LIBRARY BED 14 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1949 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1949 TABLE OF CONTENTS ' Public Health Committee 5 Representatives on Mid-Eastern Divisional Health Sub-committee 5 Representatives on the Wandle Valley Joint Sewerage Board 5 Staff 6 Statistics and Social Conditions 11 Extracts from Vital Statistics 12 Vital Statistics : Comparative Crude Birth-rates, Death-rates, Analysis of Mortality, etc., 1949 13 Registered Causes of Death 14 Violence and Accident 15 Maternal Mortality 15 Infantile. Mortality 15 General Provision of Health Services for the Area : Laboratory Facilities 16 Ambulance Facilities 16 Nursing in the Home 17 Treatment Centres and Clinics : Maternity and Child Welfare 17 Tuberculosis 17 Immunisation against Diphtheria 18 Immunisation against Whooping Cough 18 School Clinics 18 Venereal Diseases Clinics 19 Hospitals 19 Cleanliness 20 Disinfection 20 Sanitary Circumstances of the Area : Water Supplies 20 Drainage and Sewerage 21 Rivers and Streams 21 Closet Accommodation 21 Public Cleansing 22 Sanitary Inspection of the Area 23 Statement of the Senior Sanitary Inspector for the Year 1949 : Dwelling Houses 23 Milk and Dairies 23 2 Ice Cream 23 Slaughterhouses 23 Food Premises 24 Unsound Food 24 Food Analyses 25 Factories 25 Bakehouses 25 Workplaces 25 Shops and Offices 25 Complaints 25 Smoke Abatement 26 Infectious Disease and Disinfection 26 Offensive Trades and Fish Frying 26 Rats and Mice 26 Notices 26 Sanitary Improvement: Water Supply 26 Drains 26 Water Closets 26 Sinks 27 Yards 27 Dust Receptacles 27 Dampness 27 General Repairs, etc. 27 Summary of work done during the year 27 Shops and Offices 28 Camping Sites 28 Swimming Bath 28 Eradication of Bed Bugs 28 Schools 29 Dairies 29 Milk (Special Designations) Regulations 29 Slaughterhouse 29 Bakehouses 29 Factories 30 Housing 32 Inspection and Supervision of Food : Milk 32 Meat 32 Food and Drugs Act, 1938 32 Chemical and Bacteriological Examinations 34 Outbreaks of Food Poisoning and Clean Food Campaign 34 Nutrition 34 Shell Fish (Molluscan) 34 3 Adoptive Acts and Bye-Laws 34 Prevalence and Control over Infectious and other Diseases : Notifiable Diseases (other than Tuberculosis) 35 Incidence of Infectious Diseases in Age Groups and Wards 36 Monthly Incidence of Infectious Disease 37 Tuberculosis 38 Transferred Functions under the National Health Service Act, 1946 : The Care of Mothers and Young Children 40 Ante-natal and Post-natal Supervision 40 Infant Welfare Services 40 Institutional Confinements 40 Domestic Help Service 40 Treatment: Minor Ailments 41 Dental 41 Orthopaedic 41 Physiotherapy 42 Health Visiting 42 Child Life Protection 42 Care of Premature Infants 43 Care of Illegitimate Children 43 4 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITTEE December, 1949. Members : Councillor Mrs. V. M. Boyce (Chairman) Councillor A. H. Prior (Mayor) Councillor A. C. Martin (Deputy Mayor) Alderman F. G. Bryant Councillor Miss K. C. Bratt Councillor D. H. de Voil Councillor S. W. Eastman Councillor A. R. Gill Councillor G. H. Hyett Councillor C, H. Norman Councillor A. Stammers REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE Decembrr, 1949. Members ; Councillor Mrs. V. M. Boyce (Chairman) Councillor Miss K. C. Bratt Councillor D. H. de Voil Councillor A. R. Gill Councillor G. H. Hyett REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD,. December, 1949. Members : Councillor A. H. Prior (Mayor) Alderman J. Vale Councillor C. A. Bishop Councillor A. H. Pearce 5 STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. 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. W. A. Watts, A.R.S.I., M.R.I.P.H.H., M.S.I.A. Clerks:— R. F. Burns (Chief Clerk). E. D. Evezard. G. H. Bourne. P. H. Sadler (H.M. Forces). B. G. Bignell (Temporary). STAFF EMPLOYED BY THE SURREY COUNTY COUNCIL IN THE BEDDINGTON AND WALLINGTON HALF OF THE MIDEASTERN DIVISION OF THE COUNTY Divisional Medical Officer and Medical Officer to the Divisional Executive for Education Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. Assistant Clinical Medical Officers:— Margaret G. Falla, M.B., Ch.B. Ann T. Harling, M.R.C.S., L.R.C.P. Health Visitors:— Mrs. M. N. Chenery, S.R.N., S.C.M., H.V.Cert. Miss E. O. Ellis, S.R.N., S.C.M., R.F.N., H.V.Cert. Miss N. M. Lines, S.R.N., S.C.M., H.V.Cert. Mrs. K. E. Young, S.R.N., S.C.M., H.V.Cert. Physiotherapist:— Miss G. Allen, M.C.S.P. Assistant to Physiotherapist :—Miss D. S. Raymond. Administrative Assistant:— R. F. Burns. Clerks:— E. D. Evezard. Miss G. Williams. 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 1949. This is the first report on a complete year's work presented to the Corporation since the coming into operation of the National Health Service Act of 1946. As explained in the report for 1948, the Surrey County Council, as local health authority under the Act, now control the following services which were previously administered by the Corporation:— 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. The description of these services and their administration is no longer included in the body of the report, but, in order that the Corporation may have a fuller appreciation of the health of the district as a whole, a brief summary has been appended to the report, in which a statistical statement of the functioning of these transferred services is set out. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 2/50. The vital statistics are based on information supplied by the Registrar-General. The Registrar-General estimated the population of the Borough at the middle of the year at 32,890, but from information available from local sources (e.g., the Food Control Office) the population at the end of 1949 was 35,000. The birth rate per 1,000 total population shows a marked decrease at 13.23 in 1949, as compared with 14.57 in 1948, and is below that for England and Wales, which is 16.7. The stillbirth rate of 0.21 per 1,000 total population is lower than the figure of 0.46 for 1948, and compares favourably with that for England and Wales, which is 0.39. The stillbirth rate per 1,000 total births is 15.84, and is appreciably lower than that for 1948, which was 30.43. The death rate from all causes per 1,000 total population is 10.90, compared with 10.37 in 1948 and 11.7 for England and Wales. Of the 382 deaths, diseases of the heart and circulatory system accounted for 120 (31.41 per cent. of total deaths), cancer 66 (17.28 per cent. of total deaths) and tuberculosis 13 (3.40 per cent. of total deaths). The maternal mortality rate per 1,000 total births is nil, as compared with 0.98 for England and Wales. For the third 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. 7 The infantile mortality rate, which is set out on page 15, was 9.19 per 1,000 live births in 1949, being the lowest figure yet recorded in this district. The figure for 1948 was 16.74 ; that for England and Wales for 1949 being 32. This new low record is very satisfying, and certainly reflects great credit upon all those having to do with childbirth and the care of very young infants. A review of vital statistics, even on such a small scale as recorded in this Borough, inevitably invites speculation on the trend of population. Undoubtedly the decline in the birth rate, which we have continued to record will have a serious effect in the latter part of this century. The principal statistical observation concerns the proportion of the old to the young in the State. Where the proportion of the old is in excess of the young, especially in a Welfare State, it may prove almost impossible for the diminishing number of young workers to support the ever-increasing number of persons living at a pensionable age. The Rowntree Committee of the Nuffield Foundation, in their population investigation, stated that of a total population in England and Wales of 43,208,000 in 1947, 5,795,000, or 13.5 per cent., were of a pensionable age. Other statisticians have estimated the proportion of pensionable to working persons in the population at present, at 1 in 6. If, however, the present trend continues, in 20 years time this is likely to become 1 in 4, One factor of serious concern is the present high level of taxation, which makes it well-nigh impossible for persons to save up for their old age, as they did in Edwardian and Victorian times. As a result, more and more persons are likely to require State aid in their advancing years as the century progresses, and this burden of providing for the old will fall upon an ever-dwindling proportion of young workers. Our outlook on old age, however, is undergoing a change. The onset of old age (senescence) varies with individuals, and with the advance in modern medicine, it may be possible to review the arbitrary time-limit now fixed for a pensionable age. For various reasons, modern legislation has assessed pensionable age at 60 in women and 65 in men. It may be confidently anticipated that many persons over these ages will be capable of doing productive and useful work for much longer periods, and the accepted standards of old age may have to be completely revised. During the past few decades, a phenomenal fall in infantile mortality has been noticed in England and Wales, and the expectation of life and the prospect of infants reaching full maturity is very much greater than it was. This factor may to a small extent help to balance the ill-effects of a declining birth rate on the population. One other factor associated with the low birth rate is the number of families who have only one child, with the associated psychological difficulties of rearing such children. It has recently been pointed out by the distinguished paediatrician, Sir James Spence, that children reared singly, without the balancing influence of a large family, in which they are members of a group, tend to have psychological difficulties at home and in school for which it is difficult to find a remedy. Nursery schools and nursery classes in primary schools are increasingly being called upon 8 by the psychiatrists in charge of child guidance clinics to provide for these children the normal background, which they would have had in a reasonably large family. The increase in the number of children, whose parents seek the advice of psychiatrists is alarming, and presents a serious problem. It can be recorded with satisfaction that during the year considerable work has been done for the aged in Beddington and Wallington. The work of the old people's committee in promoting social clubs has done much to alleviate the lot of old persons living alone. Social outings, too, have given an opportunity for these people to visit seaside and country resorts, which they had given up hope of seeing again. The work of the Women's Voluntary Services, too, is beyond praise, and it would be ungracious not to take this opportunity of recording with what great appreciation the work of the W.V.S., particularly in connection with the home help service, has been received during the year. A W.V.S. home help supervisor (Mrs. D. Best), acting under the direction of the Divisional Medical Officer, has given voluntary full-time service throughout the whole year. Much of the provision of home help service has been on behalf of the aged, some of whom have been sick and infirm and have had to be nursed at home because of the shortage of institutional accommodation. Frequent calls by the almoners of hospitals and of the geriatric department at St. Helier Hospital have had to be met, but in spite of the financial limitation on the expansion of home help services, all deserving cases have received the attention required as soon as they were brought to the notice of the department. On page 38, under the heading of " Deaths from Tuberculosis ", it will be noticed that there has been an increase of over 100 per cent, on the figures recorded in 1948; 13 deaths in 1949 as compared with 6 in 1948. The prevalence of tuberculosis, especially amongst young people, and the amount of illness caused by this infection, is only now being properly appreciated, and is giving rise to considerable public anxiety. Statistical observers throughout England and Wales have shown that, of all the infectious diseases, tuberculosis causes the largest number of deaths in childhood. Miller has shown that in England and Wales during 1945, one-seventh (14 per cent.) of the deaths of children between one and fifteen years of age were due to tuberculosis, and has stated that at school age tuberculosis is the chief infective cause of death. A general increase in the number of cases notified in the young has also been noted throughout the country, and some administrative action on a National scale is undoubtedly called for. The contributory causes for the present spread of the scourge are, without doubt, inadequate housing and shortage of institutional beds in hospitals and sanatoria for the treatment of tuberculosis. Many advanced cases in a highly infectious state have to be nursed in already overcrowded homes, and it has been found impossible to segregate young children in such a way as to prevent their becoming infected. During the year, the Corporation has made a strenuous effort to improve the housing conditions in the Borough. 9 Housing undoubtedly remains one of the most crucial problems, not only in this Borough, but for the country as a whole. Unfortunately, the limitations of space now prevent the Corporation from undertaking any large-scale expansion. During the year, as will be seen from the tables set out on pages 35—37, there was no major outbreak of infectious disease. The highest incidence, at a total of 116, was reached by measles, affecting principally the children between the ages of 2 and 10 years, and showing its highest incidence between the months of April and July. Only one case of acute anterior poliomyelitis (infantile paralysis) was notified, and in this case no residual disability resulted. No cases of diphtheria occurred in the district during the year, which may be accounted for by the increasing number of parents availing themselves of the facilities for prevention of diphtheria by immunisation. Reviewing the year as a whole, records show that the Corporation have again completed a year, which they can regard with satisfaction in the matter of health. During the year, much pleasure was expressed throughout the Borough at the Corporation's policy in continuing to conduct the swimming bath at the Beddington Orphanage for the benefit of residents during the Summer months. On page 28 a brief note will be found describing the arrangements which were made, and the number of attendances during the period of 18 weeks the bath was open. All the arrangements and the work of supervision were conducted by the Public Health Department staff. 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, August, 1950. 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 1949 32,890 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1949 9,471 Rateable Value, December, 1949 £404,669 Sum represented by penny rate, December, 1949 £1,615 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. 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. 11 EXTRACTS FROM VITAL STATISTICS Total. M. F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 426 249 177 13.23 „ „ Illegitimate 9 4 5 Total 435 253 182 Rate per 1,000 total (live and still) births Still Births 7 4 3 15.84 Death Rate per 1,000 of the estimated resident population Deaths 382 166 216 11.61 (Crude) 10.80 (Corrected) 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 9.19 Legitimate Infants per 1,000 legitimate live births 9.19 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 66 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 12 Comparative crude birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1949:— England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Borough of Beddington and Wallington. Births— Rates per 1,000 Population. Live 16.7 18.7 18.0 18.5 13.23 Still 0.39 0.47 0.40 0.37 0.21 Deaths — All Causes 11.7 12.5 11.6 12.2 10.80 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.02 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.45 0.52 0.42 0.52 0.39 Influenza 0.15 0.15 0.14 0.11 0.12 Smallpox 0.00 0.00 —- — — Acute Poliomyelitis and Polioencephalitis 0.01 0.02 0.02 0.01 0.03 Pneumonia 0.51 0.56 0.49 0.59 0.27 Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.01 0.02 0.01 0.01 0.00 Cerebro-spinal Fever 0.02 0.03 0.02 0.02 0.00 Scarlet Fever ,. 1.63 1.72 1.83 1.46 1.34 Whooping Cough 2.39 2.44 2.39 1.70 0.42 Diphtheria 0.04 0.05 0.04 0.07 0.00 Erysipelas 0.19 0.20 0.19 0.17 0.15 Smallpox 0,00 0.00 0,00 0,00 0.00 Measles 8.95 8 91 9.18 8.54 3.52 Pneumonia 0.80 0.91 0.65 0.5 J 0.03 Acute Poliomyelitis 0.13 0.13 0,12 0.18 0.03 Acute Polioencephalitis 0,01 0.01 0.02 0.01 0.00 Food Poisoning 1.14 0.16 0,14 0.19 0.18 Rates per 1,000 Live Births. Deaths under 1 year of age 32 37 30 29 9.19 Deaths from Diarrhoea and Enteritis under 2 years of age 3.0 3.8 2.4 1.7 0.00 Notifications— Rates per 1,000 Total Births (i.e.. Live and Still). Puerperal Pyrexia 6.31 8.14 5.30 6.82 2.26 Abortion with Sepsis. Abortion without Sepsis. Puerperal Infections. Other Causes. Total Maternal Mortality : England and Wales 0.11 0.05 0.11 0.71 0 93 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 1949:— Causes of Death. Males. Females. Total. All Causes 166 216 382 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — 6. Tuberculosis of Respiratory System 8 4 12 7. Other forms of Tuberculosis — 1 1 8. . Syphilitic Disease 1 3 4 9. Influenza — 4 4 10. Measles — — — 11. Acute Poliomyelitis and Polioencephalitis 1 1 12. Acute Infectious Encephalitis -. - — 13.m Cancer of Buccal Cavity and Oesophagus (males) 1 - 1 13.f Cancer of Uterus — 4 4 14. Cancer of Stomach and Duodenum 5 6 11 15. Cancer of Breast — 8 8 16. Cancer of all other Sites 22 20 42 17. Diabetes — 2 2 18. Intra-cranial Vascular Lesions 22 34 56 19. Heart Disease 51 69 120 20. Other diseases of the Circulatory System 6 9 15 21. Bronchitis 8 7 15 22. Pneumonia 3 6 9 23. Other Respiratory Diseases 2 - 2 24. Ulceration of the Stomach or Duodenum - 3 3 25. Diarrhoea (under 2 years of age) — — — 26. Appendicitis 1 — 1 27. Other Digestive Diseases 2 2 4 28. Nephritis 5 8 13 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — — — 31. Premature Birth 2 — 2 32. Congenital Malformations, Birth Injury, Infantile Disease 2 - 2 33. Suicide 3 1 4 34. Road Traffic Accidents 2 1 3 35. Other Violent Causes 1 3 4 36. All Other Causes 18 21 39 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 120 31.41 Cancer 66 17.28 Intra-Cranial Vascular Lesions 56 14.66 Tuberculosis (All Forms) 13 3.40 Pneumonia 9 2.36 Bronchitis 15 3.93 Other Diseases of the Circulatory System 15 3.93 VIOLENCE AND ACCIDENT. Details of all deaths under this heading are as follows:— Cause of Death. Male. Female. Total. Suicide 3 1 4 Street Accidents 2 1 3 Other Violent Causes 1 3 4 Totals 6 5 11 MATERNAL MORTALITY. Members of the Council will be pleased to note that for the third year in succession, no deaths 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 0.98. INFANTILE MORTALITY. The infantile mortality rate for 1949 was 9.19 per 1,000 live births. This rate is the lowest ever recorded in the history of the district. The comparable rate for England and Wales is 32. Great credit is due to the services operated in the Borough for the care of mothers and young children, which have made the attainment of such a low rate possible. Of the total of 435 live births, only 4 deaths of infants under one year of age (4 males) were registered. 15 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. Nose and throat swabs:— Diphtheria 10 — 10 Hæmolytic Streptococci 106 16 90 Blood:— Wasserman Reaction and Kahn Tests 1 - 1 Fasces:— Dysentery 7 1 6 Sputa:— Tuberculosis 4 1 3 Totals 128 18 110 During 1949 H. Amphlett Williams, Esq., Ph.D, (Lond.), A.C.G.F.C., F.R.I.C., Public Analyst, 1 Southwark Street, S.E.1, 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. Samples of milk and water are submitted for bacteriological examination to the Ministry of Health laboratories at Epsom, reports being received free of charge under the National Health Service Act, 1946. AMBULANCE FACILITIES. General and Accident Cases. Reorganisation of the ambulance services was undertaken by the Surrey County Council on their transfer on 5th July, 1948. The main ambulance station is situated at St. Helier Hospital, with a sub-station, covering the Beddington and Wallington area, located in Carshalton. 16 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. 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 Counpil, to whom the service was transferred on the 5th July, 1948. During the year the District Nurses attended 879 cases, including 87 maternity and 42 midwifery patients. TREATMENT CENTRES AND CLINICS. 1. Child Welfare Centres. Hackbridge Centre, The Grange London Road. Bandon Hill. Centre, Methodist Hall, Sandy Lane North. Beddington Centre, Village Hall, Beddington. Wallington Centre, Baptist Hall, Queen's Road. 2. Maternity Clinics. Ante-natal Clinic. Post-natal Clinic. When held. Every Monday, 2.0-4.0 p,m. Every Tuesday, 2.0-4.0 p.m. Alternate Wednesdays, 2.0-4.0 p.m. Alternate Wednesdays, 2.0-4.0 p.m. Every Thursday, 2.0-4.0 p.m. District Nurses' Home, 57, Montagu Gardens, Wallington. 3. Physiotherapy Clinic, Dental Clinic, The Grange, London Road. By appointment. 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, 1948. Dispensary facilities continue to be available for residents of the Borough at the St. Helier Hospital, Carshalton. 17 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., 1949 2,585 3,823 6,408 Children who completed full course of immunisation during the year 379 70 449 Number of children who received reinforcing injections during the year 16 315 331 Number of children known to be immunised at 31st Dec., 1949 1,495 2,820 4,315 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, 1948. In addition to the work conducted by the Divisional Medical Officer, general practitioners have been brought into the scheme, and they forward returns of completed cases of immunisation to the Divisional Medical Officer. WHOOPING COUGH IMMUNISATION. This service has been continued by the local health authority, to whom it was transferred on the 5th July, 1948. During the year, 97 children were immunised. The service is offered to the public free of charge, the material used being Parke Davis Whooping Cough Vaccine—St. Mary's Hospital preparation. In addition, notifications have been received from general practitioners of 83 children receiving this immunisation at their hands. 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. School clinics continue to be conducted at The Grange Mansion, Wallington, Rochester 18 Road and Phoenix Flats, Carshalton. The services provided at these clinics are now general medical inspection and treatment, dental treatment, speech therapy and physiotherapy. VENEREAL DISEASES CLINIC. The Surrey County Council was, until the 5th July, 1948, responsible for the control and treatment of 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, 1948, by the Regional Hospital Board, who continue to 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. The Regional Hospital Board makes provision for the admission and treatment of cases of infectious disease in hospitals under their control. Most of the cases from Beddington and Wallington continue to be admitted to the Wandle Valley Isolation Hospital. Smallpox. The Regional Hospital Board has made arrangements for the admission of cases of smallpox to their hospital at Joyce Green, Dartford. 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. 19 CLEANLINESS. During 1949 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. 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 1 2 3 1 2 1 3 Pediculosis — - 3 3 — - — — 3 3 Total - 8 5 1 2 4 6 DISINFECTION. The disinfection of houses has been undertaken by the Council during the year and the Wandle Valley Hospital has 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 £1 per load for bedding, etc., and 7s. 6d. for the first room and 3s. 9d. for each additional roo n as applied to house disinfection. 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. 20 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 28 samples of water were examined by the Public Analyst or the Public Health Laboratory Service. From the reports 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. During the year, it was found necessary, principally owing to the depredations of rats, to relay a portion of the sewer in Belmont Road. Otherwise, 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 1949, various parts being cleansed of silt and obstructions. 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, dried up in the spring. Due to this and the exceptionally long dry periods which were experienced during the summer, serious difficulties arose in keeping the river free from pollution. 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, 21 PUBLIC CLEANSING. The collection of house refuse throughout the Borough was maintained during the year on a weekly basis. From the 1st January until the 30th April the refuse was disposed of at a controlled tip on Mitcham Common which was operated by the Croydon Corporation. This tip closed at the end of April and from then until the end of the year tipping took place on the Corporation's 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. Cesspools and earth closets are dealt with by the occupiers of the premises concerned, which continued arrangement is satisfactory. 22 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, 1949 DWELLING-HOUSES. Number of inspections of dwelling-houses 730 Number of inspections recorded under Housing Regulations 25 MILK AND DAIRIES. Number of distributors of milk on register 10 Number of dairy premises other than dairy farms on register 5 Number of above premises upon which loose milk is handled - Number of inspections of premises 7 Defects in dairy premises discovered and remedied Infringements of Acts and Regulations:— Pasteurised milk not complying with prescribed conditions 6 T.T. (Pasteurised) milk not complying with prescribed „ 1 Extraneous matter in milk 1 Unclean milk vessels 3 — 11 Number of licences issued under Milk (Special Designations) Regulations:— Tuberculin Tested Milk—Dealers' Licences „ „ „ Supplementary Licences Pasteurised Milk—Dealers' Licences „ „ Supplementary Licences Sterilized Milk—Dealers' Licences „ „ Supplementary Licences ICE CREAM. Number of premises on register 57 Number of inspections of premises 210 Number of samples taken for examination 60 SLAUGHTERHOUSES. Number of licensed slaughterhouses - Number of visits to other premises on which animals were occasionally slaughtered for human consumption ,, ,, 2 3 13 5 14 5 15 — 55 23 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 visits 880 Total number of defects discovered and remedied 34 UNSOUND FOOD, Destroyed or released for approved purposes:— lbs. Bacon 17 Cake mixture 101 Cereals 149 Cheese 35 Eggs 1,295 - Fish 1,274 Fish, canned 208 Fruit, fresh 1,278 Fruit, canned 266 Fruit, dried 149 Fruit juice 53 Jam and marmalade 143 Meat 397 Meat, canned 434 Milk, condensed 59 Milk, evaporated 262 Pickles and Sauces 51 Pudding mixture and puddings 126 Sausages 63 Soup,canned 47 Sugar 64 Vegetables, canned 421 Miscellaneous foodstuffs 64 Total 5,661 24 food analyses. Number of samples analysed by Public Analyst 112 Number of samples reported against:— Butter—spoiled 1 Coffee & Chicory Extract—contained fungoid growths 2 Curry Powder—excess of lead 1 Dates—presence of insects and fungi 1 Gelatine—inedible quality 1 Canned Stew—deteriorated 1 Camphorated Oil—incorrectly labelled 1 Salad Cream—dirty extraneous matter 1 — 9 Number of prosecutions — factories. Number of factories on register (including bakehouses) 120 Number of inspections 250 Number of defects discovered and remedied 30 bakehouses. Number of bakehouses in district 11 Number of inspections 26 Number of defects discovered — workplaces, Number of inspections of workplaces 29 Number of defects discovered — shops and offices. Number of visits to shops re sanitary requirements 393 Number of defects discovered and remedied 36 complaints. Complaints received and dealt with during the year were due to the following causes:— Defects in dwelling-houses (various) 128 Rats and mice 90 Stoppages in drains 55 Defects in drains or water closets 17 Defective dustbins 23 Food supplies 18 Insect pests 9 Miscellaneous 61 401 25 SMOKE ABATEMENT. Number of observations 164 Nuisances dealt with 3 INFECTIOUS DISEASE AND DISINFECTION. Number of visits re cases of infectious disease 54 Number of rooms disinfected 111 Lots of bedding and clothing disinfected 82 Number of library books disinfected 247 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 68 Number of defects discovered and remedied 5 RATS AND MICE. Number of visits to infested premises 247 Number of premises upon which rats were found and remedial action taken 66 NOTICES. Number of informal notices served (including verbal intimations) Number of statutory notices served:— 411 Public Health Act, 1936, Section 75 (Dustbins) 15 Public Health Act, 1936, Section 93 (Nuisances) 13 Public Health Act, 1936, Section 39 (Drains) 2 Housing Act, 1936, Section 9 3 33 SANITARY IMPROVEMENTS. Water Supply. Water pipes and fittings repaired or renewed 13 Drains Drains re-laid or repaired 39 Drains unstopped and cleansed 49 Intercepting traps provided with rod-eye stoppers 21 Manholes provided or repaired 12 Soil or ventilation pipes repaired or renewed 24 Gully kerbs and channels repaired 17 New soakaways constructed 8 Closets New closets provided 5 Buildings repaired 8 New pans fixed to water closets 9 26 Water supply re-instated 3 Flushing cisterns repaired or renewed 15 Flush pipes and pan joints repaired or renewed 12 Seats repaired or renewed 8 Urinals repaired 2 Sinks. New sinks provided 6 Waste pipes repaired or renewed 16 Yards. Yards newly paved or repaired 19 Dust Receptacles. New portable iron dustbins provided 176 Dampness. Roofs repaired 58 Rainwater gutters repaired or renewed 51 Rainwater downspouts repaired or renewed 30 Damp-proof courses provided 3 Windows, sills and doors made weatherproof 10 External walls repaired, repointed or rendered 33 Ventilation provided under floors 11 General Repairs. Rooms cleansed 69 Walls and ceilings repaired 95 Floors repaired 22 Stoves repaired or renewed 22 Windows repaired 78 Chimneys repaired 34 Number of premises disinfested from bed bugs 3 Other repairs 20 SUMMARY OF WORK DONE DURING THE YEAR. Number of inspections of dwelling-houses 730 Number of re-inspections of premises 1,780 Number of visits to work in progress 849 Number of miscellaneous visits and inspections 818 Number of visits to dairies 7 Number of visits to ice-cream premises 210 Number of visits to fried-fish shops 68 Number of visits to miscellaneous food premises 569 Number of visits to bakehouses 26 Number of visits to factories 250 Number of visits to workplaces 29 Number of visits to shops and offices 393 Number of visits to premises re slaughtering 2 27 Number of visits to stables and yards 32 Number of visits to market gardens, etc. 25 Number of visits to urinals 113 Number of visits to piggeries 21 Number of visits re infectious diseases 54 Number of visits to streams 61 Number of visits re rats 247 Number of visits re smoke abatement 164 Number of complaints received and investigated 401 Number of informal notices served 411 Number of statutory notices served 33 Number of interviews re nuisances, etc. 946 Number of drain tests applied 142 Number of rooms disinfected 111 Number of lots of bedding and clothing disinfected 82 Number of library books disinfected 247 Number of samples of foodstuffs, water etc., taken for examination 282 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS AND OFFICES. Three hundred and ninety-three inspections were made during 1949 and in 18 cases action was necessary in regard to defects, CAMPING SITES, There are no camping sites within the Borough, SWIMMING BATH. The Corporation again rented from the London County Council (for the 1949 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, youth organisations, and residents as in previous years. During the season, which covered a period of 18 weeks, the following attendances were recorded:— Youth organisations 3,707 School children 3,557 Season Ticket Holders etc: Adults 10,247 Children 6,305 Total 23,816 ERADICATION OF BED BUGS. During the year bed bugs were found to exist in 3 houses. Appropriate remedial measures were taken. 28 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 five dairies on the register but no loose milk was handled at the premises. During the year 7 visits of inspection were paid and conditions found to be satisfactory. MILK (SPECIAL DESIGNATIONS) REGULATIONS. During the year the Council granted the following number of licences under the above-mentioned regulations:— Tuberculin Tested 16 Pasteurised 19 Sterilized 20 SLAUGHTERHOUSES. There are no Slaughterhouses in use within the district. BAKEHOUSES. There are 11 Bakehouses in the district. The premises were visited periodically, and conditions were found to be satisfactory. 29 FACTORIES ACT, 1937. The following tables give details of inspections made and defects found, as supplied by the Senior Sanitary Inspector:— Part 1 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 13 28 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 107 222 3 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Total 120 250 3 — 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 9 — — — — — Cosaques, Christmas crackers,Christmas stockings, etc. 47 — — — — — Total 56 — — — — — 30 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) 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 7 7 — 1 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 3 — 3 — — Total 11 8 3 1 — 31 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 75 Tuberculin Tested Pasteurised 6 Sterilized 1 Total 82 Six samples of pasteurised milk and one sample of T.T. pasteurised milk failed to comply with the methylene blue test. MEAT. The carcases of all animals intended for sale 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, Southwark Street, London, S.E.1., is Public Analyst for the Borough. 32 The following table gives details of the samples obtained within this district during the year:— Articles. Analysed. Adulterated. Prosecu tions. Formal. Informal. Total. Formal. Informal. Total. Baking Powder — 1 1 — — — — Butter — 6 6 — 1 1 — Cakes — 10 10 — — — — Cocoa — 2 2 — — — — Coffee — 3 3 — — — — Coffee & Chicory Essence — 3 3 — — — — Coffee & Chicory Extract 1 2 3 — 2 2 — Cooking Fat — 4 4 — — — — Curry Powder — 4 4 — 1 1 — Dates — 1 1 — 1 1 — Gelatine — 4 4 — 1 1 — Ginger, Ground — 4 4 — — — — Ice-Cream — 2 2 — — — — Jam — 3 3 — — — — Margarine — 4 4 — — — — Meat & Vegetable Stew (Canned) — 1 1 — 1 1 — Milk 16 8 24 — — — — Mincemeat — 1 1 — — — — Mince Pies — 1 1 — — — — Pickles — 1 1 — — — — Salad Cream & Mayonnaise — 7 7 — 1 1 — Sausage Meat — 1 1 — — — — Soup, canned — 1 1 — — — — Tea — 4 4 — — — — Vinegar — 3 3 — — — — Whisky — 3 3 — — — — Camphorated Oil — 3 3 — 1 1 — Cod Liver Oil — 1 1 — — — — Iodine, Tincture of — 3 3 — — — — Mercury Ointment (Dilute) — 1 1 — — — Sulphur Ointment — 3 3 — — — — Totals 17 95 112 — 9 9 — 33 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 Public Health Laboratory Service. OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN. There were no outbreaks of illness associated with identifiable contaminated agents or food materials during the year. Six single cases notified as food poisoning were investigated, but the cause in these alleged cases could not be discovered. Two cases, however, were thought to be associated with an outbreak of food poisoning which occurred in the district of London in which the patients worked. The Sanitary Inspectors, by exhortation and distribution of appropriate literature, have continued to draw the attention of caterers and food purveyors to the importance of cleanliness in the conduct of their businesses if ill-health from this source is to be avoided. No specific campaign was undertaken in the Borough during the year, as it was felt that the constant supervisory work of the Sanitary Inspectors, and their close association with the persons in the trade in the district, was a more effective measure in spreading the requisite knowledge. Some of the Sanitary Inspectors have undertaken lectures to interested groups on the subject of clean food. 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. Since 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 VIII to X. Private Street Works Act, 1892. Public Health Act, 1925. Public Libraries Acts, 1892-1919. Small Dwellings Acquisition Acts, 1899-1923, 34 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. 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 1949, the number of cases removed to hospital and the number of deaths attributed to these diseases, excluding Tuberculosis:— Disease. Number Notified. Removed to Hospital. hs. Scarlet Fever 44 39 — Measles 116 — — Whooping Cough 14 1 — Erysipelas 5 2 — Puerperal Pyrexia 1 1 — Ophthalmia Neonatorum 1 1 — Acute Poliomyelitis 1 1 1** Pneumonia 1 — 9** Dysentery 1 — — Food Poisoning 6 — — Totals 190 45 10 * Includes deaths from all forms of pneumonia. ** Refers to case in which disease occurred previous to 1949. t Includes deaths of residents in homes and institutions outside the Borough, 35 36 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 1949 (excluding Tuberculosis). Disease. At all ages. Number of Cases Notified. Total Cases notified in each Ward. Cases removed to Hospital. Deaths (including deaths of residents outside the Borough). At Ages—Years. Under 1 year. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Beddington. Wallington. North. West Central. South. North. Central. South. Scarlet Fever 44 — 2 2 4 3 27 4 1 — — 1 — 15 6 4 4 5 6 4 39 — Measles 116 2 16 11 22 9 55 1 — — — — — 29 16 12 15 14 20 10 — — Whooping Cough 11 1 3 2 3 4 — — — 1 — — 3 5 2 — 2 1 1l 1 — Erysipelas 5 — — — — — — — — 1 — 2 2 1 1 — — 2 1 — 2 — Puerperal Pyrexia 1 — — — — — — — — 1 — — — — 1 — — — — 1 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — — 1 — — — — — 1 — Acute Poliomyelitis 1 — — — 1 — — — — — — — — 1 — — — — — — 1 1 * * Pneumonia 1 — — — — — — — — 1 — — — 1 — — — — — — — 9* Dysentery 1 — — 1 — — — — — — — — — — — — — 1 — — — — Food Poisoning 6 — — — 1 — — 1 — 3 — 1 — 2 — 4 — — — — — — Totals 190 3 19 17 30 15 86 6 1 6 1 4 2 52 30 22 19 24 28 15 45 10 * includes all forms. ** Refers to case in which disease occurred previous to 1949. 37 The Monthly Incidence of Infectious Disease, 1949 (excluding Tuberculosis). Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever — 6 7 3 1 2 2 2 2 2 6 11 44 Measles 5 8 8 19 11 20 30 9 2 — 3 1 116 Whooping Cough 2 2 — 2 5 1 2 — — — — — 14 Erysipelas 1 1 — — 1 — — — — — — 2 5 Puerperal Pyrexia — — — — 1 — — — — — — — 1 Ophthalmia Neonatorum — — — — — 1 — — — — — —- 1 Acute Poliomyelitis — — — — — — — — 1 — — — 1 Pneumonia 1 — — — — — — — — — — — 1 Dysentery — — — — — — — 1 — — — — 1 Food Poisoning — — — — 2 — — 1 3 — — — 6 Totals 9 17 15 24 21 24 34 13 8 2 9 14 190 Tuberculosis. There were 39 new cases notified during the year. The following table gives the number of new cases notified during the past five years:— New Cases. 1945. 1946. 1947. 1948. 1949. M. F. M. F. M. F. M. F. M. F. Pulmonary 17 13 24 6 15 8 8 11 19 17 Non-Pulmonary 3 2 2 3 6 1 1 1 1 2 Totals 20 15 26 9 21 9 9 12 20 19 Annual case rate per 1,000 of the estimated population:— 1949. 1948. Pulmonary 1.09 0.58 Non-pulmonary 0.09 0.06 The following table gives the number of deaths from this disease during the past five years:— Deaths. 1945. 1946. 1947. 1948. 1949. M. F. M. F. M. F. M. F. M. F. Pulmonary 6 10 7 1 4 4 4 2 8 4 Non-Pulmonary 2 1 — — 2 — — — — 1 Totals 8 11 7 1 6 4 4 2 8 5 It will be seen from the foregoing table that 13 deaths were registered as due to Tuberculosis. The figures correspond to a death rate per 1,000 of population of 0.39. Tuberculosis rates have unfortunately shown a marked advance throughout England and Wales, and in this district the rate is twice that for the previous year. 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:— 38 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 1 — — — — — — — 5 and under 10 — — 1 — — — — — 10 and under 15 — 1 — 1 — — — — 15 and under 20 3 4 — — — — 1 20 and under 25 2 6 — — — 1 — — 25 and under 35 4 4 — — 1 1 — — 35 and under 45 3 1 — — 1 2 — — 45 and under 55 4 — — 1 3 — — — 55 and under 65 2 1 — — 2 — — — 65 and upwards — — — — 1 — — — Totals 19 17 1 2 8 4 — 1 The new cases were distributed amongst the Wards as follows:— Beddington Wallington. North West. Cent. South North Cent. South Pulmonary 6 5 5 2 10 6 2 Non-Pulmonary 1 1 — —- — 1 — Totals 7 6 5 2 10 7 2 Arrangements have been made by the Council for the examination of sputa from cases, or suspected cases, and during the year 4 such examinations were made. Treatment for cases of Tuberculosis is the responsibility of the Regional Hospital Board, who provide both sanatorium and dispensary treatment. The Tuberculosis After-Care Committee continued its good work during 1949. 39 LOCAL HEALTH AUTHORITY TRANSFERRED FUNCTIONS. As was explained in the preamble to the report, the following brief statement summarises the work of the local health authority in respect of the transferred functions. The Care of Mothers and Young Children. During the year, the policy in the conduct of infant welfare centres and general supervisory control through health visiting was continued on similar lines by the Surrey County Council, as when the service was administered by the Corporation. The services in this district have continued to operate smoothly and efficiently, and there has been no break in con.inuity. The high standards previously set by the Corporation have been kept up. Ante-natal and Post-natal Supervision. This clinic, as in previous years, continued to be held at the Nurses' Home, 57, Montagu Gardens. During the year, 254 women made 952 pre-natal attendances. This represents an attendance of 57% of the total number of confinements which occurred during 1949. Post-natal examinations were also conducted at this clinic ; 28 patients making 34 attendances. As mentioned in previous reports, however, considerably more women have post-natal supervision than are recorded here. Those who have institutional confinements 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. Infant Welfare Services. No changes were made during the year in the operation of the four infant welfare centres, and the number of attendances showed results comparable with those of previous years. Number attending Total attendances Children under 1 year 377 5,297 Children, 1 - 5 years 786 3,533 Total attendances 1,163 8,830 Institutional Confinements. Three hundred and five, or 69 per cent. of births allocated to this district, took place in hospitals and Nursing Homes. Many of these cases were admitted because of overcrowding or other home conditions. Others were admitted to hospital for medical reasons. Domestic Help Service. This important branch of social service continued to meet a great need during the year, both for confinements and illness in the home. The service is administered by the Divisional Medical Officer from the Wallington Town Hall, and during the year one of the W.V.S. ladies (Mrs. D. Best) continued to act as Home Help 40 Supervisor under the general direction of the Divisional Medical Officer. Close liaison was kept up with the almoners of hospitals, and it was found possible to meet the many requests received for tuberculous patients and the care of the aged under the St. Helier Hospital geriatric service. The cases attended were as follows:- Full-time Part-time Total Maternity 59 13 72 General Medical 53 153 206 Tuberculosis 1 11 12 113 177 290 Treatment. Minor Ailments. One hundred and twenty-nine cases were referred from the Infant Welfare Centres to Hospital Specialists for investigation and treatment during the year. The principal defects were as follows:— Eye conditions 32 Circumcisions 29 Tonsils and adenoids 16 Naevi 12 Orthopaedic defects 9 Skin defects 8 Dental. The arrangements whereby expectant mothers, nursing mothers and infants under 5 years of age received dental treatment at the Grange clinic continued as satisfactorily as could be expected, having regard to the general shortage of dental staff. Treatments took place in the following cases:— Expectant Mothers Nursing Mothers Infants Total New Patients 18 12 57 87 Re-attendances 27 31 17 75 Total attendances 45 43 74 162 Fifty-seven patients were made dentally fit and 30 were still attending for treatment at the end of the year. Orthopaedic. Patients attending infant welfare centres who require treatment for orthopaedic defects are referred by the Clinic Medical Officer to orthopaedic surgeons at St. Helier or other hospitals. During 1949, nine cases were referred for treatment. 41 Physiotherapy. Much useful work has again been undertaken at this clinic throughout the year, and the attendance has been maintained at a very high level. In addition to ultra-violet light and infra-red irradiation, massage, manipulation and corrective treatments were given. During the year, it was found possible to introduce relaxation classes for expectant mothers and remedial exercise classes for children with postural defects. The following table gives details of attendances. Total attendances Irradiations Corrective treatments Children, 0-5 years 6,712 2,019 Children, 5 - 15 years 1,098 1,530 Adults — Expectant Mothers 104 19 Nursing Mothers 105 108 Others 320 255 8,339 3,931 Health Visiting. Four health visitors are employed by the Surrey County Council for the supervision of infants up to 5 years of age and expectant and nursing mothers, both at home and at the infant welfare and ante-natal clinics. These health visitors are also responsible for the supervision of children attending schools in the Borough, and assist the Medical Officer at immunisation sessions. Visits during the year were made as follows:— First visits Total visits Expectant mothers 125 219 Children, 0 - 1 years 546 1,989 Children, 1 - 5 years 103 2,339 Other cases 132 866 906 5,413 Child Life Protection. This function is now governed by the Children Act, 1948, which came into operation on the 5th July, 1948. A Children's Officer is appointed by the Surrey County Council to supervise all children coming within the provisions of the Act. The health visitors, however, visit on behalf of the Children's Officer deprived children under 5 years of age and certain other children in registered residential establishments. At the end of the year two foster-parents and 36 children were under their supervision. 42 Care of Premature Infants. The arrangements made for the care of premature infants continued during 1949. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Fifteen premature births were notified during the year, three being domiciliary confinements and 12 born in hospital. Two of the infants born in hospital died within 48 hours. Care of Illegitimate Children. The Surrey County Council make an annual grant to the Sutton and District Girls' Aid Association, whose visitor follows up cases occurring in the Borough. A grant is also made to homes for mothers and babies in Surrey where the unmarried mother can be admitted before the birth of her child, and cared for some months after birth. Ladies of the Women's Voluntary Services and the health visitors continue to co-operate in the alleviation of the lot of these unfortunate mothers. 43 Printed by B. JOHNSON Wellington Surrey