BED 4 LIBRARY BOROUGH OF BEDDINGTON AND WALLINGTON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1939. William Pile, Ltd., Printers (t.u ), Sutton, Epsom, Wallington. BOROUGH OF BEDDINGTON AND WALLINGTON. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1939. TABLE OF CONTENTS. Public Health Committee 5 Maternity and Child Welfare Subcommittee 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 Registered Causes of Death 13 Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1939 15 Cancer 17 Violence 18 Maternal Mortality 19 Infantile Mortality 19 General Provision of Health Services for the Area: Laboratory Facilities 21 Ambulance Facilities 21 Nursing in the Home 22 Treatment Centres and Clinics 22 Hospitals 24 Disinfection 25 Maternity and Child Welfare: General Observations 25 Ante-natal and Post-natal Supervision 25 Maternity and Child Welfare Centres 27 Maternity Ward 28 Consultant Obstetrician 28 Home Help 29 Birth Control 29 Treatment: Orthopaedic 29 Dental 29 Minor Ailments 29 Provision of Milk and other Foods 30 Health Visiting 30 Child Life Protection 31 2 Sanitary Circumstances of the Area: Water Supplies 32 Drainage and Sewerage 32 Rivers and Streams 33 Closet Accommodation 33 Public Cleansing 33 Sanitary Inspection of the Area 34 Statement of the Senior Sanitary Inspector for the Year, 1939: Dwelling Houses 35 Milk and Dairies 35 Slaughterhouse 35 Food Premises 36 Unsound Food 36 Factories 37 Bakehouses 37 Workplaces 37 Shops and Offices 37 Complaints 37 Smoke Abatement 37 Infectious Disease and Disinfection 37 Offensive Trades and Fish Frying 38 Rats and Mice (Destruction) Act 38 Increase of Rent (Restrictions) Act 38 Notices 38 Prosecutions 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 Bakehouses 40 Shops 40 Bye-laws with respect to Nuisances 40 Smoke 40 Fish Frying Premises 40 Summary of work done during the year 41 Shops and Offices 42 Camping Sites 42 3 Smoke Abatement 42 Swimming Baths 42 Eradication of Bed Bugs 42 Schools 43 Dairies 43 Milk (Special Designations) Orders 44 Slaughterhouses 44 Bakehouses 44 Other Food Preparing Places 44 Factories 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, 1915-1939 53 Monthly Incidence of Infectious Disease 54 Non-notifiable Diseases 55 Tuberculosis 55 Prevention of Blindness 57 Cases admitted to Wandle Valley Joint Hospital 58 4 BOROUGH OF BEDDINGTON AND WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1939. Members: Alderman G. Purser (Chairman). Councillor F. Backes, J.P. (The Mayor). Alderman W. W. Binnie, J.P. (Deputy Mayor). Alderman H. B. Smalley. 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, 1939. Members: Councillor Mrs. V. M. Boyce (Chairman). Councillor F. Baches, J.P. (The Mayor). Alderman G. Purser. Councillor F. G. Bryant. Councillor F. C. Elwood. Councillor Mrs. E. A. Lazenby, B.A. Co-opted Members: Miss E. Hall, Mrs. L. Rose, Mrs. M. Woods, B.A. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1939. Members: Councillor F. Backes, J.P. (The Mayor). Alderman H. D. Banks. Alderman G. Purser. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1939. Members: Councillor F. Backes, J.P. (The Mayor). Alderman G. Purser. Alderman J. Vale. Councillor F. C. Elwood. 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 E. Turnbull, S.R.N., S.C.M. Miss W. Dowdall, S.R.N., S.C.M. (commenced 12th June, 1939). Clerks:— R. F. Burns (Chief Clerk). Miss M. Frost. E. D. Evezard. Laboratory Assistant:— w. k. Stevens. *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 submit my report for the year ending 31st December, 1939. The year under review covers nine months of peace (up to 3rd September) and three months of war. The outbreak of war was followed by the evacuation of many families from the Borough, and while the general statistics for this year are not seriously affected, we may look in future reports for a striking fall in the statistical returns of the Maternity and Child Welfare section. Up to the close of the year, the war had not really gripped the imagination of the general public to make comment on changing aspects of life worth while. Departmentally, however, the mobilisation and organisation of an entirely new Service, the Casualty Service, under the direct control of the Medical Officer of Health, threw an enormous strain on the resources of the entire staff. The Public Health record for the year is good. No epidemics are to be noted, and there was no outstanding event affecting the general health of the community. The Birth Rate has been maintained at the satisfactory level of 12.63 per 1,000, while the Death Rate at 9.38 is quite low for a district having so many inhabitants who have passed middle age. The Infantile Mortality Rate is also low at 40.30 per 1,000 live births, and compares very favourably with the rate of 50, which is that of the Country as a whole. No deaths associated directly or indirectly with child-birth were recorded during the year. This is a notable achievement for the Maternity and Child Welfare Service. 7 It is the first year since 1929 that the efforts, which the Public Health Authority have so constantly directed to the solution of the problem of death in child-birth, have borne such satisfactory results, and all in the district associated with the care of maternity are to be congratulated. The records of the attendances at the Council's clinics up to September showed a steady upward tendency and reflected an evergrowing appreciation by the public of this section of the Council's work. 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. November, 1940. 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 1939 31,190 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1939 9,368 Rateable Value, December, 1939 £379,221 Sum represented by penny rate, December, 1939 £1,540 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 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. 9 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 381 194 187 12.63 Illegitimate 13 6 7 Total 394 200 194 Rate per 1,000 total births. Still Births 13 4 9 32.99 Death Rate per 1,000 of the estimated resident population. Deaths 282 142 140 9.38 Rate per 1,000 (live and still) births Deaths from Puerperal causes: — Puerperal Sepsis Nil — Other Puerperal causes Nil — Death Rate of Infants under one year of age: — All Infants per 1,000 live births 40.30 Legitimate Infants per 1,000 legitimate live births 36.46 Illegitimate Infants per 1,000 illegitimate live births 153.85 Deaths from Cancer (all ages) 56 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 1939 is 31,190, and the vital statistics in this report are based on that figure. An increase of 310 is shown over the figure for 1938, when the population for that year was estimated at 30,880. In 1915 there were 3,389 occupied houses, with an average of 4.0 persons per house. In 1939 there were 9,368 occupied houses, distributed as follows: — Beddington:— North Ward 2408 Central Ward 1399 South Ward 1644 — 5451 Wallington:— North Ward 1517 Central Ward 1490 South Ward 910 — 3917 Total 9368 The average number of persons per house was 3.3. Births. (a) Live Births.— The Registrar-General returns the number of births registered during 1939 as 394, of which 200 were males and 194 were females. This gives a live birth rate of 12.63 per 1,000 total population, compared with 12.6 in 1938 and 15.0 for England and Wales. Thirteen of the births were illegitimate, 6 males and 7 females. (b) Stillbirths.— The number of stillborn children registered in 1939 was 13, of which 4 were males and 9 were females. This gives a 12 stillbirth rate of 32.99 per 1,000 total births and 0.42 per 1,000 total population. Deaths. The Registrar-General gives the number of deaths registered as 282, of which 142 were males and 140 were females. Taking the estimated population figure of 30,070 (a figure supplied by the Registrar-General specially for the calculation of Death Rates), the crude death rate for 1939 is 9.38 per thousand, compared with 8.42 for 1938. The corresponding figures for England and Wales for 1939 and 1938 are 12.1 and 11.6 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 9.19. The Registrar-General's comparability factor for the adjustment of the death rate of Beddington and Wallingtotn is 0.98. The births and deaths occurring in the Wards of the Borough are given below:— Ward. Population (Estimated). Live births. Deaths. Beddington: North 7545 115 56 Central 4891 73 42 South 4871 40 41 Wallington : North 6023 82 44 Central 4994 63 64 South 2866 21 35 The Borough: 31190 394 282 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1939, 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 1939. Causes of Death. Males. Females. Total. All Causes 142 140 282 1. Typhoid and Paratyphoid Fevers — — — 2. Measles — — — 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria 1 — 1 6. Influenza 1 1 2 7. Enchephalitis Lethargica — — — 8. Cerebro-spinal Fever 1 — 1 9. Tuberculosis of Respiratory System 7 1 8 10. Other Tuberculosis 2 1 3 11. Syphilis 1 — 1 12. General Paralysis of the Insane, Tabes, etc 1 1 13. Cancer 23 33 56 14. Diabetes 1 1 2 15. Cerebral Hæmorrhage 3 9 12 16. Heart Disease 34 50 84 17. Aneurysm 1 — 1 18. Other Circulatory Diseases 12 6 18 19. Bronchitis 6 3 9 20. Pneumonia (all forms) 3 4 7 21. Other Respiratory Diseases 1 — 1 22. Peptic Ulcer 2 — 2 23. Diarrhoea, etc. (under 2 years) — — — 24. Appendicitis — 3 3 25. Cirrhosis of Liver 1 — 1 26. Other Diseases of Liver, etc 1 — 1 27. Other Digestive Diseases 3 4 7 28. Nephritis 4 2 6 29. Puerperal Sepsis — — — 30. Other Puerperal Causes — — — 31. Congenital Causes, etc. 8 6 14 32. Senility 4 3 7 33. Suicide 1 — 1 34. Other Violence 8 4 12 35. Other defined causes 12 9 21 36. Causes ill-defined or unknown — — — Special Causes (included in No. 35): — Smallpox — — — Poliomyelitis 1 — 1 Polioencephalitis — — — Diarrhoea (2 years and over) — 1 1 Deaths of Infants under 1 year: — Total 10 6 16 Legitimate 8 6 14 Illegitimate 2 — 2 14 Comparative crude birth rates, death rates, analysis of mortality, maternal death rates and case rates for certain infectious diseases in the year 1939:— 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 15.0 1.4.8 15.6 12.3 12.63 Still 0.59 0.59 0.57 0.44 0.42 Deaths— All Causes 12.1 12.0 11.2 11.9 9.38 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.01 0.01 0.01 0.00 0.00 Scarlet Fever 0.01 0.00 0.00 0.00 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.00 Diphtheria 0.05 0.05 0.04 0.02 0.03 Influenza 0.21 0.19 0.20 0.18 0.07 Notifications— Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 1.89 1.96 1.78 1.53 0.96 Diphtheria 1.14 1.21 1.16 0.98 0.33 Enteric Fever 0.04 0.03 0.04 0.03 0.03 Erysipelas 0.34 0.40 0.31 0.37 0.23 Pneumonia 1.02 1.21 0.89 0.99 0.40 Deaths under 1 year of age Rates per 1,000 Live Births. 50 53 40 48 40.30 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 6.3 3.0 8.2 0.00 Maternal Mortality— Puerperal Sepsis 0.77 Not available 0.00 Others 2.16 0.00 Total 2.93 0.00 Maternal Mortality— Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Sepsis 0.74 Not available 0.00 Others 2.08 0.00 Total 2.82 0.00 Notifications— Puerperal Pyrexia 14.35 17.26 12.99 14.22 4.91 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 8 2.84 Cancer 56 19.86 Cerebral Haemorrhage 12 4.26 Heart Diseases 84 29.79 Other Circulatory Diseases 18 6.38 Pneumonia (all forms) 7 2,48 Nephritis 6 2.13 Violence 13 4.61 16 During 1939, 56 deaths were registered as being due to Cancer, showing a decrease of 2 deaths from this disease compared with 1938. 17 0-5 years. 5-20 years. 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. M. F. M. F. Mouth 1 - 1 Tongue — — — — — — — — — — — — — — — — 1 — 1 - Thyroid Gland — — — — — — — — — 1 — — — — — — — — — 1 Lungs — — — — — — — 1 — — 1 — — 1 1 — — 1 2 3 Breast — — — — — — — — — 1 — 2 — 2 — 1 — 2 — 8 Oesophagus — — — — — — — — — — — — — — — 1 — — — 1 Stomach — — — — — — — — — — 1 — 2 1 — 3 — — 3 4 Liver — — — — — — 1 — — — — — — 1 — — — — 1 1 Pancreas — — — — — — — — — — — — 1 — 1 2 — — 2 2 Large Intestine — — — — — — — — — 1 1 — 1 3 2 — 1 1 5 5 Urinary Bladder — — — — — — — — — — — — 1 — — — — — 1 — Prostate — — — — — — — — — — — — — — — — — — 2 — Uterus — — — — — — — 1 — — — — — 1 — 1 — 1 — 4 Ovary — — — — — — — — — 1 — — — 1 — — — — — 2 Rectum — — — — — — — — — — — 1 3 — 1 1 1 — 5 2 — — — — — — 1 2 — 4 4 3 8 10 7 9 3 5 23 33 CANCER. The following table gives the ages, sex and localisation of the disease in the 56 cases in which death was attributed to this cause: — 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 1939 56 1.86 — VIOLENCE. One death, a male, was recorded from Suicide. There were 12 deaths from other forms of violence, of these 8 were males and 4 females. Two deaths of Wallington residents due to road accidents occurring within the Borough took place in 1939. Five 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. 18 MATERNAL MORTALITY. No deaths occurred during the year under review, directly or indirectly associated with child-birth. It is very gratifying to be able to record this fact, which reflects credit on all persons and institutions associated with the care of midwifery in the Borough. INFANTILE MORTALITY. The number of deaths registered during the year in infants under one year of age was 16 (10 males and 6 females), all but two being in legitimate childen. This gives an infantile mortality rate of 40.30 per 1,000 live births, as compared with 30.85 in 1938 and 50.0 for England and Wales. The rate is considerably lower than that for the country as a whole, and those services dealing with the preservation of infant life are to be congratulated. Only 16 deaths of infants under one year were registered out of a total of 394 live births. This rate is often taken as an index of the general health and prosperity of the district as a whole. The following table gives the age and cause of death of each infant who died:— Age. Cause of Death. 10 minutes Premature birth (6 months). Twin. 1 day 3 hours White asphyxia. Circulation through cord arrested at birth. 5 hours White asphyxia and prematurity. 8 hours Respiratory failure. Partial atelectasis. 11 hours Prematurity. 19 hours 1 day 2 days 1 week 1 week Syncope. Congenital heart disease; 6 weeks premature. 3 weeks Debility. Prematurity. 3 weeks Pneumonia-broncho. 2 months Marasmus. Natural causes. 3 months Acute broncho-pneumonia. 6 months Meningitis. Spina bifida. Hydrocephalus. 19 Nine or 56.3 per cent, of the deaths occurred in the first week of life; 13 or 81.3 per cent, occurred in the first month; and 3 or 18.8 per cent, from the second to the twelfth month. The infantile mortality in the different Wards is given below: — Beddington : — North 2 Central 2 South 4 Wallington:— North 4 Central 3 South 1 20 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 114 5 109 Tuberculosis—(Sputa) 28 3 25 Typhoid—(Blood) 1 1 — (Falces) 2 2 — Totals 145 11 134 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 170 Milk:— Bacteriological analyses 172 Microscopical examinations 52 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. 21 General and Accident Cases. In 1938 a new Ambulance Service was provided by the Council operating from the Fire Station in Belmont Road. This service was extended in October, 1939, when an additional ambulance was purchased to meet the increased demands of the residents. 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 903 cases, including 78 maternity and 85 midwifery patients. TREATMENT CENTRES AND CLINICS. Maternity and Child Welfare Centres: — Centre. When held. Beddington Village, Village Hall. Second and fourth Monday of month. October to March, 1.30-3.30; April to September, 2.0-4.0. Bandon Hill, Methodist Hall, Sandy Lane. First and third Tuesday of month. October to March, 1.30-3.30; April to September, 2.0-4.0. Elm Grove, Elm Grove Hall, Butter Hill. First and third Wednesday of month. October to March, 1.30-3.30; April to September, 2.0-4.0. Wallington, Baptist Hall, Queen's Road. Second and fourth Wednesday of month. October to March, 1.30-3.30; April to September, 2.0-4.0 Hackbridge, Labour Hall, York Street. Second and fourth Thursday of month. October to March, 1.30-3.30; April to September, 2.0-4.0. Ante-natal and Post-natal Clinic, The Nurses' Home, 57, Montagu Gardens. Thursdays and Fridays, 2.0-4.0. 22 Consultant Ante-natal and Post-natal Clinic, Third Friday of month. The Nurses' Home, 57, Montagu Gardens. Voluntary Helpers.—Mrs. Beale, Mrs. Bird, Mrs. Blake, Mrs. Boyce, Mrs. Buck, Miss Curwain, Mrs. Daw, Mrs. Duncan, Mrs. Elwood, Mrs. Hayes, Mrs. Hooper, Mrs. Hudson, Mrs. Jackson, Mrs. James, Mrs. Jeffrey, Mrs. Jennings, Mrs. Littlejohn, Mrs. Lennard, Mrs. Mellows, Mrs. Mountney, Mrs. Phillips, Mrs. Rose, Mrs. Raine, Mrs. Shaw, Mrs. Street, Mrs. Williams, Mrs. Wade. 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 (London Road J.B. School): — First, third and fifth Tuesday of month at 1.30 p.m. Each Thursday at 1 p.m. and third Saturday at 1.30 p.m. Carshalton (Rochester Road):— Every Friday at 10 a.m. Second Saturday at 2.0 p.m. IMMUNISATION ACAINST DIPHTHERIA. The scheme, commenced in 1937 for the immunisation of children against Diphtheria, continued satisfactorily throughout 1939. 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) 2 2 7 15 2 28 Number undergoing treatment 7 4 5 2 9 3 30 Total 7 6 7 9 24 5 58 23 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 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. 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. 24 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 Public Health work. During 1939 the Council's schemes for Maternity and Child Welfare continued to operate satisfactorily. The District Nursing Association midwives continued to perform yeoman service, and the fact that no maternal deaths took place during the year (which is commented upon elsewhere in this report) reflects great credit on the work of the nurses. ANTE-NATAL CLINIC. The Clinic is housed in the Nurses' Home, Montagu Gardens, where very good accommodation is rented by the Council from the District Nursing Association. The numbers of patients attending the Clinic showed a substantial increase during the year, and in December it was decided to have an additional weekly session, making two sessions a week with an average attendance of 21 patients per session. 25 Ante-natal and Post-natal Attendances, 1939. Council Cases. Nursing Association Cases. Total— 1939. Total— 1938. Number of clinics held 55 51 Ante-natal cases: — Total number attending during the year 131 145 276 237 Number of first attendances 114 120 234 204 Number of re-attendances 505 434 939 815 Total attendances 619 554 1173 1019 Average attendance per session ... 11.2 10.1 21.3 19.9 Number of consultations with Medical Officer 619 554 1173 1019 Post-natal cases: — Total number attending during the year 44 61 105 88 Number of first attendances 39 51 90 88 Number of re-attendances 9 13 22 29 Total attendances 48 64 112 117 Average attendance per session 0.9 1.1 2.0 2.3 Number of consultations with Medical Officer 48 64 112 104 During the year 276 expectant mothers attended the Clinic, as compared with 237 in 1938. This represents approximately 61 per cent, of the total notified births (live and still) which occurred in the Borough during 1939. The figures for 1938 are shown in the table for comparison purposes. POST-NATAL CLINIC. Post-natal cases are seen as they present themselves at the antenatal clinic and it is estimated that about 38 per cent, of the cases seen at the ante-natal sessions return for post-natal examinations after their confinement. Dr. Winifred Small continues to act as Ante-natal Medical Officer and her services have been greatly appreciated. 26 CONSULTANT ANTE-NATAL AND POST-NATAL CLINIC. The first Consultant Clinic was held on the 20th January, 1939, and was continued throughout the year on the third Friday in each month by Mr. Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G. The attendances were as follows: — Referred by: — Medical Officer, Ante-natal Clinic. Private Practitioners. Totals. c. N A. Clinics held 12 Patients attending: — Ante-natal 23 13 1 37 Post-natal 7 1 — 8 Total attendances ... 30 14 1 45 MATERNITY AND CHILD WELFARE CENTRES. The five Infant Welfare Centres have been held fortnightly on the same days as in previous years. For the nine months previous to the outbreak of War, all centres showed an increase in attendances, since September, however, there has been a decline. This is, of course, accounted for by voluntary evacuation of mothers and children as well as restrictions in the movements of those families who have remained. A more marked decline will unfortunately be recorded during 1940. The following table shows the attendances for 1939 at the five Centres maintained by the Council:— 27  Ban- don Hill. Bedding ton. Elm Grove. Hackbridge. Walling ton. Totals, 1939. Totals, 1938. Number of sessions held 24 22 24 24 24 118 119 Infants: — No. of new cases under 1 year 104 51 48 32 91 *326 294 No. of re-attendances ... 725 459 468 397 728 2777 3158 No. of new cases over 1 year 28 11 11 12 27 89 117 No. of re-attendances 1027 785 696 825 830 4163 3941 Total attendance of infants 1884 1306 1223 1266 1676 7355 7509 Average attendance of infants per session 78 59 51 52 70 62 63 Mothers attending 1696 1168 1056 1065 1505 6490 6472 Total attendances 3580 2474 2279 2331 3181 13845 13981 Average total attendance per session 149 112 95 97 132 117 118 *Includes 29 children who made their first attendance at Clinics outside the Borough. Approximately 75 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 18 For medical reasons 9 For unsuitable home conditions 9 Normal confinements 13 Abnormal confinements 5 Twelve cases were referred from the Ante-natal Clinic and 6 by private practitioners. CONSULTANT OBSTETRICIAN. No changes occurred in the appointment of Consultant Obstetrician during the year. The services of the Consultant were called upon once in 1939. 28 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 16 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 1939, 22 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 17 cases (defects of the feet, bow legs, knock knees, etc.) received treatment. Dental. During 1939, 79 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 58 2 19 Received treatment 29 2 13 Made dentally fit 29 2 13 Treatments: — Fillings: — (a) In temporary teeth — — - (b) In permanent teeth 20 — - Teeth extracted 242 24 55 Administrations of general anaesthesia 23 2 10 Patients supplied with dentures 18 1 Dentures supplied 31 2 — Minor Ailments. Eighty-two cases were referred from the Maternity and Child Welfare Centres to the under-mentioned Hospitals during the year: — 29 Carshalton, Beddington and Wallington (War Memorial) Hospital 32 Croydon General Hospital 32 Great Ormond Street Hospital 3 The Wilson Hospital, Mitcham 2 London Homoepathic 1 Infants' Hospital, Vincent Square 1 Redhill County Hospital 1 Epsom County Hospital 5 The conditions requiring treatment were: — Tonsils and Adenoids 20 Naevus 7 Circumsion 11 Dental defects 2 Orthopaedic defects 17 Hernia 1 Eye conditions 4 Skin conditions 8 Other conditions (vomiting, nervous conditions, Asthma, etc.) 12 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., 1939. New Cases during 7.939. Cases discontinued. Cases on 31st Dec., 1939. Milk free 90 82 82 90 Milk at half cost 20 31 29 22 Total 110 113 111 112 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. 30 The following is a summary of the work carried out during the year:— Home visiting. Visits to expectant mothers: — No. of first visits 49 No. of re-visits 61 Total 110 Visits to infants: — No. of first visits to infants under 1 year 437 No. of re-visits to infants under 1 year 740 No. of visits to infants 1-5 years 1528 Total 2705 Public Health Act (Child Life Protection): — No. of visits paid 51 Other visits: — Infantile mortality 1 Stillbirths 7 Infectious diseases 63 Tuberculosis 51 Maternity, Home Help, Milk and Dental Scheme 377 Unsuccessful 297 — 847 Total visits, 1939 3662 Total visits, 1938 4051 Attendances at clinic sessions. Maternity and Child Welfare Centres 210 Ante-natal and Post-natal Clinics 55 Total 265 Interviews at office 183 CHILD LIFE PROTECTION. The Health Visitors are the authorised Child Life Protection Visitors for the Borough. Number of persons who were receiving children for reward at the end of the year 7 Number of children on the register at the end of the year 8 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. 31 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 170 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) 116 (An average per month of 10 samples.) Private wells 50 Swimming bath water 4 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. The samples examined showed that the water supplied by the Sutton District Water Company maintained a high standard of bacteriological purity throughout the year. Manufacturers using private wells in the Borough continued to chlorinate their supplies. The Medical Officer of Health investigated such waters throughout the year, and is pleased to record that a high standard of bacteriological purity was maintained. The water in the swimming bath at the Beddington Royal Female Orphanage is subject to analysis during the warm periods of the year. During 1939 it was shown to be well looked after and in a satisfactory state of purity. □ RAINACE 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. 32 Owing to the National situation during 1939, it was found necessary to postpone the Council's scheme to lay a larger sewer in Manor Road and Woodcote Road to obviate the flooding under the railway bridge. RIVERS AND STREAMS. The watercourses in the Borough have received constant supervision throughout the year. Sections of the River Wandle were cleaned out between the Croydon Borough Boundary and Mitcham, silt, tree branches, and obstruction being removed. Negotiations are still proceeding with the Surrey County Council and Wallis's Mills regarding alleviation of flooding at Beddington Village. A new weir of approximately double the capacity of the existing one, with a large penstock and by-pass, was constructed during the year to the lake in Grange Park. CLOSET ACCOMMODATION. Practically the whole of the area is on the water carriage system, draining into the public sewers. There are a few chemical and earth closets, chiefly for use on sports grounds, within the district, and 4 cesspools remain in use. PUBLIC CLEAN SI N C. 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. Tipping on land belonging to the Croydon Corporation and at the rear of the existing tip was commenced in 1939. 33 The site in the Borough adjoining Therapia Lane, on which the Croydon Corporation commenced tipping in the latter part of 1938, is now levelled and the work nearly completed. 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. 34 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1939. □ WELLINC-HOUSES. Number of inspections of dwelling-houses 730 Number of inspections recorded under Housing Regulations 163 MILK AND DAIRIES. Number of cowkeepers on register — Number of retail purveyors of milk on register 55 Number of dairy premises on register 9 Number of inspections of premises 18 Defects or infringements of Acts and Orders discovered and remedied 2 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 4 —Supplementary Licences 6 Pasteuriser's Licence 1 — 23 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of visits to slaughterhouse 68 35 FOOD PREMISES. Number of visits to food-preparing places 521 Number of defects discovered and remedied 20 UNSOUND FOOD. Destroyed: — Pork 1061bs. Pigs' Offal 171bs. Beef 761bs. Sheep's Offal 91bs. Fish 991bs. Tuberculosis. Tuberculosis, inflammatory conditions. Decomposition. Decomposition. Decomposition. Total 3071bs. 36 CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — — 232 Number inspected... — — — — 232 All diseases except Tuberculosis. Whole carcases condemned - - - -- Carcases of which some part or organ was condemned - - - - 3 Percentage of the number inspected affected with disease other than tuberculosis - - - - 1.3 Tuberculosis only. Whole carcases condemned - - - - Carcases of which some part or organ was condemned - - - - 9 Percentage of the number inspected a ff e c t e d with tuberculosis - - - - 3.9 FACTORIES. Number of factories on register 94 Number of inspections 197 Number of defects discovered and remedied 15 BAKEHOUSES. Number of bakehouses on register 13 Number of inspections 33 Number of defects discovered and remedied 4 WORKPLACES. Number of inspections of workplaces 53 Number of defects discovered Nil SHOPS AND OFFICES. Number of visits to shops re sanitary conveniences, ventilation and temperature 464 Number of defects discovered and remedied 4 COMPLAINTS. Complaints of nuisances received during the year were due to the following causes: — Defects in dwelling-houses 32 Stoppages in drains 16 Defects in drains or water closets 10 Accumulations of refuse 12 Insect Pests 7 Miscellaneous 16 93 SMOKE ABATEMENT. Number of observations 48 Number of nuisances discovered and remedied 1 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 155 Number of rooms disinfected 95 Lots of bedding and clothing disinfected 76 Number of library books disinfected 142 37 OFFENSIVE TRADES AND FISH FRYING. Number of offensive trade premises in district Nil Number of fish frying premises in district 6 Number of visits to fish frying premises 27 Number of defects discovered and remedied 4 RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints or requests for advice received 25 Number of visits to premises 160 INCREASE OF RENT (RESTRICTIONS) ACTS. Number of applications for certificates Nil NOTICES. Number of informal notices served (including verbal intimations) 437 Number of statutory notices served:— Public Health Act, 1936, Section 93 (nuisances) ... 17 Public Health Act, 1936, Section 75 (dustbins) 6 Public Health Act, 1936, Section 39 (drains) 2 Housing Act, 1936, Section 59 (overcrowding) 1 — 26 PROSECUTIONS. Number of prosecutions Nil SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 4 Water pipes and fittings repaired or renewed 21 Water cisterns cleansed 2 Water cisterns covered 2 Drains. Drains re-laid or repaired 26 Drains unstopped and cleansed 28 Intercepting traps provided with rodeye stoppers 9 Manholes provided or repaired 18 Soil or ventilation pipes repaired or renewed 27 Gully kerbs and channels repaired 14 New soakways constructed 12 38 Closets. New water closets constructed 3 Buildings repaired 6 New pans fixed to water closets 20 Flushing cisterns repaired or renewed 18 Flush pipes and pan joints repaired or renewed 7 Seats repaired 15 Light and ventilation provided 1 Sinks. Sinks renewed 8 Waste pipes repaired or renewed 14 Yards. Yards newly paved or repaired 8 Dust Receptacles. New portable galvanised iron dustbins provided 144 Dampness. Damp-proof courses provided or repaired 32 Roofs repaired 124 Rainwater gutters repaired or renewed 148 Rainwater downspouts repaired or renewed 25 Windows, sills and doors made weatherproof 52 External walls repaired, re-pointed or rendered 138 Earth banked against house walls removed 7 External walls treated with waterproofing solution 52 Ventilation provided under floors 11 General Repairs, Etc. Rooms cleansed 217 Walls and ceilings repaired 124 Floors repaired 23 Stoves repaired or renewed 5 Coppers repaired or renewed 5 Doors repaired or renewed 2 Windows repaired 180 Windows provided with new sashcords 57 Rooms provided with means of ventilation 7 Chimneys repaired 53 Overcrowding abated 4 Refuse removed 6 Number of premises disinfested from bed bugs 5 39 Milk and Dairies. Unregistered purveyor of milk registered 1 Unlicenced seller of graded milk licenced 1 Food Premises. Premises cleansed 5 Drains repaired 5 Receptacles for refuse provided 3 Closets repaired 2 Accumulations of refuse removed 2 Washing facilities provided 1 Sink and waste pipe provided 1 Main water supply provided 1 Factories. Premises cleansed 2 Sanitary conveniences—defects remedied 5 Other defects remedied 8 Bakehouses. Premises cleansed 2 Other defects remedied 2 Shops. Washing facilities provided 2 Heating facilities provided 1 Sanitary convenience provided 1 Byelaws with respect to Nuisances. Accumulations of manure or other offensive refuse removed or covered 5 Smoke. Nuisances abated 1 Fish Frying Premises. Sanitary conveniences repaired 2 Drains repaired 1 Receptacle for refuse provided 1 40 SUMMARY OF WORK DONE DURINC THE YEAR. Number of inspections of dwelling-houses 730 Number of re-inspections of premises 2420 Number of visits to works in progress 2165 Number of miscellaneous visits and inspections 735 Number of visits to dairies 18 Number of visits to factories 197 Number of visits to bakehouses 33 Number of visits to workplaces 53 Number of visits to shops 464 Number of visits to slaughterhouse 68 Number of visits to food stores 521 Number of visits to stables and yards 64 Number of visits to market gardens, et 30 Number of visits to fried fish shops 27 Number of visits to urinals 94 Number of visits to piggeries 7 Number of visits re infectious diseases 155 Number of visits to streams 11 Number of visits re rats 160 Number of visits re smoke abatement 48 Number of complaints of nuisances received and investigated ... 93 Number of preliminary notices served 437 Number of statutory notices served 26 Number of interviews re nuisances, etc 568 Number of water tests applied to drains 29 Number of smoke tests applied to drains 37 Number of rooms disinfected 95 Number of lots of bedding and clothing disinfected 76 Number of library books disinfected 142 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. 41 SHOPS AND OFFICES. Four hundred and sixty-four inspections were made during 1939, and in 4 cases action was necessary in regard to temperature, washing facilities and sanitary accommodation. CAMPINC 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 1 case was 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 4 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 1 Council house and in 4 other houses. The Council house was disinfested by the Council, and the other premises by the tenants or owners. 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. RECULATED TRADES: DAIRIES. There are 9 registered premises within the district, this being 1 more than last year. During the year 18 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 11 SLAUGHTERHOUSES. There is only one Slaughterhouse within the district, this being licensed annually. During the year 232 animals were slaughtered. The whole of the carcases and offal were examined prior to removal from the premises. BAKEHOUSES. There are 13 Bakehouses in the district. The premises were visited periodically. Unsatisfactory conditions were found to exist in 4 instances. OTHER FOOD PREPARINC PLACES. During the year 521 visits were paid to other food preparing places within the district. The conditions found were generally satisfactory FACTORIES. There are 94 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 177 – – Factories without mechanical power 17 – – Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) 3 — — Total 197 — — 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) 2 2 Overcrowding (S. 2) Unreasonable temperature (S. 3) Inadequate ventilation (S. 4) Ineffective drainage of floors (S. 6) – – – – Sanitary Conveniences (S. 7):— Insufficient 2 2 – Unsuitable or defective 3 3 — – Not separate for sexes — — — – Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 8 8 – – 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. HOUSING 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) 712 (b) Number of inspections made for the purpose 730 (2) (a) Number of Dwelling-houses (included under head (1) above) inspected and recorded under the Housing Consolidated Regulations 163 (b) Number of inspections made for the purpose 163 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of Dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 396 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 440 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 25 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 25 (b) By Local Authority in default of owners — 46 C. Proceedings under Sections 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 7 (ii) Number of families dwelling therein 8 (iii) Number of persons dwelling therein 68 (b) Number of new cases of overcrowding reported during the year 5 (c) (i) Number of cases of overcrowding relieved during the year 4 (ii) Number of persons concerned in such cases 34 (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 99 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 18 Accredited l Pasteurised 100 Ungraded 53 Total 172 47 Graded Milk. Two samples 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 no instance was there indication that the milk had not been treated in accordance with the conditions prescribed in the Milk (Special Designations) Orders. Ungraded Milk. Of the 53 samples of ungraded milk examined during the year, 41 were found not to contain more than 200,000 bacteria per millilitre. In 47 of the samples no coliform bacillus was found in 0.01 millilitre. Of the remaining 6 samples 5 showed the bacillus to be 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. Fifty-two 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 a qualified Inspector before being placed on the market. FOOD AND DRUCS (ADULTERATION) ACT, 1928. The duties under the above-named Act were 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 1 1 Cream 4 — 4 Butter — 1 1 – – – – – Cheese – – – – – – – – Margarine – – – – – – – – Lard – – – – – – – – Meat 1 — 1 – – – – – Flour – – – – – – – – Tea – – – – – – – – Coffee – – – – – – – – Cocoa – – – – – – – – Sugar – – – – – – – – Sausages 1 — 1 1 — 1 — — Confectionery and Jam 2 – 2 – – – – – Sausage Meat – – – – – – – — Wine – – – – – – – – Beer 1 1 2 – – – – – Spirits – – – – – – – – Drugs – – – – – – – – *Other articles 3 5 8 1 2 3 — — Totals 31 7 38 3 2 5 — — *Details of other articles— Bleach Ointment 1 4 5 1 2 3 1 – Tannic Acid Jelly – 1 1 – – – – – Ammon. Tincture of Quinine 2 — 2 — — — — — 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, Wellington, under the supervision of the Medical Officer of Health. 49 NUTRITION. 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: — 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. Public Health Act, 1925. Public Libraries Acts, 1892-1919. Small Dwellings Acquisition Acts, 1899-1923. Byelaws in respect to the following are in force: — Good Rule and Government. Removal of House Refuse. Nuisances. Public Sanitary Conveniences. Underground Rooms (Regulations). Tents, Vans, Sheds, etc. Offensive Trades and Fish Frying. Houses Let in Lodgings. Houses of the Working Classes. Removal of Offensive or Noxious Matters. Slaughterhouses. Pleasure Grounds. Smoke Abatement. Allotment Gardens (Rules). Advertisements. 50 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The Minister of Health in October, 1939, made regulations providing for the notification of all cases of measles and whooping cough by medical practitioners to the Medical Officer of Health. The object of the regulations is to enable the department of the Minister of Health to ascertain readily and rapidly the incidence of these diseases, as it may be affected by the displacement of child population caused by the emergency measures following the outbreak of war and the changes that may have occurred in the geographical distribution of the infectious diseases. The following table shows the incidence of infectious disease in the Borough in 1939, the number of cases removed to hospital and the number of deaths attributed to these diseases. Disease. Number Notified. Removed to Hospital. Deaths. Scarlet Fever 29 25 Diphtheria 10 9 2 Erysipelas 7 2 — Cerebro-Spinal Meningitis 1 1 — Pneumonia 12 — *7 Acute Anterior Poliomyelitis 2 2 — Typhoid Fever 1 1 1 Measles 2 — — Ophthalmia Neonatorum 1 1 — Puerperal Pyrexia 2 1 — Totals 67 42 10 *Ineludes deaths from all forms of Pneumonia. 51 52 Cases of Infectious Disease notified during the year 1939. 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. 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. Scuth. North. Central. South. Scarlet Fever 29 — — 1 1 4 15 7 — 1 — — — 8 2 7 9 3 1 25 ___ Diphtheria 10 — — — — 1 5 1 1 2 — — — 5 2 1 1 1 — 9 2 Erysipelas 7 — — — — — — — — — 2 3 2 2 1 3 1 — — 2 — Cerebro-Spinal Meningitis 1 — — — — — — — — 1 — — — — — — 1 — — 1 — Pneumonia 12 — — — — — — — 2 3 3 3 1 1 1 1 6 2 1 — *7 Acute Poliomyelitis 2 — — — — — 1 — — 1 — — — 1 — — — 1 _ 2 — Typhoid Fever 1 — — — — — — — — — — 1 — — — 1 — — — 1 1 Measles 2 — — — — 1 1 — — — — — — 1 — — — 1 — — — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — 1 — — — __ — 1 — Puerperal Pyrexia 2 — — — — — — — — 2 — — — — 1 — 1 — — 1 — Totals 67 1 1 1 6 22 8 3 10 5 7 3 19 7 13 19 8 1 42 10 *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 former Urban District until 1939: — Cases of Infectious Disease notified in each year, 1915-1939. 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 1939 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 29 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 10 Enteric Fever 1 1 — 1 3 5 1 — 6 1 — — 4 39 1 1 1 1 — — 1 2 2 — 1 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 7 Poliomyelitis 1 — — — 2 — — — — — — — — — — — — — — — 1 — 1 6 2 Ophthalmia Neonatorum 1 — — 1 — 2 — — — — 1 1 — 2 — 2 — 1 — 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 — 2 Measles — 87 241 158 39 — — — — — — — — — — — — — — — — — — — 2 Cerebro Spinal Meningitis — — — 1 — — 1 — — 1 — — — 1 — — 1 — — — — — — 2 1 Pneumonia — — — — 16 3 8 4 5 9 2 5 14 19 20 13 16 36 42 15 4 2 1 9 12 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 26 Other Forms 6 8 4 4 — — 3 1 6 — 5 3 8 6 9 5 1 3 5 3 7 6 4 8 5 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 98 53 The monthly incidence of Infectious Disease, 1939. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 1 1 6 2 7 6 3 3 — — — 29 Diphtheria 1 — 6 — — — — 1 — 1 1 — 10 Erysipelas — — 1 1 — 1 — — — 2 1 1 7 Cerebro-Spinal Meningitis – – – 1 – – – – – – – – 1 Pneumonia 4 1 5 1 1 — — — — — — — 12 Acute Poliomyelitis – – – – – – – – 1 1 — — 2 Typhoid Fever – – – – – – – – – – – 1 1 Measles – – – – – – – – – – – 2 2 Ophthalmia Neonatorum 1 – – – – – – – – – – – 1 Puerperal Pyrexia — — 1 1 – – – – – – – – 2 Totals 7 2 19 6 8 7 3 4 1 4 2 4 67 54 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. As the schools were closed during 1939 for some months on account of the War, no useful purpose would be served in publishing the returns received, as a gross under-statement would be shown. TUBERCULOSIS. There were 31 new cases notified during the year. The following table gives the number of new cases notified during the past five years: — New Cases. 1935 1936 1937 1938 1939. M. F. M. F. M. F. M. F. M. F. Pulmonary 12 11 9 9 10 10 13 5 13 13 Non-Pulmonary 2 5 4 2 2 2 5 3 3 2 Totals ... 14 16 13 11 12 12 18 8 16 15 The annual case rate for Pulmonary Tuberculosis per 1,000 of population for 1939 was 0.80 compared with 0.58 for 1938. The annual case rate for Non-Pulmonary Tuberculosis per 1,000 of population for 1939 was 0.17 compared with 0.26 for 1938. The following table gives the number of deaths from this disease during the past five years: — Deaths. 1935 1936 1937 1938 1939. M. F. M. F M. F. M. F. M. F. Pulmonary 10 7 12 12 6 6 2 4 7 1 Non-Pulmonary 3 2 3 — 3 1 2 — 2 1 Totals 13 9 15 12 9 7 4 4 9 2 It will be seen from the foregoing table that 11 deaths were registered as due to Tuberculosis, of which 8 were Pulmonary and 3 NonPulmonary. The figures correspond to a death rate per 1,000 of popu- 55 Tuberculosis. lation of 0.27 for Pulmonary Tuberculosis and 0.10 for Non-Pulmonary Of the 11 deaths which occurred, 4 were in unnotified cases, i.e., 36.3 per cent, of the total Tuberculosis deaths. 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 and under 5 – – – – – – – – 5 and under 10 – – – — — – 10 and under 15 1 – – — — – — – 15 and under 20 1 1 – — — – 1 – 20 and under 25 – 5 1 – – – – – 25 and under 35 3 4 1 1 1 – — 1 35 and under 45 3 2 – — 2 1 — – 45 and under 55 1 1 – 1 2 – 1 — 55 and under 65 3 — 1 — 1 – — — 65 and upwards 1 — — — 1 — — Totals 13 13 3 2 7 1 2 1 The new cases were distributed amongst the Wards as follows: — Beddington. Wellington. North. Cent. South. North. Cent. South. Pulmonary 2 4 6 10 3 1 Non-Pulmonary 2 1 1 1 — — Totals 4 5 7 11 3 1 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 28 such examinations were made. 56 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 1939, assisting a number of Tuberculosis patients and their dependents in various ways. 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. 57 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to the Hospital during 1939. Disease. Beddington and Wallington. Coulsdon and Purley. Merton and Morden. Mitcham. cases deaths cases deaths cases deaths cases deaths Diphtheria 9 2 10 34 2 27 1 Scarlet Fever 25 — 43 89 — 57 – Typhoid 1 1 – Erysipelas 2 — 2 – 4 — 6 – Tonsillitis 3 — 1 – 2 — 5 1 Influenza — — 2 – 1 — — – Bronchitis — — — – 1 — — – Whooping Cough 2 — 2 – 7 — 28 3 Rubella — — 5 – — — 3 — Puerperal Fever 3 — 1 – — — 4 — Admitted with Mother 2 — 1 – 1 — 2 — Meningitis 1 — — – 1 — — — T.B. Meningitis — — 1 1 — — 1 1 Enteritis 1 – – – – – 1 — Chill 1 – – – – – – – Cerebral Haemorrhage — — — – 1 — — — Poliomyelitis 2 — — – 1 — — — Osteomyelitis — — — – 1 — — — Dermatitis 2 — — – — — 2 — Urticaria – – – – – – 1 — No apparent Disease — — — – 1 — — — Totals 54 3 68 1 144 2 137 6 58