BED 16 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1951 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1951 TABLE OF CONTENTS Public Health Committee 6 Representatives on Mid-Eastern Divisional Health Sub-committee 6 Representatives on the Wandle Valley Joint Sewerage Board 6 Staff 7 Statistics and Social Conditions 14 Extracts from Vital Statistics 15 Vital Statistics: Comparative Birth-rates, Death-rates, Analysis of Mortality, etc., 1951 16 Registered Causes of Death 17 Violence and Accident 18 Maternal Mortality 18 Infantile Mortality 18 General Provision of Health Services for the Area: Laboratory Facilities 20 Ambulance Facilities 20 Nursing in the Home 20 Treatment Centres and Clinics: Care of Mothers and Young Children 21 Tuberculosis 21 Immunisation against Diphtheria 22 Immunisation against Whooping Cough 22 School Clinics 22 Venereal Diseases Clinics 23 Cleansing of Persons 23 Hospitals 23 Disinfection 24 Sanitary Circumstances of the Area: Water Supplies 24 Drainage and Sewerage 24 Rivers and Streams 25 Closet Accommodation 25 Public Cleansing 25 Sanitary Inspection of the Area 26 3 Statement of the Senior Sanitary Inspector for the Year 1951: Dwelling Houses 26 Milk and Dairies 26 Ice Cream 26 Slaughterhouses 26 Food Premises 26 Unsound Food 27 Food Analyses 27 Factories 27 Bakehouses 27 Workplaces 28 Shops and Offices 28 Complaints 28 Smoke Abatement 28 Infectious Disease and Disinfection 28 Offensive Trades and Fish Frying 28 Rats and Mice 28 Notices 28 Sanitary Improvements: Water Supply 29 Drains 29 Water Closets 29 Sinks 29 Yards 29 Dust Receptacles 29 Dampness 29 General Repairs 29 Prosecutions 30 Summary of work done during the year 30 Shops and Offices 30 Camping Sites 30 Swimming Bath 30 Eradication of Bed Bugs 31 Schools 31 Dairies 31 Milk (Special Designation) Regulations 32 Slaughterhouses 32 Bakehouses 32 Factories 33 Housing 35 Inspection and Supervision of Food: Milk 35 Meat 35 Food and Drugs Act, 1938 35 Chemical and Bacteriological Examinations 36 Outbreaks of Food Poisoning and Clean Food Campaign 37 Nutrition 37 Shell Fish (Molluscan) 37 4 Adoptive Acts and Bye-Laws 38 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 39 Incidence of Infectious Diseases in Age Groups and Wards 40 Monthly Incidence of Infectious Disease 41 Tuberculosis 42 Transferred Functions under the National Health Service Act, 1946: The Care of Mothers and Young Children 44 Ante-natal and Post-natal Supervision 44 Infant Welfare Services 44 Institutional Confinements 44 Domestic Help Service 44 Treatment: Minor Ailments 45 Dental 45 Orthopaedic 45 Physiotherapy 46 Health Visiting 46 Child Life Protection 46 Care of Premature Infants 47 Care of Illegitimate Children 47 5 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITEE December, 1951 Members: Councillor Mrs. V. M. Boyce (Chairman) Councillor P. Sievewright Stoby (Mayor) Alderman W. W. Binnie, J.P. (Deputy Mayor) Councillor Miss K. C. Bratt Councillor D. H. de Voil Councillor G. H. Hyett Councillor F. G. Lee Councillor J. F. Legg Councillor D. H. Salari Councillor A. Stammers Councillor V. M. H. St. J. Todd REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1951 Members: Councillor Mrs. V. M. Boyce (Chairman) Councillor Miss K. C. Bratt Councillor D. H. de Voil Councillor G. H. Hyett Councillor A. Stammers REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1951 Members: Councillor P. Sievewright Stoby (Mayor) Alderman J. Vale Councillor C. A. Bishop Councillor A. H. Pearce 6 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, M.R.S.I., M.R.I.P.H.H., M.S.I.A. (Resigned 18.8.51) A. J. Hattersley. M.S.I.A. (Commenced 1.10.51) Clerks: R. F. Burns (Chief Clerk) E. D. Evezard P. H. Sadler J. P. Squibb (Resigned 6.10.51) K. I. Payne (Commenced 8.10.51). 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. (Resigned 15.4.51) Miss L. Brown, S.R.N., S.C.M., H.V.Cert. (Commenced 7.5.51; resigned 31.12.51). Physiotherapists: Miss G. Allen, M.C.S.P. (Part-time) Mrs. H. M. Henn, M.C.S.P. (Part-time) Assistant to Physiotherapists: Miss D. V. Raymond Administrative Assistant: R. F. Burns Clerks: E. D. Evezard Miss G. Williams (Resigned 30.4.51) Mis s J. D. Boorman (Commenced 1.5.51) 7 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 have the honour to present my annual report for 1951. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 42/51. The vital statistics are based on information supplied by the Registrar-General. The presentation follows that adopted for the previous two years, 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 census of the population, taken in 1951, gave the population of Beddington and Wallington as 32,751, the male and female figures being 15,094 and 17,657 respectively. This is an increase of 6,423, or 24.4 per cent., on the 1931 population. The Registrar-General's estimate, however, is used in compiling the vital statistics; this figure is 32,650. Apart from the population figures, no detailed examination of matters of general interest revealed by the census has, as yet, been published. We may anticipate, however, in due course, an analysis of many factors of national interest, for example, in housing and trends of population. The birth rate per 1,000 total population again shows a decrease at 11.17 in 1951, as compared with 12.54 in 1950. This rate is below that for England and Wales, which is 15.5. Comment on this will be made later in the report. The stillbirth rate of 0.37 per 1,000 total population shows a marked increase on the figure of 0.18, which was recorded in 1950. It is also higher than the corresponding figure for England and Wales, which is 0.36. Expressed as a rate per 1,000 total births, the stillbirth rate is 30.93. In 1950, this rate was 14.05. With a small population and a low birth rate, it requires very few stillbirths to produce high rates. The actual number of children stillborn in the district was 12, out of a total of 388 births. Each case was carefully investigated, and it would appear that the stillbirths were inevitable, and occurred in spite of everything that the maternity and ante-natal services could do. 8 The death rate from all causes per 1,000 total population is 10.47, compared with 10.95 in 1950 and 12.5 for England and Wales. Of the 372 deaths, diseases of the heart and circulatory system accounted for 120 (32.26 per cent. of total deaths), cancer 69 (18.55 per cent. of total deaths), and tuberculosis 6 (1.61 per cent. of total deaths). The maternal mortality rate per 1,000 total births is nil, as compared with 0.70 for England and Wales. For the fifth 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. The infantile mortality rate was 23.94 per 1,000 live births in 1951. The figures on which this rate is based were 9 infants, who died under the age of 1 year, out of 376 live births. On page 19 will be found an analysis of the causes of death. Congenital defects were present in six infants who died, the majority of these surviving for only a few days or weeks. Prematurity was also noted in 3 cases. There has been a very slight fall in the death rate. Most deaths, which occurred in the Borough, were amongst old people. Diseases of the heart and circulatory system accounted for a very considerable proportion. Deaths from cancer showed a slight fall, as also did deaths from cerebral haemorrhage (stroke). Diseases of the respiratory system, however, accounted for a higher proportion of deaths than in the previous year. It will be noted that the birth rate, at 11.17 per 1,000 total population, and the death rate, at 10.47, have come very close indeed. The reports over the previous 5 years for this Borough have continued to show an annual fall in the birth rate; the rate of England and Wales, too, is showing a constant decrease annually. This is the first time, in this district, however, that the two rates, death rate and birth rate, have come to a point where they almost coincide. As has been mentioned in previous reports, an ever-increasing and pressing problem is the effect of a decreasing birth rate upon the population. On a national scale, we shall be faced with the dilemma of providing for an ever-increasing aged population out of the productivity of an ever-diminishing youthful productive force. Socially and economically, two solutions suggest themselves, at the extremes of life. One is an increase in the birth rate, and the other a revision of the age at which retirement commences and production ceases. The Minister of National Insurance, reporting on the year 1951, has pointed out that 290,000 new pensions were awarded. The total number of retirement pensioners during the year increased to 4,100,000. The cost of retirement pensions in the year ended 31st March, 1951, was £248,500,000. The Minister estimates that in 1953/54, the sum will be £350,000,000 a year, out of a total expenditure from the National Insurance Fund of £540,000,000. 9 Retirement pensions are likely to show a rapid increase, and in 25 years they will cost nearly £700,000,000 per annum. Expenditure is expected to outstrip income by 1954 or 1955, and the gap will increase rapidly in succeeding years. In 25 years it is estimated that this gap will be £420,000,000 per annum. In this district, during the year, a considerable proportion of the work of the department has been concerned with the care of the aged. The Medical Officer of Health is frequently asked to intervene to obtain admission to hospital of aged persons, who cannot be adequately cared for in their own homes. In this connection, the standard as set out in Section 47 of the National Assistance Act is taken as the yardstick by which the home circumstances of these unfortunate elderly patients are judged. This section describes them as (a) suffering from grave chronic disease or, being aged, infirm or physically incapacitated, living in insanitary conditions, or (b) unable to devote to themselves, and not receiving from other persons, proper care and attention. It has generally been estimated that the number of old people, who must of necessity be admitted to a hospital or other institution, represents only approximately 3 per cent. of the elderly people in a district. The other 97 per cent. who remain at home, are helped to continue active and in normal health by the assistance of the domiciliary services. These are the provision of home helps and nursing services by the County Council, and recreational activities at Old People's Clubs and Associations. In so far as these services relieve the minor degrees of ill-health and monotony of existence for these old persons, they are essentially preventive in character, and are an extremely valuable contribution to the problem of the care of the aged. One cannot help but feel that it would be true economy to upgrade these services, and thus prevent, or postpone, more serious illness amongst old persons, which would inevitably lead them to seek hospital admission. One very important aspect of the geriatric problem, and one which undoubtedly does contribute in large measure to a proper domiciliary settlement of old persons, is the building of old people's houses by municipal authorities. During the year, the Corporation of Beddington and Wallington, who thus took their place among the more enlightened local authorities, opened eight old people's houses in Harcourt Avenue. These homes comprise one bedroom, living room, kitchen and bathroom. This provision for old people supplements that already undertaken by the Corporation in 1949, when 12 houses of the same type were built on the Park Farm estate. Work has already commenced on a further building programme for 28 houses suitable for the aged in Richmond Road. Most authorities are agreed that if suitable houses can be built and adequate domiciliary services provided, it should be possible to keep many old persons at home, who would otherwise be obliged to enter a State-aided home, institution or hospital. With the passage of time, the domiciliary services will probably be considerably augmented, with the provision of chiropody, physiotherapy, mobile meals, mobile libraries, home laundry, and other home comforts, for example, bed linen, radio, 10 etc. Sitters-in, too, would represent a very useful service. Such provision as has been made of this kind of service has been done by voluntary organisations. It should, however, be possible for welfare authorities to undertake these responsibilities in ever-increasing proportion, as it would appear to be economically sound. In this connection, we must again record with grateful thanks the work of the Old People's Clubs, which has continued under the able guidance of Councillor Mrs. V. M. Boyce during 1951. We must acknowledge with thanks, too, the day-to-day administration of the domestic help domiciliary service, in which the W.V.S. and their Domestic Help Supervisor, Mrs. D. Best, played such a large part, and which was continued on a full-time voluntary basis throughout the year. A close liaison was maintained with the Geriatric Department at St. Helier Hospital and with the almoners of all the hospitals in the neighbourhood. Urgent demands for admission were arranged most expeditiously, but with the ever-increasing strain on hospital accommodation, it is not always easy to place infirm geriatric cases satisfactorily. There has been a general improvement in the incidence and treatment of tuberculosis throughout the country, the work of the Mass Radiography Units in ensuring early recognition of the disease and improved sanatorial accommodation for new cases making it possible to prevent the spread of the disease by removing foci of infection as soon as they occur. On page 42, the record of tuberculosis in the Borough is set out, and it will be noted that while there was a slight increase in the number of cases notified in 1951, the number of deaths from tuberculosis showed a marked fall, the tuberculosis death rate per 1,000 of population in the Borough being only 0.18. A number of children from tuberculous households was dealt with under the County Council's boarding-out scheme. This service has proved eminently successful in removing susceptible young persons from infective surroundings. Domiciliary home help service, too, was extremely valuable in helping the care of tuberculous patients nursed at home. A number of children, whose parents are known to be tuberculous, have received the new B.C.G. vaccine. The introduction of this preventive measure holds out great hope in safeguarding susceptible individuals at an early age. The method is so recent, however, that it is impossible at this stage to estimate the value of the vaccine. On page 37 a note is made of the high nutritional standard of the children in the Borough. The general impression of medical officers in charge of infant welfare centres and school clinics, and conducting school medical inspections, is that the children in the district show a higher standard of growth, both in weight and height, than was seen before the 1939/1945 war. There is now so very much more done for children, and there are so very many outlets for their energies at all ages, that a natural improvement in development can be confidently looked for. 11 Among the many activities of the modern world to which adults are now only just becoming accustomed, is the introduction of television into a great number of homes. The impact of television on the minds and habits of children has been recently the subject of much controversy. Many of the older generation paint a very dark picture of the detriment to mind and body to be anticipated, following viewing by children. Others see in the new medium a powerful ancillary to education and a good broadening influence for the fuller development of the child. Most of us can recollect, in our infancy, being warned against an enormous number of indoor pursuits, which were calculated to wreck our young lives. Too much reading, reading in bed, and other childish pursuits were from time to time stressed as keeping us from following outdoor sports and healthy exercise in the open air. From a general impression of children introduced to television, while undoubtedly the novelty exerts a very powerful influence when first brought into the home, it soon falls into its natural position, like radio and the gramophone, as household entertainment, and only items of interest are followed. The televising of many of the national sporting events, and sports and games played by experts, can have an enormous stimulating influence on children. They are thus shown how the best exponents achieve their records, and in addition to having an incentive to attempt to do likewise, also see in a very intimate way how these pursuits can best be followed. Progress, however, is bound to be made in all these sciences, and no amount of decrying of the introduction of new ideas will prevent our children from taking a great interest, and following up new developments in every scientific field. A contributor in a recent issue of a scientific journal has expressed the view that "interplanetary travel during homework hours will, I feel sure, undermine the health of my great-grandchildren". On page 40 the incidence of infectious disease in the Borough in 1951 is tabulated. The total figure of infectious disease cases, at 448, is less than half the corresponding figure for 1950, which was 1,021. This considerable reduction is due to a fall in 1951 in the incidence of scarlet fever, measles and whooping cough. The deaths of two children from measles were complicated by bronchopneumonia. Both took place in hospital, but unfortunately the tender age of the patients (both 15 months) jeopardised their chances of recovery. Measles and whooping cough together still constitute one of the major threats to young children. With improvement in the production of antiwhooping cough vaccines, however, it is hoped, in time, to effect a reduction in the incidence of this disease almost comparable with the fall in cases of diphtheria. During the year, there were no cases of anterior poliomyelitis (infantile paralysis) notified, and there were no cases of diphtheria. It is now generally accepted that the low incidence of diphtheria, and the negligible death rate from this disease, can be accounted for by immunisation of the child population. 12 Considerable work on the prevention of poliomyelitis has been undertaken in recent years in Australia, and the view there has been expressed that it is highly probable, now that scientists are able to grow the poliomyelitis virus in the laboratory, that a vaccine may be produced that will confer a significant degree of immunity against the disease. Epidemiologists have now to accept poliomyelitis as being an inescapable risk to be faced by the growing individual. In the light of this, the Australian work on prevention gives great hope for future protection during the early susceptible years of life. The Department continued to administer the swimming bath at Beddington Orphanage. This provision by the Corporation was much appreciated by residents of the Borough, but unfortunately, owing to a very inclement season, the numbers of persons attending showed a decrease. The year 1951 was one in which the population of the Borough enjoyed good health and were free from epidemic disease. 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, 1952. Medical Officer of Health. 13 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,048 Population, census, 1931 26,249 Population, census, 1951 32,751 Registrar-General's estimate of resident population for 1951 32,650 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1951 9,556 Rateable Value, December, 1951 £408,671 Sum represented by penny rate, December, 1951 £1,630 The Urban District of Beddington and Wallington was constituted in 1915 by an Order of the Surrey County Council, the area up to that time being part of the Croydon Rural District. By an Order in Council, dated 20th August, 1937, H.M. King George VI granted a charter to Beddington and Wallington, which was presented on the 15th September, 1937, by the Lord Lieutenant of the County of Surrey. The Borough is bounded on the east by the County Borough of Croydon, to the north by the Borough of Mitcham, to the west by the Carshalton Urban District, and to the south by the Urban District of Coulsdon and Purley. The maintenance of parks and open spaces throughout the district continues to lend a very pleasing atmosphere. The demand for recreational facilities for school children, youth organisations and industrial sports clubs, continues to be met. During the year the district was very fortunate in being able to meet the needs of both young and old. 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. 14 EXTRACTS FROM VITAL STATISTICS Total M F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 362 194 168 11.52 (Crude) „ „ Illegitimate 14 6 8 11.17 (Corrected) Total 376 200 176 Still Births 12 7 5 Rate per 1,000 total (live and still) births 30.93 Deaths 372 172 200 Death Rate per 1,000 of the estimated resident population 11.39 (Crude) 10.47 (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 23.94 Legitimate Infants per 1,000 legitimate live births 24.86 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 75 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 15 Comparative birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1951: 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 15.5 17.3 16.7 17.8 11.17 Still 0.36 0.45 0.38 0.37 0.37 Deaths— All Causes 12.5 13.4 12.5 13.1 10.47 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.01 0.01 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.31 0.37 0.31 0.38 0.18 Influenza 0.38 0.36 0.38 0.23 0.28 Smallpox 0 00 000 0 00 0.00 0.00 Acute Poliomyelitis (including Polioencephalitis) 0 00 0.01 0.01 0.00 0.00 Pneumonia 0.61 0.65 0.63 0.61 0.34 Notifications— Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.03 0.03 0.02 0.01 0.00 Meningococcal Infection 0.03 0.04 0.03 0.03 0.00 Scarlet Fever 1.11 1.20 1.20 1.10 0.92 Whooping Cough 3.87 3.62 4.00 3.11 2.73 Diphtheria 0.02 0.02 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.15 0.12 Smallpox 0.00 0.00 0 00 — — Measles 14.07 13.93 14.82 14.64 7.35 Pneumonia 0.99 1 .04 0.96 0.72 2.26 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.00 Non-Paralytic 0.02 0.02 0.03 0.02 0.00 Food Poisoning 0.13 0.15 0.08 0.23 0.03 Deaths under 1 year of age Rates per 1,000 Live Births. 29.6 33.9 27.6 26.4 23.94 Deaths from Diarrhoea and Enteritis under 2 years of age 1.4 1.6 1.0 0.7 0.00 Notifications— Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Pyrexia 10.66 13.77 8.08 14.90 0.00 Sepsis of pregnancy childbirth and the puerperium Abortion with toxaemia Other toxaemias of pregnancy and the puerperium Haemorr. age of pregnancy and childbirth Abortion without mention of sepsis or toxaemia Abor. tion with sepsis Other complications of pregnancy childbirth and puerperium Maternal Mortality England and Wales 0.01 0.00 0.24 0.13 0.05 0.09 0.18 Beddington and Wallington 0.00 0.00 0.00 0.00 0.00 0.00 0 00 16 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1951: Causes of Death Males Females Total All Causes 172 200 372 1. Tuberculosis, respiratory 4 — 4 2. Tuberculosis, other 1 1 2 3. Syphilitic disease — — — 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles 1 1 2 9. Other infective and parasitic diseases — 1 1 10. Malignant neoplasm, stomach 10 4 14 11. Malignant neoplasm, lung, bronchus 7 1 8 12. Malignant neoplasm, breast — 8 8 13. Malignant neoplasm, uterus — 2 2 14. Other malignant and lymphatic neoplasms 22 15 37 15. Leukæmia, aleukæmia 1 — 1 16. Diabetes 1 3 4 17. Vascular lesions of nervous system 12 27 39 18. Coronary disease, angina 25 25 50 19. Hypertension with heart disease 3 5 8 20. Other heart diseases 23 39 62 21. Other circulatory diseases 8 8 16 22. Influenza 5 4 9 23. Pneumonia 6 5 11 24. Bronchitis 16 14 30 25. Other diseases of respiratory system 3 1 4 26. Ulcer of stomach and duodenum 4 — 4 27. Gastritis, enteritis and diarrhoea — — — 28. Nephritis and nephrosis 3 3 6 29. Hyperplasia of prostate 2 — 2 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 1 5 6 32. Other defined and ill-defined diseases 11 23 34 33. Motor vehicle accidents — — — 34. All other accidents 2 2 4 35. Suicide 1 3 4 36. Homicide and operations of war — — — 17 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 32.26 Cancer 69 18.55 Intra-Cranial Vascular Lesions 39 10.48 Tuberculosis (All Forms) 6 1.61 Pneumonia 11 2.96 Bronchitis 30 8.06 Other Diseases of the Circulatory System 16 4.30 Influenza 9 2.42 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 1 3 4 Other Violent Causes 2 2 4 Totals 3 5 8 MATERNAL MORTALITY Members of the Council will be pleased to note that for the fifth 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 0.79. INFANTILE MORTALITY The infantile mortality rate for 1951 was 23.94 per 1,000 live births. The comparable rate for England and Wales is 29.6. 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 376 live births, only 9 deaths of infants under one year of age (6 males and 3 females) were registered. 18 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 30 mins. M. Cerebral haemorrhage. 1 hour M. Gross prematurity. 1 day M. Extreme prematurity. 2 days M. Bilateral hemorrhagic broncho-pneumonia. Prematurity. 1 week F. Spina-bifida and hydrocephalus. Spastic paralysis of both legs. Lumbar myelo meningocele. 1 week F. Syncopal attacks. Congenital heart block. 2 weeks F. Broncho-pneumonia. 2 months M. Congenital hydrocephalus. 4 months M. Acute bronchitis. Congenital heart disease. 19 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 1951, 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 845 cases, including 72 maternity and 13 midwifery patients. A total of 17,402 visits was made. 20 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. 21 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 residing in the Borough who were treated during the year and 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., 1951 2,532 4,082 6,614 Children who completed full course of immunisation during the year 280 125 405 Number of children who received reinforcing injections during the year 3 405 408 Number of children known to be immunised at 31st Dec., 1951 1,239 3,466 4,705 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, 42 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 92 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. 22 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 Hospital, Guildford, the East Surrey Hospital, Redhill, and at hospitals previously under the London and Home Counties Scheme. Cleansing of Persons During 1951 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 5 Pediculosis 12 Other conditions 5 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. 23 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 (9,556) 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 27 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. Following a heavy storm in August flooding occurred in several places, the most serious being at the junction of Woodcote Road and Manor Road under the Railway Bridge, affecting several shops. It is understood that remedial action is being taken. 24 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 1951. The obstructions in that portion of the river bed under Wallis' Mill in Wandle Road, Beddington, have been removed and normal flow has been resumed, thereby reducing the possibility of flooding in that area. Additional oil filters have been installed in factories in the Croydon area with a very noticeable improvement in the cleanliness of the river. CLOSET ACCOMMODATION Practically the whole of the area is on the water carriage system, draining into public sewers. There are a few chemical and earth closets, chiefly for use on sports grounds within the district, whilst four cesspools were in use in the district at the end of the year. PUBLIC CLEANSING The collection of house refuse throughout the Borough was maintained during the year on a weekly basis. The joint scheme of controlled tipping on Mitcham Common with the Croydon and Mitcham Authorities has continued throughout the year. The type of receptacle in use throughout the Borough continues to be the portable galvanised iron covered bin. Residents are being encouraged to provide a receptacle of smaller capacity in order to ease the problem of collection and reduce the quantity of refuse. 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. 25 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, 1951 DWELLING-HOUSES Number of inspections of dwelling-houses 599 Number of inspections recorded under Housing Regulations 30 MILK AND DAIRIES Number of distributors of milk on register 19 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 17 Defects in dairy premises discovered Nil Infringements of Acts and Regulations: Milk sold as pasteurised not complying with prescribed conditions 2 Extraneous matter in milk 2 Unclean milk vessels 1 — 5 Number of licences issued under Milk (Special Designation) Regulations: Tuberculin Tested Milk—Dealers' Licences 6 „ „ „ Supplementary Licences 15 Pasteurised Milk—Dealers' Licences 6 „ „ Supplementary Licences 16 Sterilized Milk—Dealers' Licences 12 „ „ Supplementary Licences 16 — 71 ICE CREAM Number of premises registered for the sale of ice cream 78 Number of manufacturers 1 Number of inspections of premises 99 Number of samples taken for examination 23 SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 499 Total number of defects discovered and remedied 21 26 UNSOUND FOOD Destroyed or released for approved purposes: lbs. Cereals 28 Cheese 23 Eggs 470 — Fish 182 Fish, canned 33 Fruit, canned 1,084 Fruit, dried 25 Fruit juice, canned 33 Jam and marmalade 114 Meat 246 Meat, canned 1,627 Milk, condensed 103 Milk, evaporated 124 Pickles and Sauces 23 Sausages 10 Soup, canned 231 Spaghetti in tomato sauce, canned 42 Vegetables, canned 507 Miscellaneous foodstuffs 69 Total 4,504 FOOD ANALYSES Number of samples analysed by Public Analyst 105 Number of samples reported against: Jellies—failed to comply with setting test 2 Milk—contained extraneous matter 1 Sausages, beef—deficient in meat 1 Tincture of Quinine, ammoniated—deficient in ammonia and quinine 1 Sal Volatile—deficient in ammonia and ammonium carbonate 2 — 7 Number of prosecutions Nil FACTORIES Number of factories on register (including bakehouses) 121 Number of inspections 195 Number of defects discovered and remedied 25 BAKEHOUSES Number of bakehouses in district 11 Number of inspections 38 Number of defects discovered and remedied 6 27 WORKPLACES Number of inspections of workplaces 28 Number of defects discovered and remedied 3 SHOPS AND OFFICES Number of visits to shops re sanitary requirements 338 Number pf defects discovered and remedied 28 COMPLAINTS Complaints received and dealt with during the year were due to the following causes: Defects in dwelling-houses (various) 146 Stoppages in drains 70 Defects in drains or water closets 22 Unwholesome foodstuffs 28 Insect pests 8 Miscellaneous 74 348 SMOKE ABATEMENT Number of observations 275 Nuisances observed and abated 6 INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 93 Number of rooms disinfected 85 Lots of bedding and clothing disinfected 50 Number of library books disinfected 317 OFFENSIVE TRADES AND FISH FRYING Number of offensive trade premises in district Nil Number of fish-friers' premises in district 7 Number of visits to fish-friers' premises 28 Number of defects discovered and remedied Nil RATS AND MICE Number of visits to premises by Rodent Operative 2,227 Number of premises upon which rats or mice were found and remedial action taken 200 Number of inspections of sewer manholes 1,512 Number of baits laid 6,380 NOTICES Number of informal notices served (including verbal intimations) 247 Number of statutory notices served Public Health Act, 1936, Section 93 (Nuisances) 30 Public Health Act, 1936, Section 75 (Dustbins) 21 Housing Act, 1936, Section 9 2 — 53 28 SANITARY IMPROVEMENTS Water Supply Water pipes and fittings repaired or renewed 10 Drains Drains re-laid or repaired 37 Drains unstopped and cleansed 35 Intercepting traps provided with rod-eye stoppers 4 Manholes provided or repaired 10 Soil or ventilation pipes repaired or renewed 22 Gully kerbs and channels repaired 13 New soakaways constructed 8 Closets Buildings repaired 17 New pans fixed to water closets 9 Water supply re-instated 2 Flushing cisterns repaired or renewed 12 Flush pipes and pan joints repaired or renewed 8 Seats repaired or renewed 5 Urinals cleansed 3 Sinks Waste pipes repaired or renewed 6 Yards Yards newly paved or repaired 13 Dust Receptacles New dustbins provided 81 Dampness Roofs repaired 100 Rainwater gutters repaired or renewed 76 Rainwater downspouts repaired or renewed 39 Damp-proof courses provided 5 Windows, sills and doors made weatherproof 72 External walls repaired, repointed or rendered 60 Ventilation provided under floors 12 General Repairs Rooms cleansed 88 Walls and ceilings repaired 165 Floors repaired 43 Stoves repaired or renewed 19 Windows repaired 173 Chimneys repaired 22 Number of premises disinfested from bed bugs 3 Other repairs 19 29 PROSECUTIONS Selling milk unfit for human consumption (contained glass fragments) 1 (Fined £25 and costs) SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 599 Number of re-inspections of premises 1,596 Number of visits to work in progress 834 Number of miscellaneous visits and inspections 753 Number of visits to dairies 17 Number of visits to ice-cream premises 99 Number of visits to refreshment rooms 101 Number of visits to fried-fish shops 28 Number of visits to bakehouses 38 Number of visits to other food premises 216 Number of visits to factories 195 Number of visits to workplaces 28 Number of visits to outworkers' premises 25 Number of visits to shops and offices 338 Number of visits to stables and yards 46 Number of visits to market gardens, etc. 20 Number of visits to urinals 87 Number of visits to piggeries 16 Number of visits re infectious diseases 93 Number of visits to streams 37 Number of visits re smoke abatement 275 Number of complaints received and investigated 348 Number of informal notices served 247 Number of statutory notices served 53 Number of interviews re nuisances, etc. 806 Number of drain tests applied 114 Number of rooms disinfected 85 Number of lots of bedding and clothing disinfected 50 Number of library books disinfected 317 Number of samples of foodstuffs, water, etc., taken for examination 257 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 thirty-eight inspections were made during 1951 and in 7 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 1951 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. 30 During the season, which covered a period of 18 weeks, the following attendances were recorded: Youth organisations 2,345 School children 5,069 Season Ticket Holders, etc.: Adults 5,967 Children 3,316 Total 16,697 ERADICATION OF BED BUGS During the year bed bugs were found to exist in three houses. 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 six dairies on the register but no loose milk was handled at the premises. During the year 17 visits of inspection were paid and conditions found to be satisfactory. 31 MILK (SPECIAL DESIGNATION) REGULATIONS During the year the Council granted the following number of dealers' licences under the above-mentioned regulations: Tuberculin Tested 21 Pasteurised 22 Sterilized 28 SLAUGHTERHOUSES There are no Slaughterhouses in use within the district. BAKEHOUSES There are eleven bakehouses in the district. Thirty-eight inspections were carried out, and in two instances defects were found to exist. 32 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 20 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 109 175 10 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 121 195 10 — Part VIII of the Act Outwork Nature of Work 0) Section 110 Section 111 No. of outworkers in August list required by Sect. 110 (1)(c) (2) No. of cases of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of instances of work in unwholesome premises (5) Notices served (6) Prosecutions (7) Making of wearing apparel 11 - - - - - Stuffed toys 16 — — — — — Cosaques, Christmas crackers,Christmas stockings, etc. 80 — — — — — Total 107 — — — — — 33 Cases in which Defects were found: Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S. 1) 1 1 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary conveniences (S.7): (a) Insufficient — — — — — (b) Unsuitable or defective 11 11 — 3 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 2 1 1 — — Total 14 13 1 3 — 34 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 The Milk (Special Designations) (Specified Areas) Order, 1951, came into operation on 1st October, 1951, under which Order the use of special designations for retail sales of milk within the Borough became compulsory. During the year the following samples were examined under the provisions of the Milk (Special Designation) (Pasteurised and Sterilized Milk) Regulations. Designation No. Pasteurised 78 Tuberculin Tested Pasteurised 18 Sterilized 2 98 With the exception of 1 sample of tuberculin tested pasteurised milk and 1 sample of pasteurised milk, which failed to comply with the methylene blue test, the samples conformed to the standards prescribed by the Regulations. During the year 4 samples of unheated milk were submitted to biological test for tubercle bacilli. The results were negative. 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.l, is Public Analyst for the Borough. 35 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 — 3 3 — — — — Butter — 4 4 — — — — — Cakes — 6 6 — — — — — Cake Mixture — 1 1 — — — — — Coconut, desiccated — 3 3 — — — — — Coffee — 2 2 — — — — — Coffee & Chicory — 1 1 — — — — — Coffee & Chicory Essence — 4 4 — — — — — Cornflour — 1 1 — — — — — Gelatine — 3 3 — — — — — Golden Raising Powder — 1 1 — — — — — Ice Cream — 4 4 — — — — — Jellies — 7 7 — 2 2 — — Lard & Cooking Fat — 4 4 — — — — — Margarine — 4 4 — — — — — Milk 9 8 17 — 1 1 — — Oatmeal — 3 3 — — — — — Olive Oil — 3 3 — — — — — Pepper — 1 1 — — — — — Salad Cream — 2 2 — — — — — Sardines — 3 3 — — — — — Sauces — 3 3 — — — — — Sausages & Sausage Meat 4 2 6 1 — 1 — — Tea — 4 4 — — — — — Vinegar — 3 3 — — — — — Whisky — 3 3 — — — — — Parrish's Food — 3 3 — — — — — Tincture of Quinine, Ammoniated — 3 3 — 1 1 — — Sal Volatile — 3 3 — 2 2 — — Totals 13 92 105 1 6 7 — — 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. 36 OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN During the year, one case of food poisoning was notified. The patient was a youth attending a school in a neighbouring borough. The investigation was inconclusive, and it was thought the boy may have taken some article of food causing sickness and diarrhoea. He was admitted to hospital, but no organism was recovered. He was the only case in his household. The byelaws for securing the observance of sanitary and cleanly conditions in connection with the handling, wrapping and delivery of food and the sale of food in the open air, confirmed by the Minister of Food in 1950, came into operation on the 1st January, 1951. Following the introduction of the byelaws, all shopkeepers handling food throughout the Borough were circularised and asked to display a notice, which the Department provided, directing customers to leave their dogs outside the shop. The Sanitary Inspectors, during the course of their routine inspections, were of opinion that the greater number of shopkeepers were pleased to co-operate with the Department, and display the notices. The Sanitary Inspectors have continued to intensify supervisory control, and have been in close touch throughout the year with the catering trade, giving advice and talks where necessary on the subject of clean food. It is possible that cases of sickness and diarrhoea which might be classified as food poisoning are not brought to the attention of the Department. The general public and general practitioners frequently do not take the incidence of this type of disease seriously, and very rarely do they ask for administrative action. As a result, it is almost impossible to give a proper statistical picture of the amount of intestinal infective disease occurring in the population. From information received, however, from other sources, it would appear that such disease is more widespread than it was before the war. NUTRITION The general standard of nutrition amongst infants and toddlers attending infant welfare centres continues on a 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. 37 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. 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. 38 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease in the Borough in 1951, 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 30 22 — Measles 240 2 2 Whooping Cough 89 — — Erysipelas 4 2 — Pneumonia 77 2 *11 Dysentery 7 3 — Food Poisoning 1 — — Totals 448 31 13 * Includes deaths from all forms of pneumonia. † Includes deaths of residents in home and institutions outside the Borough. 39 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 1951 (excluding Tuberculosis) 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 30 — — 1 3 4 19 — 2 1 — — — 4 2 7 3 9 3 2 22 — Measles 240 6 15 27 36 41 101 5 6 2 — 1 — 34 24 21 48 40 23 50 2 2 Whooping Cough 89 6 7 13 13 14 32 1 — 1 1 — 1 14 19 4 9 19 11 13 — — Erysipelas 4 — — — — — — — — — — 2 2 1 — 1 — — 2 — 2 — Pneumonia 77 — — — 1 — 5 1 1 4 8 33 24 8 4 9 10 33 7 6 2 11* Dysentery 7 — — — — 1 3 — — 2 — 1 — 2 2 — 1 1 — 1 3 — Food Poisoning 1 — — — — — — — 1 — — — — — — — 1 — — — — — Totals 448 12 22 41 53 60 160 7 10 10 9 37 27 63 51 42 72 102 46 72 31 13 * Includes all forms 40 The Monthly Incidence of Infectious Disease, 1951 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever — 3 1 — 4 — 1 1 2 2 3 13 30 Measles 58 69 53 39 8 6 3 3 — — — 1 240 Whooping Cough 10 14 17 10 16 13 4 1 3 1 — — 89 Erysipelas 1 1 1 — — 1 — — — — — — 4 Pneumonia 21 45 3 3 — 1 — — 1 — — 3 77 Dysentery — 2 — 1 — — 2 — — 2 — — 7 Food Poisoning — — — — — — 1 — — — — — 1 Totals 90 134 75 53 28 21 11 5 6 5 3 17 448 41 Tuberculosis There were 36 new cases notified during the year, this being an increase of 2 on the number of cases notified in 1950. The following table gives the number of new cases notified during the past five years: New Cases 1947 1948 1949 1950 1951 M. F. M. F. M. F. M. F. M. F. Pulmonary 15 8 8 11 19 17 27 1 21 10 Non-Pulmonary 6 1 1 1 1 2 2 4 2 3 Totals 21 9 9 12 20 19 29 5 23 13 Annual case rate per 1,000 of the estimated population: 1948 1949 1950 1951 Pulmonary 0.58 1.09 0.85 0.95 Non-pulmonary 0.06 0.09 0.18 0.15 The following table gives the number of deaths from this disease during the past five years: Death 1947 1948 1949 1950 1951 M. F. M. F. M. F. M. F. M. F. Pulmonary A 4 4 4 2 8 4 7 1 4 — Non-Pulmonary 2 — — — — 1 1 1 1 1 Totals 6 4 4 2 2 8 8 2 5 1 It will be seen from the foregoing table that 6 Tuberculous patients died during the year, this being a considerable reduction on the corresponding figure for the previous year. The figures correspond to a death rate per 1,000 of population of 0 18. 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: 42 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pul- monary 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 2 1 — — — — — — 15 and under 20 — 2 — — — — — — 20 and under 25 2 2 — 1 — — — — 25 and under 35 2 3 — — 1 1 — 35 and under 45 4 2 — 1 1 — — — 45 and under 55 5 — 1 1 1 — — 1 55 and under 65 3 — — — 1 — — — 65 and upwards 2 — — — — — — — Totals 21 10 2 3 4 — 1 1 The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 3 6 7 6 3 3 3 Non-Pulmonary — — — 1 2 — 2 Totals 3 6 7 7 5 3 5 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 1951 43 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, 164 women made 620 pre-natal attendances. This represents an attendance of 42.27 per cent. of the total number of confinements which occurred during 1951. Post-natal examinations were also conducted at this clinic, 11 patients making 11 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 300 4,677 Children, 1-5 years 796 3,373 Total attendances 1,096 8,050 Institutional Confinements. Three hundred and nine, or 79-6 per cent, of births allocated to this district, took place in hospitals and nursing homes, this being a higher percentage than recorded in previous years. Patients going into hospital for a confinement are classified under two headings, those whose admission is essential on medical grounds and those who have unsatisfactory homes in which it would be inadvisable to conduct a domiciliary confinement. Every case is properly investigated, and it is only after a visit from the Health Visitor that patients requiring admission on social grounds are put forward for consideration by the hospital. 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 44 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: Total Maternity 41 General Medical 146 Tuberculosis 12 199 Treatment. Minor Ailments. Seventy 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 15 Tonsils and adenoids 14 Orthopaedic defects 11 Nævi 8 Circumcisions 6 Feeding difficulties 5 Dental. The Grange dental clinic for school children and children below the age of five years, as well as nursing and expectant mothers, continues to perform a very essential service. The accompanying table illustrates the work carried out. No. Examined Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant Mothers 7 8 22 1 3 3 Nursing Mothers — 5 2 .— — — Children, 0-5 76 106 78 — — — Totals 83 119 102 1 3 3 Orthopaedic. Patients attending infant welfare centres who require treatment for orthopædic defects are referred by the Clinic Medical Officer to orthopædic surgeons at St. Helier or other hospitals. During 1951, 11 cases were referred for treatment. 45 Physiotherapy. This department continues to do very useful work, and a high standard of attendance was maintained throughout the year. 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 5,670 2,026 Children, 5-15 years 1,247 1,854 Expectant and Nursing Mothers 36 8 Others 147 32 7,100 3,920 Visits during the year were made as follows: First visits Total visits Expectant Mothers 122 204 Children, 0-1 year 337 1,695 Children, 1-5 years 2 2,524 Other Cases 58 214 519 4,637 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. 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. 46 Care of Premature Infants. The arrangements made for the care of premature infants continued during 1951. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Nineteen premature live births were notified during the year, 1 being a domiciliary confinement and 18 were born in hospital. The infant born at home was transferred to hospital and died within 24 hours. One 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. 47 B. JOHNSON, Printer, 11, Manor Road, Wallington.