LIBRARY BEDl5 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1950 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1950 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 II Extracts from Vital Statistics 12 Vital Statistics: Comparative Birth-rates, Death-rates, Analysis of Mortality, etc., 1950 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 17 Ambulance Facilities 17 Nursing in the Home 17 Treatment Centres and Clinics: Care of Mothers and Young Children 18 Tuberculosis 18 Immunisation against Diphtheria 19 Immunisation against Whooping Cough 19 School Clinics 19 Venereal Diseases Clinics 20 Cleansing of Persons 20 Hospitals 20 Disinfection 21 Sanitary Circumstances of the Area: Water Supplies 21 Drainage and Sewerage 21 Rivers and Streams 21 Closet Accommodation 22 Public Cleansing 22 Sanitary Inspection of the Area 23 2 Statement of the Senior Sanitary Inspector for the Year 1950: Dwelling Houses 23 Milk and Dairies 23 Ice Cream 23 Slaughterhouses 23 Food Premises 23 Unsound Food 24 Food Analyses 24 Factories 24 Bakehouses 24 Workplaces 25 Shops and Offices 25 Complaints 25 Smoke Abatement 25 Infectious Disease and Disinfection 25 Offensive Trades and Fish Frying 25 Rats and Mice 25 Notices 25 Sanitary Improvements: Water Supply 26 Drains 26 Water Closets 26 Sinks 26 Yards 26 Dust Receptacles 26 Dampness 26 General Repairs 26 Prosecutions 27 Summary of work done during the year 27 Shops and Offices 27 Camping Sites 27 Swimming Bath 27 Eradication of Bed Bugs 28 Schools 28 Dairies 28 Milk (Special Designations) Regulations 29 Slaughterhouses 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 33 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, 1950 Members: Councillor Miss K. C. Bratt (Chairman) Alderman W. W. Binnie (Mayor) Councillor A. H. Prior (Deputy Mayor) Alderman F. G. Bryant Councillor Mrs. V. M. Boyce Councillor D. H. de VoIl Councillor A. R. B. Gill Councillor G. H. Hyett Councillor C. H. Norman Councillor A. Stammers Councillor T. G. Wakley REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1950 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, 1950 Members: Alderman W. W. Binnie (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.S.I.A. Additional Sanitary Inspectors: A. F. Leaney, M.R.S.I. W. A. Watts, M.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 (Resigned 8.10.50) P. H. Sadler B. G. Bignell (Temporary; Resigned 4.2.50) J. P. Squibb (Commenced 13.11.50) STAFF EMPLOYED BY THE SURREY COUNTY COUNCIL IN THE BEDDINGTON AND WALLINGTON HALF OF THE MID-EASTERN 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. Physiotherapists: Miss G. Allen, M.C.S.P. (Part-time) Mrs. H. M. Henn, M.C.S.P. (Part-time; commenced 31.7.50) Assistant to Physiotherapists: 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 Bedding ton and Wallington. Ladies and Gentlemen, I have the honour to present my annual report for 1950. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 112/50. The vital statistics are based on information supplied by the Registrar-General. The presentation follows that adopted for 1949, and those services which are under the control of the Surrey County Council, the Local Health Authority under the National Health Service Act, 1946, are reported upon in a brief statistical statement appended to the report. The services dealt with in this addendum are: 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 Registrar-General estimated the population of the Borough at the middle of the year at 32,890. The birth rate per 1,000 total population shows a decrease at 12.54 in 1950, as compared with 13.23 in 1949, and is below that for England and Wales, which is 15.8. The stillbirth rate of 0.18 per 1,000 total population is lower than the figure of 0.21 for 1949, and compares favourably with that for England and Wales, which is 0.37. The stillbirth rate per 1,000 total births is 14.05, and is appreciably lower than that for 1949, which was 15.84. The death rate from all causes per 1,000 total population is 10.95, compared with 10.8 in 1949 and 11.6 for England and Wales. Of the 387 deaths, diseases of the heart and circulatory system accounted for 130 (33.59 per cent. of total deaths), cancer 76 (19.64 per cent. of total deaths), and tuberculosis 9 (2.32 per cent. of total deaths). The maternal mortality rate per 1,000 total births is nil, as compared with 0.86 for England and Wales. For the fourth year in succession, the Corporation will 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 011 page 15, was 19 per 1,000 live births in 1950. The figure for 1949 was 9.19 (the lowest figure yet recorded in this district); that for England and Wales for 1950 being 29.8. The actual number of deaths upon which these statistics are based is relatively small. In 1949 there were 4 infantile deaths, as compared with 8 during the year under review. On page 16 of the report, an analysis of the causes of death of these infants is set out, and to show the advance in the care of mothers and young infants, a comparative summary is set out for a typical pre-war year, 1937. It will be noticed from a perusal of these two tables that there was only one death in a child over one week old in 1950, as compared with 5 in 1937. Both tables make it clear that the first week of life is the most dangerous for infants, prematurity and difficult labour still being the principal causes of neonatal mortality. It will be noted that the death rate shows a slight upward tendency, most of the deaths occurring in old or very old people. There was a considerable increase during the early months of the year in general ill-health, the incidence of respiratory diseases being particularly high. In the very aged, with already failing heart conditions, respiratory infections tend to be fatal, and this to some extent explains the increased death rate. There was also, amongst persons past middle age, an increase of the number dying from cerebral haemorrhage (stroke). The care of the aged, in the absence of adequate institutional accommodation, tends to present an ever-growing and very urgent problem. Many old persons suffering from a chronic disease, which in pre-war days would have ensured their admission to an institution (hospital, old people's home or hostel), have now to stay at home with inadequate nursing and general care. The home help service, within the limits set by the County Council's estimates, provides one means of ensuring the general maintenance of the home for these old persons, and the District Nurses endeavour to provide essential nursing. Those, however, whose duty entails visiting these old persons, understand full well that the care given is not comparable with the nursing and attention which can be provided in an old people's home or hostel. Much difficulty is experienced in endeavouring to classify these patients, some having diseases and degrees of ill-health requiring nursing in the acute wards of a hospital, while others are the typical chronic case seen in institutions maintained by Welfare Authorities. The Regional Hospital Board takes charge of the first-mentioned type of patient, and the County Welfare Authority makes provision for the second class. The problem which faces the Regional Hospital Board is that every old person admitted to the acute wards, whether surgical or medical, deprives a young active person, possibly amongst the workers, of a muchneeded bed, and thus delays the cure and rehabilitation of a person in the younger age groups, upon whose earning capacity the Government so urgently relies. 8 During the year, considerable social work was done for the aged in Beddington and Wallington, and it would be ungracious not to mention the name of Councillor Mrs. V. M. Boyce, whose Old People's Clubs did so much to provide regular recreational activities and outings. The work of these clubs is beyond praise, and has done much to alleviate the lot of those old persons living at home, who are not too infirm to take advantage of the opportunities presented. The work of the Women's Voluntary Services, too, must be acknowledged with grateful thanks. The W.V.S. Domestic Help Supervisor (Mrs. D. Best), under the direction of the Divisional Medical Officer, continued to give voluntary full-time service throughout the whole year. Close collaboration with the almoners of hospitals and the geriatric department of St. Helier Hospital was maintained, but with the everincreasing demand, it is difficult to meet all the requirements of the aged. On page 38 tables are set out showing the new cases of tuberculosis notified during the year, and the number of deaths from this disease. It is gratifying to note that in this district there has not only been a slight fall in the number of new cases notified, but also in the number of deaths. Serious concern has been felt throughout the country at the alarming increase in notifications of tuberculosis and the number of deaths from this disease. In the opinion of many, the high incidence can in part be attributed to the bad housing conditions under which serious cases of the disease must of necessity be nursed, with the added degree of risk to other members of the household, and also the shortage of sanatorial accommodation. The Regional Hospital Board is making a determined effort to reduce the waiting time for cases recommended to be admitted for treatment. Wherever possible, some degree of priority is given by housing authorities to families whose members are suffering from tuberculosis. The County Council's boarding-out scheme has proved very successful in removing children from surroundings in which the risk of tuberculous contamination is great. There has been a considerable demand for home help service to assist in the care of cases at home where hospital admission cannot be arranged. It is not always easy, however, to recruit home helps willing to undertake the risk of working in tuberculous households. During the year there was a remarkable increase in the incidence of some infectious diseases. Measles showed a very high seasonal incidence during the last three months of the year, while whooping-cough was very much more prevalent than during the preceding year, the highest incidence being reached during July and August. Influenzal pneumonia, especially affecting persons past middle age, also showed an increase, 14 cases being notified. Two cases of acute poliomyelitis (infantile paralysis) were notified during the year. Only one case, however, developed some degree of residual paralysis. This more severe case, diagnosed and removed to hospital from this Borough, was only temporarily resident in the area. 9 As in the previous year, no cases of diphtheria were notified. This is gratifying to note, and illustrates the advantage of having as many children as possible immunised. The Corporation can again be congratulated on having completed a year reasonably free from disease and showing a good health record. On page 28 is set out the record of the use of the swimming bath at Beddington Orphanage. Considerable satisfaction was expressed throughout the Borough at the Corporation's continuation of its policy to make this bath available to residents and school children during the summer months. 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 am, Ladies and Gentlemen, Your obedient servant, PATRICK J. O'CONNELL, July, 1951. 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 1950 32,890 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1950 9,515 Rateable Value, December, 1950 £405,822 Sum represented by penny rate, December, 1950 £1,595 The Urban District of Beddington and Wallington was constituted in 1915 by an Order of the Surrey County Council, the area up to that time being part of the Croydon Rural District. By an Order in Council, dated 20th August, 1937, H.M. King George VI granted a charter to Beddington and Wallington, which was presented on the 15th September, 1937, by the Lord Lieutenant of the County of Surrey. The Borough is bounded on the east by the County Borough of Croydon, to the north by the Borough of Mitcham, to the west by the Carshalton Urban District, and to the south by the Urban District of Coulsdon and Purley. The past two or three years have seen a great improvement in the Borough, in the maintenance of the parks and open spaces, whose general appearance is now approaching pre-war standards. While the demand for recreational facilities by school children, youth organisations and industrial recreational clubs continues to grow, the district is very fortunate in being able to meet most of their needs. During the summer months, Beddington Park and Grange Park have proved an inestimable boon to parents and children alike, and during August hundreds of children, both from Beddington and Wallington and neighbouring districts, whose parents are unable to take them away for holidays, spend many happy hours of healthful relaxation in these delightful open spaces. The Council's housing and development policy is also improving many parts of the district. For the most part, the district retains its good residential character, and provides a pleasant dormitory for many city workers. 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 .. 410 197 213 12.80 (Crude) „ „ Illegitimate 11 6 5 12.54 (Corrected) Total 421 203 218 Still Births 6 4 2 Rate per 1,000 total (live and still) births 14.05 Deaths 387 193 194 Death Rate per 1,000 of the estimated resident population 11.77 (Crude) 10-95 (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 19.00 Legitimate Infants per 1,000 legitimate live births 17.07 Illegitimate Infants per 1,000 illegitimate live births 90.91 Deaths from Cancer (all ages) 76 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) 1 12 Comparative birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1950: 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 15.80 17.60 16.70 17.80 12.54 Still 0.37 0.45 0.38 0.36 0.18 Deaths— All Causes 11.60 12.30 11.60 11.80 10.95 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 WhQoping Cough 0.01 0.01 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 T uberculosis 0.36 0.42 0.33 0.39 0.27 Influenza 0.10 0.09 0.10 0.07 0.06 Smallpox — — — Acute Poliomyelitis (including Polioencephalitis) 0.02 0.02 0.02 0.01 0.00 Pneumonia 0.46 0.49 0.45 0.48 0.39 Notifications— Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.03 Meningococcal Infection 0.03 0.03 0.02 0.03 0.00 Scarlet Fever 1.50 1.56 1.61 1 .23 2.83 Whooping Cough 3.60 3.97 3.15 3.21 6.48 Diphtheria 0.02 0.03 0.02 0.03 0.00 Erysipelas 0.17 0.19 0.16 0.17 0.27 Smallpox 0.00 0.00 — — Measles •39 8.76 8.36 6.57 20.89 Pneumonia 0.70 0.77 0.61 0.50 0.42 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.13 0.12 0.11 0.08 0.03 Non.Paralytic 0.05 0.05 0.06 0.05 0.03 Food Poisoning 0.17 0.16 0.14 0.25 0.00 Deaths under 1 year of age Rates per 1,000 Live Births. 29.80 33.80 29.40 26.30 19.00 Deaths from Diarrhoea and Enteritis under 2 years of age 1.90 2.20 1.60 1.00 2.37 Notifications— Puerperal Pyrexia Rates per 1,000 Total Births (i.e., Live and Still). 5.81 7.43 | 4.33 6.03 | 0.00 Abortion with Sepsis Other Abortion Complication of Pregnancy and Delivery Sepsis of Childbirth and the Puer. perium Other Complications of the Puer. perium Total Maternal Mortality England and Wales 0.09 0.05 0.54 0.03 0.15 0.86 Beddington and Wallington 0.00 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 1950: Causes of Death Males Females Total All Causes 193 194 387 1. Tuberculosis, respiratory 6 1 7 2. Tuberculosis, other 1 1 2 3. Syphilitic disease 1 1 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases — 1 1 10. Malignant neoplasm, stomach 8 5 13 11. Malignant neoplasm, lung, bronchus 15 2 17 12. Malignant neoplasm, breast. — 13 13 13. Malignant neoplasm, uterus. — 2 2 14. Other malignant and lymphatic neoplasms . 18 13 31 15. Leukaemia, aleukaemia 1 1 2 16. Diabetes 2 — 2 17. Vascular lesions of nervous system. 24 37 61 18. Coronary disease, angina 36 18 54 19. Hypertension with heart disease 3 5 8 20. Other heart diseases 35 33 68 21. Other circulatory diseases . 8 9 17 22. Influenza 1 1 2 23. Pneumonia 6 7 13 24. Bronchitis 8 7 15 25. Other diseases of respiratory system 3 3 6 26. Ulcer of stomach and duodenum . 2 — 2 27. Gastritis, enteritis and diarrhoea . — 2 2 28. Nephritis and nephrosis 1 2 3 29. Hyperplasia of prostate — — — 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 1 1 2 32. Other defined and ill-defined diseases 10 24 34 33. Motor vehicle accidents 2 — 2 34. All other accidents 1 2 3 35. Suicide — 3 3 36. Homicide and operations of war . - - - 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 130 33.59 Cancer 76 19.4 Intra-Cranial Vascular Lesions 61 15.6 Tuberculosis (All Forms) 9 2.2 Pneumonia 13 3.6 Bronchitis 15 3.8 Other Diseases of the Circulatory System 17 4.9 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 3 3 Motor Vehicle Accidents 2 — 2 Other Violent Causes 1 2 3 Totals 3 5 8 MATERNAL MORTALITY Members of the Council will be pleased to note that for the fourth 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 0.86. INFANTILE MORTALITY The infantile mortality rate for 1950 was 19 per 1,000 live births. The comparable rate for England and Wales is 29.8.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 421 live births, only 8 deaths of infants under one year of age (4 males and 4 females) were registered. 15 The following table gives the age and cause of death of each infant who died: No. Age Cause of Death 1. 3 hours Asphyxia pallida. Precipitate labour. 1. 5 hours Intra-cranial hemorrhage. Difficult confinement. l. 8 hours Extreme prematurity. 1. 9 hours Pulmonary atelectasis. Prematurity. l. 18 hours Broncho-pneumonia. Atelectasis. 1. 3 days Kernicterus. Hemolytic disease of newborn. 1. 3 days Haemorrhagic broncho-pneumonia due to congenital syphilis. 1. 8 months Gastro-enteritis. Broncho-pneumonia and bilateral mastoiditis. Comparative table for a typical pre-war year, 1937: No Age Cause of Death 1. Newly Born Asphyxia, probably caused by a woollen shawl in which child was wrapped. 1. 2 hours Inanition. Premature birth. 1. 2 hours Congenital debility. Delivered by cesarean section. 5. 2 hours Prematurity. 12 hours 1 day 1 day 1 week 1. 1 day Convulsions. Cerebral compression, pressure on the head during parturition. 1. 1 day Cardiac failure. Primary respiratory failure. Immaturity of development. 1. 1 day Cyanosis. Imperfect delivery. Premature birth. 1. 1 day Inanition. Premature birth. Albuminuria of pregnancy in mother. 2 days Prematurity. Multiple birth (twins). 1. 3 days Erythro-blastic anemia. 1. 6 days Partial atelectasis. Pyloric stenosis. Peritonitis following laparotomy. 1. 1 week Atelectasis. Premature birth and ante-natal uterine hemorrhage. 1. 1 week Heart failure. Sclerona neonatorum. 1. 8 weeks Asphyxia. Suffocation by bedclothes while sleeping with mother. 1. 3½ months Cardiac failure. Asphyxia due to being suffocated by clothes covering the cot. 1. 4 months Marasmus. Pink disease. Secondary colitis. 1. 4 months Bronchial pneumonia. Gastro enteritis, following operation for hare lip. 1. 9 months Primary thrombosis of superior longitudinal sinus. 16 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. During 1950, 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. 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. 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 Council, to whom the service was transferred on the 5th July, 1948. During the year the District Nurses attended 874 cases, including 87 maternity and 22 midwifery patients. 17 TREATMENT CENTRES AND CLINICS Care of Mothers and Young Children 1. Child Welfare Centres When held Hackbridge Centre, Every Monday, 2.0-4.0 p.m. The Grange, London Road. Bandon Hill Centre, Every Tuesday, 2.0-4.0 p.m. Methodist Hall, Sandy Lane North. Beddington Centre, Alternate Wednesdays, 2.0-4.0 p.m. Village Hall, Beddington. Wallington Centre, Alternate Wednesdays, 2.0-4.0 p.m. Baptist Hall, Queen's Road. 2. Maternity Clinics Ante-natal Clinic Every Thursday, 2.0-4.0 p.m. Post-natal Clinic District Nurses' Home, 57 Montagu Gardens, Wallington. 3. Physiotherapy Clinic, By appointment. Dental Clinic, The Grange, London Road. 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. In addition to the dispensary facilities, the mass-radiography unit visited the district in June and July, 1950. The attendances were as follows: Males Females Total 919 1,166 2,085 18 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., 1950 2,544 3,872 6,416 Children who completed full course of immunisation during the year 312 138 450 Number of children who received reinforcing injections during the year 6 369 375 Number of children known to be immunised at 31st Dec., 1950 .. 1,397 3,090 4,487 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, for which they receive a fee. 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, 28 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 60 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 Road and Phoenix Flats, Carshalton. The services provided at these clinics are now general medical inspection and treatment, dental treatment, speech therapy and physiotherapy. 19 Venereal Diseases Clinics 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. Cleansing of Persons During 1950 the Corporation Cleansing Station, situated near the Grange Mansion, provided facilities for cleansing infested persons. 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. During the year the following treatments were carried out: Scabies 1 Pediculosis 23 HOSPITALS Infectious Cases. The South-West Metropolitan 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. 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. 20 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 room 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. 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 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 1950, various parts being cleansed of silt and obstructions. In October the springs in the Waddon Ponds, which are the principal source of supply to the upper reaches of the river, began to flow again after a break of over eighteen months. As a result the river once more 21 became reasonably clean, although trouble was still experienced due to infiltration of oil from the factory area immediately over the Croydon boundary. Prior to the springs recommencing difficulties were experienced in keeping the river free from pollution, especially after periods of heavy rain. 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. From January to March the Corporation continued to dispose of all refuse to their own shoot in Beddington Lane. After March they once more began to participate in a joint scheme of controlled tipping on Mitcham Common with the Croydon and Mitcham authorities. The scheme continued for the remainder of the year. 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 occupiers of the premises concerned, which continued arrangement is satisfactory. 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, 1950 DWELLING-HOUSES Number of inspections of dwelling-houses 665 Number of inspections recorded under Housing Regulations 39 MILK AND DAIRIES Number of distributors of milk on register 16 Number of dairy premises other than dairy farms on register 6 Number of above premises upon which loose milk is handled Nil Number of inspections of premises 5 Defects in dairy premises discovered Nil Infringements of Acts and Regulations: Pasteurised milk not complying with prescribed conditions 2 Extraneous matter in milk 1 Unclean milk vessels 2 — 5 Number of licences issued under Milk (Special Designation) Regulations: Tuberculin Tested Milk—Dealers' Licences 6 ,, „ Supplementary Licences 14 Pasteurised Milk—Dealers'Licences 6 „ „ Supplementary Licences 15 Sterilized Milk—Dealers' Licences 10 „ „ Supplementary Licences 15 — 66 ICE CREAM Number of premises registered for the sale of ice cream 71 Number of manufacturers 1 Number of inspections of premises 180 Number of samples taken for examination 56 SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 819 Total number of defects discovered and remedied 47 23 UNSOUND FOOD Destroyed or released for approved purposes: lbs. Bacon 11 Cake mixture 161 Cereals 70 Cheese 32 Eggs 1,762 Fish 798 Fish, canned 97 Fruit, fresh 70 Fruit, canned 1,492 Fruit, dried 3 Fruit juice 114 Jam and marmalade 180 Meat 1,080 Meat, canned 164 Milk, condensed 133 Milk, evaporated 111 Milk, powdered 114 Pickles and Sauces 97 Pudding mixture and puddings 494 Sausages 77 Soup, canned 119 Sugar 2 Vegetables, canned 383 Miscellaneous foodstuffs 60 Total 5,862 FOOD ANALYSES Number of samples analysed by Public Analyst 103 Number of samples reported against: Milk, Condensed—contained fungus growths 1 Sausages—contained undeclared preservative 2 Glycerine, lemon and honey with ipecacuanha and squill—contained fungus and was deficient in chloroform and citric acid 1 — 4 Number of prosecutions Nil FACTORIES Number of factories on register (including bakehouses) 113 Number of inspections 209 Number of defects discovered and remedied 19 BAKEHOUSES Number of bakehouses in district 11 Number of inspections 30 Number of defects discovered and remedied 3 24 WORKPLACES Number of inspections of workplaces 19 Number of defects discovered and remedied 1 SHOPS AND OFFICES Number of visits to shops re sanitary requirements 462 Number of defects discovered and remedied 35 COMPLAINTS Complaints received and dealt with during the year were due to the following causes: Defects in dwelling-houses (various) 143 Rats and mice 112 Stoppages in drains 72 Defects in drains or water closets 20 Unwholesome foodstuffs 25 Insect pests 7 Miscellaneous 28 407 SMOKE ABATEMENT Number of observations 163 Nuisances observed Nil INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 158 Number of rooms disinfected 168 Lots of bedding and clothing disinfected 133 Number of library books disinfected 458 OFFENSIVE TRADES AND FISH FRYING Number of offensive trade premises in district Nil Number of fish-friers' premises in district 8 Number of visits to fish-friers' premises 33 Number of defects discovered and remedied 3 RATS AND MICE Number of visits to premises by Rodent Operative 1,889 Number of premises upon which rats or mice were found and remedial action taken 139 Number of inspections of sewer manholes 2,377 Number of baits laid 6,255 NOTICES Number of informal notices served (including verbal intimations) 346 Number of statutory notices served: Public Health Act, 1936, Section 75 (Dustbins) 16 Public Health Act, 1936, Section 93 (Nuisances) 15 — 31 25 SANITARY IMPROVEMENTS Water Supply Water pipes and fittings repaired or renewed 13 Drains Drains re-laid or repaired 84 Drains unstopped and cleansed 48 Intercepting traps provided with rod-eye stoppers 22 Manholes provided or repaired 31 Soil or ventilation pipes repaired or renewed 13 Gully kerbs and channels repaired 24 New soakaways constructed 17 Closets New closets provided 2 Buildings repaired 21 New pans fixed to water closets 14 Water supply re-instated 1 Flushing cisterns repaired or renewed 16 Flush pipes and pan joints repaired or renewed 14 Seats repaired or renewed 9 Urinals cleansed 1 Sinks Waste pipes repaired or renewed 12 Yards Yards newly paved or repaired 17 Dust Receptacles New dustbins provided 119 Dampness Roofs repaired 116 Rainwater gutters repaired or renewed 94 Rainwater downspouts repaired or renewed 53 Damp-proof courses provided 16 Windows, sills and doors made weatherproof 81 External walls repaired, repointed or rendered Ill Ventilation provided under floors 23 General Repairs Rooms cleansed 139 Walls and ceilings repaired 177 Floors repaired 42 Stoves repaired or renewed 18 Windows repaired 172 Chimneys repaired 24 Number of premises disinfested from bed bugs 1 Other repairs 16 26 PROSECUTIONS Failure to comply with nuisance abatement notice 1 (Nuisance order made) SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 665 Number of re-inspections of premises 1,670 Number of visits to work in progress 977 Number of miscellaneous visits and inspections 832 Number of visits to dairies 5 Number of visits to ice-cream premises 180 Number of visits to fried-fish shops 33 Number of visits to food premises 819 Number of visits to bakehouses 30 Number of visits to factories 209 Number of visits to workplaces 19 Number of visits to shops and offices 462 Number of visits to stables and yards 16 Number of visits to market gardens, etc. 22 Number of visits to urinals 103 Number of visits to piggeries 4 Number of visits re infectious diseases158 Number of visits to streams 23 Number of visits re smoke abatement 163 Number of complaints received and investigated 407 Number of informal notices served 346 Number of statutory notices served 31 Number of interviews re nuisances, etc. 951 Number of drain tests applied 187 Number of rooms disinfected 168 Number of lots of bedding and clothing disinfected 133 Number of library books disinfected 458 Number of samples of foodstuffs, water, etc., taken for examination 283 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS AND OFFICES Four hundred and sixty-two inspections were made during 1950 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 1950 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. 27 During the season, which covered a period of 18 weeks, the following attendances were recorded: Youth organisations 3,426 School children 5,006 Season Ticket Holders, etc.: Adults 6,246 Children 4,876 Total 19,554 ERADICATION OF BED BUGS During the year bed bugs were found to exist in one house. Appropriate remedial measures were taken. SCHOOLS School Closure. On no occasion during the year was a school closed by the Local Sanitary Authority on account of the prevalence of Infectious Disease amongst the scholars. As in the case of the 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. The present shortage of materials and labour, and the Government's economic policy, make it difficult to keep the maintained schools up to pre-war standards of decoration. Much work has been done, however, during the year, and although not satisfying the very latest code, the schools can be said to be free from sanitary defects. School canteens represent a danger-point and possible focus of disease for school children. This could only be satisfactorily removed, however, by a large-scale development plan involving new buildings for kitchens and dining-rooms. During the year, the Divisional Medical Officer has visited many of these canteens to investigate the conditions under which food is prepared, and to give advice on the maintenance of high standards of hygiene and sanitation. REGULATED TRADES: DAIRIES There are five dairies on the register but no loose milk was handled at the premises. During the year 5 visits of inspection were paid and conditions found to be satisfactory. 28 MILK (SPECIAL DESIGNATION) REGULATIONS During the year the Council granted the following number of dealers' licences under the above-mentioned regulations: Tuberculin Tested 20 Pasteurised 21 Sterilized 25 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 12 14 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 101 195 10 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 113 209 10 — 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 - - - - - Cosaques, Christmas crackers,Christmas stockings, etc. 39 — — — — - Total 45 — — — — — 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 ToH.M. By H.M. Inspector 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) 1 1 - - - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7): (a) Insufficient — — (b) Unsuitable or defective 12 12 - - - (c) Not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to Outwork) 4 4 - - - Total 19 19 — —- — 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 88 Tuberculin Tested Pasteurised 7 Sterilize 1 Total 96 Two samples of pasteurised milk failed to comply with the methylene blue test. MEAT No animals intended for sale for human consumption were slaughtered in the Borough during the year. 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. Dr. H. Amphlett Williams, Ph.D.(Lond.), A.C.G.F.C., F.R.I.C., of 1 Southwark Street, London, S.E.I, is Public Analyst for the Borough. 32 The following table gives details of the samples obtained within this district during the year: Articles Number Examined Number Adulterated, etc. Prosecu tions Convic tions Formal Informal Total Formal Informal Total Almonds, Ground - 4 4 - - - - - Bread — 1 1 — - — - — Butter — 6 6 - - - - - Cakes — 5 5 - - - - - Coffee — 4 4 - - - - - Cooking Fat — 4 4 - - - - - Curry Powder — 4 4 - - - - - Fish Paste — 4 4 - - - - - Flour — 1 1 - - - - - Gelatine — 4 4 - - - - - Golden Raising Powder — 3 3 - - - - - Ice Cream — 1 1 - - - - - Jam and Marmalade — 3 3 - - - - - Jellies — 4 4 - - - - - Margarine •— 4 4 - - - - - Milk 17 3 20 — - — - — Milk, Condensed — 1 1 — 1 1 - — Mincemeat — 1 I - - - - - Pepper — 3 3 — - .— - — Pickles — 3 3 - - - - Sausages 8 1 9 2 - 2 - — Tea — 4 4 - - - - - Vinegar — 3 3 - - - - - Ammoniated tincture - - - - - of Quinine — 3 3 - - - - - Friars' Balsam — 3 3 - - - Glycerine, lemon and honey with Ipecac and Squill _ 1 1 - 1 1 - - Totals 25 78 103 2 2 4 — — 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. 33 OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN The Minister of Health during the year emphasised the need for local authorities to investigate very closely the conditions under which food is prepared and purveyed in their districts. While no cases of food poisoning were notified to the Public Health Department of this Corporation during the year, there has been a large increase in the number of notified cases throughout the whole of England and Wales. The great numbers of persons having meals away from home, including school children taking school meals, has inevitably created a greater risk of food poisoning. The Medical Officer of Health attended a special conference, convened by the Minister of Health for members of local authorities and their officers, where the conditions under which food is prepared and offered for sale were very fully discussed. The Sanitary Inspectors have intensified their supervisory control and have also given lectures to interested groups in the catering trade on the subject of clean food. The Corporation approached the Minister for permission to introduce bye-laws for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food and sale of food in the open air. The Minister of Food confirmed the bye-laws on the 21st November, 1950, and fixed the date they should come into operation as the 1st January, 1951. NUTRITION The general standard of nutrition amongst infants and toddlers attending infant welfare centres continues 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 Bye-laws in respect to the following are in force: Advertisements. Allotment Gardens. Animals, The Keeping of. Buildings. Clean Handling of Food. 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. Slot Machine Sale of Contraceptives. 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 1950, 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 93 63 — Measles 687 2 — Whooping Cough 213 — — Erysipelas 9 2 — Acute Poliomyelitis:— Paralytic 1 1 — Non-paralytic 1 1 — Pneumonia 14 — * 13 Dysentery 1 1 — Paratyphoid Fever 1 1 — Herpes Ophthalmia 1 Totals 1,021 71 13 * Includes deaths from all forms of pneumonia. † Includes deaths of residents in home and institutions outside the Borough. 35 36 Cases of Infectious Disease Notified During the Year 1950 (excluding Tuberculosis) The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections: Disease Total Number of Cases Number of Cases Notified At Ages—Years Number of Cases Notified in each Ward Cases removed to Hospital Deaths (including deaths of residents outside the Borough) Under 1 year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years 20 to 35 years 35 to 45 years 45 to 65 years 65 and over Beddington Wallington North West Central South North Central South Scarlet Fever 93 - 2 2 16 8 54 7 2 2 - - - 36 7 9 12 16 9 4 63 - Measles 687 6 35 69 73 99 389 8 2 3 3 - - 166 59 77 124 138 58 65 2 - Whooping Cough 213 10 21 76 14 35 99 7 1 1 4 - - 51 73 79 37 31 73 19 - - Erysipelas Acute 9 - - - - - - - 1 1 1 2 4 6 - - - 1 - 2 2 - Poliomyelitis 2 - - - - - 1 - - 1 - - - 1 - - 1 - - - 2 - Pneumonia 14 - - - - 1 2 1 - 1 3 5 1 4 1 2 3 ?. 1 1 - 13* Dysentery 1 - - - - - - - - - - 1 - - - - - - - 1 1 - Paratyphoid Fever 1 - - - - - - 1 - - - - - 1 - - - - - - 1 - Herpes Ophthalmia 1 - - - - - - - - - - - 1 - - - - 1 - - - - Totals 1021 16 58 97 103 143 565 19 6 9 11 8 6 265 90 117 177 189 91 92 71 13 * Includes all forms 37 The Monthly Incidence of Infectious Disease, 1950 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 14 9 17 6 20 5 10 3 2 2 3 2 93 Measles 4 1 6 16 4 5 3 2 8 114 315 209 687 Whooping Cough — — 3 3 5 23 43 43 37 11 23 22 213 Erysipelas 4 - 1 1 — — 3 — — — — — 9 Acute Poliomyelitis - - - - - - - - 1 - - 1 2 Pneumonia 1 2 5 — — 2 — — — 1 — 3 14 Dysentery - - - - - - - - - - 1 — 1 Paratyphoid Fever - - - - - - - 1 - - - - 1 Herpes Ophthalmia - - - - - - - - - 1 - - 1 Totals 23 12 32 26 29 35 59 49 48 129 342 237 1,021 Tuberculosis There were 34 new cases notified during the year, this being a slight general reduction on the number of cases notified in 1949. Actually, there was an increase in the number of males notified, from 20 to 29. The following table gives the number of new cases notified during the past five years: New Cases 1946 1947 1948 1949 1950 M. F. M. F. M. F. M. F. M. F. Pulmonary 24 6 15 8 8 11 19 17 27 1 Non-Pulmonary 2 3 6 1 1 1 1 2 2 4 Totals 26 9 21 9 9 12 20 19 29 5 Annual case rate per 1,000 of the estimated population: 1948 1949 1950 Pulmonary 0.58 1.09 0.85 Non-pulmonary0.06 0.09 0.18 The following table gives the number of deaths from this disease during the past five years: Deaths 1946 1947 1948 1949 1950 M. F. M. F. M. F. M. F. M. F. Pulmonary 7 1 4 4 4 2 8 4 7 1 Non-Pulmonary — — 2 — — — — 1 1 8 1 2 Totals 7 1 6 4 4 2 8 5 It will be seen from the foregoing table that 10 Tuberculous patients died during the year. The figures correspond to a death rate per 1,000 of population of 0.30. 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-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year - - - 1 - - - - 1 and under 5 - - — 1 - - — — 5 and under 10 2 - - - - - - - 10 and under 15 1 - - - - - - 1 15 and under 20 2 - - - - - - - 20 and under 25 3 1 2 — 1 - - - 25 and under 35 6 — — — 1 - — - 35 and under 45 2 — — — - 1 — — 45 and under 55 10 — — — 2 — — - 55 and under 65 1 — — 1 3 — - - 65 and upwards — — — 1 1 — — — Totals 27 1 2 4 8 1 — 1 The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 5 3 7 5 8 1 - Non-Pulmonary — 1 1 1 — 1 1 Totals 5 4 8 6 8 2 1 Specimens of sputa from cases, or suspected cases, are sent for examination to the Pathological Laboratory at St. Helier Hospital. 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 1950 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. Infant welfare clinics and general supervisory control through health visiting were continued by the Surrey County Council during the year. In general, a high standard of visiting and a smooth and efficient service were maintained. 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, 236 women made 849 pre-natal attendances. This represents an attendance of 55 percent of the total number of confinements which occurred during 1950. Post-natal examinations were also conducted at this clinic, 22 patients making 22 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 Total attending attendances Children under 1 year 333 5,050 Children, 1-5 years 803 3,763 Total attendances 1,136 8,813 Institutional Confinements. Three hundred and four, or 71 percent, of births allocated to this district, took place in hospitals and nursing homes, this being a slightly higher percentage than recorded in previous years. Unsatisfactory home conditions, especially overcrowding, made it necessary for many women to seek a hospital confinement, and in some cases patients had their confinements in institutions 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 aeed under the St. Helier Hosnital geriatric service The cases attended were as follows: Total Maternity 52 General Medical 161 Tuberculosis 15 228 Treatment. Minor Ailments. One hundred and four 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 29 Tonsils and adenoids 15 Orthopaedic defects 12 Circumcisions 10 Nævi 9 Feeding difficulties 6 Psychological 6 Denial. Following the appointment in February, 1950, of a part-time dental surgeon, it was possible to arrange for 8 sessions per week at the Grange dental clinic for school children, as well as nursing mothers and children under 5 years of age. This has resulted in an increase in the number of cases dealt with. The dental work carried out is illustrated in the accompanying table: No. Examined Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant Mothers 19 26 12 14 2 1 Nursing Mothers 6 6 2 2 — 3 Children, 0.5 98 105 46 1 — — Totals 123 137 60 17 2 4 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 1950, 12 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. Classes for remedial exercises for children suffering from minor orthopaedic and postural defects were conducted during the year. The Physiotherapist was also able to arrange classes for pregnant mothers desiring a course of relaxation exercises. The following table gives details of attendances: Total attendances Irradiations Corrective treatments Children, 0-5 years .. 4,747 1,842 Children, 5-15 years .. .. 843 1,878 ' Adults: Expectant Mothers 192 19 Nursing Mothers 120 174 Others 170 65 6,072 3,978 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 211 326 Children, 0-1 year 415 2,613 Children, 1-5 years 45 3,585 Other Cases 81 583 752 7,107 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. 42 Care of Premature Infants. The arrangements made for the care of premature infants continued during 1950. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Twenty-five premature births were notified during the year, 12 being domiciliary confinements and 13 born in hospital. Two of the infants born in hospital died within 24 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 B. JOHNSON, 'Printer, 11, Manor Road, Wellington.