BED 13 LIBRARY BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1948 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the YEAR 1948 TABLE OF CONTENTS Public Health Committee 5 Maternity and Child Welfare Sub-Committee 5 Representatives on the Wandle Valley Joint Sewerage Board 5 Staff of Public Health Department 6 Statistics and Social Conditions 11 Extracts from Vital Statistics 12 Vital Statistics/: Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1948 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 : Maternity and Child Welfare 17 Tuberculosis 18 Immunisation against Diphtheria 18 Immunisation against Whooping Cough 19 School Clinics 19 Venereal Diseases Clinics 19 Hospitals 19 Cleanliness 20 Disinfection 21 Maternity and Child Welfare : General Observations 21 Ante-natal Supervision 22 Post-natal Supervision 22 Consultant Obstetrician 23 Child Welfare Centres 23 Institutional Confinements 24 Home Help 24 Family Planning 25 2 Treatment : Minor Ailments 25 Dental 25 Orthopaedic 26 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 1948 : Dwelling Houses 31 Milk and Dairies 31 Ice Cream 31 Slaughterhouses 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 34 Notices 34 Sanitary Improvements : Water Supply 34 Drains 34 Water Closets 34 Sinks 35 Yards 35 Dust Receptacles 35 Dampness 35 General Repairs, etc. 35 3 Summary of work done during the year 35 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 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 WALLTNGTON PUBLIC HEALTH COMMITTEE. December, 1948. Members : Councillor D. H. de Voil (Chairman) Councillor 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. July, 1948. 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 SEWERAGE BOARD. December, 1948. 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. Consultant Obstetrician :— *Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G. Senior Sanitary Inspector :— F. H. Lennard, A.M.I.S.E., M.R.S.I., M.S.I.A. Additional Sanitary Inspectors :— A. F. Leaney, M.R.S.I. M. C. Barton, A.R.S.I., M.S.LA. (Resigned 12/9/48). 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. (Resigned 20/2/48). Miss N. M. Lines, S.R.N., S.C.M., H.V.Cert. Mrs. M. Wilson, S.R.N., S.C.M., H.V.Cert. (Appointed 1/5/48 ; Resigned 30/9/48). Miss A. A. Murphy, S.R.N., H.V.Cert. (Appointed 4/10/48). Physiotherapist:— Miss G. Allen, M.C.S.P. Assistant to Physiotherapist:— Miss D. S. Raymond. Clerks :— R. F. Burns, (Chief Clerk). E. D. Evezard. G. H. Bourne. P. H. Sadler (H.M. Forces 17/3/48). B. E. Bignall (Temporary, Appointed 5/4/48). Miss D. M. Simmons (Resigned 31/12/48). *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 ray annual report for 1948, this being the twelfth I have presented, and, as a result of the coming into operation of the National Health Service Act, 1946, the last of the series of reports in which maternity and child welfare is dealt with. On the 5th July, 1948, the following services were transferred to the Surrey County Council :— Care of Mothers and Young Children ; Health Visiting ; Home Nursing ; Vaccination and Immunisation ; Ambulance Services ; Prevention of Illness, Care and After-care ; and Domestic Help. In order to give a more completely comparative picture of the health of the population, it was thought better to include all statistical information for the whole period of the twelve months of 1948. Future reports, however, will no longer contain statistical information relating to the transferred services. This will be submitted to the County Council as the local Health Authority under the Act. The year will be memorable as one of the great landmarks in the history of Public Health and Social Medicine, the importance of this new legislation being comparable with the introduction of the Public Health Act of 1875, and the Local Government Act of 1929. Many years will elapse before the full effects of the introduction of the Act can be estimated. As was foreshadowed in the report for 1947, the Borough forms, with Carshalton, the Mid-Eastern Division of the County Health Scheme, the Medical Officer of Health sharing with the Medical Officer of Health for the Urban District of Carshalton the administrative responsibility as Divisional Medical Officer. The transfer was effected very smoothly and efficiently, the inhabitants of the Borough enjoying the health services run on similar lines to those which obtained prior to the coming into operation of the Act. It will probably be some time before any major scheme of expansion or improvement can be contemplated. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 3/49. The vital statistics are based on information supplied by the Registrar-General ; this was received in mid-May, 1949. The Registrar-General's estimate of the population of the Borough at the middle of the year is 32,800, but from information available from local sources (e.g., the Food Control Office) the population at the end of 1948 was 34,902. The birth rate per 1,000 total population shows a further decrease at 14.57 in 1948, as compared with 16.91 in 1947, and is below that for England and Wales, which is 17.9. The stillbirth rate of 0.46 per 1,000 total population is lower than the figure of 0.49 for 1947, and compares favourably with that for England and Wales, which is 0.42. The stillbirth rate per 1,000 total births is 30.43 compared with 28.37 in 1947. 7 The death rate from all causes per 1,000 total population is 10.37, compared with 10.36 in 1947 and 10.80 for England and Wales. Of the 340 deaths, disease of the heart and circulatory system accounted for 189 (55.59 per cent, of total deaths), cancer 63 (18.53 per cent, of total deaths) and tuberculosis 6 (1.76 per cent, of total deaths). The maternal mortality rate per 1,000 total births is Nil, as compared with 1.02 for England and Wales. For the second year in succession, 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 (14.57), as foreshadowed in the report for 1947, has continued to decline, and now compares with the rate of 12.63 which was recorded in 1939, the last year before the war. The importance of the decline in the birth rate and the effect upon the future population has been well recognised by His Majesty's Government, who, in 1946, set up a Royal Commission to report on the problems associated with population. There was some easing of the position in relation to institutional midwifery, and it is now found possible to admit for a hospital confinement all primigravidae. It must be admitted that the need for institutional care for many cases is obvious. Abnormalities and complications of pregnancy as well as overcrowding and unsatisfactory home circumstances in many cases make home confinement impossible. The Royal College of Obstetricians and Gynaecologists, in their report entitled " A National Maternity Service " in 1944 made a general recommendation that all first pregnancies should have institutional delivery. The Ministry of Health fostered the idea of institutional confinements even before the war, and in consultation with the Royal College set a target of 70 per cent, of all deliveries being accommodated in hospital. Undoubtedly, there is an ever-increasing demand for institutional confinements, and it is doubtful whether the demand will be satisfied or reach equilibrium when the target of 70 per cent, has been reached. The growth of this demand is well illustrated by the available statistics. In 1927, 15 per cent, of women were delivered in hospital, in 1937, 35 per cent., in 1946, 54 per cent., and in Beddington and Wallington in 1948, 58 per cent. Institutional care is not essential for low maternal mortality rates or for low neo-natal and stillbirth rates. In Holland, 80 per cent, of confinements are conducted at home, and that country has always shown very low rates and has an eminently satisfactory domiciliary service. Overcrowding, bad housing, and the difficulty of obtaining domestic help are responsible for the growing demand in this country. One of the main disadvantages of pressing for an increase in hospital beds for midwifery is their rising cost. Whereas a hospital bed as recently as 1946 could be provided for £4 a week, the latest estimate from the Regional Hospital Boards shows that the present cost is about twelve guineas per week. In the face of an economic crisis and also the shortage of beds for other classes of patient, there would appear to be no justification for providing maternity beds for all or even 70 per cent, of confinements. 8 Another disadvantage is the absence of close contact of mother, and baby which is usual in hospital. In the opinion of paediatricians and psychologists, the importance of this association, for physical and psychological reasons, cannot be over-emphasised. The Council of the Royal College of Midwives, in criticising the 1944 report of the Royal College of Obstetricians and Gynaecologists, states : " In considering the relationship of domiciliary midwifery to institutional delivery we regret that greater emphasis has not been given to the undeniable benefits, both psychological and material, surrounding home delivery in favourable circumstances. We consider that selected normal primipara can, with safety, be delivered in a suitable house. The birth of children in the home strengthens family life and loyalty, and although it is in many cases not advisable, the advantage should not be overlooked." In viewing this problem from an economic standpoint, one must consider the economy in trained woman-power involved. For example, it has been roughly estimated that 2,000 deliveries in hospital require a trained staff" of 52 persons—approximately 40 deliveries per nurse-unit. In the year under review, with adequate transport, in an urbanised community such as Beddington and Wallington the Nursing Association achieved 95 births per midwife. The domiciliary service rendered in Beddington and Wallington by the District Nursing Association, and continued under the Act as agents for the County Council, is very much appreciated. Analgesia, the apparatus being carried in motor cars, is available for all mothers in confinement desiring this facility. The record in the Surrey County Council area for the training of midwives in the use and provision of apparatus, is very satisfactory indeed. Since the National Health Service Act came into operation on the 5th July, making the services of a doctor available for domiciliary midwifery free of charge, many expectant mothers have booked their medical practitioner for the confinement. It would appear that some misunderstanding exists about the nature of the medical services available for the expectant mother, who is to be confined in her own home. In these cases the doctor does not accept full responsibility for the ante-natal care, the labour and the lying-in period. This was certainly not the intention of the Act, and the Act did not intend in any way to diminish the importance of either the ante-natal clinics or the midwives by the introduction of the maternity medical services. The general practitioner providing maternity medical services undertakes :— (1) To examine the patient at the time of booking. (2) To examine the patient at about the 36th week. (3) To make a post-natal examination about six weeks after confinement. (4) To provide any medical attention additional to the above either if he considers it necessary, or in response to a call from the midwife. He is not required to undertake the more frequent routine ante-natal supervision that is essential, nor to attend the labour, unless such attendance is considered necessary by himself or by the midwife. The doctor may, of course, provide additional services if he so desires. 9 It will thus be seen that the introduction of the Act has in no way lessened the responsibility of midwives, and the satisfactory record of maternity cases and midwifery cases attended by the District Nursing Association during the year under review shows that there is no falling-off in the call upon their services. It is possible, however, that the proportion of maternity cases (cases also having the services of a doctor) may increase in relation to midwifery cases. Elsewhere in the report, mention is made of the continued progress, within the limits imposed, by the Corporation in the matter of housing. The number of persons per inhabited house has fallen from 3.6 to 3.4. Housing, however, remains one of the major social problems, and has a direct bearing upon the size of families and the method of conducting deliveries. While the domestic help service continues to make provision for many cases, if domiciliary confinements are to be made more popular more domestic help service at a reasonable cost will have to be provided. The infantile mortality rate, as will be seen on page 16, was 16.74 for 1948, being very much lower than the corresponding figure of 23.70 for 1947. This compares very favourably with the figure of 34 for England and Wales, and reflects great credit upon all services in this district having the care of mothers and infants. In reviewing the health of infants, while nutritional states noted at infant welfare centres continued at a reasonably high level, one cannot comment with satisfaction on the continued rationing of essential foodstuffs. The need for more protein and fat in the diet of children and young persons is still felt, and mothers find increasing difficulty in making attractive and nourishing meals, which are so necessary for the growing section of the community. During the year, the department continued to make available additional sources of vitamins, and also proprietary brands of dried milk. This service, which has been continued by the County Council, was very much appreciated by mothers attending infant welfare centres. As compared with the previous year, the records of cases of infectious diseases can be viewed with satisfaction. Only two cases of acute anterior poliomyelitis (infantile paralysis) were notified during the year, as compared with eight notified in the previous year. Only one case of diphtheria was notified, and the number of scarlet fever cases was lower. Measles and whooping-cough provided the most numerically large group of infectious diseases, particularly affecting children below the age of 10 years. On the whole, the Corporation can be congratulated on having completed a satisfactory year in relation to health. Problems of refuse disposal, and the care of the River Wandle, will continue to call for careful planning. Speaking generally, the state of the inhabitants was healthier than in 1947. 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, 1949. Medical Officer of Health. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,048 Population, Census, 1931 26,249 Registrar-General's estimate of resident population for 1948 32,800 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1948 9,626 Rateable Value, December, 1948 £400,045 Sum represented by penny rate, December, 1948 £1,630 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. Some of the Corporation's rehousing schemes reached fruition during the year, and the number of inhabited houses increased during the year from 9,036 to 9,626 (590). The average number of persons per house was 3.4, and while overcrowding in many properties continues, the Corporation has found it possible to abate the worst examples of overcrowding which were noted in the report for the previous year. It is gratifying to note that the average number of persons per house shows a decrease of 0.2, being 3.4 for the year under review as compared with 3.6 for 1947. While the character of the Borough as a whole remains for the most part residential and a dormitory, expansion of industry, which is concentrated in the Northern area of the district, continues. During the year it was found possible to improve many of the parks and open spaces, which had shown signs of inevitable deterioration during the war years. With this restoration, and the continued care and cultivation of such areas, the inhabitants of the Borough show much appreciation of these health-giving amenities. 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 previous years, the swimming facilities provided by the Corporation, through the courtesy of the London County Council, at the Beddington Orphanage bath. Owing to the inclemency of the weather, the season was not so successful in some ways as in 1947. However, the financial responsibility incurred by the Corporation was well repaid in the expressions of appreciation which came from all sections of the community, who had an opportunity of availing themselves of this recreation. 11 EXTRACTS FROM VITAL STATISTICS Total. M. F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 466 243 223 14.57 „ „ Illegitimate 12 7 5 Total 478 250 228 Rate per 1,000 total (live and still) births Still Births 15 7 8 30.43 Death Rate per 1,000 of the estimated resident population. Deaths 340 164 176 10.37 Deaths from Puerperal causes :— Rate per 1,000 (live and still) births Puerperal Sepsis — — Other Maternal causes — — Death Rate of Infants under one year of age :— All Infants per 1,000 live births 16.74 Legitimate Infants per 1,000 legitimate live births 15.02 Illegitimate Infants per 1,000 illegitimate live births 83.33 Deaths from Cancer (all ages) 63 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — 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 1948:— 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 17.9 20.0 19.2 20.1 14.57 Still 0.42 0.52 0.43 0.39 0.46 Deaths— All Causes 10.8 11.6 10.7 11.6 10.37 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.01 0.00 Tuberculosis 0.51 0.59 0.46 0.63 0.18 Influenza 0.03 0.03 0.04 0.02 0.05 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 0.06 Pneumonia 0.41 0.38 0.36 0.54 0.12 Notifications— Typhoid Fever 0.01 0.00 0.01 0.00 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.05 Cerebro-spinal Fever 0.03 0.03 0.02 0.03 0.0? Scarlet Fever 1.73 1.90 1.82 1.37 1.83 Whooping Cough .. 3.42 3.51 3.31 3.13 3.60 Diphtheria 0.08 0.10 0.09 0.10 0.03 Erysipelas 0.21 0.23 0.21 0.22 0.24 Smallpox — — — — — Measles 9.34 9.75 8.84 9.17 15.03 Pneumonia 0.73 0.84 0.60 0.57 0.33 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.05 Acute Polioencephalitis 0.00 0.00 0.00 * 0.00 0.00 Deaths under 1 year of age Rates per 1,000 Live Births. 34 39 32 31 16.74 Deaths from Diarrhoea and Enteritis under 2 years of age 3.3 4.5 2.1 2.4 2.09 Notifications — Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Pyrexia .. 6.89 8.90 4.71 7.34 6.09 Maternal Mortality : England and Wales Abortion with Sepsis. Abortion without Sepsis. Puerperal Infections. Other Causes. Total 0.11 0.05 0.13 0.73 1.02 Beddington and Wallington 0.00 0.00 0.00 0.00 0.00 13 REGISTERED CAUSES OF DEATH. The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1948 :— Causes of Death. Males. Females. Total. All Causes 164 176 340 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — 1 1 4. Whooping Cough — — — 5. Diphtheria — — — 6. Tuberculosis of Respiratory System.. 4 2 6 7. Other forms of Tuberculosis — — — 8. Syphilitic Disease 1 1 2 9. Influenza 1 1 2 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis 2 - 2 12. Acute Infectious Encephalitis — — — 13.m Cancer of Buccal Cavity and Oesophagus (males) 3 - 3 13./ Cancer of Uterus — 1 1 14. Cancer of Stomach and Duodenum.. 9 5 14 15. Cancer of Breast — 12 12 16. Cancer of all other Sites 20 13 33 17. Diabetes 2 —. 2 18. Intra-cranial Vascular Lesions 21 42 63 19. Heart Disease 48 57 105 20. Other diseases of the Circulatory System 11 10 21 21. Bronchitis 10 7 17 22. Pneumonia 4 — 4 23. Other Respiratory Diseases 1 — 1 24. Ulceration of the Stomach or Duodenum - - - 25. Diarrhoea (under 2 years of age) — 1 1 26. Appendicitis —- — — 27. Other Digestive Diseases 4 3 7 28. Nephritis 3 3 6 29. Puerperal and Post-abortive Sepsis .. — — — 30. Other Maternal Causes — — — 31. Premature Birth l — 1 32. Congenital Malformations, Birth Injury, Infantile Disease 6 3 9 33. Suicide 2 3 5 34. Road Traffic Accidents 1 — 1 35. Other Violent Causes 3 1 4 36. All Other Causes 7 10 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 Disease 105 30.88 Cancer 63 18.53 Intra-Cranial Vascular Lesions 63 18.53 Tuberculosis (All Forms) 6 1.76 Pneumonia 4 1.18 Bronchitis 17 5.00 Other Diseases of the Circulatory System 21 6.18 VIOLENCE AND ACCIDENT. The figures of deaths caused by suicide and street accidents remain at a low level. It is gratifying to note that there was only one resident killed in a'street accident during the year, and there were no fatal accidents in the home. Details of all deaths under this heading are as follows :— Cause of Death. Male. Female. Total. Suicide 2 3 5 Street Accident 1 — 1 Other Violent Causes 3 1 4 Totals 6 4 10 MATERNAL MORTALITY. It is gratifying to note that, for the second year in succession, no cases of death in childbirth, either from puerperal sepsis or other maternal causes, were recorded, giving a Nil maternal mortality rate. The maternal mortality rate for England and Wales per 1,000 live and still births was 1.02. 15 INFANTILE MORTALITY. The infantile mortality rate for 1948 was 16.74 per 1,000 live births. This fact reflects great credit upon the services operated in the Borough for the care of mothers and young children. The rate quoted is the lowest for the past 20 years, and compares very favourably with the figure of 34 for England and Wales. Of the total of 478 live births, only 8 deaths of infants under one year of age (6 males and 2 females, one of the females 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 23 - 23 Scarlet Fever :— Examination of nose and throat swabs 2 1 1 Dysentery :— Faces 5 2 3 Paratyphoid Fever ' B ' :— Faeces 6 — 6 Typhoid Fever :— Fasces 3 — 3 Tuberculosis :— Sputa 11 1 10 Totals 50 4 46 During 1948 H. Amphlett Williams, Esq., Ph.D. (Lond.), A.C.G.F.C., F.R.I.C., Public Analyst, 1 Southwark Street, S.E.I, continued the arrangement made in 1946 for the examination of milk, water and ice-cream. In general, pathological specimens are sent to the Pathological Laboratories at St. Helier Hospital. Towards the end of the year, arising out of provisions made under the National Health Service Act, 1946, certain pathological specimens, including some samples of milk and water, were examined free of charge at the Ministry of Health Laboratories at Epsom. 16 AMBULANCE FACILITIES. General and Accident Cases. Reorganisation of the ambulance services was undertaken by the Surrey County Council on their transfer on 5th July. Until this date, the arrangements, which came into operation in 1945, continued to operate successfully. The transfer was effected smoothly, but as under the Act no charge is made for ambulance facilities, the number of cases showed a very great increase in the second half of the year. The County Council thus found themselves faced with a need for considerable expansion. The main ambulance station is situated at St. Helier Hospital, with a sub-station, covering the Beddington and Wallington area, located in Carshalton. NURSING IN THE HOME. This service throughout the year was undertaken mainly by the staff of the Beddington and Wallington District Nursing Association, and their work in the Borough continues to be greatly appreciated. From the 5th July onwards, the Nursing Association, while continuing to offer the same excellent facilities for nursing as in previous years, continue to do this work as agents for the local health authority, the Surrey County Council, to whom the service was transferred. During the year the District Nurses attended 966 cases, including 94 maternity and 89 midwifery patients. TREATMENT CENTRES AND CLINICS. Hackbridge Centre, The Grange, 1. Child Welfare Centres. When held. Every Monday, 2.0-4.0 p.m. London Road. Bandon Hill Centre, Every Tuesday, 2.0-4.0 p.m. Methodist Hall, Sandy Lane North. 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. Post-Natal Clinic. Every Thursday, 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 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 responsibility for the treatment of cases of Tuberculosis, previously undertaken by the Surrey County Council, passed to the Regional Hospital Board on the 5th July. Dispensary facilities continue to be available for residents of the Borough at the St. Helier Hospital, Carshalton. 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 ofchildren 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., 1948 2,610 3,781 6,391 Children who completed full course of immunisation during the year 399 76 475 Number of children who received reinforcing injections during the year 32 184 216 Number of children known to be immunised at 31st Dec., 1948 .. 1,418 2,525 3,943 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. This is one of the services transferred to the local health authority on 5th July. As a result of the Minister's wish that all medical practitioners should take a full part in the immunisation service, many more cases are being immunised by practitioners, who render a return of each case treated to the Divisional Medical Officer. This return may have an important bearing on statistical information available in future years, as prior to the 5th July it had been found impossible to obtain information of patients immunised by private practitioners. 18 WHOOPING COUGH IMMUNISATION. During the year, 130 children were brought to the Public Health Department for immunisation against whooping cough. As from the 5th July, this service has been offered to the public free of charge. 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, and at the Grange Mansion, Wallington, continue to operate for dental treatment and the treatment of minor ailments in children. The Grange clinic, situated in the Beddington and Wallington half of the Mid-Eastern Division, proved most attractive, the dental clinic being a model of its kind. School teachers and parents show marked appreciation for the provision of this clinic, which has supplied a long-felt want in this part of the Division. VENEREAL DISEASES CLINICS. The Surrey County Council was, until the 5th July, 1948, responsible for venereal diseases in the area, and was a member of the London and Home Counties Scheme. This service was taken over on the 5th July by the Regional Hospital Board, who continue to be provide free diagnosis and treatment at the Croydon General Hospital, at clinics established at St. Helier Hospital, the Royal Surrey County Hospital, Guildford, the East Surrey Hospital, Redhill, and at hospitals previously under the London and Home Counties Scheme. HOSPITALS. Infectious Cases. Until 5th July, the Wandle Valley Joint Isolation Hospital at Beddington Corner continued to admit cases of infectious disease occurring in the Borough. On the 5th July, this hospital became the responsibility of the Regional Hospital Board, and was placed for management in the St. Helier Group of hospitals. While most cases in the Borough continue to be admitted to this hospital, as a result of regionalisation several find their way to other hospitals in the Region Small-pox By arrangement with the County Council and the Regional Hospital Board, 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 Hospital, Carshalton. Croydon General Hospital. The Wilson Hospital, Mitcham. GROUP HOSPITALS UNDER THE SOUTH-WEST METROPOLITAN REGIONAL HOSPITAL BOARD. The hospital provided for the area is the St. Helier Hospital at Carshalton, while some cases are sent to Epsom, Kingston and Redhill when accommodation at St. Helier is not available. Maternity Cases. The Regional Hospital Board continues the provision at St. Helier Hospital for maternity cases in the Borough requiring institutional confinements. Some patients continue to be admitted to the Carshalton, Beddington and Wallington (War Memorial) Hospital under arrangements made by their practitioners under the National Health Service Act, 1946. CLEANLINESS. During 1948 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 .. 1 2 3 3 Pediculosis 2 — 17 6 3 3 6 20 2 22 Total .. 3 23 8 6 20 5 25 DISINFECTION. The disinfection of houses has been undertaken by the Council during the year and the Wandle Valley Hospital has continued to cooperate 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 Until the 5th July, 1948, the Council continued to exercise its functions as an autonomous maternity and child welfare authority. On that date, however, this most important function, now described as the Care of Mothers and Young Children under the National Health Service Act, 1946, passed to the control of the Surrey County Council, the local health authority appointed by the Minister under the Act. The Corporation's staff of three Health Visitors thus became County Council servants from the 5th July. The transfer has been effected smoothly and efficiently, and there has been no break in the continuity of the services provided, and the high standard previously maintained by the Corporation has been kept up. The District Nursing Association midwives continue to conduct a great deal of domiciliary midwifery in the area, working in close harmony with the Department. They, too, however, from 5th July became servants of the County Council, while the District Nursing Association continues to act as agent of the County Council. During the year the midwives attended a total of 183 confinements. Ninety-four of these cases also had the services of a doctor. 21 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 11.4 patients per session. During the year, 339 expectant mothers attended the clinic, as compared with 412 in 1947. This represents approximately 69 per cent, of the total notified births, live and still, which were assigned to the Borough during 1948, and is a creditable reflection on the efficiency and consequent popularity of the Council's Ante-natal Service. POST-NATAL CLINIC. During 1948 the Post-natal Clinic, recommenced in September, 1946, continued to offer facilities in this important branch of maternal care. Considerably more women have Post-natal supervision than are recorded in the tables. Women who have an institutional delivery usually return to hospital as a routine a few weeks after their discharge, and have their post-natal examination conducted by the Hospital Medical Officers. It is possible that the number enjoying this facility is over 50 per cent, of the total mothers. Ante-natal and Post-natal Attendances, 1948 Council Cases. Nursing Association Cases Total, 1948. Total, 1947. Ante-natal Cases :— Number of Clinics held —- — 104 101 Total number attending during the year 206 133 339 412 Number of first attendances 158 83 241 302 Number of re-attendances .. 439 511 950 1,038 Total attendances 597 594 1,191 1,340 Average attendance per session 5.7 5.7 11.4 13.3 Post-natal Cases :—• * Total number attending during the year 34 51 85 111 Number of first attendances 34 48 82 III Number of re-attendances 1 3 4 26 Total attendances 35 51 86 137 22 CONSULTANT ANTE-NATAL AND POST-NATAL CLINIC. Mr. Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. (G.), M.C.O.G., continued until 5th July to conduct this clinic on the third Friday in each month when required. The facilities provided by St. Helier Hospital for consultant ante-natal and post-natal work are made use of in everincreasing degree, and the need for calling on the services of Mr. Lindsay does not often arise. The attendances were as follows :— * Referred by Medical Officer, Ante-natal Clinic Private Practitioners. Totals. 1948. 1947. C. N.A. Clinics held 2 3 Patients attending : Ante-natal 2 — 1 3 6 Post-natal 1 — — 1 1 Total attendances .. 3 — 1 4 7 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. 1948. 1947. Number of sessions held 51 48 26 26 151 153 Infants :— No. of new cases under 1 year 155 133 71 69 428 509 No. of re-attendances 2,311 1,845 674 761 5,591 5,713 No. of new cases over 1 year 52 47 23 21 143 132 No. of ances 1,448 1,286 646 739 4,119 . 3,565 Total attendance of infants 3,966 3,311 1,414 1,590 10,281 9,919 Average attendance of infants per session 77.8 69.0 54.4 61.2 68.1 64.8 Mothers attending 3,620 3,140 1,310 1,436 9,506 8,238 Total attendances 7,586 6,451 2,724 3,026 19,787 18,157 Average total attendance per session 148.8 133.3 104.8 116.4 131.1 118.7 23 INSTITUTIONAL CONFINEMENTS. As has been mentioned previously in this- report, the general demand Tor institutional confinements continues to grow. Fifty-eight per cent, of births allocated to this district took place in institutions or nursing homes. Many of these cases were admitted because of overcrowding or other home circumstances ; others had hospital confinements on medical grounds. This figure seems very high, and when the acute housing shortage has been overcome it is probable the demand will be less, thus making more beds available for other classes of patients, who so urgently require them. The number of mothers confined in hospitals formerly under the Surrey County'Council during the year was as set out below :— St. Helier 127 St. Luke's (Guildford) 4 Epsom 5 Redhill 2 Dorking 4 142 Seventy patients were delivered under private arrangements at the Carshalton, Beddington and Wallington District (War Memorial) Hospital, and a further 74 at private nursing homes and other institutions. HOME HELP AND DOMESTIC HELP SERVICE. The Corporation's sciieme for the provision of home and domestic help continued to expand throughout the first six months of the year, and was handed over to the Surrey County Council on the 5th July as a very efficient working organisation. The Corporation were much indebted, and the County Council continues to be indebted, to Mrs. Best, Mrs. Wiles and Mrs. Prince of the Women's Voluntary Services for their considerable help in running this service. As a result, the number requiring the service and not being satisfied was considerably reduced, and towards the end of the year it was found possible to satisfy 100 per cent, of requests for service. The importance of this branch of social service cannot be overemphasised, especially if we are to improve the circumstances of domiciliary midwifery. Many women, who in the past have asked for institutional confinements would probably be only too pleased to have the confinement at home if adequate domestic help were available. The cases attended were as follows :— Maternity General Medical Full-time 71 35 Part-time 3 91 74 126 24 FAMILY PLANNING. During the year the Corporation made arrangements with the Carshalton and District Family Planning Association. A few women attended the clinic conducted by the 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 forty-one cases were referred from the Maternity and Child Welfare Centres to the under-mentioned hospitals during the year :— Croydon General Hospital 53 St. Helier County Hospital 81 Queen Mary's Hospital 4 Wilson Hospital 2 Hospital for Sick Children (Great Ormond Street) 1 141 The conditions requiring treatment were :— Orthopædic Defects 6 Circumcision 41 Eye Conditions 23 Skin Conditions 9 Ear and Nose Conditions 4 Nævus 23 Tonsils and Adenoids 12 Feeding Difficulties 2 Chest Conditions 7 Nervous Conditions 1 Miscellaneous Ailments 13 Dental. During 1948, 132 cases were referred for treatment as follows :— Expectant Mothers 51 Nursing Mothers 7 Children under 5 years . 74 132 25 Orthopædic. Patients attending the Centres who require treatment for orthopædic defects are referred by the Medical Officer of Health to the Orthopædic Departments of the St. Helier, the Croydon General and Guy's Hospitals. ARTIFICIAL SUNLIGHT : SOLARIUM. During 1948, its 4th year of operation, 546 new patients attended the the Solarium, the total attendances for all cases being 7,469. 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 table below gives details of the attendances :— First Attendances. Reattend ances. Total, 1948. Total, 1947. Children : 0-5 years 395 5,188 5,583 6,089 5-15 years 88 984 1,072 629 Adults : Expectant Mothers 13 123 136 81 Nursing Mothers 9 123 132 84 Private Patients 41 505 546 189 546 6,923 7,469 7,072 In addition to the attendances for irradiation as shown in the foregoing table, 1,938 corrective treatments were carried out by the Physiotherapist either at the Solarium or in the home of the patient. 26 HEALTH VISITING. The following is a summary of the work carried out by the three Health Visitors during 1948 :— Maternity Visits. 1948. 1947. First visits to Expectant Mothers 72 106 Re-visits to Expectant Mothers 78 57 Breast Feeding observations and test feeds 48 30 Infant Welfare. First visits under 1 year 480 533 Re-visits under 1 year 809 924 First visits over 1 year 14 70 Re-visits over 1 year 1,574 1,058 Special Home Visits. Still Births 9 15 Infant Deaths 7 9 Child Life Protection. First visits 22 26 Re-visits 177 318 Infectious Diseases. Tuberculosis 48 50 Scabies and other verminous conditions 2 8 Puerperal Infections 1 1 Diphtheria Swabs taken 1 53 General Visits. Home Enquiries, Agreements, etc. 50 33 Adoption of Children 24 81 Home Help and Domestic Help 72 249 Miscellaneous visits 142 149 Ineffective visits 580 412 Totals 4,210 4,182 Attendances at Clinic Sessions. Maternity and Child Welfare Centres 354 339 Ante-natal and Post-natal Clinics 220 198 Totals 574 537 Interviews in Office 679 808 Attendance at Medical Examinations 13 8 Attendance at Immunisation Clinics 52 52 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 9 Number of children on the register at the end of the year 39 Number of children who died during the year During the year 199 visits were paid. No proceedings were taken under the Act. ADOPTION OF CHILDREN (REGULATION) ACT, 1939. The Court did not.call upon the Corporation to act as guardians ad litem for any cases during the year. By the introduction of the Children Act, 1948, on the 5th July, and the appointment of Children's Officers and the transfer of the statutory obligations previously borne by the Council to the local health authority, the Surrey County Council, it is anticipated that considerable changes will be made in the present arrangements for the supervision of children awaiting adoption. THE CARE OF PREMATURE INFANTS. The arrangements made for the care of premature infants were continued during 1948. All equipment is kept at the District Nursing Association, the headquarters of the local midwives, where it is ready for immediate use when required. Of the 25 premature births, 20 occurred in institutions and only 5 cases were recorded in the practice of the domiciliary midwives. Twenty-three of the cases responded successfully to routine treatment. The remaining 2 infants died within 24 hours. THE CARE OF ILLEGITIMATE CHILDREN. Arrangements for the care of illegitimate children, described in previous reports, were continued throughout 1948. 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 27 samples o.f 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. RIVERS AND STREAMS. The cleansing of that section of the River Wandle which is the responsibility of the Council, namely, from north of the Carshalton railway line to the Croydon boundary, has been maintained throughout 1948, various parts being cleansed of silt and obstructions, particularly that section north of London Road. Following periods of heavy rain trouble was experienced, particularly along the higher reaches of the river, due to infiltration of oil from surface water drains in the Croydon area. The Waddon Ponds, which are the principal source of supply of spring water to the river in this area, have been dry for most of the year, they recommenced flowing in December, 1948, but the amount of water entering the river was small. Due to this, difficulty was experienced throughout the year in keeping the river free from pollution. In December, 1948, the Council decided to appoint a Consulting Engineer to report on the possibility of sinking a well near the Croydon boundary in order to increase the flow to the river. 29 CLOSET ACCOMMODATION. Practically the whole of the area is on the water carriage system, draining into 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. Tipping on this shoot ceased on the 31st December, 1948, except for trade refuse. The Corporation have made arrangements for tipping on Mitcham Common, on the controlled tip already operated by Croydon Corporation. 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. 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, 1948. DWELLING-HOUSES. Number of inspections of dwelling-houses 1,065 Number of inspections recorded under Housing Regulations Underground rooms closed 8 MILK AND DAIRIES. Number of cowkeepers on register Number of purveyors of milk on register 33 Number of purveyors 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 4 Defects in dairy premises discovered and remedied 3 Infringements of Acts and Regulations : Pasteurised milk not complying with prescribed conditions 3 Extraneous matter in milk 3 Unclean milk vessels 2 — 8 Prosecutions (dirt in milk) 1 (Defendants fined £10, and £15 15s. costs.) Number of licences issued under the Milk (Special Designations) Regulations :— Tuberculin Tested—Dealers' Licences 4 „ „ Supplementary .Licences 7 Pasteurised—Dealers' Licences 3 „ Supplementary Licences 7 Pasteuriser's Licence 1 — 22 ICE CREAM. Number of premises on register 48 Number of inspections of premises 93 Number of samples taken for examination 27 SLAUGHTERHOUSES. Number of slaughterhouses on register 1 Number of animals killed at slaughterhouse — Number of visits to other premises on which animals were slaughtered for human consumption .. 2 31 Carcases inspected and condemned :— Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — — — 2 Number inspected — — — — 2 Whole carcases condemned - - or Carcases of which some part or organ was condemned - - - - - FOOD PREMISES. Total number of inspections 591 Total number of defects discovered and remedied 59 UNSOUND FOOD. Destroyed or released for approved purposes :— lbs. Bacon 44 Cereals 886 Cheese 63 Eggs No. 484 — Fish 1,494 Fish, canned 117 Fruit pulp 7,580 Fruit, canned 230 Fruit, dried 31 Fruit juice 85 Jam and marmalade 204 Meat and meat products 356 Meat, canned 553 Milk, condensed 27 Milk, evaporated 232 Mincemeat 19 Pickles 59 Poultry and rabbits 141 Pudding mixture 72 Sausages 79 Soup, canned 52 Vegetables, canned 518 Miscellaneous foodstuffs 183 Total 13,025 32 FOOD ANALYSES. Number of samples analysed by Public Analyst 103 Number of samples reported against :— Breakfast Oats—excess of free fatty acids 1 Buns—contained mineral grease 1 Curry Powder—excess of lead 1 Gelatine—excess of arsenic and zinc 1 Golden Eye Ointment—deficient in yellow mercuric oxide 1 Milk—1 per cent. added water 1 — 6 FACTORIES. Number of factories on register (including bakehouses) 108 Number of inspections 168 Number of defects discovered and remedied 101 BAKEHOUSES. Number of bakehouses in district 11 Number of inspections 25 Number of defects discovered and remedied 6 WORKPLACES. Number of inspections of workplaces 32 Number of defects discovered and remedied 1 SHOPS AND OFFICES. Number of visits to shops re sanitary requirements 288 Number of defects discovered and remedied 70 COMPLAINTS. Complaints received and dealt with during the year were due to the following causes :— Defects in dwelling-houses (various) 224 Rats and mice 75 Stoppages in drains 56 Defects in drains or water closets 29 Defective dustbins 27 Food supplies . 31 Insect pests 11 Miscellaneous 56 509 33 SMOKE ABATEMENT. Number of observations 37 Nuisances dealt with 3 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 143 Number of rooms disinfected 145 Lots of bedding and clothing disinfected 113 Number of library books disinfected 380 OFFENSIVE TRADES AND FISH FRYING. Number of offensive trade premises in district Nil Number of fish frying premises in district 7 Number of visits to fish frying premises 26 Number of defects discovered and remedied 9 RATS AND MICE. Number of visits to infested premises 167 Number of premises upon which rats were found and remedial action taken 56 NOTICES. Number of informal notices served (including verbal intimations) 555 Number ot statutory notices served :— Public Health Act, 1936, Section 75 (Dustbins) 17 Public Health Act, 1936, Section 93 (Nuisances) 11 Public Health Act, 1936, Section 45 (Closets) 4 Public Health Act, 1936, Section 39 (Drains) 1 — 33 Closing Orders (Underground Rooms) 8 SANITARY IMPROVEMENTS. Water Supply. Water pipes and fittings repaired or renewed 31 Drains. Drains re-laid or repaired 116 Drains unstopped and cleansed 57 Intercepting traps provided with rod-eye stoppers 14 Manholes provided or repaired 32 Soil or ventilation pipes repaired or renewed 13 Gully kerbs and channels repaired 37 New soakaways constructed 23 Closets. New closets provided 8 Buildings repaired 20 New pans fixed to water closets 68 34 Flushing cisterns repaired or renewed 36 Flush pipes and pan joints repaired or renewed 6 Lighted and ventilated 7 Seats repaired or renewed 30 Urinals repaired 5 Sinks. New sinks provided 5 Waste pipes repaired or renewed 29 Yards. Yards newly paved or repaired 18 Dust Receptacles. New portable iron dustbins provided 205 Dampness. Roofs repaired 134 Rainwater gutters repaired or renewed 156 Rainwater downspouts repaired or renewed 79 Damp-proof courses provided 23 Windows, sills and doors made weatherproof 41 External walls repaired, repointed or rendered 77 Ventilation provided under floors 31 General Repairs. Rooms cleansed 99 Walls and ceilings repaired 462 Floors repaired 85 Stoves repaired or renewed 20 Windows repaired 50 Chimneys repaired 65 Number of premises disinfested from bed bugs 9 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 1,065 Number of re-inspections of premises 1,970 Number of visits to works in progress 976 Number of miscellaneous visits and inspections 536 Number of visits to dairies 4 Number of visits to ice-cream premises 93 Number of visits to fried-fish shops 26 Number of visits to miscellaneous food premises 441 Number of vists to bakehouses 25 Number of vis.its to factories 168 Number of visits to workplaces 32 Number of visits to shops and offices 288 Number of visits to premises re slaughtering 2 35 Number of visits to stables and yards 34 Number of visits to market gardens, etc. 22 Number of visits to urinals . 114 Number of visits to piggeries 27 Number of visits re infectious diseases 143 Number of visits to streams 51 Number of visits re rats 167 Number of visits re smoke abatement 37 Number of complaints received and investigated 509 Number of informal notices served 555 Number of statutory notices served 33 Number of interviews re nuisances, etc. 1,009 Number of drain tests applied 216 Number of rooms disinfected 145 Number of lots of bedding and clothing disinfected 113 Number of library books disinfected 380 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-eight inspections were made during 1948 and in 12 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 1948 Summer season) the open-air swimming bath situated in the grounds of the Royal Female Orphanage. The supervision and arrangement 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 18 weeks, the following attendances were recorded :— Youth organisations 4,822 Schoolchildren 1,793 Borough Swimming Club : Adults 3,004 Children 3,859 Total 13,478 ERADICATION OF BED BUGS. During the year bed bugs were found to exist in 9 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. All the schools are supplied with water from the public mains and are connected with the sewers. During the year it was found possible to redecorate many of the schools, and generally the sanitary conditions are now better than at the end of the war. Much work remains to be done, however, and with the present shortage of materials and building facilities it is not possible to make more rapid progress. REGULATED TRADES : DAIRIES. There are six dairy premises on the register. During the year only at one dairy was loose milk handled, and this was discontinued in February, 1948. During the year 4 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 11 SLAUGHTERHOUSE There is only one Slaughterhouse within the district. No animals were killed on the premises during the year. BAKEHOUSES. There are 11 Bakehouses in the district. The premises were visited periodically. Unsatisfactory conditions were found to exist in 3 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 12 21 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 95 144 5 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 1 3 - - Total 108 168 5 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 6 1 - - - - Cosaques, Christmas crackers,Christmas stockings, etc. 33 — — — - - Total 39 1 — — — — 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 ToH.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) 1 1 — 1 - Overcrowding (S.2) — — — — - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) _ - - - - Sanitary conveniences (S.7)— - - - - (a) Insufficient — — - — - (b) Unsuitable or defective 8 8 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 7 - 7 - - Total 16 9 7 1 — 39 HOUSING No statistics in the tabular form usually required by the Ministry of Health are submitted. The Minister has not asked for this information and, owing to the present chaotic state of housing repairs and the difficulty in remedying defects, such statistics would not give an accurate picture of housing as a whole. INSPECTION AND SUPERVISION OF FOOD. MILK. During the year the following samples of milk sold within the district were examined :— Class of Milk. No. taken. Pasteurised 88 Tuberculin Tested, Pasteurised 3 Ungraded 1 Total 92 Three 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. Mr. H. Amphlett Williams, Ph.D.(Lond.), A.C.G.F.C., F.R.I.C., of 1, Sputhwark Street, London, S.E.I, is 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 & golden raising powder - 5 5 - - - - - Breakfast Oats - 1 1 - 1 1 _ _ Buns — 1 1 — 1 1 - - Butter — 6 6 - - - - - Coffee & Chicory 1 1 - - - - - Coffee & Chicory essence _ 3 3 - - - - - Confectionery - 1 1 - - - - - Cooking fat - 3 3 - 1 - - - Curry powder - 4 4 — 1 - - Flavouring essence 1 1 - - - - - Gelatine - 12 12 — 1 1 - - Margarine - 6 6 - - - - - Milk - 32 32 —- 1 1 - - Mustard - 1 1 - - - - - Peanut butter - 1 1 - - - - - Pepper - 5 5 - - - - - Soup, canned - 2 2 - - - - - Tea - 1 1 - - - - - Vinegar - 3 3 - - - - - Cherry Liqueur 1 1 - - - - - Whisky - 2 2 - - - - - Rum - 2 2 - - - - - Golden eye ointment - 2 2 - 1 1 _ _ White precipitate ointment - 3 3 - - - - - Aspirin tablets - 4 4 - - - - - Totals — 103 103 — 6 6 — — 41 CHEMICAL AND BACTERIOLOGICAL EXAMINATIONS. Work of this nature is carried out when required by H. Amphlett Williams, Esq., Ph.D.(Lond.), 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. During the whole of the year, including months subsequent to the transfer of the services to the Surrey County Council, proprietary brands of vitamin preparations, in addition to those provided under the Government's welfare food scheme, have been offered for sale at reduced charges to parents attending infant welfare centres. This service has been much appreciated, as many children cannot digest cod liver oil, and, in some cases, orange juice. 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 VII 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 1948, 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 60 49 1 Diphtheria 1 1 — Erysipelas 8 2 - Pneumonia 11 2 4* Measles 493 4 — Whooping Cough 118 2 — Puerperal Pyrexia 3 2 — Cerebro-Spinal Fever 1 1 — Acute Poliomyelitis 2 1 2 Dysentery 1 1 — Paratyphoid Fever "B" 2 2 - Totals .. 700 ' 67 7 * Includes deaths from all forms of pneumonia. Includes deaths of residents in homes and institutions outside the Borough. 43 44 Cases of Infectious Disease Notified During the Year 1948 (excluding Tuberculosis). Disease. At all ages. Number of Cases Notified. At Ages—Years. Total Cases notified in each Ward. Cases removed to Hospital. Deaths (including deaths of residents outside the Borough). 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. West Central. South. North. Central. South. Scarlet Fever 60 - 1 3 6 5 29 8 3 3 1 1 - 20 5 7 1 13 8 6 49 1 Diphtheria 1 — —- — — — — 1 — — — — — — — — 1 — — — 1 — Erysipelas 8 - - - - - - - - - - 7 1 1 3 1 1 1 1 —- 2 — Pneumonia 11 — — 1 1 — — — 1 3 2 3 — 3 2 2 — 1 2 1 2 *4 Measles 493 16 46 53 43 54 258 16 1 5 1 — — 124 52 70 36 87 94 30 4 — Whooping Cough 118 9 14 18 14 19 37 1 1 3 1 1 32 7 16 4 29 19 11 2 — Puerperal Pyrexia 3 - - - _ 1 2 - - 1 1 — 1 — — 2 — Cerebro-Spinal Fever 1 - - - - 1 - - - - - - - - - - - - 1 — 1 — Acute Poliomyelitis 2 - - - - _ 1 1 - - - — - 1 1 1 2 Dysentery 1 1 - 1 - 1 - Paratyphoid Fever ' B ' 2 -- 1 - - - - - 1 - - - - 1 - - - - - 1 2 — Totals 700 25 62 75 64 79 325 26 7 16 7 12 2 181 70 97 43 132 127 50 67 7 Includes all forms. The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections :— 45 The Monthly Incidence of Infectious Disease, 1948 (excluding Tuberculosis). Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 5 11 9 9 3 8 4 1 2 4 3 1 60 Diphtheria - - - - - - - - - 1 - - 1 Erysipelas — — — 3 — 1 — — 1 1 1 1 8 Pneumonia — 2 1 2 1 — —- 1 1 1 — 2 11 Measles 4 4 47 76 61 114 161 20 1 2 — 3 493 Whooping Cough 3 17 9 13 12 12 13 19 6 6 3 5 118 Puerperal Pyrexia 1 — — — — — — 1 — 1 — — 3 Cerebro-Spinal Fever - - - - - 1 - - - - - - 1 Acute Poliomyelitis — — — — — — — 1 — 1 — — 2 Dysentery - - - - - - 1 - - - - - 1 Paratyphoid Fever "B" - - - - - - - 2 - - - - 2 Totals 13 34 66 103 77 136 179 45 11 17 7 12 700 Tuberculosis. There were 21 new cases notified during the year. The following table gives the number of new cases notified during the past five years :— New Cases. 1944. 1945. 1946. 1947. 1948. M. F. M. F. M. F. M. F. M. F. Pulmonary 18 9 17 13 24 6 15 8 8 11 Non-Pulmonary 2 4 3 2 2 3 6 1 1 1 Totals 20 13 20 15 26 9 21 9 9 12 Annual case rate per 1,000 of the estimated population :— 1948. 1947. Pulmonary 0.58 0.71 Non-pulmonary 0.06 0.22 The following table gives the number of deaths from this disease during the past five years :— Deaths. 1944. 1945. 1946. 1947. 1948. M. F. M. F. M. F. M. F. M. F. Pulmonary 5 4 6 10 7 1 4 4 4 2 Non-Pulmonary 1 — 2 1 — — 2 — — — Totals 6 4 8 11 7 1 6 4 4 2 It will be seen from the foregoing table that 6 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 0.18. This rate is considerably lower than that for the previous year, which was 0.31. 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-Pul- monary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1 and under 5 - - - - - - - - 5 and under 10 - - - - - - - - 10 and under 15 - - - - - - - - 15 and under 20 2 1 - — 1 — — — 20 and under 25 3 1 — 1 — 1 — — 25 and under 35 2 6 1 — — 1 — — 35 and under 45 — 1 — — 2 — — — 45 and under 55 — 1 - - - - - - 55 and under 65 1 1 — — 1 — — — 65 and upwards - - - - - - - - Totals 8 11 1 1 4 2 - — The new cases were distributed amongst the Wards as follows North Beddington. South Wallington. West. Cent. North Cent. South Pulmonary 4 2 3 1 4 4 1 Non-Pulmonary — — 1 — — 1 - Totals 4 2 4 1 4 5 1 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 11 such examinations were made. Treatment for cases of Tuberculosis is now, since 5th July, the responsibility of the Regional Hospital Board, who provide both sanatorium and dispensary treatment. The Tuberculosis After-Care Committee continued its good work during 1948. 47 ■ ■