BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1943. William Pile, Ltd., Printers, 78, Woodcote Road, Wallington. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1943. William Pile, Ltd., Printers. 78, Woodcote Road, Wallington. 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 5 Staff of Public Health Department 6 Extracts front Vital Statistics 9 Vital Statistics: Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1943 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 I1 Maternity and Child Welfare: General Observations 17 Ante-Natal Supervision 17 Consultant Obstetrician 18 Post-Natal Supervision 18 Maternity and Child Welfare Centres 19 Maternity Ward 19 Home Help 20 Birth Control 20 Treatment: Minor Ailments 20 Dental 20 Orthopædic 20 Health Visiting 21 Child Life Protection 22 2 Sanitary Circumstances of the Area: Water Supplies 22 Drainage and Sewerage 23 Rivers and Streams 23 Cioset Accommodation 24 Public Cleansing 24 Sanitary Inspection of the Area 24 Statement of the Senior Sanitary Inspector for the Year 1943: Dwelling Houses 25 Milk and Dairies 25 Slaughterhouse 25 Food Premises 26 Unsound Food 26 Factories 26 Bakehouses 26 Workplaces 26 Shops and Offices 27 Complaints 27 Smoke Abatement 27 Infectious Disease and Disinfection 27 Offensive Trades and Fish Frying 27 Rats and Mice (Destruction) Act 27 Notices 27 Prosecutions 27 Sanitary Improvements: Water Supply 28 Drains 28 Water Closets 28 Sinks 28 Yards 28 Dust Receptacles 28 Dampness 28 General Repairs, etc. 28 Food Premises 29 Factories 29 Bakehouses 29 Workplaces 29 Shops and Offices 29 Summary of work done during the year 30 Shops and Offices 30 Camping Sites 20 Smoke Abatement 30 Swimming Bath 31 3 4 Eradication of Bed Bugs 31 Schools 31 Dairies 32 Milk (Special Designations) Regulations 32 Slaughterhouses 32 Bakehouses 32 Factories 32 Housing: 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 38 Shell Fish (Molluscan) 38 Adoptive Acts and Bye-Laws 38 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 39 Incidence of Infectious Diseases in Age Groups and Wards 40 Monthly Incidence of Infectious Disease 41 Tuberculosis 42 BOROUGH OF BEDDINGTON & WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1943. Members: Councillor F. G. Bryant (Chairman). Councillor H. H. Best, J.P. (Mayor). Councillor F. C. Elwood (Deputy Mayor). Alderman G. Purser. Alderman H. B. Smalley. Councillor Mrs. V. Boyce. Councillor W. W. Craig. Councillor A. R. B. Gill. Councillor D. Mackay. Councillor A. H. Pearce. Councillor Mrs. O. L. Wiles. MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1943. Members: Councillor F. G. Bryant (Chairman). Councillor H. H. Best, J.P. (Mayor). Councillor F. C. Elwood (Deputy Mayor). Alderman H. B. Smalley. Councillor Mrs. V. Boyce. Councillor Mrs. O. L. Wiles. Co-opted Members: Miss E. Hall, Mrs. L. A. Pearce, Miss MacKinnon. REPRESENTATIVES ON THE WAOLE VALLEY JOINT HOSPITAL BOARD. December, 1943. Members: Councillor H. H. Best, J.P. (Mayor). Alderman H. D. Banes. Alderman G. Purser. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1943. Members: Councillor H. H. Best, J.P. (Mayor). Councillor P. C. Elwood. 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. Charles A. Bentley, C.I.E., M.B., C.M., D.P.H., D.T.M. & H. (Temporary, appointed 17/4/43). Assistant Medical Officers for Ante-Natal Clinic:— *Eleanor H. Kelly, M.D. (Ed.), Ch.B. (Resigned 1/10/43). *Margaret G. Falla, M.B., Ch.B. *Eveleen Ashworth, M.B., B.S. (Appointed 1/10/43). 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. (Resigned 7/9/43). P. J. Shannon (Appointed 8/11/43). 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:— tR. F. Burns (Chief Clerk). A. L. Jones (Temporary Chief Clerk). Miss M. Frost. tE. D. Evezard. W. E. Morrells (Temporary). H. Bourne (Temporary). Mrs. B. L. Gowans (Temporary). Laboratory Assistant:— tW. K. Stevens. Miss P. Russenberger (Temporory). *Part-time. tOn Active Service. 6 Public Health Department. Town Hall,. Wallington. To His Worship the Mayor, Aldermen and Councillors of the Borouc-h of Beddington and Wallington. Ladies and Gentlemen, I submit my report for the year ending 31st December, 1943. As instructed by the Minister of Health, figures concerning rise and fall in the population have been withheld for security reasons. The Report has been kept as small as possible, information being mostly presented as statistical summaries and in tables which the Minister considers essential. The vital statistics continue to show a rise in the birth rate. This rise is general for the whole country. The rate for Beddington and Wallington has risen from 16.33 for the year 1942 to 17.56 for the year 1943, the total of 487 live births registered during the year having been exceeded only once before in the last 30 years. The birth rate is now 34 per cent. above the decennial average. The last time it exceeded 17 per 1,000 of the population was in 1920. The ratio of male to female births has shown a reduction to 105 in 1943, compared with 109 in 1942 and a decennial average of 111. The present ratio, however, now corresponds very closely with that of the country generally. The factors responsible for variations in the rates of male to female births are not understood, but it has been noted in the country as a whole, over a long series of years, that a rise in the ratio of male to female births has been correlated with a rise in wholesale prices. The deaths registered in the Borough during 1943 totalled 299, of which 137 were among males and 162 among females. The death rate was 10.75, against 11.21 for 1942, and a decennial average of 10.0 per 1,000. As regards infectious diseases, a marked feature of the year was the exceptional prevalence of measles, especially during the early months, followed during the summer and autumn by a considerable amount of scarlet fever. A total of 375 cases of; measles was notified during the year against only 65 in 1942; of scarlet fever there were 125 cases against 73 reported last year. Investigation appears to show that cases of scarlet fever were particularly prevalent among the children attending certain particular schools in the locality and special measures have been taken, in collaboration with the School Medical Authorities, to trace possible sources of infection. Apart from the increases of measles and scarlet fever mentioned above, there were only minor changes in the health conditions of the Borough, which continue to maintain a satisfactory level. Nevertheless, the housing problem remains acute and is a source of considerable anxiety. There is no evidence of any material change in the state of nutrition of the community commented on by Dr. P. J. O'Connell in 7 his report for 1942. Occasionally, cases of obvious deficiency of both Vitamins C and D have been observed among young children, and have, as far as possible, been corrected. As regards Vitamin D deficiency which is often responsible for delayed dentition, nervous irritability and other symptoms, such as weak ankles and bowed limbs, it is hoped that the establishment of a solarium for the application of artificial sunlight treatment will, in the early future, prove of great assistance in remedying the condition. 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, CHAS. A. BENTLEY, 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 463 239 224 17.56 ,, ,, Illegitimate 24 10 14 Total 487 249 238 Rate per 1,000 total (live and still) births Still Births 12 6 6 24.49 Death Rate per 1,000 of the estimated resident population. Deaths 299 137 162 10.75 Rate per 1,000 (live and still) births Deaths from Puerperal causes: — Puerperal Sepsis 1 2.04 Other Puerperal causes Nil — Death Rate of Infants under one year of age: — All Infants per 1,000 live births 32.85 Legitimate Infants per 1,000 legitimate live births 30.23 Illegitimate Infants per 1,000 illegitimate live births 83.33 Deaths from Cancer (all ages) 53 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 9 Comparative crude birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1943: — England and Wales. 126 CountyBoroughs 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. Birth:— Rates per 1,000 Population. Live 16.5 18.6 19.4 15.8 17.56 Still 0.5 0.63 0.61 0.45 0.43 Deaths— All Causes 12.1 14.2 12.7 15.0 10.75 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.03 0.03 0.03 0.03 - Diphtheria 0.03 0.04 0.04 0.02 - Influenza 0.37 0.36 0.37 0.27 0.35 Smallpox — — — — — Measles 0.02 0.02 0.02 0.02 — Notifications— Typhoid Fever 0.01 0.01 0.02 0.01 - Paratyphoid Fever 0.01 0.01 0.01 0.01 0.07 Cerebro Spinal Fever 0.08 0.10 0.06 0.09 0.07 Scarlet Fever 3.01 3.29 3.54 3.80 4.49 Whooping Cough 2.54 2.82 2.25 2.68 0.64 Diphtheria 0.88 1.12 0.77 0.74 0.32 Erysipelas 0.31 0.35 0.27 0.42 0.50 Smallpox — — — — — Measles 9.88 9.23 9.77 9.17 13.45 Pneumonia 1.34 1.62 1.16 1.27 0.89 Deaths under 1 year of age Rates per 1,000 Live Births. 49 58 46 58 32.85 Deaths from Diarrhoea and Enteritis under 2 years of age 5.3 7.9 4.4 10.4 - Notifications— Rates per 1.000 Total Births (i.e., Live and Still). Puerperal Pyrexia 11.68 15.11 9.26 15.23 2.00 Maternal Mortality Abortion with Sepsis. Abortion without Sepsis. Puerperal Infections. Other Causes. England and Wales 0.34 0.11 0.39 1.45 Beddington and Wallington 2.00 - - - 10 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar General, gives the causes of death of residents in the Borough during 1943:— Causes of Death. Males. Females. Total. All Causes 137 162 299 1. Typhoid and Paratyphoid Fevers - - - 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 8 3 11 7. Other forms of Tuberculosis 1 2 3 8. Syphilitic Disease 2 — 2 9. Influenza 4 6 10 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis - - - 12. Acute Infectious Encephalitis — — - 13.mCancer of Buccal Cavity and Oesophagus (males) 1 - 1 13./ Cancer of Uterus — 4 4 14. Cancer of Stomach and Duodenum 5 2 7 15. Cancer of Breast — 5 5 16. Cancer of all other Sites 22 14 36 17. Diabetes — 3 3 18. Intra-cranial Vascular Lesions 12 18 30 19. Heart Disease 32 43 75 20. Other diseases of the Circulatory System 7 4 11 21. Bronchitis 13 8 21 22. Pneumonia 2 7 9 23. Other Respiratory Diseases 1 1 2 24. Ulceration of the Stomach or Duodenum 2 1 3 25. Diarrhœa (under 2 years of age) — — — 26. Appendicitis 1 — 1 27. Other Digestive Diseases 1 4 5 28. Nephritis 1 3 4 29. Puerperal and Post-abortive Sepsis — 1 1 30. Other Maternal Causes — — — 31. Premature Birth 1 3 4 32. Congenital Malformations, Birth Injury, Infantile Disease 1 3 4 33. Suicide 3 — 3 34. Road Traffic Accidents 3 2 5 35. Other Violent Causes 5 6 11 36. All Other Causes 9 19 28 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 75 25.08 Cancer 53 17.72 Intra Cranial Vascular Lesions 30 10.03 Bronchitis 21 7.02 Violence and Accident 19 6.35 Pulmonary Tuberculosis 11 3.67 Influenza 10 3.34 Pneumonia 9 3.01 VIOLENCE AND ACCIDENT. Three deaths, all male, were recorded from suicide. Details of all deaths under this heading are as follows:— Cause of Death. Male. Female. Total. Suicide 3 - 3 Street Accident 3 2 5 Accidents at Home 3 4 7 Other Accidental Causes 2 1 3 War Operations 1 1 Totals 11 8 19 Two of the deaths by suicide and three of the deaths due to accidents in the home were caused by coal-gas poisoning. MATERNAL MORTALITY. There was one case which occurred in hospital from sepsis following abortion involving an inquest. INFANTILE MORTALITY. Of 487 live births 16 deaths of infants under 1 year of age were registered. Of these, 7 were males and 9 females: with two exceptions, all were legitimate children. This gives an infantile mortality rate of 32.85 per 1,000 live births, as compared with 44.74 in 1942 and 49.00 for England and Wales. 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 examination of swabs for local practitioners 87 5 82 Tuberculosis—(Sputa) 27 3 24 Typhoid 8 1 7 Totals 122 9 113 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:— Specimens. Number Examined. Water:— Bacteriological analyses 251 Milk: — Bacteriological analyses 101 Microscopical examinations 15 Pathological Specimens:— Blood 39 Urine 59 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 Cases. The Council operate two motor ambulances for the removal of cases of accident occurring in the 13 Borough and also for general public requirements. The service is under the control of the Medical Officer of Health. Civil Ambulance Removals during 1943 totalled 810, being made up as follows:— Private Removals 326 Maternity Cases 249 Accidents 235 NURSING IN THE HOME. This service is undertaken mainly by the staff of the Beddington and Wallington District Nursing Association and their work in the Borough is greatly appreciated. During the year the District Nurses attended 955 cases, including 81 maternity and 98 midwifery patients. TREATMENT CENTRES AND CLINICS. 1. Child Welfare Centres. When held. Elm Grove, The Grange, London Road. First and third Mondays of the month.* - Hackbridge, The Grange. London Road. Second and fourth Mondays of the month.* Bandon Hill, Methodist Hall, Sandy Lane North. First and third Tuesdays of the month.* High View, Methodist Hall, Sandy Lane North. Second and fourth 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. 2. Maternity Clinics. Ante-Natal Clinic. Thursdays and Fridays, 2.0-4.0. Post-Natal Clinic. First Wednesday of the month, 2.0-4.0. 14 Midwives' Clinic. Second and fourth Tuesday or month. Consultant's Clinic. Third Friday of the month. All Maternity Clinics are held at the District Nurses' Home, 57, Montagu Gardens, Wallington. Voluntary Helpers.—Mrs. Boyce, Mrs. Harley-Boynes, Mrs. Budd, Mrs. Daw, Mrs. Dewit, Mrs. Feldon, Mrs. Hooper, Mrs. Jackson, Mrs. James, Mrs. Jennings, Mrs. Jeffrey, Mrs. Lennard, Mrs. Melton, Mrs. Phillips, Mrs. Rose, Mrs. Shaw, Mrs. Williams, Mrs. Wild, and the ladies of the Inner Wheel of Rotary. TUBERCULOSIS. The treatment of cases of Tuberculosis is under the control of the Surrey County Council, who provide both sanatorium and dispensary treatment. The dispensary available for residents of the Borough is situated at the St. Helier County Hospital, Carshalton, sessions being held as follows:— Tuesdays at 10 a.m. Thursdays at 1.30 p.m. Every fourth Thursday in the month, 5.30 p.m. IMMUNISATION AGAINST DIPHTHERIA. The immunisation of children against diphtheria was begun in the Borough in 1937, but an intensive national drive to have all children below the age of 15 years immunised only began in 1941. The Borough took its full share in the Government campaign, with the result that the numbers of children brought to clinics and immunised in private and elementary schools has greatly increased. Particular attention has been concentrated on the immunisation of children attending at Infant Welfare Centres on attaining the age of one year. The following table gives the number of children who were treated during the year and, after necessary corrections, the estimated percentage of children immunised in both age groups:— 0-5 years 5-15 years Total 0-15 years Approximate number of children in the Borough at 31st Dec., 1943 1825 3750 5575 Children who completed full course of immunisation during the year 327 188 515 Children immunised before 1st Jan., 1943 1064 2479 3026 Percentage of child population immunised at 31st Dec., 1943 54.25 67.2 62.9 15 Alum precipitated toxoid (A.P.T.) 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. 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. A further V.D. clinic has been opened at St. Helier Hospital, Carshalton. HOSPITALS. Infectious Cases. Cases of infectious disease occurring in the Borough are admitted to the Wandle Valley Joint Isolation Hospital. Beddington Corner. Smail-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:— Carshalton, Beddington and Wallington District (War Memorial) Hospital. St. Helier County Hospital, Carshalton. Croydon General Hospital. The Wilson Hospital, Mitcham. MUNICIPAL HOSPITALS. The Municipal Hospitals serving this area are administered by the Surrey County Council, and are situated at Epsom and Kingston, and at the new County Council Hospital at St. Helier, Carshalton. Maternity Cases. Under an agreement between the Council and the Carshalton, Beddington and Wallington District (War Memorial) Hospital, a few maternity cases are admitted upon the recommendation 16 of the Medical Officer of Health, but a much greater number go to the Municipal 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. Disinfection which is not absolutely essential in the interests of the public health is also 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 1943 the Council's schemes for Maternity and Child Welfare continued to operate satisfactorily. The District Nursing Association midwives continued to perform yeoman service, the number of midwifery cases being 98. 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 12 patients per session Ante-Natal and Post-Natal Attendances, 1943. Council Cases. Nursing Association Cases. Total— 1943 Total— 1942 Number of Clinics held 104 103 Ante Natal Cases: — Total number attending during the year 253 145 398 434 Number of first attendances 216 84 300 349 Number of re-attendances 485 470 955 1460 Total attendances 701 554 1255 1809 Average attendance per session 6.7 5.3 12.0 17.5 All cases are seen by a Medical Officer when attending these clinics. 17 During the year, 398 expectant mothers attended the Clinic as compared with 434 in 1942. This represents approximately 81.7 per cent. of the total notified births (live and still) which occurred in the Borough during 1943. The figures for 1942 are shown in the table for comparison purposes. The reduction in the number of expectant mothers attending the Ante-Natal Clinic has followed the opening of the Ante-Natal Clinic at St. Helier Hospital. POST-NATAL CLINIC. The reduction in the number of clinics is due to the establishment of separate Post-Natal Clinics at monthly intervals. Previously post-natal cases were seen at the Ante-Natal Clinics. Post-Nata! Clinic Attendances, 1943. Council Cases. Nursing Association Cases. Total. 1943. Total. 1942. Number of clinics held 32 103 Total number attending during the year 44 49 94 105 Number of first attendances 44 * 49 94 102 Number of re-attendances 6 11 17 13 Total attendances 50 60 110 115 Average attendance per session 4.1 5.0 9.1 1.1 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. No changes occurred in this service during the year under review. The attendances were as follows:— Referred by:— Medical Officer, Ant- natal Clinic Private Practitioners. Totals. C. N.A. 1943. 1942 Clinics held 7 10 : Patients attending: Ante-natal 6 5 1 12 15 Post-natal 3 — — 3 1 Total attendances 9 5 1 15 16 18 MATERNITY AND CHILD WELFARE CENTRES. Six Infant Welfare Centres have been held fortnightly on the same days as in previous years. The following table shows the attendances for 1943 at the six centres maintained by the Council, from which it will be seen the increase reported last year has continued. In these circumstances it has been necessary to provide an additional clinic to relieve the congestion at the Bandon Hill Centre. Bandon Hill. Highview. Bedding ton. The Grange Elm HackGrove. bridge. Walling ton. Totals, 1943 Totals, 1942 Number of sessions held 24 16 24 24 21 24 133 117 Infants: — No. of new cases under 1 year 110 29 54 56 40 117 406 382 No. of re-attendances 822 282 435 522 308 901 3370 2973 No. of new cases over 1 year 34 16 12 10 4 32 108 181 No. of re-attendances 835 381 638 566 351 779 3550 3864 Total attendance of infants 1801 708 1139 1254 703 1829 7434 7400 Average attendance of infants per session 75.0 44.3 47.5 52.3 33.5 76.2 55.9 63 Mothers attending 1615 595 1081 1124 637 1746 6798 6657 Total attendances 3416 1303 2220 2378 1340 3575 14232 14057 Average total attendance per session 142.3 81.4 92.5 99 1 63.8 149.0 104.0 120 MATERNITY WARD. Throughout the year the arrangements between the Council and the Carshalton, Beddington and Wallington District (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 1 For unsuitable home conditions 1 Normal confinements 1 Abnormal confinements 1 Both cases were referred from the Ante-Natal Clinic. 19 HOME HELP SERVICE. Home Helps are employed by the authority to assist in domestic duties during confinements occurring in the homes of residents. During the year the Council approved a scheme whereby the Home Help Service was extended to include attendance at specified cases of non-infectious sickness, particularly in cases where the care of young children was necessary owing to the mother's illness. An establishment of 4 full-time and 2 part-time Home Helps was approved, but even with the co-operation of the Ministry of Labour and National Service, at times considerable difficulty was experienced in maintaining the service at full strength. During 1943 Home Helps attended the following cases: — Maternity. Non-infectious Sickness. Full-time service 35 4 Part-time service 17 1 Total 52 5 BIRTH CONTROL. During 1943 25 women sent from the Borough attended the Voluntary Centre at Croydon. TREATMENT. Minor Ailments, Eighty-three cases were referred from the Maternity and. Child Welfare Centres to the under-mentioned hospitals during the year:— St Helier County Hospital 33 Croydon General Hospital 28 Carshalton, Beddington and Wallington District (War Memorial) Hospital 17 Hospital for Sick Children (Gt. Ormond Street) 4 Wandle Valley Isolation Hospital 1 The conditions requiring treatment were:— Tonsils and Adenoids 19 Circumcision 12 Eye Conditions 10 Skin Conditions 7 Naevus 5 Hernia 5 Ear and Nose Conditions 5 Avitaminosis D 2 Impetigo 2 Mental Development 1 Miscellaneous Ailments 15 20 Dental. During 1943 17 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 12 1 4 Received treatment 7 1 3 Made dentally fit 7 1 3 Treatments:— Fillings:— In temporary teeth — - — In permanent teeth 7 — — Teeth extracted 72 12 14 Administrations of general anaesthesia 6 1 3 Patients supplied with dentures ... 6 1 - Dentures supplied 8 2 - Orthopedic. Patients attending the Centres who 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 3 cases received treatment. HEALTH VISITINC. 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:— Maternity Visits. First visits to Expectant Mothers 59 Re-visits to Expectant Mothers ... 22 Infant Welfare. First visits under 1 year 387 Re-visits under 1 year 212 First visits over 1 year 108 Re-visits over 1 year 637 Special Home Visits. Still Births 4 Child Life Protection. First visits 25 Re-visits 97 Infectious Diseases. General Enquiries 102 Tuberculosis 45 Scabies 154 21 Impetigo 9 Eye conditions 1 Verminous conditions 12 Diphtheria Immunisation 763 Puerperal Infections 1 General Visits. Home Enquiries, Agreements, etc. 52 Hospital Cases rid Convalescence 9 Adoption of children 17 Home Help Service 54 Miscellaneous visits 42 Unsuccessful visits 146 Total 2958 Attendances at Clinic Sessions. Maternity and Child Walfare Centres 373 Ante-Natal and Post-Natal Clinics 259 Total 632 Total attendances, 1942 404 Interviews in Office 300 CHILD LIFE PROTECTION. The Health Visitors are the authorised Child Life Protection Visitors lor 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 26 Number of children who died during the year — During the year 122 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. WAR-TIME DAY NURSERY. When first opened in April the Nursery was intended to cater for 40 children, but it proved so popular that within three months it was upgraded by the Minister of Health to a 50-place Nursery. Situated at Spencer Toad, Hackbridge, the pre-fabricated building was specially designed for the purpose and the children are excellently cared for in light, airy surroundings. 22 Monthly Attendances. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total Daily Average: 261 622 639 956 1001 1021 1010 1113 940 0-2 6.8 13.1 13.6 18.9 20.3 21.2 17 19.8 13.42 2-5 5 11.2 11.8 17.9 19.7 25.7 21.8 23 22.7 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 253 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 13 samples) 163 Private wells 77 Other waters 13 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. DRAINACE 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 1943, silt, tree branches and obstructions being removed. Certain water-courses feeding the River Wandle were also cleaned. 23 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. As from the 28th 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. 24 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1943. DWELLING-HOUSES. Number of inspections of dwelling-houses 680 Number of inspections recorded under Housing Regulations — MILK AND DAIRIES. Number of cowkeepers on register — Number of purveyors of milk on register 40 Number of dairy premises on register 7 Number of inspections of premises 17 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 4 „ „ —Supplementary Licences 6 Pasteurised—Dealer's Licences 5 „ —Supplementary Licences 6 Pasteuriser's Licence 1 22 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of visits to slaughterhouse 2 Number of visits to other premises on which animals were slaughtered 8 Carcases inspected and condemned: — Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — 1 — — 7 Number inspected — 1 — — 7 Whole carcases condemned or — — — — — Carcases of which some part or organ was condemned — — — — 26 FOOD PREMISES. Number of visits to food-preparing places 235 Number of defects discovered and remedied 8 UNSOUND FOOD. Destroyed or released for approved purposes: — Tons cwts. qtrs. lbs. Dried Fruit 1 4 — — Canned foodstuffs — 12 1 4 Fruit pulp — 8 — — Carrots in brine — 4 1 24 Fish — 1 2 — Flour — 1 0 17 Cheese — — 1 26 Bacon — — 1 25 Sausages — — 1 12 Sugar — — — 8 Rabbits — — — 8 Fish Cakes — — — 6 Oatmeal — — — 2 Eggs 222 Totals 2 12 3 20 FOOD ANALYSES. Number of samples analysed by Public Analyst 100 Number of samples reported against: — Black Currant Flavoured Beverage—Contained preservative 1 Liquid Coffee and Chicory—Deficient in coffee extractives 1 Dried Mint—Excess of mint stalk, foreign leaves, etc. 1 Dried Sage—Excessive amount of arsenic 1 — 4 Number of prosecutions — FACTORIES. Number of factories on register 95 Number of inspections 117 Number of defects discovered and remedied 8 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 28 Number of defects discovered and remedied 1 WORKPLACES. Number of inspections of workplaces 36 Number of defects discovered and remedied 4 20 ' SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 172 Number of defects discovered and remedied 9 COMPLAINTS. Complaints received during the year were due to the following causes: — Defects in dwelling-houses 59 Stoppages in drains 55 Defective dustbins 31 Food supplies 10 Defects in drains or water closets 9 Defective water fittings 8 Insect pests 8 Accumulations of refuse 4 Miscellaneous 26 210 SMOKE ABATEMENT. Number of observations 12 Number of nuisances observed — INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 222 Number of rooms disinfected 183 Lots of bedding and clothing disinfected 169 Number of library books disinfected 511 OFFENSIVE TRADES AND FISH FRYING. Number of offensive trade premises in district Nil Number of fish frying premises in district 3 Number of visits to fish frying premises 3 Number of defects discovered — RATS AND MICE (DESTRUCTION) ACT, 1919. Number of visits to premises 344 Number of premises found infested and dealt with 63 NOTICES. Number of informal notices served (including verbal intimations) 483 Number of statutory notices served: — Public Health Act, 1936, Section 93 (nuisances) 8 Public Health Act, 1936, Section 75 (dustbins) 5 Public Health Act, 1936, Section 45 (closets) 2 Public Health Act, 1936, Section 39 (drains) 2 Housing Act, 1936, Section 9 (housing defects) 1 — 18 PROSECUTIONS Nil 37 SANITARY IMPROVEMENTS. Water Supply. Water supply reinstated 8 Water pipes and fittings repaired or renewed 29 Drains. Drains re-laid or repaired 25 Drains unstopped and cleansed 65 Intercepting traps provided with rodeye stoppers 16 Manholes provided or repaired 22 Soil or ventilation pipes repaired or renewed 15 Gully kerbs and channels repaired 19 New soakaways constructed 9 Closets. New closets provided 2 Buildings repaired 4 New pans fixed to water closets 14 Flushing cisterns repaired or renewed 10 Flush pipes and pan joints repaired or renewed 9 Seats repaired 8 Water supply re-instated 3 Sines. Waste pipes repaired or renewed 12 Yards. Yards newly paved or repaired 3 Dust Receptacles. New portable iron dustbins provided 376 Dampness. Damp-proof courses provided or repaired 8 Roofs repaired 77 Rainwater gutters repaired or renewed 35 Rainwater downspouts repaired or renewed 27 Windows, sills and doors made weatherproof 10 External walls repaired, re-pointed, or rendered 23 External walls treated with waterproofing solution 5 Ventilation provided under floors 7 General Repairs, Etc. Rooms cleansed 40 Walls and ceilings repaired 63 Floors repaired 35 Stoves repaired or renewed 11 Doors repaired or renewed 1 Windows repaired 76 Chimneys repaired 22 Overcrowding abated 3 Number of premises disinfested from bed bugs 3 Refuse removed 3 28 Food Premises. Drainage defects remedied 3 Accumulations of refuse removed 2 Receptacles for refuse provided 2 Yards cleansed 1 Factories. Sanitary conveniences—defects remedied 5 Other defects remedied 3 Bakehouses. Premises cleansed 1 Workplaces. Drains cleansed 2 Water supply provided to sanitary convenience 1 Additional sanitary conveniences provided 1 Shops and Offices. Drainage defects remedied 3 Premises cleansed or repaired 3 Refuse removed 3 29 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 680 Number of re-inspections of premises 1771 Number of visits to works in progress 972 Number of miscellaneous visits and inspections 946 Number of visits to dairies 17 Number of visits to factories 117 Number of visits to bakehouses 28 Number of visits to workplaces 36 Number of visits to shops and offices 172 Number of visits to premises re slaughtering 10 Number of visits to food premises 235 Number of visits to stables and yards 85 Number of visits to market gardens, etc 65 Number of visits to fried fish shops 3 Number of visits to urinals 11 Number of visits to piggeries 40 Number of visits re infectious diseases 222 Number of visits to streams 16 Number of visits re rats 344 Number of visits re smoke abatement 12 Number of' complaints received and investigated 210 Number of informal notices served 483 Number of statutory notices served 18 Number of interviews re nuisances, etc 570 Number of rooms disinfected 183 Number of lots of bedding and clothing disinfected 169 Number of library books disinfected 511 Number of visits to Public Air-Raid Shelters 324 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS AND OFFICES. One hundred and seventy-two inspections were made during 1943, and in 9 cases action was necessary in regard to sanitary defects or requirements. GAMPiNC SITES. There are no camping sites within the Borough SMOKE ABATEMENT. No nuisances arising from the emission of smoke occurred during the year. 30 SWIMMING BATHS. As in the previous year, the Council were able to meet the large demand for swimming facilities for young people and residents of the Borough. The London County Council were approached and, for an agreed rental, consented to allow the Beddington and Wallington Corporation to meet the demand by the grant of generous sessions at the swimming bath situated in the grounds of the Royal Female Orphanage, Beddington. As forecast last year, it was found possible to extend facilities to a larger section of the population, with the result that on Sundays the bath was available for use of residents enrolled in a Borough Swimming Club, under the control of Corporation officials. This arrangement, as well as the programme drawn up for school children and youth organisations, was eminently satisfactory, with the result that a large number of residents availed themselves of this offer to enjoy swimming activities. The following attendances were recorded during the season, which lasted 22 weeks:— Youth Organisations 6289 School Children 4260 Borough Swimming Club 2943 Total 13492 ERADICATION OF BED BUGS. During the year bed bugs were found to exist in 2 Council houses, and in 1 other house. 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 31 Schools in the district have been inspected from time to time. They are all supplied with water from the public mains and connected with the sewers. RECULATED TRADES: DAIRIES. There are 7 registered premises within the district, this being the same as last year. During the year 17 visits of inspection were paid, and conditions found to be satisfactory. MILK (SPECIAL DESIGNATIONS) REGULATIONS. During the year the Council granted the following number of licences under the above-mentioned Regulations: — Tuberculin Tested 10 Pasteurised 12 SLAUGHTERHOUSES. There is only one Slaughterhouse within the district, this being licensed annually. One animal was 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. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories with mechanical power 108 3 — Factories without mechanical power 9 — — Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) Total 117 3 — 32 2. Defects found. Particulars. (1) Number of Defects. Number of defects in respect of which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred toH.M. . Inspector. (4) Want of cleanliness (S. 1) 1 1 — — Overcrowding (S. 2) — — — — Unreasonable temperature (S. 3) — — — — Inadequate ventilation (S. 4) — — — — Ineffective drainage of floors (S. 6) — — — — Sanitary Conveniences (S. 7): — Insufficient 3 3 — — Unsuitable or defective 2 2 — — Not separate for sexes — — — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 2 2 1 — Total 8 8 1 — 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) 632 (b) Number of inspections made for the purpose 680 (2) (a) Number of Dwelling-houses (included under head (1) 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 460 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 355 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 14 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice: — (a) By owners 13 (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 — 34 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 Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 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 38 (b) Number of new cases of overcrowding reported during the year 1 (c) (i) Number of cases of overcrowding relieved during the year 3 (ii) Number of persons concerned in such cases 22 (d) Particulars of any cases in which Dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of the overcrowding Nil (e) Any other particulars in respect to overcrowding conditions it is desirable to report Nil Number of Houses and Flats erected during the years— 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 1 Pasteurised 84 Ungraded 15 Total 100 Graded Milk. The sample of Tuberculin Tested milk examined was found up to standard, satisfying the prescribed methylene blue reduction test. Of the 84 cases of Pasteurised milk examined, five exceeded the 100,000 bacteria per millilitre allowed by the Milk (Special Designations) Regulations. 35 All the milks sold as Pasteurised were examined for phosphatase, to ascertain the efficiency or otherwise of Pasteurisation. Five of the samples so examined indicated that pasteurisation of the samples had not been entirely satisfactory. Ungraded Milk. Of the 15 samples examined during the year, 11 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 T.T. milk was examined microscopically for the presence of acid-fast bacilli, with a negative result. MEAT. The carcases of all animals intended for sale 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.R.I.C., of 1, Southwark Street, London, S.E.I, as Public Analyst for the Borough. I 36 The following table gives details of the samples obtained within this district during the year. Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. tions. Formal. [nformal. Total. Formal. Informal. Total. Beverage — 1 1 — 1 1 — — Butter — 8 8 — — — — — Cocoa — 4 4 — — — — — Coffee — 1 1 — — — — — Coffee and Chicory (liquid) — 2 2 — 1 1 — — Flour, Self- raising — 4 4 — — — — — Ginger, ground — 2 2 — — — — — Golden Raising Powder — 1 1 — — — — — Jam — 1 1 — — — — — Lard — 7 7 — — — — — Margarine — 8 8 — — — — — Milk 35 — 35 — — — — — Mint, dried — 1 1 — 1 1 — — Mustard — 2 2 — — — — — Nutmeg, ground — 1 1 — — — — — Pepper — 6 6 — — — — — Sage, dried — 1 1 — 1 1 — — Thyme, dried — 1 1 — — — — — Gin — 1 1 — — — — — Whisky — 2 2 — — — — — Boric Acid Ointment — 4 4 — — — — — Glauber Salts — 4 4 — — — — — Iodine, Tincture of — 3 3 — — — — — Totals 35 65 100 — 4 4 — — CHEMICAL AND BACTERIOLOGICAL EXAMINATIONS. Special work of this nature is carried out when required at the Counties Public Health Laboratories. 37 Routine examinations of mills and water samples continue to be done in the Public Health Laboratory established in 1937 at the Town Hall, Wellington, under the supervision of the Medical Officer of Health. 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. 38 PREVALENCE AMD CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1943, the number of cases removed to hospital and the number of deaths attributed to these diseases, excluding Tuberculosis: Disease. Number Notified. Removed to Hospital. †Deaths. Scarlet Fever 125 93 — Diphtheria 9 9 — Erysipelas 14 3 — Cerebro-Spinal Fever 2 2 — Pneumonia 25 4 9* Para-Typhoid Fever 2 2 — Measles 374 3 — Whooping Cough 18 2 — Puerperal Pyrexia 1 1 — Totals 570 119 9 * Includes deaths from all forms of pneumonia. †Inciudes deaths of residents in homes and institutions outside the Borough. se 40 Cases of Infectious Disease Notified During the Year 1943. (Excluding Tuberculosis). 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 125 1 1 3 6 7 82 15 6 4 — — — 46 23 9 30 14 3 93 — Diphtheria 9 — 1 — — — 3 3 1 — 1 — — — — 1 7 1 — 9 — Erysipelas 14 — — — — — — — — 2 2 7 3 4 5 — 3 2 — 3 — Cerebro-Spinal Fever 2 — — — — — 1 — 1 — — — — 2 — — — — — 2 — Pneumonia 25 1 1 — 1 — 5 1 2 2 2 6 4 6 3 3 2 7 4 4 9 Measles 374 5 16 25 35 40 231 14 5 2 — 1 — 111 73 46 55 67 22 3 — Whooping Cough 18 2 4 3 2 1 5 1 — — — — — 7 5 1 4 1 — 2 — Puerperal Pyrexia 1 — — — — — — — — — — — — — — — — — — 1 — Paratyphoid Fever 2 — — — — — — — — — — — — — — — — —— 2 — Totals 570 9 23 31 44 48 328 34 16 10 6 14 7 176 109 60 104 92 29 119 9 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. 41 The Monthly Incidence of Infectious Disease, 1943. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 3 6 6 14 14 14 13 5 22 5 15 8 125 Diphtheria 1 — 1 5 — 1 — 1 — — — — 9 Erysipelas 2 — 1 — — — — 2 1 2 3 3 14 Cerebro-Spinal Fever — — — — — 1 — — — 1 — — 2 Pneumonia 2 3 5 1 — 2 1 1 1 2 1 6 25 Measles 40 88 144 57 11 22 6 2 3 — 1 — 374 Whooping Cough 5 4 2 — 1 1 — 1 — 1 — 3 18 Puerperal Pyrexia 1 — — — — — — — — — — — 1 Paratyphoid Fever — — — — — — — — 2 — — — 2 Totals 54 101 159 77 26 41 20 12 29 11 20 20 570 Tuberculosis. There were 36 new cases notified during the year. The following table gives the number of new cases notified during the past five years: — New Cases. 1939 1940 1941 1942 1943 M. F. M. F. M. F. M. F. M. F. Pulmonary 13 13 11 9 13 15 17 12 19 10 Non-Pulmonary 3 2 1 — 4 1 1 3 2 5 Totals 16 15 12 9 17 16 18 15 21 15 Annual case rate per 1,000 of the estimated population:— 1943. 1942. Pulmonary 1.04 1.06 Non-Pulmonary 0.25 0.14 The following table gives the number of deaths from this disease during the past five years: — Deaths. 1939 1940 1941. 1942 1943 M. F. M. F. M. F M. F. M. F. Pulmonary 7 1 8 1 5 4 6 6 8 3 Non-Pulmonary 2 1 — 3 2 — — 3 1 2 Totals 9 2 8 4 7 4 6 9 9 5 It will be seen from the foregoing table that 14 deaths were registered as due to Tuberculosis, of which 11 were Pulmonary and 3 NonPulmonary. The figures correspond to a death rate per 1,000 of population of 0.39 for Pulmonary Tuberculosis and 0.11 for Non-Pulmonary Tuberculosis. Of the 14 deaths which occurred 1 was a non-notified case, i.e., 7 per cent. of the total Tuberculosis deaths. 42 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 Pul- monary. Non-Pulmonary. Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year — — — 1 — 1 — — 1 and under 5 1 — — — — — — — 5 and under 10 1 1 1 — — — — — 10 and under 15 — — 1 — — — — — 15 and under 20 3 — — — 1 — 1 — 20 and under 25 2 4 — — — 2 — — 25 and under 35 4 3 — 1 — — — — 35 and under 45 2 1 — — 4 — — — 45 and under 55 4 1 — — — — — — 55 and under 65 1 — — 2 1 — — 1 65 and upwards 1 — — 1 2 — — 1 Totals 19 10 2 5 8 3 1 2 The new cases were distributed amongst the Wards as follows: — Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 6 5 5 1 8 4 Non-Pulmonary 3 1 — 1 2 — Totals 9 6 5 2 10 4 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 27 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 continued its good work during 1943. The system of mass radiography referred to in last year's report will be in use in the early future at St. Helier Hospital, as soon as the necessary apparatus has been installed. 43 .