BED 9 BOROUGH OF BEDDINGTON & WALUNGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1944. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1944. William Pile, Ltd.. Printers (T.U.), 46-50, High Street. Sutton. 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 Statistics and Social Conditions 10 Extracts from Vital Statistics 11 Vital Statistics: Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1944 12 Registered Causes of Death 13 Violence 14 Maternal Mortality 14 Infantile Mortality 16 lieneral Provision of Health Services for the Area: Laboratory Facilities 35 Ambulance Facilities 16 Nursing in the Home 17 Treatment Centres and Clinics 17 Diphtheria Immunisation 18 Hospitals Cleanliness 20 Disinfection 21 Maternity and Child Welfare: General Observations 21 Ante-Natal Supervision 22 Post-Natal Supervision 22 Consultant Obstetrician 23 Child Welfare Centres 24 Maternity Ward 25 Home Help 25 Birth Control 26 Treatment: Minor Ailments 26 Dental 27 Orthopaedic 27 2 Solarium 27 Health Visiting 28 Child Life Protection 29 Care of Premature Infants 30 Care of Illegitimate Children 30 War-time Day Nursery 31 Sanitary Circumstances of the Area: Water Supplies 32 Drainage and Sewerage 33 Rivers and Streams 33 Closet Accommodation 33 Public Cleansing 33 Sanitary Inspection of the Area 33 Statement of the Senior Sanitary Inspector for the Year 1944: Dwelling Houses 34 Milk and Dairies 34 Slaughterhouse 34 Food Premises 35 Unsound Food 35 Factories 35 Bakehouses 35 Workplaces 36 Shops and Offices 36 Complaints 36 Smoke Abatement 36 Infectious Disease and Disinfection 36 Offensive Trades and Fish Frying 36 Rats and Mice (Destruction) Act 36 Notices 36 Prosecutions 37 Sanitary Improvements: Water Supply 37 Drains 37 Water Closets 37 Sinks 37 Yards 37 Dust Receptacles 37 Dampness 37 General Repairs, etc 37 Food Premises 38 Factories 38 Bakehouses 38 Workplaces 38 3 Shops and Offices 38 Summary of work done during the year 38 Shops and Offices 39 Camping Sites 39 Swimming Bath 39 Eradication of Bed Bugs 40 Schools 40 Dairies 40 Milk (Special Designations) Regulations 40 Slaughterhouse 40 Bakehouses 40 Factories 40 Housing: Housing Statistics: Inspection of Dwelling Houses 42 Remedy of Defects without service of Formal Notice 42 Action under Statutory Powers 42 Number of Houses and Flats erected during the year 43 Inspection and Supervision of Foo4: Milk 43 Meat 44 Food and Drugs Act, 1936 44 Chemical and Bacteriological Examinations 46 Nutrition 46 Shell Fish (Molluscan) 46 Adoptive Acts and Bye-Laws 46 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 47 Incidence of Infectious Diseases in Age Groups and Wards 48 Monthly Incidence of Infectious Disease 49 Tuberculosis 50 4 BOROUGH OF BEDDINGTON & WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1944. Members: Councillor A. R. B. Gill (Chairman). Alderman H. D. Banks, J.P. (Mayor). Councillor H. H. Best, J.P. (Deputy Mayor). Alderman G. Purser. Alderman H. B. Smalley. Councillor Mrs. V. Boyce. Councillor F. G. Bryant. Councillor W. W. Craig. Councillor F. C. Elwood. Councillor A. H. Pearce. Councillor Mrs. O. L. Wilks. MATERNITY AND CHILD WELFARE 8UB-COMMITTEE. December, 1944. Members: Councillor Mrs. V. Boyce (Chairman). Alderman H. D. Banks, J.P. (Mayor). Councillor H. H. Best, J.P. (Deputy Mayor). Alderman H. B. Smalley. Councillor F. G. Bryant. Councillor F. C. Elwood. 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, 1944. Members: Alderman H. D. Banks, J.P. (Mayor). Alderman G. Purser. Councillor A. R. B. Gill. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1944. Members: Alderman H. D. Banks, J.P. (Mayor). Councillor w. w. Craig. Councillor A. R. B. Gill. Councillor a. h. Prior. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— IPatrick 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). Assistant Medical Officers for Ante-Natal Clinic:— *Margaret G. Falla, M.B., Ch.B. *Eveleen Ashworth, M.B., B.S. 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. P. J. Shannon (Resigned 29/4/44). 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. Murrells (Temporary) (Resigned 19/2/44). H. Bourne (Temporary). Mrs. B. L. Gowans (Temporary). Miss J. Day (Temporary) (Appointed 13/7/44). Laboratory Assistant: — tW. K. Stevens. Miss P. Russenberger (Temporary). 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, The year 1944 was marked during the summer and latter half of the year by a renewal of aerial bombardment in the form of flying bombs and rockets, and the Borough of Beddington and Wallington, situated as it is in what has come to be known as "bomb-alley," suffered considerably in consequence. As a result, a considerable number of homes were destroyed, a larger number damaged so as to be rendered temporarily uninhabitable and the occupiers of hundreds of others exposed to great hardship, owing to leaking roofs and windows denuded of glass. A very large proportion of the mothers and children were quickly evacuated to safer areas, and much of the population was forced to revert to shelter life, with all its inconveniences and dangers, due to overcrowding. A large number of expectant mothers also were sent out of the danger zone to specially organised maternity homes in safe parts of the country. Possibly the slight fall in the recorded birth-rate and undoubtedly a considerable increase in the death-rate is a reflection of the unfavourable conditions imposed by this terrible visitation. The births recorded during the year numbered 468, against 487 in 1943, giving a birth-rate of 17.53 per 1,000, compared with 17.56 in 1943. But deaths, on the other hand, increased from 299 in 1943 to 353, giving a death-rate of 13.22 per 1,000, compared with only 10.75 in the previous year. The increased number of deaths included 19 directly due to the flying-bomb attacks, and heart disease and cancer also showed increases of 20 and 17 deaths respectively, compared with 1943. But while deaths among older people showed an increase it is gratifying to record that those among infants, on the other hand, showed a marked decline, the death-rate per 1,000 births amounting to only 21.36, compared with 46 for England and Wales as a whole and 61 in the administrative County of London. In this connection it may be pointed out that the Borough of Beddington and Wallington has, for a long period, been a particularly healthy place for young children, as the following statement indicates:— 7 Death Rates per 1,000 Births. (a) Infants. (b) Diarrhoea and Enteritis (under 2 years of age). 1944. 10-year Average. 1944. 10-year Average. 1. England and Wales 46.0 53.5 4.8 5.3 2. County Boroughs and Large Towns 52.0 59.8 7.3 7.4 3. Smaller Towns (25,000 to 50,000) 44.0 50.2 4.4 4.0 4. London Administrative County 61.0 58.6 10.1 10.1 5. Beddington and Wallington 21.3 36.2 2.1 2.1 The very low average child death-rates in Beddington and Wallington, when compared with the aggregate of the other smaller towns, with populations of from 25,000 to 50,000 persons, is a clear testimony to the efficient child welfare work in this Borough. With the exception of whooping cough, the incidence of infectious diseases generally showed a marked decline during 1944. The routine of public health work suffered considerably owing to the flying-bomb attacks and the evacuation of a large proportion of the children to safer areas. This is reflected in the returns of attendances at the Child Welfare Centres, which showed a sudden decline in June, when the bombs first began, dropped to less than half the usual number in the next few months, and did not begin to rise until November. The attendances at the Child Welfare Centres for the first five months of the year had been well maintained at 6,103, against 6,092 in 1943. But in the succeeding seven months they fell to 4,750, compared with 8,123 in the previous year. The evacuation of a large proportion of the child population of the Borough also led to a great fall in the diphtheria immunisations performed, which totalled only 161, against 515 in 1943. The state of nutrition of the population referred to in previous reports has shown no material change during the year. But a few examples of Avitaminosis C (Infantile Scurvy) were occasionally met with and a number of young children observed, as mentioned in last year's report, with symptoms of mild Avitaminosis D (Rickets). In this latter connection, the opening of the new Solarium at the Grange Mansion, which took place on 18th September, after several months' delay due to the flying bombs, has already proved of immense value. A total of 261 children and other patients have received treatment entailing no less than 3,105 attendances, up to the end of the year, a figure which compares very favourably with those admitted to solaria of a similar size in other parts of the country. 8 In conclusion, I wish to place on record my appreciation of the loyal service and valuable assistance I have received from every member 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 9 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 3,048 Population, Census, 1931 26,249 Registrar-General's estimate of resident population for 1944 26,690 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1944 8,986 Rateable Value, December, 1944 £385,814 Sum represented by penny rate December, 1944 £1,565 The Urban District of Beddington and Wallington was constituted in 1915 by an Order of the Surrey County Council, the area up to that time constituting part of the Croydon Rural District. By an order in Council, dated 20th August, 1937, H.M. King George VI granted a charter to Beddington and Wallington, which was presented on the 15th September, 1937, by the Lord Lieutenant of the County of Surrey. The Borough is bounded on the east by the County Borough of Croydon, to the north by the Borough of Mitcham, to the west by the Carshalton Urban District and to the south by the Urban District of Coulsdon and Purley. The character of the Borough, though it has been greatly developed, has changed little in personality and charm. For the most part the district is still residential in character, the middle third being almost wholly so, while the southern third, although including the landing ground of the Croydon Aerodrome, boasts some very fine residential property. Of recent years the northern third of the district has taken on a more industrial outlook, several large factories being developed there, especially radio engineering and manufacturing, and chocolate making. 10 EXTRACTS FROM VITAL STATISTICS. Total. M. F. Birth Hate per 1,000 of the estimated resident population Live Births—Legitimate 448 243 205 17.53 Illegitimate 20 7 13 Total 468 250 218 Rate per 1,000 total (live and still) births Still Births 14 6 8 29.04 Death Rate per 1,000 of the estimated resident population Deaths 353 163 190 13.22 Rate per 1,000 (live and still) births Deaths from Puerperal causes:— Puerperal Sepsis — — Other Puerperal causes 1 2.07 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 21.36 Legitimate Infants per 1,000 legitimate live births 22.32 Illegitimate Infants per 1,000 illegitimate live births Deaths from Cancer (all ages) 70 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea, etc. (under two years of age) 1 11 Comparative crude birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1944:— England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 to 1931 Census). London Administrative County. Borough of Beddington and Wallington. Births— Rates per 1,000 Population. Live 17.6 20.3 20.9 15.0 17.5 Still 0.50 0.64 0.61 0.42 0.52 Deaths— All Causes 11.6 13.7 12.4 15.7 13.2 Typhoid and typhoid 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 0.02 0.04 — Diphtheria 0.02 0.03 0.03 0.01 — Influenza 0.12 0.10 0.11 0.08 0.07 Smallpox 0.00 — — — — Measles 0.01 0.01 0.01 0.00 — Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.00 0.01 0.01 — Cerebro Spinal Fever 0.05 0.06 0.04 0.06 — Scarlet Fever 2.40 2.41 2.67 1.57 1.12 Whooping Cough 2.49 2.49 2.29 2.90 1.75 Diphtheria 0.58 0.67 0.69 0.31 0.22 Erysipelas 0.29 0.32 0.28 0.37 0.14 Smallpox 0.00 0.00 0.00 0.00 — Measles 4.16 4.51 3.94 2.98 1.42 Pneumonia 0.97 1.13 0.82 0.93 0.48 Deaths under 1 year Rates per 1,000 Live Births. of age 46 52 44 61 21.3 Deaths from Diarrhoea and Enteritis under 2 years of age 4.8 7.3 4.4 10.1 2.13 Notifications— | Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Pyrexia 10.34 ( 13.13 9.25 14.14 6.22 Maternal Mortality Abortion with Sepsis Abortion without Sepsis. Puerperal Infections. Other Causes. England and Wales 0.31 0.09 0.28 1.25 Beddington and Wallington — — — 2.07 12 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar General, gives the causes of death of residents in the Borough during 1944: — Causes of Death. Males. Females. Total. All Causes 163 190 353 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 5 4 9 7. Other forms of Tuberculosis 1 — 1 8. Syphilitic Disease 1 1 2 9. Influenza 2 — 2 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis — — — 12. Acute Infectious Encephalitis — — — 13.m Cancer of Buccal Cavity and Oesophagus (males) 1 — 1 13.f Cancer of Uterus — 3 3 14. Cancer of Stomach and Duodenum 5 5 10 15. Cancer of Breast — 11 11 16. Cancer of all other Sites 21 24 45 17. Diabetes — — — 18. Intra-cranial Vascular Lesions 17 20 37 19. Heart Disease 44 51 95 20. Other diseases of the Circulatory System 4 3 7 21. Bronchitis 12 8 20 22. Pneumonia 7 7 14 23. Other Respiratory Diseases 1 1 2 24. Ulceration of the Stomach or Duodenum 2 2 25. Diarrhoea (under 2 years of age) — 1 1 26. Appendicitis — 2 2 27. Other Digestive Diseases 1 5 6 28. Nephritis 3 4 7 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes 1 1 31. Premature Birth 1 2 3 32. Congenital Malformations, Birth Injury, Infantile Disease 1 3 4 33. Suicide 1 1 2 34. Road Traffic Accidents 2 — 2 35. Other Violent Causes 15 16 31 36. All Other Causes 16 17 33 13 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 95 26.9 Cancer 70 19.8 Intra Cranial Vascular Lesions 37 10.5 Violence and Accident 35 9.9 Bronchitis 20 5.7 Pneumonia 14 3.9 Tuberculosis (All Forms) 10 2.8 VIOLENCE AND ACCIDENT. A considerable increase has been recorded in the number of deaths registered as being due to violence and accident. The deaths attributed to street and home accidents and to suicide are at the same level as heretofore. The 84 per cent. increase in the total deaths in this category, as compared with last year, indicates the heavy toll taken by the flying bombs during the late summer months of 1944. Details of all deaths under this heading are as follows:— Cause of Death. Male. Female. Total. Suicide 1 1 2 Street Accident 2 — 2 Accidents at Home 2 5 7 Other Accidental Causes 2 3 5 War Operations 11 8 19 Totals 18 17 35 MATERNAL MORTALITY. One death occurred in hospital, the cause of death being certified as complications following Cesarean Section. Enquiry has revealed that the Cesarean Section was performed some years ago. Following correspondence with the Registrar-General's Department, the information has been received that the Department directed an enquiry to the practitioner concerned, requesting information as to the disease or condition which necessitated the Cesarean Section, but no reply was received. As the information was not forthcoming, the death was 14 assigned as being from "other maternal causes" in accordance with the manual of the International List of the Causes of Death. The rate of 2.07 per thousand total births is therefore misleading and does not represent a true picture of the maternal mortality in the Borough. For statistical purposes this figure must still stand but in reality the Borough can be congratulated on having no maternal deaths for the year under review. INFANTILE MORTALITY. Of a total of 468 live births, only 10 deaths of infants under one year of age were registered. Of these, 3 were males and 7 females, all being legitimate children. This gives the low infantile mortality rate of 21.36 per thousand live births, as compared with 32.85 in 1943 and 46.00 for England and Wales. The district is to be congratulated on an exceptionally low figure for infantile mortality. This figure is often taken as an index of the general health and prosperity of the district as a whole. It is much lower than the figure for England and Wales, and represents the results of the labours of all services dealing with the preservation of infant life, 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 55 2 53 Tuberculosis—(Sputa) 16 1 15 Enteric Group:— Faeces 2 — 2 Blood 1 — 1 Dysentery—(Faeces) 1 1 — Totals 75 4 71 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:— 15 Specimens. Number Examined. Water:— Bacteriological analyses 282 Milk:— Bacteriological analyses 110 Microscopical examinations 11 Pathological Specimens:— Blood 57 Urine 76 Fasces 1 Mother's milk 1 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 Borough and also for general public requirements. The service is under the control of the Medical Officer of Health. Civil ambulance removals during 1944 totalled 948, and in the course of this work the vehicles recorded a combined mileage of 9,166, these figures including journeys undertaken at the request of neighbouring Local Authorities. The mutual assistance arrangements in operation between the Borough and neighbouring authorities continued to function very satisfactorily. On 40 occasions we were able to render assistance when called under the scheme, and on the 10 occasions reciprocal services were required ambulances were immediately available. Detailed figures of the work of the Civil Ambulance Service are as follows:— Private Removals 377 Maternity Cases 260 Accidents 269 Calls answered for other Authorities 40 Calls in error to Air-raid Casualties 2 Total Calls Answered 948 Distance Travelled on Calls 9166 Average Mileage per Call 9.6 Mutual Assistance by Other Services 10 The service has been maintained at a high standard of efficiency but as one of the vehicles is now 17 years old, and rapidly nearing 16 the end of its useful life, the question of its replacement must be considered in the near future if the present standard of the service is to be maintained. 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 860 cases, including 68 maternity and 77 midwifery patients. The decline in the number of maternity and midwifery cases nursed is largely due to the evacuation of many expectant mothers during the period of the flying bombs. TREATMENT CENTRES AND CLINICS. 1. Child Welfare Centres. When held. Elm Grove, First and third Mondays of the The Grange, month, 2.0-4.0 p.m. London Road. Hackbridge, Second and fourth Mondays of The Grange, month, 2.0-4.0 p.m. London Road. Bandon Hill, First and third Tuesdays of Methodist Hall, month, 2.0-4.0 p.m. Sandy Lane North. High View, Second and fourth Tuesdays of Methodist Hall, month, 2.0-4.0 p.m. Sandy Lane North. Beddington, First and third Wednesdays of Village Hall. of month, 2.0-4.0 p.m. Wallington, Second and fourth Wednesdays Baptist Hall, of month, 2.0-4.0 p.m. Queen's Road. Toddlers' Clinic, First and third Wednesdays of Baptist Hall, the month, 10-12. Queen's Road. 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. Midwives' Clinic. Second and fourth Tuesday of month. Consultant's Clinic. Third Friday of the month. All Maternity Clinics are held at the District Nurses' Home, 57, Montagu Gardens, Wallington. 17 Voluntary Helpers.—Mrs. Boyce, Mrs. Harley-Boynes, Mrs. Budd, Mrs. Daw, Mrs. Dewit, Mrs. Feldon, Mrs. Groves, Mrs. Hooper, Mrs. James, Mrs. Jennings, 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, and since 1937 the Department has been responsible for a total of 3,802 infants and school children receiving this protection against diphtheria. This figure does not include children who are known to have been immunised by their own doctors or in schools outside the district, but such children have been included in the final calculations necessary to arrive at the estimated percentages of children immunised for the whole Borough. 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., 1944 1925 3750 5675 Children who completed full course of immunisation during the year 151 10 161 Percentage of child population immunised at 31st Dec., 1944 47.8 63.5 52.7 13 The figures of immunisations performed during 1944 are lower than have been recorded for some time but can be ascribed to the evacuation of the greater part of our child population during the flyingbomb raids. It is confidently anticipated that when all the evacuees have returned to the Borough and records are recovered from the reception authorities, a large number will be found to have received this protection whilst in the safer areas. 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 eases 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 from the department free of charge, but difficulty has been experienced in obtaining returns of children who have been immunised privately. Not all practitioners use the Government A.P.T. and therefore no reliable estimate can be mads through any check-up on material issues from the department to practitioners. Owing to the demands of national service the remaining practitioners are heavily burdened and it has not been found practicable to arrange with them for necessary periodic returns of children so treated to be rendered. 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. Small-pox. By arrangement with the County Council, cases of small-pox are admitted to the Small-pox Hospital at Clandon. 19 General 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 of the Medical Officer of Health, but a much greater number go to the Municipal Hospitals. CLEANLINESS. The general standard of cleanliness in the Borough is very good and particular attention has always been paid to this subject by the Health Visitors. The practice advocated by the Minister of Health in Circular 2831 of concentration on the homes known to be most in need of help in this matter has always been in force in this area. Approximately 80 per cent. of the children under five are regular attenders at the Council Welfare Centres, and full advantage is taken of the opportunity presented to keep the greater part of the under five population under constant surveillance. Great importance is attached to the education of the mothers in this matter, and the fact that 71 per cent. of the expectant mothers in the Borough attend the Ante-natal Clinic is not overlooked, and the stressing of the importance of cleanliness is a feature of ante-natal care. Full co-operation exists between the Health Visitors and the officials of the School Medical Service. The Borough of Beddington and Wallington has always shown a low incidence of scabies and pediculosis owing to the good social conditions and little over-crowding formerly prevailing. But the great damage and destruction to house property during 1944 resulting from enemy action, not only brought about a resumption of shelter life, but also led to a considerable amount of over-crowding; and this undoubtedly encouraged an increase of scabies. Moreover, the evacuation of a large proportion of the child population to other areas did not help matters, for a considerable number of them seem to have acquired the infection while they were away. Nevertheless, the cases treated during the year—viz., 3.9 per 1,000 of the estimated population—still compares very favourably with many 20 other areas. The incidence of pediculosis—viz., 2.3 per 1,000, mainly confined to the 0-15 age group—is also comparatively low. In view of the several unfavourable conditions referred to, an increase of both scabies and pediculosis had been anticipated, but it is gratifying to note that almost all the cases of these infestations were of a minor nature and readily yielded to the routine treatment provided at the special cleansing unit. The treatment given for scabies consisted of a hot bath, followed by the application of an emulsion of 25 per cent. Benzyl Benzoate. In only a very few cases was it necessary to repeat the treatment more than once. Pediculosis, which, as the following table indicates, was confined mainly to children, was successfully treated with Lethane Oil or "Ascabiol": — Condition New Cases 0-5 years. School children 5-15 years Adults Total Attendances for Treatment. 1st. Re. 1st. Re. 1st. Re. 1st. Re. Scabies 105 28 14 39 31 38 23 105 68 Pediculosis 62 11 — 36 5 15 3 62 8 Total 167 53 111 79 243 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 the early months of 1944 the Council's Schemes for Maternity and Child Welfare continued to operate with growing popularity, as was evidenced by steadily increasing attendances at all centres and clinics. Particularly heavy attendances at Child Welfare Centres led to the institution of a Toddlers' Clinic early in the year, which was popular from its inception. 21 Flying-bomb attacks during the latter half of the year, and the subsequent evacuation of expectant and nursing mothers, and the fact that large numbers of mothers and children took advantage of the Government Evacuation Scheme, or else evacuated under private arrangements, caused considerable disruption in the smooth and progressive operation of this work. The effect of this upheaval on all centres is clearly reflected in the following tables, where figures for the previous year's attendances are included for comparative purposes. The District Nursing Association midwives continued to provide excellent domiciliary services and worked in the closest co-operation with the department. Their work during the flying-bomb attacks was performed under the most difficult conditions but, despite this, they successfully dealt with 77 midwifery cases. 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 10.8 patients per session. During the year 344 expectant mothers attended the clinic, as compared with 398 in 1943. This represents approximately 71.4 per cent, of the total notified births, live and still, which were assigned to the Borough during 1944. Considering the unprecedented happenings of the year, this figure is a creditable reflection on the efficiency and consequent popularity of the Council's Ante-Natal Service POST-NATAL CLINIC. The separate monthly Post-Natal Clinic started at the beginning of 1943, continued to be well attended during the first five months of the year under review, and clearly emphasised the need for this special section of the Council's Maternity Services, justifying its inception. Attendances decreased considerably at the height of the flyingbomb raids and, as an administrative measure, the clinic was merged into and held conjointly with the Ante-Natal Clinic held every Friday afternoon. Such post-natal cases as required treatment or advice were seen on presenting themselves at this clinic. At the end of the year attendances had not increased sufficiently to justify the opening of the special session for post-natal cases, but it is hoped that this will become possible early in 1945. Figures in the following combined table, therefore, include attendances at the monthly Post-Natal Clinics until the beginning of August, and thereafter, the attendances of post-natal cases at the weekly Ante-Natal Clinic. 22 Ante-Natal and Post-Natal Attendances, 1944. Council Cases. Nursing Association Cases. Total— 1944 Total— 1943 Ante-Natal Cases:— Number of Clinics held – – 103 104 Total number attending during the year 226 118 344 398 Number of first attendances 199 72 271 300 Number of re-attendances 445 399 844 955 Total attendances 644 471 1115 1255 Average attendance per session 6.2 4.6 10.8 12.0 Post-Natal Cases:— Number of Clinics held – – 29 12 Total number attending during the year 27 38 65 94 Number of first attendances 27 38 65 94 Number of re-attendances 6 5 11 17 Total attendances 33 43 76 110 Average attendance per session 1.1 1.5 2.6 9.1 CONSULTANT ANTE-NATAL AND POST-NATAL CLINIC. The Consultant Clinic continued to be held throughout the year on the third Friday in each month, conducted 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, Ante-natal Clinic. Private Practitioners. Totals. 1944. 1943. C. N.A. Clinics held 5 7 Patients attending: Ante-natal 4 – – 4 12 Post-natal 3 2 — 5 3 Total attendances 7 2 — 9 15 23 MATERNITY AND CHILD WELFARE CENTRES. At the beginning of 1944 the Council's six Infant Welfare Centres were being held fortnightly on the same days as in previous years. Consequent upon the steadily increasing attendances reported in the past, at these Infant Welfare Centres, an additional clinic was considered necessary to relieve the congestion experienced at the Wallington Centre. A fortnightly clinic for Toddlers from two to five years was opened on February 2nd, and proved popular from the start. The mothers appreciated the special attention their toddlers were receiving, and it was a disappointment to all concerned when, at the end of July, the session had to be discontinued owing to mothers and toddlers being evacuated. It is hoped to start this venture afresh as soon as conditions return to normal. The following tables show the attendances for 1944 at the seven centres maintained by the Council. It is interesting to note the heavy fall in attendances in the latter part of the year owing to evacuation when the figures are set out on a monthly basis and compared with the corresponding figures for 1943. Bandon Hill. Highview. Elm Grove. Hackbridge. Bedding ton. Walling ton. Toddlers' Clinic. Totals, 1944 Totals, 1943 Number of sessons held 24 23 23 22 24 24 12 152 133 Infants: — No. of new cases under 1 year 90 31 49 28 43 97 – 338 406 No. of re-attendances 525 339 383 200 371 611 – 2429 3370 No. of new cases over 1 year 6 3 8 5 10 9 58 99 108 No. of re-attendances 489 441 438 338 421 480 122 2629 3550 Total attendance of infants 1110 814 878 571 845 1197 180 5595 7434 Average attendance of infants per session 46.3 35.4 38.2 25.9 35.2 49.9 15.0 35.7 55.9 Mothers attending 1057 710 806 526 783 1180 176 5238 6798 Total attendances 2167 1524 1684 1097 1628 2377 356 10833 14232 Average total attendance per session 90.3 66.3 73.2 49.8 67.8 99.1 29.6 71.3 104.0 24 Monthly Analysis of Attendances. Month. 1944. 1943. Month. 1944. 1943. January 1121 1245 July 552 2272 February 1236 1171 August March 1208 1195 September 513 1214 April 1216 1170 October 786 1217 May 1322 1311 November 1085 1248 June 1105 1297 December 709 875 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 2 For unsuitable home conditions — Normal confinements 1 Abnormal confinements 1 Both cases were referred from the Ante-Natal Clinic. HOME HELP SERVICE. In spite of difficulties created by prevailing conditions the Council's Home Help Service functioned successfully during 1944. The previous year the Council had approved an establishment of four full-time and two part-time Home Helps, but even with the co-operation of the Ministry of Labour and National Service considerable difficulty was experienced in 1944 in maintaining the service at full strength. In 1943 when reviewing the facilities offered by the scheme the Council had agreed to the extension of services to include the attendance of Home Helps, when not required for maternity cases, at specified cases of non-infectious sickness, particularly in cases where the care of young children was necessary owing to the mother's illness. When, therefore, Ministry of Health Circular No. 179/44 was received towards the end of the year, suggesting certain extensions of Home Help 25 ties which would be known as Domestic Help, the Council already nad the organisation in being but was only prevented from operating immediately by shortage of suitable personnel. As in the case of the other activities of the Department, progress was affected by the flying-bomb attacks and the subsequent evacuation of expectant mothers, with the result that the number of cases attending during the year was rather lower than that of the previous years. During 1944 Home Helps attended the following cases: — Maternity. Non-infectious Sickness. Full-time service 21 — Part-time service 8 8 Total 29 8 BIRTH CONTROL. The Council have made arrangements for women who need information on birth control, on the grounds of health, to attend a voluntary centre at Croydon. During 1944 19 women from the Borough were referred to this Clinic and made a total of 44 attendances. TREATMENT. Minor Ailments. One hundred and nine cases were referred from the Maternity and Child Welfare Centres to the under-mentioned hospitals during the year:— Croydon General Hospital 48 St. Helier County Hospital 46 Hospital for Sick Children (Gt. Ormond Street) 6 Carshalton, Beddington and Wallington District (War Memorial) Hospital 3 Guy's Hospital 3 Wilson Hospital 2 Epsom County Hospital 1 The conditions requiring treatment were: — Skin Conditions 20 Eye Conditions 19 Circumcision 14 Ear and Nose Conditions 10 Orthopaedic Defects 8 Chest Conditions 6 Hernia 6 Naevus 5 26 Tonsils and Adenoids 5 Feeding Difficulties 2 Avitaminosis D 1 Miscellaneous Ailments 13 Dental. During 1944 15 cases were referred for treatment under the Council's scheme as follows: — Expectant mothers. Nursing mothers. Children under 5 years. Found to be in need of treatment 10 2 3 Received treatment 3 1 2 Made dentally fit 3 1 2 Treatments: — Fillings: — In temporary teeth — — — In permanent teeth 1 — — Teeth extracted 27 24 6 Administrations of general anaesthesia 3 1 2 Patients supplied with dentures 3 1 — Dentures supplied 5 2 — Orthopaedic. Patients attending the Centres who require treatment for orthopaedic defects are referred by the Medical Officer of Health to the Orthopaedic Departments of the Croydon General and Guy's Hospitals. During the year 8 cases received treatment. ARTIFICIAL SUNLIGHT: SOLARIUM. A certain minimum of irradiation by sunlight in the open air is essential for life and health, especially for growing children. In existing circumstances in this country where, for five or six months, the sunlight is of little value, the majority of children cannot receive enough natural irradiation for optimum growth and health. Before the war certain food substances, like dairy produce and eggs, canned salmon, herrings, sardines and chocolate, all of which contain considerable quantities of Vitamin D (the product of irradiation) were consumed as food. But these are now in very limited supply. Cod liver oil, etc., which contains the natural Vitamin D (derived originally from sunlight) is provided for all children to make up to some extent for deficient sun irradiation. But it is known that many children either do not take it, or get it in amounts that are quite inadequate. Irradiation by special lamps (arc lamp, mercury vapour lamp, etc.) is used as a substitute for the sun's rays to an increasing extent, in factories and workshops, and also for child welfare centres. 27 The value of this artificial sunlight as an aid to health is now well recognised. Most of the London Boroughs possess solaria for the irradiation of children and expectant mothers attending their child welfare and ante-natal clinics, and those at Marylebone, Fulham, Bermondsey, Finsbury, Deptford, Southwark and Lewisham have been inspected by the Medical Officer of Health. Members of the Public Health Committee have also visited the Solarium at Fulham. Solaria are preventive health institutions designed for group irradiation of 12 or more children simultaneously, and differ materially from the arrangements provided in hospitals for the irradiation of single cases requiring special curative treatment. Beddington and Wallington has now come into line with other progressive health authorities and the Solarium referred to in last year's report is an established fact. It was ready to be opened in the summer but the visitation of the flying bombs resulted in some damage to the room and eventually the Solarium was opened by the Mayoress on September 18th. Between that date and the end of the year 261 individual patients have received treatment and there has been a total of 3,105 attendances. The table below gives details of the attendances month by month: — Month. 0-5 years 5-15 years Adults. Expectant Mothers Nursing Mothers Private Patients Attendances for Treatment. 1st. Re. 1st. Re. 1st. Re. 1st. Re. 1st. Re. September 34 84 – – – – – – – – October 94 620 9 49 2 10 – – 2 10 November 74 864 2 45 3 12 2 18 2 8 December 33 724 1 31 1 20 2 11 18 Total 235 2592 12 125 6 42 4 29 4 36 Attendances 2847 137 48 33 40 Total Attendances to end of year 3,105. 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:— 28 Maternity Visits. First visits to Expectant Mothers 46 Re-visits to Expectant Mothers 26 Breast Feeding observations 4 Post-Natal visits 2 Infant Welfare. First visits under 1 year 338 Re-visits under 1 year 174 First visits over 1 year 9 Re-visits over 1 year 325 Special Home Visits. Still Births 11 Infant Deaths 8 Child Life Protection. First visits 16 Re-visits 46 Inspection of premises 1 Infectious Diseases. General Enquiries 4 Tuberculosis 44 Scabies 140 Impetigo 3 Eye conditions 1 Verminous conditions 28 Puerperal Infections 2 General Visits. Home Enquiries, Agreements, etc. 10 Adoption of children 11 Home Help Service 32 Miscellaneous visits 48 Unsuccessful visits 21 Total 1350 Attendances at Clinic Sessions. Maternity and Child Welfare Centres 289 Ante-Natal and Post-Natal Clinics 185 Total 474 Total attendances, 1943 632 Interviews in Office 311 CHILD LIFE PROTECTION. The Health Visitors are the authorised Child Life Protection Visitors for the Borough. 29 Number of persons who were receiving children for reward at the end of the year 9 Number of children on the register at the end of the year 14 Number of children who died during the year — During the year 63 visits were paid to the homes of the children. No proceedings were taken under the Act during the year. THE CARE OF PREMATURE INFANTS. The Borough Council has taken action along the lines indicated by the Minister as regards formulating adequate and suitable arrangements for the care of premature infants. Local practitioners and midwives were requested to bring full details of all such cases occurring in domiciliary practice to the notice of the Medical Officer of Health. The question of the provision of suitable equipment available for loan when required in the home was fully considered, and the articles ordered in due course. As the Council is not a supervising authority under the Midwives' Act, and appreciating that the Midwives would be the first to be aware of such cases, the Health Committee gave instructions that the equipment should be stored at the District Nursing Association, the headquarters of the local midwives, to be drawn on as required. The existing home help facilities are considered adequate. Excellent hospital accommodation is provided by the St. Helier County Hospital, which can offer also the services of a resident paediatrician. Special equipment has been made for the ambulance based on the Hospital and the vehicle will be available for the transport of all premature infants admitted. The whole question of the care of premature infants has been discussed at meetings of district Medical Officers of Surrey, and it is hoped that the request for a short course of special lectures for Health Visitors and Midwives, giving up to date instruction on the care of premature infants, can be implemented in the near future. THE CARE OF ILLEGITIMATE CHILDREN. As a Maternity and Child Welfare authority, the Council has always been fully aware of the need for special interest and care in regard to the well-being of the unmarried mother and her infant. The peculiar problems involved demand a great measure of tact and sympathy from all concerned with assisting cases of this nature, and more so during the war years, with the general tendency for increases in illegitimacy being noted in this Borough also. The local organisation of the Women's Voluntary Services has been most co-operative, and the work of these ladies in augmenting the advice and assistance 30 of the Health Visitors has been more than appreciated both by the Department and by the mothers concerned. The Council concurred with the suggestion of the Ministry that a promising line of attack would be co-operation with existing moral welfare associations in this important work and accordingly made arrangements with the governing body of the Sutton District Girls' Aid Society. For an annual grant the Society have been able to increase the facilities they could offer as far as this Borough is concerned and the most cordial relations have existed between the officers of the Corporation and this voluntary society. Office accommodation has been found in Wallington for the fulltime welfare worker of the Society and she is now able to devote three half-days a week of her time to the needs of Wallington residents. The Moral Welfare Society began this work in Wallington towards the end of June, and between then and the end of the year their welfare worker had been in contact with 13 such cases and had made 69 visits to them or on their behalf. The total illegitimate live and still births for the Borough during the year numbered 20. WAR-TIME DAY NURSERY. The 50-place War-time Day Nursery, which was opened in April, 1943, continued during 1944 to fulfil its important role as an integral part of the Council's Maternity and Child Welfare Services and there is no doubt that a large number of mothers, freed from anxiety regarding the welfare of their children, were thus enabled to take up factory work in furtherance of the war effort. Situated at Spencer Road, Hackbridge, the pre-fabricated building was specially designed for the purpose and the children are excellently cared for in light, airy surroundings. Medical inspections are held at regular intervals and active publicity measures taken in connection with diphtheria immunisation resulted in a considerable number of parents taking advantage of the facilities offered for their children's well-being. As will be seen from the following table, attendances during the year under review fluctuated considerably for various reasons. Sharp attacks of mumps and whooping cough in the early months of the year were reflected in the attendance figures and in June the flying-bomb attacks heralding a period of intense enemy air activity caused an immediate fall in the number of children attending the Nursery. Evacuation facilities in July and August caused further attendance drops when mothers and children took advantage of the opportunity for removing to safer areas. An improvement was noticed towards the end of the year when, in spite of the menace of the long-range rocket attacks, children were returning slowly but steadily. 31 Month. Age. Month. Age. Month. Age. 0-2. 2-5. 0-2. 2-5. 0-2. 2-5. January 336 618 May 313 798 September 185 342 February 305 373 June 181 694 October 270 510 March 457 631 July 106 346 November 400 632 April 444 536 August 188 338 December 227 597 Total 9827 0-2 3412 2-5 6415 Daily Average during the year: 0-2 years 11 2-5 years 21 Daily average during: — Age. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. 0-2 14.6 13.4 6.2 11.8 2-5 21.6 28.9 13.3 22.9 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 282 samples of water were submitted for bacteriological examination in the Council's laboratory. Samples were taken as follows: — Main Water Supply (Sutton Well and Woodmansterne Well) (An average per month of 14 samples) 168 Private wells 82 Swimming Bath 32 The main water supply continues to be satisfactory both in quantity and in 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. 32 DRAINAGE AND SEWERAGE. The Council have continued the maintenance of the soil and storm water drainage systems during the year. Because of the war, however, no extensions have been undertaken. RIVERS AND STREAMS. In addition to the normal maintenance of the River Wandle undertaken throughout the year, certain sections of the river were cleaned out during 1944, silt, tree branches and obstructions being removed. Certain water-courses feeding the River Wandle were also cleaned. 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. During the year continued labour difficulties, combined with other urgent work due to enemy air attacks, made regular fortnightly collection impossible, but the Council are giving special attention to this matter and hope to reorganise the existing systems with increased man-power early in the New Year. 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. 33 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1944. DWELLING-HOUSES. Number of inspections of dwelling-houses 659 Number of inspections recorded under Housing Regulations — MILK AND DAIRIES. Number of cowkeepers on register — Number of purveyors of milk on register 37 Number of dairy premises on register 7 Number of inspections of premises 15 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 5 „ —Supplementary Licences 7 Pasteurised—Dealer's Licences 4 „ —Supplementary Licences 7 Pasteuriser's Licence 1 24 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of visits to slaughterhouse 4 Number of visits to other premises on which animals were slaughtered 3 Carcases inspected and condemned:— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — — 5 Number inspected — — — — 5 Whole carcases condemned — — — — — or Carcases of which some part or organ was condemned — — — — — 34 FOOD PREMISES. Number of inspections 603 Number of defects discovered and remedied 5 UNSOUND FOOD. Destroyed or released for approved purposes: — lbs. Fruit and Vegetables 2699 Cocoa and Chocolate Powder 2600 Bread, Flour and Flour Confectionery 2161 Tinned Foods 992 Cereals 693 Jams 448 Meat and Meat Products 293 Sugar 274 Fish 217 Sugar Confectionery 154 Dried Fruit 150 Butter and other Fats 139 Poultry 120 Bacon 76 Miscellaneous 693 Total 11709 FOOD ANALYSES. Number of samples analysed by Public Analyst 101 Number of samples reported against:—. Gelatine—Excessive amounts of arsenic and preservative 2 Mustard—Consisted of white mustard flour only 1 Sponge Mixture—Misleading label 1 Dried Milk—Contained extraneous matter 1 — 5 Number of prosecutions — FACTORIES. Number of factories on register 95 Number of inspections 156 Number of defects discovered and remedied 12 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 48 Number of defects discovered and remedied 1 35 WORKPLACES. Number of inspections of workplaces 25 Number of defects discovered — SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 112 Number of defects discovered and remedied 2 COMPLAINTS. Complaints received during the year were due to the following causes:— Defects in dwelling-houses (various) 66 Stoppages in drains 60 Defects in drains or water closets 41 Defective dustbins 33 Food supplies 22 Defective water fittings 20 Insect pests 10 Miscellaneous 19 271 SMOKE ABATEMENT. Number of observations 8 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 149 Number of rooms disinfected 87 Lots of bedding and clothing disinfected 78 Number of library books disinfected 253 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 5 Number of defects discovered — RATS AND MICE (DESTRUCTION) ACT, 1919. Number of visits to premises 450 Number of premises found infested and dealt with 82 NOTICES. Number of informal notices served (including verbal intimations) 458 Number of statutory notices served: — Public Health Act, 1936, Section 93 (nuisances) 1 Public Health Act, 1936, Section 75 (dustbins) 4 36 Public Health Act, 1936, Section 39 (drains) 1 Housing Act, 1936, Section 9 (housing defects) 2 8 PROSECUTIONS Nil SANITARY IMPROVEMENTS. Water Supply. Water pipes and fittings repaired or renewed 22 Water supply reinstated 1 Drains. Drains re-laid or repaired 15 Drains unstopped and cleansed 76 Intercepting traps provided with rodeye stoppers 10 Manholes provided or repaired 10 Soil or ventilation pipes repaired or renewed 11 Gully kerbs and channels repaired 4 New soakaways constructed 4 Closets. New closets provided 1 Buildings repaired 3 New pans fixed to water closets 14 Flushing cisterns repaired or renewed 9 Flush pipes and pan joints repaired or renewed 1 Water supply re-instated 2 Sinks. New sinks provided 3 Waste pipes repaired or renewed 11 Yards. Yards newly paved or repaired 2 Dust Receptacles. New portable iron dustbins provided 247 Dampness. Roofs repaired 27 Rainwater gutters repaired or renewed 9 Rainwater downspouts repaired or renewed 9 Windows, sills and doors made weatherproof 2 External walls repaired, re-pointed, or rendered 3 Ventilation provided under floors 4 General Repairs, Etc. Rooms cleansed 20 Walls and ceilings repaired 28 Floors repaired 13 37 Stoves repaired or renewed 1 Windows repaired 13 Chimneys repaired 7 Number of premises disinfested from bed bugs 7 Refuse removed 1 Food Premises. New sinks provided 2 Sanitary conveniences repaired 1 Water supply reinstated 1 Premises cleansed 1 Factories. Sanitary conveniences—defects remedied 11 Other defects remedied 1 Bakehouses. Premises cleansed 1 Shops and Offices. Premises cleansed 1 Water supply reinstated 1 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 659 Number of re-inspections of premises 1117 Number of visits to works in progress 519 Number of miscellaneous visits and inspections 1027 Number of visits to dairies 15 Number of visits to factories 156 Number of visits to bakehouses 48 Number of visits to workplaces 25 Number of visits to shops and offices 112 Number of visits to premises re slaughtering 7 Number of visits to food premises 603 Number of visits to stables and yards 150 Number of visits to market gardens, etc 27 Number of visits to fried fish shops 5 Number of visits to urinals 34 Number of visits to piggeries 44 Number of visits re infectious diseases 149 Number of visits to streams 75 Number of visits re rats 450 Number of visits re smoke abatement 8 Number of complaints received and investigated 271 Number of informal notices served 458 Number of statutory notices served 8 Number of interviews re nuisances, etc. 563 38 Number of rooms disinfected 87 Number of lots of bedding and clothing disinfected 78 Number of library books disinfected 253 Number of visits to Public Air-Raid Shelters 440 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 twelve inspections were made during 1944 and in 2 cases action was necessary in regard to sanitary defects or requirements. CAMPING SITES. There are no camping sites within the Borough 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 the facilities offered to the general public in the previous year proved so popular, by a re-arrangement of the programme it was found possible to increase the Sunday facilities by three mid-week sessions. Residents using the bath were enrolled in a Borough Swimming Club under the control of officers of the Corporation. The revised arrangements promised to be extremely popular but the prospects of a successful season diminished greatly when the flying-bomb attacks commenced in the middle of June. But in spite of the evacuation of school children and the cancellation of swimming parades by the youth organisations, an emergency revision of the programme resulted in higher attendances than ever before by members of the Borough Swimming Club. The following attendances were recorded during the season, which lasted 22 weeks: — Youth Organisations 1228 Schools 1625 Borough Swimming Club 5396 Total 8249 39 ERADICATION OF BED BUCS. During the year bed bugs were found to exist in 2 Council houses, and in 5 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 Conditions. All the Public Elementary Schools in the district have been inspected from time to time. They are all supplied with water from the public mains and connected with the sewers. RECULATED TRADES: DAIRIES. There are 7 registered premises within the district, this being the same as last year. During the year 15 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 12 Pasteurised 12 SLAUGHTERHOUSES. There is only one Slaughterhouse within the district, this being licensed annually. Two 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: — 40 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 152 Factories without mechanical power 4 — Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) • Total 156 — — 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) 1 1 - - Overcrowding (S. 2) - - - - Unreasonable temperature (S. 3) - - - - Inadequate ventilation (S. 4) - - - - Ineffective drainage of floors (S. 6) - - - - Sanitary Conveniences (S. 7): — - - - - Insufficient — - Unsuitable or defective 10 10 Not separate for sexes 1 1 - Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) - - - - Total 12 12 - 3. Outwork in Unwholesome Premises. No instances were discovered. 41 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) 631 (b) Number of inspections made for the purpose 659 (2) (a) Number of Dwelling-houses (included under head (1) above) inspected and recorded under the Housing Consolidated Regulation — (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 438 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 411 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 (2) Number of Dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 2 (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 6 (2) Number of Dwelling-houses in which defects were remedied after service of formal notice: — (a) By owners 6 (b) By Local Authority in default of owners — 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 — 42 (2) Number of Dwelling-houses demolished in pursuance of Demolition Orders — D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 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 1 Number of Houses and Flats erected during the year:— By the Council Nil By other persons Nil INSPECTION AND SUPERVISION OF FOOD. MILK. During the year the following samples of milk were taken within the district and examined bacteriologically in the laboratory of the Corporation's Public Health Department:— Class of Milk. No. taken. Tuberculin Tested 5 Pasteurised 99 Ungraded 6 Total 110 Craded Milk. (1) Tuberculin Tested. The examination of the five samples of milk sold under this designation was satisfactory, all samples satisfying the prescribed methylene blue reduction test. In addition, these samples were examined microscopically for the presence of acid fast bacilli with negative results. (2) Pasteurised Milk. All samples of pasteurised milk were submitted to the phosphatase test to ascertain the efficiency or otherwise of the pasteurisation process. One sample only of the 99 examined during the course of the year exceeded the 100,000 bacteria per millilitre allowed by the Milk (Special Designations) Regulations. Since August, 1944, when the necessary equipment was obtained, samples have been submitted, in addition, to the Methylene Blue Test in accordance with the provisions of the Heat Treated Milk (Prescribed Tests) Order, 1944. Thirty-six samples were thus submitted to this double test with satisfactory results. 43 Ungraded Milk. Of the 6 samples examined during the year, all 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. 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 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.R.I.C., of 1, Southwark Street, London, S.E.I, as Public Analyst for the Borough. 44 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 Infor mal. Tota Baking Powder - 2 2 - - - - - Butter — 8 8 — — — — — Cake and Sponge Mixtures - 7 7 - 1 1 - - Coffee — 5 5 - - - - - Curry Powder — 4 4 — — . — — — Flour, Self-raising _ 1 1 - - - - - Gelatine 1 5 6 1 1 2 — — Margarine — 6 6 — — — — — Meat Paste — 4 4 — — — — — Milk 30 — 30 - - - - Milk, Dried — 5 5 — 1 1 — — Mustard — 2 2 — 1 1 — — Pepper — 2 2 - - - - - Pickles — 4 4 - - - - - Soup Powder — 2 2 - - - - - Soya Flour — 1 1 - - - - - Tea — 1 1 - - - - - Rum — 1 1 — — — — — Anti-gas Ointment, No. 2 - 3 3 - - - - - Camphorated Oil - 4 4 - _ - - - Zinc Ointment — 3 3 — — — — — Totals 31 70 101 1 4 5 — — 45 CHEMICAL AND BACTERIOLOCICAL EXAMINATIONS. Special work of this nature is carried out when required at the Counties Public Health Laboratories. Routine examinations of milk and water samples continue to be done in the Public Health Laboratory established in 1937 at the Town Hall, Wallington, under the supervision of the Medical Officer of Health. NUTRITION. On the whole, the nutritional standards of the population, as shown by mothers, infants and young children, appear to have been fairly well maintained, but there have been a number of mild cases of Avitaminosis D (rickets)' seen in children who have possibly not received enough cod liver oil or have failed to get enough sunshine. In this connection, benefit has already been noted from attendance at the Solarium and when parents can once more take their children to the seaside in the summer fewer cases of Avitaminosis D are likely to be encountered. Several cases of Infantile Scurvy were observed during the year in children who, while being bottle-fed, had not received enough orange juice or other form of Vitamin C. These cases quickly responded to Vitamin C tablets. The relative scarcity of animal food owing to the rationing since war conditions is to some extent reflected in the flabby muscles and poor appetite of children of the toddler class. There is bound to be an improvement when rationing of important foodstuffs is no longer necessary. 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. 46 Underground Rooms (Regulations). Tents, Vans, Sheds, etc. Offensive Trades and Fish Frying. Houses Let in Lodgings. Houses of the Working Classes. Removal of Offensive or Noxious Matters. Slaughterhouses. Pleasure Grounds. Smoke Abatement. Allotment Gardens (Rules). Advertisements. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1944, 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 30 19 - Diphtheria 6 5 — Erysipelas 4 1 — Pneumonia 13 2 14* Measles 38 2 Whooping Cough 47 4 - Puerperal Pyrexia 3 1 - Dysentery 4 2 1 Totals 145 36 15 Includes deaths from all forms of pneumonia. Includes deaths of residents in homes and institutions outside the Borough. 47 Cases of Infectious Disease Notified During the Year, 1944. (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 30 - - 1 1 1 7 10 6 1 2 1 8 5 6 2 6 3 19 ___ Diphtheria Erysipelas 6 4 - - 1 — — 2 1 1 1 1 2 1 4 2 - - 1 1 2 - 5 1 - Pneumonia 13 - - 1 — — — — — 1 2 4 5 2 1 1 3 3 3 2 14* Measles 38 - 2 7 2 1 23 1 1 — — 1 — 11 7 17 2 1 — 2 — Whooping Cough 47 10 6 2 6 6 17 - - - - - - 14 10 2 10 11 — 4 — Puerperal Pyrexia 3 - - - - - - - - - - - - - - - - - - 1 _ Dysentery 4 — — - - - 1 - - 1 1 - 1 - - - 3 1 - 2 1 Totals 145 10 8 12 9 8 50 12 8 7 6 8 7 41 23 28 21 26 6 36 15 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. 48 49 The Monthly Incidence of Infectious Disease, 1944, (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 3 6 1 - 2 1 - - - 5 6 6 30 Diphtheria 1 2 — — 1 - - 1 1 6 Erysipelas 1 — — — 1 — 1 - 1 4 Pneumonia 1 — 1 1 3 1 2 - 2 - 2 13 Measles — — 2 — 2 1 2 3 - 28 38 Whooping Cough — 11 3 9 7 8 7 2 - 47 Puerperal Pyrexia 1 — 1 — — — — - 1 - 3 Dysentery - 1 - 2 - — — - — — 1 1 4 Totals 7 20 8 12 16 11 11 2 — 11 9 38 145 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. 1940 1941 1942 1943 1944 M. F. M. F. M. F. M. F. M. F. Pulmonary 11 9 13 15 17 12 19 10 18 9 Non-Pulmonary 1 — 4 1 1 3 2 5 2 4 Totals 12 9 17 16 18 15 21 15 20 13 Annual case rate per 1,000 of the estimated population: — 1944. 1943. Pulmonary 1.01 1.04 Non-Pulmonary 0.22 0.75 The following table gives the number of deaths from this disease during the past five years:— Deaths. 1940 1941. 1942 1943 1944 M. F. M. F M. F. M. F. M. F. Pulmonary 8 1 5 4 6 6 8 3 5 4 Non-Pulmonary — 3 2 — — 3 1 2 1 — Totals ... 8 4 7 4 6 9 9 5 6 4 It will be seen from the foregoing table that 9 deaths were registered as due to Tuberculosis, of which 8 were Pulmonary and 1 NonPulmonary. The figures correspond to a death rate per 1,000 of population of 0.33 for Pulmonary Tuberculosis and 0.04 for Non-Pulmonary Tuberculosis. Of the 9 deaths which occurred 1 was a non-notified case. 50 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 1 1 1 1 — — — — 20 and under 25 3 — — — — — — — 25 and under 35 4 2 — 1 1 2 — — 35 and under 45 1 4 — — — 1 — — 45 and under 55 4 — 1 1 1 1 1 — 55 and under 65 4 — — — 2 — — — 65 and upwards - - - - - - - Totals 18 9 2 4 5 4 1 — The new cases were distributed amongst the Wards as follows:— Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 9 3 4 4 4 3 Non-Pulmonary 2 1 1 2 — — Totals 11 4 5 6 * 3 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 16 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 1944. Mass radiography, as referred to in last year's report, is now in operation at St. Helier Hospital, and a considerable number of persons resident in the Borough have had the advantage of being examined. It is understood that the personnel of many of the industrial organisations and public services will now have an opportunity of undergoing this valuable form of health examination in the early future. 51 ■