Library BED 19 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1954 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1954 TABLE OF CONTENTS Public Health Committee 5 Representatives on Mid-Eastern Divisional Health Sub-committee 5 Representatives on the Wandle Valley Joint Sewerage Board 5 Staff 6 Statistics and Social Conditions 13 Extracts from Vital Statistics 14 Vital Statistics: Comparative Birth-rates, Death-rates, Analysis of Mortality, etc., 1954 15 Registered Causes of Death 16 Violence and Accident 17 Maternal Mortality 17 Infantile Mortality 17 General Provision of Health Services for the Area: Laboratory Facilities 19 Ambulance Facilities 19 Nursing in the Home 19 Treatment Centres and Clinics: Care of Mothers and Young Children 20 Tuberculosis 20 Immunisation against Diphtheria 21 Immunisation against Whooping Cough 21 School Clinics 21 Venereal Diseases Clinics 22 Cleansing of Persons 22 Hospitals 22 Disinfection 23 Sanitary Circumstances of the Area: Water Supplies 23 Drainage and Sewerage 24 Rivers and Streams 24 Closet Accommodation 24 Public Cleansing 24 3 Report of the Chief Sanitary Inspector for the Year 1954: Housing 25 Milk and Dairies 25 Ice Cream 26 Slaughterhouses 26 Food Premises 26 Unsound Food 27 Food and Drugs Act, 1938 27 Factories 28 Bakehouses 30 Workplaces, Shops and Offices 30 Complaints 31 Smoke Abatement 31 Infectious Disease and Disinfection 31 Offensive Trades 31 Rats and Mice 31 Notices 32 Sanitary Improvements 32 Summary of work done during the year 34 Swimming Bath 35 Schools 35 Outbreaks of Food Poisoning and Clean Food Campaign 36 Nutrition 36 Shell Fish (Molluscan) 36 Adoptive Acts and Bye-Laws 37 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 38 Incidence of Infectious Diseases in Age Groups and Wards 39 Monthly Incidence of Infectious Disease 40 Tuberculosis 41 Transferred Functions under the National Health Service Act, 1946: The Care of Mothers and Young Children 43 Ante-natal and Post-natal Supervision 43 Infant Welfare Services 43 Institutional Confinements 43 Domestic Help Service 43 Treatment: Minor Ailments 44 Dental 44 Orthopaedic 44 Physiotherapy 45 Health Visiting 45 Child Life Protection 45 Care of Premature Infants 46 Care of Illegitimate Children 46 4 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITTEE December, 1954 Members: Councillor Miss K. C. Bratt (Chairman) Alderman F. G. Bryant (Mayor) Councillor H. Rennison (Deputy Mayor) Councillor Mrs. V. M. Boyce Councillor D. H. de Voil Councillor S. J. Dunwoodie Councillor G. H. Hyett, O.B.E. Councillor S. G. Reading Councillor Miss R. M. Smith Councillor A. Stammers Councillor Mrs. J. L. K. Thurston REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTI SUB-COMMITTEE December, 1954 Members: Councillor Mrs. V. M. Boyce (Chairman) Councillor Miss K. C. Bratt Councillor D. H. de Voil Councillor G. H. Hyett, O.B.E. Councillor A. Stammers REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1954 Members: Alderman F. G. Bryant (Mayor) Alderman J. Vale Councillor S. J. Dunwoodie Councillor A. H. Prior 5 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. Chief Sanitary Inspector: (a.b.c.) H. G. Cripps, M.S.I A. Additional Sanitary Inspectors: (a.b.) A. J. Hattersley. M.S.I.A. (Resigned 31.12.54) (a.b.) E. C. George, A.R.San.I., M.S.I.A. (Resigned 11.12.54) (a) Sanitary Inspector's Certificate (R.S.I. & S.I.E.J. Board). (b) Meat and Other Foods Certificate (R.S.I.) (c) Smoke Certificate (R.S.I.) Clerks: R. F. Burns (Chief Clerk) E. D. Evezard B. E. Bignall C. I. Phillips 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. Maureen Adams, M.B., B.S., M.R.C.S., L.R.C.P. Health Visitors: Mrs. V. Beatt, S.R.N., S.C.M., R.F.N., H.V.Cert. Mrs. M. N. Chenery, S.R.N., S.C.M., H.V.Cert. Miss N. M. Lines, S.R.N., S.C.M., H.V.Cert. Mrs. M. Maynard, S.R.N., S.C.M., R.F.N., H.V.Cert. Physio therapists: 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 (Resigned 7.9.54) Mrs. J. F. Smith (Commenced 6.9.54) Miss B. G. Thompson (School Health) Home Help Supervisor: Mrs. H. M. Long (Part-time) 6 Public Health Department, Town Hall, Wallington. To the Worshipful the Mayor, Aldermen and Councillors of the Borough of Bedding ton and Wallington. Ladies and Gentlemen, I have the honour to present my annual report for 1954. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circulars 1/54 and 28/54. The vital statistics are based on information supplied by the Registrar-General. The presentation follows that adopted for the previous five 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 1954 is 32,620, and this figure is used in the compilation of the vital statistics. The figure shows an increase of 110 over the Registrar-General's estimate for mid-year 1953. The census of population taken in 1951 was 32,751. The birth rate per 1,000 total population shows an increase at 13.52 in 1954, as compared with 12.65 in 1953. This rate is below that for England and Wales, which is 15.20. The stillbirth rate is 0.25 per 1,000 total population, as compared with 0.12 recorded in 1953. The corresponding figure for England and Wales is 0.36. Expressed as a rate per 1,000 total births, the stillbirth rate is 18.87. In 1953 this rate was 10.20. The number of children stillborn in the district was 8, out of a total of 424 births. Although this figure is an increase on that recorded for 1953, it is still commendably low. Many factors, such as abnormal development of the foetus, which are not thoroughly understood, are involved in stillbirths, over which we have no control. The death rate from all causes per 1,000 total population is 9.45, compared with 9.23 in 1953 and 11.30 for England and Wales. Of the 347 deaths, diseases of the heart and circulatory system accounted for 128 (36.88 per cent. of total deaths), cancer 70 (20.17 per cent. of total deaths), and tuberculosis 3 (0.86 per cent. of total deaths). 7 The birth rate in 1954 showed an increase, although remaining below that for England and Wales. This is the second consecutive year that an increase in the birth rate has been recorded in this district, and shows a general trend observed in many parts of the country for married people to aim at a slightly larger family. The death rate is higher than in 1953, and an analysis of the causes of death shows an increase in deaths from certain specific causes. The causes of death and the comparative rates are set out in the tables on pages 14 and 16, from which it will be noted that cancer again shows an increase, in particular cancer of the lung and bronchus. The rate for deaths from cancer of the lungs, at 0.4 per 1,000 population, is higher than the corresponding death rate from pneumonia. Much work is still going on to establish the relationship between smoking and lung cancer. Twelve males died from this cause, as against one female, and although it is now generally admitted that modern women smoke almost as much as men, it is possible that, having regard to the ages at death in these cases, at the time the seeds of the disease were sown, smoking was commoner amongst the male population. Coronary disease, with 36 deaths in males and 14 in females, is very high on the list of causes of death. This condition, together with diseases of the arteries of the nervous system and heart diseases, account for a considerable proportion of the total deaths. The average age at death continues to be relatively high, which is only to be expected in a population which has a great number of people living over the age of 65. Three deaths were recorded from motor vehicle accidents, as compared with 1 in 1953. All other accidents accounted for 8 deaths, as compared with 3 in 1953. Suicide, too, shows a marked increase, a total of 7 cases being recorded, as compared with 2 in 1953. The maternal mortality rate per 1,000 total births is 2.36, as compared with 0.69 for England and Wales. The previous year, and the 5 years previous to 1952, all showed a nil return. In 1954 there was one death in childbirth. Having regard, however, to the total number of births being only 424, the rate given by one death is 2.36. The mother, who died, had every care and attention, but was suffering from a chronic kidney disease. Considerable thought and care are given to the arrangements by which mothers can be assured of safer childbirth, and the fact that so few maternal deaths have occurred since the war reflects great credit upon all the services engaged in midwifery in the district. The infantile mortality rate shows a slight increase at 14.42 per 1,000 live births, as compared with 12.89 in 1953. Only six infants died under the age of 1 year in 1954, out of 416 live births. On page 18 will be found an analysis of the causes of death. It will be seen that prematurity and abnormal congenital developments accounted for the majority of the infant deaths. 8 The care of the aged still occupies a considerable part of the work of the department. In this, the able assistance of the ladies of the W.V.S., under the effective guidance of Mrs. O. L. Wiles, together with the close co-operation of the geriatric department at St. Helier Hospital, has proved invaluable in bringing some relief and comfort to the numerous old persons falling on ill-health and poverty in the district, and for whom no other source of help is available. The Wallington Old People's Welfare Committee, under the chairmanship of Councillor Mrs. V. M. Boyce, continued their admirable social work for the old people. The number of aged, who have no-one to care for them, and for whom institutional care has to be provided, appears to be increasing. Many of these elderly persons were found to be living in extreme discomfort and insanitary conditions, and were unable to devote to themselves, and were not receiving from other persons, proper care and attention. Where it was found necessary, admission to an institution was arranged forthwith. On page 39 will be found a table setting out the incidence of infectious diseases, other than tuberculosis, during 1954. From this, it will be observed that the number of cases of infectious disease notified during the year was very low indeed. All the major infections, particularly measles and whooping-cough, were at a remarkably low level, with measles at 16 cases, as compared with 454 in 1953, and whooping-cough at 53 as compared with 159 in 1953. No cases of poliomyelitis were notified, and none of food poisoning. It is interesting to note that 1954 was a year in which the rainfall was particularly high and temperatures recorded were generally low. Whether this accounted for the low incidence of zymotic diseases Or not, is a matter for conjecture. It is generally noted, however, that poliomyelitis seems to thrive in hot dry weather, and the cold wet summer may have been responsible in part for the absence of the disease in some districts. In former reports, mention has been made of the advances to be anticipated from further research following the discovery of methods of growing the poliomyelitis virus. The unfortunate experiences, which have so far been recorded in the use of the Salk vaccine, would appear at first glance to be something of a setback. The experience gained, however, has convinced the British research workers that the best hope of a vaccine for universal use in immunising against poliomyelitis will be found by cultivating strains of attenuated, or weak, viruses rather than making use of the virulent strains as was done with the Salk vaccine. It is understood that the Medical Research Council in England are actively pursuing this line, and we may still hope that in due course a suitable vaccine will be available. In the meantime, in the absence of an immunisation technique, the general public are constantly asking what else can be done to prevent, or limit, the incidence of poliomyelitis. As the father of seven young children, I can readily appreciate the emotional concern of parents when faced with the possibility of poliomyelitis attacking any one of their youngsters. In a recent article in the British Medical Journal, Dr. T. Anderson, Reader in Infectious Diseases, Glasgow University, says, 9 "The lay press still regards even the single case as news", and an alarmist view in many quarters is understandable. It must be stressed, however, that absence of fear and anxiety plays a most important part in recovery, and in framing suggestions for the prevention of the disease, gloom and despondency must be avoided. Many workers in the field of infectious disease still insist upon strict quarantine of all contacts, but, as has recently been pointed out by those of the medical profession most qualified to speak, isolation would seem to have played a very minor role in the prevention of spread of this disease. In his article in the British Medical Journal Dr. Anderson says: "For the 'exotic' infections such as smallpox, in which the epidemic results from single introductions into a virgin community, strict isolation pays dividends because of the comparative ease with which all affected cases may be recognised. In a situation where the mass of infection is unrecognised and unrecognisable it is difficult to believe that strict isolation of all contacts is likely to succeed in limiting spread. This is, however, a thorny problem, which in the present state of our knowledge cannot be adequately solved by emotional argument, and it is well that the subject is being thoroughly investigated. "So far as the welfare of the individual contact is concerned, the only advice which it seems reasonable to give is to avoid all excessive physical activity. Should any febrile episode occur the patient must go to bed at once and remain there for one week. Even when this practice is carried out faithfully paralysis may still develop, but experience suggests that the subsequent illness is mild." One preventive measure of practical value, which is always adopted by this Public Health Department in the summer months, is the discontinuance of injections for the immunisation of children against diphtheria and whooping-cough. Additional measures are an extremely strict control of the water in the swimming bath at Beddington Orphanage, a sufficient dose of chlorine being maintained not only to keep the water sterile, but also to leave a small residual content of free chlorine. General rules of conduct are laid down and distributed in pamphlet form to known contacts of cases. As it is now known that patients suffering from, and carriers of, poliomyelitis, excrete the organism in their faeces, particular attention to the washing of hands after the use of the toilet and before meals is important. Only 16 new cases of tuberculosis were notified during 1954, or approximately half the number of cases notified in 1953. Since the end of the war, a great amount of work has been done by all connected with the control of tuberculosis—Government departments, Regional Hospital Boards and the Medical Research Council—to try and reduce the incidence and improve facilities for treatment of tuberculosis. This work is now beginning to bear fruit. 10 During 1954, B.C.G. vaccination was introduced for a section of the school population by the Local Health Authority. Previously this B.C.G. vaccination has been reserved for doctors, nurses, close contacts of cases of tuberculosis, and those whose work brings them into close association with persons suffering from tuberculosis. Briefly, the scheme is to offer to all school children, just prior to their 14th birthday, the opportunity to have a test (the Mantoux test) to show whether they have come into contact with the disease, and have thus acquired immunity, as shown by a positive reaction to the test, or whether they have had no opportunity of developing antibodies to tuberculosis. Following the test, those children who are negative are given B.C.G. vaccination; that is, an immunising dose of a special variety of modified tubercle bacilli, which will produce the same immunity as if they had had a primary infection, which they had combated and thrown off during the normal course of their lives. The Government have decided that the group of children who are most susceptible are young adolescents leaving school and entering new conditions in business and industry. Observations On the incidence of tuberculosis have shown that the adolescent period is one of the most susceptible in a person's life, and the Government feel that this group should be specially selected for protection. In December 1954, of the 246 school children to whom this service was offered in Beddington and Wallington. 127 accepted and were Mantoux tested, and 110 were immunised. With regard to treatment, just after the war the emphasis was upon surgical removal of infected lung tissue, and striking results were obtained by modern surgical techniques, assisted by antibiotic drugs. It was thought at that time that surgery would play a more prominent part in the treatment of tuberculosis than medicine, and it will be recalled that Regional Hospital Boards made every effort to secure more hospital beds for thoracic surgery. In particular, a move was made to secure the Carshalton, Beddington and Wallington District (War Memorial) Hospital for this specific purpose. The popular outcry, however, which was raised at this suggestion persuaded the Regional Hospital Board to give up this project. It is interesting to note that since that time the medical treatment of tuberculosis has been revolutionised by the introduction of three new drugs: PAS, streptomycin and isoniazid. With the advent of these new medical armaments, while surgery will undoubtedly play an important part in some cases of the disease by eradicating diseased lung tissue, its place is subordinated to the medical treatment of the patients. As a result, there is not now the same demand for beds for thoracic surgery. Mass Radiography continues to play a very important part in the early detection of the disease, and with the brighter prospects held out to patients through improved medical treatment and immunisation, many observers in this field consider that within the lifetime of many now living, tuberculosis may possibly, in Western civilized communities, show as spectacular a fall in incidence as has diphtheria as the result of diphtheria immunisation. 11 It was conclusively shown, however, by speakers at the 4th Commonwealth Health and Tuberculosis Conference held in London in 1955, and which your Medical Officer attended, that all these methods of preventing and treating tuberculosis will be unavailing without the maintenance of a high standard of nutrition and housing, and good working conditions in business and industry. The ravages of tuberculosis found in war-torn Europe and in peoples living on low standards of hygiene and nutrition are only too well known. Every effort must be made by governments to maintain the standard of the public health at as high a level as possible, if tuberculosis is to recede in the way we hope. The ending of meat rationing in July 1954, which thus ended all restrictions on the purchase of food, paved the way for one more step to a higher standard of nutrition. Taking the year as a whole, and the light incidence of so many diseases, the Corporation can be congratulated on having completed a year in which the population enjoyed excellent health. During 1954, the swimming bath at Beddington Orphanage (now Carew Manor School) was again brought into use to provide swimming facilities for residents in the Borough and for school children. The administrative arrangements were the same as have operated in previous years, and financial arrangements were made with the Surrey County Council, who proved very helpful in co-operating with the Corporation to make these excellent swimming facilities possible. Unfortunately, owing to the inclement weather, which prevailed during the greater part of the summer, the number of attendances was lower than in the previous year, and the expenditure to be borne by the rate fund was proportionately higher. In conclusion, I wish to place on record my appreciation of the loyal service and valuable assistance I have received from all the members of my staff throughout the year. I have the honour to be, Ladies and Gentlemen, Your obedient servant, PATRICK J. O'CONNELL, July, 1955. Medical Officer of Health. 12 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 1954 32,620 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1954 9,822 Rateable Value £420,303 Sum represented by penny rate £1,680 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. 13 EXTRACTS FROM VITAL STATISTICS Total M F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 407 210 197 12.75 (Crude) „ „ Illegitimate 9 2 7 13.52 (Corrected) Total 416 212 204 Still Births 8 6 2 Rate per 1,000 total (live and still) births 18-87 Deaths 347 174 173 Death Rate per 1,000 of the estimated resident population 10.62 (Crude) 9.45 (Corrected) Deaths attributable to: Rate per 1,000 (live and still) births Pregnancy, Childbirth, Abortion, rate per 1,000 live and still births 2.36 Death Rate of Infants under one year of age: All Infants per 1,000 live births 14.42 Legitimate Infants per 1,000 legitimate live births 9.83 Illegitimate Infants per 1,000 illegitimate live births 222.22 Deaths from Cancer (all ages) 70 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 14 Comparative birth rates, civilian death rates, analysis of mortality, and case rates for certain infectious diseases in 1954: Rate per 1,000 Total Population Rate per 1,000 Total (live and still) Births Rate per 1,000 Related Live Births Death rate per 1,000 Population Live Births Deaths (all ages) Stillbirths Maternal Deaths Infant Deaths Under 1 year Whooping Cough Diphtheria Acute Poliomyelitis Influenza Pneumonia Tuberculosis (all forms) Cancer of the Lung and Bronchus England and Wales 15.2 11.3 23.5 0.69 25.5 0.00 0.00 0.00 0.04 0.41 0.18 0.37 160 County Boro's and Great Towns including London. 15.2 11.1 23.3 — 25.2 0.00 0.00 0.00 0.03 0.45 0.20 0.43 160 Smaller Towns Resident population 25,000 to 50,000 at 1951 Census 14.9 11.3 24.0 — 26.6 0.00 0.00 0.00 0.04 0.41 0.18 0.34 Beddington and Wallington 13.52 9.45 18.87 2.36 14.42 0.00 — 0.00 0.00 0.37 0.09 0.40 15 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives th causes of death of residents in the Borough during 1954: Causes of Death Males Females Total All Causes 174 173 347 1. Tuberculosis, respiratory 2 - 2 2. Tuberculosis, other — 1 1 3. Syphilitic disease — 2 2 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — 1 1 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases 2 — 2 10. Malignant neoplasm, stomach 5 3 8 11. Malignant neoplasm, lung, bronchus 12 1 13 12. Malignant neoplasm, breast — 10 10 13. Malignant neoplasm, uterus — 3 3 14. Other malignant and lymphatic neoplasms 18 18 36 15. Leukaemia, aleukæmia — — - 16. Diabetes 1 1 2 17. Vascular lesions of nervous system 21 36 57 18. Coronary disease, angina 36 14 50 19. Hypertension with heart disease 5 3 8 20. Other heart diseases 20 36 56 21. Other circulatory diseases 6 8 14 22. Influenza — — — 23. Pneumonia 6 6 12 24. Bronchitis 9 4 13 25. Other diseases of respiratory system 2 2 4 26. Ulcer of stomach and duodenum 4 1 5 27. Gastritis, enteritis and diarrhœa — 1 1 28. Nephritis and nephrosis 2 — 2 29. Hyperplasia of prostate 6 — 6 30. Pregnancy, childbirth, abortion — 1 1 31. Congenital malformations — 1 1 32. Other defined and ill-defined diseases 6 13 19 33. Motor vehicle accidents 3 — 3 34. All other accidents 4 4 8 35. Suicide 4 3 7 36. Homicide and operations of war - — — 16 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 114 32.85 Other Diseases of the Circulatory System 14 4.03 Vascular Lesions of Nervous System 57 16.43 Cancer 70 20.17 Bronchitis 13 3.75 Pneumonia 12 3.46 Tuberculosis (All Forms) 3 0.86 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 4 3 7 Other Violent Causes 7 4 11 Totals 11 7 18 MATERNAL MORTALITY In 1954 one mother died from chronic kidney disease, aggravated by the strain of pregnancy and childbirth. It is exceptional in this Borough to have to record such a fatality, as for many years, with the exception of a break in 1952, we have had a nil maternal mortality rate. INFANTILE MORTALITY The infantile mortality rate for 1954 was 14.42 per 1,000 live births. The comparable rate for England and Wales is 25.5. 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 416 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) occurred within the first four weeks of life. Premature illegitimate twins were born in a hospital outside the area, for whom no birth notifications were received. One succumbed within one hour and the other within eight hours of birth. The RegistrarGeneral assigned both deaths to this area as the mother, who was in domestic service, had previously resided in Beddington. 17 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 1 hour F. Prematurity 8 hours F. „ 2 days M. Cerebral Haemorrhage. 2 months F. Hydrocephalus and menigocele. 2 months F. Asphyxia due to regurgitation of stomach contents. 8 months M. Laryngo-tracheitis. 18 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 1954, H. Amphlett Williams, Esq., Ph.D.(Lond.), A.C.G.F.C., F.R.I.C., Public Analyst, 1 Southwark Street, S.E.1, continued the arrangement made in 1946 for the examination of milk, water and ice-cream. In general, pathological specimens are sent to the Pathological Laboratories at St. Helier Hospital. Samples of milk and water are submitted for bacteriological examination to the Ministry of Health laboratories at Epsom, reports being received free of charge under the National Health Service Act, 1946. AMBULANCE FACILITIES General and Accident Cases. Reorganisation of the ambulance services was undertaken by the Surrey County Council on their transfer on 5th July, 1948. The main ambulance station is situated at St. Helier Hospital, with a sub-station, covering the Beddington and Wallington area, located in Carshalton. NURSING IN THE HOME The Beddington and Wallington District Nurses' Home, administered by the Surrey County Council, continues to offer excellent facilities for nursing as in previous years, the day-to-day administration being 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 801 cases, including 107 maternity and midwifery patients. A total of 17,322 visits was made. Interviews at the Nurses' Home numbered 1,928. 19 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. Maternity Clinics Ante-natal Clinic Every Thursday, 2.0-4.0 p.m. Post-natal Clinic, District Nurses' Home, 57 Montagu Gardens, Wallington. 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. 20 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., 1954 1,970 4,580 6,550 Number of children known to be immunised at 31st Dec., 1954 1,041 4,215 5,256 Percentage of children immunised 52.8 92.0 80.2 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, 353 children were immunised at County Council clinics or by their general practitioner. The new whooping-cough vaccine, combined with diphtheria prophylactic in a mixed vaccine continued to be used, especially amongst young children in attendance at infant welfare centres. Mothers have shown themselves very appreciative of whooping-cough immunisation, and the percentage of parents availing themselves of this service seems to have increased. This service continues to be offered free of charge. 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 21 continue to be conducted at The Grange Mansion, Wallington, Rochester Road and Phœnix 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 1954 the Corporation Cleansing Station, situated near the Grange Mansion, continued to provide facilities for cleansing infested persons. The general standard of cleanliness, as shown by the examinations conducted by Health Visitors in schools and clinics, is at an extremely high level, a very small number of people having been treated' It is now rare to find a child in school suffering from pediculosis of the head or body. Special attention paid by Health Visitors and Sanitary Inspectors during their routine visits and through their contact with the public at the Town Hall, together with a higher standard of personal hygiene, makes real uncleanliness a rare condition. During the year the following treatments were carried out: Scabies 2 Pediculosis 3 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. 22 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. 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 (9,822) 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 35 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. 23 DRAINAGE AND SEWERAGE During the year a major blockage occurred in the sewer in Wandle Road, Hackbridge. The sewer was found to be defected and a section had to be relaid. In Stafford Road a subsidence occurred and upon opening up the road it was found that the sewer had collapsed. A major repair had to be carried out. There were a number of minor blockages in combined sewers which were easily cleaned. RIVERS AND STREAMS Normal cleansing of the River Wandle was carried out. The back water in the upper portion of Grange Park Lake was cleared of mud. The section of the river between the Croydon boundary and Wandle Mills was also cleared of mud. In this case the mud was pumped into lagoons to drain and will be used for reforming the banks when a re-alignment of the river is carried out in 1955. 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 type of receptacle in use throughout the Borough continues to be the portable galvanised iron covered bin. The collection of trade refuse was also continued as required. Cesspools and earth closets are dealt with by occupiers of the premises concerned, which continued arrangement is satisfactory. SANITARY INSPECTION OF THE AREA The following statement by the Chief Sanitary Inspector gives statistics as to the number of complaints received, inspections made, defects remedied, and other work carried out by the Sanitary Inspectors. 24 REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR, 1954 HOUSING The number of houses inspected during the year showed a surprising increase over the previous year. This was due to an increase in complaints received and the resumption of systematic inspections under the Housing (Consolidated) Regulations. One house was closed and two others acquired with a view to future demolition. Two hundred and sixteen houses were rendered fit as a result of informal or statutory action under the Public Health Act, 1936. Twelve applications were received for Certificates of Disrepair (Housing Repairs & Rents Act, 1954). Eleven certificates were issued. Number of inspections of dwelling-houses 955 Number of inspections recorded under Housing Regulations 131 MILK AND DAIRIES Number of distributors of milk on register 16 Number of dairy premises other than dairy farms on register 6 Number of above premises upon which loose milk is handled Nil Number of inspections of premises 38 Defects in dairy premises discovered Nil Infringements of Acts and Regulations Nil 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 15 Sterilized Milk—Dealers' Licences 12 ,, „ Supplementary Licences 15 — 69 BACTERIOLOGICAL EXAMINATION OF MILK Ninety-seven samples of milk were submitted for examination. The results of the tests are set out below: Designation No. of Samples Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurized 57 57 — 57 — — — T.T. Pasteurized 30 30 — 30 — — — Sterilized 8 — — — — 8 — Tuberculin Tested (Farm Bottled) 2 1 1 — — — — 25 CHEMICAL ANALYSES OF MILK Forty-four samples of milk were submitted to the Public Analyst. All were reported genuine. The average composition was as follows: Fat % 3.75 Solids-not-fat % 8.77 Total Solids % 12.52 ICE CREAM Number of premises registered for the sale of ice cream 84 Number of manufacturers Nil Number of inspections of premises 154 Forty-seven samples of ice cream (including ten ice lollies) were procured and submitted for bacteriological examination. The results are set out in the following table:— Type No. of Samples Methylene Blue Test Coliforms Faecal Coli present Grade 1 Grade 2 Grade 3 Grade 4 Present in 1/10 ml. Ice cream 37 30 1 5 1 4 2 Ice lolly 10 10 — — — 1 — The unsatisfactory samples were manufactured by two firms in premises outside the Borough. The authorities concerned were notified. Following investigations by these Authorities repeat samples proved satisfactory. CHEMICAL ANALYSES OF ICE CREAM Four samples of ice cream were submitted for analysis. All complied with the standard. The average fat content of the samples varied between 11.0% and 12.3%. The average fat content was 11.7%. SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 1125 Total number of defects discovered and remedied 48 FOOD PREMISES IN THE DISTRICT Bakers 15 Butchers 24 Catering Establishments 45 Chemists 12 Confectioners (sweets) 27 Fishmongers (including friers) 10 Greengrocers 33 Grocers 70 Licensed Premises 13 26 FOOD PREMISES REGISTERED UNDER SECTION 14 OF THE FOOD & DRUGS ACT, 1938 Sausage manufacturers 26 Fish friers 7 Jam manufacturers 1 Ice cream (sale only) 84 Ice cream (manufacture and sale) 3 INSPECTIONS OF REGISTERED FOOD PREMISES Ice cream (manufacture and sale) 154 Fish friers 13 Sausage manufacturers 76 Jam manufacturers 4 UNSOUND FOOD Destroyed or released for animal feeding:— lbs. Beverages 1 Biscuits 3 Cake Mixture 1 Cheese 5 Cream 2 Fish, canned 7 Fruit, canned 243 Golden syrup 25 Jam 23 Jelly 1 Marmalade 13 Meat 636 Meat, canned 518 Milk, condensed 4 Milk, evaporated 18 Paste 1 Pickles and sauces 3 Soup 5 Spaghetti 1 Vegetables, canned 28 Total 1,536 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. 27 FOOD ANALYSES Number of samples analysed by Public Analyst 106 Number of samples reported against 8 The following table gives details of the samples obtained within this district during the year: Articles No. Examined Adulterated Prosecu tions Convic tions Formal. Informal. Total Formal. Informal. Total Almonds. Ground — 1 1 — — — — — Bacon —- 1 1 — — — — — Bread — 1 1 — — — — — Butter 1 — 1 — — — — — Cake mixture 1 — 1 — — — — — Cheese 1 — 1 — — — — — Confectionery, Flour 1 — 1 — — — — — ,, , Sugar 2 1 3 — — — — — Cooking fat 1 — 1 — — — — — Drinks, Soft — 2 — — — — — — Fish cakes 1 — 1 — — — — — „ , canned — 1 1 — — — — — ,, paste — 1 1 — — — — — Flour, Self-raising 1 — 1 — — — — — Fruit, bottled 1 — 1 — — —— — — „ , dried 1 — 1 — — — — — ,, , Glace (Cherries) 1 — 1 — — — — — , salad 1 — 1 — — — — — Gelatine 1 — 1 — — — — — Ginger. Preserved 1 — 1 — — — — — Honey — 1 1 — — — — — Ice cream 4 — 4 — — — — — ,, ,, powder 1 — 1 — — — — — Jam 2 — — — — — — Margarine 1 — 1 — — — — — Marzipan — 1 1 — — — — — Meat products 4 — 4 — — — — — Milk 31 13 44 — — — — — ,, , condensed — 1 1 — — — — — Mincemeat — 1 1 — — — — — Peas, canned 1 —- 1 — — — — — Pickle 1 — 1 — — — — — Pudding, Christmas — 1 1 — — — — — Rice, Flaked — 1 1 — — — — — „ , Ground 1 — 1 — — — — — Sauce — 2 2 — — — — — Sausages & sausage meat 6 — 6 — — — — — Soup, canned 2 — 2 — — — — — ,, , preparation 1 — 1 — — — — — Suet, Shredded 1 — 1 — — — — — Sugar, icing — 1 1 — — — — — Tea 1 — 1 — — — — — Tomatoes, canned — 1 1 — — — — — Vinegar 1 1 2 — — — — — Total 73 32 105 — — — — — FACTORIES Number of factories on register (including bakehouses) 142 Number of inspections 274 Number of defects discovered and remedied 13 28 FACTORIES ACT, 1937 The following tables give details of inspections made and detects found: Part I of the Act Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors): Premises (1) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3,4 and 6 are to be enforced by Local Authorities 11 14 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 131 260 5 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Total 142 274 5 — Part VIII of the Act Outwork Nature of Work (1) 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 — — — — — — Stuffed toys 8 — — — — — Cosaques, Christmas crackers,Christmas stockings, etc. — — — — — — Total 8 — — — — — 29 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) — — — — — 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 6 6 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 7 7 2 — — Total 13 13 2 — — BAKEHOUSES Number of bakehouses in district 8 Number of inspections 34 Number of defects discovered 5 WORKPLACES, SHOPS AND OFFICES Number of inspections 732 Number of defects discovered and remedied 15 30 COMPLAINTS The number of complaints received shewed an increase of 30% over 1953 and 150% over 1952 Complaints received and dealt with during the year were due to the following causes: Rats and Mice 162 Housing defects 91 Choked drains and sewers 71 Defective dustbins 193 Defective drainage (including closets) 15 Unsound or adulterated food 19 Atmospheric Pollution 20 Insect pests 27 Offensive accumulations 14 Foxes3 Miscellaneous 26 641 SMOKE ABATEMENT Number of observations 487 Nuisances observed 3 INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 112 Number of rooms disinfected 81 Lots of bedding and clothing disinfected 35 Number of library books disinfected 253 OFFENSIVE TRADES Number of offensive trade premises in district Nil RATS AND MICE Number of premises inspected 2,161 Number of visits to premises 3,056 Number of premises upon which rats or mice were found and remedial action taken 242 Number of baits laid 5,335 SEWER RAT CONTROL Following a ten per cent. test of sewer manholes in May, two maintenance treatments were carried out, one in July and one in December. The results are summarised below: July Treatment December Treatment Manholes baited 189 114 Manholes in which takes were recorded 64 58 Percentage of manholes showing infestations 33 50 31 NOTICES Number of informal notices served (including verbal intimations) 781 Number of statutory notices served Public Health Act, 1936, Section 93 (Nuisances) 10 Public Health Act, 1936, Section 75 (Dustbins) 13 Public Health Act, 1936, Section 24 (Public Sewers) 2 — 25 SANITARY IMPROVEMENTS (1) Dwelling Houses Brickwork repaired or repointed 13 Ceilings:— (a) Repaired or renewed 29 (b) Cleansed and redecorated 14 Chimneys:— (a) Stacks repaired 8 (b) Flues repaired 3 (c) Pots renewed 1 (d) Cowls provided 3 Dampness remedied:— (a) Roofs repaired 34 (c) Walls rendered 30 (d) (i) Damp-proof course inserted 7 (d) (ii) Steps repaired 2 (e) Gutters and rainwater pipes repaired and unstopped 34 (f) Earth removed 5 Disinfestations 1 Doors—repaired or renewed 4 Drainage:— (a) Obstructions cleared 76 (b) Repaired and relaid 25 (c) Sealed off 1 (d) Inspection chambers provided and repaired 15 (e) Inspection chamber covers provided 6 (f) Interceptor traps and caps provided 4 (g) F.A.I. provided, etc. 8 (h) Soil-vent. pipes provided, repaired or renewed 6 (i) Waste-pipes repaired and renewed 6 (j) Soakaways provided, repaired or renewed 6 (k) Rodding-eye stopper replaced 2 Dustins provided 172 Fireplaces and stoves repaired or renewed 9 Floors:— (a) Repaired or renewed 11 (b) Ventilation provided or improved 3 Sinks renewed, etc. 1 Stairs:— (a) Repaired or renewed 6 (b) Handrails provided 1 32 Walls:— (a) Repaired or rebuilt 15 (b) Replastered 13 (c) Cleansed and redecorated 12 Water supply:— (a) Pipes repaired or renewed 10 (b) Water tanks repaired, replaced, etc. 1 W.C. Accommodation:— (a) Structure repaired 2 (b) Cisterns repaired or renewed 9 (c) Flush pipe joint repaired 9 (d) Pans provided, removed or replaced 11 (e) Seats repaired, renewed or provided 3 Windows:— (a) Frames repaired or renewed 8 (b) Casements and sashes eased 4 (c) Sashcords and beading renewed 72 (e) Glazing and putties renewed 28 (f) Cills repaired 6 (g) New windows provided 1 Yard paving repaired or renewed 2 (2) Factories Cleansed 1 Abstract provided 1 Sanitary Accommodation:— (a) Provided 1 (b) Lighting provided 3 (c) Repaired 1 (d) Cleansed 1 Walls and Ceilings cleansed, redecorated, etc. 1 (3) Food Premises Structural defects remedied 3 Cleansing of walls, floors, ceilings, etc. 19 Cleansing of utensils 1 Drains—new, repaired or renewed 1 Dampness remedied, etc. 1 Sink and/or water supply provided, renewed or repaired 2 Storage provided or improved 4 Yards:— (a) Repaired 2 (b) Accumulation removed 1 Washing Accommodation:— (a) Hot water provided 7 (b) Wash basins provided 2 W.C. accommodation cleansed, repaired, etc. 4 Ventilation improved, provided, etc. 1 33 (4) Other Nuisances Accumulations removed 6 Smoke nuisances abated 2 Dangerous structures demolished or rebuilt 1 Ditches, etc., cleansed 1 Nuisance from animals and insects abated 2 (5) Shops Heating provided or improved 1 Sanitary accommodation provided 2 Washing accommodation provided 1 Defective structure, walls, floors 6 Ceilings, etc., repaired and redecorated 3 Lighting provided or improved 2 SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 955 Number of re-inspections of premises 1,076 Number of visits to work in progress 202 Number of miscellaneous visits and inspections 496 Number of visits to schools 32 Number of visits to dairies 38 Number of visits to ice-cream premises 154 Number of visits to refreshment rooms 122 Number of visits to fried-fish shops 13 Number of visits to bakehouses 34 Number of visits to other food premises 675 Number of visits to factories 274 Number of visits to shops, offices and workplaces 732 Number of visits to stables and yards 14 Number of visits to market gardens, etc. 47 Number of inspections of urinals 133 Number of visits to piggeries 16 Number of visits re infectious diseases 112 Number of visits re insect pests 83 Number of inspections and visits re rats 3,056 Number of visits to streams 72 Number of visits re smoke abatement 487 Number of inspections of swimming bath 18 Number of complaints received and investigated 628 Number of informal notices served 781 Number of statutory notices served 25 Number of interviews re nuisances, etc. 753 Number of drain tests applied 36 Number of rooms disinfected 81 Number of lots of bedding and clothing disinfected 35 Number of library books disinfected 253 Number of samples of foodstuffs, water, etc., taken for examination 295 H. G. CRIPPS, Chief Sanitary Inspector. 34 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1954 Summer season) the open-air swimming bath situated in the grounds of what was formerly the Royal Female Orphanage, now the Carew Manor School. 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 1,448 School children 5,715 Season Ticket Holders, etc.: Adults 8,393 Children 2,660 Total 18,216 SCHOOLS School Closure. Infectious diseases common to childhood were not prevalent in epidemic form in any of the schools during the year. As a result it was not found necessary for any school to be closed by the local sanitary authority to prevent the spread of infectious disease. Medical Inspection. Under the 1944 Education Act the Assistant Medical Officers of the County Council continued to carry out routine and special medical inspections of schoolchildren in the maintained schools. This work is under the general supervision of the Medical Officer of Health, in his capacity of Divisional School Medical Officer for the Mid-Eastern Divisional Executive of the Surrey County Council. Water Supply and Sanitary Conditions. All the schools are supplied with water from the public mains and are connected with the sewers. During the year some progress was made in bringing the maintained schools up to pre-war standards of decoration. No major sanitary defects were found. Considerable thought has been given to the maintenance of good standards of hygiene in school canteens. The serving of meals on a large scale in establishments such as schools, represents a danger-point for the occurrence of food poisoning. The maintenance of high standards of hygiene and sanitation is dependent upon the intelligent co-operation of every individual member of a canteen staff. The Ministries of Health and Education are constantly devising methods of educating staff to realise the importance of a high standard of personal hygiene, in order to avoid outbreaks of food poisoning. 35 OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN During the year no notifications of food poisoning were received. The Public Health Department staff continued to pursue an active policy in the supervision and control of food premises. This is reflected in the considerable increase in the total number of visits paid to food premises, as recorded on page 26. No prosecutions were brought against any person under the Food and Drugs Act, or the bye-laws, during the year. In general, it can be stated that good standards of hygiene are maintained throughout the Borough in all the food trades. NUTRITION One important event which took place in July was the discontinuance of meat rationing. This was the last article of food left in the Government's rationing scheme, and with the freedom to purchase meat in any quantity from any butcher, a considerable step forward was made in ensuring a better supply of first-class protein. Nutritional standards, as observed by examining children in schools and at infant welfare clinics, are now at the highest level yet recorded. The Government scheme for the provision of welfare foods has been continued. In June, the Ministry of Food handed over to the local health authority the distribution scheme for welfare foods. This is now handled locally by the Divisional Medical Officer's staff and issues are made at a converted hut in the Corporation's car park, at infant welfare centres, and also at the branch library in Beddington. Ladies of the W.V.S. have most generously helped in the distribution of these welfare foods, and we are most grateful for their willing co-operation in this important service to mothers and infants. Proprietary brands of vitamin preparations and some dried milk foods continue to be available to mothers at infant welfare centres and at the Town Hall. SHELL FISH (MOLLUSCAN) Only a small quantity of shell fish is marketed in the district, and is obtained chiefly from Billingsgate Market, London. 36 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. 37 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease in the Borough in 1954, 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 28 18 — Measles 16 — — Whooping Cough 53 1 — Erysipelas 6 1 — Pneumonia 14 7 12* Dysentery 4 1 — Puerperal Pyrexia 3 1 — Cerebro-Spinal Meningitis 2 2 1 Totals 126 31 13* * Includes deaths from all forms of pneumonia. † Includes deaths of residents in homes and institutions outside the Borough. 39 Cases of Infectious Disease Notified During the Year 1954 (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 28 – – 2 1 1 22 – 1 – – 1 – 5 3 5 2 6 — 7 18 — Measles 16 1 2 4 — 4 5 – – – – – – 1 1 2 1 5 3 3 — — Whooping Cough 53 5 1 1 6 4 30 2 – 1 – – – 11 13 7 2 6 7 7 1 — Erysipelas 6 – – – – – 1 – – 1 – 3 1 1 2 — 1 — 1 1 1 — Pneumonia 14 – – – – – 1 1 1 3 2 3 3 3 4 3 — 3 1 — 7 12* Dysentery 4 1 — — 1 — — – 1 — — 1 — 1 1 — 1 — 1 — I — Puerperal Pyrexia 3 – – – – – – – – 3 – – – – – 3 – – – – 1 — Cerebro-Spinal Meningitis 2 – – – 1 – 1 – – – – – – – – 1 – 1 – – 2 1 Totals 126 7 6 7 9 9 60 3 3 8 2 8 4 22 24 21 7 21 13 18 31 13 The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections: * Includes all forms 40 The Monthly Incidence of Infectious Disease, 1954 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 1 2 2 5 3 4 4 – 1 — — 6 28 Measles 5 — — — — 1 4 1 — — — 5 16 Whooping Cough 4 2 2 3 6 3 2 3 3 — 8 17 53 Erysipelas 1 – 1 1 — 1 1 — — — — 1 6 Pneumonia 3 2 — — — 1 — – 1 7 — — 14 Dysentery — — — 1 1 – – 1 – – – 1 4 Puerperal Pyrexia — 1 — — — 1 – — 1 — — — 3 Cerebro-Spinal Meningitis – – – 2 – – – – – – – – 2 Totals 14 7 5 12 10 11 11 5 6 7 8 30 126 Tuberculosis There were 16 new cases notified daring the year, this being a decrease of 14 on the number of cases notified in 1953. The following table gives the number of new cases notified during the past five years: New Cases 1950 1951 1952 1953 1954 M. F. M. F. M. F. M. F. M. F. Pulmonary 27 1 21 10 23 12 16 12 8 8 Non-Pulmonary 2 4 2 3 1 2 1 1 — — Totals 29 5 23 13 24 14 17 13 8 8 Annual case rate per 1,000 of the estimated population: 1951 1952 1953 1954 Pulmonary 0.95 1.08 0.86 0.50 Non-pulmonary 0.15 0.09 0.06 0.00 The following table gives the number of deaths from this disease during the past five years: Deaths 1950 1951 1952 1953 1954 M. F. M. F. M. F. M. F. M. F. Pulmonary 7 1 4 — 4 3 6 — 4 1 Non-Pulmonary 1 1 1 1 — — 1 1 — 1 Totals 8 2 5 1 4 3 7 1 4 2 It will be seen from the foregoing table that 6 Tuberculous patients died during the year, this being a decrease of two 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: 41 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year – – – – – – – – 1 and under 5 – – – – – – – – 5 and under 10 – – – – – – – – 10 and under 15 – – – – – – – – 15 and under 20 – – – – – – – – 20 and under 25 1 4 – – – – – – 25 and under 35 3 1 – – – – – – 35 and under 45 3 – – – – – – – 45 and under 55 — 2 — — 1 — — — 55 and under 65 – – – – – – – – 65 and upwards 1 1 — — 3 1 — 1 Totals 8 8 – — 4 1 — 1 The new cases were distributed amongst the Wards as follows: Beddington North West Cent. South Wallington North Cent. South Pulmonary 3 2 3 2 3 3 — Non-Pulmonary Totals 3 2 3 2 3 3 — 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 magnificent work in the district during 1954. As in previous years, the major effort of the Committee was directed towards alleviating the lot of tuberculous patients and their families. Money grants, supplements of clothing and nourishing foods, help with the debts and the multifarious difficulties of necessitous families were given, and the work was greatly appreciated. 42 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, 142 women made 553 pre-natal attendances. This represents an attendance of 33.5 per cent. of the total number of confinements which occurred during 1954. 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 recorded were an increase on those of previous years. Number attending Total attendances Children under 1 year 329 4,916 Children, 1-5 years 733 3,257 Total attendances 1,062 8,173 Institutional Confinements. Three hundred and eighteen, or 75.00 per cent. of births allocated to this district, took place in hospitals and nursing homes, this being a similar percentage to that 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 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 at the Wallington Town Hall, and a part-time supervisor, who acts under the general direction of the Divisional Medical Officer, is employed. 43 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 43 Chronic Sick (including aged and infirm) 89 Acute Sick 92 Tuberculosis 8 232 Treatment. Minor Ailments. Seventy-four cases were referred from the Infant Welfare Centres to Hospital Specialists for investigation and treatment during the year. The principal defects were as follows: Eye conditions 17 Tonsils and adenoids 9 Orthopædic defects 8 Nævi 9 Circumcisions 11 Hernia 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 3 1 2 1 – – Nursing Mothers 3 7 1 — — — Children, 0-5 57 37 82 — — — Totals 63 45 85 1 — — Orthopaedic. Patients attending infant welfare centres who require treatment for orthopedic defects are referred by the Clinic Medical Officer to orthopaedic surgeons at St. Helier or other hospitals. During 1954, 8 cases were referred for treatment. 44 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 are 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 2,414 1,003 Children, 5-15 years 2,806 2,584 Expectant and Nursing Mothers 49 315 5,269 3,902 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. Visits during the year were made as follows: First visits Tota visits Expectant Mothers 243 452 Children, 0-1 year 435 1,987 Children, 1-5 years 9 3,025 Other Cases 21 45 Ineffectual — 746 708 6,255 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. 45 Care of Premature Infants. The arrangements made for the care of premature infants continued during 1954. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Twent-one premature live births were notified during the year, eighteen of which occurred in hospital. One of the infants born at home was transferred to hospital on or before the 28th day. All these infants 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. 46 B. JOHNSON, ^Printer, 11, Manor Road, Wellington.