BED 11 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1946. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1946. TABLE OF CONTENTS, Public Health Committee 5 Maternity and Child Welfare Sub-Committee 5 Representatives on the Wandle Valley Joint Hospital Board 5 Representatives on the Wandle Valley Joint Sewerage Board 5 Staff of Public Health Department 6 Statistics and Social Conditions 10 Extracts from Vital Statistics 12 Vital Statistics: Comparative Crude Birth-rates. Death-rates, Analysis of Mortality, etc., 1946 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 17 Treatment Centres and Clinics 17 Immunisation against Diphtheria 18 Hospitals 19 Immunisation against Whooping Cough 19 Cleanliness 20 Disinfection 21 Maternity and Child Welfare: General Observations 21 Ante-Natal Supervision 21 Post-Natal Supervision 22 Consultant Obstetrician 23 Child Welfare Centres 23 Institutional Confinement 24 Home Help 24 Family Planning 24 Treatment: Minor Ailments 25 Dental 25 Orthopædic 26 2 Solarium 26 Health Visiting 26 Child Life Protection 27 Adoption of Children 28 Care of Premature Infants 28 Care of Illegitimate Children 28 War-time Day Nursery 28 Sanitary Circumstances of the Area: Water Supplies 28 Drainage and Sewerage 29 Rivers and Streams 29 Closet Accommodation 29 Public Cleansing 29 Sanitary Inspection of the Area 31 Statement of the Senior Sanitary Inspector for the Year 1946: Dwelling Houses 31 Milk and Dairies 31 Slaughterhouse 31 Food Premises 32 Unsound Food 32 Food Analyses 33 Factories 33 Bakehouses 33 Workplaces 33 Shops and Offices 33 Complaints 33 Smoke Abatement 34 Infectious Disease and Disinfection 34 Offensive Trades and Fish Frying 34 Rats and Mice (Destruction) Act 34 Notices 34 Prosecutions 34 Sanitary Improvements: Water Supply 34 Drains 34 Water Closets 35 Sinks 35 Yards 35 Dust Receptacles 35 Dampness 35 General Repairs, etc. 35 Summary of work done during the year 35 3 Shops and Offices 36 Camping Sites 36 Swimming Bath 36 Eradication of Bed Bugs 36 Schools 36 Dairies 37 Milk (Special Designations) Regulations 37 Slaughterhouse 37 Bakehouse 37 Factories 38 Housing: Housing 40 Inspection and Supervision of Food: Milk 40 Meat 40 Food and Drugs Act, 1938 40 Chemical and Bacteriological Examinations 42 Nutrition 42 Shell ???h (Molluscan) 42 Adoptive Acts and Bye-Laws 42 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 43 Incidence of Infectious Diseases in Age Groups and Wards 44 Monthly Incidence of Infectious Disease 45 Tuberculosis 46 4 BOROUGH OF BEDDINGTON AND WALLINGTON. PUBLIC HEALTH COMMITTEE. December, 1946. Members: Councillor D. H. de Voil (Chairman). Councillor Mrs. V. M. Boyce, J.P. (Mayor). Alderman J. Vale (Deputy Mayor). Alderman W. W. Binnie, J.P. Alderman F. G. Bryant. Councillor Miss K. C. Bratt. Councillor A. R. B. Gill. Councillor W. P. Hunt. Councillor J. F. Legg. Councillor A. H. Pearce. Councillor A. C. Walker-Griffin MATERNITY AND CHILD WELFARE SUB-COMMITTEE. December, 1946. Members: Councillor D. H. de Voil (Chairman). Councillor Mrs. V. M. Boyce, J.P. (Mayor). Alderman F. G. Bryant. Councillor Miss K. C. Bratt. Councillor A. R. B. Gill. Councillor J. F. Legg. 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, 1946. Members: Councillor Mrs. V. M. Boyce, J.P. (Mayor). Alderman H. D. Banks. Councillor D. H. de Voil. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1946. Members: Councillor Mrs. V. M. Boyce, J.P. (Mayor). Councillor A. R. B. Gill. Councillor A. H. Pearce. Councillor A. H. Prior. 5 STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health:— †Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. (Returned 1/3/46). Assistant Medical Officers for Ante-Natal and Maternity and Child Welfare Clinics:— *Charles A. Bentley, C.I.E., M.B., C.M., D.P.H., D.T.M. & H. (acting M.O.H. until 1/3/46). *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 Inspector:— A. F. Leaney, M.R.S.I. Health Visitors:— Miss E. Turnbull, S.R.N., S.C.M., H.V. Cert Miss E. C. Richardson, R.S.C.N., S.C.M., H.V. Cert. (Resigned 16/3/46). Miss M. Ramsay, S.R.N., S.C.M., H.V. Cert. (Appointed 17/6/46); Resigned 31/12/46). Miss K. M. Dixon, S.R.N., S.C.M., H.V. Cert. (Appointed 15/7/46). Physio-Therapist:— Miss G. Allen, M.C.S.P. Assistant to Physio-Therapist: — Miss D. S. Raymond. Clerks:— †R. F. Burns (Chief Clerk) (Returned 1/6/46). A. L. Jones (Temporary Chief Clerk until 24/8/46). Miss M. Frost (Resigned 31/1/46). †E. D. Evezard (Returned 2/9/46). G. H. Bourne (Temporary). Miss J. Day. Mrs. V. G. Cole (Temporary until 23/3/46). P. H. Sadler (Temporary) (Appointed 26/3/46). Laboratory Assistant:— †W. K. Stevens (Resigned 5/4/46). *Part-time. †On Active Service. 6 Public Health Department. Town Hall, Wallington. To The Worshipful the Mayor, Aldermen and Councillors of the Borough of Beddington and Wallington. Ladies and Gentlemen, I beg to present my annual report for 1946. This is the first report I have presented following the cessation of hostilities. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 13/47. The vital statistics are based on information supplied by the Registrar-General; this was received in mid-June, 1947. The Registrar-General's estimate of the population of the Borough at the middle of the year is 31,460, but from information available from local sources (e.g., the Food Control Office) the population at the end of 1946 exceeded 33,000. The birth rate per 1,000 total population has remained practically stationary at 18.63 in 1946, as compared with 18.10 in 1945, and is below that for England and Wales, which is 19.10. The stillbirth rate of 0.29 per 1,000 total population is about the same as in 1945 and compares favourably with that for England and Wales, which is 0.53. The stillbirth rate per 1,000 total births is 15.13 compared with 11.79 in 1945. The death rate from all causes per 1,000 total population is 10.39 compared with 11.00 for 1945 and 11.50 for England and Wales. Of the 327 deaths, disease of the heart and circulatory system accounted for 105 (32.1 per cent. of total deaths), cancer 60 (18.3 per cent. of total deaths) and tuberculosis 8 (2.4 per cent. of total deaths). The maternal mortality rate per 1,000 total births is 1.68 as compared with 1.43 for England and Wales. The table on page 13 showing comparative birth and death rates for other areas shows that the Borough compares very favourably, and the Corporation can regard this with some satisfaction. Nineteen-forty-six will be a year memorable in the history of Public Health for the passing of the National Health Service Act. The principal effect upon this local authority when the Act comes into operation (the anticipated day being 5th July, 1948) will be the transfer of the following functions from the control of the Corporation to the Surrey County Council:—ambulance service, health visiting, infant welfare centres, ante-natal and post-natal clinics and all other maternity and child welfare functions, and diphtheria immunisation. Discussions commenced during the year as to how the relevant sections of the Act could best be applied to the Borough, and it is anticipated that a final scheme will be brought forward by the Surrey County Council before the end of 1947. 7 During the year the public health laboratory in the Medical Officer of Health's Department at the Town Hall, which had given very good service from 1937, ceased to carry out the routine examination of samples of milk and water. This work has now been handed over to the Public Analyst, Mr. H. Amphlett Williams, and the services of a trained laboratory attendant have been discontinued. There was no epidemic disease during the year. The incidence of the common infectious diseases of childhood varied little from that to be anticipated in a normal year. Three cases of diphtheria were recorded during the year, all being adults, and none being fatal. It is significant that there were no cases among children, which emphasises the efficacy of the Council's immunisation scheme. Measles with a total of 201 cases showed the greatest incidence, in particular amongst children between the ages of 5 and 10 years. Whooping-cough, with a total figure of 39, was reasonably low. During the year the immunisation scheme for whooping-cough introduced in 1945 continued satisfactorily, many parents availing themselves of this immunisation service. The Minister of Health has inaugurated a plan to test the efficacy of the immunisation and of the various whooping-cough vaccines at present in use. The records of immunisation in three large towns, Tottenham, Wembley, and Manchester, will be analysed after a two-year period, and it is hoped that a Government pronouncement on the prevention of whoopingcough will be forthcoming in due course. Amongst social conditions, which have shown marked deterioration during the war years, housing is probably the worst. The shortage of housing accommodation and the over-crowded conditions under which people are compelled to live and rear families are reflected in the work of a public health department. The health of mothers and children cannot but be adversely affected by unsuitable living conditions, and the psychological problems of many families living together with parents-in-law give rise to much discontent. Another effect of the destruction of property as well as the shortage of personnel has been the shortage of maternity beds. Although during the year no urgent case was refused admission to a County hospital for confinement, difficulty was experienced in allotting the beds to the right persons. Domiciliary confinement was encouraged wherever possible, and in this respect the district nurses have co-operated very well with the Department. Of a total of 595 births (live and still) 280 took place at home, as compared with 315 in institutions and nursing homes. The Corporation's Home Help Service was of inestimable value in assisting domiciliary confinements, but the expense involved per birth is very much higher than in the case of institutional delivery. The number of mothers unable to breast-feed their infants showed an increase as compared with pre-war years. This is easily understandable when one considers the ever-increasing burdens placed on 8 housewives; the daily search for food, the monotony and paucity of rations, overcrowding, and absence of domestic help, all adversely affect breast-feeding, and during the year it was noticed that more and more mothers had to rely on artificial infant foods. As recorded elsewhere in the text, the appointment of a third Health Visitor was made during the year, which has enabled a large expansion of the Maternity and Child Welfare Services to be undertaken. On the 30th June the Corporation ceased to administer the Day Nursery at Spencer Road, Mitcham Junction, and this institution is now under the control of the local Education Authority, and continues to provide a very useful service for mothers doing domestic or factory work. In March the Health Visitors assisted in the compilation of the questionnaire on births undertaken by the Royal College of Obstetricians and Gynæcologists and Population Investigation Committee. The report is expected to be published in 1947. During the year Dr. C. A. Bentley, the Acting Medical Officer of Health for the war years, was able to relinquish his post from the 1st March on my return from His Majesty's Forces. The Chairman and Members of the Public Health Committee, together with other members of the Corporation, have already recorded their appreciation of the excellent way in which Dr. Bentley served the district in the capacity of Acting Medical Officer of Health. I personally would like to add a note to express my own appreciation of Dr. Bentley's work. Two other members of the Department, the Chief Clerk (Mr. R. F. Burns) and the Senior Assistant Clerk (Mr. E. D. Evezard) also returned after their period of war service with the Armed Forces. In conclusion, I wish to place on record my appreciation of the loyal service and valuable assistance I have received from all the members of my staff throughout the year. I have the honour to be, Ladies and Gentlemen, Your obedient servant, PATRICK J. O'CONNELL, Medical Officer of Health. July, 1947. 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 1946 31,460 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1946 9,015 Rateable Value, December, 1946 £384,705 Sum represented by penny rate, December, 1946 £1,554 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 being 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. Since the cessation of hostilties in 1945, the population has shown a steady increase, and by the end of 1946 was back to pre-war level. The number of inhabited houses, however, is below the 1939 figure, and the number of persons per house has risen to almost 3.5 as compared with 3.3 in 1939. Overcrowding exists in certain properties, as the average figure is not evenly spaced. The rateable value and the sum represented by a penny rate are both greater than in 1939. The expansion of industry in the district, particularly in the Northern part, which was noted in 1939, continued to grow during the war years. In spite of this, however, the district is mainly residential in character, and has changed little in personality and charm. It is gratifying to note that among the peace-time occupations to which the Corporation have directed particular attention, the 10 cultivation of the parks and open spaces has been undertaken with vigour, and the Borough can now boast a return almost to the high level maintained before the war. The demand for open spaces for recreation by school children, youth organisations and industrial recreational clubs is very great, and continues to grow. The Borough is fortunate in being well provided to meet this demand. Of the many additional social and recreational activities which sprang up during the war, the Borough Swimming Club and the swimming facilities provided by the Corporation during the summer months by courtesy of the London County Council, at the Beddington Orphanage, continue to flourish, the administration being conducted by the Public Health Department. 11 EXTRACTS FROM VITAL STATISTICS. Total. M. F. Birth Rate per 1,000 of the estimated resident population. Live Births—Legitimate 564 295 269 18.63 Illegitimate 22 10 12 Total 586 305 281 Rate per 1,000 total (live and still) births Still Births 9 5 4 15.13 Death Rate per 1,000 of the estimated resident population Deaths 327 163 164 10.39 Rate per 1,000 (live and still) births. Deaths from Puerperal causes:— Puerperal Sepsis — — Other Maternal causes 1 1.68 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 30.72 Legitimate Infants per 1,000 legitimate live births 30.14 Illegitimate Infants per 1,000 illegitimate live births 45.45 Deaths from Cancer (all ages) 60 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 1946:— 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— Live Rates per 1,000 Population. 19.1 22.2 21.3 21.5 18.6 Still 0.53 0.67 0.59 0.54 0.29 Deaths— All Causes 11.5 12.7 11.7 12.7 10.39 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.10 Smallpox 0.00 0.00 0.00 — — Measles 0.00 0.01 0.00 0.01 0.00 Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 0.03 Paratyphoid Fever 0.02 0.02 0.01 0.01 0.03 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 0.03 Scarlet Fever 1.38 1.51 1.33 1.42 1.08 Whooping Cough 2.28 2.48 2.08 2.22 1.24 Diphtheria 0.28 0.32 0.31 0.24 0.09 Erysipelas 0.22 0.25 0.22 0.27 0.06 Smallpox 0.00 0.00 0.00 0.00 — Measles 3.92 4.73 3.70 7.35 6.39 Pneumonia 0.89 1.02 0.74 0.75 0.28 Deaths under 1 year of age Rates per 1,000 Live Births. 43 46 37 41 30 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 - Notifications— Puerperal Pyrexia Rates per 1,000 Total Births (i.e., Live and Still). 8.50 10.35 7.63 9.68 5.04 Maternal Mortality Abortion with Sepsis. Abortion without Sepsis. Puerperal Infections. Other Causes. Total. England and Wales 0.13 0.06 0.18 1.06 1.43 Beddlngton and Wallington — — — 1.68 1.68 13 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar General, gives the causes of death of residents in the Borough during 1946:— Causes of Death. Males. Females. Total. All Causes 163 164 327 1. Typhoid and Paratyphoid Fevers - - - 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 7 1 8 7. Other forms of Tuberculosis — — — 8. Syphilitic Disease 3 — 3 9. Influenza 2 1 3 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis - 1 1 12. Acute Infectious Encephalitis — — — 13.mCancer of Buccal Cavity and Oesophagus (males) 3 - 3 13.f Cancer of Uterus — 1 1 14. Cancer of Stomach and Duodenum 8 5 13 15. Cancer of Breast — 5 5 16. Cancer of all other Sites 21 17 38 17. Diabetes — 1 1 18. Intra-cranial Vascular Lesions 16 25 41 19. Heart Disease 42 63 105 20. Other diseases of the Circulatory System 5 4 9 21. Bronchitis 8 9 17 22. Pneumonia 6 4 10 23. Other Respiratory Diseases 2 — 2 24. Ulceration of the Stomach or Duodenum 2 2 4 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis 2 - 2 27. Other Digestive Diseases 4 2 6 23. Nephritis 2 7 9 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — 1 1 31. Premature Birth 4 2 6 32. Congenital Malformations, Birth Injury, Infantile Disease 7 3 10 33. Suicide 3 — 3 34. Road Traffic Accidents 1 — 1 35. Other Violent Causes 6 2 8 36. All Other Causes 9 8 17 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 105 32.1 Cancer 60 18.3 Intra Cranial Vascular Lesions 41 12.5 Tuberculosis (All Forms) 8 2.4 Pneumonia 10 3.1 Bronchitis 17 5.2 Violence and Accident 12 3.7 VIOLENCE AND ACCIDENT. 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 3 - 3 Street Accident 1 — 1 Accidents at Home 5 1 6 Strangulation by Violence — 1 1 Judicial Hanging 1 — 1 Totals 10 2 12 MATERNAL MORTALITY. One death occurred, the cause of death being certified as "eclamptic convulsions, toxaemia of pregnancy, valvular disease of heart." The maternal mortality rate per thousand live and still-births for the year was 1.68, as compared with the figure of 1.43 for England and Wales. The rate appears unduly high for a district of this type, but 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 upon the ante-natal care given by the Hospital. 15 The infantile mortality rate for 1946 was 30.72 per thousand live births. This is an increase on the exceptionally low figure of 21.78 per thousand live births for 1945, but compares favourably with the figure of 43 for England and Wales. Of the total of 586 live births, 18 deaths of infants under one year of age (13 males and 5 females, one of the latter being illegitimate) were registered. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. The Corporation's arrangements for the examination of swabs, sputa, and other pathological material continue as heretofore. Specimens examined. Totals. Positive. Negative. Diphtheria:— Examination of nose and throat swabs 75 2 73 Scarlet Fever:— Examination of nose and throat swabs 19 - 19 Cerebro-Spinal Fever:— Examination of nose and throat swabs 3 - 3 Tuberculosis:— Sputa 6 2 4 Enteric Group:— Faeces 11 1 10 Totals 114 5 109 During 1946 the arrangements for examination of milk, water and ice-cream were transferred from the Council's laboratory in the Town Hall to the Public Analyst, Mr. H. Amphlett Williams, as it was found more economical, with the increasing cost of materials and wages, to make this alteration. Pathological specimens are sent to the Pathological Laboratories at the St. Helier County and Croydon General Hospitals. 16 AMBULANCE FACILITIES. Ceneral and Accident Cases. The arrangements following prewar practice, which came into operation in 1945, continued to operate successfully during 1946. The National Fire Service continued to house the one ambulance in use and the four full-time personnel at the National Fire Service Station in Belmont Road. Details of the work of the Ambulance during 1946 are as follows:— Private Removals 392 Maternity Cases 217 Accidents 257 Calls answered for other Authorities 69 Total Calls Answered 935 Distance Travelled on Calls 7004 Average Mileage per Call 7.71 Mutual Assistance by Other Services 65 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 1,104 cases, including 102 maternity and 133 midwifery patients. TREATMENT CENTRES AND CLINICS. 1. Child Welfare Centres. Hackbridge Centre, The Grange, London Road. Bandon Hill Centre, Methodist Hall, Sandy Lane North. Beddington Centre, Village Hall, Beddington. Wallington Centre, Baptist Hall, Queen's Road. 2. Maternity Clinics. Ante-Natal Clinic. Post-Natal Clinic. Midwives' Clinic. Consultant's Clinic. When held. Every Monday, 2.0-4.0 p.m. Every Tuesday, 2.0-4.0 p.m. Alternate Wednesday afternoons, 2.0-4.0 p.m. Alternate Wednesday afternoons. 2.0-4.0 p.m. Thursdays and Fridays, 2.0-4.0 p.m. First Tuesday in month, 2.0-4.0 p.m. Second and fourth Tuesday of month, 2.0-4.0 p.m. Third Friday of the month. All Maternity Clinics are held at the District Nurses' Home. 57, Montagu Gardens, Wallington. 17 Voluntary Helpers.—Mrs. Budd, Mrs. Bunting, Mrs. Carver, Mrs. Feldon, Mrs. Harley-Boynes, Mrs. Hooper, Mrs. Jeffery, Mrs. Jennings, Mrs. King, Mrs. Lennard, Mrs. Rose, Mrs. Shaw, Mrs. Uwins, Mrs. Warrington, Mrs. Wild, Mrs. Williams, Mrs. Witt, ladies of Inner Wheel of Rotary and lady members of the British Red Cross Society. 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. Four clinics are held weekly to give immunisation against diphtheria. These are held at each of the three Infant Welfare Centres and at the Medical Officer of Health's Department at the Town Hall. 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 Approximate number of children in the Borough at 31st Dec., 1946 2550 3880 6430 Children who completed full course of immunisation during the year 295 20 315 Number of children known to be immunised at 31st Dec., 1946 1006 1771 2777 Alum precipitated toxoid (A.P.T.) is provided free from the Government's Central Laboratories and has been used throughout the year in our immunisation scheme. No cases of illness have resulted from the injections and no child has been prevented from following his daily routine on treatment days. Where private practitioners desire to carry out this treatment themselves, prophylactic material is supplied from the department free 18 of charge, but difficulty has been experienced in obtaining returns of children who have been immunised privately. WHOOPING COUCH. During the year, 47 children were brought to the Public Health Department for immunisation against whooping cough. This facility is offered to the public on payment of the cost of the vaccine. The material used is Parke Davis Whooping Cough Vaccine—St. Mary's Hospital preparation. Immunisation against whooping cough is still in the experimental stage, and although no known cases of the disease occurred amongst immunised children in the Borough during the year, the figures are too small to be used as a basis for conclusive argument. The Minister of Health, it is hoped, will in due course, after the trial immunisation in the three large towns conducted by his department, give an authoritative pronouncement and recommendation on this matter. SCHOOL CLINICS. With the coming into operation of the 1944 Education Act, the Medical Officer of Health was appointed in September, 1945, Divisional Medical Officer for the Beddington and Wallington half of the MidEastern Divisional Executive of the County of Surrey. Clinics at Rochester Road and Phoenix Flats, Carshalton, continued to operate for treatment of minor ailments of children during the year, and the proposal for the use of part of the Grange Mansion as an additional minor ailment and dental clinic was put forward. It is hoped to bring this further clinic into operation before the end of 1947. 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 St. Helier County Hospital, the Royal Surrey County Hospital, Guildford, the East Surrey Hospital, Redhill, and at hospitals under the London and Home Counties Scheme. HOSPITALS. Infectious Cases. Cases of infectious disease occurring in the Borough are admitted to the Wandle Valley Joint Isolation Hospital, Beddington Corner. Small-pox. By arrangement with the County Council, cases of small-pox are admitted to the Small-pox Hospital at Clandon. 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 Hospital provided by the Surrey County Council serving this area is the St. Helier Hospital at Carshalton. Cases are treated at Municipal Hospitals at Epsom, Kingston and Redhill when accommodation at St. Helier is unavailable. Maternity Cases. The Surrey County Council have made provision at St. Helier County Hospital for the reception of maternity cases. This matter is dealt with fully under the Maternity and Child Welfare Section. An agreement exists between the Council and the Carshalton, Beddington and Wallington District (War Memorial) Hospital for a limited number of maternity cases to be admitted upon the recommendation of the Medical Officer of Health. During the year, however, no opportunity arose for making use of this facility. CLEANLINESS. During 1946 the Corporation brought into use a new Cleansing Station situated near the Grange Mansion. Facilities tor undressing, hot bath and washing of the hair, together with adequate drying, are provided. A table is appended showing the number of cases treated during the year. Infestation by head or body lice remains at a very low level, and the number of cases of scabies treated show a gratifying decrease. The general standard of cleanliness throughout the Borough remains at a reasonably high level, special attention being paid to this matter by the Health Visitors and Sanitary Inspectors during their routine visits and in their contact with the public at the Town Hall:— 20 Condition 0-5 years. School children Adults Households Individual Cases Total Cases Treated No. of Families Members Involved 1st. Re. 1st. Re. 1st. Re. Scabies 17 7 26 9 37 12 21 62 18 80 Pediculosis 2 — 16 10 3 2 6 17 4 21 Total 26 61 54 27 79 22 101 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. 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. During 1946 the Corporation continued to exercise its functions as an autonomous Maternity and Child Welfare authority. In July, 1946, with the approval of the Minister of Health, a third Health Visitor took up her duties. This appointment was considered essential by the Corporation because of the rapid expansion of the work. The District Nursing Association midwives continued to conduct a great deal of domiciliary midwifery in the area, working in close harmony with the Department. During the year they attended a total of 235 confinements. One hundred and two of these cases also had the services of a doctor. 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 16.5 patients per session. 21 During the year 406 expectant mothers attended the clinic, as compared with 397 in 1945. This represents approximately 71.7 per cent. of the total notified births, live and still, which were assigned to the Borough during 1946, and is a creditable reflection on the efficiency and consequent popularity of the Council's Ante-Natal Service. POST-NATAL CLINIC. It was found possible, following the appointment of the third Health Visitor, to reintroduce the monthly Post-Natal Clinic in September, 1946. The importance of post-natal examinations has been stressed, and the Corporation decided to reinstate this clinic in order to offer more facilities to mothers in the area. The post-natal cases attending during 1946 represented 22.8 per cent. of the total notified births. It is reliably estimated that considerably more patients receive post-natal care than attend at the Council 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 to 50 per cent. Figures in the following combined table include, therefore, post-natal attendances at the Council's Friday Ante-Natal Clinic. Ante-Natal and Post-Natal Attendances, 1946. Council Cases. Nursing Association Cases. Total— 1946. Total— 1945. Ante-Natal Cases:— Number of Clinics held - — 101 100 Total number attending during the year 247 159 406 397 Number of first attendances 239 154 393 336 Number of re-attendances. 638 634 1272 897 Total attendances 877 788 1665 1233 Average attendance per session 8.7 7.8 16.5 12.3 Post-Natal Cases:— Total number attending during the year 53 77 130 106 Number of first attendances 53 77 130 104 Number of re-attendances. — 5 5 26 Total a attendances 53 82 135 130 22 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:— Medical Ante-natal Referred by Officer, Clinic. Private Practitioners. Totals. 1946. 1945. C. NA. Clinics held 5 8 Patients attending: Ante-natal 1 2 - 3 8 Post-natal - 2 — 2 4 Total attendances 1 4 - 5 12 CONSULTATIONS IN THE HOME. The services of Mr. Lindsay continued to be available to medical practitioners who required a specialist's opinion. During the year he was called into consultation on one occasion. MATERNITY AND CHILD WELFARE CENTRES. The following table gives a record of the attendances at the Infant Welfare Clinics. Four centres continued to operate during the year, and the attendances at all showed a very gratifying increase:— Bandon Hill. Hackbridge. Beddington. Wellington. Totals. 1946. 1945. Number of sessions held 52 49 24 23 148 144 Infants:— No. of new cases under 1 year 155 147 64 97 463 410 No. of re-attendances 2050 2152 646 592 5440 4086 No. of new cases over 1 year 34 32 4 5 75 95 No. of re-attendances 1477 1287 621 690 4075 3838 Total attendance of infants 3716 3618 1335 1384 10053 8429 Average attendance of infants per session 71.5 73.8 55.6 60.2 67.9 58.5 Mothers attending. 3630 3537 1329 1366 9862 8155 Total attendances. 7346 7155 2664 2750 19915 16854 Average total attendance per session 141.27 146 111 119.6 134.6 115.2 23 INSTITUTIONAL CONFINEMENTS. The number of mothers confined in Surrey County Council hospitals during the year was as set out below:— St. Helier County Hospital 147 Dorking County Hospital 13 St. Luke's County Hospital (Guildford) 10 Redhill County Hospital 3 Epsom County Hospital 2 Kingston County Hospital 1 176 Sixty-three patients were delivered under private arrangements at the Carshalton, Beddington and Wallington District (War Memorial) Hospital. The County Council experienced great difficulty in making adequate provision for the reception of maternity cases. This was occasioned by the shortage of staff as well as the carrying out of wardamage repairs to the County Council's hospitals. No urgent or necessitous case was, however, refused institutional confinement, admission to one or other of the County hospitals being satisfactorily arranged. HOME HELP AND DOMESTIC HELP SERVICE. The services of four full-time paid helpers were utilised throughout the year. The cases attended were as follows:— Home Help. Domestic Help. Full-time 62 21 Part-time 25 17 87 38 The demand for this service fluctuates greatly, rising and falling as the number of births occur. The importance of making provision to assist women having domiciliary confinements cannot be overemphasised. The great majority of women asking for this service were satisfied, but the operation of the service would have been much simplified had there been a sufficient number of part-time home helps available to meet the sudden increase in demands which occurred from time to time. It may be anticipated that the present trend in the birth rate will reach the peak in 1947, after which the provision of adequate home and domestic help should be less difficult. FAMILY PLANNING. During the year the Corporation made arrangements with the Carshalton and District Family Planning Association. A few women 24 attended the clinic conducted by this Association. They belong to the limited class of married women defined in Ministry of Health Memorandum 153, in whose cases further pregnancy would be detrimental to health. TREATMENT. Minor Ailments. Two hundred and ten cases were referred from the Maternity and Child Welfare Centres to the under-mentioned hospitals during the year:— Croydon General Hospital 85 St. Helier County Hospital 85 Guy's Hospital 26 Hospital for Sick Children (Great Ormond Street) ... , ... 12 Sutton and Cheam Hospital 1 Ear, Nose and Throat Hospital, W.l 1 210 The conditions requiring treatment were:— Orthopaedic Defects 36 Circumcision 37 Eye Conditions 32 Skin Conditions 32 Ear and Nose Conditions 9 Nsevus 7 Tonsils and Adenoids 18 Feeding Difficulties 3 Chest Conditions 2 Speech Difficulties and Otherwise Backward ... 4 Hernia .... 2 Miscellaneous Ailments 28 Dental. During 1946 7 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 ... 3 2 2 Received treatment 2 1 — Made dentally fit 2 1 — Treatments: — Fillings: — In temporary teeth — — — In permanent teeth — — — Teeth extracted 26 7 — Administrations of general anaesthesia 2 1 Patients supplied with dentures ... 2 1 Dentures supplied 4 2 25 Orthopaedic. Patients attending the Centres who require treatment for orthopsedic defects are referred by the Medical Officer of Health to the Orthopaedic Departments of the St. Helier County, the Croydon General and Guy's Hospitals. During the year 36 cases were so referred and treated. ARTIFICIAL SUNLIGHT: SOLARIUM. During 1946, its second year of operation, the Solarium treated 718 individual patients, making a total of 9,518 attendances. This Clinic continues to grow in popularity, and the doctors in charge of the Maternity and Child Welfare Centres continue to refer many children and mothers for treatment. In addition, school children from maintained schools in the Mid-Eastern Divisional Executive area are enabled to attend, the fee being paid by the Surrey County Council. The table below gives details of the attendances:— 1st Attendances. Reattend ances. Total, 1946. Total, 1945. Children: 0-5 years 589 7375 7964 7144 5-15 years 58 644 702 537 Adults: Expectant Mothers. 13 116 129 211 Nursing Mothers 36 372 408 440 Private Patients 22 293 315 316 718 8800 9518 8648 HEALTH VISITING. As noted previously, the Corporation now employs three full-time Health Visitors, who work under the supervision of the Medical Officer of Health. 26 From the following summary of their work, it will be seen that, although the third Health Visitor only took up her duties for the latter part of the year, the number of visits has been substantially increased, the total being more than doubled: — 1946. 1945. Maternity Visits. First visits to Expectant Mothers 77 47 Re-visits to Expectant Mothers 13 14 Breast Feeding observation and test feeds 37 16 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 9 Number of children on the register at the end of the year 38 Number of children who died during the year— During the year 80 visits were paid to the homes of the children. No proceedings were taken under the Act. Infant Welfare. First visits under 1 year 519 348 Re-visits under 1 year 422 190 First visits over 1 year 132 36 Re-visits over 1 year 643 255 Special Home Visits. Still Births 7 4 Infant Deaths 4 4 Child Life Protection. First visits 33 11 Re-visits 47 22 Infectious Diseases. Tuberculosis 31 41 Scabies 28 64 Impetigo 1 1 Verminous conditions 8 6 Puerperal Infections 1 1 General Visits. Home Enquiries, Agreements, etc 67 39 Adoption of Children 31 5 Home Help and Domestic Help 170 59 Miscellaneous visits 116 27 Ineffective visits 271 14 Totals 2658 1214 Attendances at Clinic Sessions. Maternity and Child Welfare Centres 297 296 Ante-Natal and Post-Natal Clinics 158 163 Totals 455 459 Interviews in Office 479 303 Attendance at Medical Examinations 10 23 Attendance at Immunisation Clinics 29 — 27 ADOPTION OF CHILDREN (REGULATION) ACT, 1939. The regulations under this Act came into operation in 1943. During 1946 nine persons gave notice of reception under Section 7 (3) of the Act. At the close of the year 7 children were under supervision under the Act, the Corporation being guardians ad litem. The importance of work under this heading cannot be overemphasised, and through its Health Visitors the Corporation is carryout all its statutory obligations satisfactorily. THE CARE OF PREMATURE INFANTS. The arrangements made for the care of premature infants were continued during 1946. 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 5 cases were recorded in the practice of the domiciliary midwives. One of these cases died on the second day and one at three months. The remaining cases responded successfully to routine domiciliary treatment. THE CARE OF ILLEGITIMATE CHILDREN. Arrangements for the care of illegitimate children, described in previous reports, were continued throughout 1946. An annual grant is made to the Sutton and District Girls' Aid Association, whose visitor follows up the cases occurring in the Borough. During the year 120 visits were made by the Association. Ladies of the Women's Voluntary Services and Health Visitors continue to co-operate in the alleviation of the lot of these unfortunate mothers. DAY NURSERY. On the 1st July, 1946, the Day Nursery which the Corporation had operated since April, 1943, was handed over to the Surrey County Council, to be continued under the Mid-Eastern Divisional Executive as a Nursery School within the meaning of the 1944 Education Act. SANITARY CIRCUMSTANCES OF THE AREA. WATER SUPPLIES. The water supply is piped throughout the district from the Sutton District Water Company. During the year the supply has been satisfactory both in quality and quantity. It is understood that the Water Company carry out routine bacteriological examinations of the raw and finished water daily from the wells at Sutton and Woodmansterne, and also of the treated water going into supply. Routine chemical examinations are also carried out. The raw water from the deep wells is of a relatively high degree of hardness. 28 The company are under a statutory obligation (Sutton District Waterworks Act, 1903) to deliver water of not more than 9 degrees of hardness, and an elaborate softenng plant is in use. During the year 36 samples of water taken in the district by the Sanitary Inspectors were examined by the Public Analyst. From these analyses the water supply is shown to be satisfactory both in chemical and bacteriological purity, and no cases of illness associated with pollution of water supplies were recorded during the year. The chlorination of water from private wells situated in industrial premises was continued throughout the year. DRAINAGE AND SEWERAGE. No major difficulties were experienced in the maintenance and cleansing of soil and storm water drainage systems during the year. A much needed extension of the surface water sewer in Bute Gardens West was carried out by contract, and the frequent flooding after storms has been effectively disposed of. RIVERS AND STREAMS. The River Wandle and its tributaries were maintained throughout 1946, and part of the river bed cleansed of silt and snags. Pollution by oil film was traced definitely during the year to outside sources, but efforts to stop this annoyance were only partly effective, and a sudden storm still brought in its train quantities of oil which through violent agitation tends to emulsify and coat the bed and sides of the Wandle and separate out again when the water is relatively quiescent. 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 CLEANSINC. The collection of house refuse throughout the Borough was reorganised during 1946 under the direction of the Borough Engineer and Surveyor, and a weekly collection by direct labour resumed, the use of Italian Co-operators labour being discontinued. The refuse was satisfactorily disposed of at the shoot off Beddington Lane and through reciprocal arrangements with Carshalton U.D.C. and the County Borough of Croydon. The future of refuse disposal is under consideration by the relevant Committee and becomes increasingly urgent, especially as during the year under review the collection and disposal of trade refuse at 4d. per bin of 2i cu. ft. was for the first time undertaken under the powers conferred by Section 73 of the Public Health Act, 1936. 29 The type of receptacle in use throughout the Borough continues to be the portable galvanised iron covered bin. Cesspools and earth closets are dealt with by the occupiers of the premises concerned, which continued arrangement is satisfactory. The Croydon Corporation Tip off Therapia Lane is nearing saturation point, but constant supervision by this Council's officers has raised no controversial points. 30 SANITARY INSPECTION OF THE AREA. The following statement by the Senior Sanitary Inspector gives statistics as to the number of complaints received, inspections made, defects remedied, and other work carried out by the Sanitary Inspectors. STATEMENT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1946. DWELLING-HOUSES. Number of inspections of dwelling-houses 1317 Number of inspections recorded under Housing Regulations — MILK AND DAIRIES. Number of cowkeepers on register — Number of purveyors of milk on register 36 Number of dairymen distributing milk 5 Number of dairy premises on register 6 Number of dairy premises upon which loose milk is handled or treated 1 Number of inspections of premises 7 Defects in dairy premises discovered — Infringements of Acts and Orders discovered and dealt with: Extraneous matter in milk 1 Unclean milk vessels 2 3 Number of licences issued under the Milk (Special Designations) Regulations:— Tuberculin Tested—Dealer's Licences 3 „ Supplementary Licences 7 Pasteurised—Dealer's Licences 3 „ Supplementary Licences 7 Pasteuriser's Licence 1 21 SLAUGHTERHOUSE. Number of slaughterhouses on register 1 Number of animals killed in slaughterhouses — Number of visits to other premises on which animals were slaughtered for human consumption 3 31 Carcases inspected and condemned:— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — — 3 Number inspected — — — — 3 Whole carcases condemned – – – – – or Carcases of which some part or – – – – organ was condemned — — — — — FOOD PREMISES. Number of inspections 302 Number of defects discovered and remedied 9 UNSOUND FOOD. Destroyed or released for approved purposes:— lbs. Cereals 74 Eggs (32) — Fish 687 Fish, Canned 173 Fish Cakes 30 Fruit, Canned 146 Fruit, Dried 205 Golden Syrup 15 Jam 103 Marmalade 18 Meat 102 Meat, Canned 124 Milk, Condensed 48 Milk, Dried 236 Milk, Evaporated 302 Mustard 36 Rabbits 217 Sausages 96 Soup, Canned 40 Vegetables, Canned 338 Vegetables, Dried 47 Miscellaneous 46 Total 3083 32 FOOD ANALYSES. Number of samples analysed by Public Analyst 101 Number of samples reported against:— Baking Powder—Deficient in carbon-dioxide 1 Curry Powder— Excessive amount of lead 1 Excessive amount of salt 1 Gelatine—Contained added preservatives 1 Vinegar, Non-brewed—51% deficient in acetic acid 1 Proprietary Medicine—Not in accordance with formula on label 1 a Number of prosecutions — FACTORIES. Number or factories on register 104 Number of inspections 102 Number of defects discovered 16 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 33 Number of defects discovered and remedied 9 WORKPLACES. Number of inspections of workplaces 24 Number of defects discovered — SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 325 Number of defects discovered and remedied 5 COMPLAINTS. Complaints received during the year were due to the following Causes:— Defects in dwellings-houses (various) 184 Stoppages in drains 69 Defects in drains or water closets 59 Defective dustbins1 73 Food supplies 23 Insect pests 16 Miscellaneous 53 477 33 SMOKE ABATEMENT. Number of observations 23 Nuisances dealt with 2 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 95 Number of rooms disinfected 86 Lots of bedding and clothing disinfected 95 Number of library books disinfected 166 OFFENSIVE TRADES AND FISH FRYINC. Number of offensive trade premises in district Nil Number of fish frying premises in district 4 Number of visits to fish frying premises 5 Number of defects discovered — RATS AND MICE (DESTRUCTION) ACT, 1919. Number of visits to premises 251 Number of complaints received 94 Number of premises found infested 55 NOTICES. Number of informal notices served (including verbal intimations) 827 Number of statutory notices served: — Public Health Act, 1936, Section 39 (Drains) 1 Public Health Act, 1936, Section 45 (Closets) 2 Public Health Act, 1936, Section 75 (Dustbins) 8 Public Health Act, 1936, Section 93 (Nuisances) 11 Public Health Act, 1936, Section 101 (Smoke) 1 23 PROSECUTIONS Nil SANITARY IMPROVEMENTS. Water Supply. Water pipes and fittings repaired or renewed 30 Drains. Drains re-laid or repaired 63 Drains unstopped and cleansed 89 Intercepting traps provided with rodeye stoppers 8 Manholes provided or repaired 14 Soil or ventilation pipes repaired or renewed 15 Gully kerbs and channels repaired 32 New soakaways constructed 25 34 Closets. New closets provided 1 Buildings repaired 8 New pans fixed to water closets 28 Flushing cisterns repaired or renewed 27 Flush pipes and pan joints repaired or renewed 6 Water supply reinstated 3 Seats repaired or renewed 9 Sinks. New sinks provided 4 Waste pipes repaired or renewed 20 Yards. Yards newly paved or repaired 2 Dust Receptacles. New portable iron dustbins provided 186 Dampness. Roofs repaired 83 Rainwater gutters repaired or renewed 50 Rainwater downspouts repaired or renewed 27 Damp-proof courses provided 9 Windows, sills and doors made weatherproof 9 External walls repaired, repointed or rendered 41 Ventilation provided under floors 11 General Repairs, Etc. Rooms cleansed 26 Walls and ceilings repaired 64 Floors repaired 42 Stoves repaired or renewed 16 Windows repaired 40 Chimneys repaired 26 Number of premises disinfested from bed bugs 1 Refuse removed 1 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 1317 Number of re-inspections of premises 1140 Number of visits to works in progress 444 Number of miscellaneous visits and inspections 657 Number of visits to dairies 7 Number of visits to factories 102 Number of visits to bakehouses 33 Number of visits to workplaces 24 Number of visits to shops and offices 325 Number of visits to premises re slaughtering 3 Number of visits to food premises 302 35 INFANTILE MORTALITY Number of visits to stables and yards 78 Number of visits to market gardens, etc 13 Number of visits to fried fish shops 5 Number of visits to urinals 33 Number of visits to piggeries 11 Number of visits re infectious diseases 95 Number of visits to streams 18 Number of visits re rats 251 Number of visits re smoke abatement 23 Number of complaints received and investigated 477 Number of informal notices served 827 Number of statutory notices served 23 Number of interviews re nuisances, etc 605 Number of rooms disinfected 86 Number of lots of bedding and clothing disinfected 95 Number of library books disinfected 166 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS AND OFFICES. Three hundred and twenty-five inspections were made during 1946 and in 5 cases action was necessary in regard to sanitary defects. CAMPING SITES. There are no camping sites within the Borough. SWIMMINC BATH. The Corporation again rented (for the 1946 Summer season) the swimming bath situated in the grounds of the Royal Female Orphanage, from the London County Council. The supervision and arrangements of sessions were under the control of the Public Health Department, and although the season was relatively poor, it was felt that the provision was generally appreciated. ERADICATION OF BED BUCS. During the year bed bugs were found to exist in 1 house. Appropriate remedial measures were taken. SCHOOLS. School Closure. On no occasion during the year was a School closed by the Local Sanitary Authority on account of the prevalence of Infectious Disease amongst the scholars. As in the case of the Public Elementary Schools, notice is given to the Head Teachers of all private schools in the event of the pupils suffering from, or having been in contact with, Infectious Disease. 36 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. Under the 1944 Education Act the Assistant Medical Officer of the County Council continued to carry out routine and special medical inspections of school children in the maintained schools. This work is under the general supervision of the Medical Officer of Health, in his capacity of Divisional School Medical Officer for the Mid-Eastern Divisional Executive of the Surrey County Council. From this officer's report it is noted that 1,343 routine, 161 special examinations, and 238 re-examinations were carried out in the Borough during the year. Water Supply and Sanitary Conditions. During the year the Medical Officer of Health conducted a thorough inspection of all maintained schools in the Beddington and Wellington half of the Mid-Eastern Divisional Executive, and submitted a report to that body, suggesting various alterations and improvements to bring the sanitary conditions into line with the revised standards set by the Minister of Education. The report covered water supplies, arrangements for the provision of school meals, and general sanitation and accommodation in school premises. It is understood that such recommendations as were made are being followed up by the various statutory bodies concerned. REGULATED 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 7 visits of inspection were paid and conditions found to be satisfactory. MILK (SPECIAL DESIGNATIONS) REGULATIONS. During the year the Council granted the following number of licences under the above-mentioned Regulations: — Tuberculin Tested 10 Pasteurised 11 SLAUGHTERHOUSE. There is only one Slaughterhouse within the district. No animals were slaughtered on the premises during the year. BAKEHOUSES. There are 12 Bakehouses in the district. The premises were visited periodically. Unsatisfactory conditions were found to exist in three instances. 37 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 99 2 Factories without mechanical power 3 — – Other Premises under the Act (including works of building and engineering construction, but not including outworkers' premises) Total 102 2 – 38 1. Defects found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 4 4 – – Overcrowding (S. 2) – – – – Unreasonable temperature (S. 3) – – – – Inadequate ventilation (S. 4) – – – – Ineffective drainage of floors (S. 6) – – – – Sanitary Conveniences (S. 7):— Insufficient 1 — — — Unsuitable or defective 5 5 — — Not separate for sexes — — — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 6 6 – – Total 16 15 — — 3. Outwork in Unwholesome Premises. No instances were discovered. 39 HOUSING. No statistics in the tabular form usually required by the Ministry of Health are submitted. The Minister has not asked for this informating 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. During the year the following samples of milk sold within the district were examined. MILK. Class of Milk. No. taken. Pasteurised 92 Tuberculin Tested, Pasteurised 1 Tuberculin Tested, Certified 1 Heat Treated 4 Total 98 Seven samples of pasteurised milk failed to comply with statutory requirements. M EAT. The carcases of all animals intended for human consumption and slaughtered in the Borough are inspected by a qualified Inspector. FOOD AND DRUGS ACT, 1938. On 1st April, 1940, the Corporation became the Food and Drugs Authority for the Borough, and took over the duties under the Act from the Surrey County Council. The Corporation appointed H. Amphlett Williams, Esq., A.C.G.F.C., F.R.I.C., of 1, Southwark Street, London, S.E.I, as Public Analyst for the Borough. 40 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 Baking Powder – 3 3 – 1 1 – – Bread — 1 1 — — — — — Butter — 9 9 — — — — — Coffee — 2 2 — — — — — Coffee and Chicory – 3 3 – – – – Coffee & Chicory Essence – 3 3 – – – – Curry Powder. — 6 6 — 2 2 — — Drinks, soft — 3 3 — — — — — Gelatine — 3 3 — 1 1 — — Ginger, ground — 3 3 — — — — — Fat, cooking — 2 2 — — — — — Fish Paste — 2 2 – – – – – Flour, Self-raising — 2 2 — — — Jam — 5 5 — — — — — Margarine — 8 8 — — — — — Milk 20 7 27 — — — — — Pepper — 1 1 — — — — — Pickles — 3 3 — — — — — Stuffing, sage and onion — 2 2 — — — Tea — 4 4 — — — — — Vinegar, Malt — 1 1 — — — — — Vinegar, Nonbrewed — 1 1 1 1 — — Aspirin tablets — 2 2 — — — — — Iodine, Tincture of — 2 2 — — Parrish's Chemical Food — 1 1 — — — — — Proprietary Medicine — 2 2 — 1 1 — — Totals 20 81 101 — 6 6 — — 41 CHEMICAL AND BACTERIOLOCICAL EXAMINATIONS. Work of this nature is carried out when required by Mr. H. Amphlett Williams, A.C.C.F.C., F.R.I.C., Public Analyst, and the Counties Public Health Laboratories. NUTRITION. During the year 1946, the first complete year since the cessation of hostilities, His Majesty's Government were, unfortunately, obliged to continue the rationing of foodstuffs. This has meant an unavoidable shortage of animal food, with the result that average diets are insufficient in first-class protein. While the nutritional standards, with which we were familiar during the war have not worsened, the Medical Officers conducting welfare centres have observed many children in whom flabby muscles and poor appetite reflect the insufficiency of their diet. The grosser degree of malnutrition, such as rickets and infantile scurvy, so common after the first world war, are no longer seen. A few children, however, showed incipient manifestations of both these conditions, and opportunity has been given throughout the year for the purchase of products containing vitamins A and D and vitamin C. The provision of these vitamin preparations, together with the continued use of the Solarium, has been of the greatest advantage in preventing nutritional defects amongst mothers and children. 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: — Advertisements. Allotment Gardens. Animals, The Keeping of. Buildings. Fish-Frying and Offensive Trades. Good Rule and Government. House Refuse, etc., Removal. Houses Let in Lodgings. 42 Houses of the Working Classes. New Streets. Nuisances. Offensive or Noxious Matter. Parking Place off Woodcote Road. Pleasure Grounds. Public Sanitary Conveniences. Slaughterhouses. Smoke Abatement. Tents, Vans, Sheds, etc. Underground Rooms. PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. The following table shows the incidence of infectious disease in the Borough in 1946, the number of cases removed to hospital and the number of deaths attributed to these diseases, excluding Tuberculosis: Disease. Number Notified. Removed to Hospital. hs. Scarlet Fever 34 30 Diphtheria 3 3 — Erysipelas 2 1 — Pneumonia 9 2 10* Measles 201 2 — Whooping Cough 39 — — Puerperal Pyrexia 3 2 — Cerebro-Spinal Fever 1 1 — Typhoid Fever 1 — — Paratyphoid B 1 1 — Dysentery 2 1 — Pemphigus Neonatorum 1 — — Totals 297 43 10 * Includes deaths from all forms of pneumonia. † Includes deaths of residents in homes and institutions outside the Borough. 43 Cases of Infectious Disease Notified During the Year, 1946. (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 34 – – 2 5 3 11 4 3 4 2 – – 9 3 5 9 8 – 30 – Diphtheria 3 — — — — — 1 1 1 — 1 — __ 2 – 3 – Erysipelas 2 — — — — — 1 — 1 — — — 1 1 1 Pneumonia 9 — — — 1 — 1 — 2 5 4 3 1 1 2 *10 Measles 201 1 11 18 19 35 104 6 2 2 1 2 48 40 37 41 23 12 2 – Whooping Cough 39 10 2 4 8 5 8 1 — — 1 — 9 — 2 20 8 Cerebro-Spinal 3 —- — — — — — — — 2 1 — — 1 — 2 — 2 Puerperal Pyrexia Fever 1 1 – – – – – – – – – – – – – – 1 – – 1 – Typhoid Fever 1 —. — — — — — — 1 — — — – – – 1 – – Paratyphoid B 1 — 1 — – – – – – 1 – – – – 1 – Dysentery 2 — — 1 — — — — — 1 — — — — — 1 — 1 1 Pemphigus Neonatorum 1 1 – – – – – – – – – – – – – – – – 1 – – Totals 297 13 13 25 32 43 124 12 7 11 8 8 1 70 49 45 76 42 15 43 *10 44 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, 1946. (Excluding Tuberculosis.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever — 3 6 7 1 2 3 2 3 6 1 34 Diphtheria — — 1 — — — — — — — 2 3 Erysipelas 1 — — — – 1 — — — — — — 2 Pneumonia — 6 — — – — — — — — — 3 9 Measles 1 9 10 — 16 65 48 22 1 1 — 28 201 Whooping Cough 1 2 10 7 9 3 1 — — 1 — 5 39 Puerperal Pyrexia — — — — — — — 2 — — 1 — 3 Cerebro-Spinal Fever – – – – – – – – – – – 1 1 Typhoid Fever — 1 — — — — — — — — — — 1 Paratyphoid B — — — — — — — — — 1 — — 1 Dysentery — — — — — — 1 — — — — 1 2 Pemphigus Neonatorum – – – – – – – – 1 – – – 1 Totals 3 21 27 14 26 71 53 26 2 6 9 39 297 45 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. 1942 1943 1944 1945 1946 M. F. M. F. M. F. M. F. M. F. Pulmonary 17 12 19 10 18 9 17 13 24 6 Non-Pulmonary 1 3 2 5 2 4 3 2 2 3 Totals 18 15 21 15 20 13 20 15 26 9 Annual case rate per 1,000 of the estimated population: — 1946.  Pulmonary 0.95 1.07 Non-Pulmonary 0.16 0.18 The following table gives the number of deaths from this disease during the past five years:— Deaths. 1942 1943 1944 1945 1946 M. F M. F. M. F. M. F. M. F. Pulmonary 6 6 8 3 5 4 6 10 7 1 Non-Pulmonary — 3 1 2 1 — 2 1 — — Totals 6 9 9 5 6 4 8 11 7 1 It will be seen from the foregoing table that 8 deaths were registered as due to Tuberculosis, all of whch were Pulmonary. The figures correspond to a death rate per 1,000 of population of 0.25. Of the 8 deaths which occurred, 3 were non-notified cases. 46 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. #] Under 1 year – – – – – – – – 1 and under 5 – – – – – – – – 5 and under 10 — 1 — — – – – – 10 and under 15 — 1 1 — – — – – 15 and under 20 1 1 — 1 1 1 – – 20 and under 25 3 — — — – – – – 25 and under 35 6 2 1 — 2 – – – 35 and under 45 6 1 — 2 1 – – – 45 and under 55 5 – – – – – – – 55 and under 65 2 — — — 2 – – – 65 and upwards 1 — — — 1 — — — Totals 24 6 2 3 7 1 — — The new cases were distributed amongst the Wards as follows: — Beddington. Wallington. North. Cent. South. North. Cent. South. Pulmonary 6 2 3 8 3 8 Non-Pulmonary 3 2 — — — — Totals 9 4 3 8 3 8 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 6 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 1946. Mass radiography is undertaken at St. Helier County Hospital, and up to date many school children in the Borough have been submitted for examinaton. In the near future it is to be hoped that considerable sections of the population, particularly in industry and public services, will have an opportunity of being examined. 47