BEO 7 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1942. William Pile, Ltd., Printers, 78, Woodcote Road, Wellington. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1942. TABLE OF CONTENTS. Public Health Committee 5 Maternity and Child Welfare Sub-Committee 5 Representatives on the Wandle Valley Joint Hospital Board 5 Representatives on the Wandle Valley Joint Sewerage Board 6 Staff of Public Health Department 6 Extracts from Vital Statistics Vital Statistics: Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1942 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 Diphtheria Immunisation 15 Hospitals 16 Disinfection 17 Maternity and Child Welfare: General Observations 17 Ante-natal and Post-natal Supervision 17 Maternity and Child Welfare Centres 18 Maternity Ward 19 Consultant Obstetrician 19 Home Help 19 Birth Control 20 Treatment: Orthopedic 20 Dental 20 Minor Ailments 20 Health Visiting 21 Child Life Protection 21 Sanitary Circumstances of the Area: Water Supplies 22 Drainage and Sewerage 22 Rivers and Streams 22 Closet Accommodation 22 Public Cleansing 22 2 Sanitary Inspection ot the Area 23 Statement of the Senior Sanitary Inspector for the Year 1942: 23 Dwelling Houses 23 Milk and Dairies 23 Slaughterhouse 24 Food Premises 24 Unsound Food 24 Factories 25 Bakehouses 25 Workplaces 25 Shops and Offices 25 Complaints 25 Smoke Abatement 25 Infectious Disease and Disinfection 25 Offensive Trades and Fish Frying 25 Rats and Mice (Destruction) Act 26 Increase of Rent (Restrictions) Act 26 Notices 26 Prosecutions 26 Sanitary Improvements: 26 Water Supply 26 Drains 26 Water Closets 26 Sinks 26 Yards 27 Dust Receptacles 27 Dampness 27 General Repairs, etc 27 Food Premises 27 Factories 27 Bakehouses 27 Workplaces Shops and Offices 27 Bye-laws with respect to Nuisances 28 Fish Frying Premises 28 Summary of work done during the year 28 Shops and Offices 28 Camping Sites 28 Smoke Abatement 29 Swimming Baths 29 Eradication of Bed Bugs 29 Schools 29 Dairies 29 Milk (Special Designations) Regulations 30 Slaughterhouses 30 3 Bakehouse 30 Factories 30 Housing: Housing Statistics: 32 Inspection of Dwelling Houses 32 Remedy of Defects without service of Formal Notice 32 Action under Statutory Powers 32 Housing Act, 1936—Part IV—Overcrowding 33 Number of Houses and Flats erected during the year 33 Inspection and Supervision of Food: Milk 33 Meat 34 Food and Drugs Act, 1938 34 Chemical and Bacteriological Examinations 35 Nutrition 36 Shell Fish (Molluscan) 36 Adoptive Acts and Bye-Laws 36 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 37 Incidence of Infectious Diseases in Age Groups and Wards 38 Monthly Incidence of Infectious Disease 39 Tuberculosis 40 4 BOROUGH OF BEDDINGTON & WALLiNGTON. PUBLIC HEALTH COMMITTEE. December, 1942. Members: Alderman H. B. Smalley (Chair man). Councillor F. C. Elwood, J.P. (Mayor). Councillor F. G. Bryant (Deputy Mayor). Alderman G. Purser. Councillor H. H. Best. Councillor Mrs. V. Boyce. Councillor W. W. Craig. Councillor A. R. B. Gill. Councillor Mrs. O. L. Wiles. Councillor A. H. Pearce. Councillor S. W. Phipps. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1942. Members: Alderman H. B. Smalley (Chairman). Councillor F. C. Elwood J.P. (Mayor). Councillor F. G. Bryant (Deputy Mayor). Councillor Mrs. V. Boyce. Councillor A. R. B. Gill. Councillor Mrs. O. L. Wiles. Co-opted Members: Miss E. Hall, Mrs. L. A. Pearce, Miss MacKinnon. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1942. Members: Councillor F. C. Elwood, J.P. (Mayor). Alderman H. d. Banks. Alderman G. Purser. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1942. Members: Councillor F. C. Elwood J.P. (Mayor). Councillor Mrs. V. Boyce. Councillor W. W. Craig. Councillor A. R. B. Gill. 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:— Eleanor H. Kelly, M.D. (Ed.), Ch.B. (appointed 11th Dec., 1941) Margaret G. Falla, M.B., Ch.B. (appointed 11th Dec., 1941). Consultant Obstetrician:— *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., H.V. Cert Miss W. Dowdall, S.R.N., S.C.M., H.V. Cert. Clerks:— R. F. Burns (Chief Clerk). Miss M. Frost. IE. D. Evezard. W. E. Murrells (Temporary). H. Bourne (Temporary). Mrs. B. L. Gowans (Temporary) Appointed 26/5/42. Laboratory Assistant: — †W. K. Stevens. E. Morris (Temporary), Resigned October, 1942. Miss P. Russenberger (Temporary), Appointed 12/10/42. *Part-time. †On Active Service. 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, 1942. As instructed by the Minister of Health, no figures are given in the Report concerning rise and fall in the population. The Minister is of opinion that such information should be withheld for security reasons.. The Report as a whole has been kept as small as possible, most of the information being presented as statistical summaries, and only those tables which the Minister considers essential being included. Amongst the vital statistics, the most significant is the large rise in the birth rate.This rise is general for the whole country. The rate for Beddington and Wallington has risen from 10.79 for the year 1941 to 16.33 for the year 1942, a total of 447 live births being registered during the year. The death rate, at 11.21, remains practically stationary. One of the most important problems which the Corporation has had to face during the year and one which, unfortunately, will become even worse during the later stages of the war and the first years of peace, is the housing shortage. The health of the community as a whole, as revealed in the statistical information supplied in the Report, remains at a high level. No epidemics or marked increase in any of the infectious diseases was recorded during the year. The general state of nutrition of the community was maintained at a good level, having regard to the inevitable reductions in the purchase of essential foods, due to the Government's rationing scheme. There was no evidence of serious vitamin deficiencies. It is possible, however, that minor degrees of vitamin deficiency do exist and cause moderate degrees of ill-health among certain classes of the community. Amongst young children, deficiencies in Vitamins C and D, although not causing many cases with marked clinical features of the deficiency diseases, undoubtedly give rise to minor maladies of childhood. Late dentition, nervous irritability and other symptoms of a slightly lower standard of health were noted. Such departures from the ideals to be aimed at in child welfare bear no relation, however, to the very much lower standards seen during the last great war. There is no room for complacency, however, and no 7 effort should be spared by the Government and Local Authorities to ensure as wide a distribution of vitamin products as possible. 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, Ladles 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 422 226 196 16.33 „ „ Illegitimate 25 12 13 Total 447 238 209 Rate per 1,000 total (live and still) births Still Births 10 6 4 22.34 Death Rate per 1,000 of the estimated resident population Deaths 317 139 178 11.21 Rate per 1,000 (live and still) births. Deaths from Puerperal causes:— Puerperal Sepsis — — Other Puerperal causes — — Death Rate of Infants under one year of age: — All Infants per 1,000 live births 44.74 Legitimate Infants per 1,000 legitimate live births 45 Illegitimate Infants per 1,000 illegitimate live births 40 Deaths from Cancer (all ages) 57 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 1942: — 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 15.8 17,3 18.4 14.0 16.33 Still 0.54 0.66 0.62 0.48 0.40 Deaths— All Causes 11.6 13.3 12.1 13.9 11.21 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 - Whooping Cough 0.02 0.03 0.02 0.04 0.07 Diphtheria 0.05 0.06 0.04 0.02 - Influenza 0.09 0.09 0.10 0.07 0.07 Smallpox — - Measles 0.01 0.02 0.01 0.01 - Notifications— Typhoid Fever 0.01 0.01 0.01 0.02 - Paratyphoid Fever 0.01 0.01 0.01 0.01 - Cerebro Spinal Fever 0.14 0.17 0.12 0.15 0.07 Scarlet Fever 2.19 2.49 2.34 1.86 2.66 Whooping Cough 1.73 1.97 1.58 2.72 1.82 Diphtheria 1.05 1.35 0.91 0.76 0.21 Erysipelas 0.30 0.36 0.26 0.43 0.07 Smallpox 0.00 0.00 — 0 00 — Measles 7.46 9.27 7.39 8.62 2.44 Pneumonia 1.07 1.30 0.94 0.94 0.25 Deaths under 1 year of age Rates per 1,000 Live Births. 49 59 46 60 44.74 Deaths from Diarrhoea and Enteritis under 2 years of age 5.2 7.5 4.8 8.6 — Maternal Mortality Rates per 1,000 Total Births (i.e., Live and Still). (excluding abortion) Puerperal Sepsis 0.42 Not available — Others 1.59 — Total 2.01 — Notifications— Puerperal Pyrexia 12.61 15.94 10.80 17.69 10.9 10 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar General, gives the causes of death of residents in the Borough during 1942: — Causes of Death. Males. Females. Total. All Causes 139 178 317 1. Typhoid and Paratyphoid Fevers - - - 2. Cerebro-spinal Fever — — - 3. Scarlet Fever — - - 4. Whooping Cough 1 1 2 5. Diphtheria — — - 6. Tuberculosis of Respiratory System 6 6 12 7. Other forms of Tuberculosis — 3 3 8. Syphilitic Disease — — - 9. Influenza 1 1 2 10. Measles - — - 11. Acute Poliomyelitis and Polioencephalitis - - - 12. Acute Infectious Encephalitis — — — 13.mCancer of Buccal Cavity and Oesophagus (males) 3 3 13.f Cancer of Uterus — 2 2 14. Cancer of Stomach and Duodenum 6 3 9 15. Cancer of Breast — 8 8 16. Cancer of all other Sites 17 18 35 17. Diabetes — 3 3 18. Intra-cranial Vascular Lesions 10 21 31 19. Heart Disease 51 50 101 20. Other diseases of the Circulatory System 2 6 8 21. Bronchitis 8 10 18 22. Pneumonia 5 5 10 23. Other Respiratory Diseases 2 1 3 24. Ulceration of the Stomach or Duodenum 5 2 7 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis — — — 27. Other Digestive Diseases 2 6 8 28. Nephritis 2 4 6 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — — — 31. Premature Birth 1 4 5 32. Congenital Malformations, Birth Injury, Infantile Disease 3 6 9 33. Suicide 1 1 2 34. Road Traffic Accidents 2 — 2 35. Other Violent Causes 2 1 3 36. All Other Causes 9 16 25 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. Heart Diseases 101 31.86 Cancer 57 17 9 Intra Cranial Vascular Lesions 35 11.04 Bronchitis 18 5.67 Pulmonary Tuberculosis 12 3.78 Pneumonia 10 3.15 Violence 7 2.2 VIOLENCE. Two deaths, 1 male and 1 female were recorded from suicide. There were 5 deaths occurring from other forms of violence, 4 males and 1 female, and in the case of 1 person dying outside the Borough the death was certified as being due to war operations. Of the remaining 4 deaths from violence, 2 were the results of accidents in the home, and 2 resulted from road accidents. MATERNAL MORTALITY. There were no deaths associated with childbirth during the year. INFANTILE MORTALITY. Of 447 live births 20 deaths of, infants under 1 year of age were registered. Of these, 7 were males and 13 females; with one exception, all were legitimate children. This gives an infantile mortality rate of 44.74 per 1,000 live births, as compared with 21.13 in 1941 and 49.00 for England and Wales. No one specific cause can be given for this increase in the infantile mortality rate, but as the births for the year are considerably greater than have been registered previously, the rate probably represents a truer picture of the infantile mortality rate for the Borough than has heretofore been presented. 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 81 1 80 Tuberculosis—(Sputa) 29 4 25 Typhoid 2 — 2 Dysentry 1 — 1 Totals 113 5 108 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 256 Milk: — Bacteriological analyses 146 Microscopical examinations 21 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. General and Accident Gases. The new ambulance service provided by the Council and operated from the Fire Station in Belmont Road was transferred in January to premises in Milton Road. This transfer was consequent upon the Fire Service being placed under National control. 13 The Council have continued to operate two ambulances successfully, under the control of the Medical Officer of Health, for the removal of cases of accident occurring in the Borough. NURSINC IN THE HOME. This service is undertaken mainly by the staff of the Beddington and Wallington District Nursing Association and their work in the Borough is greatly appreciated. During the year the District Nurses attended 937 cases, including 69 maternity and 106 midwifery patients. TREATMENT CENTRES AND CLINICS. Maternity and Child Welfare Centres:— Centre. Elm Grove, The Grange, London Road. When held. 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. 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, Miss Curwain, Mrs. Daw, Mrs. Dewit, Mrs. Hooper, Mrs. Jackson, Mrs. James, Mrs Jennings, Mrs. Jeffrey, Mrs. Lennard, Mrs. Melton, Mrs. Mountney, Mrs. Phillips, Mrs. Rose, Mrs. Street, Mrs. Williams, Mrs. Wild, and the ladies of the Inner Wheel of Rotary. 14 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. But only a small number of residents availed themselves of the service during the first years during which the scheme was in operation. During the year 1941, 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 the numbers of children brought to clinics and immunised in private and elementary schools was greatly increased. Particular attention has been concentrated on the immunisation of children attending at Infant Welfare Centres, on 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 following table gives the number of children who were treated during the year:— 0-5 years 5-15 years Total 0-15 years Approximate number of children in the Borough at 31st Dec., 1942 1400 3250 4650 Children who completed full course of immunisation during the year 416 245 661 Children immunised before 1st Jan., 1942 404 1961 2365 Percentage of child population immunised at 31st Dec., 1942 58.6 67.9 50.8 The Government's recommended scheme of giving two injections, at a month's interval, of Alum Precipitated Toxoid (A.P.T.) was adopted in 1941. 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 15 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. 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. It is anticipated that a further V.D. clinic will be opened at St. Helier Hospital in the early future. 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. Genera! 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. MUNICIPAL HOSPITALS. The Municipal Hospitals serving this area are administered by the Surrey County Council, and are situated at Epsom and Kingston. During 1941 it was hoped to bring the new County Council Hospital at St. Helier into full operation to cater for the needs of this and the neighbouring county districts. This hope was frustrated owing to enemy action, and the hospital was not able to function as early as was anticipated. It was not until the latter half of 1942 that this hospital was able to operate effectively and to receive both maternity and general hospital cases from this area. 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. The greater number of maternity cases are admitted to the Municipal Hospitals. 16 DISINFECTION. The disinfection of houses has been undertaken by the Council during the year and the Wandle Valley Hospital Board have continued to co-operate in the disinfection of bedding, etc. When residents request disinfection which is not essential in the interests of the public health, this is undertaken upon a payment of 10s. per load for bedding, etc., and 5s. for the first room and 2s. 6d. for each additional room as applied to house disinfection. MATERNITY AND CHILD WELFARE. The Council is the responsible authority for this important section of Public Health work. During 1942 the Council's schemes for Maternity and Child Welfare continued to operate satisfactorily. The District Nursing Association midwives continued to perform yeoman service, the increase in their midwifery cases being from 82 to 106. 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 17 patients per session. Ante Natal and Post Natal Attendances 1942. Council Cases. Nursing Association Cases. Total— 1942 Total— 1941 Number of Clinics held 103 101 Ante Natal Cases:— Total number attending during the year 277 157 434 281 Number of first attendances 235 114 349 244 Number of re-attendances . 878 582 1460 1107 Total attendances 1113 696 1809 1351 Average attendance per session 1 10.8 6.7 17.5 13.4 • Post Natal Cases:— Total number attending during the year 50 55 105 89 Number of first attendances 49 53 102 89 Number of re-attendances 4 9 13 22 Total attendances 53 62 115 111 Average attendance per session 0.5 0.6 1.1 - All cases are seen by the Medical Officer when attending these clinics. 17 During the year 434 expectant mothers attended the Clinic as compared with 281 in 1941. This represents approximately 98 per cent of the total notified births (live and still) which occurred in the. Borough during 1942. The figures for 1941 are shown in the table for comparison purposes. POST-NATAL CLINIC. Post-natal cases are seen as they present themselves at the antena'tal clinic and it is estimated that about 24 per cent. of the cases seen at the ante-natal sessions return for post-natal examinations after their confinements. The Medical Officers at the Clinic, and the Health Visitors, are endeavouring to persuade the mothers to make more use of the PostNatal facilities. When the percentage has increased sufficiently, it is anticipated that a special Post-Natal Clinic will be- required monthly. 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. 1 Totals. 1942 1941 C. N.A. Clinics held 10 10 Patients attending: Ante-natal 13 1 1 15 27 Post-natal 1 — — 1 2 Total attendances 14 1 1 16 29 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 1942 at the five centres maintained by the Council, from which it will be seen there has been a great all-round increase on the previous year. 18  Bandon Hill. Bedding ton. The Grange Elm HackGrove. bridge. Walling ton. Totals, 1942 Totals, 1941 Number of sessions held 24 24 22 23 24 117 117 Infants: — No. of new cases under 1 year 116 61 57 47 101 382* 267 No. of re-attendances 790 697 429 314 743 2973 1870 No. of new cases over 1 year 65 29 23 17 47 181 173 No. of re-attendances 1121 746 743 457 797 3864 3005 Total attendance of infants 2092 1533 1252 835 1688 7400 5315 Average attendance of infants per session 87 64 57 36 70 63 45 Mothers attending 1903 1373 1073 720 1588 6657 4712 Total attendances 3995 2906 2325 1555 3276 14057 10027 Average total attendance per session 166 121 105 68 136 120 87 *Includes 15 children who made their first attendance at Clinics outside the Borough 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 17 For medical reasons 4 For unsuitable home conditions 13 Normal confinements 9 Abnormal confinements 8 Sixteen cases were referred from the Ante-natal Clinic, and one case was sent into hospital, having been referred to the Medical Officer of Health by her own doctor. CONSULTANT OBSTETRICIAN. No changes occurred in the appointment of Consultant Obstetrician during the year. HOME HELP. Two Home Helps are employed by the authority to assist in domestic duties during confinements occurring in the homes of residents. A Home Help was provided in 21 cases during the year. 19 BIRTH CONTROL. The Council have made arrangements for women who need information on birth control, on the grounds of health, to attend a volun- * tary centre at Croydon. During 1942 23 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 24 cases (defects of the feet, bow legs, knock knees, etc.) received treatment. Dental. During 1942 45 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 Received treatment 35 - 10 Made dentally fit 20 - 8 Treatments:— 20 - 8 Fillings:— In temporary teeth — - 1 In permanent teeth 2 - - Teeth extracted 171 - 25 Administrations of general anaesthesia 15 - 7 Patients supplied with dentures 13 - - Dentures supplied 22 — - Minor Ailments. One hundred and fourteen cases were referred from the Maternity and Child Welfare Centres to the under-mentioned hospitals during the year:— Croydon General Hospital 59 Carshalton, Beddington and Wallington (War Memorial) Hospital 37 Great Ormond Street Hospital 11 The Wilson Hospital, Mitcham 5 Royal National Orthopaedic Hospital 1 St. Helier County Hospital 1 The conditions requiring treatment were:— Tonsils and Adenoids 26 Orthopaedic defects 24 Eye conditions 16 Circumcision 15 Skin conditions 8 Nævus 5 Ear conditions 3 Miscellaneous ailments 14 20 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 69 No. of re-visits 44 Total 113 Visits to infants:— No. of first visits to infants under 1 year 431 No. of re-visits to infants under 1 year 498 No. of visits to infants 1-5 years 1271 Total 2200 Public Health Act (Child Life Protection):— No. of visits paid 110 Other visits:— Infantile Mortality 13 Stillbirths 5 Infectious diseases 64 Tuberculosis 39 Scabies 70 Impetigo 2 Verminous Heads 7 Maternity, Home Help, Milk and Dental Scheme, Wartime Nurseries, etc. 221 Unsuccessful visits 368 Total 899 Total visits, 1942 3212 Total visits, 1941 3508 Attendances at clinic sessions. Maternity and Child Welfare Centres 212 Ante-natal and Post-natal Clinics 192 Total attendances, 1942 404 Total attendances, 1941 440 Interviews at office 255 CHILD LIFE PROTEGTSON. 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 11 Number of children on the register at the end of the year 34 Number of children who died during the year — During the year 110 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. 21 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 258 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 15 samples) 187 Private wells 64 Other waters 1 The main water supply continues to be satisfactory both in quantity and in bacteriological purity. 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 1942 involving damage to water mains. DRAINAGE AND SEWERACE. 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. In addition to the normal maintenance of the River Wandle undertaken throughout the year, certain sections of the river were cleaned out during 1942, silt, tree branches and obstructions being removed. Certain water-courses feeding the River Wandle were also cleaned, while substantial lengths of camp sheeting were provided to strengthen the river banks at Beddington. 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. Four cesspools were in use in the district at the end of the year. PUBLIC CLEANSING. The collection of house refuse throughout the Borough is carried out by direct labour, under the supervision of the Borough Surveyor and Engineer. The refuse is deposited on a site within the district. 22 As from the 28t,h September, 1942, by instruction of the Council, a fortnightly instead of a weekly house refuse collection was instituted. 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. 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 1942. DWELLING-HOUSES. Number of inspections of dwelling-houses 807 Number of inspections recorded under Housing Regulations — MILK AND DAIRIES. Number of cowkeepers on register — Number of purveyors of milk on register 45 Number of dairy premises on register 7 Number of inspections of premises 30 Defects in dairy premises discovered — Infringements of Acts and Orders discovered and dealt with:— Extraneous matter in milk 1 Unclean milk vessels 3 4 Number of licences issued under the Milk (Special Designations) Regulations:— Tuberculin Tested—Dealer's licences 2 —Supplementary Licences 7 Pasteurised—Dealer's Licences 4 —Supplementary Licences 6 Pasteuriser's Licence 1 20 23 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of visits to slaughterhouse 2 Number of visits to other premises on which animals were slaughtered 7 Carcases inspected and condemned:— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — — 9 Number inspected — — — •— 9 Whole carcases condemned or — — — — — Carcases of which some part or organ was condemned — - — — — FOOD PREMISES. Number of visits to food-preparing places 666 Number of defects discovered and remedied 15 UNSOUND FOOD. Destroyed or released for approved purposes:— Tons cwts. qtrs. lbs. Dried Fruits 48 4 — 5 Tinned foods (various) 12 2 — Fruit 6 — 4 Fish 2 2 9 Vegetables 2 — — Cheese 1 — 5 Sausages 1 9 Bacon 1 6 Eggs 523 Totals 49 8 3 10 FOOD ANALYSIS. Number of samples analysed by Public Analyst 100 Number of samples reported against:— Cordial substitutes—Contained preservative 2 Whisky—54.6 degrees underproof 1 Marzipan—Contained no almonds 1 Milk—Added water, 7 per cent 1 — 5 Number of prosecutions 1 24 FACTORIES. Number of factories on register 97 Number of inspections 145 Number of defects discovered and remedied 21 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 38 Number of defects discovered and remedied 7 WORKPLACES. Number of inspections of workplaces 34 Number of defects discovered and remedied 4 SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 447 Number of defects discovered and remedied 16 COMPLAINTS. Complaints received during the year were due to the following causes:— Defects in dwelling-houses 56 Stoppages in drains33 Prevalence of rats 22 Defects in drains or water closets 21 Defective dustbins 20 Defective water fittings 20 Food supplies 9 Accumulations of refuse 7 Insect pests 6 Miscellaneous 15 209 SMOKE ABATEMENT. Number of observations 12 Number of nuisances discovered and remedied — INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 139 Number of rooms disinfected 139 Lots of bedding and clothing disinfected 144 Number of library books disinfected 258 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 11 Number of defects discovered — 35 RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints or requests for advice received 22 Number of visits to premises 197 Number of infested premises dealt with 28 INCREASE OF RENT (RESTRICTIONS) ACTS. Number of applications for certificates Nil NOTICES. Number of informal notices served (including verbal intimations) 475 Number of statutory notices served:— Public Health Act, 1936, Section 93 (nuisances) 14 Public Health Act, 1936, Section 75 (dustbins) 17 Public Health Act, 1936, Section 45 (closets) 2 Public Health Act, 1936, Section 39 (drains) 3 36 PROSECUTIONS. Selling whisky 54.6 degrees under proof, contrary to Fined £2 0 0 Section 3, Food and Drugs Act, 1938 costs £5 5 0 SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 12 Water pipes and fittings repaired or renewed 58 Drains. Drains re-laid or repaired 29 Drains unstopped and cleansed 63 Intercepting traps provided with rodeye stoppers 9 Manholes provided or repaired 28 Soil or ventilation pipes repaired or renewed 14 Gully kerbs and channels repaired 26 New soakaways constructed 9 Cesspools emptied 2 Closets. New closets provided 5 Buildings repaired 5 New pans fixed to water closets 16 Flushing cisterns repaired or renewed 23 Flush pipes and pan joints repaired or renewed 13 Seats repaired 12 Light and ventilation provided 2 Urinals repaired 1 Sinks. Sinks renewed 5 Waste pipes repaired or renewed 17 26 Yards. Yards newly paved or repaired 8 Dust Receptacles. New portable galvanised iron dustbins provided 256 Dampness. Damp-proof courses provided or repaired 5 Roofs repaired 54 Rainwater gutters repaired or renewed 57 Rainwater downspouts repaired or renewed 25 Windows, sills and doors made weatherproof 14 External walls repaired, re-pointed, or rendered 31 External walls treated with waterproofing solution 1 Ventilation provided under floors 11 General Repairs, Etc. Rooms cleansed 54 Walls and ceilings repaired 61 Floors repaired 14 Stoves repaired or renewed 14 Doors repaired or renewed 4 Windows repaired 32 Chimneys repaired 24 Overcrowding abated 3 Number of premises disinfested from bed bugs 6 Refuse removed 13 Food Premises. Drainage defects remedied 9 Accumulations of refuse removed 3 Receptacles for refuse provided 3 Factories. Premises cleansed 4 Sanitary conveniences—defects remedied 8 Other defects remedied 9 Bakehouses. Premises cleansed 1 Other defects remedied 6 Workplaces. Drains cleansed 2 Water supply reinstated 1 Refuse removed 1 Shops and Offices. Drainage defects remedied 8 Premises cleansed or repaired 4 Refuse removed 2 Heating facilities provided or repaired 2 27 Byelaws with respect to Nuisances. Offences discovered and remedied — Fish Frying Premises. Defects discovered — SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 807 Number of re-inspections of premises 1733 Number of visits to works in progress 679 Number of miscellaneous visits and inspections 862 Number of visits to dairies 30 Number of visits to factories 145 Number of visits to bakehouses 38 Number of visits to workplaces 34 Number of visits to shops and offices 447 Number of visits to premises re slaughtering 9 Number of visits to food premises 666 Number of visits to stables and yards 79 - Number of visits to market gardens, etc 39 Number of visits to fried fish shops 11 Number of visits to urinals 60 Number of visits to piggeries 28 Number of visits re infectious diseases 139 Number of visits to streams 16 Number of visits re rats 197 Number of visits re smoke abatement 12 Number of complaints received and investigated 209 Number of informal notices served 475 Number of statutory notices served 36 Number of interviews re nuisances, etc 632 Number of rooms disinfected 139 Number of lots of bedding and clothing disinfected 144 Number of library books disinfected 258 Number of visits to Public Air Raid Shelters 311 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS AND OFFICES. Four hundred and forty-seven inspections were made during 1942, and in 9 cases action was necessary in regard to sanitary defects or requirements. CAMPING SITES. There are no camping sites within the Borough. 28 SMOKE ABATEMENT. No nuisances arising from the emission of smoke occurred during the year. SWIMMING BATHS. During the year the Council decided to meet the growing demand for swimming facilities for young people in the Borough. The London County Council were approached and consented, for an agreed rental, to allow Beddington and Wallington Corporation to meet the demand by using the swimming bath situated at the Royal Female Orphanage, Beddington. This, arrangement was eminently satisfactory, and during the months of July, August and September, in spite of inclement weather, school-children, youth organisations and Civil Defence personnel were able to enjoy swimming activities. It is hoped that next year an arrangement may be entered into early in the season and the facilities extended to embrace a larger section of the population. ERADICATION OF BED BUCS. During the year bed bugs were found to exist in 2 Council houses, and in 4 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 7 registered premises within the district, this being one less than last year. During the year 30 visits of inspection were paid, and conditions found to be satisfactory. 29 MILK (SPECIAL DESIGNATIONS) REGULATIONS. During the year the Council granted the following number of licences under the above-mentioned Regulations:— Tuberculin Tested 9 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 one instance. 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. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power 133 4 - Factories without mechanical power 12 — - Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) - - - Total 145 4 — 30 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 6 6 — - 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.) 10 9 1 - Total 22 21 1 — 3. Outwork in Unwholesome Premises. No instances were discovered. 31 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 798 (b) Number of inspections made for the purpose 807 (2) (a) Number of Dwelling-houses (included under head (D above) inspected and recorded under the Housing Consolidated Regulations — (b) Number of inspections made for the purpose — (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 ... 409 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 407 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 36 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice:— (a) By owners 35 (b) By Local Authority in default of owners 1 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 — 32 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 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room shaving 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 53 (b) Number of new cases of overcrowding reported during the year 5 (c) (1) Number of cases of overcrowding relieved during the year 3 (ii) Number of persons concerned in such cases 27 (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. Graded Milk. The sample of Tuberculin Tested milk examined was found up to standard, satisfying the prescribed methylene blue reduction test. Of the 65 cases of Pasteurised milk examined, only one exceeded the 100,000 bacteria per millilitre allowed by the Milk (Special Designations) Regulations. All the milks sold as Pasteurised were examined for phosphatase, to ascertain the efficiency or otherwise of Pasteurisation, all the samples so examined being satisfactory. 33 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 1 Pasteurised 65 Ungraded 81 Total 147 Ungraded Milk. Of the 81 samples examined during the year, 76 contained fewer than 200,000 bacteria per millilitre, and in all the 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. One sample of milk was examined microscopically for the presence of acid-fast bacilli, with a negative result. 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 DRUCS 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.I, as Public Analyst for the Borough. 34 The following table gives details of the samples obtained withir this district during the year. Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. Convic tions. Formal. Informal. Total. Formal. Informal. Total. Almonds - 1 1 - - - - - Apples (Canned) - 1 1 - - - - - Apple Juice — 1 1 - - - — — Baking Powder — 3 3 - - - — — Barley, Pearl — 1 1 - - - - - Barley Water — 1 1 - - - - - Butter — 11 11 - - - — — Cordials and Cordial substitutes 1 4 5 - 2 2 - - Flour, Self- raising - 2 2 - - - - - Lard - 11 11 - - - — — Lemon Barley Water - 1 1 - - - - - Lemonade Crystals - 1 1 - - - - - Margarine — 5 - - - - - - Marzipan 1 — 1 1 - 1 — — Milk Milk Dried (Machine 35 2 37 - 1 1 - - Skimmed) — 1 1 - - - - - Orange Juice Concentrated - 1 1 - - - - - Pepper — 5 - - - - - - Gin — 1 1 — - — — — Whisky 1 — 1 1 - 1 1 1 Camphorated Oil - 3 3 - - - - - Glauber Salts — 3 3 - - - - - Tincture of Iodine — 3 3 - - - — — Totals 38 62 100 2 3 5 1 1 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 35 Hall, Wallington, under the supervision of the Medical Officer of Health. One case of food poisoning occurred during the year, the patient dying in hospital, and the diagnosis being confirmed by inquest. The patient was found, at the inquest, to have died from bacterial infection, thought to have been acquired by the ingestion of food purchased outside the Borough. NUTRITION. Evidence gained by the supervision of mothers and infants at the Council's Clinics showed that, throughout the year, the average nutritional standards were well maintained. No marked cases of vitamin deficiency presented themselves, but it is possible that, as the war advances, some vitamin deficiencies may be present without giving rise to marked clinical features at medical inspections. 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. 36 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1942 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 73 68 - Diphtheria 6 6 - Erysipelas 2 — - Cerebro-Spinal Fever 2 2 - Pneumonia 6 1 *10 Typhoid Fever — — — Measles 65 2 — Whooping Cough 50 — 2 Puerperal Pyrexia 5 5 — Dysentery 6 1 — Malaria 1 — — Totals 216 85 12 * Includes deaths from all forms of pneumonia. Includes deaths of residents in homes and institutions outside the Borough. 37 38 Cases of Infectious Disease Notified During the Year 1942. 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 73 — 3 5 2 43 11 2 6 — 1 - 24 27 5 8 8 1 68 - Diphtheria 6 1 — — — — — — 2 3 — — - 1 1 — 3 1 — 6 - Erysipelas 2 — — — — — — — — — 1 1 - 2 — — - — — — - Cerebro-Spinal Fever 2 - - - - 1 - - - 1 - - - - 2 - - - - 2 - Pneumonia 6 1 — — — — — 1 — 1 — 3 - — — — 4 — 2 1 *10 Measles 65 1 7 10 7 8 25 4 1 1 1 — - 29 1 5 15 14 1 2 - Whooping Cough Puerperal 50 4 11 9 4 5 15 - 1 1 - - - 16 4 4 12 12 2 — 2 Pyrexia 5 — — — — — — - - 4 1 - - 3 — 1 1 — — 5 — Dysentery 6 — — 1 — — 1 1 — 2 1 - — — 6 — — — 1 — Malaria 1 - - - - - - - - - - 1 - - - - 1 - - — — Totals 216 7 21 20 16 16 84 17 6 17 5 7 - 75 35 21 44 35 6 85 12 The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various Infections: — *Includes all forms. 39 The Monthly Incidence of infectious Disease, 1942. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 1 2 3 3 3 7 5 4 7 6 16 16 73 Diphtheria - 1 3 - — 1 - 1 — — - 6 Erysipelas — - - - 1 — — - - 1 - - 2 Cerebro-Spinal Fever - - - - 1 - - - - - - 1 2 Pneumonia — - 1 - - 2 — —a. - - — 3 6 Measles — - 2 6 21 15 10 1 1 — 9 - 65 Whooping Cough 16 9 5 5 5 — 1 2 - 4 3 - 50 Puerperal Pyrexia — 1 2 1 — — — 1 - — - - 5 Dysentery 5 - — 1 — — — — - — - - 6 Malaria — — — 1 — — — — — — — - 1 Totals 22 13 13 20 31 24 17 8 9 11 28 20 216 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. 1938 1939 1940 1941 1942 M. F. M. F. M. F. M. F. M. F. Pulmonary 13 5 13 13 11 9 13 15 17 12 Non-Pulmonary 5 3 3 2 1 - 4 1 1 3 Totals 18 8 16 15 12 9 17 16 18 15 The annual case rate for Pulmonary Tuberculosis per 1,000 of population for 1942 was 1.06 compared with 1.08 for 1941. The annual case rate for Non-Pulmonary Tuberculosis per 1,000 of population for 1942 was 0.14 compared with 0.19 for 1941. The following table gives the number of deaths from this disease during the past five years: — Deaths. 1938 1939 1940 1941. 1942 M. F. M. F. M. F. M. F M. F. Pulmonary 2 4 7 1 8 1 5 4 6 6 Non-Pulmonary 2 — 2 1 — 3 2 — — 3 Totals 4 4 9 2 8 4 7 4 6 9 It will be seen from the foregoing table that 15 deaths were registered as due to Tuberculosis, of which 12 were Pulmonary and 3 NonPulmonary. The figures correspond to a death rate per 1,000 of population of 0.43 for Pulmonary Tuberculosis and 0.19 for Non-Pulmonary Tuberculosis. Of the 15 deaths which occurred 3 were non-notified cases, i.e., 20 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. 40 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 - - - 1 - - - - 5 and under 10 - - - 1 - - - 1 10 and under 15 1 - - - 1 - - - 15 and under 20 2 1 - - - - - - 20 and under 25 4 2 - 1 1 - - 1 25 and under 35 3 7 1 — 1 4 - — 35 and under 45 2 1 - - - 1 - — 45 and under 55 3 — — — 1 - - - 55 and under 65 2 1 — — 1 1 — — 65 and upwards — — — — 1 — — 1 Totals 17 12 1 3 6 6 — 3 The new cases were distributed amongst the Wards as follows: — Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 8 4 4 5 6 2 Non-Pulmonary 2 — 2 — — — Totals 10 4 6 5 6 2 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 29 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 1942, assisting a number of Tuberculosis patients and their dependents in various ways. The increased incidence of Tuberculosis amongst the population generally and in the Services has given the Minister of Health cause for some concern. In order to ascertain the exact distribution of Tuberculosis amongst the population, it is suggested that the system of mass radiography be introduced. By this method, it will be possible to have an X-ray photograph taken of the lungs of large sections of the community and thus form a true estimate of the incidence of the disease. The Surrey County Council are already negotiating for the purchase of the special apparatus. 41