LIBRARY BOROUGH OF BEDDINGTON AND WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1940 BOROUGH OF BEDDINGTON AND WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1940 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., 1940 15 Cancer 17 Violence 18 Maternal Mortality 18 Infantile Mortality 18 General Provision of of Health Services for the Area: Laboratory Facilities 20 Ambulance Facilities 20 Nursing in the Home 21 Treatment Centres and Clinics 21 Hospitals 23 Disinfection 24 Maternity and Child Welfare: General Observations 24 Ante-natal and Post-natal Supervision 24 Maternity and Child Welfare Centres 26 Maternity Ward 27 Consultant Obstetrician 27 Home Help 28 Birth Control 28 Treatment: Orthopaedic 28 Dental 28 Minor Ailments 28 Provision of Milk and other Foods 29 Health Visiting 29 Child Life Protection 30 2 Sanitary Circumstances of the Area: Water Supplies 31 Drainage and Sewerage 32 Rivers and Streams 32 Closet Accommodation 32 Public Cleansing 32 Sanitary Inspection of the Area 33 Statement of the Senior Sanitary Inspector for the Year 1940: Dwelling Houses 34 Milk and Dairies 34 Slaughterhouse 34 Food Premises 35 Unsound Food, 35 Factories 36 Bakehouses, 36 Workplaces 36 Shops and Offices 36 Complaints 37 Smoke Abatement 37 Infectious Disease and Disinfection 37 Offensive Trades and Fish Frying 37 Rats and Mice (Destruction) Act 37 Increase of Rent (Restrictions) Act 37 Notices 38 Prosecutions 38 Sanitary Improvements: Water Supply 38 Drains 38 Water Closets 38 Sinks 38 Yards 38 Dust Receptacles 38 Dampness 39 General Repairs, etc 39 Milk and Dairies 39 Food Premises 39 Factories 39 Bakehouses 39 Workplaces 39 Shops and Offices 40 Bye-laws with respect to Nuisances 40 Fish Frying Premises 40 Summary of work done during the year 40 Shops and Offices 41 Camping Sites 41 3 Smoke Abatement 41 Swimming Baths 41 Eradication of Bed Bugs 41 Schools 42 Dairies 42 Milk (Special Designations) Orders 43 Slaughterhouses 43 Bakehouses 43 Other Food Preparing Places 43 Factories 43 Housing: Housing Statistics: Inspection of Dwelling Houses- 45 Remedy of Defects without service of Formal Notice 45 Action under. Statutory Powers 45 Housing Act, 1936—Part IV—Overcrowding 46 Number of Houses and Flats erected during the year 46 Inspection and Supervision of Food: Milk 46 Meat 47 Food and Drugs Act, 1938 47 Chemical and Bacteriological Examinations 48 Nutrition 49 Shell Fish (Molluscan) 49 Adoptive Acts and Bye Laws 49 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 50 Incidence of Infectious Diseases in Age Groups and Wards 51 Cases of Infectious Diseases notified, 1915-1940 52 Monthly Incidence of Infectious Disease 53 Non-notifiable Diseases 54 Tuberculosis 54 Prevention of Blindness 56 Cases admitted to Wandle Valley Joint Hospital 57 4 BOROUGH OF BEDDINGTON AND WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1940. Members: Councillor Mrs. V. Boyce (Chairman). Alderman W. W. Binnie, J.P. (Mayor). Councillor F. G. Bryant (Deputy Mayor). Alderman G. Purser. Councillor H. H. Best. Councillor B. W. Brenner. Councillor W. W. Craig. Councillor F. C. Elwood. Councillor J. H. Emmett. Councillor B. Grundy. Councillor Mrs. O. L. Wiles. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1940. Members: Councillor Mrs. V. M. Boyce (Chairman). Alderman W. W. Binnie, J.P. (Mayor). Councillor F. G. Bryant (Deputy Mayor). Councillor F. C. Elwood. Councillor Mrs. O. L. Wiles. Co-opted Members: Miss E. Hall. Mrs. L. Rose, Mrs. M. Woods, B.A. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1940. Members: Alderman W. W. Binnie, J.P. (Mayor). Alderman H. D. Banks. Alderman G. Purser. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERACE BOARD. December, 1940. Members: Alderman W. W. Binnie, J.P. (The Mayor). Alderman J. Vale. Councillor F. C. Elwood. Councillor W. P. Hunt. 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. Clerks:— R. F. Burns (Chief Clerk). Miss M. Frost. E. D. Evezard. Laboratory Assistant:— †W. K. Stevens. E. Morris (Temporary). †On Active Service. *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, 1940. This health report is the first to cover one full year of war. The text of the report has been kept at a minimum by reason of war economy and comprises merely the summary of essential statistics. It is as well, however, in this introductory letter, to refer to the more significant of the statistics and draw inferences, where possible, to illustrate the effect of the war upon the inhabitants of the Borough. The Registrar-General's estimate of the resident population for 1940 was 27,410. The population during the year fluctuated considerably, rising from 28,328 in January to 29,645 in August, and falling to 26,293 in December. Many persons who, with their families, had left the district in 1939 began in 1940 to return, and this mflux continued up till August. During that month, however, the German air attack fell heavily on this district, and continued until the end of 1940 with little respite. During the last three months of the year an outward flow again took place, the population falling in December to 26,293. The fluctuating circumstances of the population had a bearing on the attendances at the Maternity and Child Welfare clinics. The figures reached their lowest level during the worst months of the air attack, but towards the end of the year already an increasing number of evacuees from bombed properties in the Metropolitan districts began to flow into the area. It may be anticipated that, during subsequent war years, this flow of evacuees from London, together with the presence of an increasing number of residents from South Coast towns, will keep our population figure at a fairly high level. The Birth Rate has been maintained at approximately the same level as in 1939, being 12.55 per 1,000. The Death Rate, however, is higher, being 12.62 per 1,000 as compared with 9.38 per 1,000 in 1939. In the report it will be noticed that 38 deaths were attributed to war operations, 26 residents being killed in air raids within the Borough and 12 residents elsewhere. In addition, 3 non-residents were killed in raids in the Borough. 7 A further improvement is to be noted in the Infantile Mortality Rate which, at 34.88 per 1,000 live births for 1940, is much better than the figure for 1939 of 40.30 per 1,000 live births. When compared with the rate for the country as a whole, 55.0 per 1,000 live births, the figure is even more significant. The health of infants, in spite of war dietary, has been good. There have been no epidemics of infantile diseases and no cases of malnutrition and deficiency diseases were seen at centres during the year. There were no deaths associated directly or indirectly with child birth. This fact is well worthy of recognition, and it reflects credit on all associated with maternal care. The Ante-natal Clinic continues to perform a very useful function. Amongst the mothers seen at the clinic, few cases were noticed in which war dietary is having an adverse effect, but possibly it is too early in the war to make any pronouncement. Public air raid shelters were under the constant supervision of the Medical Officer of Health and the Sanitary Inspectors, and while it must be frankly admitted that the shelters are only just within the minimum hygiene standards for requirements of health, we cannot recall any cases in which the spread of disease or ill-health was directly attributable to shelter life. The extent to which the shelters are used varies considerably, but during the last four months of the year under review we probably reached the highest figures of shelter population yet recorded. In general terms it must be acknowledged that the health of the population of this district during the first complete war year has been exceptionally good. For future years it is to be hoped that, in spite of extremely difficult conditions of diet, the provision of vitamin concentrates, where they are most needed, should make it possible to avoid some of the worst effects of war, especially in its relation to the health of mothers and infants. In conclusion, 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. October, 1941. 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 1940 27,410 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1940 9,417 Rateable Value, December, 1940 £386,320 Sum represented by penny rate, December, 1940 £1,521 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 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. 10 11 EXTRACTS FROM VITAL STATISTICS. Total. M. F. Birth Rate per 1,000 of the estimated resident population. Live Births—Legitimate 333 190 143 12.55 „ „ Illegitimate 11 7 4 Total 344 197 147 Rate per 1,000 total births. Still Births 9 6 3 25.50 Death Rate per 1,000 of the estimated resident population. Deaths 346 159 187 12.62 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 34.88 Legitimate Infants per 1,000 legitimate live births 33.00 Illegitimate Infants per 1,000 illegitimate live births 90.90 Deaths from Cancer (all ages) 49 Deaths from Measles (all ages Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) 1 VITAL STATISTICS. Area. The area of the Borough is 3,048 acres. Population. The Registrar-General's estimate of the resident population for the mid-year 1940 is 27,410, and the vital statistics in this report are based on that figure. A, decrease of 3,780 is shown over the figure for 1939,. when the population for that year was estimated at 31,190. The war-time population shows a considerable decrease as a result of voluntary evacuation. This is more noticeable in the southern area, many houses being occupied by the Services and some remaining empty. In 1915 there were 3,389 occupied houses, with an average of 4.0 persons per house. In 1940 there were 9,417 occupied houses, distributed as follows: — Beddington: — North Ward 2421 Central Ward 1402 South Ward 1659 5482 Wallington: — North Ward 1517 Central Ward 1498 South Ward 920 3935 Total 9417 The average number of persons per house was 2.9. Births. (a) Live Births.—The Registrar-General returns the number of births registered during 1940 as 344, of which 197 were males and 147 were females. This gives a live birth rate of 12.55 per 1,000 total population, compared with 12.63 in 1939 and 14.6 for England and Wales. Eleven of the births were illegitimate, 7 males and 4 females. 12 (b) Stillbirths.—The number of stillborn children registered in 1940 was 9, of which 6 were males and 3 were females. This gives a stillbirth rate of 25.50 per 1,000 total births and 0.33 per 1,000 total population. Deaths. The Registrar-General gives the number of deaths registered as 346, of which 159 were males and 187 were females. Taking the estimated population figure of 27,410, the crude death rate for 1940 is 12.62 per thousand, compared with 9.38 for 1939. The corresponding figures for England and Wales for 1940 and 1939 are 14.3 and 12.1 respectively. The corrected death rate, i.e., the rate which would be arrived at if the age and sex constitution of the population of Beddington and Wallington was in the same proportion as the country as a whole, shows no change as the Registrar-General's comparability factor for the adjustment of the death rate of Beddington and Wallington is 1.00. REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1940, 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 occuring during the year 1940. Causes of Death. Males. Females. Total. All Causes 159 187 346 1. Typhoid and Paratyphoid Fevers 1 1 2. Cerebro-spinal Fever 2 1 3 3. Scarlet Fever - - - 4. Whooping Cough - - - 5. Diphtheria - - - 6. Tuberculosis of Respiratory System 8 1 9 7. Other forms of Tuberculosis - 3 3 8. Syphilitic Disease - 2 2 9. Influenza 2 1 3 10. Measles - - - 11. Acute Poliomyelitis and Polioencephalitis - - - 12. Acute Infectious Encephalitis 1 — 1 13.mCancer of Buccal Cavity and Oesophagus (males) - - - 13.fCancer of Uterus — 1 1 14. Cancer of Stomach and Duodenum 3 3 6 15. Cancer of Breast 1 5 6 16. Cancer of all other Sites 18 18 36 17. Diabetes 1 1 18. Intra-cranial Vascular Lesions 9 11 20 19. Heart Disease 46 54 100 20. Other Dieases of the Circulatory System 5 9 14 21. Bronchitis 8 9 17 22. Pneumonia 4 9 13 23. Other Respiratory Diseases 2 — 2 24. Ulceration of the Stomach or Duodenum 3 2 5 25. Diarrhoea (under 2 years of age) — 1 1 26. Appendicitis — — — 27. Other Digestive Diseases — 5 5 28. Nephritis 5 6 11 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — — — 31. Premature Birth 2 1 3 32. Congenital Malformations, Birth Injury, Infantile Disease 3 1 4 33. Suicide 3 2 5 34. Road Traffic Accidents 1 — 1 35. Other Violent Causes 24 22 46 36. All Other Causes 8 19 27 14 Comparative crude birth rates, death rates, analysis of mortality, maternal death rates and case rates for certain infectious diseases in the year 1940:— \ England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Borough of Beddington and Wallington. Births— Rates per 1,000 Population. Live 14.6 16.0 15.7 13.7 12.55 Still 0.55 0.64 0.55 0.44 0.33 Deaths— All Causes 14.3 15.8 12.8 17.8 12.62 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.04 Smallpox — — — — — Measles 0.02 0.02 0.02 0.01 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.00 0.00 Diphtheria 0.06 0.07 0.05 0.01 0.00 Influenza 0.32 0.29 0.30 0.18 0.11 Notifications— Cerebro Spinal Fever 0.32 0.33 0.29 0.28 0.18 Measles 10.24 1.23 9.99 1.78 2.74 Whooping Cough 1.34 1.29 1.35 0.22 0.18 Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 1.63 153 1.57 0.82 0.77 Diphtheria 1.16 1.29 1.21 0.61 0.18 Enteric Fever 0.07 0.06 0.10 0.06 0.04 Erysipelas 0.33 0.36 0.30 0.35 0.15 Pneumonia 1.20 1.37 1.00 0.87 0.26 Deaths under 1 year of age Rates per 1,000 Live Births. 55 61 54 50 34.88 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 5.9 4.4 5.8 2.90 Maternal Rates per 1,000 Total Births (i.e., Live and Still). Mortality— 0.52 1 Not available 0.00 Puerperal Sepsis Others 1.64 0.00 Total 2.16 0.00 Notifications— Puerperal Pyrexia 11.96 13.90 9.73 13.34 2.83 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 9 2.60 Cancer . 49 14.16 Intra Cranial Vascular Lesions 20 5.78 Heart Diseases 100 28.90 Other Circulatory Diseases 14 4.05 Pneumonia (all forms) 13 3.76 Bronchitis 17 4.92 Nephritis 11 3.18 Violence 52 15.03 16 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 CANCER. The following table gives the ages, sex and localisation of the disease in the 49 cases in which death was attributed to this cause: — M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Brain _ — 1 — — — — 1 — Larynx — — — — — — — — — — 1 — — — — — — — 1 — Lungs — — — — — — — — — — 1 2 — — — 1 — — 1 3 Breast — — — — — — — — 1 — — 1 — 1 — 2 — I 1 5 Stomach — — — — — — — — — 2 1 — — — 1 1 1 — 3 3 Liver — — — — — — — — — — 1 — 1 1 — — — 1 2 2 Kidney — — — — — — — — — — 1 — — — 1 — — — 2 — Pancreas — — — — — — — — — — — — 1 — — — — — 1 — Large Intestine — — — — — — — — — — — — — 5 — 1 — 1 — 7 Urinary Bladder — — — — — — — — — — — — — — — — — — 2 — Prostate — — — — — — — — — — — — — — 1 1 — 2 — Testicles — — — — — — — — — — — — — — 1 — — — 1 — Vagina — -— — — — — — — — — — 1 — — — — — 1 Uterus — — — — — — — — — 1 — — — — — — — — — 1 Ovary — — — — — — — 1 — — — 1 — — — — — — — 2 Rectum — — — — — — 1 — — 1 1 — 2 1 — 1 — — 4 3 Unclassified — — — — — — 1 — — — — — — — — — — — 1 — — — — — 1 — 2 1 2 4 6 4 5 9 4 6 2 3 22 27 17 VIOLENCE. Five deaths, 3 males and 2 females, were recorded from Suicide. There were 47 deaths from other forms of violence, 25 males and 22 females. Thirty-eight of the deaths were due to War operations. One death of a Wallington resident, due to a road accident, occurred outside the Borough. No deaths of Wallington residents occurred in roads within the Borough. MATERNAL MORTALITY. No deaths occurred during the year under review, directly or indirectly associated with child-birth. It is again 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 undei one year of age was 12 (9 males and 3 females), all but one toeing in legitimate children. This gives an infantile mortality rate of 34.88 per 1,000 live births, as compared with 40.30 in 1939 and 55.0 for Sr. gland and Wales. This low figure for infantile mortality is a matter for congratulation. It is much lower than the rate for the country as a whole and. represents the results of the labours of all services dealing with the preservation of infant life. Only 12 deaths of infants under one year were registered out of a total of 344 live births. This rate is often taken as an index of the general health and prosperity of the district as a whole. 18 The following table gives the age and cause of death of each infant who died: — Age. Cause of Death. Few minutes Difficult delivery (Forceps). 10 hours Birth injury. Shoulder presentation, version to breech. 1 day Prematurity 1 week 2 weeks 2 weeks 3 weeks Regurgitation of stomach contents into air passage. 7 weeks Asphixia, caused by pressure of bed-clothes in the cot. 3 months Congenital heart disease. 5 months Gastro-enteritis (infantile). 5 months Bronchial pneumonia. 5 months Inhalation of regurgitant food into lungs. Three or 25 per cent, of the deaths occurred in the first week of life; 7 or 58.3 per cent, occurred in the first month; and 5 or 41.7 per cent, from the second to the twelfth month. The infantile mortality in the different Wards is given below: — Beddington : — North 2 Central 3 South 1 Wallington: — North 1 Central 5 South — 19 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITSES. 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 122 3 119 Tuberculosis—(Sputa) 30 4 26 Totals 152 7 145 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 227 Milk: — Bacteriological analyses 206 Microscopical examinations 44 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. 20 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. 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 395 cases, including 56 maternity and 106 midwifery patients. TREATMENT CENTRES AND CLINICS. Maternity and Child Welfare Centres: — Centre. When held. Elm Grove, The Grange, London Road. First and third Mondays of the month.* Hackbridge, The Grange, London Road. Second and fourth Mondays of the month.* Bandon Hill, Methodist Hall, Sandy Lane North. First and third Tuesdays of the month.* Beddington, Village Hall. First and third Wednesdays of the month.* Wallington, Baptist Hall, Queen's Road. Second and fourth Wednesdays of the month.* *October to March, 1.30-3.30. April to September, 2.0-4.0. Thursdays and Fridays, 2.0-4.0. Ante-natal and Post-natal Clinic, The Nurses' Home, 57, Montagu Gardens Consultant Ante-natal and Post-natal Clinic, The Nurses' Home, . 57, Montagu Gardens. Every third Friday of the month. 21 Voluntary Helpers.—Mrs. Beale, Mrs. Blake, Mrs. Boyce, Mrs. Buck, Miss Curwain, Mrs. Daw, Mrs. Dixon, Mrs. Duncan, Mrs. Elwood, Mrs. Gorman, Mrs. Hooper, Mrs. Hudson, Mrs. Jackson, Mrs. James, Mrs. Jeffrey, Mrs. Littlejohn, Mrs. Lennard, Mrs. Mellows, Mrs. Mountney, Mrs. Phillips, Mrs. Rose, Mrs. Raine, Mrs. Scott, 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 AGAINST DIPHTHERIA. The scheme, commenced in 1937 for the immunisation of children against Diphtheria, continued satisfactorily throughout 1940. 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 4 3 4 7 9 1 28 Number undergoing treatment 1 2 1 3 11 5 23 Total 5 5 5 10 20 6 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. 22 The treatment at present in use consists of three injections of 1 cubic centimetre of Toxoid Antitoxin Floccules (TA.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. IMMUNISATION AGAINST TYPHOID FEVER. During the year, because of the added risk of infection by diseases of the Typhoid group, which might result from interference with sanitation due to enemy action, the Council offered free facilities for inoculation against this group of diseases. Forty-one clinics were held and 495 injections given. 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 infeetious 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. General 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. 23 Public Assistance Hospitals. The Public Assistance Hospitals serving this area are situated at Epsom and Kingston. Maternity Cases. Under an agreement between the Council and the Carshalton, Beddington and Wallington (War Memorial) Hospital, a very limited number of maternity cases are admitted upon the recommendation of the Medical Officer of Health. Maternity cases are also admitted to the Public Assistance Hospitals. DISINFECTION. The disinfection of houses has been undertaken by the Council during the year and the Wandle Valley Hospital Board have continued to co-operate in the disinfection of bedding, etc. When residents request disinfection which is not essential in the interests of the public health, this is undertaken upon a payment of 10s. per load for bedding, etc., and 5s. for the first room and 2s. 6d. for each additional room as applied to house disinfection. MATERNITY AND CH LD WELFARE. The Council is the responsible authority for this important section of Public Health work. During 1940 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. No change took place in the arrangement of this clinic, two sessions weekly being held, with an average attendance of 13 patients per session. 24 Ante-natal and Past-natal Attendances, 1940. Council Cases. Nursing Association Cases. Total— 1940. Total— 1939. Number of clinics held 99 55 Ante-natal cases: — Total number attending during the year 115 131 246 276 Number of first attendances 95 95 190 234 Number of re-attendances 418 518 936 939 Total attendances 513 613 112 6 1173 Average attendance per session 5.2 6.2 11.4 21.3 Number of consultations with Medical Officer 513 613 1126 1173 Post-natal cases: — Total number attending during the year 73 44 117 105 Number of first attendances 42 71 113 90 Number of re-attendances 3 3 6 22 Total attendances 45 74 119 112 Average attendance per session 0.5 0.7 1.2 2.0 Number of consultations with Medical Officer 45 74 119 112 During the year 246 expectant mothers attended the Clinic as compared with 276 in 1939. This represents approximately 79 per cent. of the total notified births (live and still) which occurred in the Borough during 1940. The figures for 1939 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 48 per cent, of the cases seen at the ante-natal sessions return for post-natal examinations after their confinements. Dr. Winifred Small continues to act as Ante-natal Medical Officer and her services have been greatly appreciated. 25 CONSULTANT ANTE-NATAL AND POST-NATAL CLINIC. The Consultant Clinic continued to be held 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. 1940 1939 Clinics held 12 12 Patients attending: Ante-natal 23 10 33 37 Post-natal 1 — — 1 8 Total attendances 24 10 — 34 45 MATERNITY AND CHILD WELFARE CENTRES. The five Infant Welfare Centres have been held fortnightly on the same days as in previous years. As foreshadowed in last year's report, the numbers of patients attending the Centres has shown, a marked decline in 1940. Voluntary evacuation proceeded at a fairly rapid rate from September, 1939 onwards, and although the percentage of children living in the area attending' the clinics was maintained at 73%, the child population was so reduced as to reflect a considerable fall in total attendances. 26 The following table shows the atendances for 1940 at the five Centres maintained by the Council: — Bandon Hill Bedding ton Elm Grove Hackbridge Walling- ton: Totals, 1940 Totals, 1939. Number of sessions held 24 22 24 23 23 116 118 Infants: — No. of new cases under 1 year 90 49 48 35 79 *301 326 No. of re-attendances 583 394 528 262 551 2318 2777 No. of new cases over 1 year 35 14 23 15 29 116 89 No. of re-attendances 845 623 675 673 648 3464 4163 Total attendance of infants 1553 1080 1274 985 1307 6199 7355 Average attendance of infants per session 65 49 53 43 57 53 62 Mothers attending 1373 938 1100 800 1197 5408 6490 Total attendances 2926 2018 2374 1785 2504 11607 13845 Average total attendance per session 122 92 99 78 109 100 117 "Includes 51 children who made their first attendance at Clinics outside the Borough. Approximately 73 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 8 For medical reasons 6 For unsuitable home conditions 2 Normal confinements 4 Abnormal confinements 4 All the cases were referred from the Ante-natal Clinic. CONSULTANT OBSTETRICIAN. No changes occurred in the appointment of Consultant Obstetrician during the year. The services of the Consultant were called upon three times in 1940. 27 HOME HELP. Two Home Helps are employed by the authority, an additional Home Help being appointed in December, 1940, to assist in domestic duties during confinements occurring in the homes of residents. A Home Help was provided in 18 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 1940, 12 women from the Borough attended this clinic. TREATMENT. Orthopedic. 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 14 cases (defects of the feet, bow legs, knock knees, etc.) received treatment. Dental. During 1940, 67 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 42 3 22 Received treatment 20 3 18 Made dentally fit 20 3 18 Treatments: — Fillings: — (a) In temporary teeth — -— — (b) In permanent teeth 5 — 6 Teeth extracted 151 40 58 Administrations of general anaesthesia 18 2 13 Patients supplied with dentures 14 3 — Dentures supplied 24 6 — Minor Ailments. Fifty-three cases were referred frem the Maternity and Child Welfare Centres to the-under-mentioned Hospitals during the year: — 28 Carshalton, Beddington and Wallington (War Memorial) Hospital 6 Croydon General Hospital 40 Great Ormond Street Hospital 1 The Wilson Hospital, Mitcham 5 Royal National Orthopaedic 1 The conditions requiring treatment were: — Tonsils and Adenoids 8 Naevus 12 Circumcision 1 Dental defects 1 Orthopaedic defects 16 Ear conditions 2 Eye conditions 6 Skin conditions 6 Other conditions (Tongue defect) 1 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., 1940. New Cases during 1940. Cases discontinued. Cases on 31st Dec., 1940. Milk free 90 58 138 10 Milk at half cost 22 25 47 — Total 112 83 185 10 In addition, in certain cases, concentrated vitamin 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 VISITING. Two full-time Health Visitors, who work under the supervision of the Medical Officer of Health, are employed. 29 The following is a summary of the work carried out during the year: — Home visiting. Visits to expectant mothers: — No. .of first visits 23 No. of re-visits 23 Total 46 Visits to infants: — No. of first visits to infants under 1 year 343 No. of re-visits to infants under 1 year 563 No. of visits to infants 1-5 years 1212 Total 2118 Public Health Act (Child Life Protection): — No. of visits paid 59 Other visits: — Infantile mortality 3 Stillbirths 6 Infectious diseases 11 Tuberculosis 20 Maternity, Home Help, Milk and Dental Scheme 350 Unsuccessful 159 549 Total visits, 1940 2713 Total visits, 1939 3662 Attendances at clinic sessions. Maternity and Child Welfare Centres 206 Ante-natal and Post-natal Clinics 99 Total attendances, 1940 305 Total attendances, 1939 265 Interviews at office 201 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 9 Number of children on the register at the end of the year 16 Number of children who died during the year Nil During the year 59 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. 30 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 227 samples of water were submitted for bacteriological examination in the Council's laboratory. Samples were taken as follows: — Main Water Supply (Sutton Well and Woodmansterne Well) (An average per month of 14 samples) 164 Private Wells 61 Spring Water (Water-cress beds) 2 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 Company have made adequate provision to meet disturbances in the water supply resulting from enemy action. Incidents in which they were called upon to repair mains and distribute water by cartage were attended by no untoward results, the repairs being carried out with expedition and efficient sterility. Certain additional sources of supply, which might be used in an emergency were investigated by the Medical Officer o'f Health and an emergency scheme for the district was agreed upon by the Civil Defence Committee. 31 DRAINAGE AND SEWERAGE. The Council have continued the maintenance of the soil and storm water drainage systems during the year. Because of the war, however, no extensions have been undertaken. During the last quarter of the year, some main sewers, particularly in the northern part of the district were damaged as a result of enemy action. Repairs, although difficult in some instances, were carried out promptly and efficiently. In spite of the temporary inconvenience and disturbance of normal drainage systems, no case of illness resulted from this cause. RIVERS AND STREAMS. The regular maintenance and cleansing of the watercourses in the Borough was undertaken throughout the year, so far as limited staff would allow, and no flooding due to natural causes occurred in any part of the district. 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 in use in the district, their number having been increased recently by the necessity of installing chemical closets in Air Raid Shelters and Wardens' Posts. Four cesspools remain in use, but have created no nuisance during the year. PUBLIC CLEANS!NC. 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 from private premises. The occupiers of the premises concerned carry out the work in a satisfactory manner. 32 Tipping on land belonging to the Croydon Corporation and at the rear of the existing tip was commenced in 1939 and is now completed. The Croydon Corporation commenced tipping in the latter part of the year on a site in the Borough north of Therapia Lane. This work is continuing satisfactorily and is under constant supervision by the Council's Officers. 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. 33 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1940. DWELLING-HOUSES. Number of inspections of dwelling-houses 532 Number of inspections recorded under Housing Regulations 5 MILK AND DAIRIES. Number of cowkeepers on register — Number of purveyors of milk on register 51 Number of dairy premises on register 8 Number of inspections of premises 44 Defects or infringements of Acts and Orders discovered and remedied 1 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 4 Number of visits to other premises on which animals were slaughtered 6 34 CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — — 10 Number inspected — — — — 10 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 — — — — 30 Tuberculosis only. Whole carcases condemned — — — — — Carcases of which some part or organ was condemned — — — — — Percentage of the number inspected affected with tuberculosis — — — — — *Emergency slaughter. FOOD PREMISES. Number of visits to food-preparing places 885 Number of defects discovered and remedied 17 UNSOUND FOOD. Destroyed or released for suitable disposal: — Tons cwts. qtrs. lbs. Sugar 50 15 — — Cocoa and chocolate 24 11 1 12 Sugar confectionery 14 11 — — 35  Tons cwts qtrs. lbs. Confectioner's starch 13 11 1 22 Skimmed milk powder 6 — 2 — Jams and jellies 3 4 2 — Glucose 1 11 — 14 Tea 2 1 9 Golden syrup 2 — 20 Fruit and vegetables 1 2 5 Bread and flour confectionery 3 14 Cotton seed oil 2 — Bacon 1 25 Fish 1 16 Margarine and cooking fat 1 — Butter 10 Beef 3 3 Bullock's Offal 18 Lamb 1 12 Sheep's Offal 20 Pork 2 Pigs' Offal 1 — Total 114 15 1 6 FACTORIES. Number of factories on register 90 Number of inspections 151 Number of defects discovered and remedied 10 BAKEHOUSES. Number of bakehouses in district 13 Number of inspections 44 Number of defects discovered and remedied 4 WORKPLACES. Number of inspections of workplaces 20 Number of defects discovered and remedied 1 SHOPS AND OFFICES. Number of visits to shops re sanitary conveniences, ventilation and temperature 709 Number of defects discovered and remedied 12 36 COMPLAINTS. Complaints received during the year were due to the following Causes: — Defects in dwelling-houses 35 Prevalence of rats 25 Stoppages in drains 31 Defects in drains or water closets 17 Food supplies 9 Insect Pests 6 Accumulations of refuse 4 Miscellaneous 6 133 SMOKE ABATEMENT. Number of observations 22 Number of nuisances discovered and remedied — INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 112 Number of rooms disinfected 84 Lots of bedding and clothing disinfected 60 Number of library books disinfected 218 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 12 Number of defects discovered and remedied 1 RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints or requests for advice received 25 Number of visits to premises 125 Number of infested premises dealt with 22 INCREASE OF RENT (RESTRICTIONS) ACTS. Number of applications for certificates Nil 37 NOTICES. Number of informal notices served (including verbal intimations) 281 Number of statutory notices served: — Public Health Act, 1936, Section 93 (nuisances) 14 Public Health Act, 1936, Section 75 (dustbins) 7 Public Health Act, 1936, Section 39 (drains) 6 Housing Act, 1936, Section 59 (overcrowding) 1 — 28 PROSECUTIONS. Number of prosecutions Nil SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 5 Water pipes and fittings repaired or renewed 28 Drains. Drains re-laid or repaired 7 Drains unstopped and cleansed 31 Intercepting traps provided with rodeye stoppers 9 Manholes provided or repaired 4 Soil or ventilation pipes repaired or renewed 5 Gully kerbs and channels repaired 14 New soakaways constructed 8 Closets. Buildings repaired 4 New pans fixed to water closets 23 Flushing cisterns repaired or renewed 20 Flush pipes and pan joints repaired or renewed 5 Seats repaired 11 Light and ventilation provided 4 Sinks. Sinks renewed 2 Waste pipes repaired or renewed 22 Yards. Yards newly paved or repaired 4 Dust Receptacles. New portable galvanised iron dustbins provided 83 38 Dampness. Damp-proof courses provided or repaired 3 Roofs repaired 46 Rainwater gutters repaired or renewed 45 Rainwater downspouts repaired or renewed 20 Windows, sills and doors made weatherproof 10 External walls repaired, re-pointed or rendered 80 Earth banked against house walls removed 6 External walls treated with waterproofing solution 5 Ventilation provided under floors 2 General Repairs, Etc. Rooms cleansed 65 Walls and ceilings repaired 36 Floors repaired 9 Stoves repaired or renewed 25 Coppers repaired or renewed 1 Doors repaired or renewed 6 Windows repaired 11 Windows provided with new sashcords 19 Chimneys repaired 65 Overcrowding abated 1 Refuse removed 3 Number of premises disinfes-ted from bed bugs 6 Milk and Dairies. Unregistered purveyor of milk registered 1 Food Premises. Premises cleansed 6 Drains repaired 2 Receptacles for refuse provided 3 Closets provided 1 Accumulations of refuse removed 2 Washing facilities provided 2 Sink and waste pipe provided 1 Factories. Premises cleansed 4 Sanitary conveniences—defects remedied 4 Other defects remedied 2 Bakehouses. Premises cleansed 3 Other defects remedied 2 Workplaces. Drains cleansed 1 38 Shops and Offices. Washing facilities provided 2 Ventilation provided 1 Sanitary conveniences provided or repaired 6 Refuse receptacles provided 3 Byelaws with respect to Nuisances. Offences discovered Nil Fish Frying Premises. Receptacle for refuse provided 1 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling houses 532 Number of re-inspections of premises 2210 Number of visits to works in progress 1154 Number of miscellaneous visits and inspections 1006 Number of visits to dairies 44 Number of visits to factories 151 Number of visits to bakehouses 44 Number of visits to workplaces 20 Number of visits to outworkers' premises 2 Number of visits to shops and offices 709 Number of vistis to slaughterhouse premises 10 Number of visits to food stores 885 Number of visits to stables and yards 33 Number of visits to market gardens, etc. 15 Number of visits to fried fish shops 12 • Number of visits to ice cream shops 44 Number of visits to urinals 58 Number of visits to piggeries 16 Number of visits re infectious diseases' 112 Number of visits to streams 7 Number of visits re rats 125 Number of visits re smoke abatement 22 Number of complaints received and investigated 133 Number of preliminary notices served 281 Number of statutory notices served 28 Number of interviews re nuisances, etc 539 Number of rooms disinfected 84 Number of lots of bedding and clothing disinfected 60 Number of library books disinfected 218 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. 40 SHOPS AND OFFICES. Seven hundred and nine inspections were made during 1940, and in 12 cases action was necessary in regard to washing facilities, ventilation and sanitary conveniences. CAMPING SITES. There are no camping sites within the Borough. SMOKE ABATEMENT. No nuisances arising from the emission of smoke occurred during the year. SWIMMINC BATHS. There is only one swimming bath in the district situated at, and owned by, the Royal Female Orphanage, Beddington. The bath was not brought into use during the year. ERADICATION OF BED BUGS. During the year bed bugs were found to exist in 2 Council houses and in 4 other houses. The Council houses were 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. The liquid insecticides used during the year were "Zaldecide" and "Vermoose." 41 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. Schooli 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 8 registered premises within the district, this being 1 less than last year. During the year 44 visits of inspection were paid, and conditions found to be satisfactory. 42 MILK (SPECIAL DESIGNATIONS) ORDERS. During the year the Council granted the following number of licences under the above-named Orders:— Tuberculin Tested11 Accredited 1 Pasteurised 11 SLAUGHTERHOUSES. There is only one Slaughterhouse within the district, this being licensed annually. No animals were slaughtered on the premises during the year. BAKEHOUSES. There are 13 Bakehouses in the district. The premises were visited peripdically. Unsatisfactory conditions were found to exist in 4 instances. OTHER FOOD PREPARING PLACES. During the year 885 visits were paid to other food preparing places within the district. The conditions found were generally satisfactory. FACTORIES. There are 90 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 135 1 - Factories without mechanical power 16 — - Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) - - - Total 151 1 — 43 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) 4 4 - - 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 2 2 — - 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.) 2 2 - - Total 10 10 — — 3. Outwork in Unwholesome Premises. No instances were discovered. 44 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) 521 (b) Number of inspections made for the purpose 532 (2) (a) Number of Dwelling-houses (included under head (1) above) inspected and recorded under the Housing Consolidated Regulations 5 (b) Number of inspections made for the purpose 5 (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 241 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 239 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 22 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 22 (b) By Local Authority in default of owners — 45 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 6 (ii) Number of families dwelling therein 6 (iii) Number of persons dwelling therein 54 (b) Number of new cases of overcrowding reported during the year — (c) (i) Number of cases of overcrowding relieved during the year 1 (ii) Number of persons concerned in such cases 9 (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 12 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 22 Pasteurised 100 Ungraded 84 Total 206 46 Graded Milk.— All the samples of Tuberculin Tested milk examined were found to be satisfactory. In regard to the Pasteurised milk, thirteen of the samples exceeded the 100,000 bacteria per millilitre allowed by the Milk (Special Designations) Order, but only in one case was a count of 128,000 bacteria per millilitre exceeded. All milks sold as pasteurised were examined for phosphatase for the purpose of ascertaining the efficiency or otherwise of pasteurisation. Ungraded Milk.-Of the 84 samples examined during the year, 67 contained fewer than 200,000 bacteria per millilitre, and in 79 samples coliform bacillus was absent in 0.01 millilitre. Where a milk falls below this standard, it is assumed that the sample has not attained the standard of bacterial cleanliness which could reasonably be expected, and appropriate action is taken in all such cases to secure an improvement in the bacteriological condition of the milk. Tubercle Bacilli.—Forty-four 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 intended for human consumption and slaughtered in the Borough are inspected by a qualified Inspector before being placed on the market. FOOD AND DRUGS ACT, 1938. On 1st April, 1940, the Corporation became the Food and Drugs Authority for the Borough, and took over the duties under the Act from the Surrey County Council. The Corporation appointed H. Amphlett Williamns, Esq., A.C.G.F.C., F.I.C., of 1, Southwark Street, London, S.E.1, as Public Analyst for the Borough. The following table gives details of the samples obtained within this district during the year. Eleven of the samples were taken by officers of the Surrey County Council during the 1st quarter of the year. 47 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 Almonds (Ground) — 2 2 - - - - - Butter — 12 12 - - - - - Coffee — 2 2 - - - - - Egg (Dried) — 1 1 - - - - - Fish (Canned) — 5 5 - - - - - Fruit (Canned) — 2 2 - - - - - Jam — 1 1 - - - - - Lard — 4 4 - - - - - Margarine — 5 5 - - - - - Meat — 1 1 — - - - - Milk 32 2 34 - - - - - Pepper — 1 1 — — — — — Tea — 3 3 - - - - - Vegetables (Canned) — 3 3 - - - - - Vinegar — 3 3 — — — — — Beer — 6 6 - - - - - Spirits 3 3 6 — 2 2 — — Zinc Ointment — 3 3 - - - - - Boric Ointment - 3 3 - - - - - Totals 35 62 97 — 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, Wallington, under the supervision of the Medical Officer of Health. 48 NUTRITION. During war-time nutrition is a matter of considerable importance and one which has taxed Government Departments and Local Authorities alike. During the year under review, the general nutrition of children (toddlers and infants) attending Infant Welfare Centres has been maintained at a high standard. In July, 1940, the Ministry of Food introduced their war-time Milk Scheme, by which children below the age of five years and expectant and nursing mothers receive one pint per head per day. Mothers attending Centres were found to be well-nourished. The supply of vitamin concentrates at Centres was much appreciated, and with careful supervision no cases of deficiency diseases need arise. Health Visitors continue to discuss dietetic questions with mothers at the Infant Welfare Centres and in their homes, 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. 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. 49 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1940, the number of cases removed to hospital and the number of deaths attributed to these diseases. Disease. Number Notified. Removed to Hospital. tDeaths. Scarlet Fever 21 18 - Diphtheria 6 6 — Erysipelas 4 4 — Cerebro-Spinal Meningitis 5 4 3 Pneumonia 7 — *13 Typhoid Fever 1 1 1 Measles 75 — — Whooping Cough 5 — — Puerperal Pyrexia 2 2 — Totals 126 35 17 *Includes deaths from all forms of Pneumonia. †Includes deaths of residents in homes and institutions outside the Borough. 50 51 Cases of Infectious Disease notified during the year 1940. The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections:— Disease. At all ages. Number of Cases Notified. Total cases notified in each Ward. Cases removed to Hospital. Deaths (including deaths of residents outside the Borough) At Ages—Years. Under 1 Year. 1 and under 2. 2 and under 3. and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. and under^sr. 55. Beddington. Wallington. 45 ana under i 65 and over North. Central. scum. North. Central. South. Scarlet Fever 21 - - - - 2 11 8 - - - - - 6 2 - 10 3 — 18 - Diphtheria 6 - - - - - 2 1 1 2 - - - — 1 3 — 1 1 6 — Erysipelas Cerebro-Spinal Meningitis 4 5 - 1 - - - - 1 2 - 2 1 2 4 1 - 1 3 - - 4 4 3 Pneumonia 7 1 - - - - - - 1 9 9 - 1 - 9 1 3 - - 13 Typhoid Fever 1 - - - - - - 1 - - - - - - - - 1 - - 1 1 Measles 75 1 5 4 8 9 16 3 6 2 1 - - 21 1 4 40 8 1 — — Whooping Cough Puerperal 5 — - 2 - - 1 1 1 - - - - 2 — - 1 2 — — — Pyrexia 2 — - - - - - - - -— 2 - - - -1 1 — — — — 2 — Totals 126 1 6 7 8 11 51 14 9 9 3 5 2 36 5 10 56 17 2 35 17 *Includes all forms. . The following table shows the history of infections from the date of the inception of the former Urban District until 1940:— Cases of Infectious Disease notified in each year, 1915-1940. 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 1940 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 21 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 6 Enteric Fever 1 1 — 1 3 5 1 — 6 1 — - 4 39 1 1 1 1 — — 1 2 2 — 1 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 4 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 2 Measles — 87 241 158 39 - - - - - - - - - - - - - - - - - - - 2 75 Cerebro Spinal Meningitis — — — 1 — — 1 — — 1 — — — 1 — — 1 — — — — — — 2 1 5 Pneumonia — — — — 16 3 8 4 5 9 2 5 14 19 20 13 16 36 42 15 4 2 1 9 12 7 Malaria — — — — 6 4 — — — — — — — — 1 — — — — — — — — — — — Chicken Pox - — — — 3 — — — 6 3 - - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - - - - - - - - - 1 1 — — Encephalitis Lethargica - - - - - - 1 — 3 1 - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - 5 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 20 Other Forms 6 8 4 4 — — 3 1 6 — 5 3 8 6 9 5 1 3 5 3 7 6 4 8 5 1 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 98 147 82 The monthly incidence of Infectious Disease, 1940. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. . April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever - - 1 — 1 3 3 3 5 2 1 2 21 Diphtheria 1 — — — 1 - — — 1 2 — 1 6 Erysipelas — — — — — - — — 1 1 — 2 4 Cerebro-Spinal Meningitis — 1 — 1 1 - 1 —— — 1 - - 5 Pneumonia 1 3 — — — 1 1 — — — — 1 7 Typhoid Fever — — — — — 1 — —. — — — — 1 Measles 7 15 4 1 2 1 5 31 5 — 1 3 75 Whooping Cough — 4 — — — . — 1 — — — 1 — 5 Puerperal Pyrexia — — — — — - - - ■ - 1 2 Totals 9 23 5 2 5 6 11 34 12 6 3 10 126 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. It is gratifying to note that during the war year under review, there was no prevalence of non-notifiable diseases among school children. In spite of shelter life, diseases of the skin and respiratory systems, which might have been expected to be high, were at a low ebb. TUBERCULOSIS. There were 21 new cases notified during the year. The following table gives the number of new cases notified during the past five years:— New Cases. 1936 1937 1938 1939 1940 M. F. M. F. M. F. M. F. M. F. Pulmonary 9 9 10 10 13 5 13 13 11 9 Non-Pulmonary 4 2 2 2 5 3 3 2 1 — Totals 13 11 12 12 18 8 16 15 12 9 The annual case rate for Pulmonary Tuberculosis per 1,000 of population for 1940 was 0.73 compared with 0.80 for 1939. The annual case rate for Non-Pulmonary Tuberculosis per 1,000 of population for 1940 was 0.04 compared with 0.17 for 1939. The following table gives the number of deaths from this disease during the past five years:— Deaths. 1936 1937 1938 1939 1940 M. F M. F M. F. M. F. M. F. Pulmonary 12 12 6 6 2 4 7 1 8 1 Non-Pulmonary 3 — 3 1 2 — 2 1 — 3 Totals 15 12 9 7 4 4 9 2 8 4 It will be seen from the foregoing table that 12 deaths were regis' tered as due to Tuberculosis, of! which 9 were Pulmonary and 3 NonPulmonary. The figures correspond to a death rate per 1,000 of 54 lation of 0.33 for Pulmonary Tuberculosis and 0.11 for Non-Pulmonary Tuberculosis. Of the 12 deaths which occurred, 1 was an unnotified case, i.e., 8.3 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 - - - - - - - 1 10 and under 15 - - - - - - - - 15 and under 20 1 1 - - - - - - 20 and under 25 2 1 — — — — - 1 25 and under 35 1 3 1 — 2 — - 1 35 and under 45 4 3 — — 2 — — — 45 and under 55 1 1 — — 2 1 — - 55 and under 65 1 - - - - - - - 65 and upwards 1 — - — 2 — — Totals 11 9 1 — 8 1 — 3 The new cases were distributed amongst the Wards as follows:— Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary - 4 6 7 3 - Non-Pulmonary — — - — 1 — Totals — 4 6 7 4 — Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 30 such examinations were made. 55 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 1940, 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. 56 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases admitted to Hospital during the year ended 31st December, 1940 Disease. Beddington and Wallington. Coulsdon and Purley. Merton and Morden. Mitcham. cases deaths cases deaths cases deaths cases deaths Diphtheria 6 - 22 - 18 1 45 4 Scarlet Fever 18 - 50 - 81 — 51 — Typhoid 1 - 2 - 3 — — — Erysipelas 4 - 4 - 3 — 9 1 Tonsillitis 3 — 6 - 1 — 5 — Measles — - — - 17 — 22 — Influenza — - — - 4 — 1 — Whooping Cough — - 1 - 2 — 1 — Rubella — - 6 - 2 — 9 — Pneumonia — - — - 1 1 2 - Septicaemia - - 3 - 1 1 — - Meningitis 4 1 5 - 7 2 9 3 T.B. Meningitis — - 1 1 1 1 1 1 Chicken Pox — - — - 2 — 7 — Boils in Ear 1 - - - - - - - Ulcerated Mouth - - - - - - 1 — Dermatitis - - - - - - 1 — Puerperal Fever 2 - 2 - 2 — 1 — Cellulitis of Limb — - 1 - 1 1 — — Admitted with Mother 1 - 1 - 1 — 1 — Totals 40 1 104 1 147 7 166 9 †Cellulitis of Arm and Cerebral Embolus. 57 -