BED 20 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1955 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1955 TABLE OF CONTENTS Public Health Committee 5 Representatives on Mid-Eastern Divisional Health Sub-committee 5 Representatives on the Wandle Valley Joint Sewerage Board 5 Staff 6 Statistics and Social Conditions 11 Extracts from Vital Statistics 12 Vital Statistics: Comparative Birth-rates, Death-rates, Analysis of Mortality, etc., 1955 13 Registered Causes of Death 14 Violence and Accident 15 Maternal Mortality 15 Infantile Mortality 15 General Provision of Health Services for the Area: Laboratory Facilities 17 Ambulance Facilities 17 Nursing in the Home 17 Treatment Centres and Clinics: Care of Mothers and Young Children 18 Tuberculosis 18 Immunisation against Diphtheria 19 Immunisation against Whooping Cough 19 School Clinics 19 Venereal Diseases Clinics 20 Cleansing of Persons 20 Hospitals 20 Disinfection 21 Sanitary Circumstances of the Area: Water Supplies 21 Drainage and Sewerage 22 Rivers and Streams 22 Closet Accommodation 22 Public Cleansing 22 3 Report of the Chief Sanitary Inspector for the Year 1955: Housing 23 Milk and Dairies 23 Ice Cream 24 Slaughterhouses 24 Food Premises 24 Unsound Food 25 Food and Drugs Act, 1955 25 Factories .. 26 Unsatisfactory Samples 27 Bakehouses 29 Workplaces, Shops and Offices 29 Complaints 30 Smoke Abatement 30 Infectious Disease and Disinfection 30 Offensive Trades 30 Rats and Mice 30 Notices 31 Sanitary Improvements 31 Summary of work done during the year 33 Swimming Bath 34 Schools 34 Outbreaks of Food Poisoning and Clean Food Campaign 35 Nutrition 35 Shell Fish (Molluscan) 35 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 4 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITTEE December, 1955 Members: Alderman D. H. de Voil (Chairman) Councillor S. W. C. Sprunt (Mayor) Alderman F. G. Bryant (Deputy Mayor) Councillor Miss K. C. Bratt Councillor S. J. Dunwoodie Courcillor G. H. Hyett, O.B.E. Councillor J. A. Parker Councillor Miss R. M. Smith Councillor A. Stammers Councillor Mrs. J. L. K. Thurston Councillor E. P. Vaughan REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1955 Members: Alderman D. H. de Voil Alderman H. Rennison Councillor Miss K. C. Bratt Councillor G. H. Hyett, O B.E. Councillor A. Stammers REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1955 Members: Councillor S. W. C. Sprunt, (Mayor) Alderman F. G. Bryant Alderman A. H. Prior Councillor S. J. Dunwoodie 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.) D. A. Eves, M.S.I.A. (Commenced 21.2.55) (a.) V. L. I.erigo, M.S.I.A., A.R.S.H. (Commenced 12.9.55) (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 (on National Service from 5.12.55) E. Statter, (Temp. Commenced 5.12.55) 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. (Resigned 31.7.55) 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. Mrs. M. E Bennett, S.R.N., S.C.M., H.V.Cert. (Commenced 26.9.55) Physio therapists: Miss G. Allen, M.C.S.P. (Part-time) (Resigned 10.8.55) Mrs. H. M. Henn, M.C.S.P. (Part-time) Mrs. M. Turnbull, M.C.S.P. (Part Time) (Commenced 1.9.55) Assistant to Physiotherapists: Miss D. V. Raymond Administrative Assistant: R. F. Burns Clerks: E. D. Evezard Mrs. J. F. Smith Miss B. G. Thompson (School Health) Home Help Supervisor: Mrs. H. M. Long (Part-time) 6 Public Health Dfpartment, Town Hall, Wallington. To the Worshipful the Mayor, Aldermen and Councillors of the Borough of Beddington and Wallington. Ladies and Gentlemen, I have the honour to present my annual report for 1955. The report is drawn up in accordance with the suggestions made by the Minister cf Health in his Circulars 28/54 and 17/55. The vital statistics are based on information supplied by the Registrar-General. The presentation follows that adopted since 1948, 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 Home Help. The Registrar-General's estimate of the population of Beddington and Wallington at mid-year 1955 is 32,530, and this figure is used in the compilation cf the vital statistics. The figure shows an decrease of 90 compared with the Registrar-General's estimate for mid-year 1954. The census of population taken in 1951 was 32,751. The birth rate per 1,000 total population shows an decrease at 11.89 in 1955, as compared with 13.52 in 1954. This rate is much below that for England and Wales, which is 15 00. This is the lowest birth rate, which has been recorded in this district since the constitution of the Urban District in 1915. The stillbirth rate per 1,000 total births is 21.45. This is lower than that for England and Wales, which is recorded as 23.2. It is however, higher than the rate for this district in 1954, which was 18.7. The number of children stillborn in the district was 8, the same number as recorded in 1954, but out of a total number of 373 births, as compared with 424 births in 1954. 7 The death rate from all causes per 1,000 total population is 8.81, compared with 9.45 in 1954 and 11.70 for England and Wales. Of the 322 deaths, diseases of the heart and circulatory system accounted for 123 (38.20 per cent, of total deaths), cancer 60 (18.63 per cent, of total deaths), and tuberculosis 4 (1 .21 per cent, of total deaths). The death rate is lower than in 1954, and is one of the lowest yet recorded, the last comparable rate being 8.8 in 1934. The tables on pages 13 and 14 indicate the comparative rates and causes of death. From these tables it will be seen that deaths from cancer are lower than in 1954. Even when considered as a percentage of the total deaths, this is lower than in 1954, being 18.63 as compared with 20.17. Deaths from diseases of the heart and circulatory system account for a very high proportion of the causes of death, there being an increase in the rate, as compared with the previous year, being 38.20 per cent in 1955 as compared with 36.88 per cent in 1954. Coronary disease again showed an increase, there being 55 deaths from this cause as compared with 50 in 1954. Deaths from all diseases were generally higher amongst the older age groups, which is accounted for by the large number of people over 65 years of age living in the district. Three deaths were recorded from motor vehicle accidents, this being the same number as in 1954. All other accidents accounted for 4 deaths, as compared with 8 in 1954. Suicides totalled 2 cases, compared with 7 in 1954. No mothers died in childbirth during 1955, and this gives a maternal mortality rate per 1,000 total births of nil, as compared with 0.64 for England and Wales. The infantile mortality rate shows a decrease at 13.70 per 1,000 live births, as compared with 14.42 in 1954. Only five infants died under the age of 1 year in 1955, out of 365 live births. On page 16 will be found an analysis of the causes of death. Congenital defects accounted for 4 of the deaths, and one infant died through a very difficult labour. Geriatric problems continued to take an important place in the work of the department during 1955. Once again we wish to record the very helpful liaison established with the W.V.S., under the able guidance of Mrs. O. L. Wiles. The care of the aged will continue to be an evergrowing preoccupation for many sections of the health service, and the assistance given by home helps and district nurses was effective in keeping many old people in reasonable comfort in their own homes. An effective liaison with the geriatric department of St. Helier Hospital is maintained, and a few old people who required institutional care were admitted during the year. 8 On page 37 will be found a table setting out the incidence of infectious diseases, other than tuberculosis, during 1955 From this, it will be observed that the number of cases of infectious disease notified was, with the exception of measles, about average. There were 659 cases of measles, and although the figure is high, it cannot be said to have reached epidemic proportions. It was not found necessary to close any classes in maintained schools because of this disease. Whooping cough and scarlet fever amongst infantile complaints were higher than in 1954, but cannot be described as being higher than average. During the year, five cases of poliomyelitis occurred, 3 of which were paralytic. There were no deaths from this disease. Research work to find a vaccine to stamp out this disease was continued throughout the year, but the introduction of the new vaccine belongs to the year 1956. One aspect of the incidence of the disease in this part of Surrey during 1955 was the apparent absence of any seasonal influence; cases continued to occur sporadically throughout the year, and not, as generally recorded, during the summer months. The disease, too, would appear to be no respector of age, and an increasing number of adults continue to be notified as sufferering from the disease, the word "infantile" paralysis as a description of the disease being now somewhat of a misnomer. No cases of food poisoning were notified during the year, although sporadic cases of intestinal infection of a dysenteric character continue to come to light from time to time. Amongst infectious diseases, which have assumed considerable importance since the war, tuberculosis in 1955 was slightly lower than in previous years. Only 13 new cases were notified during the year, this being a decrease of 3 on the cases notified in 1954. Deaths from this disease, too, fell, there being only four deaths compared with six in 1954 B.C.G. vaccination continues to be offered to school children before their 14th birthday, and during 1955, 220 children representing 56.12 per cent of the eligible children, accepted this preventive treatment. The Mass Radiography Unit did not visit Beddington and Wallington during the year, but the next visit is planned for 1956. The Corporation can note with satisfaction that, although certain infectious diseases were slightly higher than during the previous year, the year can be regarded with satisfaction as being one in which the general health of the population was maintained at a high level. During 1955, the swimming bath at 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. 9 The weather during the swimming season was very fine, and many more residents availed themselves of the facilities, with the result that the number of attendances was much higher than in the bad summer of 1954. The work of the Chief Sanitary Inspector's Department was considerably handicapped during 1955 by delays experienced in filling vacancies with suitably qualified persons, due to the present shortage of Sanitary Inspectors and by changes in the clerical staff. In all, 55 man weeks of Sanitary Inspectors' time were lost during the year with the result that the number of inspections and visits recorded is lower than in the previous year. Changes in the clerical staff resulted in further loss of achievement. 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, 1956. Medical Officer of Health. 10 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 1955 32,530 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1955 10,003 Rateable Value £655,247 Sum represented by penny rate £2,600 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. During recent years, there has been considerable development in the southern part of the Borough, with the provision of new roads of detached houses. All this development, in one of the best parts of the district, has been carried out on a policy of low density of houses to the acre, and the whole character of the scheme is in keeping with the accepted standards of the southern part of the Borough. Parks and open spaces continue to be well maintained, and give breathing space and facilities for open-air recreational activities. Beddington Park and Grange Park are used as much as ever, and are an inestimable boon during the holiday months to children and parents, who are unable to go away for a holiday. The pleasing residential charpcter of the district is well maintained, and is much appreciated by many City workers, who return home to pleasant relaxation in their gardens and allotments in the evenings. 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 bath in the grounds adjoining the Carew Manor School. 11 EXTRACTS FROM VITAL STATISTICS Total M F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 358 184 174 11.22 (Crude) „ „ Illegitimate 7 4 3 11.89 (Corrected) Total 365 188 177 Rate per 1,000 total (live and still) births Still Births 8 4 4 21.45 Death Rate per 1,000 of the estimated resident population Deaths 322 150 172 9.90 (Crude) 8.81 (Corrected) Deaths attributable to: Pregnancy, Childbirth, Abortion, rate per 1,000 live and still births Nil Death Rate of Infants under one year of age: All Infants per 1,000 live births 13.70 Legitimate Infants per 1,000 legitimate live births 13.70 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 60 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 12 Comparative birth rates, civilian death rates, analysis of mortality, and case rates for certain infectious diseases in 1955: 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 150 11.7 23.2 0.64 24.9 0.00 0.00 0.01 0.07 0.49 0.15 0.39 160 County Boro's and Great Towns including London 14.9 11.6 23.2 — 25.1 0.00 0.00 0.01 0.06 0.53 0.17 0.45 160 Smaller Towns Resident population 25,000 to 50,000 at 1951 Census 14.9 116 23.3 — 25.2 0.00 0.00 0.00 0.07 0.45 0.13 0.37 Beddington and Wallington 11.89 8.81 21.45 0.00 13.70 0.00 0.00 0.00 0.03 0.46 0.12 0.43 13 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1955: Causes of Death Males Females Total All Causes 150 172 322 1 Tuberculosis, respiratory 4 — 4 2. Tuberculosis, other — — 3. Syphilitic disease — 1 1 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases 1 — 1 10. Malignant neoplasm, stomach 4 3 7 11. Malignant neoplasm, lung, bronchus 12 2 14 12. Malignant neoplasm, breast — 4 4 13. Malignant neoplasm, uterus — 3 3 14. Other malignant and lymphatic neoplasms 11 21 32 15 Leukaemia, aleukaemia 1 1 2 16. Diabetes — 2 2 17. Vascular lesions of nervous system 16 32 48 18. Coronary disease, angina 28 27 55 19. Hypertension with heart disease 5 — 5 20. Other heart diseases 14 29 43 21. Other circulatory diseases 13 7 20 22. Influenza 1 — 1 23. Pneumonia 8 7 15 24. Bronchitis 9 7 16 25. Other diseases of respiratory system 3 1 4 26. Ulcer of stomach and duodenum — 2 2 27. Gastritis, enteritis and diarrhoea — 5 5 28. Nephritis and nephrosis 1 3 4 29. Hyperplasia of prostate — 2 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 3 — 3 32. Other defined and ill-defined diseases 8 11 19 33. Motor vehicle accidents 3 — 3 34. All other accidents 3 2 5 35. Suicide — 2 2 36. Homicide and operations of war — - - 14 The following table shows the principal causes of death with the rate per cent, of total deaths: Cause of Death Number of Deaths Rate per cent, of Total Deaths Heart Disease 103 31 .99 Other Diseases of the Circulatory System 20 6.21 Vascular Lesions of Nervous System Cancer 48 60 14.66 18.63 Bronchitis 16 4.97 Pneumonia 15 4.66 Tuberculosis (All Forms) 4 1.2! VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 2 2 Other Violent Causes 6 2 8 Totals 6 4 10 MATERNAL MORTALITY No deaths in childbirth, either from puerperal sepsis or other maternal causes, were recorded during the year. The maternal mortality rate for England and Wales per 1,000 live and still births was 0.64. INFANTILE MORTALITY The infantile mortality rate for 1955 was 13.70 per 1,000 live births. The comparable rate for England and Wales is 24 .9. 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 365 live births, only 5 deaths of infants under one year of age (3 males and 2 females) were registered. Three of the deaths (2 males and 1 female) occurred within the first four weeks of life. 15 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 10 hours M. Fracture of skull. Tentorial tear, (following attempted forceps delivery) 24 hours M. Prematurity 24 hours F. Atelectasis. 6 weeks M. Congenital cardiac lesion 6 weeks F. Congenital Morbus Cordis 16 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA LABORATORY FACILITIES The Corporation's arrangements for the examination of swabs, sputa and other pathological material continue as heretofore. During 1955, 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 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 898 cases, including 81 maternity and midwifery patients. A total of 19,314 visits was made. 17 TREATMENT CENTRES AND CLINICS Care of Mothers and Young Children Child Welfare Centres Hackbridge Centre, The Grange, London Road. When held Every Monday, 2.0^1.0 p.m. Bandon Hill Centre, Methodist Hall, Sandy Lane North. Every Tuesday, 2.0-4.0 p.m. Beddington Centre, Village Hall, Beddington. Alternate Wednesdays, 2.0-4.0 p.m. Wallington Centre, Baptist Hall, Queen's Road. Alternate Wednesdays, 2.0-4.0 p.m. Maternity Clinics Ante-natal Clinic Post-natal Clinic, Every Thursday, 2.0-4.0 p.m. District Nurses' Home, 57 Montagu Gardens, Wallington. Physiotherapy Clinic, Dental Clinic, The Grange, London Road. By appointment. 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. 18 Immunisation Against Diphtheria Four clinics are held weekly to give immunisation against diphtheria. These are held at each of the three Infant Welfare Centres and at the Medical Officer of Health's Department at the Town Hall. The following table gives the number of children residing in the Borough who were 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., 1955 1,990 4,590 6,580 Number of children known to be immunised at 31st Dec., 1955 1,025 4,342 5,367 Percentage of children immunised 51.5 94.6 81.6 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, 278 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 19 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 1955 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 urcleanliness a rare condition. During the year the following treatments were carried out: Scabies Nil Pediculosis 5 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. 20 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 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 37 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. 21 DRAINAGE AND SEWERAGE During the year the sewers have been systematically cleaned and flushed. Trouble is being experienced with partial blockages in the sewers in Melbourne Road, Belmont Road, Clifton Road and Park Road. A redrainage scheme is being prepared for this area. A considerable quantity of silt was found in the sewer in Croydon Road some of which has been cleared manually, arrangements have been made for a specialist firm to complete the work with mechanical equipment. Eighteen minor blockages were cleared in private connections. RIVERS AND STREAMS Normal cleansing of the River Wandle was carried out. Camp sheeting has been provided for both banks of the river at Richmond Green and the Bridle Path. 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. 22 REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR, 1955 HOUSING One hundred and twenty six houses were rendered fit as a result of informal or statutory action under the Public Health Act, 1936. Ten applications were received for Certificates of Disrepair (Housing Repairs & Rents Act, 1954). Nine certificates were issued. Number of inspections of dwelling-houses 517 Number of inspections recorded under Housing Regulations 19 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 26 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 11 „ „ Supplementary Licences 16 — 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 48 48 — 48 — — — T.T. Pasteurized 34 32 2 34 — — — Sterilized 3 — — — — 3 — Tuberculin Tested (Farm Bottled) 10 5 5 — — — 23 CHEMICAL ANALYSES OF MILK Twenty-six 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 % 8.72 Total Solids % 12.47 ICE CREAM Number of premises registered for the sale of ice cream 88 Number of manufacturers Nil Number of inspections of premises 69 Forty-seven samples of ice cream (including ten ice lollies) were procured and submitted for bacteriological examination. procured and submitted for bacteriological examination. The results are set out in the following table:— Type No. of Samples Methylene Blue Test l i Grade 1 Grade 2 Grade 3 Grade 4 Ice cream 38 25 7 4 2 Ice lolly 3 3 — — — 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 6.0% and 10.4%. The average fat content was 9.4%. SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 665 Total number of defects discovered 63 FOOD PREMISES IN THE DISTRICT Bakers 14 Butchers 24 Catering Establishments 47 Chemists 12 Confectioners (sweets) 27 Fishmongers (including friers) 10 Greengrocers 32 Grocers 70 Licensed Premises 13 24 FOOD PREMISES REGISTERED UNDER SECTION 14 OF THE FOOD & DRUGS ACT, 1955 Sausage manufacturers 29 Fish friers 7 Jam manufacturers 1 Ice cream (sale only) 88 Ice cream (manufacture and sale) 3 INSPECTIONS OF REGISTERED FOOD PREMISES Ice cream (manufacture and sale) 69 Fish friers 5 Sausage manufacturers 21 Jam manufacturers 3 UNSOUND FOOD Destroyed or released for animal feeding:— lbs. Cheese 261 Fish, canned 7 Fruit, canned 191 Jam 6 Jelly 1 Marmalade 16 Meat 161 Meat, canned 127 Milk, canned 32 Paste 36 Pickles and sauces 4 Soup 8 Vegetables, canned 109 Total 955 FOOD AND DRUGS ACT, 1955 On 1st April, 1940, the Corporation became the Food and Drugs Authority for the Borough, and took over the duties under the Act from the Surrey County Council. Dr. H. Amphlett Williams, Ph.D.(Lond.), A.C.G.F.C., F.R.I.C., of 1 Southwark Street, London, S.E.l, is Public Analyst for the Borough. 25 FOOD ANALYSES Number of samples analysed by Public Analyst 107 Number of samples reported against 3 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 Aspirin Tablets — 1 1 — — — — — Beverages 1 2 3 — — — — — Bread — 2 2 — 1 1 — — Cake mixture — 1 1 — — — — — Cocoa — 1 1 — — — — — Codeine Tablets. Compound — 1 1 — — — — — Coffee Essence — 1 1 — — — — — Confectionery, Flour 1 1 2 — 1 1 — — „ , Sugar 4 3 7 — — — — — Cough Syrup — 1 1 — — — — — Cough Mixture — 1 1 — — — — — Cream — 1 1 — — — — — Dripping — 1 1 — — — — — Fish, canned — 2 2 — — — — — Flavouring Essence — 1 1 — — — — — Fruit, canned — 3 3 — — — — — ,, , dried 2 — 2 — — — — — Fruit juice — 1 1 — — — — — Gin 1 — 1 — — — — — Ice cream 4 — 4 — — — — — Ice Lollies — 2 2 — — — — — Jam — 4 4 — — — — — Jelly Tablets — 1 1 — — — — — Lard 1 — 1 — — — — — Marmalade — 2 2 — — — — — Meat, canned — 1 1 — — — — — Milk 16 10 26 — — — — — „ , condensed — 2 2 — — — — — Mincemeat — 1 1 — — — — — Olive Oil — 1 1 — — — — — Pepper — 1 1 — — — — — Pickles — 1 1 — — — — — Pudding, Christmas — 1 1 — — — — — Pudding Mixture — 1 1 — — — — — Rum 1 — 1 — — — — — Salad Cream — 1 1 — — — — — Sauce — 3 3 — — — — — Sausages 5 — 5 1 — 1 — — Soda, Bicarbonate of — 1 1 — — — — — Soup, canned — 1 1 — — — — — Spice, mixed — 1 1 — — — — — Suet, Shredded — 3 3 — — — — — Tea 1 2 3 — — — — — Tomatoes, canned — 1 1 — — — — — Vinegar 1 1 2 — — — — — Whisky 3 — 3 — — — — — Total 41 66 107 I 2 3 — — FACTORIES Number of factories on register (including bakehouses) 143 Number of inspections 119 Number of defects discovered and remedied 8 26 UNSATISFACTORY SAMPLES Formal Sample No. 78—Beef Sausages The sample contained sulphite preservative, 300 parts per million, calculated as sulphur dioxide. Warning letter sent to vendor. Informal Sample No. S.2—Bread The sample, submitted as a result of a complaint, contained a dead insect identified as an Ephestia larva. The larva was adhering to the bottom of the loaf, in which position it had evidently been baked. Investigations at the bakehouse revealed no evidence of infestation. Letter sent to manufacturer. Informal Sample No. S.3—Bun Round The sample, submitted as a result of a complaint, contained a phenolic compound, approximately 0.005 per cent. The bun had an objectionable taste, due to the presence of the phenol, and was unfit for consumption. Investigations carried out at the bakery revealed no evidence of phenolic compound. In view of doubt as to time and place of contamination and unwillingness of the complainant to give evidence, no further action was taken. 27 FACTORIES ACT, 1937 The following tables give details of inspections made and defects found: 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 10 – – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 133 109 8 – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) – – – – Total 143 119 8 — Part VIII of the Act Outwork Section 110 Section 111 Nature of Work No. of outworkers in August list required by Sect. 110 (D(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 Stuffed toys 7 — — — — Cosaques, Christmas crackers,Christmas stockings, etc. .. — — — — Total .. 7 — — — — — 28 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) 2 2 — — — 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 — 2 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 8 8 — 2 — BAKEHOUSES Number of bakehouses in district 7 Number of inspections 28 WORKPLACES, SHOPS AND OFFICES Number of inspections 429 Notices served 22 29 COMPLAINTS The number of complaints received continues to increase Complaints received and dealt with during the year were due to the following causes: Rats and Mice 196 Housing defects 118 Choked drains and sewers 74 Defective dustbins 104 Defective drainage (including closets) 19 Unsound or adulterated food 52 Atmospheric Pollution 15 Insect pests 41 Offensive accumulations 6 Miscellaneous 36 661 SMOKE ABATEMENT Number of observations 341 Nuisances observed 3 INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 139 Number of rooms disinfected 86 Lots of bedding and clothing disinfected 42 Number of library books disinfected 493 OFFENSIVE TRADES Number of offensive trade premises in district Nil RATS AND MICE Number of premises inspected 2,514 Number of visits to premises 3,256 Number of premises upon which rats or mice were found and remedial action taken 290 Number of baits laid 4,248 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 199 198 Manholes in which takes were recorded 115 45 Percentage of manholes showing infestations 67 23 30 NOTICES Number of informal notices served (including verbal intimations) 305 Number of statutory notices served Public Health Act, 1936, Section 93 (Nuisances) 27 Public Health Act, 1936, Section 75 (Dustbins) 1 — 28 SANITARY IMPROVEMENTS (1) Dwelling Houses Brickwork repaired or repointed 28 Ceilings:— (a) Repaired or renewed 41 (b) Cleansed and redecorated 25 Chimneys:— (a) Stacks repaired 20 (b) Flues repaired 2 (c) Pots renewed 1 (d) Cowls provided 2 Dampness remedied:— (a) Roofs repaired 103 (b) Walls rendered 58 (c) (i) Damp-proof course inserted 4 (d) (ii) Steps repaired 3 (e) Gutters and rainwater pipes repaired and unstopped 75 (f) Earth removed 1 Disinfestations 1 Doors—repaired or renewed 43 Drainage:— (a) Obstructions cleared 23 (b) Repaired and relaid 10 (c) Sealed off 1 (d) Inspection chambers provided and repaired 6 (e) Inspection chamber covers provided 6 (f) Interceptor traps and caps provided 4 (g) F.A.I. provided, etc. 4 (h) Soil-vent, pipes provided, repaired or renewed 5 (i) Waste-pipes repaired and renewed 10 (j) Soakaways provided, repaired or renewed 1 (k) Rodding-eye stopper replaced 3 Dustins provided 64 Fireplaces and stoves repaired or renewed 17 Floors:— (a) Repaired orrenewcd 44 (b) Ventilation provided or improved 6 Food storage provided or improved — Sinks renewed, etc. 46 Stairs:— (a) Repaired or renewed 9 (b) Handrails provided 3 31 Walls:— (a) Repaired or rebuilt 33 (b) Replastered 63 (c) Cleansed and redecorated 29 Water supply:— (a) Pipes repaired or renewed 7 W.C. Accommodation:— (a) Structure repaired 2 (b) Cisterns repaired or renewed 7 (c) Flush pipe joint repaired 8 (d) Pans provided or replaced 10 (e) Seats repaired, renewed or provided 4 Windows:— (a) Frames repaired or renewed 19 (b) Casements and sashes eased 23 (c) Sashcords and beading renewed 102 (d) Glazing and putties renewed 36 (e) Cills repaired 21 Yard paving repaired or renewed 7 (2) Factories Cleansed 2 Sanitary Accommodation:— Ventilated space provided 1 Walls and Ceilings cleansed, redecorated, etc. 4 (3) Food Premises Structural defects remedied 6 Cleansing of walls, floors, ceilings, etc. 6 Dampness remedied, etc. 1 Refuse accommodation provided 4 Storage provided or improved 7 Yards:— (a) Repaired 2 (b) Accumulation removed 3 Washing Accommodation:— (a) Hot water provided 5 (b) Wash basins provided 2 W.C. accommodation cleansed, repaired, etc. 5 Ventilation improved, provided, etc. 1 32 (4) Other Nuisances Accumulations removed 2 Smoke nuisances abated 2 Nuisance from animals and insects abated 1 Sheds, etc., ratproofed 2 (5) Shops Heating provided or improved 3 Sanitary accommodation provided I Washing accommodation provided 2 Defective structure, walls, floors 1 Ceilings, etc., repaired and redecorated 7 Seats provided 5 Forms exhibited 11 SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 536 Number of re-inspections of premises 1,234 Number of visits to work in progress 106 Number of miscellaneous visits and inspections 417 Number of visits to schools 14 Number of visits to dairies 26 Number of visits to ice-cream premises 69 Number of visits to refreshment rooms 91 Number of visits to fried-fish shops 5 Number of visits to bakehouses 28 Number of visits to other food premises 473 Number of visits to factories 119 Number of visits to shops, offices and workplaces 429 Number of visits to market gardens, etc. 52 Number of inspections of urinals 34 Number of visits to piggeries 9 Number of visits re infectious diseases 139 Number of visits re insect pests 46 Number of inspections and visits re rats 3,256 Number of visits to streams 70 Number of visits re smoke abatement 341 Number of inspections of swimming bath 18 Number of complaints received and investigated 661 Number of informal notices served 305 Number of statutory notices served 28 Number of interviews re nuisances, etc. 483 Number of drain tests applied 15 Number of rooms disinfected 86 Number of lots of bedding and clothing disinfected 42 Number of library books disinfected 493 Number of samples of foodstuffs, water, etc., taken for examination 290 H. G. CRIPPS, Chief Sanitary Inspector. 33 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1955 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 2,159 School children 6,085 Season Ticket Holders, etc.: Adults 10,474 Children 5,089 Total 23,807 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. 34 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. No prosecutions were brought against any person under the Food and Drugs Act, or the byelaws, 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 The nutritional standards of school children, as observed at routine examinations, and children below school age, as observed at infant welfare centres, are maintained at a very high level, the general impression gained being that children tend to be taller and heavier in the respective age-groups than formerly. The Local Health Authority continued the scheme for the distribution of welfare foods since it was handed over by the Ministry of Food in June, 1954. Local issues are made from an office situated in the Corporation Car Park by the Divisional Medical Officer's staff and ladies of the W.V.S. Issues were also made at infant welfare centres and at the branch library in Beddington. Grateful thanks are due to the many volunteers, who so willingly co-operate in this important service for 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. 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 1955, 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 32 21 — Measles ... 659 7 — Whooping Cough 70 1 — Erysipelas 8 1 — Pneumonia 24 6 15* Dysentery 9 6 1 Poliomyelitis— Paralytic 3 3 — Non-paralytic 2 1 — Meningo coccal Meningitis 1 1 — Puerperal Pyrexia 1 — — Totals 809 47 16* * Includes deaths from all forms of pneumonia, † Includes deaths of residents in homes and institutions outside the Borough. 37 The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections: Cases of Infectious Disease Notified During the Year 1955 (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 3 to 4 years 5 to 9 years 10 to 14 years 15 to 24 years 25 to 44 years 45 to 64 years 65 and over Beddington Wallington North West Central South North Central South Scarlet Fever 32 — 1 9 19 1 1 1 — — 7 2 5 9 5 1 3 21 — Measles 659 12 86 139 406 10 2 4 — — 192 85 66 61 153 54 48 7 — Whooping Cough 70 5 11 10 3S 4 — 1 — — 8 7 28 5 11 3 8 1 — Erysipelas 8 — — — — — — 1 3 4 2 2 — 1 1 1 1 1 — Pneumonia 24 — — 1 1 3 — 2 11 6 4 9 5 1 2 2 1 6 15* Dysentery 9 — 1 — 2 2 1 2 — 1 — 2 — 6 — — 1 6 1 Poliomyelitis— Paralytic 3 — 1 — — — — 2 — — 2 — 1 — — — — 3 — Non-paralytic 2 — — — 2 — — — — — — — — 1 — 1 — 1 — Meningo coccal Meningitis 1 — — 1 — — — — — — — — — — — — 1 1 — Puerperal Pyrexia 1 — — — — — — 1 — — — — — 1 — — — — — Totals 809 17 100 160 469 20 4 14 14 11 215 107 105 85 172 62 63 47 16 *Includes all forms 38 The Monthly Incidence of Infectious Disease, 1955 (exchiding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec.  Scarlet Fever 2 5 5 5 5 — 3 2 1 — 2 2 32 Measles 19 100 200 148 130 57 2 2 — — — 1 659 Whooping Cough 15 6 15 9 13 7 — — — — — 5 70 Erysipelas 1 — 1 — 1 — 1 — 3 1 — — 8 Pneumonia 5 7 5 — 2 2 — 1 — 2 — — 24 Dysentery — — 6 1 1 — — 1 — — — 9 Poliomyelitis— Paralytic — — — — — 1 — — — — 2 — 3 Non-Paralytic — — — — — — — 1 1 — — 2 Meningo coccal Meningitis — — 1 — — — — — — — — — 1 Puerperal Pyrexia — — — — — — 1 — — — — — 1 Totals 42 118 233 163 152 67 7 5 6 4 4 8 809 39 Tuberculosis There were 13 new cases notified during the year, this being a decrease of 3 on the number of cases notified in 1954. The following table gives the number of new cases notified during the past five years: New Cases 1951 1952 1953 1954 1955 M. F. M. F. M. F. M. F. M. F. Pulmonary 21 10 23 12 16 12 8 8 9 3 Non-Pulmonary 2 3 1 2 1 1 — — — 1 Totals 23 13 24 14 17 13 8 8 9 4 Annual case rate per 1,000 of the estimated population: 1951 1952 1953 1954 1955 Pulmonary 0.95 1.08 0.86. 0.50 0.37 Non-pulmonary 0.15 0.09 0.06 0.00 0.03 The following table gives the number of deaths from this disease during the past five years: Deaths 1951 1952 1953 1954 1955 M. F. M. F. M. F. M. F. M. F. Pulmonary 4 — 4 3 6 — 4 1 4 — Non-Pulmonary .. 1 1 — 1 I — 1 — — Totals 5 1 4 3 7 1 4 2 4 — It will be seen from the foregoing table that 4 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 12. 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:  New Cases Deaths Age Periods Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1 to 2 years — — — — — — — — 3 to 4 years — — — — — — — — 5 to 9 years 1 2 — — — — — — 10 to 14 years — — — — — — — — 15 to 24 years 2 — — — — — — — 25 to 44 years 2 1 — 1 — — 1 — 45 to 64 years 3 — — — — — 1 — 65 and over 1 — — — — — 2 — Totals 9 3 — 1 — — 4 — The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 1 — — 3 3 2 3 Non-Pulmonary 1 — Totals 1 — — 3 3 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 1955. 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. 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, 121 women made 460 pre-natal attendances. This represents an attendance of 32.4 per cent. of the total number of confinements which occurred during 1955. Post-natal examinations were also conducted at this clinic, 10 patients making 10 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 comparable with those of previous years. Number attending Total attendances Children under 1 year 269 4,393 Children, 1-5 years 800 3,409 Total attendances 1,069 7,802 Institutional Confinements. Three hundred and eight, or 82.6 per cent. of births allocated to this district, took place in hospitals and nursing homes, compared with 75.00 per cent 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. 42 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 23 Chronic Sick (including aged and infirm) 126 Acute Sick 53 Tuberculosis 4 206 Treatment. Minor Ailments. Fifty 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 12 Tonsils and adenoids 1 Orthopaedic defects 9 Naevi 11 Circumcisions 7 Hernia 5 Dental. The Grange dental clinic for school children and children below the age of five years, as well as nursing and expectant mothers, continues to perform a very essential service. continues to perform a very essential service. The accompanying table illustrates the work carried out. No. of New Cases Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant Mothers 15 23 31 — — 4 Nursing Mothers 10 31 18 3 6 1 Children, 0-5 58 25 183 — — — Totals 83 79 232 3 6 5 Orthopaedic. Patients attending infant welfare centres who require treatment for orthopaedic defects are referred by the Clinic Medical Officer to orthopaedic surgeons at St. Helier or other hospitals. During 1955, 9 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 are given. Classes for remedial exercises for children suffering from minor orthopædic 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 1,470 761 Children, 5-15 years 2,667 3,101 Expectant and Nursing Mothers 20 332 4,157 4,194 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 Total visits Expectant Mothers 194 357 Children, 0-1 year 372 1,632 Children, 1-5 years 7 2,931 Other Cases 14 17 Ineffectual — 702 587 5,639 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 1955. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Twenty-one premature live births were notified during the year, sixteen of which occurred in hospital. Two of the infants born in hospital died within 24 hours of birth. The remaining 19 children 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. B. JOHNSON, Printer, 11, Manor Road, Wallington.