BCD 10 BOROUGH OF BEDDINGT0N & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1945. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1945. William Pile, Ltd., Printers, 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 11 Extracts from Vital Statistics 12 Vital Statistics: Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1945 13 Registered Causes of Death 14 Violence and Accident 15 Maternal Mortality 15 Infantile Mortality 16 General Provision of Health Services for the Area: Laboratory Facilities 16 Ambulance Facilities 17 Nursing in the Home 18 Treatment Centres and Clinics 18 Diphtheria and Whooping Cough Immunisation 19 Hospitals 20 Cleanliness 21 Disinfection 22 Maternity and Child Welfare: General Observations 22 Ante-Natal Supervision 23 Post-Natal Supervision 23 Consultant Obstetrician 24 Child Welfare Centres 25 Maternity Ward 26 Home Help 26 Birth Control 27 Treatment : Minor Ailments 27 Dental 28 Orthopaedic 28 2 Solarium 28 Health Visiting 30 Child Life Protection 31 Care of Premature Infants 31 Care of Illegitimate Children 31 War-time Day Nursery 32 Sanitary Circumstances of the Area: Water Supplies 33 Drainage and Sewerage 33 Rivers and Streams 33 Closet Accommodation 34 Public Cleansing 34 Sanitary Inspection of the Area 34 Statement of the Senior Sanitary Inspector for the Year 1945: Dwelling Houses 35 Milk and Dairies 35 Slaughterhouse 35 Food Premises 36 Unsound Food 36 Food Analyses 38 Factories 37 Bakehouses 37 Workplaces 37 Shops and Offices 37 Complaints 37 Smoke Abatement 38 Infectious Disease and Disinfection 38 Offensive Trades and Fish Frying 38 Rats and Mice (Destruction) Act 38 Notices 38 Prosecutions 38 Sanitary Improvements : Water Supply 38 Drains 38 Water Closets 39 Sinks Yards 39 Dust Receptacles 39 Dampness 39 General Repairs, etc. 39 Summary of work done during the year 39 Shops and Offices 40 Camping Sites 40 Swimming Bath 40 3 Eradication of Bed Bugs 41 Schools 41 Dairies 41 Milk (Special Designations) Regulations 41 Slaughterhouse 42 Bakehouses 42 Factories 42 Mousing: Housing 34 inspection and Supervision of Food: Milk 44 Meat 44 Food and Drugs Act, 1938 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 AND WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1945. Members: Councillor Mrs. V. M. Boyce (Chairman). Alderman J. Vale, J.P. (Mayor). Alderman H. D. Banks, J.P. (Deputy Mayor). Alderman W. W. Binnie, J.P. Alderman F. G. Bryant. Councillor Miss K. C. Bratt. Councillor D. H. de Voil. Councillor F. C. Elwood, J.P. Councillor A. R. B. Gill. Councillor A. H. Pearce. Councillor A. C. Walker-Griffin MATERNITY AND CHILD WELFARE 8UB-COMMITTEE. December, 1945. Members: Councillor Mrs. V. M. Boyce (Chairman). Alderman J. Vale, J.P. (Mayor). Alderman H. D. Banks, J.P. (Deputy Mayor). Alderman F. G. Bryant. Councillor Miss K. C. Bratt. Councillor D. H. de Voil. Councillor F. C. Elwood. J.P. Councillor A. R. B. Gill. Councillor A. C. Walker-Griffin Co-opted Members: Miss E. Hall, Mrs. L. A. Pearce, Mrs. O. L. Wiles. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD. December, 1945. Members: Alderman J. Vale, J.P. (Mayor). Alderman H. D. Banks, J.P. (Deputy Mayor). Councillor Mrs. V. M. Boyce. 5 REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1945. Members: Alderman J. Vale, J.P. (Mayor). Councillor A. R. B. Gill. Councillor A. H. Pearce. Councillor A. H. Prior. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: — †Patrick J. O'Connell, M.D., B.9., 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 Askworth, M.B., B.S. Consultant Obstetrician:— *Douglas Lindsay. M.D.. Ch.B.. P.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 Inspector:— A. F. Leaney, M.R.S.I. 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. (Resigned 4/10/45). Miss E. C. Richardson, R.S.C.N., S.C.M., H.V. Cert. (Appointed 1/12/45). Electro-Therapist:— Miss G. Allen, M.C.S.P. Clerks:— †R. F. Burns (Chief Clerk). A. L. Jones (Temporary Chief Clerk). Miss M. Frost. †E. D. Evezard. H. Bourne (Temporary). Mrs. B. L. Gowans (Temporary) (Resigned 26/10/45). Miss J. Day (Temporary). Mrs. V. G. Cole (Temporary) (Appointed 5/11/45). Laboratory Assistant: — †W. K. Stevens. Miss P. Russenberger (Temporary). *Part-time. †On Active Service. 6 Public Health Department. Town Hall. wellington. To His Worship the Mayor, Aldermen and Councillors of the Borough of Beddington and Wallington. Ladies and Gentlemen, After nearly six years of war, 1945 turned out quite unexpectedly to be the Year of Victory. In these circumstances it has appeared to be a suitable opportunity for giving below in tabular form a brief summary of certain facts regarding the public health of the population of the Borough during the six years of active fighting, compared with similar data for the six preceding years:— Period 1934-39. Period 1940-45. Increase or Decrease. Percentage. Total Births 2234 2543 +286 + 12.8% Mean Birth-rate 12.8 15.5 + 2.7 + 21.0% Ratio of Male to Female Births 107 114 + 7 + 6.5% Still Births 70 58 - 12 - 17.1% Illegitimate Births 72 136 + 64 + 88.8% Total Deaths 1660 1909 + 249 + 15.0% Mean Death Rate 9.3 11.7 + 2.4 + 15.8% Ratio of Male to Female Deaths 102 85 - 17 - 16.6% Causes of Death:— Cerebral Haemorrhage, etc. 65 183 + 118 + 181.3% Heart Disease 440 560 + 120 + 27.2% Bronchitis 26 161 + 135 + 570.8% Cancer 314 327 + 13 + 4.4% Congenital Malformation Accidents at Birth, etc. 67 33 - 34 - 50.5% Influenza 30 18 - 12 - 40.0% Pneumonia 63 73 + 10 + 15.9% Suicide 25 17 - 8 - 32.0% Road Accidents 29 18 - 11 - 38.0% Tuberculosis 93 71 - 22 - 23.6% Notifications:— Tuberculosis 151 191 + 40 + 26.5% Scarlet Fever 366 301 - 65 - 17.7% Diphtheria 99 42 - 57 - 57.5% 7 During the war period the number of births increased by 12.8 per cent., but owing to the considerable decline of population, the average birth-rate showed a rise of no less than 21 per cent. A considerable increase in the ratio of male to female births is a phenomenon that has often been noticed during wars and has never been explained. The great increase in illegitimate births, on the other hand, is easily understandable. Among causes of death, the great increase of deaths from cerebral hæmorrhage and heart disease respectively, during the war period, reflects the peculiar strains of that trying time. Similarly, the abnormal rise in the number of deaths reported from bronchitis was probably a direct consequence of "shelter life" upon old people. Apart from pneumonia, which showed a moderate increase, deaths from infectious diseases generally showed little change, except for influenza and tuberculosis, which fell considerably. Notifications of new cases of tuberculosis, on the other hand, showed an increase of 26.5 per cent. Notifications for scarlet fever were fewer than before the war, and those for diphtheria showed a 57 per cent. decline, reflecting probably the results of the recent campaign for immunisation. Turning to the year 1945, it may be noted that the upward trend in the birth-rate first noted in 1942 continued, and as a result the number of births recorded reached a total of 505, giving a birth-rate of 18.1 per 1,000 of the population, a figure considerably higher than that of 16.1 for the country as a whole. On the other hand, the deathrate of: 11.0 per 1,000, although comparing favourably with that of the whole country and most other towns, has not yet fallen to its exceedingly favourable pre-war level, which was often below 10 per 1,000 of the population. Last year I commented on the particularly healthy conditions for child life in the Borough and noted the very low average infant death-rate, and the exceptionally few deaths from diarrhoea and enteritis among children under 2 years of age. In 1945 there were no deaths from these causes and the infant death-rate of only 21 per 1,000 births is far below that of most other towns and the country as a whole, which stood' at 46. Infectious disease, with the exception of measles, which led to 256 notifications in the year, showed a very low incidence, but there were 4 cases of poliomyelitis and 1 of polio-encephalitis during the year, and the latter unfortunately proved fatal. The recovery of the cases of poliomyelitis speaks well for the exceptional care and attention they received in the Wandle Valley Hospital. During recent years attention has been called in certain areas to the fact that schools often appear to be concerned in the spread of scarlet fever and other infections. This has prompted me to investigate the age incidence of whooping cough, measles, scarlet fever and diphtheria respectively as shown by the record of notifications in the Borough during a number of past years. Some of the results are tabulated below: — 8 Age Incidence of Certain Infectious Diseases. Disease. Under 2 years. 2-5 years. 5-10 years. 10-15 years. Over 15 years. Whooping Cough 24% 30% 40% 3% 3% Measles 9% 30% 52% 5% 4% Scarlet Fever 5% 12% 50% 19% 14% Diphtheria 3% 14% 28% 16% 39% It will be clear from these figures that the age period 5.10 years is particularly important and probably reflects the special risks of infection attendant on school life. Both whooping cough and measles are exceptionally infectious, but fortunately one attack usually confers a lasting immunity. No less than 54 per cent. of children appear to have contracted whooping cough before they reach the school-going age, compared with 39 per cent. for measles and 17 per cent. for both scarlet fever and diphtheria respectively. But the early years of school life are marked by a particularly heavy incidence of each of these diseases, measles being highest with 52 per cent., followed by scarlet fever, 50 per cent; whooping cough, 40 per cent.; and diphtheria, 28 per cent.; respectively. Attacks of neither scarlet fever nor diphtheria confer immunity and thus we see a considerable proportion of cases of these diseases occurring among persons long past the school-going age. Nevertheless, scarlet fever is peculiarly an infection of school life, as may be seen from the fact that no less than 69 per cent. of all notifications relate to the age period 5 to 15 years Diphtheria also shows a heavy incidence at this period, viz., 44 per cent., a fact which points to the need for repeating the "boosting dose" of diphtheria vaccine, which many children already get before entering school, on one or more occasions during their school career. The record number of births that occurred in the Borough during the year taxed the available accommodation for maternity cases to its extreme limit. Unfortunately, the destruction caused at St. Helier Hospital in 1944 by flying-bombs had put a number of beds out of operation and an extreme shortage of nurses and domestic staff added to the difficulty. Nevertheless a larger number of cases, viz., 240, was admitted to one or other of: the local hospitals than ever before, while in spite of the fact that, owing to the destruction and damage to house property and the grave difficulty of securing domestic assistance, home confinements were not so easily arranged as formerly, no less than 219 took place during the year, a figure which closely corresponds with 222, the average for the past seven years, and compares favourably with that of 193 for 1944. Meanwhile, the repair of the damaged wards at St. Helier Hospital is expected to relieve the pressure on existing maternity accommodation very materially in the early future. One of the most satisfactory features of the year's public health work has been the growing popularity of the Solarium. During the 9 year no less than 717 individual patients received treatment and there was a total of 8,648 attendances. The need for an institution of this sort has been emphasized by the series of poor summers that have marked the war years, and it is most encouraging to find that mothers from every part of the Borough are continually testifying to the benefit that their children have derived from attendance at the Solarium. The fact that many of these mothers are willing to walk with their children to the Grange even from the extreme limits of the Borough at least twice a week is clear proof of the value they attach to the treatment provided at the Solarium. In conclusion, I wish to refer to the great assistance that I have received from the staff of the Public Health Department throughout the year and to place on record my appreciation of the loyal help they have always accorded me. I have the honour to be, Ladies and Gentlemen, Your obedient servant, CHARLES A. BENTLEY, Acting Medical Officer of Health. 10 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 1945 27,900 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1945 9,034 Rateable Value, December, 1945 £384,377 Sum represented by penny rate, December, 1945 £1,567 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. 11 EXTRACTS FROM VITAL STATISTICS. Total. M. F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 461 241 220 18.1 Illegitimate 44 22 22 Total 505 263 242 Still Births 6 3 3 Rate per 1,000 total (live and still) births 11.74 Death Rate per 1,000 of the estimated resident population Deaths 307 151 156 11.00 Rate per 1,000 (live and still) birth Deaths from Puerperal causes: — Puerperal Sepsis — Other Puerperal causes 1 1.95 Death Rate of Infants under one year of age: — All Infants per 1,000 live births 21.78 Legitimate Infants per 1,000 legitimate live births 19.52 Illegitimate Infants per 1,000 illegitimate live births 45.45 Deaths from Cancer (all ages) 51 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea, etc. (under two years of age) — 12 Comparative crude birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1945: — England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Borough of Beddington and Wallington. Births— Rates per 1,000 Population. Live 16.1 19.1 19.2 15.7 18.1 Still 0.46 0.58 0.53 0.40 0.21 Deaths— All Causes 11.4 13.5 12.3 13.8 11.0 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.01 0.02 Diphtheria 0.02 0.02 0.02 0.01 Influenza 0.08 0.07 0.07 0.07 Smallpox — — — — — Measles 0.02 0.02 0.02 0.01 — Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.01 0.00 0.01 0.00 — Cerebro Spinal Fever 0.05 0.05 0.05 0.06 0.03 Scarlet Fever 1.89 2.02 2.03 1.57 1.03 Whooping Cough 1.64 1.65 1.47 1.25 0.43 Diphtheria 0.46 0.52 0.56 0.31 0.14 Erysipelas 0.25 0.28 0.24 0.31 0.28 Smallpox 0.00 0.00 — 0.00 — Measles 11.67 10.89 11.19 9.03 9.17 Pneumonia 0.87 1.03 0.72 0.78 0.46 Deaths under 1 year Rates per 1,000 Live Births. of age 46 54 43 53 21 Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 7.8 4.5 7.6 — Notifications— Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Pyrexia 9.93 12.65 8.81 15.87 1.95 Maternal Mortality Abortion with Sepsis Abortion without Sepsis. Puerperal Infections. Other Causes. Total. England and Wales 0.25 0.08 0.24 1.22 1.79 Beddington and Wallington 1.95 — — 1.95 13 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar General, gives the causes of death of residents in the Borough during 1945: — Causes of Death. Males. Females. Total. All Causes 151 156 307 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — 1 1 3. Scarlet Fever — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 6 10 16 7. Other forms of Tuberculosis 2 1 3 8. Syphilitic Disease 1 1 2 9. Influenza — — — 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis 1 1 12. Acute Infectious Encephalitis — — — 13.mCancer of Buccal Cavity and Oesophagus (males) 2 — 2 13. Cancer of Uterus — 3 3 14. Cancer of Stomach and Duodenum 5 — 5 15. Cancer of Breast — 3 3 16. Cancer of all other Sites 23 15 38 17. Diabetes — 2 2 18. Intra-cranial Vascular Lesions 10 23 33 19. Heart Disease 46 45 91 20. Other diseases of the Circulatory System 10 8 18 21, Bronchitis 8 4 12 22. Pneumonia 11 4 15 23. Other Respiratory Diseases 3 — 3 24. Ulceration of the Stomach or Duodenum 2 — 2 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis — 1 1 27. Other Digestive Diseases 3 3 6 28. Nephritis 4 5 9 29. Puerperal and Post-abortive Sepsis — 1 1 30. Other Maternal Causes — — — 31. Premature Birth 1 — 1 32. Congenital Malformations, Birth Injury, Infantile Disease 1 10 11 33. Suicide 1 1 2 34. Road Traffic Accidents 2 2 4 35. Other Violent Causes 2 2 4 36. All Other Causes 7 11 18 14 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 91 29.6 Cancer 51 16.6 Intra Cranial Vascular Lesions 33 10.7 Tuberculosis (All Forms) 19 6.1 Pneumonia 15 4.8 Bronchitis 12 3.9 Violence and Accident 10 3.2 VIOLENCE AND ACCIDENT. Deaths from violence and accidental causes show a welcome decrease on the figures for the previous year. Civilian deaths due to enemy action had previously contributed largely to the rather higher figures recorded during the war years. One person only died as a result of war operations and it is gratifying to note that the figures of deaths caused by suicide, street accidents and accidents in the home still remain at a low level. Details of all deaths under this heading are as follows: — Cause of Death. Male. Female. Total. Suicide 1 1 2 Street Accident 2 2 4 Accidents at Home — 2 2 Other Accidental Causes 1 — 1 War Operations 1 — 1 Totals 5 5 10 MATERNAL MORTALITY. One death occurred in hospital, the cause of death being certified as "general peritonitis due to septic abortion" after an inquest in which an open verdict was returned. The maternal mortality rate per thousand live and still births for the year was 1.95, as compared with the figure of 1.79 for England and Wales. The rate appears unduly high for a district' 'of this type, but 15 as the figures dealt with are small, the rate does not give a true impression of the facts, nor can a case of this nature be regarded as any reflection cast upon the hospital or the general maternity and child welfare services of the Borough. INFANTILE MORTALITY. Of a total of 505 live births, only 11 deaths of infants under one year of age were registered. Of these, 5 were males and 6 females, 2 of the males being illegitimate children. This gives the low infantile mortality rate of 21.78 per thousand live births, comparing well with the figure of 21.36 in 1944 and 46.0 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 113 1 112 Tuberculosis—(Sputa) 11 3 8 Enteric Group: — Faeces 1 1 Dysentery—(Faeces) 1 — 1 Totals 126 4 122 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:— 16 Specimens. Number Examined. Water: — Bacteriological analyses 269 Milk:— Bacteriological analyses 149 Microscopical examinations 2 Pathological Specimens: — Blood 118 Urine 102 Faeces 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. On the cessation of hostilities in Europe, the Council reverted to its pre-war practice of operating one ambulance vehicle only for the removal of accident cases occurring in the Borough and also for general public requirements. The service is under the control of the Medical Officer of Health. As forecast last year, the second ambulance, which is now over 17 years old, was withdrawn from regular service and is now used for occasional relief work only. Through the courtesy of the National Fire Service, the ambulances were returned to the pre-war base at Belmont Road Fire Station, and special mention must be made of the friendly co-operative attitude that has at all times been displayed by the officers and firemen at the Belmont Road Fire Station. Civil ambulance removals during 1945 totalled 927, and in the course of: this work a mileage of 7,463 was recorded, these figures including journeys undertaken at the request of neighbouring local authorities. The mutual assistance arrangements in operation between the Borough and contiguous authorities continued to function very satisfactorily. The Council's ambulance assisted on 78 occasions when called under the scheme and on 39 occasions when reciprocal services were required ambulances were immediately available. Details of the work of the Civil Ambulance during 1945 are as follows:— 17 Private Removals 336 Maternity Cases 297 Accidents 216 Calls answered for other Authorities 78 Total Calls Answered 927 Distance Travelled on Calls 7463 Average Mileage per Call 8.05 Mutual Assistance by Other Services 39 NURSINC IN THE HOME. This service is undertaken mainly by the staff of the Beddington and Wallington District Nursing Association and their work in the Borough is greatly appreciated. During the year the District Nurses attended 897 cases, including 71 maternity and 79 midwifery patients. TREATMENT CENTRES AND CLINICS. 1. Child Welfare Centres. When held. Hackbridge Centre, Every Monday afternoon, 2.0-4.0. The Grange, London Road. Bandon Hill Centre, Every Tuesday afternoon, 2.0-4.0. Methodist Hall, Sandy Lane North. Beddington Centre, First and third Wednesdays of Village Hall, the month, 2.0-4.0. Beddington. Wallington Centre, Second and fourth Wednesdays Baptist Hall, of the month, 2.0-4.0. Queen's Road. 2. Maternity Clinics. Ante-Natal Clinic. Thursdays and Fridays, 2.0-4.0. Post-Natal Clinic. Every Friday, 2.0-4.0. Held jointly with the Ante-Natal Clinic. 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. Voluntary Helpers.— Mrs. Budd, Mrs. Bunting, Mrs. Carver, Mrs. Feldon, Mrs. Hooper, Mrs. James, Mrs. Jennings, Mrs. King. Mrs. Melton, Mrs. Phillips, Mrs. Rose, Mrs. Shaw, Mrs. Wild, ladies of the Inner Wheel of Rotary and lady members of the British Red Cross Society. 18 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 ACAINST 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 4,221 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. The following table gives the number of children who were treated during the year and, after necessary corrections, the number of children known to be immunised in both age groups:— 0-5 years 5-15 years Total 0-15 years Apr cximate number of children in the Borough at 31st Dec., 1945 2200 3750 5950 Children who completed full course of immunisation during the year 389 30 419 Number of children known to be immunised at 31st Dec., 1945 948 1553 2501 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. 19 "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 made 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. WHOOPING COUGH. In response to requests from many of the mothers attending at the Child Welfare Centres, the Public Health Committee decided to offer facilities for immunisation against whooping cough to all children in the Borough providing their parents asked for the treatment and were prepared to pay the cost of the prophylactic material used. The scheme started in February, 1945, and by the end of the year 44 children had been immunised and a further 11 had started, but not completed, the course of injections. The material used is Parke Davis Whooping Cough Vaccine—St. Mary's Hospital preparation—the treatment consisting of four injections of 1 c.c. at weekly intervals. At present the numbers of children immunised are not sufficient to justify the formulation of conclusions regarding the efficacy of the treatment in preventing whooping cough. The fact that prophylactic inrioculations are being used to an increasing extent by a number of Public Health Departments does suggest, however, that experience is pointing to the value of the treatment in reducing the virulence of attacks of whooping cough. 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. 20 Small-pox. By arrangement with the County Council, cases of small-pox are admitted to the Small-pox Hospital at Clandon. General and Accident Cases. Cases from this area are admitted to:— 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, Kingston and St. Helier, Carshalton. Maternity Cases. Under an agreement between the Council and the Carshalton, Beddington and Wallington District (War Memorial) Hospital, a limited number of 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 nearly 78 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 overcrowding formerly prevailing. The acute housing shortage, intensified during 1945 by the return home of men and women from the Forces and other forms of national service, resulted in a considerable degree of overcrowding, and in such conditions an increase in the incidence of scabies had been anticipated. Nevertheless, the cases treated during the year—viz., 6.7 per 1,000 of the estimated population—still compares very favourably with many 21 other areas. The incidence of pediculosis—viz., 0.86 per 1,000, mainly confined to the 0-15 age group—is also comparatively low. 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 Totals 1946 1945 Attendances for Treatment. 1st. Re. 1st. Re. 1st. Re. 1st. Re. 1st. Re. Scabies 188 43 16 64 38 81 35 188 89 105 68 Pediculosis 24 7 — 15 — 2 24 - 62 8 Total 212 66 117 118 301 243 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. From the beginning of the year attendances at all centres and clinics were recovering progressively from the setbacks of the previous year. Following the cessation of hostilities and the subsequent return to more normal conditions, pressure on the staif of this section of the department became so heavy that the Medical Officer of Health felt it necessary to advise the Council that an increase in the permanent establishment of Health Visitors was a matter for early consideration if the Maternity and Child Welfare Services were 22 to be maintained at their present high standard. The acute shortage of trained Health Visitors made recruitment a matter of some difficulty, but it is hoped that the position will be easier in 1946. The District Nursing Association midwives continued to provide excellent domiciliary services and worked in the closest co-operation with the department. During the year under review they attended 71 maternity and 79 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 12.3 patients per session. During the year 397 expectant mothers attended the clinic, as compared with 344 in 1944. This represents approximately 77.6 per cent. of the total notified births, live and still, which were assigned to the Borough during 1945, and is a creditable reflection on the efficiency and consequent popularity of the Council's Ante-Natal Service. POST-NATAL CLINIC. During 1945 such post-natal cases as required treatment or advice continued to be seen at the Ante-Natal Clinic held on Friday afternoons. By the end of the year it was becoming evident that attendances had increased sufficiently to justify considering the re-opening of the separate Post-Natal Clinic which had been closed during the emergency which obtained during the summer of 1944. As the post-natal cases attending during 1945 constituted about 20 per cent. of the total births notified, it is hoped that arrangements can be made to re-open this clinic early in 1946, when it is expected that still more post-natal cases will take advantage of these facilities. It is reliably estimated that considerably more patients receive post-natal care than attend at the Council's clinics. The majority of women confined at County Council Hospitals are instructed on discharge to return for post-natal examination, usually within the month, and the majority of mothers readily avail themselves of these facilities. It is likely, therefore, that the number of women who receive postnatal care under local authority or County Council Maternity Services is likely to reach as high as 45 per cent. to 50 per cent. Figures in the following combined table include, therefore, post-natal attendances at the Council's Friday Ante-Natal Clinic. 23 Ante-Natal and Post-Natal Attendances, 1945. Council Cases. Nursing Association Cases. Total— 1945. Total— 1944. Ante-Natal Cases:— Number of Clinics held - - 100 103 Total number attending during the year 287 110 397 344 Number of first attendances 244 92 336 271 Number of re-attendances 525 372 897 844 Total attendances 769 464 1233 1115 Average attendance per session 7.7 4.6 12.3 10.8 Post-Natal Cases:— Number of Clinics held - - 50 29 Total number attending during the year 55 51 106 65 Number of first attendances 54 50 104 65 Number of re-attendances 17 9 26 11 Total attendances 71 59 130 76 Average attendance per session 1.4 1.2 2.6 2.6 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 Totals. Medical Officer, Ante-natal Clinic. Private Practitioners. 1945. 1944. C. N A. Clinics held 8 5 Patients attending: Ante-natal 6 1 1 8 4 Post-natal 4 — — 4 5 Total attendances 10 1 1 12 9 24 MATERNITY AND CHILD WELFARE CENTRES. At the beginning of the year the six Infant Welfare Centres maintained by the Council, as an administrative measure, were re-organised and conducted as four centres. The step was proposed to enable children, especially those recently born, to have the benefit of weekly supervision instead of fortnightly before the change over, and was effected by the fusion of the four centres held on alternate Monday and Tuesday afternoons into two centres held regularly every Monday and Tuesday. It is expected also that, when conditions are more normal and the hoped-for increase in the Health Visitors' establishment materialises, it will be practicable to effect similar improvements to the Beddington Village Hall and Wallington Baptist Hall Centres, now held on alternate Wednesday afternoons. The following tables show the attendances for 1945 at the four Cliild Welfare Centres and comparative figures of combined monthly attendances with the figures recorded in 1944. It is gratifying to be able to record that attendances have more than recovered from the setbacks occasioned by the unprecedented happenings of the previous year and it is a creditable reflection upon the work of all concerned with the conducting of this very popular and undoubtedly appreciated service of the department. Bandon Hill. Hackbridge. Beddington. Wallington. Totals. 1945. 1944. Number of sessons held 50 49 23 22 144 152 Infants:— No. of new cases under 1 year 138 118 65 89 410 338 No. of re-attendances 1553 1340 540 653 4086 2429 No. of new cases over 1 year 44 27 9 15 95 99 No. of re-attendances 1521 1179 515 623 3838 2629 Total attendance of infants 3256 2664 1129 1380 8429 5595 Average attendance of infants per session 65.1 54.4 49.0 62.7 58.5 35.7 Mothers attending 3120 2563 1110 1362 8155 5238 Total attendances 6376 5227 2239 2742 16584 10833 Average total attendance per session 127.5 106.7 97.3 124.6 115.2 71.3 25 Monthly Analysis of Attendances. Month. 1945. 1944. Month. 1945. 1944. January 1070 1121 July 2886 552 February 1273 1236 August March 1212 1208 September 1517 513 April 1292 1216 October 1964 786 May 1197 1322 November 1634 1085 June 1451 1105 December 1088 709 MATERNITY WARD. The arrangements between the Corporation and the Carshalton, Beddington and Wallington District (War Memorial) Hospital whereby, under an agreement, the hospital provided limited facilities for cases referred from the Ante-Natal Clinic by reason of unsuitable home conditions or for medical reasons, continued throughout the year. During the year under review there were no cases admitted under this scheme, but during this period 88 cases were admitted for confinement under arrangements made privately. In addition, a further 142 cases were confined during the year in various County Hospitals as under:— St. Helier County Hospital 102 Epsom County Hospital 20 Dorking County Hospital 16 Redhill County Hospital 4 142 HOME HELP AND DOMESTIC HELP SERVICE. This important section of the Council's Public Health Services functioned satisfactorily during 1945. Despite the fullest assistance from the Ministry of Labour and National Service, extreme difficulty was experienced in maintaining the service at the authorised personnel establishment of 4 full-time and 2 part-time Home Helps. Cooperating with the Ministry of Labour and National Service in an effort to obtain suitable recruits, a summer publicity week was organised in the Borough, during which period all the usual publicity media—newspaper advertisements, cinema slides, posters and leaflets —were used to the full. The results were most disappointing and, although the Corporation had increased wages and improved conditions of employment closely in conformity with the Hetherington recommendations, the response did not fulfil expectations. 26 Home Helps. The increasing difficulties experienced in obtaining institutional maternity accommodation, particularly by the section of the population which would normally use the services of private nursing homes, coupled with a further increase generally in the birth rate, resulted in increased demands for Home Helps to attend at domestic confinements. Although it was not possible in every case to give the service requested, in only very few cases were the demands for assistance not met in some way. Domestic Help. Home Helps, when not engaged in maternity cases, are available to serve for limited periods in homes requiring assistance of the kind specified by the Minister of Health under the provisions of Circular 179/44. Staff difficulties limited the assistance which the department was able to extend under this service, whilst in a very large number of cases it was found that short period service was not what was actually required. Nevertheless assistance of some form was provided in a certain number of cases which was usually sufficient to cover the period of the emergency. In serving the cases analysed in the following table, the Corporation's Home Helps performed some very good work, which was much appreciated by the households concerned:— Home Help. Domestic Help. Full-time 33 7 Part-time 35 18 68 25 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 1945 30 women from the Borough were referred to this clinic and made a total of 51 attendances. TREATMENT. Minor Ailments. Two hundred and twenty-two cases were referred from the Maternity and Child Welfare Centres to the under-mentioned hospitals during the year:— Croydon General Hospital 98 St. Helier County Hospital 76 Guy's Hospital 27 Hospital for Sick Children (Great Ormond Street) 14 Westminster Hospital 2 Carshalton, Beddington and Wallington District (War Memorial) Hospital 1 27 Wilson Hospital (Mitcham) 1 St. Thomas's Hospital 1 Mayday Hospital (Croydon) 1 King's College Hospital 1 222 The conditions requiring treatment were:— Orthopaedic Defects 59 Circumcision 32 Eye Conditions 30 Skin Conditions 29 Ear and Nose Conditions 13 Nævus 8 Tonsils and Adenoids 8 Feeding Difficulties 7 Chest Conditions 7 Speech Difficulties and Otherwise Backward 8 Hernia 1 Miscellaneous Ailments 20 Dental. During 1945 13 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 6 — 7 Received treatment 3 — 6 Made dentally fit 3 — 6 Treatments:— Fillings:— In temporary teeth — — — In permanent teeth 2 - — Teeth extracted 46 - 27 Administrations of general anaesthesia 2 - 6 Patients supplied with dentures 4 — — Dentures supplied 6 — — Orthopædic. 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 59 cases were so referred and treated. 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 28 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 for Child Welfare Centres and the value of this artificial sunlight as an aid to health is now well recognised. 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 unqualified success. During this first full year that the Solarium has been in operation 717 individual patients had received treatment and there had been a total of 8,648 attendances. The table below gives details of the attendances month by month:— Month. 0-5 years 5-15 years Adults. Totals. Expectant Mothers Nursing Mothers Private 1 Patients 1946 1945. Attendances for Treatment. 1st. Re. 1st. Re. 1st. Re. 1st. Re. 1st. Re. 1st. Re. 1st. Re. Jan. 60 430 8 19 — 8 4 25 1 1 73 483 — — Feb. 108 754 8 95 3 16 9 38 10 53 138 956 — — Mar. 45 870 6 92 3 40 3 47 2 77 59 1126 — — April 70 736 2 37 — 23 8 44 2 15 82 855 — — May 18 618 1 29 — 4 1 58 — 14 20 723 — — June 25 23 2 5 2 3 2 1 — — 31 32 — — July 45 416 2 24 — 25 2 20 2 9 51 494 — — Aug. 30 456 — 12 2 16 4 23 — 2 36 509 — — Sept. 38 417 6 17 — 7 3 33 3 7 50 481 34 84 Oct. 71 746 6 91 4 16 8 54 5 55 94 962 107 689 Nov. 50 610 2 43 1 21 4 34 3 27 60 735 83 947 Dec. 18 490 3 27 1 16 — 15 1 27 23 575 37 804 Total 578 6566 46 491 16 195 48 392 29 287 717 7931 261 2524 Attendances 7144 537 211 440 316 8648 2785 29 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:— Maternity Visits. First visits to Expectant Mothers 47 Re-visits to Expectant Mothers 14 Breast Feeding observations 16 Post-Natal visits 2 Infant Welfare. First visits under 1 year 348 Re-visits under 1 year 190 First visits over 1 year 36 Re-visits over 1 year 255 Special Home Visits. Still Births 4 Infant Deaths 4 Child Life Protection. First visits 11 Re-visits 22 Infectious Diseases. General Enquiries 8 Tuberculosis 41 Scabies 64 Impetigo 1 Verminous conditions 6 Puerperal Infections 1 General Visits. Home Enquiries, Agreements, etc. 39 Adoption of Children 5 Home Help and Domestic Help 59 Miscellaneous visits 27 Unsuccessful visits 14 Total 1214 Attendances at Clinic Sessions. Maternity and Child Welfare Centres 296 Ante-Natal and Post-Natal Clinics 163 Total 459 Total attendances, 1944 474 Interviews in Office 303 Attendance at Medical Examinations 23 30 CHILD LIFE PROTECTION. The Health Visitors are the authorised Child Life Protection Visitors for the Borough. Number of persons who were receiving children for reward at the end of the year 8 Number of children on the register at the end of the year 14 Number of children who died during the year — During the year 33 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 arrangements made for the care of premature infants were continued during 1945. All equipment is kept at the District Nursing Association, the headquarters of the local midwives, where it is ready for immediate use when required. The majority of premature births occurred in institutions and only 7 cases were recorded in the practice of the domiciliary midwives. All these cases responded successfully to routine domiciliary treatment and there was no occasion to call upon the specialised services provided by the St. Helier County Hospital. THE CARE OF ILLEGITIMATE CHILDREN. The arrangements made for the care of illegitimate children, fully described in the Annual Report for 1944, were continued throughout the year. The local organisation of the Women's Voluntary Services was again most co-operative and the work of these ladies in augmenting the advice and assistance of the Health Visitors was much appreciated, both by the department and the mothers concerned. The usual annual grant was again accorded to the Sutton and District Girls' Aid Association, and the most cordial relations existed between Officers of the Corporation and the workers of this voluntary society. The Association's welfare worker assisted the following cases during the year:— Unmarried mothers 11 Married women with illegitimate children 3 Girls in needs of care and protection 1 Bigamous marriage 1 The welfare worker further reports that, of the unmarried mothers, 2 had their babies adopted and the other girls preferred to keep their infants. The total illegitimate births for the Borough during the year under review numbered 44, 22 males and 22 females, this figure giving a rate of 86.1 illegitimate births per 1,000 total (live and still) births. This represents a big increase on the figures returned for the previous year, when only 20 illegitimate births were recorded, and is undoubtedly the 31 result of the very conditions experienced in the year which saw the end of hostilities and the start of the difficult transition period before normal times return. DAY NURSERY. The 50-place Day Nursery, which was opened in April, 1943, as a war-time measure, continued during 1945 to fill its important role as an integral part of the Corporation's Maternity and Child Welfare Services. Situated at Spencer Road, Hackbridge, the prefabricated sectional building was erected specially for its purpose and the children are excellently cared for in light, airy surroundings. The children are medically inspected at frequent, regular intervals and the physical improvement noticed in all cases very shortly after admission to the nursery is a tribute to the care and attention given to them by the staff. Staff difficulties during the summer months of 1945 caused a certain amount of anxiety, the shortage of personnel in all branches of the nursing profession being equally acute in the case of nurses experienced in or desirous of taking up nursery work. Much appreciated help was given by the Nursing Appointments Section of the Ministry of Labour and National Service in overcoming these difficulties and the department was indeed fortunate, with their assistance, in securing the services of: Mrs. E. E. Shepherd, S.R.N., as matron to All a vacancy which arose at a very difficult period. As will be observed from the analysis of attendances, in the early months of the year a sharp attack of measles resulted in a noticeable falling off of attendances, but generally the health of the children was uniformly good and was no doubt the result of the good, regular feeding and the well-ordered routine which obtained at the nursery. For the rest of the year attendances were fairly regular. Month. Age. Month. Age. Month. Age. 0-2. 2-5. 0-2. 2-5. 0-2. 2-5. January 219 682 May 325 573 September 324 695 February 237 406 June 312 742 October 255 656 March 153 481 July 286 792 November 259 664 April 289 548 August 272 561 December 208 574 32 Attendance analysis:— Age. Year. 1945. 1944. 0-2 years 3141 3412 2-5 years 7399 6415 Total 10540 9827 Daily average:— 0-2 years 10.5 11 2-5 years 24.9 21 Total 35.4 32 SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. During the year 251 samples of water were submitted for bacteriological examination in the Council's laboratory. Samples were taken as follows:— Main Water Supply (Sutton Well and Woodman- sterne Well) (An average per month of: 13 samples) 165 Private Wells 73 Swimming Bath 13 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. DRAINAGE AND SEWERAGE. The Council have continued the maintenance of the soil and storm water drainage systems during the year. 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 1945, silt, tree branches and obstructions being removed. Certain water-courses feeding the River Wandle were also cleaned. 33 CLOSET ACCOMMODATION. Practically the whole of the area is on the water carriage system, draining into the public sewers. There are a few chemical and earth closets, chiefly for use on sports grounds within the district, whilst 4 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. Collections were made fortnightly throughout the year, the available labour force being augmented by Italian co-operators for most of the period. With the return of men from the Forces, the co-operators were superseded, but the labour position did not reach the point which would admit the resumption of weekly collection. 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. 34 STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1945. DWELLING-HOUSES. Number of inspections of dwelling-houses 806 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 dairymen distributing milk 5 Number of dairy premises on register 7 Number of dairy premises upon which loose milk is handled or treated 1 Number of inspections of premises 12 Defects in dairy premises discovered 1 Infringements of Acts and Orders discovered and dealt with:— Extraneous matter in milk 1 Unclean milk vessels 5 6 Number of licences issued under the Milk (Special Designations) Regulations:— Tuberculin Tested—Dealer's Licences 4 Supplementary Licences 7 Pasteurised—Dealer's Licences 4 Supplementary Licences 7 Pasteuriser's Licence 1 23 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of visits to slaughterhouse 2 Number of visits to other premises on which animals were slaughtered 3 35 Carcases inspected and condemned:— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — 5 Number inspected — — — — 5 Whole carcases condemned or — — — — — Carcases of which some part or organ was condemned — — — — - FOOD PREMISES. Number of inspections 331 Number of defects discovered and remedied 3 UNSOUND FOOD. Destroyed or released for approved purposes:— lbs. Fish 686 Meat 404 Canned Foods 342 Fruit 220 Milk, Evaporated 178 Cereals 99 Marmalade 91 Milk, Condensed 76 Dried Fruit 70½ Pudding Mixture 70½ Rabbits 43 Sausages 42 Jam 38 Curry Powder 27½ Eggs 271 Miscellaneous 23 Total 2410½ 36 FOOD ANALYSES. Number of samples analysed by Public Analyst 98 Number of samples reported against:— Dried Apricots—Excessive amount of deteriorated preservative 1 Pudding Mixture—Infested with mites 1 Curry Powder— Excess bean meal—contained insects 2 Excessive amount of lead 1 Flour, Self-raising—Infested with mites 1 Jam—Excessive amount of deteriorated preservative 1 Milk, Dried Skimmed—Solubility low, moisture high—protein decomposition 1 Sauce, Tomato—Contained preservative 1 Vinegar— Deficient in acetic acid 1 Non-brewed and deficient in acetic acid 1 Glycerine of: Borax—Contained oil and camphor 1 12 Number of prosecutions — FACTORIES. Number of factories on register 98 Number of inspections 109 Number of defects discovered 12 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 31 Number of defects discovered and remedied 4 WORKPLACES. Number of inspections of workplaces 18 Number of defects discovered - SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 137 Number of defects discovered and remedied 1 COMPLAINTS. Complaints received during the year were due to the following Causes:— Defects in dwelling-houses (various) 134 Stoppages in drains 97 Defects in drains or water closets 41 Defective dustbins 70 37 Food supplies 27 Defective water fittings 37 Insect pests 12 Miscellaneous 49 467 SMOKE ABATEMENT. Number of observations 32 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 141 Number of rooms disinfected 106 Lots of bedding and clothing disinfected 142 Number of library books disinfected 206 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 9 Number of defects discovered — RATS AND MICE (DESTRUCTION) ACT, 1919. Number of visits to premises 247 Number of complaints received 76 Number of premises found infested 41 NOTICES. Number of informal notices served (including verbal intimations) 632 Number of statutory notices served:— Public Health Act, 1936, Section 93 (nuisances) 5 Public Health Act, 1936, Section 75 (dustbins) 22 27 PROSECUTIONS Nil SANITARY IMPROVEMENTS. Water Supply. Water pipes and fittings repaired or renewed 48 Water supply reinstated 2 Drains. Drains re-laid or repaired 18 Drains unstopped and cleansed 121 Intercepting traps provided with rodeye stoppers 12 Manholes provided or repaired 12 Soil or ventilation pipes repaired or renewed 6 , Gully kerbs and channels repaired 9 New soakaways constructed 5 38 Closets. New closets provided 1 Buildings repaired 5 New pans fixed to water closets 14 Flushing cisterns repaired or renewed 19 Flush pipes and pan joints repaired or renewed 15 Water supply reinstated 2 Seats repaired or renewed 6 Sinks. New sinks provided 4 Waste pipes repaired or renewed 17 Yards. Yards newly paved or repaired 2 Dust Receptacles. New portable iron dustbins provided 301 Dampness. Roofs repaired 37 Rainwater gutters repaired or renewed 27 Rainwater downspouts repaired or renewed 13 Damp-proof courses provided 3 Windows, sills and doors made weatherproof 3 External walls repaired, repointed or rendered 3 Ventilation provided under floors 6 General Repairs, Etc. Rooms cleansed 5 Walls and ceilings repaired 19 Floors repaired 28 Stoves repaired or renewed 9 Windows repaired 16 Chimneys repaired 5 Number of premises disinfested from bed bugs 3 Refuse removed 3 SUMMARY OF WORK DONE DURINC THE YEAR. Number of inspections of dwelling-houses 806 Number or re-inspections of premises 1194 Number of visits to works in progress 287 Number of miscellaneous visits and inspections 787 Number of visits to dairies 12 Number of visits to factories 109 Number of visits to bakehouses 31 Number of, visits to workplaces 18 Number of visits to shops and offices 137 Number of visits to premises re slaughtering 5 39 Number of visits to food premises 331 Number of visits to stables and yards 62 Number of visits to market gardens, etc 8 Number of visits to fried fish shops 9 Number of visits to urinals 31 Number of visits to piggeries 26 Number of visits re infectious diseases 141 Number of visits to streams 59 Number of visits re rats 247 Number of visits re smoke abatement 32 Number of complaints received and investigated 467 Number of informal notices served 632 Number of statutory notices served 27 Number of interviews re nuisances, etc. 624 Number of rooms disinfected 106 Number of lots of bedding and clothing disinfected 142 Number of library books disinfected 206 Number of visits to Public Air-Raid Shelters 114 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 thirty-seven inspections were made during 1945 and in 1 case action was necessary in regard to sanitary defects. CAMPINC SITES. There are no camping sites within the Borough. SWIMMING BATH. There is one open-air swimming bath in the Borough situated in the grounds of the Royal Female Orphanage, Beddington. As in previous years, the Council were able to satisfy, at least in part, the large demand for swimming facilities from young people and residents of the Borough generally. The London County Council were approached and, for an agreed rental, consented to allow the Beddington and Wallington Corporation to meet the demand by granting generous sessions at the swimming bath. The usual facilities offered to schools and youth organisations were eagerly accepted, and the three midweek sessions and full Sunday facilities allocated to the Borough Swimming Club were enjoyed to the full. Residents using the bath were enrolled in a Borough Swimming Club under the control of Officers of the Corporation. The following attendances were recorded during the season, which lasted for 22 weeks: — 40 Youth Organisations 4374 Schools 4618 Borough Swimming Club 10544 Total 19536 ERADICATION OF BED BUCS. During the year bed bugs were found to exist in 1 Council house and in 2 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, but only 1 is used for the treatment and handling of loose milk. During the year 12 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 11 Pasteurised 12 41 SLAUGHTERHOUSE. 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 two instances. FACTORIES. The following tables give details of inspections made and defects found, as supplied by the Senior Sanitary Inspector: — 1. Inspections for purposes of provisions as to health. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with mechanical power ... 104 2 Factories without mechanical power 5 — — Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) ... - - - Total 109 2 — 42 2. Defects found. Particulars. Number of Defects. Number of 1 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) 3 3 - - 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 3 2 — - Not separate for sexes — — — - Other offences 6 6 — - (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 11 — — 3. Outwork in Unwholesome Premises. No instances were discovered. 43 HOUSING. No statistics in the tabular form usually required by the Ministry of Health are submitted. The Minister has not asked for this information and, owing to the present chaotic state of housing repairs and the difficulty in remedying defects, such statistics would not give an accurate picture of housing as a whole. 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. Pasteurised 113 Sterilised 16 Tuberculin Tested, Pasteurised 12 Tuberculin Tested, Certified 8 Tuberculin Tested 7 Heat Treated 1 Total 157 With the exception of 2 samples of pasteurised milk, all the samples examined complied with statutory requirements. 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 PublicAnalyst for the Borough. 44 The following table gives details of the samples obtained within this district during the year. Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. Convic tions. Formal. Informal. Total. Formal. Informal. Total Apricots, Dried - 1 1 - 1 1 - Baking Powder - 2 2 - - - - - Blackcurrant Syrup 1 1 - - - Butter — 7 7 - - - - - Cake and Pudding Mixtures - 4 4 - 1 1 - - Cocoa — 2 2 — — — - - Coffee and Chicory 1 1 - - - - - Curry Powder . 1 2 3 1 2 3 - - Eggs, Dried ... — 1 1 - - - - - Flour — 1 1 — — — - - Flour, Self-raising - 1 1 - 1 1 - - Gelatine — 2 2 - - - - - Jam — 1 1 — 1 1 - - Lard — 6 6 — — — - - Lemon Squash — 1 1 - - - - - Margarine — 7 7 - - - - - Marmalade — 2 2 — — — - Milk 28 — 28 — — — Milk, Dried, Skimmed - 1 1 - 1 1 - - Pepper — 2 2 — — — - - Pudding — 1 1 — — — - - Sauces — 3 3 — 1 1 - - Sugar — 1 1 — — — - - Tea — 2 2 — — — - - Vinegar — 7 7 — 2 2 - - Glycerine —. 3 3 — — — - - Glycerine of Borax* - 1 1 - 1 1 - - Phenacetin Tablets - 2 2 - - - - - Phenacetin and Aspirin Tablets - 1 1 - - - - - Sulphur Ointment - - - - - - - - — 3 3 - - - - - Totals 29 69 98 1 11 12 — — * Submitted privately. 45 CHEMICAL AND BACTERIOLOGICAL EXAMINATIONS. Special work of this nature is carried out when required at the Counties Public Health Laboratories. Routine examinations of milk and water samples continue to be done in the Public Health Laboratory established in 1937 at the Town Hall, Wellington, 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, have been fairly well maintained, but children who have possibly not received enough cod liver oil or one of the substitutes often show by the presence of a shallow groove across their ribs, known as Harrison's Sulcus, a mild degree of Avitaminosis D (rickets). Treatment at the Solarium is of special value in this condition, and also in the cases of delayed teething, which are not uncommon. 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 1945, the number of cases removed to hospital and the number of deaths attributed to these diseases, excluding Tuberculosis.: Disease. Number Notified. Removed to Hospital. tDeaths. Scarlet Fever 29 25 _ Diphtheria 4 4 — Erysipelas 8 6 — Pneumonia 13 3 15* Measles 256 4 — Whooping Cough 12 — — Puerperal Pyrexia 1 1 — Cerebro-Spinal Fever 1 1 1 Acute Poliomyelitis 4 4 — Acute Polioencephalitis 1 1 1 Totals 329 49 17 * 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, 1945. (Excluding Tuberculosis). Disease. At all ages. Number of Cases Notified. At Ages—Years. Total cases notified in each Ward. Beddington. Wallington. Cases removed to Hospital. Deaths (Including deaths of residents outside the Borough) 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. North. Central. South. North. Central. South. Puerperal Pyrexia 29 3 1 9 6 5 1 4 - - 4 6 3 8 6 2 25 — Scarlet Fever 4 - - - - - - 1 1 1 1 - - 1 3 4 — Diphtheria 8 - - - - - - - 1 1 4 2 2 2 2 1 1 6 - Erysipelas 13 - - - 4 1 — — 3 3 2 5 1 2 1 4 3 15* Pneumonia 256 7 31 26 28 29 115 9 6 5 — — — 91 25 19 79 32 10 4 — Measles 12 1 — — 2 1 8 — — — — — — 5 1 — 1 3 2 — — Whooping Cough 1 - - - - - - - - 1 - - - - - - 1 - - 1 — Cerebro-Spinal Fever 1 - - - - - - - 1 - - - - - - - - - 1 1 1 Acute Poliomyelitis 4 - - - - - 2 1 1 _ 2 _ _ 2 - - 4 _ Acute Polioencephalitis 1 - - - - - - - - - 1 - - - 1 - - - - 1 1 Totals 329 8 34 27 30 30 138 18 15 8 10 7 4 109 36 26 93 49 16 49 17 48 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 The Monthly Incidence of Infectious Disease, 1945. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 9 1 2 3 1 1 0 3 2 1 29 Diphtheria — — — — 1 — — 1 1 — 1 — 4 Erysipelas — — 1 1 — 2 1 — — 1 — 2 8 Pneumonia 2 2 2 — 2 1 — — — 1 2 1 13 Measles 18 34 26 84 40 47 7 — — — — — 256 Whooping cough 4 — — 1 — 4 — 1 — — 2 — 12 Puerperal Pyrexia — — — — — — — — 1 — — — 1 Cerebro-Spinal Fever 1 — — - - - - 1 Acute Poliomyelitis — — — — — — 3 — - — — — 4 Acute Polioencephalitis - - - - - - - - - - 1 — 1 Totals 34 37 31 89 44 54 12 8 6 4 7 3 329 Tuberculosis. There were 35 new cases notified during the year. The following table gives the number of new cases notified during the past five years: — New Cases. 1941 1942 1943 1944 1945. M. F. M. F. M. F. M. F. M. F. Pulmonary 13 15 17 12 19 10 18 9 17 13 Non-Pulmonary 4 1 1 3 2 5 2 4 3 2 Totals 17 16 18 15 21 15 20 13 20 15 Annual case rate per 1,000 of the estimated population: — 1945. 1944. Pulmonary 1.07 1.01 Non-Pulmonary 0.18 0.22 The following table gives the number of deaths from this disease during the past five years: — Deaths. 1941. 1942 1943 1944 1945. M. F M. F. M. F. M. F. M. F. Pulmonary 5 4 6 6 8 3 5 4 6 10 Non-Pulmonary 2 — — 3 1 2 1 — 2 1 Totals . 7 4 6 9 9 5 6 4 8 11 It will be seen from the foregoing table that 19 deaths were registered as due to Tuberculosis, of which 16 were Pulmonary and 3 Non-Pulmonary. The figures correspond to a death rate per 1,000 of population of 0.57 for Pulmonary Tuberculosis and 0.1 for NonPulmonary Tuberculosis. Of the 19 deaths which occurred, 3 were non-notified cases. 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: — 50 New Cases. Deaths Age Periods. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary. M. F M. F M. F M. F. Under 1 year 1 and under 5 - - - - - - - - 5 and under 10 - - - - - - - - 10 and under 15 — — — — — - 15 and under 20 3 3 1 — — 2 - - 20 and under 25 3 3 —. 1 1 — - - 25 and under 35 4 3 1 — — 4 1 - 35 and under 45 4 — 1 — 2 2 — 1 45 and under 55 3 2 — — 2 1 1 — 55 and under 65 — 1 — — 1 — — — 65 and upwards — 1 — 1 — 1 — - Totals 17 13 3 2 6 10 2 1 The new cases were distributed amongst the Wards as follows:— Beddington. Wallington. North. Cent. South North. Cent. South. Pulmonary 8 4 8 4 3 3 Non-Pulmonary 1 1 — — — 3 Totals 9 5 8 4 3 6 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 1945. 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