BED 17 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1952 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1952 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 12 Extracts from Vital Statistics 13 Vital Statistics: Comparative Birth-rates, Death-rates, Analysis of Mortality, etc., 1952 14 Registered Causes of Death 15 Violence and Accident 16 Maternal Mortality 16 Infantile Mortality 16 General Provision of Health Services for the Area: Laboratory Facilities 18 Ambulance Facilities 18 Nursing in the Home 18 Treatment Centres and Clinics: Care of Mothers and Young Children 19 Tuberculosis 19 Immunisation against Diphtheria 20 Immunisation against Whooping Cough 20 School Clinics 20 Venereal Diseases Clinics 21 Cleansing of Persons 21 Hospitals 21 Disinfection 22 Sanitary Circumstances of the Area: Water Supplies 22 Drainage and Sewerage 22 Rivers and Streams 23 Closet Accommodation 23 Public Cleansing 23 Sanitary Inspection of the Area 24 3 Statement of the Senior Sanitary Inspector for the Year 1952: Dwelling Houses 24 Milk and Dairies 24 Ice Cream 24 Slaughterhouses 24 Food Premises 24 Unsound Food 25 Food Analyses 25 Factories 25 Bakehouses 26 Workplaces 26 Shops and Offices 26 Complaints 26 Smoke Abatement 26 Infectious Disease and Disinfection 26 Offensive Trades and Fish Frying 26 Rats and Mice 26 Notices 26 Sanitary Improvements: Water Supply 27 Drains 27 Water Closets 27 Sinks 27 Yards 27 Dust Receptacles 27 Dampness 27 General Repairs 27 Prosecutions 28 Summary of work done during the year 28 Shops and Offices 28 Camping Sites 28 Swimming Bath 29 Eradication of Bed Bugs 29 Schools 29 Dairies 30 Milk (Special Designation) Regulations 30 Slaughterhouses 30 Bakehouses 30 Factories 31 Housing 33 Inspection and Supervision of Food: Milk 33 Meat 33 Food and Drugs Act, 1938 33 Chemical and Bacteriological Examinations 34 Outbreaks of Food Poisoning and Clean Food Campaign 35 Nutrition 35 Shell Fish (Molluscan) 35 4 Adoptive Acts and Bye-Laws 36 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 37 Incidence of Infectious Diseases in Age Groups and Wards 38 Monthly Incidence of Infectious Disease 39 Tuberculosis 40 Transferred Functions under the National Health Service Act, 1946: The Care of Mothers and Young Children 42 Ante-natal and Post-natal Supervision 42 Infant Welfare Services 42 Institutional Confinements 42 Domestic Help Service 42 Treatment: Minor Ailments 43 Dental 43 Orthopaedic 43 Physiotherapy 44 Health Visiting 44 Child Life Protection 44 Care of Premature Infants 45 Care of Illegitimate Children 45 5 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITEE December, 1952 Members: Councillor Miss K. C. Bratt (Chairman) Councillor D. H. de Voil (Mayor) Councillor P. Sievewright Stoby (Deputy Mayor) Councillor Mrs. V. M. Boyce Councillor H. Ferguson Councillor G. H. Hyett Councillor F. G. Lee Councillor Miss R. M Smith Councillor A. Stammers Councillor V. M. H. St. J. Todd Councillor E. S. Wickenden REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1952 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, 1952 Members: Councillor D. H. de Voil (Mayor) Alderman J. Vale Councillor A. H. Pearce Councillor S. G. Reading 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. A. J. Hattersley, M.S.I.A. Clerks: R. F. Burns (Chief Clerk) E. D. Evezard B. E. Bignall (Commenced 18.2.52) K. I. Payne 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. Miss M. Parry (Commenced 1.4.52, Resigned 5.9.52) Mrs. M. Maynard (Commenced 1.10.52) 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 J. D. Boorman 7 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 1952. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circulars 2/53 and 42/51. The vital statistics are based on information supplied by the Registrar-General. The presentation follows that adopted for the previous three 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 Registrar-General's estimate of the population of Beddington and ' Wallington at mid-year 1952 is 32,510, and this figure is used in the compilation of the vital statistics. This represents a decrease of 140 on the previous year's estimate, and is 241 less than the figure obtained at the census of population taken in 1951, which was 32,751. The birth rate per 1,000 total population again shows a decrease at 10.74 in 1952, as compared with 11.17 in 1951. This rate is below that for England and Wales, which is 15.3. The stillbirth rate of 0.12 per 1,000 total population shows a marked decrease on the figure of 0.37 which was recorded in 1951. The corresponding figure for England and Wales is 0.35. Expressed as a rate per 1,000 total births, the stillbirth rate is 10-99. In 1951, this rate was 30.93. The number of children stillborn in the district was 4, out of a total of 364 births. This figure is commendably low, but stillbirths will continue to occur, as in many cases they are inevitable, and they take place in spite of everything the maternity and ante-natal services can do. The death rate from all causes per 1,000 total population is 11.01, compared with 10.47 in 1951 and 11.3 for England and Wales. Of the 389 deaths, diseases of the heart and circulatory system accounted for 137 (35.22 per cent. of total deaths), cancer 69 (17.74 per cent. of total deaths), and tuberculosis 7 (1.80 per cent. of total deaths). 8 It will be noted that the death rate, at 11.01, has, this year, exceeded the birth rate, at 10.74 per 1,000 total population. Comment has been made in previous reports since the war, on the continued fall in the birth rate in this district and that of England and Wales as a whole. It is understood, however, that this is the first time a birth rate has been recorded lower than the death rate in any district. The death rate showed a small rise in 1952, as compared with that for the previous year, the figures being 11.01 and 10.47 respectively, per 1,000 total population. Deaths registered continued to be highest amongst persons over the age of 65, the average age at death being in the 70's and 80's. The figures, in common with those for the rest of the country, show a rise in the incidence of coronary thrombosis as a cause of death. Diseases of the heart and circulatory system account for a very considerable proportion. Deaths were particularly high during the winter months of the year, the greatest number being recorded in December. Many of these were deaths from respiratory disease and associated with climatic conditions, particularly the fog, which was prevalent during the last weeks of 1952. From the table on page 16 it will be seen that deaths from all forms of violence have shown an increase. The maternal mortality rate per 1,000 total births is 5.49 as compared with 0.72 for England and Wales. Some speculation is inevitable when comparing this figure with that of Nil recorded for the previous five years. The explanation is that the district has been credited with two deaths, only one of which was a direct complication of childbirth, taking place three weeks after the birth. The other was a death occurring in a London hospital, in which the death certificate recorded toxaemia of pregnancy as being a contributory cause. Enquiry showed that the person had not been pregnant for the previous 15 years, but in the light of the wording of the death certificate, the Registrar-General felt obliged to classify this as a maternal death, even though 15 years had elapsed between the alleged toxaemia and the death. The infantile mortality rate was 16.67 per 1,000 live births in 1952. The figures on which this rate is based were 6 infants, who died under the age of 1 year, out of 360 live births. On page 17 will be found an analysis of the causes of death. This is a gratifying fall from the rate of 23.94 per 1,000 live births recorded in 1951, and reflects credit on all persons, midwives, doctors and others, engaged in midwifery and child welfare in the district. It is interesting to note that a child born prematurely in St. Helier Hospital, weighing only 1 lb. 14 oz., survived. Considerable attention has been given in recent years to the care of premature infants, and this survival reflects the enormous advances made in the treatment of such children. 9 The disadvantages have been pointed out previously, of having an ever-ageing population to be provided for by insurance and pensions by an ever-diminishing youthful labour force. The problem of the care of the aged still occupies a great deal of attention, both in Parliament and amongst authorities charged with the responsibility of making provision for geriatric care. With the continued shortage of hospital beds, it is more than ever necessary to try and keep old people active and happy in their own homes. One of the most useful ways in which this can be accomplished is by expansion of the home help service, and also by voluntary organisations, old people's welfare committees, old people's clubs, and other social efforts to fill the lonely lives of the aged. During the year, the services of the Wallington Old People's Welfare Committee, under the chairmanship of Councillor Mrs. V. M. Boyce, have continued to render invaluable service, which has been markedly appreciated by the old people of the district. The work of the W.V.S., too, in this sphere, under the able guidance of Mrs. O. L. Wiles, was very much appreciated. It is inevitable that, with the ever-growing problem of the care of the aged, expansion of all these activities will be called for. On page 37, the table dealing with infectious diseases shows that the total incidence of infectious diseases, at 333, represents a fall as compared with the previous year, in which 448 cases were notified. This fall in incidence is reflected in all the major infectious diseases. It will also be noted that a combined immunising material against diphtheria and whooping-cough is being brought into regular use, now that the efficacy of whooping-cough vaccine has been considerably improved. During the year, whooping-cough was not prevalent in a very severe form. The number of cases was not high, and those children affected showed symptoms of a very mild character. While measles did not reach epidemic proportions, and the notifications were considerably lower than in the previous year, this disease still constitutes one of the major threats in childhood. No deaths, however, were recorded from measles, and only two cases were removed to hospital for nursing. As in 1951, it is gratifying to note that during the year no cases of anterior poliomyelitis were notified. This dread disease still continues to cause anxiety to parents through the summer months. Since the war, the general incidence of this disease continues to show, not only a rise, but a higher incidence among older persons, the disease no longer being confined to the young. A great deal of research is being carried out in many parts of the world, and the truly infectious nature of the disease is now generally accepted. As a result, isolation, and the supervision of contacts will be undertaken more thoroughly than in the past. 10 Considerable work on the preparation of a suitable vaccine has been undertaken, both in this country and in America, and from the reports of recent researches, the wholesale immunisation of persons exposed to this risk may be the first line of defence within the foreseeable future. From the observations of medical officers in charge of infant welfare centres, and examinations in schools, it was generally felt that the average nutrition of children at all ages continued to be maintained at a very high level. With the gradual removal of rationing restrictions, diet in childhood is more satisfactory. During 1952, the swimming bath at Beddington Orphanage continued to provide facilities for residents in the Borough, under similar administrative arrangements to those which previously obtained. During the course of the year, negotiations were opened with the Surrey County Council, into whose hands the Orphanage passed, for the continuance of this excellent recreational activity for some years to come. The inclement weather noted in 1951 was not repeated in 1952, and during the very fine summer the attendances at the bath showed a marked increase on the previous year. The Corporation are to be congratulated on the excellent health of the Borough during 1952. The district was free from epidemic disease, and apart from the diseases associated with advancing years, illness was at a relatively low level. 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, 1953. Medical Officer of Health. 11 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 1952 32,510 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1952 9,643 Rateable Value, December, 1952 £411,955 Sum represented by penny rate, December, 1952 £1,645 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 Surrey County Council, at the Beddington Orphanage bath. 12 EXTRACTS FROM VITAL STATISTICS Total M F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 348 174 174 11.07 (Crude) „ „ Illegitimate 12 8 4 10.74 (Corrected) Total 360 182 178 Rate per 1,000 total (live and still) births Still Births 4 - 4 10.99 Death Rate per 1,000 of the estimated resident population Deaths 389 172 217 11.97 (Crude) 11.01 (Corrected) Rate per 1,000 (live and still) births Deaths attributable to: Pregnancy, Childbirth, Abortion 5.49 Death Rate of Infants under one year of age: All Infants per 1,000 live births 16.67 Legitimate Infants per 1,000 legitimate live births 17.24 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 69 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 13 Comparative birth rates, civilian death rates, analysis of mortality, maternal mortality and case rates for certain infectious diseases in the year 1952: England and Wales. 160 County Boroughs and Great Towns including London. 160 Smaller Towns (Resident Populations 25,000 to 50,000 at 1951 Census). London Administrative County. Borough of Beddington and Wallington. Births— Rates per 1,000 Population. Live 15.3 16.9 15.5 17.6 10.74 Still 0.35 0.43 0.36 0.34 0.12 Deaths— All Causes 11.3 12.1 11.2 12.6 11.01 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 - 0.00 Whooping Cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.24 0.28 0.22 0.31 0.22 Influenza 0.04 0.04 0.04 0.05 0.00 Smallpox 000 — — — — Acute Poliomyelitis (including Polioencephalitis) 0.01 0.01 0.00 0.01 0.00 Pneumonia 0.47 0.52 0.43 0.58 0.46 Notifications— Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever 0.02 0.02 0.03 0.01 0.00 Meningococcal Infection 0.03 0.03 0.03 0.02 0.00 Scarlet Fever 1.53 1.75 1.58 1.56 3.45 Whooping Cough 2.61 2.74 2.57 1.66 2.21 Diphtheria 0.01 0.01 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.14 0.28 Smallpox 0.00 0.00 0.00 — - Measles 8.86 10.11 8.49 9.23 3.66 Pneumonia 0.72 0.80 0.62 0.57 0.62 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.00 Non-Paralytic 0.03 0.03 0.02 0.03 0.00 Food Poisoning 0.13 0.16 0.11 0.18 0.00 Deaths under 1 year of age. Rates per 1,000 Live Births. 27.6 31.2 25.8 23.8 16.67 Deaths from Diarrhoea and Enteritis under 2 years of age 1.1 1.3 0.5 0.7 0.00 Notifications— Rates per 1,000 Total Births (i.e., Live and Still). Puerperal Pyrexia 17.87 23.94 10.22 30.77 0.00 Sepsis of pregnancy childbirth and the puerperium Abortion with toxaemia Other toxaemias of pregnancy and the puerperium Haemorrhage of pregnancy and childbirth Abortion without mention of sepsis or toxaemia Abortion with sepsis Other complications of pregnancy childbirth and puerperium Maternal Mortality England and Wales 0.09 0.02 0.21 0.09 0.04 0.07 0.20 Beddington and Wallington 0.00 0.00 2.75 0.00 0.00 0.00 2.75 14 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1952: Causes of Death Males Females Total All Causes 172 217 389 1. Tuberculosis, respiratory 4 3 7 2. Tuberculosis, other — — — 3. Syphilitic disease - 3 3 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases — 2 2 10. Malignant neoplasm, stomach 6 3 9 11. Malignant neoplasm, lung, bronchus 5 4 9 12. Malignant neoplasm, breast.. — 13 13 13. Malignant neoplasm, uterus.. — 1 1 14. Other malignant and lymphatic neoplasms 17 20 37 15. Leukaemia, aleukæmia 1 2 3 16. Diabetes — — — 17. Vascular lesions of nervous system.. 18 25 43 18. Coronary disease, angina 28 27 55 19. Hypertension with heart disease 2 4 6 20. Other heart diseases 32 44 76 21. Other circulatory diseases 5 19 24 22. Influenza — — — 23. Pneumonia 9 6 15 24. Bronchitis 14 6 20 25. Other diseases of respiratory system 5 2 7 26. Ulcer of stomach and duodenum 1 1 2 27. Gastritis, enteritis and diarrhœ — 1 1 28. Nephritis and nephrosis — 1 1 29. Hyperplasia of prostate 4 — 4 30. Pregnancy, childbirth, abortion — 2 2 31. Congenital malformations .. — 4 4 32. Other defined and ill-defined diseases 14 17 31 33. Motor vehicle accidents 2 2 4 34. All other accidents 3 3 6 35. Suicide 2 2 4 36. Homicide and operations of war - - - 15 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 137 35.22 Cancer 69 17.74 Intra-Cranial Vascular Lesions 43 11.05 Tuberculosis (All Forms) 7 1.80 Pneumonia 15 3.86 Bronchitis 20 5.14 Other Diseases of the Circulatory System 24 6.17 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 2 2 4 Other Violent Causes 5 5 10 Totals 7 7 14 MATERNAL MORTALITY As mentioned in the preamble to this report, the district was credited with two deaths associated with childbirth. One was immediate, that is, took place within three weeks of the birth of the infant, the patient dying from pulmonary embolism. The second was remote, that is, toxaemia of pregnancy was recorded as a contributory factor when a woman died 15 years after her last confinement. The maternal mortality rate is 5-49, compared with 0.72 for England and Wales, per 1,000 live and still births. INFANTILE MORTALITY The infantile mortality rate for 1952 was 16.67 per 1,000 live births. The comparable rate for England and Wales is 27.6. 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 360 live births, only 6 deaths of infants under one year of age (2 males and 4 females) were registered. Three of the deaths (1 male and 2 females) died within the first four weeks of life. 16 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 3 hours M. Erythroblastosis foetalis. 4 days F. Congenital heart action. 6 days F. Cerebral haemorrhage, hæmorrhagic disease. 1 month F. Meningitis, leaking meningo-myelocele and hydrocephalus. 6 months F. Convulsions, cerebral agenesis. 8 months M. Broncho-pneumonia. 17 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 1952, 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 The Beddington and Wallington District Nursing Association came under the direct control of the Surrey County Council and its officers from the 1st April, 1952. From the 5th July, 1948, the Association continued to offer the same excellent facilities for nursing as in previous years, but as agents for the local health authority, the Surrey County Council. From the 1st April, 1952, the Surrey County Council have exercised a greater control over the administration and finances of the Association, and the day-to-day supervision is now in the hands of the Divisional Medical Officer for the Beddington and Wallington part of the Mid-Eastern Division. During the year the District Nurses attended 848 cases, including 77 maternity and 14 midwifery patients. A total of 17,265 visits was made. Interviews at the Nurses' Home numbered 1,766. 18 TREATMENT CENTRES AND CLINICS Care of Mothers and Young Children 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 was again generously given by many ladies in the district, in assisting in the operation of the infant welfare centres. Among these, special mention should be made of the members of the British Red Cross Society, who continued to supply the great majority 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. 19 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., 1952 2,092 4,759 6,851 Children who completed full course of immunisation during the year 299 94 393 Number of children who received reinforcing injections during the year 456 456 Number of children known to be immunised at 31st Dec., 1952 1,138 3,833 4,971 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 was continued throughout the year by the local health authority, to whom it was transferred on the 5th July, 1948. During the year, 107 children were immunised. In the later months of the year, owing to great improvements in the preparation of whooping-cough vaccine, it was decided to introduce a mixed vaccine useful against both whooping-cough and diphtheria. This mixed vaccine will be used exclusively in future, all children thus being doubly immunised. This service continues to be offered free of charge to the public. In addition, notifications have been received from general practitioners of 88 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 20 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. 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 1952 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 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 4 HOSPITALS Infectious Cases. The South-West Metropolitan Regional Hospital Board make 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 have 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 continue 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. 21 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 (9,643) 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 31 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 A major blockage occurred during the year in the Park Road, Wallington, soil sewer, which was only cleared after some difficulty, necessitating the construction of two additional manholes. No other difficulties have been experienced in the maintenance and cleansing of the soil and storm water drainage systems. Remedial action has been put in hand to reduce the probability of a recurrence of flooding in Woodcote Road and Manor Road which was brought about by a heavy storm in August, 1951. 22 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 1952. 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. In March, the joint scheme of controlled tipping on Mitcham Common with the Croydon and Mitcham Authorities ceased, and tipping recommenced on the Corporation's own tip in Beddington Lane. 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. 23 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, 1952 DWELLING-HOUSES Number of inspections of dwelling-houses 518 Number of inspections recorded under Housing Regulations 37 MILK AND DAIRIES Number of distributors of milk on register 18 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 27 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 3 Unclean milk vessels 1 6 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 13 „ „ Supplementary Licences 16 72 ICE CREAM Number of premises registered for the sale of ice cream 78 Number of manufacturers 1 Number of inspections of premises 11 Number of samples taken for examination 17 SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 794 Total number of defects discovered and remedied 29 24 UNSOUND FOOD Destroyed or released for approved purposes: lbs. Bacon 7 Cake mixtures 13 Cereals 6 Cheese 6 Custard Powder 4 Fish 416 Fish, canned 27 Fish Cakes 5 Flour 10 Flour, self-raising 33 Fruit, canned 960 Fruit, dried 34 Fruit juice, canned 81 Gravy Powder 3 Honey 4 Jam and marmalade 119 Jellies 18 Meat 827 Meat, canned 430 Milk, condensed 17 Milk, evaporated 53 Milk, dried 1 Mincemeat 2 Pudding mixture 2 Sauce 21 Sausages 84 Soup, canned 51 Spaghetti 38 Vegetables, canned 207 Total 3,479 FOOD ANALYSES Number of samples analysed by Public Analyst 102 Number of samples reported against: Sausages—deficient in meat content 5 Dried Fruit (Prunes)—mouldy 2 Molasses—fermentation 1 Sal Volatile—deficient in ammonia and ammonium carbonate 2 Sal Volatile—deficient in ammonia 1 11 Number of prosecutions (by Ministry of Food)—Sausages 2 FACTORIES Number of factories on register (including bakehouses) 133 Number of inspections 263 Number of defects discovered and remedied 29 25 BAKEHOUSES Number of bakehouses in district 12 Number of inspections 52 Number of defects discovered and remedied 10 WORKPLACES, SHOPS AND OFFICES Number of inspections 522 Number of defects discovered and remedied 17 COMPLAINTS Complaints received and dealt with during the year were due to the following causes: Defects in dwelling-houses (various) 88 Stoppages in drains 50 Defects in drains or water closets 16 Unwholesome foodstuffs 18 Defective dustbins 10 Insect pests 10 Miscellaneous 58 250 SMOKE ABATEMENT Number of observations 112 Nuisances observed Nil INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 212 Number of rooms disinfected 127 Lots of bedding and clothing disinfected 114 Number of library books disinfected 493 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 25 Number of defects discovered and remedied 1 RATS AND MICE Number of premises inspected 1348 Number of visits to premises 3,211 Number of premises upon which rats or mice were found and remedial action taken 160 Number of inspections of sewer manholes 1,155 Number of baits laid 6,462 NOTICES Number of informal notices served (including verbal intimations) 193 Number of statutory notices served Public Health Act, 1936, Section 93 (Nuisances) 10 Public Health Act, 1936, Section 75 (Dustbins) 2 Public Health Act, 1936, Section 39 (Drains) 1 13 26 SANITARY IMPROVEMENTS Water Supply Water pipes and fittings repaired or renewed 18 Drains Drains re-laid or repaired 51 Drains unstopped and cleansed 76 Intercepting traps provided with rod-eye stoppers 15 Manholes provided or repaired 16 Soil or ventilation pipes repaired or renewed 9 Gully kerbs and channels repaired 18 New soakaways constructed 6 Closets Buildings repaired 6 New pans fixed to water closets 7 Water supply re-instated 2 Flushing cisterns repaired or renewed 13 Flush pipes and pan joints repaired or renewed 3 Seats repaired or renewed 7 Urinals cleansed 1 Sinks Waste pipes repaired or renewed 17 Yards Yards newly paved or repaired 3 Dust Receptacles New dustbins provided 25 Dampness Roofs repaired 79 Rainwater gutters repaired or renewed 76 Rainwater downspouts repaired or renewed 38 Damp-proof courses provided 4 Windows, sills and doors made weatherproof 71 External walls repaired, repointed or rendered 42 Ventilation provided under floors 3 General Repairs Rooms cleansed 59 Walls and ceilings repaired 58 Floors repaired 36 Stoves repaired or renewed 13 Windows repaired 73 Chimneys repaired 31 Number of premises disinfested from bed bugs 4 Other repairs 13 27 PROSECUTIONS Failing to take precautions against contamination of food (Dirty conditions in bakehouse) 1 (Fined £30 and costs) SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 518 Number of re-inspections of premises 1,103 Number of visits to work in progress 510 Number of miscellaneous visits and inspections 602 Number of visits to schools 25 Number of visits to dairies 27 Number of visits to ice-cream premises 115 Number of visits to refreshment rooms 109 Number of visits to fried-fish shops 25 Number of visits to bakehouses 52 Number of visits to other food premises 466 Number of visits to factories 222 Number of visits to shops, offices and workplaces 522 Number of visits to stables and yards 39 Number of visits to market gardens, etc. 55 Number of inspections of urinals 112 Number of visits to piggeries 15 Number of visits re infectious diseases 212 Number of visits re insect pests 37 Number of inspections and visits re rats 4,366 Number of visits to streams 24 Number of visits re smoke abatement 112 Number of inspections of swimming bath 29 Number of complaints received and investigated 250 Number of informal notices served 193 Number of statutory notices served 13 Number of interviews re nuisances, etc. 727 Number of drain tests applied 71 Number of rooms disinfected 127 Number of lots of bedding and clothing disinfected 114 Number of library books disinfected 493 Number of samples of foodstuffs, water, etc., taken for examination 240 F. H. LENNARD, m.r.san.i., a.m.i.s.e., m.s.i.a., Senior Sanitary Inspector. SHOPS, OFFICES AND WORKPLACES Five hundred and twenty-two inspections were made during 1952 and in 14 cases action was necessary in regard to defects. CAMPING SITES There are no camping sites within the Borough. 28 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1952 Summer season) the open-air swimming bath situated in the grounds of the Royal Female Orphanage. The supervision and arrangement of sessions were under the control of the Public Health Department. Facilities were given to schools, youth organisations, and residents as in previous years. During the season, which covered a period of 18 weeks, the following attendances were recorded: Youth organisations 3,475 Schoolchildren 6,971 Season Ticket Holders, etc.: Adults 11,747 Children 6,188 Total 28,381 ERADICATION OF BED BUGS During the year bed bugs were found to exist in four 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. 29 REGULATED TRADES: DAIRIES There are six dairies on the register but no loose milk was handled at the premises. During the year 27 visits of inspection were paid and conditions found to be satisfactory. 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 29 SLAUGHTERHOUSES There are no Slaughterhouses in use within the district. BAKEHOUSES There are twelve bakehouses in the district. Fifty-two inspections were carried out, and in three instances defects were found to exist. 30 FACTORIES ACT, 1937 The following tables give details of inspections made and detects found, as supplied by the Senior Sanitary Inspector: Part I of the Act Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors): Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3,4 and 6 are to be enforced by Local Authorities 10 17 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 123 205 4 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 133 222 4 — 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 - - - - - Stuffed toys 13 — — — — - Cosaques, Christmas crackers,Christmas stockings, etc. 17 — - - - - Total 36 — — — — — 31 Cases in which Defects were found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 1 1 - - - Overcrowding (S.2) — — - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7): (a) Insufficient 2 1 - - - (b) Unsuitable or defective 15 15 - 5 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 5 4 1 - - Total 23 21 1 5 — 32 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 69 Tuberculin Tested Pasteurised 16 Sterilized 5 90 With the exception of 2 samples of pasteurised milk which failed to comply with the methylene blue test, the samples conformed to the standards prescribed by the Regulations. 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. 33 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 Arrowroot - 4 4 - - - - - Butter — 3 3 - - - - - Cheese Straws — 1 1 - - - - - Confectionery, flour — 4 4 - - - - - Cocoa — 1 1 - - - - - Coffee — 2 2 - - - - - Cooking Fat — 3 3 - - - - - Curry Powder — 6 6 - - - - - Fish Paste — 3 3 - - - - - Flour, self-raising — 4 4 - - - - - Fruit, dried (prunes) . — 4 4 — 2 2 — — Gelatine — 2 2 - - - - - Ginger, ground — 4 4 - - - - - Ice Cream — 6 5 - - - - - Jam, canned — 1 1 - - - - - Jelly tablets & crystals — 4 4 - - - - - Margarine — 3 3 - - - - - Milk 3 7 10 - - - - - Mincemeat — 3 3 - - - - - Molasses — 1 1 — 1 1 — — Pickles — 2 2 - - - - - Rice — 3 3 - - - - - Sardines — 2 2 - - - - - Sausages & Sausage Meat 8 8 5 - 5 - - Tea — 3 3 — — — - — Vinegar (malt) — 3 3 - - - - - Whisky — 2 2 - - - - - Camphorated Oil — 2 2 - - - - - Glycerine — 2 2 - - - - - Quinine, Ammoniated, Tincture of - 1 1 - - - - - Sal Volatile — 6 6 — 3 3 - — Totals 11 91 102 5 6 11 — — 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. 34 OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN The department continued to pursue actively all measures directed to ensuring clean food, both in preparation and as served in cafes and eating houses. This is reflected in the increased number of visits paid to bakehouses and other food premises during the year, as recorded in the table on page 28. One successful prosecution was brought, against the proprietor of a bakehouse, because of the dirty conditions which prevailed. Apart from this one case, the high standard which is general throughout the district in all the food trades is reflected by the fact that no cases of food poisoning were notified by doctors practising in the area, throughout the year. 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. 35 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. 36 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease in the Borough in 1952, 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 112 87 - Measles 119 2 — Whooping Cough 72 2 -— Erysipelas 9 2 1 Pneumonia 20 11 15* Dysentery 1 - - Totals 333 104 16 * Includes deaths from all forms of pneumonia. f Includes deaths of residents in homes and institutions outside the Borough. 37 38 Cases of Infectious Disease Notified During the Year 1952 (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 112 - — 2 5 14 80 6 2 - 1 1 1 18 12 15 17 22 8 20 87 - Measles 119 1 6 11 12 12 69 4 - 2 2 - - 47 9 5 9 8 14 77 2 - Whooping Cough 72 9 7 6 10 6 30 2 — 1 1 — — 8 4 18 8 15 14 5 2 - Erysipelas 9 - - - - - - - - - 4 3 2 2 3 1 1 1 — 1 2 1 Pneumonia 20 2 - - - - - - 1 5 3 4 5 12 3 2 — 2 — 1 11 15* Dysentery 1 - - - - - - - - - - - - - - - - - - - - - Totals 333 12 13 19 27 32 179 12 3 9 11 8 8 87 31 41 35 49 36 54 104 16 * Includes all forms 39 The Monthly Incidence of Infectious Disease, 1952 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 7 34 13 5 12 8 5 2 5 8 6 7 112 Measles 2 8 3 3 8 24 41 9 2 — 2 17 119 Whooping Cough — 2 4 12 14 6 16 3 3 5 4 3 72 Erysipelas 2 2 — 1 1 — — 1 — 1 1 — 9 Pneumonia 2 6 3 1 3 2 1 — — — — 2 20 Dysentery - - - - - - - - - - - 1 1 Totals 13 52 23 22 38 40 63 15 10 14 13 30 333 Tuberculosis There were 38 new cases notified during the year, this being an increase of 2 on the number of cases notified in 1951. The following table gives the number of new cases notified during the past five years: New Cases 1948 1949 1950 1951 1952 M. F. M. F. M. F. M. F. M. F. Pulmonary 8 11 19 17 27 1 21 10 23 12 Non-Pulmonary 1 1 1 2 2 4 2 3 1 2 Totals 9 12 20 19 29 5 23 13 24 14 Annual case rate per 1,000 of the estimated population: 1949 1950 1951 1952 Pulmonary 1.09 0.85 0.95 1.08 Non-pulmonary 0.09 0.18 0.15 0.09 The following table gives the number of deaths from this disease during the past five years: Deaths 1948 1949 1950 1951 1952 M. F. M. F. M. F. M. F. M. F. Pulmonary 4 2 8 4 7 1 4 — 4 3 Non-Pulmonary — — — 1 1 1 1 1 — — Totals 4 2 8 5 8 2 5 1 4 3 It will be seen from the foregoing table that 7 Tuberculous patients died during the year, this being an increase of one on the corresponding figure for the previous year. The figures correspond to a death rate per 1,000 of population of 0.22. 40 The following table, compiled from local records, shows the number of new cases of Tuberculosis notified during the year, together with the deaths at various age periods: Age Periods New Cases Deaths Pulmonary Non-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 2 - - - - - - - 10 and under 15 1 — 1 - - - - - 15 and under 20 3 2 - - - - - - 20 and under 25 2 - - - - - - - 25 and under 35 2 4 - - - - - - 35 and under 45 4 1 — — — 3 — — 45 and under 55 5 3 — 1 — — — — 55 and under 65 1 2 — —. 2 — — — 65 and upwards 3 — — — 2 — — — Totals 23 12 1 2 4 3 — — The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 2 3 8 5 4 3 10 Non-Pulmonary — — — — 1 — 2 Totals 2 3 8 5 5 3 12 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 1952 41 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, 156 women made 585 pre-natal attendances. This represents an attendance of 42-86 per cent. of the total number of confinements which occurred during 1952. Post-natal examinations were also conducted at this clinic, 11 patients making 16 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 271 4,162 Children, 1-5 years 678 3,470 Total attendances 949 7,632 Institutional Confinements. Two hundred and seventy, or 74.2 per cent. of births allocated to this district, took place in hospitals and nursing homes, this being a lower percentage than recorded in the previous year. 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 Heip 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 continued to act as Home Help 42 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 38 General Medical 148 Tuberculosis 17 203 Treatment. Minor Ailments. Sixty-five 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 9 Tonsils and adenoids 16 Orthopaedic defects 15 Nævi 4 Circumcisions 2 Feeding difficulties 7 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. of Cases Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant Mothers 5 14 3 1 2 1 Nursing Mothers 1 2 2 — — — Children, 0-5 76 104 77 — — — Totals 82 120 82 1 2 1 Orthopaedic. Patients attending infant welfare centres who require treatment for orthopædic defects are referred by the Clinic Medical Officer to orthopaedic surgeons at St. Helier or other hospitals. During 1952, 15 cases were referred for treatment. 43 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 2,928 1,309 Children, 5-15 years 1,214 1,793 Expectant and Nursing Mothers — 16 4,142 3,118 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 153 236 Children, 0-1 year 353 1,653 Children, 1-5 years 11 2,825 Other Cases 52 153 569 4,867 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. 44 Care of Premature Infants. The arrangements made for the care of premature infants continued during 1952. 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, 2 were born in a private nursing home, and 16 in hospital. One of the infants (weight 2 lb. 2 oz.) born in hospital, died after only 4 hours. As mentioned in the preamble to the report, a child born prematurely in St. Helier Hospital, weighing only 1 lb. 14 oz.. survived. 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. 45 B. JOHNSON, Printer, 11, Manor Road, Wallington.