supervision of Food: Milk 47 Meat 48 Food and Drugs (Adulteration) Act 48 Chemical and Bacteriological Examinations 49 Nutrition 50 Shell Fish (Molluscan) 50 Adoptive Acts and Bye-Laws 50 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 51 Incidence of Infectious Diseases in Age Groups and Wards 52 Cases of Infectious Diseases notified, 1915-1938 53 Monthly Incidence of Infectious Disease54 Scarlet Fever 65 Diphtheria 55 Enteric Fever 55 Erysipelas 55 Puerperal Fever and Puerperal Pyrexia 56 Opthalmia Neonatorum 56 Cerebro-Spinal Fever 56 Pneumonia 56 Acute Poliomyelitis 56 Dysentery 56 Food Poisoning 57 Non-notifiable Diseases 57 Tuberculosis 57 Prevention of Blindness 59 Cases admitted to Wandle Valley Joint Hospital 60 Miscellaneous: Examination of Employees 61 Propaganda 61 4 BOROUGH OF BEDDINGTON AND WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1938. Members: Councillor F. C. Elwood (Chairman). Alderman H. B. Smalley, J.P. (The Mayor). Councillor F. Backes (Deputy Mayor). Councillor H. J. W. Bliss, B.A. Councillor Mrs. V. M. Boyce. Councillor B. W. Brenner. Councillor F. G. Bryant. Councillor Mrs. E. A. Lazenby, B.A. Councillor D. Mackay. Councillor S. W. Phipps. Councillor H. E. H. Vardon. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1938. Members: Councillor F. C. Elwood (Chairman). Alderman H. B. Smalley, J.P. (The Mayor). Councillor Mrs. V. M. Boyce. Councillor F. G. Bryant. Councillor Mrs. E. A. Lazenby, B.A. Councillor S. W. Phipps. Co-opted Members: Miss E. Hall, Mrs. L. Rose, Mrs. M. Woods, B.A. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1938. Members: Alderman H. B. Smalley, J.P. (The Mayor). Alderman H. D. Banks. Alderman G. Purser. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1938. Members: Alderman H. B. Smalley, J.P. (The Mayor). Alderman G. Purser. Alderman J. Vale. Councillor H. J. W. Bliss, B.A. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. Assistant Medical Officer for Ante-Natal Clinic:— *Winifred M. Small, M.B., Ch.B. Consultant Obstetricians— *Leslie Williams, M.D., M.S., F.R.C.S. * Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G. 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. Health Visitors:— Miss M. Holman, S.C.M. Miss E. Turnbull, S.R.N., S.C.M. Clerks:— R. F. Burns (Chief Clerk) (commenced 1st May, 1938). W. A. Watts (resigned 28th February, 1938). Miss M. Frost. E. D. Evezard. Laboratory Attendant:— W. K. Stevens (commenced 24th January, 1938). *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 the year 1938. This, the second report I have had the honour to lay before you, presents a record of the state of the Public Health during the first full year in which I have held office as Medical Officer of Health. The year under review from a public health standpoint was very satisfactory. While no epidemics of major importance visited the district, the incidence of some of the infectious diseases is substantially higher than last year. The incidence of Diphtheria was higher, and acute Anterior Poliomyelitis (Infantile Paralysis) showed a marked increase in the autumn months. This disease of the nervous system shows a tendency to recur at the third and fourth quarters of the year in ever-increasing severity. Much research into the cause and treatment is being undertaken, and it is possible that soon some measure of control and prevention may be forthcoming. The Birth Rate remains almost stationary, but the Death Rate is much lower than ever previously recorded, whilst the average age at death remains remarkably high, maintaining the reputation of the Borough for the longevity of its inhabitants. During the year the Public Health and the Maternity and Child Welfare Committees have given much time and thought to the further expansion of those services under their control, taking the Minister of Health's report on Maternal Mortality (1937) and the correlated Circular 1622 as their guides. All provisions desired by this circular of Local Authorities have now been met in the Borough, and schemes have been put into operation which should provide for every contingency related to pregnancy, child-birth and infant care. 7 That the Council are to be congratulated on the results of their labours is well shown in the gratifying fall in the Infantile Mortality rate. This year's rate of 30.85 per 1,000 as compared with the 58 of the previous year is the lowest in Infantile Mortality figures for this district since 1931, and compares very favourably with 53 for England and Wales. The far-seeing policy of the Council in establishing their own laboratory in 1937 has been well borne out during 1938, the feeling of security concerning our milk and water we enjoy from such a provision is ample justification for the work undertaken. The requirements of the Air Raid Precautions Act, 1937, have increased the work and responsibilities of Local Government Officials in every department and not least in that of the Medical Officer of Health, who is the controlling official of all the Council's Casualty Services. So far the obligations of the Act have been met, and with improved organisation and the delegation of duties, with the active co-operation of the Medical Practitioners in the area, we may hope to satisfy all the requirements of civil defence. The graph, which was included in last year's report, has been omitted. It is to be hoped that a quinquennial edition of the graph will be sufficient to record the development of the district, and comparative changes in Birth and Death Rates. 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. June 1939. 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 1938 30,880 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1938 9,222 Rateable Value, December, 1938 £370,552 Sum represented by penny rate, December, 1938 £1,500 The year 1938 represents the first full year in which the district has enjoyed Borough status. The district continues to expand, although the rapid growth which preceded the granting of the charter has slowed down considerably. 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 377 181 196 12.60 Illegitimate 12 6 6 Total 389 187 202 Rate per 1,000 total births. Still Births 6 2 4 15.19 Death Rate per 1,000 of the estimated resident population. Deaths 260 127 133 8.42 Deaths from Puerperal causes: — Rate per 1,000 (live and still) births. Puerperal Sepsis Nil — Other Puerperal causes 1 2.53 Death Rate of Infants under one year of age: — All Infants per 1,000 live births 30.85 Legitimate Infants per 1,000 legitimate live births 29.18 Illegitimate Infants per 1,000 illegitimate live births 83.33 Deaths from Cancer (all ages) 58 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 1938 is 30,880, and the vital statistics in this report are based on that figure. An increase of 290 is shown over the figure for 1937, when the population for that year was estimated at 30,590. In 1915 there were 3,389 occupied houses, with an average of 4.0 persons per house. In 1938 there were 9,222 occupied houses, distributed as follows: Beddington: — North Ward 2389 Central Ward 1366 South Ward 1620 5375 Wallington:— North Ward 1491 Central Ward 1486 South Ward 870 3847 Total 9222 The average number of persons per house was 3.3. The average number of persons during the year in the Beddington Royal Female Orphanage, which is the only large residential institution in the district, was 121. Births. (a) Live Births.—The Registrar-General returns the number of births registered during 1938 as 389, of which 187 were males and 202 were females. This gives a live birth rate of 12.6 per 1,000 total population, compared with 12.91 in 1937 and 15.1 for England and Wales. Twelve of the births were illegitimate, 6 males and 6 females. (b) Stillbirths.—The number of stillborn children registered in 1938 was 6, of which 2 were males and 4 were females. This gives a 12 stillbirth rate of 15.19 per 1,000 total births and 0.19 per 1,000 total population. Deaths. The Registrar-General gives the number of deaths registered as 260, of which 127 were males and 133 were females. Taking the estimated population figure of 30,880, the crude death rate for 1938 is 8.42 per thousand, compared with 10.0 for 1937. The corresponding figures for England and Wales for 1938 and 1937 are 11.6 and 12.4 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 8.25. 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 7462 116 15.5 54 7.2 Central 4843 66 13.6 41 8.5 South 4824 54 11.2 38 7.8 Wallington: North 5971 75 12.6 36 6.0 Central 4944 59 11.9 61 12.3 South 2836 19 6.7 30 10.6 The Borough: 30880 389 12.6 260 8.4 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1938, 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 1938. Causes of Death. Males. Females. Total. All Causes 127 133 260 1. Typhoid and Paratyphoid Fevers — — — 2. Measles — — — 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Influenza 1 1 2 7. Enchephalitis Lethargica — — — 8. Cerebro-spinal Fever — 1 1 9. Tuberculosis of Respiratory System 2 4 6 10. Other Tuberculosis Diseases 2 — 2 11. Syphilis — 2 2 12. General Paralysis of the Insane, Tabes, etc 1 — 1 13. Cancer 28 30 58 14. Diabetes 2 — 2 15. Cerebral Haemorrhage 3 4 7 16. Heart Disease 25 35 60 17. Aneurysm 1 — 1 18. Other Circulatory Diseases 6 9 15 19. Bronchitis 2 2 4 20. Pneumonia (all forms) 5 5 10 21. Other Respiratory Diseases 1 2 3 22. Peptic Ulcer 2 — 2 23. Diarrhoea, etc. (under 2 years) 1 1 2 24. Appendicitis 2 — 2 25. Cirrhosis of Liver 1 — 1 26. Other Diseases of Liver, etc — 3 3 27. Other Digestive Diseases 4 2 6 28. Nephritis 6 7 13 29. Puerperal Sepsis — — — 30. Other Puerperal Causes — 1 1 31. Congenital Causes, etc. 4 3 7 32. Senility 1 2 3 33. Suicide 4 — 4 34. Other Violence 6 5 11 35. Other defined causes 17 14 31 36. Causes ill-defined or unknown — — — Special Causes (included in No. 35):— Smallpox — — — Poliomyelitis — — — Polioencephalitis — — — Deaths of Infants under 1 year:— Total 6 6 12 Legitimate 5 6 11 Illegitimate 1 — 1 Population (estimated mid-1938) 30880 14 Comparative crude birth rates, death rates, analysis of mortality, maternal death rates and case rates for certain infectious diseases in the year 1938: — England and Wales. 126 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 15.1 15.0 15.4 13.4 12.60 Still 0.60 0.65 0.60 0 48 0.19 Deaths— All Causes 11.6 11.7 11.0 11.4 8.42 Typhoid and typhoid Fevers 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.04 0.05 0.03 0.06 0.00 Scarlet Fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.00 Diphtheria 0.07 0.07 0.06 0.05 0.00 Influenza 0.11 0.10 0.11 0.06 0.06 Notifications— Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 2.41 2.60 2.58 2.05 1.52 Diphtheria 1.58 1.85 1.53 1.90 0.55 Enteric Fever 0.03 0.03 0.04 0.05 0.00 Erysipelas 0.40 0.46 0.39 0.46 0.26 Pneumonia 1.10 1.28 0.98 0.98 0.29 Deaths under 1 year of age Rates per 1,000 Live Births. 53 57 51 57 30.85 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 5.14 Maternal Mortality— Puerperal Sepsis 0.89 Not available 0.00 Others 2.19 2.57 Total 3.08 2.57 Maternal Mortality— Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Sepsis 0.86 Not available 0.00 Others 2.11 2.53 Total 2.97 2.53 Notifications— Puerperal Fever 14.42 18.08 12.51 3.53 0.00 Puerperal Pyrexia 15.46 0.00 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 6 2.31 Cancer 58 22.31 Cerebral Haemorrhage 7 2.69 Heart Diseases 60 23.08 Other Circulatory Diseases 15 5.77 Pneumonia (all forms) 10 3.85 Nephritis 13 5.00 Suicide 4 1.54 Other forms of Violence 11 4.23 It will be seen that Cancer and Heart Disease are still amongst the deaths ranking high in the Borough. These causes together with Cerebral Haemorrhage and other circulatory diseases accounted for 140 deaths; followed by Nephritis, 13; Pneumonia, 10; and Pulmonary Tuberculosis, 6. Violence (including Suicide) accounted for 15 deaths. HEART DISEASE AND DISEASES OF THE CIRCULATORY SYSTEM. Twenty-nine 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-two per cent. had attained the age of 65 years or over. 16 17 0-5 years. M. F. 5-20 years. M. F. 20-30 years M. F. 30-40 years. M. F. 40-50 years. M. F. 50-60 years. M. F. 60-70 years. M. F. 70-80 years. M. F. Over 80. M. F. Total. M. F. CANCER. The following table gives the ages, sex and localisation of the disease in the 58 cases in which death was attributed to this cause: — Jaw — — — — — — — — — — — — — — 1 — — — 1 — Tongue — — — — — — — — — — — — 1 — — — — — 1 — Thyroid Gland — — — — — — — — — — — — — — 1 — — — 1 — Bronchus — — — — — — — — — — — — 1 1 — — — — 1 1 Lungs 1 — — — — — — — — — 2 — — — 3 1 — — 6 1 Ribs — — — — — — — — 1 — — — — — — — — — 1 — Breast — — — — — — — 1 — 1 — — — — — 1 — — — 3 Oesophagus — — — — — — — — — 1 1 — — — 1 — — — 2 1 Stomach — — — — — — — — 1 — — — 1 1 1 3 — 1 3 5 Peritoneum — — — — — — — — — — — — — — — 1 — — — 1 Liver — — — — — — — — — — — — — 1 — — — — — 1 Pancreas — — — — — — — — — — — — — — 1 — — — 1 — Large Intestine — — — — — — — — — — — — 1 — 1 2 2 1 4 3 Urinary Bladder — — — — — — — — — — — — 1 — 1 — 1 _ 3 _ Prostate — — — — — — — — — — — — 2 — 1 — — — 3 — Testicle — — — — — — — — — — — — — — 1 — — — 1 — Vulva — — — — — — — — — — — — — 2 — — — — — 2 Vaginal Wall — — — — — — — — — — — — — — — 1 — — — 1 Uterus — — — — — — — — — — — 2 — 2 — — — — — 4 Ovary — — — — — — — — — — — — — — — 1 — 1 — 2 Rectum — — — — — — — — — — — — — 1 — — — 4 — 5 1 — — — — — — 1 2 2 3 2 7 8 12 10 3 7 28 30 During 1938, 58 deaths were registered as being due to Cancer, showing a decrease of 13 deaths from this disease compared with 1937. It is gratifying to note that deaths from this cause, although still high, are considerably less than last year. With regard to the anatomical distribution of the disease, deaths due to Cancer of the uterus and appendages predominate in females, while Cancer of the intestinal tract seems to be common in both sexes. Carcinoma of the lungs is diagnosed more frequently in recent years, probably due to the improved methods and better technique available in our hospitals. The following table compares the actual death rate from Cancer in Beddington and Wallington with the corresponding rate for the whole country: — 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 1938 58 1.88 1.66 Again, however, one finds that deaths attributed to this group are more common in the aged, and an analysis of the death returns shows 18 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. No discovery of outstanding importance in diagnosis or treatment was made in 1938, but a very steady advance continues to be 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 (males) were recorded from Suicide. There were 11 deaths from other forms of violence, of these 6 were males and 5 females. The cause of death in the 4 cases of Suicide was as follows:— Strangulation by hanging 2 Asphyxia due to Carbon Monoxide (Coal Gas) Poisoning 1 Cut throat wounds of the neck 1 One death of a Wallington resident due to a road accident occurring within the Borough took place in 1938. Two 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 19 safety on our own roads and thus contribute our share towards National Safety. MATERNAL MORTALITY. One death in a woman directly associated with childbirth occurred during the year, giving a maternal mortality rate of 2.53 per 1,000 live and stillbirths as compared with 2.97 for England and Wales. The patient, who died in King's College Hospital, was under the observation of a consultant obstetrician, both for ante-natal care and management of labour. Death took place at the Hospital under anaesthesia during labour, the Coroner's verdict being "cardiac failure and pulmonary oedema due to exhaustion during labour." Although only 1 death is recorded, because of the small number of figures dealt with, the rate appears at 2.53 per 1,000 total births, the rate thus not being a true picture of the facts. No deaths were recorded among patients delivered in the district during the year (including private cases and those entering Carshalton Hospital under the Council's Scheme). INFANTILE MORTALITY. The number of deaths registered during the year in infants under one year of age was 12 (6 males and 6 females), all but one being in legitimate children. This gives an infantile mortality rate of 30.85 per 1,000 live births, as compared with 58.23 in 1937 and 53.0 for England and Wales. The rate is abnormally low and reflects great credit on those services dealing with the preservation of infant life. Only 12 deaths of infants under one year were registered out of a total of 387 live births. This rate is often taken as an index of the general health and prosperity of the district as a whole. 20 The following table gives the age and cause of death of each infant who died:— Age. Cause of Death 4 hours. Prematurity (at 7 months). 10 hours. Cardiac failure. Prematurity of birth. 12 hours. Defective development. Premature birth. 16 hours. Protracted and difficult labour. Fortnight over term. 21 hours. Enlarged thymus. 1 day. Convulsions. Congenital debility. Asphyxia neonatorum. 4 days. Jaundice and inanition. Premature birth. 1 week. Convulsions. Inanition. 1 month. Acute nephritis. 1 month. Congenital abnormality of heart. 6 months. Infantile convulsions. Gastric catarrh. 7 months. Acute gastro-enteritis. Seven, or 58.3 per cent., of the deaths occurred in the first week of life; 8, or 65.7 per cent., occurred in the first month; and 4, or 33.3 per cent., from the second to the twelfth month. The infantile mortality in the different Wards is given below: — Beddington: — North 7 Central 1 South 1 Wallington: — North — Central 2 South 1 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 86 3 83 Tuberculosis—(Sputa) 20 2 18 Totals 106 5 101 The Medical Officer of Health's laboratory in the Town Hall, commenced in 1937, continues to fill a very important role in ensuring a high standard of bacteriological purity in the milk and water supplies of the district. The scope of the routine work carried out is illustrated in the following table: — Samples. Number Taken. Water: — Bacteriological analyses 259 Milk:— Bacteriological analyses 183 Microscopical examinations 18 Ice Cream:— Bacteriological analyses 7 Specimens which cannot be examined adequately in the Council's laboratory are sent to the Counties Public Health Laboratories, 91, Queen Victoria Street, London, and some pathological specimens are sent to the pathological laboratory of the Croydon General Hospital. AMBULANCE FACILITIES. Infectious Cases. Two motor ambulances have been provided by the Wandle Valley Joint Hospital Board. 22 Ceneral and Accident Cases. In 1938 a new Ambulance Service was 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. NURSING 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 1,006 cases, including 76 maternity and 93 midwifery patients. TREATMENT CENTRES AND CLINICS. Maternity and Child Welfare Centres:— Centre. When held. Voluntary Helpers. Beddington Village, Village Hall. Second and fourth Monday of month, 2-4 p.m. Mrs. Hudson. Mrs. Lewes-Sayer. Mrs. Mountney. Mrs. Woodward. Mrs. Jennings. Bandon Hill, Methodist Hall, Sandy Lane. First and third Tuesday of month, 2-4 p.m. Mrs. Moore. Mrs. Philips. Mrs. Street. Mrs. Morrison. Mrs. Heley. Elm Grove, Elm Grove Hall, Butter Hill. First and third Wednesday of month, 2-4 p.m. Mrs. Boyce. Mrs. Buck. Mrs. Jackson. Wallington, Baptist Hall, Queen's Road. Second and fourth Wednesday of month, 2-4 p.m. Mrs. Beale. Mrs. Blake. Mrs. Cowper. Mrs. Daw. Mrs. James. Mrs. Jeffrey. Mrs. Mellows. Mrs. Shaw. Hackbridge, Labour Hall, York Street. Second and fourth Thursday of month, 2-4 p.m. Mrs. Curwain. Mrs. Elwood. Mrs. Williams. Mrs. Bird. Ante-natal and Post-natal Clinic, The Nurses Home, 57, Montagu Gardens. Fridays, 2-4 p.m. 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 Carshalton, 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. Carshalton (Rochester Road):— Every Friday at 10 a.m. Third Tuesday of month at 5.30 p.m. IMMUNISATION AGAINST DIPHTHERIA. In May, 1937, the Council approved the Medical Officer of Health's scheme for the immunisation of children against Diphtheria. The scheme commenced operation late in 1937, and only a few cases were reported on last year. The figures for 1938 show a gratifying response on the part of the parents. The following table gives the numbers of children who were treated during the year:— 1-2 2-3 3-4 4-5 5-10 10-15 Total. Number for whom treatment has been completed (as shown by Negative Schick Test) 1 5 1 21 9 37 Number undergoing treatment — — 1 3 10 — 14 Total — 1 6 4 31 9 51 No cases of illness have resulted from the injections and no child has been prevented from following his normal daily routine on treatment days. The treatment at present in use consists of three injections of 1 cubic centimetre of Toxoid Antitoxin Floccules (T.A.F.) at intervals 24 of 14 days, followed by a Schick Test at the end of three months to ascertain if immunisation is complete. One hundred per cent. of children treated up to the end of the year have shown a negative result of the final Schick Test. Where private practitioners desire to carry out this treatment themselves, prophylactic material is supplied free of charge. Two practitioners requested supply of material for two cases during the year. 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. 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 25 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 into Maternal Mortality. This was followed in May of that year 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. 26 Discussions were continued in 1938 by the sub-committee, the principal points to which the sub-committee's attention was drawn being:— (1) Insufficient Maternity and Ante-natal beds. (2) No provision of Consultant Ante-natal clinics. (3) No provision of Consultant Post-natal clinics. With regard to the first point, it was decided to wait for the increased accommodation of maternity beds which will be available in 1940 at the St. Helier Hospital. The Committee decided to ask Mr. Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G., 6, Beech House Road, Croydon, who was appointed in June as additional consultant obstetrician, to attend the Nursing Association Premises once a month to see both Ante-natal and Post-natal cases referred from the Ante-natal clinic and by the general practitioners of the area for the consultant's opinion. An agreement was reached with the County Borough of Croydon, by which the Croydon Emergency Unit will be made available in Beddington and Wallington, at an agreed fee. The unit will operate from Mayday Road Hospital, and will be called by practitioners requiring its service. This provision meets all the requirements desired by the Minister of Health and now all matters in Circular 1622 have been discussed and dealt with by the Council, and it remains for the practical application of the recommendations to make headway in the district, before an assessment of their value can be judged. General practitioners in the area have been informed and are fully conversant with all the matters relating to Maternity and Child Welfare Service in which the Council have interested themselves; it is anticipated that a helpful co-operation will ensure the success of all these measures. The District Nursing Association midwives continue to perform yeoman service, their work being materially increased in 1938 as the result of the operations of the Midwives Act, 1936. ANTE-NATAL CLINIC. Ante-natal Clinics are held weekly, with an average attendance of about 20 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. 27 Ante-natal and Post-natal Attendances, 1938. Council Cases. Nursing Association Cases. Total. Number of clinics held 51 Ante-natal cases:— Total number attending during the year 115 122 237 Number of first attendances 100 104 204 Number of re-attendances 387 428 815 Total attendances 487 532 1019 Average attendance per session 9.5 10.4 19.9 Number of consultations with Medical Officer 487 532 1019 Post-natal cases:— Total number attending during the year 34 54 88 Number of first attendances 34 54 88 Number of re-attendances 14 15 29 Total attendances 48 69 117 Average attendance per session 0.9 1.4 2.3 Number of consultations with Medical Officer 42 62 104 During the year 237 expectant mothers attended the Clinic, as compared with 200 in 1937. This represents approximately 61 per cent. of the total notified births (live and still) which occurred in the Borough during 1938. The total number of attendances made at the 51 sessions was 1,019, as compared with 804 in 1937. POST-NATAL CLINIC. Post-natal cases are seen as they present themselves at the antenatal clinic and it is estimated that about 37 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 the consultant post-natal clinics are in operation, 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. 28 The following table shows the attendances for 1938 at the five Centres maintained by the Council:— Ban- don Hill. Bedding ton. Elm Grove Hackbridge Walling ton. Totals, 1938. Number of sessions held 24 23 24 24 24 119 Infants: — No. of new cases under 1 year 86 66 44 33 65 294 No. of re-attendances 817 687 513 393 747 3157 No. of new cases over 1 year 31 18 28 17 23 117 No. of re-attendances 837 863 567 823 851 3941 Total attendance of infants 1771 1634 1152 1266 1686 7509 Average attendance of infants per session 74 71 48 53 70 63 Mothers attending 1596 1396 1036 1006 1438 6472 Total attendances 3367 3030 2188 2272 3124 13981 Average total attendance per session 140 140 91 95 130 119 During the year the total number of attendances made by the children at the Centres was 7,509 as compared with 6,437 in 1937, an increase of 1,072. Approximately 77 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 22 For medical reasons 15 For unsuitable home conditions 7 Normal confinements 18 Abnormal confinements 4 Eighteen cases were referred from the Ante-natal Clinic and 4 by private practitioners. 29 CONSULTANT OBSTETRICIAN. As reported in a previous section, Mr. Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G., was asked to conduct the Consultant Antenatal and Post-natal Clinics and act generally as consultant for the Council's services. Mr. Lindsay's appointment is in addition to that held by Mr. Leslie Williams, M.D., M.S., F.R.C.S. 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 13 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 1938, 19 women from the Borough attended this clinic. 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 16 cases (defects of the feet, bow legs, knock knees, etc.) received treatment. Dental. During 1938 50 cases were referred for treatment under the Councils' scheme as follows:— Expectant mothers. Nursing mothers. Children under 5 years. Found to be in need of treatment 29 12 11 Received treatment 19 10 6 Made dentally fit 19 10 6 Treatments:— Fillings:— (a) In temporary teeth — — — (b) In permanent teeth 21 1 — Teeth extracted 162 102 16 Administrations of general anaesthesia 14 6 4 Patients supplied with dentures 9 9 — Dentures supplied 17 18 — 30 Minor Ailments. Eighty-two 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 31 Croydon General Hospital 34 Great Ormond Street Hospital 4 The Wilson Hospital, Mitcham 1 South-Eastern Hospital for Children 6 Guy's Hospital 1 Infants' Hospital, Vincent Square 2 King's College Hospital 1 St. Anthony's Hospital 1 Epsom County Hospital 1 The conditions requiring treatment were:— Tonsils and Adenoids 26 Nævus 8 Circumcision 9 Dental defects 4 Orthopaedic defects 16 Hernia 3 Eye conditions 5 Other conditions (vomiting, nervous condition, Asthma, etc.) 11 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., 1938. New Cases during 1938. Cases discontinued. Cases on 31st Dec., 1938. Milk free 46 99 55 90 Milk at half cost 13 18 11 20 Total 59 117 66 110 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. 31 HEALTH VISITING. 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 100 No. of re-visits 114 Total 214 Visits to infants: — No. of first visits to infants under 1 year 363 No. of re-visits to infants under 1 year 884 No. of visits to infants 1-5 years 1687 Total 2934 Public Health Act (Child Life Protection):— No. of visits paid 48 Other visits: — Infantile mortality 6 Stillbirths 4 Infectious diseases 174 Tuberculosis 49 Maternity, Home Help, Milk and Dental Scheme 397 Miscellaneous 25 Unsuccessful 200 903 Total visits, 1938 4051 Total visits, 1937 4504 Attendances at clinic sessions. Maternity and Child Welfare Centres 238 Ante-natal and Post-natal Clinics 51 Total 289 Interviews at office 178 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 4 Number of children on the register at the end of the year 15 Number of children who died during the year Nil During the year 48 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. 32 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 259 samples of water were examined bacteriologically in the Council's laboratory. The samples taken were as follows:— Main water supply (Sutton Well and Woodmansterne Well) 143 (An average per month of 12 samples.) Private wells 110 Swimming bath water 6 The main water supply continues to be satisfactory both in quantity and in bacteriological purity. The present daily routine of systematic bacteriological analyses adopted at the Sutton District Water Company's premises ensures a supply of safe drinking water and during the year no authentic case of illness arising in the district associated with drinking water was brought to light. The routine sampling conducted in the district by the Council's staff and examination in the Council's laboratory provides a check and safeguards the water as supplied at the consumer's tap. Too little attention has been paid in recent years by water undertakings to the condition of the water actually delivered to the consumer after passing through the Company's mains and in one instance during the year the work of the Council's staff in safeguarding this aspect of water undertaking was very well illustrated. The samples examined showed that the water supplied by the Sutton District Water Company maintained a high standard of bacteriological purity throughout the year. The Medical Officer of Health continued to investigate the conditions obtaining at the private wells maintained in the district. As a result of examination of the well waters, and representation by the Medical Officer of Health to firms maintaining their own wells, all such water is now subjected to chlorination. The water in the swimming bath at the Beddington Royal Female Orphanage is subject to analysis during the warm periods of the year. During 1938 it was shown to be well looked after and in a satisfactory state of purity. 33 DRAINACE AND SEWERACE. 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 and road improvements. The soil sewer in Woodmansterne Lane has been extended and 13 cottages on the smallholdings have been drained into it. Water closets have been fixed in all these cottages and the existing earth closets abolished. A new soil sewer has been constructed to drain efficiently Messrs. G. Payne's factory and the Croydon Cricket Club's pavilion, the existing cesspools being no longer required. Negotiations are still proceeding for the drainage into the main sewer of the pavilions in Hillcrest Road. It is anticipated that the surface water sewer in Manor Road and Woodcote Road from Springfield Road to Stafford Road will be abolished in 1939 and a considerably larger sewer laid, thus obviating flooding under the railway bridge. The last of the new sludge digestion tanks constructed by the Croydon Corporation at Beddington Farm was brought into operation during the year, and no nuisance has arisen since the scheme has been in operation. RIVERS AND STREAMS. All the watercourses in 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 providing to maintain the banks. Negotiations are in progress with the Surrey County Council and Wallis's Mills regarding alleviation of flooding at Beddington Village. The Surrey County Council intend to appoint a Rivers Pollution Officer in 1939, to deal with and report all cases of river pollution. In this connection a survey has been made of all factory effluents discharging into the River Wandle. Work is to be commenced immediately on the abolition of the existing weir and sluice gate to the lake in Grange Park and a new 34 weir of approximately double the capacity with a large penstock and by-pass will be constructed. CLOSET ACCOMMODATION. Practically the whole of the area is on the water carriage system, draining into the public sewers. During the year the earth closets at 22 dwelling-houses were converted from the conservancy system to water closets and connected to the public sewer. There remains now only a few chemical and earth closets chiefly for use on sports grounds. PUBLIC CLEANSING. 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. It is anticipated that tipping on land belonging to the Croydon Corporation and at the rear of the existing tip will be commenced early in 1939. The Croydon Corporation commenced tipping on land in the Borough, adjoining Beddington Lane, in the latter part of the year in accordance with an agreement with this Council. 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. 35 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1938. DWELLINC-HOUSES. Number of inspections of dwelling-houses 964 Number of inspections recorded under Housing Regulations 305 MILK AND DAIRIES. Number of cowkeepers on register 1 Number of retail purveyors of milk on register 51 Number of dairy premises on register 8 Number of inspections of premises 27 Defects or infringements of Acts and Orders discovered and remedied 2 Number of samples of milk taken for bacteriological examination 183 Number of licences issued under Milk (Special Designations) Orders:— Tuberculin Tested—Dealer's Licences 6 „ „ —Supplementary Licences 5 Accredited—Supplementary Licence 1 Pasteurised—Dealer's Licences 6 —Supplementary Licences 6 Pasteuriser's Licence 1 2R MEAT AND OTHER FOODS. Number of slaughterhouses on register (licensed) 1 Number of visits to slaughterhouse 19 Number of animals killed at slaughterhouse:— Sheep 44 Pigs 6 Calves 2 Cattle, other than Cows — Cows — 52 Number of carcases, with offal, inspected at slaughterhouse 52 36 Number of condemnations at slaughterhouse:— Whole carcases Nil Organs Nil Number of visits to other food-preparing places 322 Number of defects found and remedied 9 Unsound food destroyed Nil FACTORIES. Number of factories on register 92 Number of inspections 176 Number of defects discovered and remedied 15 BAKEHOUSES. Number of bakehouses on register 12 Number of inspections 35 Number of defects discovered and remedied 6 WORKPLACES. Number of inspections of workplaces 48 Number of defects discovered Nil SHOPS ACT, 1934. Number of visits to shops re sanitary conveniences, ventilation and temperature 317 Number of defects discovered and remedied 6 COMPLAINTS. Complaints of nuisances received during the year were due to the following causes:— Defects in dwelling-houses 37 Stoppages in drains 25 Defects in drains or water closets 9 Accumulations of refuse 16 Smoke 3 Insect Pests 6 Miscellaneous 16 112 37 INFECTIOUS DISEASE AND D DISINFECTION. Number of visits re cases of infectious disease 132 Number of rooms disinfected 129 Lots of bedding and clothing disinfected 100 Number of library books disinfected 407 RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints or requests for advice received 39 Number of visits to premises 231 INCREASE OF RENT (RESTRICTIONS) ACTS. Number of certificates issued Nil NOTICES. Number of informal notices served (including verbal intimations) 606 Number of statutory notices served (Public Health Acts) 17 SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 3 Water pipes and fittings repaired or renewed 20 Water cisterns cleansed 4 Private wells—chlorination plants provided 3 Drains. Drains re-laid or repaired 67 Drains unstopped and cleansed 61 Intercepting traps renewed 16 Intercepting traps provided with rodeye stoppers 15 Manholes provided or repaired 20 Manholes cleansed 5 Ventilation pipes repaired or renewed 17 Ventilation pipes provided 30 Soil pipes repaired or renewed 4 Gullies renewed or cleansed 33 Gully kerbs and channels repaired 22 New soakaways constructed 21 Rainwater pipes disconnected from drain 11 38 Closets. Earth closets and chemical closets converted to water closets 25 New water closets constructed 27 New pans fixed to water closets 30 Dirty pans cleansed 2 Water supply reinstated 2 Flushing cisterns repaired or renewed 22 Flush pipes and pan joints repaired or renewed 26 Seats repaired 29 Closed-in seats abolished 12 Walls, floors, etc., repaired 28 Light and ventilation provided 1 Doors repaired or renewed 8 Sinks. Sinks renewed or repaired 21 Waste pipes repaired or renewed 45 Yards. Yards newly paved or repaired 22 Yards cleansed 6 Dust Receptacles. New portable galvanised iron dustbins provided 189 Dampness. Damp-proof courses provided or repaired 57 Roofs repaired •156 Rainwater gutters repaired or renewed 154 Rainwater downspouts repaired or renewed 72 Windows, sills and doors made weatherproof 126 External walls repaired, re-pointed or rendered 146 Earth banked against house walls removed 20 External walls treated with waterproofing solution 32 Ventilation provided under floors 42 General Repairs, Etc. Rooms cleansed 252 Walls and ceilings repaired 115 Floors repaired 54 Stoves repaired or renewed 41 Coppers repaired or renewed 13 Doors repaired or renewed 14 39 Windows repaired 130 Windows provided with new sashcords 110 Staircases repaired 13 Handrails to stairs provided 4 Rooms provided with means of ventilation 11 Food stores ventilated or provided 2 Chimneys repaired 59 Overcrowding abated 4 Refuse removed 11 Number of premises disinfested from bed bugs 4 Milk and Dairies. Unregistered purveyors of milk registered 2 Food Premises. Premises cleansed 6 Receptacles for refuse provided 2 Refuse removed 1 Factories. Premises cleansed 6 Sanitary conveniences—defects remedied 2 Other defects remedied 7 Bakehouses. Premises cleansed 4 Other defects remedied 2 Shops. Heating facilities provided 3 Ventilation provided 3 Byelaws with respect to Nuisances. Accumulations of manure or other offensive refuse removed or covered 2 Smoke. Nuisances abated 4 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 964 Number of re-inspections of premises 2888 Number of visits to works in progress 2331 Number of miscellaneous visits and inspections 789 Number of visits to dairies 27 40 Number of visits to factories 176 Number of visits to bakehouses 35 Number of visits to workplaces 48 Number of visits to shops 317 Number of visits to slaughterhouse 19 Number of visits to food stores 322 Number of visits to stables and yards 55 Number of visits to market gardens, etc 29 Number of visits to fried fish shops 12 Number of visits to urinals 41 Number of visits to piggeries 1 Number of visits re infectious diseases 132 Number of visits to streams 9 Number of visits re rats 231 Number of visits re smoke abatement 11 Number of complaints of nuisances received and investigated 112 Number of preliminary notices served 606 Number of statutory notices served 17 Number of interviews re nuisances, etc. 601 Number of water tests applied to drains 44 Number of smoke tests applied to drains 22 Number of rooms disinfected 129 Number of lots of bedding and clothing disinfected 100 Number of library books disinfected 407 Number of samples of drinking water obtained 253 Number of samples of swimming bath water obtained 6 Number of milk samples obtained 183 Number of ice cream samples obtained 7 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. 41 SHOPS AND OFFICES. Three hundred and seventeen inspcetions were made during 1938, and in 6 cases action was necessary in regard to ventilation and temperature. CAM PI N C SITES. There are no camping sites within the Borough. SMOKE ABATEMENT. It was not found necessary to take formal action to abate nuisances arising from the emission of smoke during the year, but 4 cases were dealt with informally. SWIMMINC 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 6 samples were 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 3 Council houses and in 1 other house. The Council houses were disinfested by the Council, and in the other premises by the tenant. The Council has not, so far, employed a contractor to carry out disinfestation. The methods employed for freeing infested houses of bed bugs are as follows:— 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. 2.—Where the infestation is such that the tenant is unlikely to achieve a satisfactory result, disinfestation is carried out by employees 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. 42 The liquid insecticides used during the year were "Zaldecide" and "Vermoose." 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. 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. REGULATED TRADES: DAIRIES. There are 8 registered premises within the district, this being 2 less than last year. One cowkeeper remained on the register during the year. During the year 27 visits of inspection were paid, and conditions found to be satisfactory. 43 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 13 SLAUGHTERHOUSES. There is only one Slaughterhouse within the district, this being licensed annually. During the year 52 animals were slaughtered. The whole of the carcases and offal were examined prior to removal from the premises. BAKEHOUSES. There are 12 Bakehouses in the district. The premises were visited periodically. Unsatisfactory conditions were found to exist in 6 instances. OTHER FOOD PREPARINC PLACES. During the year 322 visits were paid to other food preparing places within the district. The conditions found were generally satisfactory. FACTORIES. There are 92 Factories in the district. The following tables give details of inspections made and defects found, as supplied by the Senior Sanitary Inspector:— 1. Inspections for purposes of provisions as to health. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 155 1 — Factories without mechanical power 21 — — f Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) — — — Total 176 1 — tElectrical Stations should be reckoned as factories. 44 2. Defects found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 6 6 — — Overcrowding (S. 2) — — — — Unreasonable temperature (S. 3) — — — — Inadequate ventilation (S. 4) — — — — Ineffective drainage of floors (S. 6) — — — — Sanitary Conveniences (S. 7):— Insufficient 1 1 — — Unsuitable or defective 1 1 — — Not separate for sexes — — — — Other offences 7 7 — — (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and shops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 15 15 — — 3. Outwork in Unwholesome Premises. No instances were discovered. 45 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. HOUSINC STATISTICS. 1. Inspection of Dwelling-houses during the year. (1) (a) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 947 (b) Number of inspections made for the purpose 964 (2) (a) Number of Dwelling-houses (included under subhead (1) above) inspected and recorded under the Housing Consolidated Regulations 305 (b) Number of inspections made for the purpose 305 (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 543 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 509 3. Action under Statutory Powers during the year. A. Proceedings under Sections 9, 10 and 16 of the Housing Act. 1936:— (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 17 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 17 (b) By Local Authority in default of owners — 46 C. Proceedings under Section 11 and 13 of the Housing Act, 1936:— (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 12 of the Housing Act, 1936:— (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 6 (ii) Number of families dwelling therein 6 (iii) Number of persons dwelling therein 57 (b) Number of new cases of overcrowding reported during the year 2 (c) (i) Number of cases of overcrowding relieved during the year 4 (ii) Number of persons concerned in such cases 22 (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 233 INSPECTION AND SUPERVISION OF FOOD. MILK. During the year the following number of samples of milk was taken within the district and were examined bacteriologically in the laboratory of the Corporation's Public Health Department:— Class of Milk. No. taken. Tuberculin Tested 30 Tuberculin Tested Pasteurised 2 Pasteurised 90 Ungraded 61 Total 183 47 Craded Milk. One sample of Tuberculin Tested milk failed to pass the Methylene Blue Reduction Test and 7 samples of Pasteurised milk gave bacterial counts of over 100,000 per millilitre. The samples of Pasteurised milk were examined for the presence of Phosphatase, but in two instances only was there indication that the samples had not been treated in accordance with the conditions prescribed in the Milk (Special Designations) Orders. Ungraded Milk. Of the 61 samples of ungraded milk examined during the year, 46 were found not to contain more than 200,000 bacteria per millilitre. In 58 of the samples no coliform bacillus was found in 0.01 millilitre, and in the remaining 3 samples the bacillus was absent from 0.001 millilitre. Where the results show a total number of bacteria exceeding 200,000 per millilitre or the coliform bacillus is found in 0.01 millilitre, it is assumed that the sample has not attained the standard of bacterial cleanliness which can reasonably be expected. During the year, therefore, appropriate action was taken in all such cases to secure an improvement in the bacteriological condition of the milk. Tubercle Bacilli. Eighteen 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. 48 The following numbers of samples have been collected from this area during the year:— Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. Convic tions. Formal. Informal. Total Formal. Informal. Total Milk 19 — 19 2 — 2 — — Cream — — — — — — — — Butter 3 — 3 — — — — — Cheese — — — — — — — — Margarine — — — — — — — — Lard — — — — — — — — Meat 2 — 2 — — — — — Flour 2 — 2 — — — — — Coffee — — — — — — — — Cocoa — — — — — — — — Sugar — — — — — —- — — Sausages — — — — — — — — Confectionery and Jam — — — — — — — — Sausage Meat — — — — — — — — Wine — — — — — — — — Beer — — — — — — — — Spirits — — — — — — — — Drugs 1 — 1 — — — — — *Other articles 3 — 3 1 — 1 1 1 Totals 30 — 30 3 — 3 1 1 *Details of other articles— Honeycomb Sponge Mixture 1 — 1 — — — — — Chocolate Roll 1 — 1 1 — 1 — — Grape Juiee 1 — 1 — — — — — CHEMICAL AND BACTERIOLOCICAL EXAMINATIONS. Special work of this nature is carried out when required at the Counties Public Health Laboratories. Routine examinations of milk and water samples continue to be done in the Public Health Laboratory established in 1937 at the Town Hall, Wallington, under the supervision of the Medical Officer of Health. 49 NUTRITION. This subject formed part of the Council's activities in the National Health Campaign outlined in this report under the heading of propaganda. The average nutrition of children (toddlers and infants) attending Infant Welfare Centres is of a very high standard, this fact of course reflecting the general prosperity of the district as a whole. No cases of malnutrition were noted at any of the centres and the Council's generous allowances of milk under Assisted Schemes materially prevent the occurrence of such a state. Health Visitors continue to discuss dietetic questions with mothers at the Infant Welfare Centres and in their home; where necessary indicating desirable methods of cooking. SHELL FISH (MOLLUSCAN). Only a small quantity of shell fish is marketed in the district, and is obtained chiefly from Billingsgate Market, London. In addition to the above, oysters are obtained from layings at Helford, Cornwall, and cockles from Leigh-on-Sea. ADOPTIVE ACTS AND BYELAWS. The following Acts have been adopted: — Infectious Diseases (Prevention) Act, 1890. 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. 50 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. The above byelaws have been in force in the district for some years, but as a result of incorporation in 1937 some of them have ceased to be operative. The Council have adopted many new byelaws during 1938; these will become operative in 1939. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1938, the number removed to hospital and the number of deaths attributed to these diseases:— Disease. Number Notified. Removed to Hospital. Deaths. Scarlet Fever 47 38 Diphtheria 17 15 Erysipelas 8 4 1 Cerebro-Spinal Meningitis 2 2 1 Pneumonia 9 1 10* Acute Anterior Poliomyelitis 6 6 — Dysentery 1 1 — Food Poisoning 1 1 — Totals 91 68 12 *Includes deaths from all forms of Pneumonia. 51 The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections: — Cases of Infectious Disease notified during the year 1938. Disease. At all ages. Number of Cases Notified. Total cases notified in each Ward. Cases removed to Hospital. Deaths. At Ages—Years. Under 1 Year. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Beddington. Wallington. 10 and under North. Central. Scuth. North. Central. South. Scarlet Fever 47 — — 1 — 3 26 10 1 5 1 — — 19 4 9 9 5 1 38 — Diphtheria 17 1 — — 2 — 3 4 — 5 2 — — 9 3 3 2 — — 15 — Erysipelas 8 — 1 — — — — — — — 1 4 2 1 1 1 1 2 2 4 1 Cerebro-Spinal Meningitis 2 — — — — — 1 — — 1 — — — — 1 — 1 — — 2 1 Pneumonia 9 — — — — 1 2 — 1 1 1 2 1 1 1 2 1 4 — 1 *10 Acute Poliomyelitis 6 — — — — 1 3 1 1 — — — — 3 2 — — 1 — 6 — Dysentery 1 — — — — — 1 — — — — — — — 1 — — — — 1 — Food Poisoning 1 — — — — — — — — — — 1 — — 1 — — — — 1 — Totals 91 1 1 1 2 5 36 15 3 12 5 7 3 33 14 15 14 12 3 68 12 *Includes all forms. 52 The following table shows the history of infections from the date of the inception of the former Urban District until 1938: — Cases of Infectious Disease notified in each year, 1915-1938. 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 1938 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 47 Diphtheria 14 24 9 23 43 47 34 19 40 15 12 16 70 21 17 12 16 14 17 33 22 13 4 17 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 8 Poliomyelitis 1 — — 2 — — — — — — — — — — — — — — — 1 — 1 6 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 — — — — — — 2 Pneumonia — — — — 16 3 8 4 5 9 2 5 14 19 20 13 16 36 42 15 4 2 1 9 Malaria — — — — 6 4 — — — — — — — — 1 — — — — — — — — — Chicken Pox — — — — 3 — — — 6 3 — — — — — — — — — — — — — — Dysentery — — — — — — 1 — — — — — — — — — — — — — — — 1 1 Encephalitis Lethargica — — — — — — 1 — 3 1 — — — — — — — — — — — — — — Food Poisoning — — — — — — — — — — — — — — — — — — — — — — — 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 18 Other Forms 6 8 4 4 — — 3 1 6 — 5 3 8 6 9 5 1 3 5 3 7 6 4 8 Totals 85 162 288 252 197 149 148 99 118 65 78 76 154 176 144 136 142 143 147 157 161 102 105 117 53 The monthly incidence of Infectious Disease, 1938. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 4 5 3 4 6 6 5 2 2 6 3 1 47 Diphtheria 3 1 8 1 1 — 2 — — — 1 — 17 Erysipelas 1 — 2 — 1 — — — — 2 2 — 8 Cerebro-Spinal Meningitis — — — — — — 1 — — 1 — — 2 Pneumonia 3 1 1 1 1 — — — — — — 2 9 Acute Poliomyelitis — — — — — — — 2 3 — 1 — 6 Dysentery — — — — — — —- — — — — 1 1 Food Poisoning — — — — — — — 1 — — — — 1 Totals 11 7 14 6 9 6 8 5 5 9 7 4 91 54 SCARLET FEVER. This disease continues mild in character and complications and sequelae are less prevalent. The total number of cases notified (47) compares very favourably with last year (65). This reduction probably reflects a better state of general health amongst the young community as a whole as well as absence of marked seasonal variation in climatic conditions. The greater prevalence was in May and June, months which usually show a marked increase in incidence, but which in 1938, being much colder than in previous years, showed only a slight rise in notified cases. No deaths were recorded from Scarlet Fever during the year. DIPHTHERIA. This disease showed a marked increase (17 cases) as compared with the abnormally low incidence (4 cases) of the previous year. These yearly variations in incidence with the possibility of the occurrence of severe types of the disease emphasize the importance of protecting the community at an early age by the modern methods of immunisation. Fifteen cases were treated in Hospital and 2 at home, all of whom recovered. ENTERIC FEVER. No cases of this disease occurred in the district and no notifications were received concerning Wallington residents from other districts. ERYSIPELAS. Eight cases of this disease were notified in 1938 as compared with 3 in 1937. Four cases were treated in the local Isolation Hospital. One death was recorded in an unnotified case treated in an institution outside the district, particulars only being obtained by inward transfer of the death registration. 55 PUERPERAL PYREXIA. No cases coming within the regulations governing the notification of this condition in childbirth were recorded during the year. OPHTHALMIA NEONATORUM. No cases of this disease were notified during 1938. CEREBRO-SPINAL FEVER. Notifications were received of 2 cases of this disease during the year. One patient, a girl aged 9 years, died in the Isolation Hospital after an acute fulminating attack. The child was in a poor state of health, following a severe illness, when attacked by the disease. PNEUMONIA. Nine cases of primary or influenzal pneumonia were notified under the Public Health Acts during the year. The greater number of these cases occurred during the colder months. ACUTE POLIOMYELITIS. This disease unfortunately returns in increasing severity during the early autumn of each year. The number of cases notified (6) is much greater than has previously been recorded. Fortunately, most of the cases were mild and there were no deaths. One little girl who showed an extensive paralysis following the acute stage of the disease is still under treatment at the Orthopaedic Hospital at Pyrford, Surrey. Much time is being spent both in this country and abroad (particularly in the United States of America and Australia) on the investigation of the cause and treatment of the disease. While the bacteriologists seem to be making slow progress with prevention of the disease and the protection of the individual, we must look to the orthopaedic surgeons for improvement in methods of treatment and prevention of crippling defects. DYSENTERY. One case of this complaint was notified; the patient recovered. 56 FOOD POISONING. One authentic case of Food Poisoning came to our notice during the year, the patient being removed to the Wandle Valley Joint Isolation Hospital, where recovery took place. 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 223 Mumps 156 Chicken-Pox 80 Whooping Cough 24 German Measles 8 TUBERCULOSIS. There were 26 new cases notified during the year. The following table gives the number of new cases notified during the Dast five vears: — New Cases. 1934 1935 1936 1937 1938 M. F. M. F. M. F. M. F. M. F. Pulmonary 13 4 12 11 9 9 10 10 13 5 Non-Pulmonary 1 2 2 5 4 2 2 2 5 3 Totals 14 6 14 16 13 11 12 12 18 8 The annual case rate for Pulmonary Tuberculosis per 1,000 of population for 1938 was 0.58 compared with 0.65 for 1937. The annual case rate for Non-Pulmonary Tuberculosis per 1,000 of population for 1938 was 0.26 compared with 0.13 for 1937. The Registrar-General returns the number of deaths which occurred from Tuberculosis in 1938 as 8. 57 The following table gives the number of deaths from this disease during the past five years: — Deaths. 1934 1935 1936 1937 1938 M. F. M. F. M. F M. F. M. F. Pulmonary 3 4 10 7 12 12 6 6 2 4 Non-Pulmonary 1 1 3 2 3 — 3 1 2 — Totals 4 5 13 9 15 12 9 7 4 4 It will be seen from the foregoing table that 8 deaths were registered as due to Tuberculosis, of which 6 were Pulmonary and 2 NonPulmonary. The figures correspond to a death rate per 1,000 of population of 0.19 for Pulmonary Tuberculosis and 0.06 for Non-Pulmonary Tuberculosis. Of the 8 deaths which occurred, 1 was in an unnotified case, i.e., 12.5 per cent, of the total Tuberculosis deaths. The unnotified death was a resident who died outside the area and came to notice by inward transfer. Investigation as to the reasons for omission of notification is 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 — 1 and under 5 — — 1 — — — — — 5 and under 10 — — 1 — — — — — 10 and under 15 — — 2 — — — 1 — 15 and under 20 — 2 1 1 — — — — 20 and under 25 — 1 — — — 1 — — 25 and under 35 7 2 — — — 3 — — 35 and under 45 4 — — — 1 — — — 45 and under 55 2 — — — 1 — — — 55 and under 65 — — — — — — — — 65 and upwards — — — 2 — — — — Totals 13 5 5 3 2 4 2 — 58 The new cases were distributed amongst the Wards as follows: — Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 4 — — 7 3 4 Non-Pulmonary 1 1 1 4 1 — Totals 5 1 1 11 4 4 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 20 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 1938, assisting a number of Tuberculosis patients and their dependents in various ways. At the end of the year 168 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 defeats 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. 59 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to the Hospital during 1938. Disease. Beddington and Wallington. Coulsdon and Purley. Merton and Morden. Mitcham. cases deaths cases deaths cases deaths cases deaths Diphtheria 15 — 10 — 33 2 76 1 Scarlet Fever 38 — 59 — 143 — 128 — Typhoid — — 1 — — — 1 — Erysipelas 4 — 1 — 6 1 2 1 Tonsillitis 1 — 1 — 2 — 4 — Measles — — 4 — 5 — 8 — Whooping Cough — — — — 2 — 1 — Rubella 1 — 1 — 2 — 3 — Enteritis 1 — — — — — 1 — Pneumonia 1 — — — 1 — — — Cancer of Bowel 2 1 — — — — — — Chill — — — — 1 — — — Chicken Pox 1 — — — — — 2 — T.B. Meningitis 1 1 — — — — 1 1 Septicaemia — — — — 1 — — — Rheumatism — — 1 — — — — — Puerperal Sepsis — — 1 — — — — — Malta Fever — — 1 — — — — — Anterior Poliomyelitis 4 — 1 — — — 2 — Mumps 1 — — — — — — — Impetigo — — — — — — 1 — Admitted with Mother — — 1 — — — 1 — Streptococcal Meningitis 1 1 — — — — — — Influenza — — — — — — 2 — Totals 71 3 82 — 196 3 233 3 60 MISCELLANEOUS. EXAMINATION OF EMPLOYEES. During the year the Medical Officer of Health carried out the examination of all new staff for admission to the Council's Superannuation Scheme. Twenty-four candidates were examined and all were admitted to the scheme. PROPACANDA. Public health propaganda engaged the attention of the Council during the first three months 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, was run in conjunction with the National Health Campaign inaugurated by the Prime Minister in his broadcast address on September 30th, 1937. The object of the campaign was to stimulate the nation to a more vigorous health consciousness and to obtain a wider use of the health services provided by local authorities. On the whole, the meetings were well attended, and the gratifying increase in numbers of patients attending the various clinics shows that the campaign is already bearing fruit. 61 WILLIAM PILE. LTD.. 18, WOOnCOTE ROAD. WALLINGTON-