BED 21 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1956 ' BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1956 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 12 Extracts from Vital Statistics 13 Vital Statistics: Comparative Birth-rates, Death-rates, Analysis of Mortality, etc., 1956 14 Registered Causes of Death 15 Violence and Accident 16 Maternal Mortality 16 Infantile Mortality 16 General Provision of Health Services for the Area: Laboratory Facilities 18 Ambulance Facilities 18 Nursing in the Home 18 Treatment Centres and Clinics: Care of Mothers and Young Children 19 Tuberculosis 19 Immunisation against Diphtheria 20 Immunisation against Whooping Cough 20 School Clinics 21 Venereal Diseases Clinics 21 Cleansing of Persons 21 Hospitals 21 Disinfection 22 Sanitary Circumstances of the Area: Water Supplies 22 Drainage and Sewerage 23 Rivers and Streams 23 Closet Accommodation 23 Public Cleansing 23 3 Report of the Chief Public Health Inspector for the Year 1956 : Housing 24 Milk and Dairies 24 Ice Cream 25 Slaughterhouses 25 Food Premises 25 Food and Drugs Act, 1955 26 Unsound Food 26 Unsatisfactory Samples 28 Factories Act, 1937 30 Bakehouses 31 Workplaces, Shops and Offices 31 Complaints 32 Smoke Abatement 32 Infectious Disease and Disinfection 32 Offensive Trades 32 Rats and Mice 33 Notices 33 Sanitary Improvements 33 Summary of work done during the year 35 Swimming Bath 36 Schools 36 Outbreaks of Food Poisoning and Clean Food Campaign 37 Nutrition 37 Shell Fish (Molluscan) 37 Adoptire Acts and Bye-Laws 38 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 39 Incidence of Infectious Diseases in Age Groups and Wards 40 Monthly Incidence of Infectious Disease 41 Tuberculosis 42 Transferred Functions under the National Health Service Act, 1946: The Care of Mothers and Young Children 44 Ante-natal and Post-natal Supervision 44 Infant Welfare Services 44 Institutional Confinements 44 Domestic Help Service 45 Treatment: Minor Ailments 45 Dental 45 Orthopaedic 46 Physiotherapy 46 Health Visiting 46 Child Life Protection 46 Care of Premature Infants 47 Care of Illegitimate Children 47 4 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITTEE December, 1956 Members: Councillor A. Stammers (Chairman until Oct. 1956) Councillor G. H. Hyett, O.B.E. (Chairman from Nov. 1956) Councillor F. G. Lee (Mayor) Councillor S. W. C. Sprunt (Deputy Mayor) Alderman F. G. Bryant Alderman D. H. de Voil Councillor Mrs. A. R. Barty Councillor S. J. Dunwoodie Councillor G. J. W. Hellon (from Nov. 1956) Councillor J. A. Parker Councillor E. W. Popplestone Councillor Miss R. M. Smith (until Oct. 1956) REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1956 Members: Alderman D. H. de Voil Alderman H. Rennison Councillor Mrs. A. R. Barty Councillor G. H. Hyett, O B.E. Councillor A. Stammers REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1956 Members: Councillor F. G. Lee (Mayor) Alderman F. G. Bryant Alderman A. H. Prior Councillor S. W. C. Sprunt 5 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: Patrick J. O'Connell, M.D., B.S., D.P.H., B.Hy. Chief Public Health Inspector: (a.b.c.) H. G. Cripps, M.R.S.H., M.A.P.H.I. Additional Public Health Inspectors: (a.b.) D. A. Eves, M.A.P.H.I. (a.) V. L. Lerigo, A.R.S.H., M.A.P.H.I. (a.) J. W. Parton (Commenced 2.7.56. Resigned 30.9.56) Assistant to Public Health Inspectors: R. W. Bradstock (Commenced 23.7.56) (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 (Resigned 15.1.56) Mrs. S. C. Clements (Commenced 19.3.56) C. I. Phillips (on National Service from 5.12.55) E. Statter (Temp.) (Resigned 30.11.56) P. C. Robinson (Temp.) (Commenced 4.12.56) 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. 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. (Resigned 19.5.56) Mrs. M. Maynard, S.R.N., S.C.M., R.F.N., H.V.Cert. Miss M. E. Bennett, S.R.N., S.C.M., H.V.Cert. Miss M. B. Brown, S.R.N., S.C.M., H.V.Cert (Commenced 22.5.56) Physiotherapists: Mrs. H. M. Henn, M.C.S.P. (Part-time) Mrs. M. Turnbull, M.C.S.P. (Part Time) (Resigned 31.3.56) Mrs. B. Manwaring, M.C.S.P. (Part Time) (Commenced 1.5.56) 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) Mrs. E. Bass (Part Time) (Commenced 26.3.56) Home Help Supervisor: Mrs. H. M. Long (Part Time) (Resigned 29.2.56) Mrs. V. Beatt (Part Time) (Commenced 1.3.56) 6 Public Health Department, Town Hall, Wallington. To the Worshipful the Mayor, Aldermen and Councillors of the Borough of Beddington and Wallington Ladies and Gentlemen, I have the honour to present my annual report for 1956. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 19/56. 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 1956 is 32,540, and this figure is used in the compilation of the vital statistics. The figure shows an increase of 10 compared with the Registrar-General's estimate for mid-year 1955. The census of population taken in 1951 was 32,751. The birth rate per 1,000 total population shows an increase at 12.12 in 1956, as compared with 11.89 in 1955. This rate is below that for England and Wales, which is 15.7 The stillbirth rate per 1,000 total births is 15.87, compared with 21.45 in 1955. This is lower than that for England and Wales, which is recorded as 23.0. The number of children stillborn in the district was 6, which is 2 less than the number recorded in 1955, out of a total of 378 births, as compared with 373 in 1955. The death rate from all causes per 1,000 total population is 10.52, compared with 8.81 in 1955, and 11.70 for England and Wales. Of the 353 deaths, diseases of the heart and circulatory system accounted for 122 (34.56 per cent of total deaths), cancer 77 (21.82 per cent of total deaths), and tuberculosis 3 (0.85 per cent of total deaths). The death rate is higher than in 1955, which was one of the lowest rates recorded for this district. The tables on pages 14 and 15 indicate the comparative rates and causes of death. From these tables it will be seen that deaths from cancer are higher than in 1955. The situation of the cancers, however, has shown a slight decrease in cancer of the lung, but an increase of cancer in females, that is, of the breast and uterus. 7 It is to be noted, however, that the proportion of males dying from cancer of the lung, to females, is 9 to 1. The association of smoking, especially cigarette smoking, with growths of the lung, has been clearly defined in statements made by the Minister of Health, based on the work of the Medical Research Council. The conclusions reached by the Medical Research Council are worth noting:— (1) A very great increase has occurred during the past 25 years in the death rate from lung cancer in Great Britain and other countries. (2) A relatively small number of the total cases can be attributed to specific industrial hazards. (3) A proportion of cases, the exact extent of which cannot yet be defined, may be due to atmospheric pollution. (4) Evidence from many investigations in different countries indicates that a major part of the increase is associated with tobacco smoking, particularly in the form of cigarettes. In the opinion of the Council, the most reasonable interpretation of this evidence is that the relationship is one of direct cause and effect. (5) The identification of several carcinogenic substances in tobacco smoke provides a rational basis for such a causal relationship. In a statement in the House of Commons on the 27th July, 1957, the Minister of Health said "the Government feel that it is right to ensure that this latest authoritative opinion is brought effectively to public notice, so that everyone may know the risks involved in smoking. The Government consider that these facts should be made known to all those with responsibility for health education. The Minister of Education included in his recently published Handbook for Teachers on Health Education advice about the dangers of smoking and he is circulating copies of this statement to local education authorities and education authorities generally. Corresponding action will be taken by the Scottish Education Department in Scotland. The Government now propose to bring these views to the notice of the local health authorities, who are concerned under statute in the prevention of illness and who are responsible for health education as means of prevention. Local health authorities will be asked to take appropriate steps to inform the general public and in this task they will have the assistance of the Central and Scottish Councils for Health Education. In due course local health authorities will draw the attention of the general public to the risks, which are now known to be associated with smoking. In doing this, they will have to rely upon members of the public, as responsible persons, to take such action as they feel right to safeguard their own health." It would be difficult, however, to conduct a crusade against smoking on the same lines as has been done in the past against the consumption of alcohol. The general public are not likely to be influenced by the presentation of dry statistics, and the horror tactics of the temperance reformer, with his lurid descriptions of ruined families, mental degeneracy, misery, and poverty associated with inebriety cannot be drawn upon to emphasize the dangers of smoking. The presentation of films, giving the 8 macabre details of post-mortem examinations of those, who have died from cancer of the lung, might produce a sufficient sense of horror to bring home to the smoker the fate which might be his. Possibly the best way to tackle the problem is to conduct further research in an endeavour to extract the carcinogenic factors from tobacco. Certainly one cannot help but feel that, at a time when the National Health Service Pharmaceutical Services report an ever-increasing consumption of sedative and tranquillising drugs, propaganda against smoking is more likely than not to fall upon many deaf ears. Deaths from diseases of the heart and circulatory system again, in 1956, continued to account for a very high proportion of total deaths. There were 54 deaths from coronary disease, 55 from vascular lesions of the nervous system (cerebral haemorrhage), and 60 from other heart diseases. 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. Four deaths were recorded from motor vehicle accidents, compared with 3 in 1955. All other accidents accounted for 4 deaths, the same number as in 1955. Suicides totalled 4 cases, compared with 2 in 1955. No mothers died in childbirth during 1956, and this gives a maternal mortality rate per 1,000 total births of nil, as compared with 0.56 for England and Wales. The infantile mortality rate shows an increase at 18.82 per 1,000 live births, as compared with 13.70 in 1955. Only seven infants died under the age of 1 year in 1956, out of 372 live births. On page 17 will be found an analysis of the causes of death. During the year, the care of the aged and geriatric problems generally occupied a considerable proportion of the time of the department. Home helps and district nurses were provided for many old people who otherwise would have had to be admitted to institutional care. The home help service was particularly pressed during the year, and the number of equivalent full-time home helps employed reached the highest figure yet recorded in the district. The work of the W.V.S. was again beyond praise, and under the able guidance of Mrs. O. L. Wiles, a close liaison continued to operate to the great advantage of old and necessitous sick alike. A few old persons, who required institutional care were dealt with by the geriatric department of St. Helier Hospital, and close co-operation with the hospital was maintained throughout the year. The year under review was exceptionally light in the notification of infectious diseases generally. The table on page 40 sets out the incidence of the various diseases. The principal reduction was in the number of cases of measles. The year 1956 was not a measles year, and only 81 cases were notified, as compared with 659 in 1955. The incidence of scarlet fever was about average, but that of whooping-cough was quite low, only 25 cases being notified. 9 This reducing figure for whooping-cough may be the result of the growing number of parents availing themselves of whooping-cough vaccination. If a sufficient number of parents accept this vaccination, especially during the first year of the infant's life, it may be possible to reduce the incidence of whooping-cough to negligible proportions, as has been done in the case of diphtheria. Two cases of poliomyelitis were notified, one of whom, a young adult, died in hospital. This patient had acquired the disease whilst on holiday on the Continent, and succumbed almost immediately on his return home. The year was memorable for the introduction, for the first time in this country, of anti-poliomyelitis vaccination. The Minister of Health announced his scheme in January, and registrations of children in the 1947-1954 age-groups were commenced in March. Of those eligible, 39 per cent (1,307 children) accepted vaccination, and at the end of the year, 104 children had been vaccinated with the material made available by the Minister, and a further 16 had received the first injection. It is too early yet to give an estimate of what the final effects of vaccination are likely to be, but there is every indication that the proportion of cases of poliomyelitis amongst vaccinated children is small by comparison with the unvaccinated. There were no cases of serious illness associated with the vaccination. Most children took the injections in their stride and thought no more about it. Amongst deaths due to infectious diseases, it is necessary to refer to a death accredited to diphtheria. The circumstances of the case are as follows. At the time of his death, the patient, a male, was aged 46, and he died from chronic nephritis leading to uraemia and malignant hypertension. It is understood, however, that the deceased's condition was due to an attack of diphtheria in childhood, and so, in the ultimate sense, the Registrar-General thought this was the cause of death. This explanation is necessary, since, as the Corporation are well aware, no case of diphtheria has occurred in the district since 1948. No cases of food poisoning were notified during the year, but there were 19 cases of dysentery notified to the department. These cases were of a mild character associated with an infection known as sonne dysentery. Outbreaks of this disease appear from time to time in the Greater London area, and the district was fortunate in not having more cases, as the disease was epidemic in some neighbouring areas towards the end of 1955 and the beginning of 1956. The Chief Public Health Inspector and his assistants continued an active campaign to ensure compliance with the 1955 Food Hygiene Regulations, and during the year a total of 937 visits was paid to premises in the Borough where food is prepared or served. It was found on visiting that few of the premises entirely satisfied the requirements of the Regulations. By the end of the year, all food premises had been inspected, and the proprietors notified of different ways in which they fell short of the required standard. It was also possible to institute follow-up inspections, in an endeavour to ensure compliance. 10 Only 3 deaths of tuberculous patients occurred during the year, and notifications of new cases were reasonably low at 22. The Mass Radiography Unit visited the town in June and July, and this probably accounts for the slight increase in the numbers of new cases discovered. The Regional Hospital Board supplied the following figures, which indicate a very good response from the population. Male Female Total Total number examined 1,435 1,920 3,355 B.C.G. vaccination amongst school children was continued. This scheme for the prevention of tuberculosis in young adolescents is of too recent origin for any conclusions to be drawn from comprehensive data. It is generally felt, however, by those best qualified to speak, that in due course the incidence will show a marked decline. It is gratifying to record that once again the year was one in which the general health of the population was maintained at a high level. Facilities for swimming in the bath at the Carew Manor School were again provided, and although the season was at times inclement and had an adverse effect upon attendances, considerable pleasure was derived from this provision. The administrative arrangements continued to be, as heretofore, in the hands of the Public Health Department, financial arrangements being concluded with the Surrey County Council. The conditions under which the Chief Public Health Inspector's department operated were much improved by the provision of a new van for the exclusive use of the department, and the combined appointment of driver/assistant to the inspectors enabled a considerable expansion in the work of the department to take place. Two Public Health Inspectors in addition to the Chief Inspector were employed throughout the year, one being a locum tenent to take the place of one inspector, who returned to duty, after a long illness, in October. 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, 1957. Medical Officer of Health. 11 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 3,048 Population, census, 1931 26,249 Population, census, 1951 32,751 Registrar-General's estimate of resident population for 1956 32,540 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1956 10,078 Rateable Value £643,354 Sum represented by penny rate £2,525 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 character 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. 12 EXTRACTS FROM VITAL STATISTICS Total M F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 362 183 179 11.43 (Crude) „ „ Illegitimate 10 6 4 12.12 (Corrected) Total 372 189 183 Still Births 6 5 1 Rate per 1,000 total (live and still) births) 15.87 Deaths 353 186 167 Death Rate per 1,000 of the estimated resident population 10.85 (Crude) 10.52 (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 18.82 Legitimate Infants per 1,000 legitimate live births 19.34 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) .. 77 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea, etc. (under two years of age) Nil 13 Comparative birth rates, civilian death rates, analysis of mortality, and case rates for certain infectious diseases in 1956: 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 15.6 11.7 22.9 0.56 23.8 0.00 0.00 0.01 0.06 0.52 0.12 0.41 160 County Boro's and Great Towns 15.6 11.6 23.0 — 24.0 0.00 0.00 0.00 0.04 0.57 0.14 0.47 160 Smaller Towns Resident population 25,000 to 50,000 at 1951 Census 15.6 116 22.7 — 24.1 0.00 0.00 0.00 0.05 0.45 0.11 0.39 Beddington and Wallington 12.12 10.52 15.87 0.00 18.82 0.00 0.03 0.03 0.03 0.25 0.09 0.31 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1956: Causes of Death Males Females Total All Causes 186 167 353 1. Tuberculosis, respiratory 3 — 3 2. Tuberculosis, other — — – 3. Syphilitic disease 2 1 3 4. Diphtheria 1 — 1 5. Whooping Cough — — — 6. Meningococcal infections — — — 7. Acute poliomyelitis 1 — 1 8 Measles — — — 9. Other infective and parasitic diseases — 1 1 10 Malignant neoplasm, stomach 6 3 9 11. Malignant neoplasm, lung, bronchus 9 1 10 12. Malignant neoplasm, breast.. — 8 8 13. Malignant neoplasm, uterus.. — 6 6 14. Other malignant and lymphatic neoplasms 22 22 44 15. Leukaemia, aleukaemia 3 1 4 16. Diabetes I — 1 17. Vascular lesions of nervous system.. 29 26 55 18. Coronary disease, angina 34 20 54 19. Hypertension with heart disease 5 3 8 20. Other heart diseases 27 33 60 21. Other circulatory diseases 6 6 12 22. Influenza — 1 1 23 Pneumonia 5 3 8 24. Bronchitis 13 9 22 25. Other diseases of respiratory system — 1 1 26. Ulcer of stomach and duodenum — 1 1 27. Gastritis, enteritis and diarrhoea 1 — 1 28. Nephritis and nephrosis 4 — 4 29. Hyperplasia of prostate 3 — 3 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 1 1 2 32. Other defined and ill-defined diseases 4 14 18 33. Motor vehicle accidents 2 2 4 34 All other accidents 1 3 4 35. Suicide 3 1 4 36. Homicide and operations of war – – – 15 The following table shows the principal causes of death with the rate per cent, of total deaths: Cause of Death Number of Deaths Rate per cent, of Total Deaths Heart Disease 122 34.56 Other Diseases of the Circulatory System 12 3.40 Vascular Lesions of Nervous System 55 15.58 Cancer 77 21.81 Bronchitis 22 6.23 Pneumonia 8 2.27 Tuberculosis (All Forms) 3 0.85 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 3 1 4 Other Violent Causes 3 5 8 Totals 6 6 12 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 0-56. INFANTILE MORTALITY The infantile mortality rate for 1956 was 18-82 per 1,000 live births. The comparable rate for England and Wales is 23 -8. Great credit is due to the services operated in the Borough for the care of mothers and young children, which have made the attainment of such a low rate possible. Of the total of 372 live births, only 7 deaths of infants under one year of age (5 males and 2 females) were registered. Four of the deaths (3 males and 1 female) occurred within the first four weeks of life. 16 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 2 hours F Prematurity 2 days M Prematurity 2 days M Cerebral haemorrhage 15 days M Broncho-pneumonia 1 month F. Congenital Morbus Cordis 4 months M Broncho-pneumonia 9 months F Congenital Morbus Cordis 17 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA LABORATORY FACILITIES The Corporation's arrangements for the examination of swabs, sputa and other pathological material continue as heretofore. During 1956, 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 971 cases, including 88 maternity and midwifery patients. A total of 22,053 visits was made. 18 TREATMENT CENTRES AND CLINICS Care of Mothers and Young Children Child Welfare Centres When held Hackbridge Centre, Every Monday, 2.0-4.0 p.m. The Grange, London Road. Bandon Hill Centre, Every Tuesday, 2.0-4.0 p.m. Methodist Hall, Sandy Lane North. Beddington Centre, 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 Every Thursday, 2.0-4.0 p.m. Post-natal Clinic, 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. 19 Immunisation Against Diphtheria Four clinics are held weekly to give immunisation against diphtheria. These are held at each of the three Infant Welfare Centres and at the Medical Officer of Health's Department at the Town Hall. The following table gives the number of children residing in the Borough who were 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., 1956 1,760 4,640 6,400 Number of children known to be immunised at 31st Dec., 1956 1,086 4,404 5,490 Percentage of children immunised 61.7 94.9 85.8 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, 376 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. Poliomyelitis Vaccination As mentioned in the preface to the report, the poliomyelitis vaccination scheme was introduced in January, 1956. A propaganda drive and the distribution of consent forms was undertaken by the department, and of an estimated child population of 3,350 in the eligible age-groups 1947 to 1954, acceptances were received for 1,307, being a percentage of 39. 20 With the vaccine made available by the Ministry of Health, by the end of the year 104 children had received two injections and thus completed the coarse, while a further 16 children had received one injection, and were awaiting the second in 1957. No cases of illness associated with the vaccination were recorded, and it can confidently be expected that in future years, the acceptances will be much higher. School Clinics With the coming into operation of the 1944 Education Act, the Medical Officer of Health was appointed in September, 1945, Divisional Medical Officer for the Beddington and Wallington half of the MidEastern Divisional Executive of the County of Surrey. School clinics continue to be conducted at The Grange Mansion, Wallington, Rochester Road and Phoenix Flats, Carshalton The services provided at these clinics are now general medical inspection and treatment, dental treatment, speech therapy and physiotherapy. 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 1956 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 Public Health 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 no treatments were carried out at the Cleansing Stations. 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. 21 Smallpox. The Regional Hospital Board have made arrangements for the admission of cases of smallpox to their hospital at Joyce Green, Dartford. General and Accident Cases. Cases from this area are admitted to: Carshalton, Beddington and Wallington District (War Memorial) Hospital. St. Helier Hospital, Carshalton. Croydon General Hospital. The Wilson Hospital, Mitcham. Maternity Cases. The Regional Hospital Board continue the provision at St. Helier Hospital for maternity cases in the Borough requiring institutional confinements. Some patients continue to be admitted to the Carshalton, Beddington and Wallington (War Memorial) Hospital under arrangements made by their practitioners under the National Health Service Act, 1946. 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 38 samples of water were examined by the Public Analyst or the Public Health Laboratory Service. 22 From the reports the water supply is shown to be satisfactory both in chemical and bacteriological purity, and no cases of illness associated with pollution of water supplies were recorded during the year. The chlorination of water from private wells situated in industrial premises was continued throughout the year. DRAINAGE AND SEWERAGE During the year the sewers have been systematically cleaned and flushed. No major difficulties were experienced in the maintenance and cleansing of soil and storm water drainage systems during the year. RIVERS AND STREAMS Normal cleansing of the River Wandle was carried out. 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 Public Health Inspector gives statistics as to the number of complaints received, inspections made, defects remedied, and other work carried out by the Public Health Inspectors. 23 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR FOR THE YEAR, 1956 HOUSING Two hundred and eighty houses were rendered fit as a result of informal or statutory action under the Public Health Act, 1936. Three applications were received for Certificates of Disrepair (Housing Repairs & Rents Act, 1954). Three certificates were issued. Number of inspections of dwelling-houses 491 Number of inspections recorded under Housing Regulations .. 10 MILK AND DAIRIES Number of distributors of milk on register 18 Number of milk depots other than dairy farms on register 3 Number of above premises upon which loose milk is handled Nil Number of inspections of premises 31 Defects in premises 3 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-three 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 60 58 2 60 — — — T.T. Pasteurized 25 24 1 25 — — — Sterilized 5 — — — — 5 — Tuberculin Tested (Farm Bottled) 3 3 –– – – – – 24 CHEMICAL ANALYSES OF MILK Thirty-nine samples of milk were submitted to the Public Analyst. All were reported genuine. The average composition was as follows: Fat % 3.87 Solids-not-fat % 8.75 Total Solids % 12.62 ICE CREAM Number of premises registered for the sale of ice cream 90 Number of manufacturers Nil Number of inspections of premises 93 Twenty-nine samples of ice cream were procured and submitted for bacteriological examination. The results are set out in the following table:— Type No. of Samples Methylene Blue Test Grade 1 Grade 2 Grade 3 Grade 4 Ice cream 29 28 1 — — CHEMICAL ANALYSES OF ICE CREAM Three samples of ice cream were submitted for analysis. All complied with the standard. The fat content of the samples varied between 10.0% and 14.4%. SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 937 Total number of defects or contraventions 688 FOOD PREMISES IN THE DISTRICT Bakers 16 Butchers 24 Catering Establishments 64 Chemists 12 Confectioners (sweets) 39 Fishmongers (including friers) 10 Greengrocers 26 Grocers 68 Licensed Premises 13 Bakehouses 6 Food Factories 3 25 FOOD PREMISES REGISTERED UNDER SECTION 16 OF THE FOOD & DRUGS ACT, 1955 Sausage manufacturers 29 Fish friers Jam manufacturers Ice cream (sale only) Ice cream (manufacture and sale) 7 1 90 3 FOOD AND DRUGS ACT, 1955 FOOD HYGIENE REGULATIONS, 1955 During 1956 the emphasis, so far as the Public Health Inspectors' work was concerned, was on education with a view to securing compliance with the Food Hygiene Regulations. Prior to the Regulations coming fully into force, a start was made on visiting, by appointment, the food premises in the Borough to discuss with the person in charge and his staff the requirements as they affected the particular business or premises. This approach has been generally appreciated and it is felt that considerable improvements will be effected without the necessity for enforcement action. Few of the food premises entirely satisfied the requirements of the Regulations. Details of those matters by which they fell short have been communicated to the occupiers concerned. By the end of the year the inspection of food premises had been completed and a start made on follow-up action. The table on page 27 gives the number and type of premises inspected and the contraventions revealed UNSOUND FOOD Destroyed or released for animal feeding:— lbs. Cheese 30 Confectionery 13 Dried Frozen Egg 93 Fish, canned 12 Fish 42 Flour 7 Fruit, canned 199 Ham, canned 143 Meat and Offal 358 Meat, canned 304 Milk, canned 23 Preserves 8 Vegetables, canned 78 Total 1310 SAMPLING. 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 Surrev Countv Council. Dr. H. Amphlett Williams, Ph.D.QLond.), A.C.G.F.C., F.R.I.C., of 1 Southwark Street, London, S.E.1, is Public Analyst for the Borough. 26  Bakers Shops Confectioners & ice cream Grocers and General Stores Bakehouses Butchers Fishmongers and Friers Greengrocers Caterers Works Canteens, etc. Hotels and Public Houses Milk Depots Food Factories Totals No. inspected 16 39 68 6 24 10 26 26 30 8 3 3 259 Contraventions relating to: Reg. 6 Fittings and Equipment — — 14 2 10 — - 16 3 — — 1 46 Containers 1 1 4 - 2 — — 1 — — — — 9 Reg. 8 Protection of Food 4 — 10 — 1 — 5 4 — — — 1 25 External food displays 1 — 2 — — — 4 — — — 2 — 9 Reg. 9 Personal cleanliness — — 1 — — — — 1 — — — — 2 Use of Tobacco — — 1 — — — 1 3 — — — — 5 Reg. 12 Drainage — — 3 — — 1 2 6 — 1 — 1 14 Reg. 14 Sanitary accommodation 1 4 5 — 3 1 6 11 — 1 — — 32 Lighting of 2 2 9 1 4 1 — 2 2 1 — — 24 Notices 1 2 4 1 1 — 2 5 — — — — 16 Ventilation (vent spaces) 1 — — — — — — 1 — — — — 2 Reg. 15 Water supply 2 1 1 — 2 — — 1 — — — — 7 16 Ablution facilities (wash hand basins and/or constant hot water 3 15 27 4 14 — 9 22 7 — — 2 103 Reg. 17 First-aid equipment 1 1 11 — 8 1 3 4 — — 1 — 30 Reg. 18 Accommodation for clothing 1 3 11 1 6 — 4 14 2 — — — 42 Reg. 19 Sinks (incl. hot water) 3 5 12 — 11 — 6 8 3 — — — 48 tog. 20- 21 Light and ventilation — — 2 — - — — — — — — — 2 tog. 22 Sleeping rooms — — — — — — 1 — — — — — 1 Reg. 23 Premises Cleanliness — 1 5 — 5 1 6 10 5 — — 2 35 Decoration 3 2 17 2 11 2 7 13 8 — — — 65 Repair 3 8 19 1 7 1 7 10 — 1 — — 57 Suitable surfaces 2 3 10 — 5 — — 11 3 — — — 34 tog. 24 Accumulations of refuse — — 2 — 1 — 2 1 — — — 1 7 Dustbins (Bye Laws) — 2 6 1 3 1 6 8 — 1 — 1 29 Reg. 29 Control of temperature — — 3 - — — 1 3 1 — — — 8 Other unsatisfactory conditions .. — 3 10 — 2 1 4 4 3 — — — 27 Unsanitary premises — — 2 — 1 1 — 5 — - — — 9 Totals 29 53 191 13 97 11 76 164 37 5 3 9 688 27 UNSATISFACTORY SAMPLES Informal Sample No. 21—Baked Beans (canned) The sample, submitted as a result of a complaint, contained the remains of a disintegrated cigarette end, distributed throughout the beans. Complainant not willing to give evidence. Warning letter sent to manufacturer. Informal Sample No. 23 Formal Sample No. 45 —Lung Syrup Samples showed deficiency in the chloroform content as stated on label. Letter sent to manufacturers who are endeavouring to prevent loss of chloroform by diffusion through closure. Informal Sample No. 28—Wholemeal self-raising flour The sample, submitted as a result of a complaint, contained 122 mouse droppings, 11 live larvae of a species of ephestia, a small number of mites, a quantity of insect webbing and droppings, and was 75 per cent deficient in available carbon dioxide. Vendor prosecuted. Fined £10. £4 18s. costs. Informal Sample No. 39—Milk Chocolate Drops The sample contained vegetable fat not derived from cocoa beans and no appreciable amount of milk fat. Formal sample obtained which satisfied requirements. Correct name for the confection is Fairy Drops. Informal Sample No. 76—Bread The sample, submitted as a result of a complaint, was contaminated by mineral oil. Complainant not willing to give evidence. Warning letter sent to manufacturer. Informal Sample No. 80—Bread The sample, submitted as a result of a complaint, contained a torn piece of thick blue paper embedded in the loaf. Complainant not willing to give evidence. Warning letter sent to manufacturer. 28 FOOD ANALYSES The following table gives details of samples submitted for analysis during the year: Totals 1956 Articles No. Examined Adulterated Prosecu tions Convic tions Formal. Informal Total Formal Informal Total Almonds 1 1 - - - - - Baking Powder — 1 1 - - - - - Beer 1 — 1 - - - - - Brandy 1 — 1 - - - - - Bread 1 3 4 — 2 2 — — Butter 1 — 1 - - - - - Cheese 1 — 1 - - - - - Chocolate cakes 1 — 1 - - - - - -Chocolate milk — 1 1 - - - - - Chocolate spread — 1 1 - - - - - Confectionery: sugar 2 4 6 — 1 1 — — Cream — 2 2 Curry powder 1 — 1 — — — — — Drink: soft orange 4 — 4 - - - - - Flavouring essence — 1 1 - - - - - Flour: self-raising 1 1 2 — 1 1 1 1 Gin 1 — 1 - - - - - Honey — 1 1 - - - - - Ice cream 3 — 3 - - - - - Ice lolly — 2 2 - - - - - Jelly tablets — 3 3 - - - - - Lemonade powder 1 — 1 - - - - - Lung syrup 1 1 2 1 1 2 — — Margarine 1 — 1 - - - - - -Meat products 1 1 2 - - - - - -Meat, minced 1 — 1 - - - - - Milk 27 12 39 - - - - - Mustard 1 - 1 - - - - - Peanut butter — 1 1 - - - - - Pepper 1 — 1 — — — — — Rice, canned 1 1 2 - - - - - -Rum 1 — 1 - - - - - Salad cream 1 — 1 - - - - - Sauce (horseradish) — 1 ] - - - - - Sausages 4 — 4 - - - - - Tomatoes - 2 2 — 1 1 — — Treacle — 1 1 - - - - - Vinegar 1 — 1 - - - - - Whisky 1 — 1 - - - - - Wine, alcoholic — 1 1 - - - - - Total 61 42 103 1 6 7 1 1 29 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 Public Health 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 1 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 133 120 17 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) .. Total 143 130 18 — Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sect. 110 (1) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Making of wearing apparel - - - - - - Stuffed toys 7 — — — — - Cosaques, Christmas crackers,Christmas stockings, etc. - — — - Total .. 7 — — — — — 30 Cases in which Defects were found: Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 3 4 1 - - Overcrowding (S.2) — — — - - Unreasonable temperature (S.3) - - Inadequate ventilation (S.4) 1 3 - Ineffective drainage of floors (S.6) 3 - Sanitary conveniences (S.7): (a) Insufficient 1 3 - - - (b) Unsuitable or defective 17 22 - - - (c) Not separate for sexes 1 1 - - - Other offences against the Act (not including offences relating to Outwork) - - 1 - - Total 23 36 2 — — BAKEHOUSES Number of bakehouses in district 6 Number of inspections 24 WORKPLACES, SHOPS AND OFFICES Number of inspections 235 Notices served 12 31 COMPLAINTS The number of complaints received shewed an increase of 137 over the previous year and were due to the following causes: Rats and Mice 185 Housing defects 153 Choked drains and sewers 94 Defective dustbins 138 Defective drainage (including closets) 34 Unsound or adulterated food 46 Atmospheric Pollution 29 Insect pests 40 Offensive accumulations 14 Miscellaneous 65 798 SMOKE ABATEMENT Number of observations 349 Nuisances observed 7 INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 153 Number of rooms disinfected 55 Number of library books disinfected 300 OFFENSIVE TRADES Number of offensive trade premises in district Nil Prevention of Damage by Pests Act, 1949 Report for 12 months ending 31st December, 1956 Type of Property Local Authority Dwelling Houses Business (& other premises) Total Agricultural Number of Properties in Local Authority's district 37 10,009 1,259 11,305 33 Number of inspections as a result of: (a) Notification 4 142 34 180 (b) Survey under the Act 231 282 127 640 33 (c) Primarily for some other purpose 20 654 1,401 2,075 46 Total Inspections (including reinspections) — — — 3,694 79 Properties found to shew major rat infestations — — — — — Properties found to shew minor rat infestations 14 162 31 207 — Properties found to shew major mice infestations — — — — — Properties found to shew minor mice infestations — 12 21 33 — Total Infestations 14 174 50 238 — 32 SEWER RAT CONTROL Following a ten per cent. test of sewer manholes in July, two maintenance treatments were carried out, one in August and one in December. The results are summarised below: August Treatment December Treatment Manholes baited 248 247 Manholes in which takes were recorded 111 93 Percentage of manholes showing infestations 45 38 NOTICES Number of informal notices served (including verbal intimations) 503 Number of statutory notices served Public Health Act, 1936—Section 93 (Nuisances) 23 —Section 39 (Drainage) 3 —Section 45 (Water closets) 2 —Section 75 (Dustbins) 8 — 36 SANITARY IMPROVEMENTS (1) Dwelling Houses Brickwork repaired or repointed 14 Ceilings— Repaired, renewed or cleansed 32 Chimneys— (a) Stacks and flues repaired 10 (b) Cowls provided 2 Dampness remedied— (a) Roofs repaired 65 (b) Walls rendered 70 (c) (i) Damp-proof course inserted 2 id) (ii) Steps repaired 2 (e) Gutters and rainwater pipes repaired and unstopped 70 Doors—repaired or renewed 13 Drainage— (a) Obstructions cleared 9 (b) Repaired and relaid 10 (c) Inspection chambers provided and repaired 5 (d) Inspection chamber covers provided 3 (e) F.A.I, provided, etc 7 (/) Soil-vent, pipes provided, repaired or renewed 5 (g) Waste-pipes repaired and renewed 9 (,h) Soakaways provided, repaired or renewed 1 (/') Rodding-eye stopper replaced 2 33 Dustbins provided 44 Fireplaces and stoves repaired or renewed 9 Floors— (a) Repaired or renewed 17 (b) Ventilation provided or improved 11 Food storage provided or improved Sinks renewed, etc. 5 Stairs— (a) Repaired or renewed 5 lb) Handrails provided 2 Walls— (a) Repaired or rebuilt 16 (b) Plaster repaired and redecorated 46 Water supply— Pipes repaired or renewed 5 W.C. Accommodation— (a) Structure repaired 5 (b) Cisterns repaired or renewed 7 (c) Flush pipe joint repaired (d) Pans provided or replaced 8 (e) Seats repaired or renewed 6 Windows— (a) Frames and sashes repaired or renewed 31 (b) Sashcords and beading renewed 35 (c) Glazing and putties renewed 25 (d) Cills repaired 11 Yard paving repaired or renewed 4 (2) Factories Cleansed 4 Sanitary Accommodation— Ventilated space provided 2 (3) Food Premises Structural defects remedied 4 Cleansing of walls, floors, ceilings, etc 12 Refuse accommodation provided 5 Yards— (a) Repaired 4 (b) Accumulation removed 1 Washing Accommodation— (a) Hot water provided 3 \b) Wash basins provided 3 W.C. accommodation cleansed, repaired, etc. 15 34 (4) Other Nuisances Accumulations removed 5 Nuisance from animals and insects abated 4 (5) Shops Heating provided or improved 1 Sanitary accommodation provided 5 Washing accommodation provided 15 Defective structure, walls, floors 17 Ceilings, etc., repaired and redecorated 14 Seats provided 3 SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 501 Number of re-inspections of premises 1,225 Number of visits to work in progress 227 Number of miscellaneous visits and inspections 736 Number of visits to schools 19 Number of visits to food premises 937 Number of visits to factories 130 Number of visits to shops, offices and workplaces 235 Number of visits to watercress beds, smallholdings, etc. 46 Number of inspections of public conveniences 113 Number of visits to piggeries 7 Number of visits re infectious diseases 153 Number of visits re insect pests 55 Number of inspections and visits re rats 3,773 Number of visits to streams 65 Number of visits re smoke abatement 349 Number of inspections of swimming bath 25 Number of complaints received and investigated 798 Number of informal notices served 503 Number of statutory notices served 36 Number of interviews re nuisances, etc. 401 Number of drain tests applied 119 Number of rooms disinfected 53 Number of lots of bedding and clothing disinfected 55 Number of library books disinfected 300 Number of samples of foodstuffs, water, etc., taken for examination 280 H. G. CRIPPS, Chief Public Health Inspector. 35 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1956 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 2,050 School children 6,344 Season Ticket Holders, etc.: Adults 10,450 Children 2,710 Total 21,554 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. 36 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. 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. 37 ADOPTIVE ACTS AND BYE-LAWS The following Acts have been adopted: Public Health Acts (Amendment) Act, 1890, Parts I, II and III. Public Health Acts (Amendment) Act, 1907, Parts I to VI and VIII to X. Private Street Works Act, 1892. Public Health Act, 1925. Public Libraries Acts, 1892-1919. Small Dwellings Acquisition Acts, 1899-1923. Bye-laws in respect to the following are in force: Advertisements. Allotment Gardens. Animals, The Keeping of. Buildings. Clean Handling of Food. Fish-frying and Offensive Trades. Good Rule and Government. House Refuse, etc., Removal. Houses Let in Lodgings. Houses of the Working Classes. New Streets. Nuisances. Offensive or Noxious Matter. Parking Place off Woodcote Road. Pleasure Grounds. Public Sanitary Conveniences. Slaughterhouses. Slot Machine Sale of Contraceptives. Smoke Abatement. Tents, Vans, Sheds, etc. Underground Rooms. 38 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease in the Borough in 1956, the number of cases removed to hospital and the number of deaths attributed to these diseases, excluding Tuberculosis: Disease Number Notified Removed to Hospital f Deaths Scarlet Fever 42 15 - Measles 81 — — Whooping Cough 25 3 — Erysipelas 4 — — Pneumonia 13 1 8* Dysentery 19 4 — Poliomyelitis— Paralytic 2 2 1 Non-paralytic — — — Meningococcal Meningitis 1 — — Puerperal Pyrexia 2 — — Paratyphoid Fever 1 1 — Totals 190 26 9* * 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 1956 (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 42 3 4 24 8 3 8 5 1 - 15 7 6 15 — Measles 81 1 11 13 53 2 1 - 5 6 7 32 18 2 11 — — Whooping Cough 25 1 6 6 11 1 - - - - - 5 3 5 1 5 6 3 — Erysipelas 4 - - - - - - 1 1 2 1 — — — 1 2 — — — Pneumonia 13 - - 1 1 1 - 4 6 3 2 3 1 — 2 2 1 8* Dysentery 19 - 2 2 10 1 3 1 — — 3 4 — 2 7 3 — 4 — Poliomyelitis— Paralytic 2 - - - 1 - - 1 - - - - - 1 1 - - 2 1 Non-paralytic - - - - - - - - - - - - - - - - - - - Meningococcal Meningitis 1 - - - - - - - 1 - - - - 1 - - - - - Puerperal Pyrexia 2 - - - - - - 2 - - - - 1 - 1 - - - - Paratyphoid Fever 1 - 1 - - - - - - - - - 1 - - - - 1 - Totals 190 2 23 25 100 13 8 5 6 8 20 22 16 42 44 21 25 26 9 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, 1956 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 11 5 9 2 4 3 1 — 1 5 1 — 42 Measles — 1 2 2 1 3 1 3 1 1 6 60 81 Whooping Cough — 1 — — 2 7 — 5 5 1 4 — 25 Erysipelas — — — — 1 1 1 - — — 1 — 4 Pneumonia — — 3 2 — 1 — 1 — 1 1 4 13 Dysentery — — — — — 2 1 - — — 8 8 19 Poliomyelitis— Paralytic - - 1 - - - - 1 - - - - 2 Non-Paralytic - - - - - - - - - - - - Meningococcal Meningitis — - - - - 1 - - - - - - 1 Puerperal Pyrexia - - - 1 - - - - 1 - - - 2 Paratyphoid B Fever 1 - - - - - - - - - - - 1 Totals 12 7 15 7 8 18 4 10 8 8 21 72 190 41 Tuberculosis There were 22 new cases notified during the year, this being an increase of 9 on the number of cases notified in 1955. The following table gives the number of new cases notified during the past five years: New Cases 1952 1953 1954 1955 1956 M. F. M. F. M. F. M. F. M. F. Pulmonary 23 12 16 12 8 8 9 3 17 5 Non-Pulmonary 1 2 1 1 — — — 1 — — Totals 24 14 17 13 8 8 9 4 17 5 Annual case rate per 1,000 of the estimated population: 1952 1953 1954 1955 1956 Pulmonary 1.08 0.86 0.50 0.37 0.68 Non-pulmonary 0 09 0.06 0.00 0.03 0.00 The following table gives the number of deaths from this disease during the past five years: Deaths 1952 1953 1954 1955 1956 M. F. M. F. M. F. M. F. M. F. Pulmonary 4 3 6 - 4 1 4 — 3 — Non-Pulmonary — — 1 1 — 1 — — — — Totals 4 3 7 1 4 2 4 — 3 — It will be seen from the foregoing table that 3 Tuberculous patients died during the year, this being a decrease of one on the corresponding figure for the previous year. The figures correspond to a death rate per 1,000 of population of 0 09. The following table, compiled from local records, shows the number of new cases of Tuberculosis notified during the year, together with the deaths at various age periods: 42 Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1 to 2 years — — — — — — — — 3 to 4 years — — — — — — — — 5 to 9 years — — — — — — — — 10 to 14 years — — — — — — — — 15 to 24 years 6 1 — — — — — — 25 to 44 years 5 4 — — — — 1 — 45 to 64 years 5 — — — — — 1 — 65 and over 1 — — — — — 1 — Totals 17 5 — — — — 3 — The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 3 1 4 5 3 4 2 Non-Pulmonary - - - - - - - Totals 3 1 4 5 3 4 2 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 1956. 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. 43 Mass Radiography. The Mass Radiography unit visited the Borough from the 18th June to 6th July. 1956. The survey was well attended and the following is a summary of the work carried out. Male Female Total number examined 1,435 1,920 Pulmonary Tuberculosis, Active 1 1 Pulmonary Tuberculosis, Inactive 58 92 Non-Tuberculosis abnormalities 53 52 Not yet diagnosed—further investigations required 19 8 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, 100 women made 384 pre-natal attendances. This represents an attendance of 26.5 per cent. of the total number of confinements which occurred during 1956. Post-natal examinations were also conducted at this clinic, 7 patients making 7 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 was ccmparable with those of previous years. Number attending Total attendances Children under 1 year 329 4,804 Children, 1-5 years 784 3,333 Total attendances 1,113 8,137 Institutional Confinements. Two hundred and ninety four or 77.8 per cent. of births allocated to this district, took place in hospitals and nursing homes, compared with 82.6 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 44 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. Close liaison was kept up with the almoners of hospitals, and it was found possible to meet the many requests received for tuberculous patients and the care of the aged under the St. Helier Hospital geriatric service. The cases attended were as follows: Total Maternity 38 Chronic Sick (including aged and infirm) 178 Acute Sick 50 Tuberculosis 3 269 Treatment. Minor Ailments. Forty 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 14 Tonsils and adenoids 3 Orthopaedic defects 4 Ncevi 3 Circumcisions 8 Hernia 1 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 New Cases Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant Mothers 7 3 29 - - - Nursing Mothers 11 10 28 1 5 2 Children, 0-5 49 63 119 — — — Totals 67 76 176 1 5 2 45 Orthopsedic. 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 1956, 4 cases were referred for treatment. 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 1,713 632 Children, 5-15 years 1,744 3,048 Expectant and Nursing Mothers 35 296 3,492 3,976 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 175 293 Children, 0-1 year 385 1,981 Children, 1-5 years 11 3,287 Other Cases — 55 Ineffectual — 970 571 6,586 Child Life Protection. This function is now governed by the Children Act, 1948, which came into operation on the 5th July, 1948. A Children's Officer is appointed by the Surrey County Council to supervise all children coming within the provisions of the Act. The health visitors, however, visit on behalf of the Children's Officer deprived children under 5 years of age and certain other children in registered residential establishments. 46 Care of Premature Infants. The arrangements made for the care of premature infants continued during 1956. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Nineteen premature live births were notified during the year, all of which occurred in hospital. Two of the infants died within 48 hours of birth. The remaining 17 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. 47 B. JOHNSON, Printer, 11, Manor Road, Wallington. B. JOHNSON, Printer, 11, Manor Road, Wallington.