BED 22. BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1957 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1957 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., 1957 13 Registered Causes of Death 14 Violence and Accident 15 Maternal Mortality 15 Infantile Mortality 15 General Provision of Health Services for the Area: (Including Transferred Functions under the National Health Service Act, 1946). Nursing in the Home 17 Domestic Help Service 17 Care of Mothers and Young Children 17 Immunisation and Vaccination 22 School Clinics 23 Venereal Diseases 23 Cleansing of Persons 23 Laboratory Facilities 23 Hospitals 24 Ambulance Facilities 24 Disinfection 24 Sanitary Circumstances of the Area: Water Supplies 24 Drainage and Sewerage 25 Rivers and Streams 25 Closet Accommodation 25 Public Cleansing 25 3 Report of the Chief Public Health Inspector for the Year 1957 : Housing 26 Milk and Dairies 26 Ice Cream 27 Slaughterhouses 28 Food Premises 28 Food and Drugs Act, 1955 28 Unsound Food 29 Unsatisfactory Samples 31 Factories Act, 1937 32 Bakehouses 33 Workplaces, Shops and Offices 33 Complaints 34 Smoke Abatement 34 Infectious Disease and Disinfection 34 Offensive Trades 34 Rats and Mice 35 Notices 36 Sanitary Improvements 36 Summary of work done during the year 38 Swimming Bath 39 Schools 39 Outbreaks of Food Poisoning and Clean Food Campaign 40 Nutrition 40 Shell Fish (Molluscan) 40 Adoptive Acts and Bye-Laws 41 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 42 Incidence of Infectious Diseases in Age Groups and Wards 43 Monthly Incidence of Infectious Disease 44 Tuberculosis 45 4 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITTEE December, 1957 Members: Alderman D. H. de Voil (Chairman) Councillor T. G. Wakley (Mayor) Councillor F. G. Lee (Deputy Mayor) Councillor Mrs. H. Bridger Councillor W. E. Dellow Councillor S. J. Dunwoodie Councillor A. G. Gref.nhead Councillor G. J. W. Hellon Councillor J. A. Parker Councillor E. W. Popplestone Councillor H. R. Trost REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1957 Members: Alderman D. H. de Voil Alderman H. Rennison Councillor Mrs. H. Bridger Councillor J. A. Parker Councillor J. L. K. Thurston REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1957 Members: Councillor T. G. Wakley (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) 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.) Assistant to Public Health Inspectors: R. W. Bradstock Clerks: R. F. Burns (Chief Clerk) E. D. Evezard Mrs. S. C. Clements C. I. Phillips (Returned from National Service 16.12.57) P. C. Robinson (Temp.) (Resigned 20.3.57) Miss M. Minihane, (Temp.) (from 9.4.57 to 30.9.57) E. Statter (Temp.) (from 14.10.57 to 31.12.57) 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. 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 Physiotherapists: Mrs. H. M. Henn, M.C.S.P. (Part-time) Mrs. B. Manwaring, M.C.S.P. (Part Time) 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) (Resigned 31.5.57) Mrs. I. M. Kingsley (School Health) (Commenced 20.5.57) Mrs. E. Bass (Part Time) Home Help Supervisor: Mrs. V. Beatt (Part Time) 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 1957. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 1/58. The vital statistics are based on information supplied by the Registrar-General. The report includes those services which are under the control of the Surrey County Council, the Local Health Authority under the National Health Service Act, 1946, under the heading of General Provision of Health Service for the Area. These services are:— Nursing in the Home; Domestic Help Service; Care of Mothers and Young Children ; Immunisation and Vaccination; Ambulance Facilities. The Registrar-General's estimate of the population of Beddington and Wallington at mid-year 1957 is 32,460, and this figure is used in the compilation of the vital statistics. The figure shows a decrease of 80 compared with the Registrar-General's estimate for mid-year 1956. The census of population taken in 1951 was 32,751. The birth rate per 1,000 total population shows an increase at 13.04 in 1957, as compared with 12.12 in 1956. This rate is below that for England and Wales, which is 16.1. The stillbirth rate per 1,000 total births is 9.83, compared with 15.87 in 1956. This is lower than that for England and Wales, which is recorded as 22.5. The number of children stillborn in the district was 4, which is 2 less than the number recorded in 1956, out of a total of 407 births, as compared with 378 in 1956. The death rate from all causes per 1,000 total population is 10.44, compared with 10.52 in 1956, and 11.50 for England and Wales. Of the 353 deaths, diseases of the heart and circulatory system accounted for 106 (30.03 per cent of total deaths), cancer 77 (21.81 per cent of total deaths), and tuberculosis 2 (0.57 per cent of total deaths). Deaths from diseases of the heart and circulatory system again, in 1957, continued to account for a very high proportion of total deaths. There were 45 deaths from coronary disease, 49 from vascular lesions of the nervous system (cerebral haemorrhage), and 61 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. 7 Four deaths were recorded from motor vehicle accidents, being the same number as in 1956. All other accidents accounted for 3 deaths, compared with 4 in 1956. Suicides totalled 4 cases, compared with 4 in 1956. No mothers died in childbirth during 1957, and this gives a maternal mortality rate per 1,000 total births of nil, as compared with 0.47 for England and Wales. The infantile mortality rate shows a decrease at 9.93 per 1,000 live births, as compared with 18.82 in 1956. Only 4 infants died under the age of 1 year in 1957 out of 403 live births. On page 16 will be found an analysis of the causes of death. Old persons in need of care and attention, fall administratively into two categories:— (1) Those who are ambulant and can do a certain amount for themselves, and for whom the County Council accept responsibility through Part III of the National Assistance Act of 1948, and (2) Those who are so severely incapacitated or generally ill as to require the services of the Regional Hospital Board. Both groups are increasing in numbers, partly owing to increased longevity, and partly owing to the larger number of old persons having no relations to fall back on. Housing difficulties, too, contribute towards making residential accommodation of both kinds necessary. During the year the department worked in close association with the Geriatric Department of St. Helier Hospital, who, through their Geriatric Almoner and Visiting Physician, were able to deal with quite a number of patients requiring hospital admission, and also in close association with the W.V.S. through their most efficient Centre Organiser, Mrs. O. L. Wiles, and also the Senior Divisional Welfare Officer. The latter is responsible for arranging admissions to the County Council's Old People's Homes, and a very effective relationship was maintained throughout the year, which enabled several old people to be accommodated in the County Council's care. The Home Help Service was operated to capacity throughout the year, and we were thus able to keep many people in their homes through giving home help service and nursing attention through the District Nurses, who would otherwise have had to be admitted. With the ever-growing need for attention to old persons living in their own homes, both these services will continue to expand. Mention should be made here of the Meals on Wheels service operated by the W.V.S., with a grant from the Corporation. This service commenced in 1957, cooking being undertaken at British Red Cross House in Woodcote Road, and the meals being delivered, from vehicles loaned by the Borough Council, to the homes of the old and sick requiring them. 8 A special word of thanks is owing to Mrs. Campbell-Little, who, in her W.V.S. capacity, organises a rota of volunteers and supervises the cooking of the meals and the general administration of the service. The incidence of infectious disease during the year was reasonably light, with the exception of measles, which showed a marked increase, there being 426 notified cases, as compared with 81 in 1956. This number is not excessive, for what can be described as a "measles year". There were no deaths from the disease, and only three cases were removed to hospital. Scarlet fever, with 22 cases, was just about half the number notified in 1956. There were 20 cases of pneumonia notified, with only two removals to hospital. There were, however, 17 deaths from all forms of this disease, mostly in old persons. The incidence of whooping cough showed a slight increase. There were 34 cases notified compared with 25 in the previous year. No cases were removed to hospital. It is possible that the continuation of whooping cough vaccination for children below the age of 12 months is beginning to show results. With the present scheme, every endeavour is made to have children immunized against whooping cough before they are six months old. It is generally felt that protection at an early age is of the utmost value in preventing morbidity and mortality from this disease in childhood. One case of paralytic poliomyelitis was notified during the year, this patient being removed to hospital for nursing. The patient, who was an expectant mother, made a very good recovery. The infant, however, was prematurely stillborn. During the year the Government's scheme for poliomyelitis vaccination was continued within the prescribed age groups. These were children born between 1947 and 1954. At the end of the year the Minister extended the service to include children born between 1943 and 1957 and expectant mothers. By the end of the year 1,100 children completed immunization against poliomyelitis. There were, however, 2,417 cases outstanding, whose immunizing procedure was continued into 1958. The general response from the public here was exceptionally good, acceptances reaching a level of 75 %. There were no cases of inconvenience or illness (worth recording) associated with the scheme. It is too early, yet, to say what effect on the incidence of the disease the campaign is having, but from the experience gained in America and elsewhere, considerable reduction in incidence can be confidently expected. For the ninth year there were no cases of diphtheria notified. The immunization against this disease continues to occupy a large place in the work of the department, both in children attending Infant Welfare Centres and Schools in the Borough. 9 One case of food poisoning was notified. The patient was an adult male working in a neighbouring town. Clinically the symptoms were characteristic of food poisoning, but examination of food consumed, and the patients' fomites, did not reveal any pathogenic organism. Only two cases of dysentery were notified, as compared with 19 in 1956. This is a very satisfactory record, as most cases of dysentery are associated with the ingestion of contaminated food, and a reduction in the number of cases notified may indicate a higher standard of food hygiene. In this connection, the Chief Public Health Inspector and his assistants have continued, during the year, to obtain compliance with the 1955 Food Hygiene Regulations. During the year a total of 1,070 visits were paid to premises in the Borough, where food is prepared or served. The general impression is that standards are gradually rising, and proprietors, and indeed all persons handling food, are becoming more conscious of their responsibilities to the general public in this important matter. Two deaths were recorded from tuberculosis, this being a decrease of one on the previous year. Incidence of this disease also showed a reduction, being 16, a decrease of 6 on the number of cases notified in 1956. The drive against tuberculosis through the Mass Radiography Unit and the B.C.G. vaccination of school children, continued with marked success throughout the year. The Mass Radiography Unit visits this district every second year for public sessions, although closed sessions for industrial workers are undertaken more frequently. The next visit is expected in 1958. The response of eligible school children to B.C.G. vaccination was good, at 70%. In all, 231 children were vaccinated. The Council may congratulate themselves on the completion of yet another year without any major epidemic, and with a high general level of health amongst the entire population. 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. 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, 1958. 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 1957 32,460 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1957 10,122 Rateable Value £653,032 Sum represented by penny rate £2,620 The Urban District of Beddington and Wallington was constituted in 1915 by an Order of the Surrey County Council, the area up to that time being part of the Croydon Rural District. By an Order in Council, dated 20th August, 1937, H.M. King George VI granted a charter to Beddington and Wallington, which was presented on the 15th September, 1937, by the Lord Lieutenant of the County of Surrey. The Borough is bounded on the east by the County Borough of Croydon, to the north by the Borough of Mitcham, to the west by the Carshalton Urban District, and to the south by the Urban District of Coulsdon and Purley. The Borough is practically fully developed, but the Council has preserved much of the open character of the area, by the extensive use of its powers in providing parks and open spaces. The area is mainly residential, but there are factories in the Borough, providing employment for some 9,000 people, these being situated mostly in the northern part of the Borough. During recent years there has been considerable residential 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. 11 EXTRACTS FROM VITAL STATISTICS Total M F. Birth Rate per 1,000 of the estimated resident population 12.42 (Crude) 13.04 (Corrected) Live Births—Legitimate 395 208 187 „ Illegitimate 8 3 5 Total 403 211 192 Still Births 4 3 1 Rate per 1,000 total (live and still) births 9.83 Deaths 353 174 179 Death Rate per 1,000 of the estimated resident population 10.87 (Crude) 10.44 (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 9.93 Legitimate Infants per 1,000 legitimate live births 10.13 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 12 13 Comparative birth rates, civilian death rates, analysis of mortality, and case rates for certain infectious diseases in 1957: 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) r of the Lung and Bronchus England and Wales 16.1 11.5 22.5 0.47 23.1 0.00 0.00 0.01 0.15 0.52 0.11 0.43 160 County Boro's and Great Towns 16.1 11.5 22.5 -. 23.5 0.00 0.00 0.00 0.15 0.58 0.12 0.50 160 Smaller Towns Resident population 25,000 to 50,000 at 1951 Census 16. 0 11.4 23.2 .- 23.5 0.00 0.00 0.00 0.15 0.47 0.10 0.40 Beddington and Wallington 13.04 10.44 9.83 0.00 9.93 0.00 0.00 0.00 0.09 0.52 0.06 0.34 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1957: Causes of Death Males Females Total All Causes 174 179 353 1. Tuberculosis, respiratory 1 — 1 2. Tuberculosis, other 1 — 1 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 2 4 6 11. Malignant neoplasm, lung, bronchus 8 3 11 12. Malignant neoplasm, breast.. — 10 10 13. Malignant neoplasm, uterus.. — 3 3 14. Other malignant and lymphatic neoplasms 25 22 47 15 Leukaemia, aleukaemia — 1 1 16 Diabetes 1 2 3 17. Vascular lesions of nervous system 19 30 49 18 Coronary disease, angina 28 17 45 19. Hypertension with heart disease 1 2 3 20 Other heart diseases 27 31 58 21 Other circulatory diseases 14 11 25 22 Influenza 2 1 3 23 Pneumonia 8 9 17 24. Bronchitis 12 10 22 25 Other diseases of respiratory system 2 — 2 26. Ulcer of stomach and duodenum .. 1 — 1 27. Gastritis, enteritis and diarrhoea 1 1 2 28. Nephritis and nephrosis — 1 1 29. Hyperplasia of prostate 6 — 6 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations .. 1 1 2 32. Other defined and ill-defined diseases 8 13 21 33. Motor vehicle accidents 4 — 4 34 All other accidents 1 2 3 35. Suicide 1 3 4 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 106 30.03 Other Diseases of the Circulatory System 25 7.08 Vascular Lesions of Nervous System 49 13.88 Cancer 77 21.81 Bronchitis 22 6.23 Pneumonia 17 4.82 Tuberculosis (All Forms) 2 0.57 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 1 3 4 Other Violent Causes 5 2 7 Totals 6 5 11 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 0.47. INFANTILE MORTALITY The infantile mortality rate for 1957 was 9.93 per 1,000 live births. The comparable rate for England and Wales is 23.1. 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 403 live births, only 4 deaths of infants under one year of age (3 males and 1 female) were registered. All of the deaths occurred within the first 24 hours of life. 15 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 2 hours M Atelectasis Prematurity 17 hours M Atelectasis Prematurity 1 day M Atelectasis 1 day F Pulmonary Atelectasis. Liver Tumour 16 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA (Including transferred functions adminstered by the local health authority — The Surrey County Council.) 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 Mid-Eastern Division. During the year the District Nurses attended 968 cases, including 89 maternity and midwifery patients. A total of 20,542 visits was made. 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 Medical and Surgical patients and the care of the aged under the St. Helier Hospital geriatric service. The cases attended were as follows: Total Maternity 45 Chronic Sick (including aged and infirm) 169 Acute Sick 50 Tuberculosis 6 270 THE CARE OF MOTHERS AND YOUNG CHILDREN 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, 146 women made 518 pre-natal attendances. This represents an attendance of 35.9 per cent of the total number of confinements which occured during 1957. 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. 17 Institutional Confinements. Three hundred and thirteen or 76.9 per cent. of births allocated to this district, took place in hospitals and nursing homes, compared with 77.8 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. Treatment Centres and Clinics Child Welfare Centres Hackbridge Centre, The Grange, London Road. When held Every Monday, 2.0-4.0 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, District Nurses' Home, 57 Montagu Gardens, Wallington. Every Thursday, 2.0-4.0 p.m. 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. 18 The ladies of the W.V.S. continued to organize the sales and distribution of the Welfare Foods, previously administered by the Ministry of National Insurance. Infant Welfare Services. 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. No changes were made during the year in the operation of the four infant welfare centres, and the number of attendances recorded was comparable with those of previous years. Number attending Total attendances Children under 1 year 336 4,780 Children, 1-5 years 782 3,407 Total attendances 1,118 8,187 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 254 466 Children, 0-1 year 423 2,084 Children, 1-5 years 9 3,386 Other Cases — 66 Ineffectual — 723 686 6,725 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. Care of Premature Infants. The arrangements made for the care of premature infants continued during 1957. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Twenty-four premature live births were notified during the year, 22 of which occurred in hospital. Two of the infants died within 24 hours of birth. The remaining 22 children survived. 19 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. 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 8 Tonsils and adenoids 8 Orthopaedic defects 4 Nævi 5 Circumcisions 5 Hernia 3 Dental. The Grange dental clinic for school children and children below the age of five years, as well as nursing and expectant mothers, continues to perform a very essential service. The accompanying table illustrates the work carried out. No. of Cases Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant and Nursing Mothers 21 13 85 12 5 Children, 0-5 51 44 196 - — — Totals 72 57 281 12 — 5 Orthopaedic. Patients attending infant welfare centres who require treatment for orthopædic defects are referred by the Clinic Medical Officer to orthopaedic surgeons at St. Helier or other hospitals. During 1957, 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 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. 20 The following table gives details of attendances: Total attendances Irradiations Corrective treatments Children, 0-5 years 2,005 599 Children, 5-15 years 2,163 3,012 Expectant and Nursing Mothers 41 537 4,209 4,148 21 Immunisation Against Diphtheria Four clinics are held weekly to give immunisation against diphtheria. These are held at each of the three Infant Welfare Centres and at the Medical Officer of Health's Department at the Town Hall. The following table gives the number of children residing in the Borough who were 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., 1957 1,780 4,560 6,340 Number of children known to be immunised at 31st Dec., 1957 1,052 4,216 5,268 Percentage of children immunised 59.1 92.5 83.1 Formol toxoid 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, 295 children were immunised at County Council clinics or by their general practitioner. Poliomyelitis The Poliomyelitis vaccination scheme, introduced in January 1956 continued, within the prescribed age groups, throughout 1957. The following summary gives the position at the end of the year: Children immunised at 31st Dec., 1956 104 Children who completed immunisation during 1957 1,100 Cases awaiting immunisation at 31st Dec., 1957 2,417 22 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 1957 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 Station. LABORATORY FACILITIES The Corporation's arrangements for the examination of swabs, sputa and other pathological material continue as heretofore. During 1957, 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. 23 HOSPITALS Infectious Cases. The South-West Metropolitan Regional Hospital Board make provision for the admission and treatment of cases of infectious disease in hospitals under their control. Most of the cases from Beddington and Wallington continue to be admitted to the Wandle Valley Isolation Hospital. Smallpox. The Regional Hospital Board have made arrangements for the admission of cases of smallpox to their hospital at Joyce Green, Dartford. General and Accident Cases. Cases from this area are admitted to: Carshalton, Beddington and Wallington District (War Memorial) Hospital. St. Helier Hospital, Carshalton. Croydon General Hospital. The Wilson Hospital, Mitcham. Maternity Cases. The Regional Hospital Board continue the provision at St. Helier Hospital for maternity cases in the Borough requiring institutional confinements. Some patients continue to be admitted to the Carshalton, Beddington and Wallington (War Memorial) Hospital under arrangements made by their practitioners under the National Health Service Act, 1946. 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 Bishopsford Road, Morden, with a sub-station, covering the Beddington and Wallington area, located in Carshalton. 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. 24 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 40 samples of water were examined by the Public Analyst or the Public Health Laboratory Service. From the reports the water supply is shown to be satisfactory both in chemical and bacteriological purity, and no cases of illness associated with pollution of water supplies were recorded during the year. The chlorination of water from private wells situated in industrial premises was continued throughout the year. DRAINAGE AND SEWERAGE 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 In March of the year under review, the Borough Surveyor was able to bring into use, a new system of refuse collection, which continued to be on a weekly basis, but involved the use of a freighter of an improved pattern. It is hoped to achieve some economy with these new freighters, but it is too early yet to comment. 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. None of these premises are dwelling houses. 25 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. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR FOR THE YEAR, 1957 HOUSING One hundred and eighteen houses were rendered fit as a result of informal or statutory action under the Public Health Act, 1936. One application was received for a Certificate of Disrepair (Housing Repairs & Rents Act, 1954). One certificate was issued. Forty-seven applications were received for Certificates of Disrepair (Rent Act, 1957). Forty-five notices of intention to issue Certificates of Disrepair were sent out. Eight Certificates of Disrepair were issued. Number of inspections of dwelling-houses 654 Number of inspections recorded under Housing Regulations 46 HOUSING ACT, 1957 (Overcrowding) In the absence of a complete survey of the Borough, it is impossible to give accurate figures relating to the number of cases of overcrowding. Evidence available indicates that the number is low. The table below sets out information concerning cases of overcrowding which have come to the knowledge of the Health Department. Number of dwellings overcrowded at the end of the year 3 Number of families dwelling therein 3 Number of persons dwelling therein 12 Number of new cases of overcrowding reported 1 Number of cases of overcrowding relieved 4 Number of persons concerned 21 Number of dwellinghouses in respect of which the Local Authority have taken steps for the abatement of overcrowding and which have again become overcrowded Nil MILK AND DAIRIES Number of distributors of milk on register 16 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 17 26 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 One hundred and five 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 82 82 — 82 — — — T.T. Pasteurized 16 16 — 16 — — — Sterilized 2 — — — — 2 — Tuberculin Tested (Farm Bottled) 5 1 - - - - - Four samples of Tuberculin Tested milk were submitted for biological examination - Tubercle bacilli were not isolated. CHEMICAL ANALYSES OF MILK Nineteen samples of milk were submitted to the Public Analyst. All were reported genuine. The average composition was as follows: Fat % 3.95 Solids-not-fat % 8.74 Total Solids % 12.69 ICE CREAM Number of premises registered for the sale of ice cream 96 Number of manufacturers Nil Number of inspections of premises 95 27 Thirty-six 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 4 Ice cream 36 33 2 — CHEMICAL ANALYSES OF ICE CREAM Two samples of ice cream were submitted for analysis. Both complied with the standard. SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 1070 FOOD PREMISES IN THE DISTRICT Bakers 15 Butchers 25 Catering Establishments 85 Chemists 12 Confectioners (sweets) 42 Fishmongers (including friers) 10 Greengrocers 26 Grocers 68 Licensed Premises 12 Bakehouses 6 Food Factories 3 FOOD PREMISES REGISTERED UNDER SECTION 16 OF THE FOOD & DRUGS ACT, 1955 Sausage manufacturers 27 Fish friers 7 Jam manufacturers 1 Ice cream (sale only) 96 Ice cream (manufacture and sale) 2 28 UNSOUND FOOD Destroyed or released for animal feeding:— lbs. Beverages 4 Cheese 21 Confectionery 5 Fish, canned 10 Fish 28 Fruit, canned 171 Ham, canned 68 Meat and Offal 184 Meat, canned 111 Milk, canned 15 Nuts 17 Preserves 4 Vegetables, canned 11 Total 649 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 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.1, is Public Analyst for the Borough. 29 FOOD ANALYSES The following table gives details of samples submitted for analysis during the year: Totals 1957 Articles No. Examined Adulterated Prosecu tions Convic tions Formal. Informal Total Formal Informal Total Ale & Stout 4 - 4 - - - - - Baby Food, Canned — 1 1 - - - - - Beetroot Pickled, — 1 1 - - - - - Blackcurrant Syrup 1 — 1 - - - - - Bread — 4 4 — 1 1 — — Bread & Butter 1 — 1 - - - - - Butter 1 — 1 - - - - - Cake Mixture 1 — 1 - - - - - Cheese 1 — 1 - - - - - Coffee Extract 2 — 2 - - - - - Confectionery: Flour 2 3 5 — 1 1 — — Sugar 4 3 7 - - - - - Cooking Fat 1 — 1 - - - - - Cough Pastilles — 1 1 - - - - - Cream — 3 3 - - - - - Drink: soft orange 2 1 3 - - - - - Fish Cakes 1 — 1 - - - - - Fish & Chips — 1 1 - - - - - Fish Paste — 1 1 - - - - - Fruit, Canned Apricots — 2 2 - - - - - Gin 1 — 1 - - - - - Herbs, Dried (Mixed) — 1 1 - - - - - Ice cream 2 — 2 - - - - - Ice lollipop 1 — 1 - - - - - Lung syrup — 2 2 — 1 1 — — Macaroni Cheese 1 — 1 — — — — — Magnesia, Milk of — 1 1 - - - - - Margarine 1 — 1 - - - - - Meat products 3 — 3 - - - - - Milk 8 11 19 — 1 1 — — Oil, Cooking 1 — 1 - - - - - Olive Oil 1 — 1 - - - - - Pickle (Mixed Sweet) — I 1 - - - - - Preserves 2 3 5 1 — 1 — — Pudding, Christmas — 1 1 - - - - - Pudding, Plum 1 — 1 - - - - - Rum 1 — 1 - - - - - Sauce 1 1 2 - - - - - Sausages 6 — 6 - - - - - Soup 1 — 1 - - - - - Sugar — 1 1 - - - - - Tea 3 — 3 - - - - - Tomato Juice 1 1 2 - - - - - Tomatoes, Canned 1 — 1 - - - - - Vinegar 2 1 3 - - - - - Whisky 2 — 2 - - - - - Wine, alcoholic — 1 1 - - - - - Total 61 46 107 1 4 5 — — 30 UNSATISFACTORY SAMPLES Formal Sample No. 23—Marmalade This sample was from a small stock of marmalade manufactured in the Borough. Remainder of the stock was withdrawn from sale. Warning letter sent. Informal Sample No. 43—Lung Syrup The sample contained chloroform 0.07 per cent. The formula printed on the label indicated that the syrup contained, inter alia, chloroform 0.24 per cent. A repeat formal sample in a bottle with a new type closure was obtained. This sample proved satisfactory. Informal Sample No. 56—Buns This sample was submitted as a result of a complaint and was found to contain a small quantity of black extraneous matter, mixed and baked in the dough. This matter was found to consist of charred flour with other vegetable matter, mainly woody tissues. Investigations showed that the dough had become contaminated by contact with a worn and dirty peel. Warning letter sent to manufacturer. Informal Sample No. 85—Bread This sample was submitted as a result of a complaint. The loaf was discoloured by dark streaks. Discolouration was found to be due to the presence of a number of very fine particles of iron which had become mixed with the dough before baking. A satisfactory report was received from the Local Authority in whose district the bakehouse is sited. Warning letter sent to Management. Informal Sample No. 88—Channel Islands Milk The sample contained fat 3.79 per cent, solids-not-fat 8.75 per cent, corresponding to a deficiency of 5 per cent of the milk fat. Channel Islands milk should contain at least 4 per cent milk fat. Repeat formal samples were obtained, all of which satisfied the standard. 31 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 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 132 113 6 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 142 123 6 — Part VIII of the Act Outwork Nature of Work (1) Section 110 Section 111 No. of outworkers in August list required by Sect. 110 (1) (c) (2) No. of cases of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of instances of work in unwholesome premises (5) Notices served (6) Prosecutions (7) Making of wearing apparel - - - - - - Stuffed toys 12 — — — — - Cosaques, Christmas crackers,Christmas stockings, etc. — — — — — - Total 12 - - — — — 32 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 0) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 5 5 - - - Overcrowding (S.2) — — - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7): (a) Insufficient 6 6 - — - (b) Unsuitable or defective 8 8 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 19 19 — — — BAKEHOUSES Number of bakehouses in district 6 Number of inspections 28 WORKPLACES, SHOPS AND OFFICES Number of inspections 524 Notices served 7 33 COMPLAINTS The total number of complaints received was 728. They were due to the following causes: Rats and Mice 155 Housing defects 60 Choked drains and sewers 54 Defective dustbins 276 Defective drainage (including closets) 35 Unsound or adulterated food 38 Atmospheric Pollution 20 Insect pests 43 Offensive accumulations 11 Miscellaneous 36 728 SMOKE ABATEMENT Number of observations 194 Nuisances observed 5 CLEAN AIR ACT, 1956 A survey was made of 308 houses, including 71 Council houses, in an endeavour to estimate the implications and cost of the establishment of a smoke control area for the whole Borough. For this purpose 417 inspections were made, as a result of which it was found that 85 of the houses were already equipped to burn smokeless fuel and that the remainder would require the replacement of 228 stool bottom and other grates if included in a smoke control area. Estimated figures for the total cost of such replacements and for the proportion which would be borne by the Council, were prepared and submitted. It was decided that no action be taken at that time and that the matter be reviewed in twelve months. INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 232 Number of rooms disinfected 67 Number of library books disinfected 395 OFFENSIVE TRADES Number of offensive trade premises in district Nil 34 Prevention of Damage by Pests Act, 1949 Report for 12 months ending 31st December, 1957 Type of Property Local Authority Dwelling Houses Business (& other premises) Total Agricultural Number of Properties in Local Authority's district 37 10,122 1,255 11,412 33 Number of inspections as a result of: (a) Notification 9 113 22 144 4 (b) Survey under the Act 283 125 263 671 65 (c) Primarily for some other purpose 68 414 1,206 1,688 55 Total Inspections (including reinspections) — — — 2,696 124 Properties found to shew major rat infestations — — — — — Properties found to shew minor rat infestations 13 114 39 166 4 Properties found to shew major mice infestations — — — — — Properties found to shew minor mice infestations — 25 8 33 — Total Infestations 13 139 47 199 4 SEWER RAT CONTROL During the year, three maintenance treatments were carried out. These were in the months of March, June and September. The results are summarised below: March Treatment June Treatment September Treatment Manholes baited 156 149 66 Manholes in which takes were recorded 35 36 8 Percentage of manholes showing infestations 22 24 12 A new method of baiting and the use of warfarin bait appears to have had the result of reducing the rat infestation of those sewers which have been found to be persistently infested despite the use of normal poison. 35 NOTICES Number of informal notices served (including verbal intimations) 249 Number of statutory notices served Public Health Act, 1936—Section 93 (Nuisances) 9 —Section 39 (Drainage) 5 —Section 45 (Water closets) 1 —Section 75 (Dustbins) 5 —Section 24 (Sewer Maint.) 2 22 SANITARY IMPROVEMENTS (1) Dwelling Houses Brickwork repaired or repointed 4 Ceilings— Repaired, renewed or cleansed 4 Chimneys— Stacks and flues repaired 2 Dampness remedied— (a) Roofs repaired 28 (b) Walls rendered 14 (c) Damp-proofing works 9 (d) Gutters and rainwater pipes repaired and unstopped 22 Doors—repaired or renewed 3 Drainage— (a) Obstructions cleared 37 (b) Repaired and relaid 7 (c) Inspection chambers provided and repaired 5 (d) F.A.I, provided, etc. 3 (e) Waste-pipes repaired and renewed 3 (f) Rainwater drainage provided, repaired or renewed 9 (g) Rodding-eye stopper replaced 6 Dustbins provided 270 Fireplaces and stoves repaired or renewed 1 Floors— (a) Repaired or renewed 6 (b) Ventilation provided or improved 6 Food storage provided or improved 1 Sinks renewed, etc. 1 Stairs— (a) Repaired or renewed 3 (b) Handrails provided 2 Walls— (a) Repaired or rebuilt 28 (b) Plaster repaired and redecorated 4 Water supply— Pipes repaired or renewed — 36 W.C. Accommodation— (a) Structure repaired 8 (b) Cisterns repaired or renewed 4 (c) Flush pipe joint repaired 3 (d) Pans provided or replaced 2 (e) Seats repaired or renewed 3 Windows— (a) Frames and sashes repaired or renewed 26 (b) Sashcords and beading renewed 19 (c) Glazing and putties renewed 5 (d) Cills repaired 26 Yard paving repaired or renewed 3 (2) Factories Cleansed 5 Sanitary Accommodation— Provided 6 Improved 4 Redecorated 1 Other Improvements 3 (3) Food Premises Fittings & equipment improved 15 Protection for food stuff provided 18 Displays improved 4 Drainage improved or repaired 9 Sanitary accommodation improved 28 Sanitary notices provided 4 Water supplies improved 15 Ablution facilities provided or improved 32 First aid equipment provided 16 Accommodation for assistants clothing provided 15 Sinks and hot water provided 32 Premises repaired 10 Cleaned and redecorated 52 Lighting and ventilation improved 20 Accumulations removed 6 Refrigeration provided or control of temperature improved 9 Dustbins provided 12 Personal cleanliness improved 6 Flooring improved 12 Other unsatisfactory conditions remedied 38 (4) Shops Sanitary accommodation provided 3 Washing accommodation provided 3 Defective structure, walls, floors 7 Ceilings, etc., repaired and redecorated 11 Forms exhibited 3 37 SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 654 Number of re-inspections of premises 822 Number of visits to work in progress 45 Number of miscellaneous visits and inspections 600 Number of visits to schools 20 Number of visits to food premises 1070 Number of visits to factories 123 Number of visits to shops, offices and workplaces 524 Number of visits to watercress beds, smallholdings, etc. 41 Number of inspections of public conveniences 68 Number of visits to piggeries 15 Number of visits re infectious diseases 232 Number of visits re insect pests 60 Number of inspections and visits re rats 3,284 Number of visits to streams 36 Number of visits re smoke abatement 239 Number of visits re smoke control area 417 Number of inspections of swimming bath 25 Number of complaints received and investigated 728 Number of informal notices served 249 Number of statutory notices served 22 Number of interviews re nuisances, etc. 284 Number of drain tests applied 434 Number of rooms disinfected 67 Number of lots of bedding and clothing disinfected 48 Number of library books disinfected 395 Number of samples of foodstuffs, water, etc., taken for examination 310 H. G. CRIPPS, Chief Public Health Inspector. 38 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1957 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 2,701 School children 6,593 Season Ticket Holders, etc.: Adults 15,184 Children 5,129 Total 29,607 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. 39 OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN During the year one notification of food poisoning was received. The patient was an adult male working in a neighbouring town. Clinically the symptons were characteristic of food poisoning, but examination of food consumed, and the patient's fomites did not reveal any pathogenic organism. 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 bye-laws, 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. 40 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. 41 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease in the Borough in 1957, 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 22 10 - Measles 426 3 — Whooping Cough 34 — — Pneumonia 20 2 17* Dysentery 2 1 — Poliomyelitis— Paralytic 1 1 — Non-paralytic — — — Puerperal Pyrexia 1 — — Food Poisoning 1 - - Totals 507 17 17 * Includes deaths from all forms of pneumonia. † Includes deaths of residents in homes and institutions outside the Borough. 42 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 1957 (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 22 - 1 4 17 - - - - - 12 2 1 4 1 1 1 10 — Measles 426 6 72 95 240 10 2 1 — — 86 74 62 46 65 58 35 3 — Whooping Cough 34 3 4 9 15 2 - 1 — — 9 9 — 6 4 1 3 — — Pneumonia 20 - - - 3 1 - 3 8 5 8 1 3 — 5 2 1 2 17* Dysentery 2 - - - - 2 - - - - 1 - 1 - - - — 1 — Poliomyelitis— Paralytic 1 - - - - - - 1 - - - - - - - - 1 1 — Non-paralytic - - - - - - - - - - - - - - - - - — — Puerperal Pyrexia 1 - - - - - - 1 - - 1 - - - - - - - - Food Poisoning 1 - - - - - - - 1 - 1 - - - - - - - - Totals 507 9 77 108 275 15 2 7 9 5 118 86 67 56 75 62 43 17 17 *Includes all forms 43 The Monthly Incidence of Infections Disease, 1957 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 2 - 1 3 4 2 6 1 1 1 - 1 22 Measles 168 169 49 18 9 8 5 — — .— — — 426 Whooping Cough 2 4 2 3 2 3 4 2 8 — 1 3 34 Pneumonia 2 1 3 4 2 1 — 1 — 6 — — 20 Dysentery — — — — — 1 1 - - - - - 2 Poliomyelitis— Paralytic - - - - - - - - - - 1 - 1 Non-Paralytic - - - - - - - - - - - - - Puerperal Pyrexia — — 1 — - — — — — — — — 1 Food Poisoning - - - - 1 - — - - — — — 1 Totals 174 174 56 28 18 15 16 4 9 7 2 4 507 44 Tuberculosis There were 16 new cases notified during the year, this being a decrease of 6 on the number of cases notified in 1956. The following table gives the number of new cases notified during the past five years: New Cases 1953 1954 1955 1956 1957 M. F. M. F. M. F. M. F. M. F. Pulmonary 16 12 8 8 9 3 17 5 11 5 Non-Pulmonary 1 1 — — — 1 — — — — Totals 17 13 8 8 9 4 17 5 11 5 Annual case rate per 1,000 of the estimated population: 1953 1954 1955 1956 1957 Pulmonary 0.86 0.50 0.37 0.68 0.49 Non-pulmonary 0.06 0.00 0.03 0.00 0.00 The following table gives the number of deaths from this disease during the past five years: Deaths 1953 1954 1955 1956 1957 M. F. M. F. M. F. M. F. M. F. Pulmonary 6 — 4 1 4 — 3 — 1 — Non-Pulmonary 1 1 — 1 — — — — 1 — Totals 7 1 4 2 4 — 3 — 2 — It will be seen from the foregoing table that 2 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 06. 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: 45 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 4 2 - - - - - - 25 to 44 years 2 1 - - - - - - 45 to 64 years 5 2 — — 1 — 1 — 65 and over - - - - - - - - Totals 11 5 — — 1 — 1 — The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 3 3 3 4 1 — — Non-Pulmonary - - - - - - - Totals 3 3 3 4 1 — — 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. 46