Bed 12 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1947 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1947 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., 1947 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 Diptheria 18 Immunisation against Whooping Cough 19 Hospitals 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 Confinements 24 Home Help 24 Family Planning 24 Treatment: Minor Ailments 25 Denta1 25 Orthopædic 26 2 Solarium 26 Health Visiting 27 Child Life Protection 28 Adoption of Children 28 Care of Premature Infants 28 Care of Illegitimate Children 28 Sanitary Circumstances of the Area: Water Supplies 28 Drainage and Sewerage 29 Rivers and Streams 29 Closet Accommodation 30 Public Cleansing 30 Sanitary Inspection of the Area 31 Statement of the Senior Sanitary Inspector for the Year 1947: 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 37 Dairies 37 Milk (Special Designations) Regulations 37 Slaughterhouse 37 Bakehouses 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 Fish (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, 1947. Members: Councillor D. H. de Voil (Chairman) Cuuncillor A. C. Martin, J.P. (Mayor) . Councillor Mrs. V. M. Boyce (Deputy Mayor). Alderman W. W. Binnie, J.P. Alderman F. G. Bryant. Councillor Miss K. C. Bratt. Councillor W. P. Hunt. Councillor C. H. Norman. Councillor A. E. Scrase. Councillor A. Stammers. Councillor A. C. Walker-Griffin. MATERNITY AND CHILD WELFARE SUB-COMMITTEE December, 1947. Members: Councillor D. H. de Voil (Chairman). Councillor A. C. Martin, J.P. (Mayor). Councillor Mrs. V. M. Boyce (Deputy Mayor). Alderman F. G. Bryant. Councillor Miss K. C. Bratt. Councillor A. Stammers. 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, 1947. Members: Councillor A. C. Martin, J.P. (Mayor). Alderman H. D. Banks. Councillor D. H. de Voil. REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD. December, 1947. Members: Councillor A. C. Martin, 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. 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. *Margaret G. Falla, M.B., Ch.B. *Eveleen Ashworth, M.B., B.S. Consultant Obstetrician:— *Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G. Senior Sanitary Inspector:— F. H. Lennard, A.M.I.S.E., M.R.S.I., M.S.I.A, Additional Sanitary Inspectors:— A. F. Leakey, M.R.S.I. M. C. Barton, A.R.S.I., M.S.I.A. (Appointed 30/6/47), Health Visitors:— Miss E. Turnbull, S.R.N., S.C.M., H.V. Cert. Miss K. M. Dixon, S.R.N., S.C.M., H.V. Cert. Miss N. M. Lines, S.R.N., S.C.M., H.V. Cert. (Appointed 24/2/47). Physio-Therapist:— Miss G. Allen, M.C.S.P. Assistant to Physio-Therapist:— Miss D. S. Raymond. Clerks:—- R. F. Burns (Chief Clerk). E. D. Evezard. G. H. Bourne. Miss J. Day (Transferred 30/6/47). P.H. Sadler. Miss B. A. Bignell (Appointed 30/6/47, resigned 1/11/47), Miss D. M. Simmons (Appointed 3/11/47). *Part-time. 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 1947. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 170/47. The vital statistics are based on information supplied by the Registrar-General; this was received in mid-June, 1948. The Registrar-General's estimate of the population of the Borough at the middle of the year is 32,400, but from information available from local sources (e.g. the Food Control Office) the population at the end of 1947 exceeded 34,000. The birth rate per 1,000 total population shows a decrease at 16.91 in 1947, as compared with 18.63 in 1946, and is below that for England and Wales, which is 20.5. The stillbirth rate of 0.49 per 1,000 total population is considerably higher than the figure of 0.29 for 1946, but compares favourably with that for England and Wales, which is 0.50. The stillbirth rate per 1,000 total births is 28.37 compared with 15.13 in 1946. The death rate from all causes per 1,000 total population is 10.56, compared with 10.39 for 1946 and 12.00 for England and Wales. Of the 342 deaths, disease of the heart and circulatory system accounted for 105 (30.7 per cent. of total deaths), cancer 51 (14.9 per cent. of total deaths) and tuberculosis 10 (2.9 per cent. of total deaths). The maternal mortality rate per 1,000 total births is Nil, as compared with 1.17 for England and Wales. The Corporation will no doubt view with satisfaction the record of maternal health as shown by the previous paragraph. No maternal deaths, that is deaths during pregnancy from puerperal sepsis or other maternal causes, were recorded during the year. The birth rate, however, is noted to have decreased, and although that for England and Wales shows an increase, it cannot but be anticipated that this is temporary and that the birth rate for the country as a whole will show a marked decline in the next two or three years. Arrangements for confinements, especially in institutions, continue to present some difficulty. Domiciliary confinements, especially in the generally overcrowded conditions which persist, are not easy, and continue to be more expensive than institutional deliveries. Admission to an institution for confinement is still dependent on the medical condition of the mother or adverse home circumstances, such as overcrowding or undesirable premises. The lot of pregnant women, and especially women faced with a domiciliary confinement, is hard indeed, and one cannot pretend that any of our present national or local schemes make it easy for a mother to have her baby at home. 7 Shortage of maternity beds and nursing staffs means that only mothers suffering severe ill-health or presenting abnormalities in labour can be delivered in hospital. The remainder of normal deliveries, from whom it is anticipated the future population will grow, have to be conducted at home with such help as Nursing Associations and Home Help Schemes can provide. One cannot help but feel that if the nation is to prosper, more encouragement and help should be given to women having normal deliveries. It should not be more expensive to have a baby at home than in hospital, and the standard of service rendered in the home should be made comparable with that obtaining in the best of maternity homes. The present attitude of some of our legislators, who, when faced with overcrowding difficulties for large families, can only suggest that such families be limited, cannot be too strongly deprecated. Already, as shown in this report, although the death rate continues low, the birth rate, after the post-war boom, shows signs of falling, and we will soon be faced again with the population problems which disturbed the minds of many in the late 'thirties. The present difficult lot of the mother and housewife makes it inevitable that voluntary parenthood will continue. Only when housing difficulties and the difficulties experienced in obtaining domestic help are overcome, will the child-bearing population of the country produce a birth rate sufficiently high to balance the death rate, and thus relieve the anxiety of our more far-seeing legislators, of a falling and ageing population. The infantile mortality rate, as will be seen on page 16, was 23.7 for 1947, being lower than the corresponding figure of 30.72 for 1946. This compares very favourably with the figure of 41 for England and Wales. Deaths in infants below one year of age are considerably less than they were, and the general health of this group of the population shows considerable improvement. The Government's welfare food scheme probably contributes very largely to this improvement. The Government vitamin preparations, however, are not always well tolerated by infants, and to supplement and give a wider variety of choice of products containing vitamins A & D, B, and C, the Corporation during the year offered for sale or assisted supply a considerable range of proprietary preparations. This service was very much appreciated by mothers attending infant welfare centres, and during the year the turnover of these articles, together with additional sources of proprietary brands of dried milk, amounted to over £2,000. With the present scheme of rationing continuing, many mothers find difficulty in balancing the dietary of infants. Amongst children attending infant welfare centres, deficiencies of protein and fat were frequently noticed, producing such minor bony deformities as knock-knees and weak ankles. The monotony of the present diet bears hard upon youngsters, who constantly crave for greater variety, especially of protein and fatty foods, which unfortunately continue in short supply. During the year the routine infectious diseases did not give rise to anxiety, but, as will be seen from the table on page 44, we had eight cases of Acute Anterior Poliomyelitis, but fortunately no deaths, 8 This is a larger number of cases of infantile paralysis than has previously been recorded in any year in this Borough. We were fortunate, however, not to have had more, as infantile paralysis was epidemic over the greater part of the country during the Summer of 1947. Most of our cases were diagnosed early and brought under experienced treatment at the first opportunity. As a result, crippling defects are at a minimum, and are continuing to be dealt with through the physiotherapy departments of St. Helier County Hospital and our own department at the Grange. One case, in an adult male aged 32 years, has proved very severe and intractable, and this patient at the end of the year was still in an iron lung at the Wandle Valley Isolation Hospital. During succeeding years, the Corporation will be called upon to review carefully two matters of grave Public Health importance. These are the future maintenance of the River Wandle and the disposal of the Corporation's dry refuse. Owing to the failure of the springs from which the River Wandle draws much of its water supply, and possibly owing to the greater extraction of water by local wells here and in Croydon, the river has degenerated into a sluggish, stagnant stream. Persons living in the immediate vicinity called on the Corporation's officers during the year to carry out cleansing of certain sections of the river, and while this relieved temporarily the nuisance of accumulated refuse and foreign matter in the bed of the stream, the main cause of trouble, that is, failure of sufficient head of water, remains a matter for some concern. During the year the Corporation gave preliminary discussion to the matter of refuse disposal, as it would appear the life of the existing tip in Beddington Lane is limited, and the necessity for finding other sites for refuse disposal has become acute. This problem will continue to be explored by the authority during subsequent years, but at first sight the solution is not apparent. Much time was spent during the year in consultation with the Surrey County Council on how best to apply the National Health Service Act, 1946, to the County districts. At the close of the year, however, a concrete scheme had been put forward with the agreement of all parties, by which Beddington & Wallington and Carshalton become one County Health District, governed by a Sub-Committee of the Central County Health Committee. It is to be hoped that during 1948 these plans will be put into successful operation, with the coming into force from the 5th July of this Act and other social legislation aimed at the improvement of the country's health services. 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, July, 1948. Medical Officer of Health. 9 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,048 Population, Census, 1931 26,249 Registrar-General's estimate of resident population for 1947 32,400 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1947 9,036 Rateable Value, December, 1947 £391,201 Sum represented by penny rate, December, 1947 £1,590 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. The population, as shown by the Registrar-General's figure, shows an increase on the previous year by approximately 1,000. Inhabited houses, however, have only risen by 21. The number of persons per house shows an increase of 0.1, being 3.6 for the year under review. Overcrowding in many properties continues, and the difficulties of rehousing persons remains as acute as in the previous year. Industries remain concentrated for the most part in the northern area of the district, and there has been very little change in the character of the Borough as a whole, being for the most part residential and a dormitory. During the year, the progressive policy of the Council in maintenance of parks and open spaces has been shown in the care and cultivation of such areas and the continued appreciation of the population as a whole of these health-giving amenities. 10 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. The Public Health Department continued to administer, as in the previous year, the swimming facilities provided by the Corporation, through the courtesy of the London County Council, at the Beddington Orphanage bath. The weather during the Summer of 1947 proved exceptionally fine, and the swimming bath provided a welcome recreation for many of the inhabitants of the district. 11 EXTRACTS FROM VITAL STATISTICS Total. M. F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 526 270 256 16.91 „ „ Illegitimate 22 16 6 Total 548 286 262 Rate per 1,000 total (live and still) births Still Births 16 10 6 28.37 Death Rate per 1,000 of the estimated resident population. Deaths 342 160 182 10.56 Rate per 1,000 (live and still) births Deaths from Puerperal causes:— Puerperal Sepsis — - Other Maternal causes — - Death Rate of Infants under one year of age:— All Infants per 1,000 live births 27.37 Legitimate Infants per 1,000 legitimate live births 24.71 Illegitimate Infants per 1,000 illegitimate live births 83.33 Deaths from Cancer (all ages) 51 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea, etc. (under two years of age) 1 12 Comparative crude birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1947:— 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 20.5 23.3 22.2 22.7 16.91 Still 0.50 0.62 0.54 0.49 0.49 Deaths— All Causes 12.0 13.0 11.9 12.8 10.56 Typhoid and typhoid 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 0.03 0.02 0.02 0.03 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.09 0.09 0.08 0.08 0.06 Smallpox 0.00 0.00 0.00 0.00 — Measles 0.01 0.02 0.02 0.02 0.00 Notifications— Typhoid Fever 0.01 0.01 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Cerebro-Spinal Fever 0.05 0.06 0.05 0.05 0.09 Scarlet Fever 1.37 1.54 1.37 1.31 1.94 Whooping Cough 2.22 2.41 2.02 2.80 3.46 Diphtheria 0.13 0.15 0.14 0.14 0.06 Erysipelas 0.19 0.21 0.18 0.22 0.19 Smallpox 0.00 0.00 0.01 0.00 — Measles 9.41 9.13 9.58 5.29 2.84 Pneumonia 0.79 0.89 0.68 0.64 0.19 Deaths under 1 year of age Rates per 1,000 Live Births. 41 47 36 37 27 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 8.0 3.7 4.8 1.8 Notifications— Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Pyrexia 7.16 8.99 6.27 6.94 1.77 Maternal Mortality Abortion with Sepsis. Abortion without Sepsis. Puerperal Infections. Other Causes. Total. England and Wales 0.10 0.06 0.16 0.85 1.17 Beddington and Wallington - - - - — 13 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1947:— Causes of Death. Males. Females. Total. All Causes 160 182 342 1.Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever 1 — 1 3. Scarlet Fever —• — — 4. Whooping Cough 1 — 1 5. Diphtheria — — — 6. Tuberculosis of Respiratory System 3 4 7 7. Other forms of Tuberculosis 3 — 3 8. Syphilitic Disease 1 — 1 9. Influenza 1 1 2 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis _ - - 12. Acute Infectious Encephalitis — — — 13.m Cancer of Buccal Cavity and Oesophagus (males) 3 - 3 13.f Cancer of Uterus — — — 14. Cancer of Stomach and Duodenum 3 2 5 15. Cancer of Breast — 7 7 16. Cancer of all other Sites 17 19 36 17. Diabetes — 1 1 18. Intra-cranial Vascular Lesions 9 30 39 19. Heart Disease 48 57 105 20. Other diseases of the Circulatory System 7 11 18 21. Bronchitis 12 6 18 22. Pneumonia 8 6 14 23. Other Respiratory Diseases 3 2 5 24. Ulceration of the Stomach or Duodenum 4 1 5 25. Diarrhoea (under 2 years of age) 1 — 1 26. Appendicitis 1 — 1 27. Other Digestive Diseases 3 3 6 28. Nephritis 3 3 6 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — — — 31. Premature Birth 1 1 2 32. Congenital Malformations, Birth Injury, Infantile Disease 6 2 8 33. Suicide 4 1 5 34. Road Traffic Accidents 2 — 2 35. Other Violent Causes 4 3 7 36. All Other Causes 11 22 33 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 Disease 105 30.70 Cancer 51 14.91 Intra-Cranial Vascular Lesions 39 11.40 Tuberculosis (All Forms) 10 2.92 Pneumonia 14 4.09 Bronchitis 18 5.26 Other Diseases of the Circulatory System 18 5.26 VIOLENCE AND ACCIDENT. The figures of deaths caused by suicide, street accidents and accidents in the home remain at a low level. Details of all deaths under this heading are as follows:— Cause of Death. Male. Female. Total. Suicide 4 1 5 Street Accident 2 — 2 Accidents at Home — 2 2 Other Violent Causes 4 1 5 Totals 10 4 14 MATERNAL MORTALITY. It is gratifying to note that no cases of death in childbirth, either from puerperal sepsis or other maternal causes, were recorded during the year. The maternal mortality rate for England and Wales per 1,000 live and still births was 1.17. 15 INFANTILE MORTALITY. The infantile mortality rate for 1947 was 27.37 per 1,000 live births. This is a decrease from the figure of 30.72 per 1,000 live births for 1946, and compares favourably with the figure of 41 for England and Wales. Of the total of 548 live births, 15 deaths of infants under one year of age (9 males and 6 females, two of the males being illegitimate) were registered. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. LABORATORY FACILITIES. The Corporation's arrangements for the examination of swabs, sputum, and other pathological material continue as heretofore. Specimens Examined. Totals. Positive. Negative. Diphtheria:— Examination of nose and throat swabs 95 1 94 Scarlet Fever:— Examination of nose and throat swabs 21 2 19 Dysentery:— Faces 3 1 2 Tuberculosis:— Sputum 5 - 5 Totals 124 4 120 During 1947 Mr. H. Amphlett Williams, Public Analyst, 1 Southwark Street, S.E.I, continued the arrangement made in 1946 for the examination of milk, water and ice-cream. Pathological specimens are sent to the Pathological Laboratories at the St. Helier County and Croydon General Hospitals. 16 AMBULANCE FACILITIES. General and Accident Cases. The arrangements which came into operation in 1945 continued to operate successfully during 1947. The National Fire Service continued to house the one ambulance in use and the five full-time personnel at the National Fire Service Station in Belmont Road. Details of the work of the Ambulance during 1947 are as follows:— Private Removals 502 Maternity Cases 227 Accidents 302 Calls answered for other Authorities 91 Total Calls Answered 1,122 Distance Travelled on Calls 8,839 miles Average Mileage per Call 7.88 Mutual Assistance by Other Services 81 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 1,007 cases, including 96 maternity and 109 midwifery patients. TREATMENT CENTRES AND CLINICS. 1. Child Welfare Centres. Hackbridge Centre, The Grange, London Road. When held. Every Monday, 2.0-4.0 p.m. Beddington Centre, Village Hall, Beddington. Alternate Wednesdays, 2.0-4.0 p.m. Wallington Centre, Baptist Hall, Queen's Road. Alternate Wednesdays, 2.0-4.0 p.m. 2. Maternity Clinics. Ante-Natal Clinic. Thursdays and Fridays, 2.0-4.0 p.m. Post-Natal Clinic. First Wednesday in month, 10.0 a.m.-12 noon. Midwives' Clinic. Second and fourth Tuesday of month, 2.0-4.0 p.m. Consultant's Clinic. Third Friday of the month. All Maternity Clinics are held at the District Nurses' Home, 57, Montagu Gardens, Wallington. 17 Bandon Hill Centre, Methodist Hall, Sandy Lane North. Every Tuesday, 2.0-4.0 p. During the year voluntary help in the conduct of infant welfare centres was provided by many generous-hearted ladies in the district. Among these, mention should be made of the ladies of the Inner Wheel of Rotary and of the British Red Cross Society, who continued to supply the greater part of the voluntary help given. 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., 1947 2,650 3,850 6,500 Children who completed full course of immunisation during the year 439 161 600 Number of children who received reinforcing injections during the year 4 661 665 Number of children known to be immunised at 31st Dec., 1947 .. 1,218 2,427 3,645 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 COUGH. During the year, 105 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. By the end of the year, the minor ailments and dental clinic for school children and maternity and child welfare services at the Grange Mansion, was ready to be brought into operation at the beginning of 1948. 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 1947 the Corporation Cleansing Station situated near the Grange Mansion provided facilities for cleansing infested persons. 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 shows 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 9 4 15 6 9 3 7 26 7 33 Pediculosis 3 1 7 12 2 1 4 12 - 12 Total 17 40 15 11 38 7 45 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 1947 the Corporation continued to exercise its functions as an autonomous Maternity and Child Welfare authority. During the year, the Corporation's staff of three Health Visitors was well maintained. There was one change, and a lapse of two months occurred between one Health Visitor leaving and another taking up her duties. 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 205 confinements. Ninety-six 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 13.3 patients per session. 21 During the year, 412 expectant mothers attended the clinic, as compared with 406 in 1946. This represents approximately 73.1 per cent. of the total notified births, live and still, which were assigned to the Borough during 1947, and is a creditable reflection on the efficiency and consequent popularity of the Council's Ante-Natal Service. POST-NATAL CLINIC During 1947, the Corporation's Post-Natal Clinic, recommenced in September 1946, continued to offer facilities in this important branch of maternal care. The post-natal cases attending during 1947 represented 19.7 per cent, of the total notified births. It is reliably estimated that considerably more patients receive postnatal 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 post-natal 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, 1947 Council Cases. Nursing Association Total, 1947. Total, 1946. Ante-Natal Cases:— Number of Clinics held - - 101 101 Total number attending during the year 239 173 412 406 Number of first attendances 174 128 302 393 Number of re-attendances 472 566 1,038 1,272 Total attendances 646 694 1,340 1,665 Average attendance per session 6.4 6.9 13.3 16.5 Post-Natal Cases:— Total number attending during the year 30 81 111 130 Number of first attendances 30 81 111 130 Number of re-attendances 6 20 26 5 Total attendances 36 101 137 135 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:— Referred by Medical Officer, Ante-natal Clinic Private Practitioners. Totals. 1947. 1946. C. N.A. Clinics held 3 5 Patients attending: Ante-natal 4 1 1 6 3 Post-natal — 1 — 1 2 Total attendances 4 2 1 7 5 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, however, he was not called into consultation. 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 response:— Bandon Hill. Hackbridge. Beddington. Wallington. Totals. 1947. 1946. Number of sessions held 52 49 27 25 153 148 Infants:— No. of new cases under 1 year 163 151 79 116 509 463 No. of re-attendances 1,969 2,142 704 898 5,713 5,440 No. of new cases over 1 year 47 28 32 25 132 75 No. of re-attendances 1,282 1,122 581 580 3,565 4,075 Total attendance of infants 3,461 3,443 1,396 1,619 9,919 10,053 Average attendance of infants per session 66.6 70.3 51.7 64.7 64.8 67.9 Mothers attending 3,156 2,379 1,298 1,405 8,238 9,862 Total attendances 6,617 5,822 2,694 3,024 18,157 19,915 Average total attendance per session 127.3 118.8 99.8 121 118.7 134.6 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 137 St. Luke's County Hospital (Guildford) 13 Epsom County Hospital 4 154 Sixty-four patients were delivered under private arrangements at the Carshalton, Beddington and Wallington District (War Memorial) Hospital. Some difficulty continues to be experienced in making adequate provision for institutional confinements. No urgent or necessitous case was, however, refused institutional confinement, admission to one or other of the County hospitals being satisfactorily arranged. There is still an acute shortage of domestic and nursing staff in the County Council's hospitals, and although war damage repairs have in most hospitals now been satisfactorily completed, many beds remain unstaffed. 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 54 17 Part-time 22 17 76 34 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 over-emphasised. Requests for service were for the most part satisfied, but difficulty is still experienced in obtaining the right type of woman for this job. 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. One hundred and sixty-nine cases were referred from the Maternity and Child Welfare Centres to the under-mentioned hospitals during the year :— Croydon General Hospital 76 St. Helier County Hospital 84 Guy's Hospital 1 Hospital for Sick Children (Great Ormond Street) .. .. .. .. .. .. 8 169 The conditions requiring treatment were Orthopedic Defects 54 Circumcision 46 Eye Conditions 19 Skin Conditions 9 Ear and Nose Conditions 1 Naevus 17 Tonsils and Adenoids 6 Feeding Difficulties 5 Chest Conditions 1 Nervous Conditions 3 Miscellaneous Ailments 8 Dental. During 1947, 10 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 1 4 5 Received treatment 1 2 3 Made dentally fit 1 2 3 Treatments :—- Fillings— In temporary teeth —- — 8 In permanent teeth 12 1 — Teeth extracted 1 14 5 Administrations of general anaesthesia - 2 2 Patients supplied with dentures 1 2 — Dentures supplied 2 3 - 25 Orthopaedic. Patients attending the Centres who require treatment for orthopaedic defects are referred by the Medical Officer of Health to the Orthopaedic Departments of the St. Helier County, the Croydon General and Guy's Hospitals. During the year 54 cases were so referred and treated. ARTIFICIAL SUNLIGHT : SOLARIUM. During 1947, its third year of operation, 543 new patients attended the Solarium, the total attendances for all cases being 7,072. This Clinic maintains its 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 :— First Attendances. Re- attendances. Total, 1947. Total, 1946. Children : 0-5 years 459 5,630 6,089 7,964 5-15 years 48 581 629 702 Adults : Expectant Mothers 10 71 81 129 Nursing Mothers .. 8 76 84 408 Private Patients .. 18 171 189 315 543 6,529 7,072 9,518 In addition to the attendances for irradiation as shown in the foregoing table, the following corrective treatments were carried out by the Physiotherapist either at the Solarium or in the home of the patient :— Treatments. Manipulation and exercises for physical defects of the feet .. 144 „ „ „ „ ankles 24 legs 154 neck 112 Massage and re-education for spastic conditions 55 Education in walking 20 Massage for fibrositis 22 „ „ post-poliomyelitis 34 „ „ miscellaneous conditions 79 Breathing exercises 30 26 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. The following summary of the work of the Health Visitors shows how this branch of the service has increased since the introduction of a third Health Visitor in 1946. Maternity Visits. 1947. 1946. First visits to Expectant Mothers 106 77 Re-visits to Expectant Mothers 57 13 Breast Feeding observations and test feeds 30 37 Infant Welfare. First visits under 1 year 533 519 Re-visits under 1 year 924 422 First visits over 1 year 70 132 Re-visits over 1 year 1,058 643 Special Home Visits. Still Births 15 7 Infant Deaths 9 4 Child Life Protection. First visits 26 33 Re-visits 318 47 Infectious Diseases. Tuberculosis 50 31 Scabies and other verminous conditions 8 28 Puerperal Infections 1 1 Diphtheria Swabs taken 53 -— General Visits. Home Enquiries, Agreements, etc. 33 67 Adoption of Children 81 31 Home Help and Domestic Help 249 170 Miscellaneous visits 149 116 Ineffective visits.. 412 271 Totals 4,182 2,658 Attendances at Clinic Sessions. Maternity and Child Welfare Centres 339 297 Ante-Natal and Post-Natal Clinics 198 158 Totals 537 455 Interviews in Office 808 479 Attendance at Medical Examinations 8 10 Attendance at Immunisation Clinics 52 29 27 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 .. .. .. 11 Number of children on the register at the end of the year .. .. .. .. .. .. 43 Number of children who died during the year .. — During the year 344 visits were paid. No proceedings were taken under the Act. ADOPTION OF CHILDREN (REGULATION) ACT, 1939. The regulations under this Act came into operation in 1943. During 1947 13 persons gave notice of reception under Section 7 (3) of the Act, At the close of the year 2 children were under supervision under the Act, the Corporation being guardians ad litem. The importance of work under this heading cannot be over-emphasised, and through its Health Visitors the Corporation is carrying out all its statutory obligations satisfactorily. THE CARE OF PREMATURE INFANTS. The arrangements made for the care of premature infants were continued during 1947. 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 the 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 1947. An annual grant is made to the Sutton and District Girls' Aid Association, whose visitor follows up the cases occurring in the Borough. Ladies of the Women's Voluntary Services and Health Visitors continue to co-operate in the alleviation of the lot of these unfortunate mothers. SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLIES. The water supply is piped throughout the district from the Sutton District Water Company. All dwelling-houses in the area are connected to public water mains. None of the inhabitants rely upon stand pipes. During the year the supply has been satisfactory both in quality and quantity. 28 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. 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 softening plant is in. use. During the year 31 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. Flooding took place under the Manor Road railway bridge on one occasion following a storm of exceptional intensity. The water rose to a height of about three feet, but got away quickly as soon as the storm abated. RIVERS AND STREAMS. The River Wandle and its tributaries were maintained throughout 1947 and various parts of the river bed were cleansed of silt and obstructions. During the year the Surrey County Council assumed responsibility for the maintenance of that portion of the River Wandle north of the Carshalton railway line. They were already maintaining the Carshalton side of the river, and the Council considered that no good case could be made out for the division of authority. Following the heavy storm referred to in the previous paragraph, slight flooding took place in Beddington Village, but the duration was short and damage was only slight. Following the very dry summer the springs at Waddon Ponds, which feed the head of the Wandle, dried up in the Autumn and the flow of the river was reduced almost to nothing. The conditions arising from this lack of flow are far from satisfactory and constant vigilance is necessary to ensure that no nuisance arises. Following a relatively dry Winter it is not anticipated that the springs will commence to flow again until 1949. 29 CLOSET ACCOMODATION. 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 four cesspools were in use in the district at the end of the year. PUBLIC CLEANSING. The collection of house refuse throughout the Borough was maintained during the year on a weekly basis, the refuse being disposed of at the Beddington Lane shoot. The type of receptacle in use throughout the Borough continues to be the portable galvanised iron covered bin. The collection of trade refuse was also continued as required. With the Beddington Lane shoot nearing the end of its useful life, the question of future" refuse disposal arrangements was under consideration by the relevant Committee. Cesspools and earth closets are dealt with by the occupiers of the premises concerned, which continued arrangement is satisfactory. 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, 1947. DWELLING-HOUSES. Number of inspections of dwelling-houses .. .. .. 1,753 Number of inspections recorded under Housing Regulations MILK AND DAIRIES. Number of cowkeepers on register — Number of purveyors of milk on register 34 Number of dairymen distributing milk 5 Number of dairy premises on register 6 Number of dairy premises upon which loose milk is handled 1 Number of inspections of premises 14 Defects in dairy premises discovered — Infringements of Acts and Orders discovered and dealt with :— Extraneous matter in milk 1 Unclean milk vessels 1 — 2 Number of licences issued under the Milk (Special Designations) Regulations :— Tuberculin Tested—Dealer's Licences 3 „ „ Supplementary Licences 8 Pasteurised—Dealer's Licences 3 „ Supplementary Licences 8 Pasteuriser's Licence 1 — 23 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 5 31 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 372 Number of defects discovered 28 UNSOUND FOOD. Destroyed or released for approved purposes :— Bacon 4 Cereals 320 Cheese 19 Eggs (917) Fish 1,221 Fish, Canned 129 Fruit 111 Fruit, Canned 204 Fruit, Dried 96 Golden Syrup 3 Jam 95 Marmalade 29 Meat 622 Meat, Canned 234 Milk, Condensed 23 Milk, Evaporated 468 Mincemeat 5 Poultry 72 Pudding Mixture 21 Sausages 83 Sausages, Canned 37 Soup, Canned 42 Vegetables, Canned 339 Vegetables, Dried 122 Miscellaneous 184 Total 4,483 32 FOOD ANALYSES. Number of samples analysed by Public Analyst 102 Number of samples reported against :— Coffee and chicory essence—deficiency of coffee extractives 1 Epsom salts—contained potassium permanganate, 0.01 per cent. 1 Pepper—pepper substitute 1 *Non-brewed vinegar—deficiency of 62.5 per cent, of acetic acid 1 Ground ginger—contained 18.5 per cent, of sodium nitrate 1 Marmalade, canned—faulty manufacture and over- long storage in the can 1 Glauber's salt—contained flowers of sulphur, 0.035 per cent. 1 Butter—contained 0.2 per cent, excess water 1 Margarine—contained 0.3 per cent, excess water 1 — 9 * Vendors prosecuted and fined £5 with £7 7 0 costs FACTORIES. Number of factories on register 107 Number of inspections 151 Number of defects discovered 36 BAKEHOUSES. Number of bakehouses in district 12 Number of inspections 30 Number of defects discovered 11 WORKPLACES. Number of inspections of workplaces 17 Number of defects discovered SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 281 Number of defects discovered.. 18 COMPLAINTS. Complaints received during the year were due to the following causes : Detects in dwelling-houses (various) 281 Stoppages in drains 78 Defects in drains or water closets 64 Defective dustbins 52 Food supplies 32 Insect pests 29 Miscellaneous 83 619 33 SMOKE ABATEMENT. Number of observations 18 Nuisances dealt with 2 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 145 Number of rooms disinfected 173 Lots of bedding and clothing disinfected 122 Number of library books disinfected 381 OFFENSIVE TRADES AND FISH FRYING. Number of offensive trade premises in district Nil Number of fish frying premises in district 4 Number of visits to fish frying premises 12 Number of defects discovered — RATS AND MICE (DESTRUCTION) ACT, 1919, Number of visits to premises 139 Number of complaints received 92 Number of premises upon which rats were found 47 NOTICES. Number of informal notices served (including verbal intimations) 910 Number of statutory notices served :— Public Health Act, 1936, Section 75 (Dustbins) 36 Public Health Act, 1936, Section 93 (Nuisances) 2 Public Health Act, 1936, Section 45 (Closets) 1 — 39 PROSECUTIONS (Food and Drugs Act) 1 SANITARY IMPROVEMENTS. Water Supply. Water pipes and fittings repaired or renewed 28 Drains. Drains re-laid or repaired 48 Drains unstopped and cleansed 49 Intercepting traps provided with rod-eye stoppers 20 Manholes provided or repaired 17 Soil or ventilation pipes repaired or renewed 9 Gully kerbs and channels repaired 12 New soakaways constructed 10 34 Closets. New closets provided 1 Buildings repaired 7 New pans fixed to water closets 48 Flushing cisterns repaired or renewed 19 Flush pipes and pan joints repaired or renewed 11 Water supply reinstated 2 Seats repaired or renewed 15 Sinks. New sinks provided 2 Waste pipes repaired or renewed 23 Yards. Yards newly paved or repaired 13 Dust Receptacles. New portable iron dustbins provided 455 Dampness. Roofs repaired 92 Rainwater gutters repaired or renewed 94 Rainwater downspouts repaired or renewed 45 Damp-proof courses provided 10 Windows, sills and doors made weatherproof 52 External walls repaired, repointed or rendered 68 Ventilation provided under floors 13 General Repairs. Rooms cleansed 33 Walls and ceilings repaired 106 Floors repaired 63 Stoves repaired or renewed 18 Windows repaired 47 Chimneys repaired 36 Number of premises disinfested from bed bugs 2 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 1,753 Number of re-inspections of premises 1,888 Number of visits to works in progress 944 Number of miscellaneous visits and inspections 365 Number of visits to dairies 14 Number of visits to factories 151 Number of visits to bakehouses 30 Number of visits to workplaces 17 Number of visits to shops and offices 281 Number of visits to premises re slaughtering 5 Number of visits to food premises 372 35 Number of visits to stables and yards 73 Number of visits to market gardens, etc. 16 Number of visits to fried fish shops 12 Number of visits to urinals 42 Number of visits to piggeries 19 Number of visits re infectious diseases 145 Number of visits to streams 28 Number of visits re rats 139 Number of visits re smoke abatement 18 Number of complaints received and investigated 619 Number of informal notices served 910 Number of statutory notices served 39 Number of interviews re nuisances, etc. 653 Number of rooms disinfected 173 Number of lots of bedding and clothing disinfected 122 Number of library books disinfected 381 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS AND OFFICES. Two hundred and eighty-one inspections were made during 1947 and in 18 cases action was necessary in regard to sanitary defects. CAMPING SITES. There are no camping sites within the Borough. SWIMMING BATH. The Corporation again rented from the London County Council (for the 1947 Summer season) the open-air swimming bath situated in the grounds of the Royal Female Orphanage. The supervision and arrangements of sessions were under the control of the Public Health Department. Facilities were given to schools and youth organisations, and residents using the bath were enrolled in a Borough Swimming Club, under the control of .a Committee consisting of officers and members of the Corporation and representatives of outside organisations. During the season, which covered a period of 20 weeks, the following attendances were recorded :— Youth organisations 7,544 School children 1,907 Borough Swimming Club : Adults 3,931 Children 4,281 8,212 Total 17,663 ERADICATION OF BED BUGS. During the year bed bugs were found to exist in 2 houses. Appropriate remedial measures were taken. 36 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 maintained schools, notice is given to the Head Teachers of all independent 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. Under the 1944 Education Act the Assistant Medical Officer of the County Council continued to carry out routine and special medical inspections of schoolchildren 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. Water Supply and Sanitary Conditions. Following up the special report on the sanitary circumstances of schools submitted by the Medical Officer of Health in December, 1946, the Medical Officer of Health has kept these premises under supervision. Unfortunately, owing to the lack of materials and building facilities, it has been impossible to carry out many of the alterations suggested in the report. Many schools, however, have had partial redecoration, and some of the recommendations concerning sanitary conveniences were still being pursued at the close of the year. All the schools are supplied with water from the public mains and are connected with the sewers. REGULATED TRADES : DAIRIES. There are 6 registered premises within the district, but only 1 is used for the treatment and handling of loose milk. During the year 14 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 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 6 instances. 37 FACTORIES ACT, 1937. The following tables give details of inspections made and defects found, as supplied by the Senior Sanitary Inspector Part I of the Act. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors) : Premises. Number on Register Number of Inspections. Written notices. Occupiers prosecuted. (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3,4 and 6 are to be enforced by Local Authorities 11 12 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 95 137 5 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) .. 1 2 - - Total 107 151 6 - Part VIII of the Act Outwork Nature of Work. Section 110. Section 111. No. of outworkers in August list required by Sect. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists. No. of instances of work in unwholesome premises. Notices served. Prosecutions. (1) (2) (3) (4) (5) (6) (7) Making of wearing apparel 3 - - - - - Cosaques, Christmas crackers,Christmas stockings, etc. 49 — — — — - Total 52 — — — — — 38 Cases in which Defects were found : Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Remedied. Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 6 6 - 3 - Overcrowding (S.2) — — - — - Unreasonable temperature (S.3) - - - - _ Inadequate ventilation (S-4) _ Ineffective drainage of floors (S.6) _ _ Sanitary conveniences (S-7)— (a) Insufficient 1 1 - - - (a) Unsuitable or defective 4 4 - 1 _ (c) Not separate for sexes - - - - _ Other offences against the Act (not including offences relating to Outwork) 12 - 12 - - Total 23 11 12 4 — 39 HOUSING During the year the following samples of milk sold within the district were examined :— MILK. Class of Milk. No. taken. Pasteurised . 82 Tuberculin Tested, Pasteurised 1 Sterilised 1 Ungraded 1 Total . 85 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. Nine samples of pasteurised milk failed to comply with statutory requirements. MEAT. 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. Butter 6 6 - 1 1 - - Cheese — 1 1 - - - - - Cocoa — 2 2 - - - - - Coffee — 2 2 - - - - - Coffee&Chicory Essence - 2 2 - 1 1 - - Cook'ing Fat — 5 5 - - - - - Drinks, soft — 1 1 - - - - - Flour — 1 1 - - - - - „ self-raising — 2 2 - - - - - Gelatine — 4 4 - - - - - Ginger, Ground 1 1 - 1 1 - - Herbs — 2 2 - - - - - Margarine — 8 8 — 1 1 — — Marmalade, Canned 1 1 - 1 1 - - Milk 12 18 30 - - - - - Milk, Dried — 1 1 - - - - - Pepper — 7 7 — 1 1 - — Sauce — 2 2 - - - - - Soya flour — 4 4 - - - - - Sugar — 1 1 - - - - - Vinegar — 4 4 - - - - - Vinegar, Nonbrewed 1 2 3 1 1 1 1 Camphorated Oil - 4 4 - - - - - Epsom Salts — 1 1 — 1 I - — Glauber Salts — 4 4 —. 1 1 - — Vitamin tablets - - 1 - - - - - Zinc ointment - 2 2 - - - - - Totals 13 89 102 1 8 9 1 1 41 CHEMICAL AND BACTERIOLOGICAL EXAMINATIONS. Work of this nature is carried out when required by Mr. H. Amphlett Williams, A.C.G.F.C., F.R.I.C., Public Analyst, and the Counties Public Health Laboratories. NUTRITION. The general standard of nutrition amongst infants and toddlers attending infant welfare centres remains on a reasonably high level. No gross vitamin deficiencies were noted and it would appear that mothers are taking full advantage of the Government scheme for the provision of welfare foods. As has been mentioned, however, in the preamble to the report, it was found necessary to put on sale many proprietary brands of vitamin preparations because of the unpalatability experienced by some children, of cod-liver oil and orange juice. The shortage of first-class proteins and fats is still noticeable in children's diets, and the monotony is frequently commented upon by mothers, who experience difficulty in preparing appetising meals for their 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 BYE-LAWS 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 Requisition 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 1947, the number of cases removed to hospital and the number of deaths attributed to these diseases, excluding Tuberculosis : Disease. Number Notified. Removed to Hospital. †Deaths. Scarlet Fever 63 51 - Diphtheria 2 2 - Erysipelas 6 4 1 Pneumonia 6 — 14* Measles 92 1 — Whooping Cough 112 3 1 Puerperal Pyrexia 1 — - Cerebro-Spinal Fever 3 2 1 Encephalitis Lethargica 1 . 1 — Acute Poliomyelitis 8 8 — Dysentery 5 1 — Polioencephalitis 1 1 —- Totals 300 74 17 * Includes deaths from all forms of pneumonia. | Includes deaths of residents in homes and institutions outside the Borough, 43 The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections :— Cases of Infectious Disease Notified During the Year 1947 (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. Beddington. Wallington. 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. Scarlet Fever 63 — 2 3 2 5 22 19 1 2 6 1 — 29 8 7 3 10 6 51 —• Diphtheria 2 — — — — — 1 1 — — — — •— — 1 1 — — —• 2 .— Erysipelas .. 6 - - - - - - - - - 2 1 3 2 — 2 — 2 — 4 1 Pneumonia 6 — — - — — 1 — 1 — 1 1 2 1 1 3 1 — — — 14* M;asles 92 2 5 16 15 14 36 2 2 — — — — 33 17 15 9 10 8 1 — Whooping Cough .. 112 4 6 20 10 20 49 1 1 1 40 20 20 9 15 8 3 1 Puerperal Pyrexia .. 1 - - - - - - - - 1 - - - - - - - - 1 - - Cerebro-Spinal Fever 3 1 1 - - - - 1 - - - - - 1 - - 1 1 - 2 1 Encephalitis Lethargica 1 - - - - - - - - 1 - - - - - 1 - - - 1 - Acute Poliomyelitis .. 8 - 2 - 2 - 3 - - 1 - - - 4 2 - - 2 - 8 - Dysentery .. 5 1 — 1 — — 2 — — 1 — - - — — — 4 — 1 1 — Polioencephalitis 1 - - - - - - - - 1 - - - 1 - - - - - 1 Totals .. 300 8 16 40 29 39 114 24 4 8 10 3 5 111 49 49 27 40 24 74 17 * Includes all forms. 44 The Monthly Incidence of Infectious Disease, 1947 (excluding Tuberculosis). Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 4 5 3 4 8 7 3 3 10 9 7 63 Diphtheria 1 - - - - - - - - - 1 — 2 Erysipelas — 1 1 1 2 — - — — — 1 ' — 6 Pneumonia 1 3 1 - - - - - - 1 — —- 6 Measles 13 17 8 3 23 4 13 11 — — — — 92 Whooping Cough 5 3 22 10 14 27 12 5 2 4 6 2 112 Puerperal Pyrexia 1 - - - - - - - - - - - 1 Cerebro-Spinal Fever — 2 - - - - - - - - - 1 3 Encephalitis Lethargica — 1 - - - - - - - - - - 8 Acute Poliomyelitis - - - - - 1 — 1 1 5 — — 8 Dysentery - - - - - - - - - 4 — 1 5 Polioencephalitis - - - - - - 1 - - - - - 1 Totals 25 27 37 17 43 40 33 20 6 24 17 11 300 45 Tuberculosis. There were 30 new cases notified during the year. The following table gives the number of new cases notified during the past five years :—- New Cases. 1943. 1944. 1945. 1946. 1947. M. F. M. F. M. F. M. F. M. F. Pulmonary 19 10 18 9 17 13 24 6 15 8 Non-Pulmonary 2 5 2 4 3 2 2 3 6 1 Totals 21 15 20 13 20 15 26 9 21 9 Annual case rate per 1,000 of the estimated population :— 1947. 1946. Pulmonary 0.71 0.95 Non-pulmonary 0.22 0.16 The following table gives the number of deaths from this disease during the past five years :—- Deaths. 1943. 1944. 1945. 1946. 1947. M. F. M. F. M. F. M. F. M. F. Pulmonary 8 3 5 4 6 10 7 1 4 4 Non-Pulmonary 1 2 1 — 2 1 •— — 2 — Totals 9 5 6 4 8 11 7 1 6 4 It will be seen from the foregoing table that 10 deaths were registered as due to Tuberculosis, all of which were Pulmonary. The figures correspond to a death rate per 1,000 of population of 0.31. 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 :— 46 Age Periods. New Cases. Deaths. Pulmonary. Non-Pul- monary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1 and under 5 5 and under 10 - - 2 - — — 1 - 10 and under 15 1 - 1 1 1 - - - 15 and under 20 1 1 - - - - - - 20 and under 25 3 3 — - 1 1 — - 25 and under 35 2 3 - - — 2 — - 35 and under 45 4 1 1 - 1 — — - 45 and under 55 2 — - - 1 1 — - 55 and under 65 1 — 1 - - - - - 65 and upwards 1 — 1 - — — 1 - Totals 15 8 6 1 4 4 2 - The new cases were distributed amongst the Wards as follows :—• Beddington. Wallington. North Cent. South North Cent. South Pulmonary 5 5 4 4 2 3 Non-Pulmonary 2 — — 2 2 1 Totals .. 7 5 4 6 4 4 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 5 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 1947. 47 . Printed by BERTRAM JOHNSON 11 Manor Road Wallington, Surrey