LIBRARY BED 6 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1941. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1941. TABLE OF CONTENTS. Public Health Committee 5 Maternity and Child Welfare Sub=Committee s Representatives on the Wandle Valley Joint Hospital Board 5 Representatives on the Wandle Valley Joint Sewerage Board 6 Staff of Public Health Department 6 Extracts from Vital Statistics 9 Vital Statistics: Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1941 10 Registered Causes of Death 11 Violence 12 Maternal Mortality 12 Infantile Mortality 12 General Provision of Health Services for the Area: Laboratory Facilities 13 Ambulance Facilities 13 Nursing in the Home 14 Treatment Centres and Clinics 14 Hospitals 16 Disinfection 17 Maternity and Child Welfare: General Observations 17 Ante-natal and Post-natal Supervision 17 Maternity and Child Welfare Centre 19 Maternity Ward 19 Consultant Obstetrician 20 Home Help 20 Birth Control 20 Treatment: Orthopaedic 20 Dental 20 Minor Ailments 21 Provision of Milk and other Foods 21 Health Visiting 22 Child Life Protection 23 Sanitary Circumstances of the Area: Water Supplies 23 Drainage and Sewerage ZH Rivers and Streams 24 Closet Accommodation 24 Public Cleansing 24 2 Sanitary Inspection of the Area 25 Statement of the Senior Sanitary Inspector for the Year 1941: Dwelling Houses 25 Milk and Dairies 25 Slaughterhouse 25 Food Premises 26 Unsound Food 26 Factories 27 Bakehouses 27 Workplaces 27 Shops and Offices 27 Complaints 27 Smoke Abatement 27 Infectious Disease and Disinfection 28 Offensive Trades and Fish Frying 28 Rats and Mice (Destruction) Act 28 Increase of Rent (Restrictions) Act 28 Notices 28 Prosecutions 28 Sanitary Improvements: Water Supply 28 Drains 29 Water Closets 29 Sinks 29 Yards 29 Dust Receptacles 29 Dampness 29 General Repairs, etc 29 Food Premises 29 Factories 30 Bakehouses 30 Workplaces 30 Shops and Offices 30 Bye-laws with respect to Nuisances 30 Fish Frying Premises 30 Summary of work done during the year 30 Shops and Offices 31 Camping Sites 31 Smoke Abatement 31 Swimming Baths 31 Eradication of Bed Bugs 31 Schools 31 Dairies 31 Milk ((Special Designations) Regulations 32 Slaughterhouses 32 3 Bakehouses 32 Other Food Preparing Places 32 Factories 32 Mousing: Housing Statistics: Inspection of Dwelling Houses 34 Remedy of Defects without service of Formal Notice 34 Action under Statutory Powers 34 Housing Act, 1936—Part IV— Overcrowding 35 Number of Houses and Flats erected during the year ... 35 Inspection and Supervision of Food: Milk 35 Meat 36 Food and Drugs Act, 1938 36 Chemical and Bacteriological Examinations 37 Nutrition 37 Shell Fish (Molluscan) 38 Adoptive Acts and Bye=Laws 38 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 38 Incidence of Infectious Diseases in Age Groups and Wards 39 Monthly Incidence of Infectious Disease 40 Non-notifiable Diseases 41 Tuberculosis 41 Prevention of Blindness 43 4 BOROUGH OF BEDDINGTON & WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1941. Members: Councillor F. C. Elwood (Chairman). Councillor F. G. Bryant, J.P. (Mayor). Alderman W. W. Binnie, J.P. (Deputy Mayor). Alderman G. Purser. Alderman H. B. Smalley. Councillor H. H. Best. Councillor Mrs. V. Boyce. Councillor W. W. Craig. Councillor J. H. Emmett. Concillor A. R. B. Gill. Councillor Mrs. O. L. Wiles. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1941. Members: Councillor F. C. Elwood (Chairman). Councillor F. G. Bryant, J.P. (Mayor). Alderman W. W. Binnie, J.P. (Deputy Mayor). Councillor V. Boyce. Councillor J. H. Emmett. Councillor Mrs. O. L. Wiles. Co-opted Members: Miss E. Hall, Mrs. L. Rose, Mrs. L. A. Pearce. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1941. Members: Councillor F. G. Bryant, J.P. (Mayor). Alderman H. D. Banks. Alderman G. Purser. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERACE BOARD. December, 1941. Members: Councillor F. G. Bryant, J.P. (Mayor). Alderman W. W. Binnie, J.P. (Deputy Mayor). Alderman G. Purser. 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 Officers for Ante-Natal Clinic:— "^Winifred M. Small, M.B., Ch.B. (resigned 11th Dec., 1941). Eleanor H. Kelly, M.D. (Ed.), Ch.B. (appointed 11th Dec., 1941). Margaret G. Falla, M.A., Ch.B. (appointed 11th Dec., 1941). 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. tE. D. Evezard. W. E. Murrells (Temporary). H. Bourne (Temporary). Laboratory Assistant:— tW. K. Stevens. E. Morris (Temporary). *On Active Service. *Part-time Officials. 8 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, 1941. The year under review, the second whole year of war, was notable for many important events, some of which had a direct bearing upon the work of the public health services of the Borough. After a very strenuous winter period, with almost continual heavy bombing raids, the last big raid took place on 15th May. Following this date, the general tension of the community relaxed, and the public air raid shelters, which had previously given some concern to the Department, on health grounds, ceased to be used, except by a small percentage of the population. Since this date also, there has been a gradual return of former residents to the district, and a reopening of many houses. In many parts of Beddington and Wallington housing accommodation is now extremely limited, and one of the most important future problems, which the.Borough will have to face, is housing. No figures are quoted in this Report giving specific details of rise and fall in the population, as the Minster • of Health has given instructions that statistical information regarding populations shall, for security reasons, be excluded from the annual reports of MedicalOfficers of Health. During the year, infectious diseases in the town did not assume large proportions. The number of cases occurring was-average, with only one disease, measles, showing slightly increased prevalence. The Corporation's maternity and child welfare schemes continued to occupy a most important place in the health services. The attendances at Maternity and Child Welfare Centres showed the increasing appreciation, of resident# in the Borough of the Corporation's scheme. In co-operation with the Food Executive Officer and the Minister of Health, vitamin products were distributed at the Centres during the year. No. cases of malnutrition or of vitamin deficiency were noted amongst children in attendance. The examination of patients at the Centres, and also at the Ante-natal Clinics, showed that the nutritional state of the community is being maintained at a high level, in spite of the exigencies of war. The infantile mortality rate for the year was especially low, being 21.13 per thousand, as compared with 34.88 for the previous year and 59 for the country as a whole. This figure reflects great credit upon all the services of the Corporation, dealing with infant life. 7 One death associated with childbirth took place during the year. This, the first puerperal death recorded in this Borough for many years, occurred in spite of adequate medical and nursing care being given the patient, both before and after childbirth. Throughout the year, the Government's policy for the increase of diphtheria immunisation amongst children of all ages, but especially those below the age of 5 years, was pursued vigorously in the Borough Children were immunised by the Medical Officer of Health at Infant Welfare Centres, in the schools, both private, elementary and secondary, and at a clinic held weekly at the Town Hall. On the 14th November, the Minister of Health found it necessary to introduce the Scabies Order, to deal with a marked increase in the disease amongst war-workers and troops throughout the country. In this district, fortunately, the incidence of this disease, as well as of the other contagious diseases, has been extremely low. The Council considered the advisability of making further provision for treatment of these conditions, but at the close of the year, the incidence having been so small, no new scheme was introduced. In reviewing health conditions generally, the Corporation can congratulate themselves on having completed another war year without any serious epidemic and with the general health of the community at an extremely high level. 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 8 EXTRACTS FROM VITAL STATISTICS. Total. M. F Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 278 152 126 10.79 Illegitimate 12 5 7 Total 290 157 133 Rate per 1,000 total births. Still Births 7 2 5 25.18 Death Rate per 1,000 of the estimated resident population Deaths 287 130 157 11.14 Rate per 1,000 (live and still) births Deaths from Puerperal causes:— Puerperal Sepsis 1 3.44 Other Puerperal causes — — Death Rate of Infants under one year of age:— All Infants per 1,000 live births 21.13 Legitimate Infants per 1,000 legitimate live births 22.06 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) Nil Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea, etc. (under two years of age) Nil 9 Comparative crude birth rates, death rates, analysis of mortality, maternal death rates and case rates for certain infectious diseases in the year 1941:— 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 14.2 14.7 16.4 8.9 10.79 Still 0.51 0.58 0.60 0.33 0.27 Deaths— All Causes 12.9 14.9 13.00 16.3 11.14 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.01 0.00 Smallpox — - - — — Measles 0.03 0.03 0.03 0.02 0.00 Scarlet Fever 0.00 0.00 0.01 0.00 0.00 Whooping Cough 0.06 0.07 0.06 0.04 0.08 Diphtheria 0.07 0.08 0.06 0.03 0.04 Influenza 0.19 0.17 0.20 0.15 0.04 Notifications— Cerebro Spinal Fever 0.25 0.31 0.20 0.30 0.19 Measles 10.33 8.27 10.47 4.77 7.34 Whooping Cough 4.39 4.37 4.50 3.50 2.95 Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 1.47 1.49 1.51 1.01 0.89 Diphtheria 1.25 1.53 1.19 0.98 0.43 Enteric Fever 0.12 0.24 0.12 0.09 0.16 Erysipelas 0.30 0.36 0.27 0.50 0.31 Pneumonia 1.25 1.53 1.04 1.07 0.48 Deaths under 1 year of age Rates per 1,000 Live Births. 59 71 56 68 21.13' Deaths from Diarrhoea and Enteritis under 2 years of age 5.1 7.5 4.6 6.8 0.00 Maternal Rates per 1,000 Total Births (i.e., Live and Still). Mortality— Puerperal Sepsis 0.48 Not available 3.44 Others 1.75 0.00 Total 2.23 3.44 Notifications— Puerperal Pyrexia 11.91 15.64 9.43 19.3 3.44 10 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar General, gives the causes of death of residents in the Borough during 1941: Causes of Death. Males. Females. Total. All Causes 130 157 287 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — 2 2 5. Diphtheria — 1 1 6. Tuberculosis of Respiratory System 5 4 9 7. Other forms of Tuberculosis 2 — 2 8. Syphilitic Disease 1 — 1 9. Influenza — 1 1 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis - - - 12. Acute Infectious Encephalitis — - — 13.mCancer of Buccal Cavity and Oesophagus (males) - - - 13f Cancer of Uterus — 3 3 14. Cancer of Stomach and Duodenum 4 7 11 15. Cancer of Breast — 5 5 13. Cancer of all other Sites 15 13 28 17. Diabetes — 2 2 18. Intra-cranial Vascular Lesions 7 25 32 19. Heart Disease 46 52 98 20. Other diseases of the Circulatory System 3 1 4 21. Bronchitis 6 7 13 22. Pneumonia 7 5 12 23. Other Respiratory Diseases — 3 3 24. Ulceration of the Stomach or Duodenum 3 2 5 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis - — — 27. Other Digestive Diseases 1 2 3 28. Nephritis 4 4 8 29. Puerperal and Post-abortive Sepsis — 1 1 30. Other Maternal Causes — — — 31. Premature Birth — 1 1 32. Congenital Malformations, Birth Injury, Infantile Disease 1 - 1 33. Suicide 2 1 3 34. Road Traffic Accidents 4 — 4 35. Other Violent Causes 7 1 8 36. All Other Causes 12 14 26 11 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 3.14 Cancer 47 16.38 intra Cranial Vascular Lesions 32 11.15 Heart Diseases 98 34.15 Pneumonia (all forms) 12 4.18 Bronchitis 13 4.53 Nephritis 8 2.79 Violence 15 5.23 VIOLENCE. Three deaths, 2 males and 1 female, were recorded from Suicide. There were 12 deaths from other forms of violence, 11 males and 1 temale. Three of the deaths which occurred outside the Borough were due to War operations. Four deaths of Wallington residents, due to road accidents, occurred outside the Borough.. No deaths of Wallington residents occurred in roads within the Borough. MATERNAL MORTALITY. The maternal mortality rate for the year was 3.44 per thousand total births. This rate is misleading and scarcely represents a true picture of the maternal mortality in the area, as only one death occurred in the year under review. INFANTILE MORTALITY. Of a total of 284 live births, only 6 deaths of infants under one year of age were registered. Of these, 3 were males and 3 females, all being legitimate children. This gives an infantile mortality rate of 21.13 per 1,000 live births, as compared with 34.88 in 1940 and 59.00 for England and Wales. The district is to be congratulated on an exceptionally low figure for infantile mortality. This rate is often taken as an index of the general health and prosperity of the district as a whole. 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. 12 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 124 4 120 Tuberculosis—(Sputa) 25 — 25 Typhoid 4 — 4 Malaria 1 — 1 Totals 154 4 150 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 stanadrd 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 241 Milk:— Bacteriological analyses 160 Microscopical examinations 16 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. 13 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 fs greatly appreciated. During the year the District Nurses attended 743 cases, including 44 maternity and 82 midwifery patients. TREATMENT CENTRES AND CLINICS. Maternity and Child Welfare Centres: — Centre. When held. Elm Grove, First and third Mondays of the The Grange, month.* London Road. Hackbridge, Second and fourth Mondays of The Grange. the month.* London Road. Bandon Hill, First and third Tuesdays of Methodist Hall, the month.* Sandy Lane North. Beddington, First and third Wednesdays of Village Hali the month.* Wallington, Second and fourth Wednesdays Baptist Hall, of the month.* Queen's Road. October to March, 1.30-3.30. April to September, 2.0-4.0. Ante-natal and Thursdays and Fridays, 2.0-4.0. Post-natal Clinic, The Nurses' Home, 57, Montagu Gardens. Consultant Ante-natal and Every third Friday of the Post-natal Clinic, month. The Nurses' Home, 57, Montagu Gardens. Voluntary Helpers.—Mrs. Boyce, Mrs. Buck, Mrs. Daw, Mrs. Dewit, Mrs. Hooper, Mrs. Jennings, Mrs. Jeffrey, Mrs. Lennard, Mrs. 14 Mountney, Mrs. Phillips, Mrs. Rose, Mrs. Raine, Mrs. Scott, Mrs. Street, Mrs. Williams, Mrs. Wild. 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 (St. Helier County Hospital):— Every Friday at 10 a.m. Fourth Wednesday at 5.30 p.m. IMMUNISATION ACAINST DIPHTHERIA. A scheme for the immunisation of children against diphtheria was begun in the Borough in 1937. Only a small number of residents, however, availed themselves of the service during the first years during which the scheme was in operation. During the year 1941, however, His Majesty's Government instituted an intensive national drive in an effort to have all children below the age of 15 years immunised. The Borough took its full share in the Government campaign by the distribution of leaflets, press publicity and films, with the result that during the year under review, the numbers of children brought to clinics and immunised in private and elementary schools was enormously increased. In this district, particular attention has been concentrated on the immunisation of children in attendance at Infant Welfare Centres, attaining the age of 1 year. Immunisation is carried out at all sessions, and it is hoped, in due course, to immunise 100 per cent, of this group of the population. The follow- immunise 100 per cent, of this group of the population. The following table gives the number of children who were treated during the year: — 0—1 1—5 5—15 Total 1—15 Approximate number of children in the Borough at 31st Dec., 1941: *290 1,110 3,250 4,360 Children who completed full course of immunisation during the year 339 1,866 2,205 Children immunised before 1st Jan., 1941 — 65 95 160 Percentage of child population immunised at 31st Dec., 1941 - 38% 60% 55% *It is not the accepted practice to immunise this group. 15 The treatment formerly used consisted of 3 injections of Toxoid Anti-Toxin Floccules (T.A.F.). During this year, however, the Government's recommended scheme of giving 2 injections, at a month's interval, of Alum Precipitated Toxoid (A.P.T.) was adopted. This prophylactic material is provided free from the Government's central laboratories, and has been used throughout the year in our immunisation scheme. No cases of illness have resulted from the injections, and no child has been prevented from following his daily routine on treatment days. 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. Twenty-one clinics were held and 98 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 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 16 serving this area are situated at Epsom and Kingston. It was hoped during 1941 to bring the new County Council Hospital known as St. Helier into full operation, to serve the needs of this and the neighbouring districts. This hope, however, was frustrated by enemy bombing in 1940 and, during the year under review, the Hospital was able to operate only to a limited extent. It is anticipated, however, that in 1942 the Hospital will be able to receive both maternity and general hospital cases. 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 find 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 1941 the Council's schemes for Maternity and Child Welfare continued to operate satisfactorily. The District Nursing Association midwives continued to perform yeoman service. 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 yearly being held, with an average attendance of 15 patients per session. 17 Ante-natal and Post-natal Attendances, 1941. Council Cases. Nursing Association Cases. Total— 1941. Total— 1940. Number of clinics held 101 99 Ante-natal cases:— Total number attending during the year 166 115 281 246 Number of first attendances 149 95 244 190 Number of re-attendances 568 • 539 1107 936 Total attendances 717 634 1351 1126 Average attendance per session 7.1 6.3 13.4 L1.4 Number of consultations with Medical Officer 717 634 1351 1126 Post-natal cases:— Total number attending during the year 33 56 89 117 Number of first attendances 33 56 89 113 Number of re-attendances 11 11 22 16 Total attendances 44 67 111 119 Average attendance per session 0.4 0.7 1.1 1.2 Number of consultations with medical officer Medical Officer 44 67 111 119 During the year 281 expectant mothers attended the Clinic as compared with 246 in 1940. This represents approximately 94 per cent, of the total notified births (live and still) which occurred in the Borough during 1941. The figures for 1940 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 32 per cent of the cases seen at the ante-natal sessions return for post-natal examinations after their confinements. In December, 1941, Dr. Winifred Small, the Ante-natal Medical Officer, resigned her appointment, her services being replaced by those of Doctors Kelly and Falla. Dr. Small's resignation was due to ill-health, consequent upon the increased pressure of work resultant from the war. 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. 18 The attendances were as follows:— Referred by:— Medical Officer, Ante-natal Clinic. Private Practitioners. Totals. 1941 1940 C. N.A. Clinics held 10 12 Patients attending: Ante-natal 22 5 — 27 33 Post-natal 1 1 — 2 1 Total attendances 23 6 — 29 34 MATERNITY AND CHILD WELFARE CENTRES. The five Infant Welfare Centres have been held fortnightly on the same days as in previous years. The following table shows the attendances for 1941 at the five Centres maintained by the Council:— Bandon Hill. Bedding ton. Elm Grove. Hackbridge. Walling ton. Totals, 1941. Totals, 1940. Number of sessions held 24 23 22 24 24 117 116 Infants: — No. of new cases under 1 year 72 45 27 36 87 267 301* No. of re-attendances 361 375 260 305 569 1870 2318 No. of new cases over 1 year 46 33 15 22 57 173 116 No. of re-attendances 575 165 643 465 707 3005 3464 Total attendance of infants 1054 1068 945 828 1420 5315 6199 Average attendance of infants per session 44 46 43 35 59 45 53 Mothers attending 967 927 821 665 1332 4712 5408 Total attendances 2021 1995 1766 1493 2752 10027 11607 Average total attendance per session 84 87 80 62 115 87 100 *Includes 34 children who made their first attendance at Clinics outside the Borough. MATERNITY WARD. Throughout the year the arrangements between the Council and 19 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 2 For medical reasons 2 For unsuitable home conditions — Normal confinements — Abnormal confinements 2 Both cases were referred from the Ante-natal Clinic. CONSULTANT OBSTETRICIAN. No changes occurred in the appointment of Consultant Obstetrician during the year. 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 21 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 1941 14 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 20 cases (defects of the feet, bow legs, knock knees, etc.) received treatment. Dental. During 1941, 74 cases were referred for treatment under the Councils' scheme as follows:— 20  Expectant mothers. Nursing mothers. Children under 5 years. Found to be in need of treatment 51 3 20 Received treatment 32 3 13 Made dentally fit 32 3 13 Treatments:— Fillings:— (a) In temporary teeth 1 — — (b) In permanent teeth 23 — 3 Teeth extracted 219 39 48 Administrations of general anaesthesia 20 2 11 Patients supplied with dentures 15 3 — Dentures supplied 22 5 — Minor Ailments. Seventy-one cases were referred from the Maternity and Child Welfare Centres to the under-mentioned Hospitals during the year:— Carshalton, Beddington and Wallington (War Memorial) Hospital 21 Croydon General Hospital 43 Great Ormond Street Hospital 5 The Wilson Hospital, Mitcham 1 St. Anthony's Hospital, Cheam 1 The conditions requiring treatment were:— Tonsils and Adenoids 13 Naevus 5 Circumcision 9 Dental defects 1 Orthopaedic defects 20 Ear conditions 1 Eye conditions 6 Skin conditions 11 Other conditions 5 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:— 21  Cases on 1st Jan., 1941. New Cases during 1941. Cases discontinued. Cases on 31st Dec., 1941. Milk free 10 22 22 10 Milk at half cost — 4 — 4 Total 10 26 22 14 The number of families in receipt of benefit from the Corporation is considerably reduced by the operation of the Ministry of Food Milk Schemes, introduced during the war. The Government's comprehensive plan for the distribution both of liquid and dried milk has relieved the local authority of: the necessity for supplementing milk supplies to families to a considerable extent. This is reflected in the foregoing table: In adition, 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. The following is a summary of the work carried out during the year:— Home visiting. Visits to expectant mothers:— No. of first visits 30 No. of re-visits 36 Total 66 Visits to infants:— No. of first visits to infants under 1 year 228 No. of re-visits to infants under 1 year 468 No. of visits to infants 1-5 years 1824 Total 2520 Public Health Act (Child Life Protection):— No. of visits paid 87 Other visits:— Infantile mortality — Stillbirths — Infectious diseases 80 Tuberculosis 51 22 Maternity, Home Help, Milk and Dental Scheme, Wartime Nurseries, etc 312 Unsuccessful 392 835 Total visits, 1941 3508 Total visits, 1940 2713 Attendances at clinic sessions. Maternity and Child Welfare Centres 234 Ante-natal and Post-natal Clinics 206, Total attendances, 1941 240 Total attendances, 1940 305 Interviews at office 264 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 8 Number of children on the register at the end of the year 20 Number of children who died during the year Nil During the year 87 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 241 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 16 samples) 190 Private wells 46 Other waters 5 The main water supply continues to be satisfactory both in quantity and in bacteriological purity. 23 No cases of illness associated with pollution of the water supplies have been recorded during the year. The chlorination of water from private manufacturing wells was continued throughout the year and examination in the Council's laboratory showed that the standard of purity was high. There were no bombing incidents in the Borough in 1941 involving damage to water mains. 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. 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. The few chemical and earth closets normally in use in the district have been increased recently by the necessity of installing chemical closets in Air Raid Shelters and Wardens' Posts. Five cesspools were in use in the district at the end of the year. 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 from private premises. The occupiers of the premises concerned carry out the work in a satisfactory manner. The Croydon Corporation commenced tipping in the latter part of the year 1940 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. 24- 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. STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1941. DWELLING-HOUSES. Number of inspections of dwelling-houses 590 Number of inspections recorded under Housing Regulations 6 MILK AND DAIRIES. Number of cowkeepers on register - Number of purveyors of milk on register 50 Number of dairy premises on register 8 Number of inspections of premises 50 Defects in dairy premises discovered Infringements of Acts and Orders discovered and dealt with:— Extraneous matter in milk 2 Unclean milk vessels 1 Milk bottled in street 1 Precautions not taken to prevent contamination of milk 1 5 Number of licences issued under the Milk (Special Designations) Regulations:— Tuberculin (rested—Dealer's Licences 4 „ —Supplementary Licences 7 Pasteurised—Dealer's Licences 4 —Supplementary Licences 6 Pasteuriser's Licence 1 22 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of visits to slaughterhouse 4 Number of visits to other premises on which animals were slaughtered 5 25 Carcases inspected and condemned:— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed - — — — 5 Number inspected — — — — 5 Whole carcases condemned or - - — — — Carcases of which some part or organ was condemned - - — — — FOOD PREMISES. Number of visits to food-preparing places 781 Number of defects discovered and remedied 21 UNSOUND FOOD. Destroyed or released for suitable disposal:— Tons cwts. qtrs. lbs. Fruit 15 1 — — Cocoa and chocolate confectionery 1 6 3 16 Vegetables 13 3 8 Rabbits 4 — — Fish 3 18 Bacon 1 7 Dried Fruit 25 Sausages 24 Tinned foods (various) 22 Cheese 8 Eggs 273 Total 17 7 2 16 FOOD ANALYSIS. Number of samples analysed by Public Analyst 98 Number of samples reported against:— Milk—4% added water 1 ” —2% ,, ” 2 ” —1% „ ,, 3 ” —Excessive acidity 1 Butter—Boric acid .012% 1 26 Orange substitute—deficient in Vit. C 2 juice (synthetic) deficient in Vit. C and citric acid 1 Whisky—Excessive water 8.7% 1 12 Number of prosecutions 1 FACTORIES. Number of factories on register 95 Number of inspections 209 Number of defects discovered and remedied 18 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 28 Number of defects discovered and remedied 4 WORKPLACES. Number of inspections of workplaces 33 Number of defects discovered and remedied 4 SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 665 Number of defects discovered and remedied 19 COMPLAINTS. Complaints received during the year were due to the following causes:— Defects in dwelling-houses 40 Prevalence of rats 26 Stoppages in drains 41 Defects in drains or water closets 26 Food supplies 13 Defective water fittings 10 Insect pests 6 Accumulations of refuse 4 Miscellaneous 12 178 SMOKE ABATEMENT. Number of observations 6 Number of nuisances discovered and remedied — 27 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 97 Number of rooms disinfected 71 Lots of bedding and clothing disinfected 101 Number of library books disinfected 257 OFFENSIVE TRADES AND FISH FRYING Number of offensive trade premises in district Nil Number of fish frying premises in district 4 Number of visits to fish frying premises 17 Number of defects discovered — RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints or requests for advice received 26 Number of visits to premises 377 Number of infested premises dealt with 31 INCREASE OF RENT (RESTRICTIONS) ACTS. Number of applications for certificates Nil NOTICES. Number of informal notices served (including verbal intimations) 370 Number of statutory notices served:— Public Health Act, 1936, Section 93 (nuisances) 5 Public Health Act, 1936, Section 75 (dustbins) 2 Public Health Act, 1936, Section 45 (closets) 1 Public Health Act, 1936, Section 39 (drains) 2 Housing Act, 1936, Section 9 (housing defects) 1 11 PROSECUTIONS. Milk bottles filled and closed other than on registered premises, contrary to Article 31 (2) Fined £5 0 0 of the Milk and Dairies Order, 1926 Costs £2 2 0 Precautions not taken for preventing milk from being contaminated by dirt, contrary to Article Fined £5 0 0 32 of the Milk and Dairies Order, 1926 Costs £2 2 0 Label supplied with orange substitute falsely describing the article, contrary to Section 6 (1) Fined £10 0 0 of the Food and Drugs Act, 1938 Costs £5 5 0 Advertisement falsely describing orange substitute, contrary to Section 6 (2) of the Food and Drugs Fined £10 0 0 Act, 1938 Costs £5 5 0 SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 5 Water pipes and fittings repaired or renewed 29 28 Drains. Drains re-laid or repaired 26 Drains unstopped and cleansed 82 Intercepting traps provided with rodeye stoppers 10 Manholes provided or repaired 12 Soil or ventilation pipes repaired or renewed 5 Gully kerbs and channels repaired 11 New soakaways constructed 3 Closets. New provided 2 Buildings repaired 8 New pans fixed to water closets 14 Flushing cisterns repaired or renewed 13 Flush pipes and pan joints repaired or renewed 7 Seats repaired 7 Light and ventilation provided 1 Cleansed 4 Sinks. Sinks renewed 6 Waste pipes repaired or renewed 15 Yards. Yards newly paved or repaired 6 Dust Receptacles. New portable galvanised iron dustbins provided 58 Dampness. Damp-proof courses provided or repaired 7 Roofs repaired 50 Rainwater gutters repaired or renewed 56 Rainwater downspouts repaired or renewed 25 Windows, sills and doors made weatherproof 4 External walls repaired, re-pointed or rendered 33 External walls treated with waterproofing solution 4 Ventilation provided under floors 5 General Repairs, Etc. Rooms cleansed 33 Walls and ceilings repaired 47 Floors repaired 5 Stoves repaired or renewed 4 Doors repaired or renewed 4 Windows repaired 32 Windows provided with new sashcords 9 Chimneys repaired 26 Overcrowding abated 2 Number of premises disinfested from bed bugs 4 Food Premises. Premises cleansed 3 Drains repaired or cleansed 15 Accumulations of refuse removed 3 29 Factories. Premises cleansed 4 Sanitary conveniences—defects remedied 1 Other defects remedied 13 Bakehouses. Premises cleansed 1 Other defects remedied 3 Workplaces. Drains renewed 2 Water closet defects remedied 2 Shops and Offices. Drainage defects remedied 12 Yards cleansed 2 Refuse removed 3 Heating facilities provided 2 Byelaws with respect to Nuisances. Offences discovered and remedied 1 Fish Frying Premises. Defects discovered - SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 590 Number of re-inspections of premises 1837 Number of visits to works in progress 598 Number of miscellaneous visits and inspections 884 Number of visits to dairies 50 Number of visits to factories 209 Number of visits to bakehouses 28 Number of visits to workplaces 33 Number of visits to outworkers' premises 4 Number of visits to shops and offices 665 Number of visits to premises re slaughtering 9 Number of visits to food stores 781 Number of visits to stables and yards 62 Number of visits to market gardens, etc 66 Number of visits to fried fish shops 17 Number of visits to urinals 76 Number of visits to piggeries 35 Number of visits re infectious diseases 97 Number of visits to streams 32 Number of visits re rats 377 Number of visits re smoke abatement 6 Number of complaints received and investigated 178 Number of preliminary notices served 370 Number of statutory notices served 11 Number of interviews re nuisances, etc 660 Number of rooms disinfected 71 Number of lots of bedding and clothing disinfected 101 Number of library books disinfected 257 Number of visits to Public Air Raid Shelters 686 F. H. LENNARD, M.R.SAN.I., a.m.i.s.e., m.s.i.a. Senior Sanitary Inspector, 30 SHOPS AND OFFICES. Six hundred and sixty-five inspections were made during 1941, and in 19 cases action was necessary in regard to sanitary defects or requirements. CAMPING SITES. There are no camping sites within the Borough. SMOKE ABATEMENT. No nuisances arising from the emission of smoke occurred during the year. SWIMMING 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 one Council house, and in 3 other houses. Appropriate remedial measures were taken. SCHOOLS. School Closure. On no occasion during the year was a School closed by the Local Sanitary Authority on account of the prevalence of Infectious Disease amongst the scholars. As in the case of the Public Elementary Schools, notice is given to the Head Teachers of all private schools in the event of the pupils suffering from, or having been in contact with, Infectious Disease. The advice of the Medical Officer of Health as to further action is available should this be requested, and disinfection is provided when required. Medical Inspection. The medical inspection of the Public Elementary School children is carried out by the Education Department of the Surrey County Council. Water Supply and Sanitary Condition. All the Public Elementary Schools in the district have been inspected from time to time. They are all supplied with water from the public mains and connected with the sewers. REGULATED TRADES: DAIRIES. There are 8 registered premises within the district, this being the same as last year. During the year 50 visits of inspection were paid, and conditions found to be satisfatory. 31 MILK (SPECIAL DESIGNATIONS) REGULATIONS. During the year the Council granted the following number of licences under the above-mentioned Regulations:— Tuberculin Tested 11 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 12 Bakehouses in the district. The premises were visited periodically. Unsatisfactory conditions were found to exist in 4 instances. OTHER FOOD PREPARING PLACES. During the year 781 visits were paid to other food preparing places within the district. The conditions found were generally satisfactory. FACTORIES. 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. Number of Premises. Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 189 1 - Factories without mechanical power 20 — — Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) - - - Total 209 1 — 32 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 — — — — Unsuitable or defective - — — — Not separate for sexes 1 1 — — 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.) 13 13 - - Total 18 18 — — 3. Outwork in Unwholesome Premises. No instances were discovered. 33 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) 572 (b) Number of inspections made for the purpose 590 (2) (a) Number of Dwelling-houses (included under head (1) above) inspected and recorded under the Housing Consolidated Regulations 6 (b) Number of inspections made for the purpose 6 (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 319 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 290 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 1 (2) Number of Dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1 (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 10 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 10 (b) By Local Authority in default of owners— C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (10 Number of Dwelling-houses in respect of which Demolition Orders were made 34 (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 4 (ii) Number of families dwelling therein 4 (iii) Number of persons dwelling therein 39 (b) Number of new cases of overcrowding reported during (the year — (c) (i) Number of cases of overcrowding relieved during the year 2 (ii) Number of persons concerned in such cases 15 (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 Nil INSPECTION AND SUPERVISION OF FOOD. MILK. During the year the following number of samples of milk was taken within the district and examined bacteriologically in the laboratory of the Corporation's Public Health Department:— Class of Milk. No. taken. Tuberculin Tested 6 Pasteurised 74 Ungraded 80 Total 160 Graded —Five of the samples of Tuberculin Tested milk examined were found to be satisfactory, the remaining sample failed to satisfy the prescribed methylene blue reduction test. In regard 35 to the Pasteurised milk, not one of the samples exceeded the 100,000 bacteria per millilitre allowed by the Milk (Special Designations) Regulations. All the milks sold as pasteurised were examined for phosphatase for the purpose of ascertaining the efficiency or otherwise of pasteurisation and three of the samples were found to be unsatisfactory. Ungraded Milk.— Of the 80 samples examined during the year. 69 contained fewer than 200,000 bacteria per millilitre, and in 75 of the samples coliform bacillus was absent in 0.01 millilitre. Where a milk falls below this standard, it is assumed that the sample has riot 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.— Sixteen 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 Williams, Esq., A.C.G.F.C., F.I.C., of 1, Southwark Street, London, S.E.1, as Public Analyst for the Borough. 36 The following table gives details of the samples obtained within his district during the year. Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. Convic tions. Formal. Informal. Total. Formal. Informal. Total. Bread - 1 1 - - - - — Butter — 14 14 - 1 1 — — Cheese — 3 3 - - - — — Fish (Canned) - 3 3 - - - - - Lemon substitute - 1 1 - - - - - Margarine — - 5 — - — — — Milk 50 1 51 6 - 6 - — Milk, Evaporated - 1 1 - 1 1 - - Orange Substitute 1 1 2 1 1 2 1 1 Orange Juice (Synthetic) - 1 1 - 1 1 - - Pepper Self - raising — 2 2 — - - - — Flour — 1 1 - - - - - Sugar Substitute - 1 1 - - - - - Tea — 1 1 - - - - — Vegetables (Canned) - 4 4 - - - - - Vinegar — 2 2 - - - - - Vit. C Tablets — 2 2 - - - - Whisky — . 3 3 — 1 1 — — Totals 51 47 98 7 5 12 1 i CHEMICAL AND BACTERIOLOGICAL 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. NUTRITION. At the close of the second year of war, the evidence gained by the examination of mothers and children at the Council's Clinics showed that the state of average nutrition was especially high. This satisfactory state of affairs is undoubtedly due to the better distribuof foodstuffs than obtained in the last war, and also to the granting of priority supplies of milk and vitamin products to mothers and young children. 37 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. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1941, 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 23 19 - Diphtheria 11 11 1 Erysipelas 8 3 - Cerebro-Spinal Meningitis 5 5 — Pneumonia 12 4 *12 Typhoid Fever 4 2 — Measles 189 — — Whooping Cough 76 4 2 Puerperal Pyrexia 1 1 - Totals 329 49 15 *Includes deaths from all forms of Pneumonia. † lncludes deaths of residents in homes and institutions outside the Borough. 38 The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections:— Cases of Infectious Disease Notified During the Year, 1941. 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. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Beddington. Wallington. North. Central. South. North. Central. South. Scarlet Fever 23 — - 1 1 — 19 7 1 1 2 1 — 3 1 1 11 7 — 19 - Diphtheria 11 — - 1 1 — 2 1 3 — 2 1 — 1 3 2 2 1 3 11 1 Erysipelas 8 - - - - - - - - - 1 6 1 — 4 — 2 2 3 - Cerebro-Spinal Meningitis 5 - - 1 - - 2 1 1 1 — — — 1 — 1 1 2 — 5 — Pneumonia 12 1 1 — - — — 1 2 — 1 2 4 3 1 3 2 — 3 4 *12 Typhoid Fever 4 - - — - 1 1 — 1 — — 1 — 2 — — — 1 1 2 — Measles 189 5 9 13 12 35 91 14 4 5 — 1 — 51 53 30 14 24 17 — — Whooping Cough 76 2 9 6 7 9 36 4 1 2 — — — 30 9 9 1U 9 9 4 2 Puerperal Pyrexia 1 — — — — — — — — 1 — — — 1 — — — — - 1 — Totals 329 8 19 21 21 45 141 28 13 10 6 12 5 92 71 46 41 46 33 49 15 *Includes all forms. 39 40 The monthly incidence of Infectious Disease, 1941. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 2 3 - - - 1 - 1 10 1 3 2 23 Diphtheria — 1 2 — 3 1 1 1 1 — 1 — 11 Erysipelas — 1 1 1 3 — — — 1 — 1 — 8 Cerebro-Spinal Meningitis 2 1 — — — — 1 — — — — 1 5 Pneumonia — 2 3 2 2 — 1 — — 1 — 1 12 Typhoid Fever 1 1 — — — — — — 1 — 1 — 4 Measles 2 10 24 40 87 18 7 — 1 — — — 189 Whooping Cough — — 3 11 4 10 21 2 5 3 12 5 76 Puerperal Pyrexia 1 — - - — — — — —- — — — 1 Totals 8 19 33 54 99 30 31 4 19 5 18 9 329 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. Diseases of the skin and respiratory systems, which might have been expected to be high, were at a low ebb. TUBERCULOSIS. There were 33 new cases notified during the year. The following table gives the number of new cases notified during the past five years:— New Cases. 1937 1938 1939 1940 1941 M. F. M. F. M. F. M. F. M. F. Pulmonary 10 10 13 5 13 13 11 9 13 15 Non-Pulmonary 2 2 5 3 3 2 1 — 4 1 Totals 12 12 18 8 16 15 12 9 17 16 The annual case rate for Pulmonary Tuberculosis per 1,000 of population for 1941 was 1.08 compared with 0.73 for 1940. The annual case rate for Non-Pulmonary Tuberculosis per 1,000 of population for 1941 was 0.19 compared with 0.04 for 1940. The following table gives the number of deaths from this disease during the past five years:— Deaths. 1937 1938 1939 1940 1941. M. F. M. F. M. F. M. F. M. F Pulmonary 6 6 2 4 7 1 8 1 5 4 Non-Pulmonary 3 1 2 — 2 1 — 3 2 — Totals 9 7 4 4 9 2 8 4 7 4 It will be seen from the foregoing table that 11 deaths were registered as due to Tuberculosis, of which 7 were Pulmonary and 4 NonPulmonary. The figures correspond to a death rate per 1,000 of population of 0.33 for Pulmonary Tuberculosis and 0.11 for Non-Pulmonary Tuberculosis. Of the 11 deaths which occurred 1 was an unnotified case, i.e., 9.1 per cent, of the total Tuberculosis deaths. Investigation as to the 41 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 he 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 — - 1 - - - - 10 and under 15 — — 1 — — — — — 15 and under 20 1 2 - — — 1 1 — 20 and under 25 — 1 1 — 1 — — — 25 and under 35 3 5 - — 1 1 — — 35 and under 45 3 5 1 — - 1 — — 45 and under 55 4 1 - — 2 — — — 55 and under 65 1 1 1 — 1 1 1 — 65 and upwards - - - - - - - - Totals 13 15 4 1 5 4 2 — The new cases were distributed amongst the Wards as follows:— Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 4 5 6 6 5 2 Non-Pulmonary 2 — 1 — 1 1 Totals 6 5 7 6 6 3 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 25 such examinations were made. Treatment for cases of Tuberculosis is under the control of the Surrey County Council, who provide both sanatorium and dispensary treatment. The Tuberculosis After-Care Committee, which commenced activity in 1935, continued its good work during 1941, assisting a number of Tuberculosis patients and their dependents in various ways. 42 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. 43 William pile, Ltd.. 46-5c. HIGH street, SUTTON.