BED 23 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1958 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1958 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: Registered Causes of Death 14 Cancer of the Lung and Bronchus 15 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 21 School Clinics 22 Cleansing of Persons 22 Laboratory Facilities 22 Hospitals 23 Ambulance Facilities 23 Disinfection 23 Sanitary Circumstances of the Area: Water Supplies 24 Drainage and Sewerage 24 Rivers and Streams 24 Closet Accommodation 24 Public Cleansing 25 3 Report of the Chief Public Health Inspector for the Year 1958: Housing 26 Milk and Dairies 26 Ice Cream 27 Slaughterhouses 28 Food Premises 28 Food and Drugs Act, 1955 28 Food Hygiene Regulations 1955 29 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, 1958 Members: Alderman T. G. Wakley (Chairman) Councillor D. H. T. Salari (Mayor) Alderman D. H. de Voil Councillor Mrs. A. R. Barty Councillor Mrs. H. Bridger Councillor S. J. Dunwoodie Councillor A. G. Grefnhf.ad Councillor E. W. Harding Councillor E. W. Popplestone Councillor Mrs. J. L. K. Thurston Councillor H. R. Trost REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1958 Members: Alderman D. H. de Voil Alderman H. Rennison Councillor Mrs. H. Bridger Councillor J. A. Parker Councillor E. W. Popplestone REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1958 Members: Councillor D. H. T. Salari (Mayor) Alderman F. G. Bryant Alderman A. H. Prior Councillor S. W. C. Sprunt 5 STAFF OF PUBLIC HEALTH DEPARTMENT Town Hall, Wallington. Telephone: Wallington 4500 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. fa.) V. L. Lerigo, A.R.S.H., M.A.P.H.I. (a) Sanitary Inspector's Certificate (R.S.H. & S.I.E.J. Board). (b) Meat and Other Foods Certificate (R.S.H.) (c) Smoke Certificate (R.S.H.) Assistant to Public Health Inspectors: R. W. Bradstock Clerks: R. F. Burns (Chief Clerk) E. D. Evezard (Resigned 30.4.58) Mrs. L. A. Capon (Commenced 2.6.58) Mrs. S. C. Clements (Resigned 4.10.58) C. I. Phillips Miss M. Edmonston (Commenced 3.11.58) 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 (Resigned 30.4.58) Mrs. L. A. Capon (Commenced 2.6.58) Mrs. J. F. Smith Mrs. I. M. Kingsley (School Health) Mrs. E. Bass (Part Time) (Resigned 31.5.58) Mrs. M. Meadows (Part Time) (Commenced 2.6.58) Mrs. M. Osborne (Part Time) (Commenced 12.5.58) Home Help Supervisor: Mrs. V. Beatt (Part Time) 6 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 1958. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 22/58. 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 1958 is 32,390, and this figure is used in the compilation of the vital statistics. The figure shows a decrease of 70 compared with the Registrar-General's estimate for mid-year 1957. The census of population taken in 1951 was 32,751. The birth rate per 1,000 total population shows a slight decrease at 12.97 in 1958, as compared with 13.04 in 1957. This rate is below that for England and Wales, which is 16.40. The stillbirth rate per 1,000 total births is 31.48, compared with 9.83 in 1957. This is higher than that for England and Wales, which is recorded as 21.60. The number of children stillborn in the district was 13, out of a total of 413 births, as compared with 4 in 1957 out of 407 births. The stillbirth rate of the district showed a considerable increase in the year under review. It must be remembered, however, that in dealing with such small statistics, the rate tends to give an exaggerated view of the increase. The number of children stillborn was 13. In all these cases, careful maternal care was undertaken, but there still remain some complications, for which medical science has as yet found no remedy. The death rate from all causes per 1,000 total population is 9.81, compared with 10.44 in 1957 and 11.70 for England and Wales. Of the 331 deaths, diseases of the heart accounted for 115 (34.74 per cent of total deaths), cancer 64 (19.34 per cent of total deaths), and tuberculosis 3 (0.91 per cent of total deaths). Diseases of the heart and circulatory system in 1958 continued to account for a very high proportion of total deaths. There were 65 deaths from coronary disease, as compared with 45 in 1957. The proportion of these cases, as between males and females, continues to show a large proportion of males. The older age groups produced a large proportion of deaths from disease of the heart and circulatory system. 7 Two deaths were recorded from motor vehicle accidents, being two less than in 1957. All other accidents accounted for 8 deaths, compared with 3 in 1957. Suicides totalled 2 cases, compared with 4 in 1957. During the year the Minister of Health expressed considerable concern about the increase in accidents in the home, and after his Circular 6/58, together with Home Office Circular 58/1958 had been considered by your Council, a co-ordinating committee, known as theHome Safety Committee was instituted, at an inaugural meeting, held at the Town Hall on the 27th October, 1958. The constitution was on similar lines to the already operating Road Safety Committee. It is hoped that by bringing together all sections of the community interested in reducing accidents in the home, and by disseminating suitable literature emanating from the Government, and other sources, to bring the population to a more thorough understanding how accidents happen, and how best they can be avoided. It may be a reflection on the excellent work of the Road Safety Committee, that the number of deaths from motor accidents in the Borough was halved during the year. No mothers died in childbirth during 1958, and this gives a maternal mortality rate per 1,000 total births of nil, as compared with 0.43 for England and Wales. The infantile mortality rate shows a decrease at 7.50 per 1,000 live births, as compared with 9.93 in 1957. Only 3 infants died under the age of 1 year in 1958 out of 400 live births. On page 16 will be found an analysis of the causes of death. It will be noted with satisfaction, that the infantile mortality rate is the lowest yet recorded in this district. This probably reflects a higher standard of knowledge amongst the population generally, and a carefully maintained supervisory service, through clinics and health visitors having the care of young infants. The incidence of infectious disease during 1958 was exceptionally low. In part, this may be accounted for by the extremely small number of cases of measles notified. Only 10 cases of measles were notified, as compared with 426 cases in 1957. None of these cases were removed to hospital. One case of non-paralytic poliomyelitis was notified during the year. The patient was admitted to hospital where the diagnosis was made, but suffered no ill effects either of a temporary or permanent nature. The Government's scheme for poliomyelitis vaccination was continued during the year, within the prescribed age groups. These groups include children born between 1943 and 1958, and expectant mothers. On the 2nd September, 1958, the Minister issued a circular in which he extended the scheme to include persons born between the years 1933 and 1942. By the end of the year 4,386 persons had received two injections against poliomyelitis, and 1,995 a third injection. There were, however, 522 cases outstanding, whose immunisation procedure was continued into 1959. 8 For the tenth year there were no cases of diphtheria notified. The immunisation 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. 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 Peoples' 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. When considering geriatrics, and the ever-growing demand that this part of the population is likely to make in future years, the ever-pressing demand for accommodation, both under the Regional Hospital Board in hospitals, and under the Surrey County Council in Part III accommodation, will certainly have to result in more building, and the provision of ad hoc institutional beds for both these sections of the geriatric service. During the year, the W.V.S. were able to continue, and even expand, their Meals on Wheels service for old people. The Corporation continued their annual grant, and also made available the requisite vehicles to deliver meals to the homes of the old and sick on certain days of the week. The number of recipients for the meals has increased quite considerably during the year. Through the active co-operation of the W.V.S. and the British Red Cross Society, a chiropody service was also introduced during the year, and this operates in three different ways:— (1) The chiropodist attends one morning a week at British Red Cross House, in Woodcote Road, and for a small fee, old people can come and have their feet treated. (2) Arrangements are made through the Beddington and Wallington Fund for the Aged and Infirm, for a chiropodist to visit the homes of old people, who are unable to get out, and treatment is carried out in their own homes, at an agreed cost to the Fund. 9 (3) A member of the W.V.S., qualified in chiropody, occasionally gives treatment voluntarily, to home-bound and aged persons. The Home Help Service was operated to capacity throughout the year and by giving this service and nursing attention through the District Nurses, it was possible to keep many people in their own homes who would otherwise have had to be admitted for institutional care. With the ever-growing need for attention to old persons living in their own homes, these services will continue to expand. In his Circular 22/58, the Minister of Health asked for the Medical Officer of Health to comment briefly on the working of the first ten years of the National Health Service, and the functioning of the Local Health Services generally during that period. In any statement on this subject it must be emphasized at the outset that the relations between the Local Health Authority, Surrey County Council, and the Local Sanitary Authority, Beddington and Wallington Corporation, have been most harmonious, and co-operation between the various departments dealing with matters of health have been very close, and consequently, successful. All sections of the National Health Service Act of 1946 have been implemented to the benefit of citizens generally, and in particular, the specialist services dealing with mothers and young children, and with school children, have been crowned with success. In the Medical Officer of Health's Annual Reports for the period, detailed summaries of the work of both the Local Health Authority, and the Sanitary Authority, have been carefully reviewed, mostly in comprehensive statistical summaries. Attention has been drawn to the various ways in which the two Local Authorities have worked together for the advancement of the health of the citizens, and nowhere has this been more successful than in the joint consideration of problem families, especially in the matter of housing. One can only hope that the cordial relationship and effective liaison now established will be continued in the future. The Council may congratulate themselves that the year 1958 reached a new peak in the records of the health of the people. The Borough was free from epidemic disease in any form, and in all departments of health, the population appears to have fared better than in any previous year. 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. 10 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, Medical Officer of Health. Public Health Department, Town Hall, Wallington. Telephone: Wallington 4500. July, 1959. 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 1958 32,390 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1958 10,162 Rateable Value £726,234 Sum represented by penny rate £2,850 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. 12 EXTRACTS FROM VITAL STATISTICS Resident Population—Estimated mid-year 1958 32,390 Live Births Males Females Total Legitimate 204 188 392 Illegitimate 4 4 8 208 192 400 Live Birth Rate per 1,000 population 12.35 Adjusted Birth Rate 12.97 England and Wales Live Birth Rate 16.40 Illegitimate Live Births per cent of total Live Births 2.00 Still Births Legitimate 5 8 13 Illegitimate — — — 5 8 13 Rate per 1,000 total Live and Stillbirths 31.48 England and Wales Stillbirth Rate 21.60 Total Live and Stillbirths Legitimate 209 196 405 Illegitimate 4 4 8 213 200 413 Deaths 183 148 331 (i) Death Rate per 1,000 population 10.22 Adjusted Death Rate 9.81 England and Wales Death Rate 11.70 (ii) Infant Deaths—under 1 year of age Total No. of Deaths 3 Infant Mortality Rate per 1,000 Live Births 7.50 Infant Mortality Rate per 1,000 Live Births: Legitimate 7.66 Illegitimate Nil Infant Mortality Rate for England and Wales 22.60 Neo Natal Mortality Rate per 1,000 Live Births 5.00 (Under 4 weeks of age) (iii) Maternal Deaths (including abortion) total Nil Maternal Mortality Rate per 1,000 Live and Stillbirths Nil England and Wales Maternal Mortality Rate 0.43 13 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1958: Causes of Death Males Females Total All Causes 183 148 331 1. Tuberculosis, respiratory 2 1 3 2. Tuberculosis, other — — - 3. Syphilitic disease 1 — 1 4. Diphtheria — — - 5. Whooping Cough — — - 6. Meningococcal infections — — - 7 Acute poliomyelitis — — - 8 Measles — — - 9. Other infective and parasitic diseases — — - 10 Malignant neoplasm, stomach 6 1 7 11. Malignant neoplasm, lung, bronchus 10 3 13 12. Malignant neoplasm, breast — 6 6 13. Malignant neoplasm, uterus — 1 1 14. Other malignant and lymphatic neoplasms 19 18 37 15. Leukæmia, aleukæmia 1 — 1 16. Diabetes 1 — 1 17. Vascular lesions of nervous system 24 27 51 18 Coronary disease, angina 46 19 65 19. Hypertension with heart disease 1 3 4 20 Other heart diseases 16 30 46 21 Other circulatory diseases 10 7 17 22. Influenza — 1 1 23 Pneumonia 9 7 16 24. Bronchitis 15 3 18 25 Other diseases of respiratory system 3 — 3 26. Ulcer of stomach and duodenum — 3 3 27. Gastritis, enteritis and diarrhœa - 2 2 28. Nephritis and nephrosis 1 — 1 29. Hyperplasia of prostate 3 — 3 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations — 1 1 32. Other defined and ill-defined diseases 9 9 18 33. Motor vehicle accidents 1 1 2 34 All other accidents 4 4 8 35. Suicide 1 1 2 36. Homicide and operations of war - - — 14 The following table shows the principal causes of death with the rate per cent. of total deaths: Cause of Death Number of Deaths Rate per cent. of Total Deaths Heart Disease 115 34.74 Other Diseases of the Circulatory System 17 5.14 Vascular Lesions of Nervous System 51 15.41 Cancer 64 19.34 Bronchitis 18 5.44 Pneumonia 16 4.83 Tuberculosis (All Forms) 3 0.91 Cancer of the Lung and Bronchus Males Females Total Number of deaths in 1958 10 3 13 Rate per 1,000 population 0.40 England and Wales Rate 0.44 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 1 1 2 Other Violent Causes 5 5 10 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 0.43. INFANTILE MORTALITY The infantile mortality rate for 1958 was 7.50 per 1,000 live births. The comparable rate for England and Wales is 22.6. Great credit is due to the services operated in the Borough for the care of mothers and young children, which have made the attainment of such a low rate possible. Of the total of 400 live births, only 3 deaths of infants under one year of age (3 females) were registered. 15 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 7 hours F Tentorial tear following spontaneous natural delivery. 4 hours F Prematurity. 8 months F Infantile sub-endocardial fibro-elastosis. 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 822 cases, including 108 maternity and midwifery patients. A total of 19,532 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 43 Chronic Sick (including aged and infirm) 175 Acute Sick 54 Tuberculosis 1 273 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, 130 women made 503 pre-natal attendances. This represents an attendance of 31.48 per cent of the total number of confinements which occurred during 1958. Post-natal examinations were also conducted at this clinic, 18 patients making 23 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 two or 73.1 per cent, of births allocated to this district, took place in hospitals and nursing homes, compared with 76.9 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 When held Hackbridge Centre, Every Monday, 2.0-4.0 p.m. The Grange, London Road. Bandon Hill Centre, Every Tuesday, 2.0-4.0 p.m. Methodist Hall, Sandy Lane North. Beddington Centre, Alternate Wednesdays, 2.0-4.0 p.m. Village Hall, Beddington. Wallington Centre, Alternate Wednesdays, 2.0-4.0 p.m Baptist Hall, Queen's Road. Maternity Clinics Ante-natal Clinic Every Thursday, 2.0-4.0 p.m Post-natal Clinic, District Nurses' Home, 57 Montagu Gardens, Wallington. Physiotherapy Clinic, By appointment. Dental Clinic, The Grange, London Road. During the year voluntary help was again generously given by many ladies in the district, in assisting in the operation of the infant welfare centres. Among these, special mention should be made of the members of the British Red Cross Society, who continued to supply the great majority of the voluntary help given. 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 Total attending attendances Children under 1 year 326 4,971 Children, 1-5 years 777 3,205 Total attendances 1,103 8,176 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 Total visits visits Expectant Mothers 283 525 Children, 0-1 year 407 2,109 Children, 1-5 years — 3,497 Other Cases — 37 Ineffectual — 820 690 6,988 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. It is anticipated, however, that new legislation to be introduced early in 1959, will make necessary a revision of this system of visiting. Care of Premature Infants. The arrangements made for the care of premature infants continued during 1958. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Twenty premature live births were notified during the year, 16 of which occurred in hospital. One of the infants died within 24 hours of birth The remaining 19 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. Thirty-nine 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 6 Tonsils and adenoids 12 Orthopædic defects 7 Nævi 4 Circumcisions 3 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 18 13 55 7 1 4 Children, 0-5 54 39 102 — — — Totals 72 52 157 7 1 4 Orthopædic. Patients attending infant welfare centres who require treatment for orthopædic defects are referred by the Clinic Medical Officer to orthopædic surgeons at St. Helier or other hospitals. During 1958, 7 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. 20 The following table gives details of attendances: Total attendances Irradiations Corrective treatments Children, 0-5 years 1,620 664 Children, 5-15 years 1,591 2,153 Expectant and Nursing Mothers 36 515 3,247 3,332 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., 1958 1,790 4,500 6,290 Number of children known to be immunised at 31st Dec., 1958 1,077 4,335 5,412 Percentage of children immunised 60.1 96.3 86.0 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, 360 children were immunised at County Council clinics or by their general practitioner. 21 Poliomyelitis The Poliomyelitis vaccination scheme, introduced in January 1956 continued, within the prescribed age groups, throughout 1958. The following is a summary of the persons who had been vaccinated by the end of the year: Two Three Injections Injections Children born 1943—1958 3900 1990 Young persons born 1933—1942 278 2 Expectant Mothers 166 3 General Practitioner and Ambulance Staff 42 - 4386 1995 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. Cleansing of Persons During 1958 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 6 treatments for scabies 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 1958, 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. 22 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. 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. 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. 23 SANITARY CIRCUMSTANCES OF THE AREA WATER SUPPLIERS 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 184 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. As part of general maintenance and cleansing of soil and storm water drainage systems, defective 9" foul sewers in Park Road, Clifton Road, Belmont Road and Melbourne Road, totalling 733 yards, were renewed during 1958. RIVERS AND STREAMS Normal cleansing of the River Wandle was carried out. A scheme for the improvement of the River Wandle was submitted by the Surrey County Council and approved with slight modifications. The objects of the improvement are (a) to prevent flooding, (b) to improve surface water drainage, and (c) to improve the appearance and amenities of the river. 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. 24 PUBLIC CLEANSING During the year under review, the Borough Surveyor was able to continue refuse collection on a weekly basis. It is generally felt that some economy has effected by the use of the new freighters, since the new system of refuse collection was introduced in March, 1957. 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, 1958 HOUSING One hundred and forty houses were rendered fit as a result of informal or statutory action under the Public Health Act, 1936. Twenty-eight applications were received for Certificates of Disrepair (Rent Act, 1957). Twenty-five notices of intention to issue Certificates of Disrepair were sent out. Twelve Certificates of Disrepair were issued. Number of inspections of dwelling-houses 680 Number of inspections recorded under Housing Regulations 84 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 2 Number of cases of overcrowding relieved 2 Number of persons concerned . . 12 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 two 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 71 70 1 70 1 — — T.T. Pasteurized 19 19 — 19 — — — Sterilized 9 — — — — 9 — Tuberculin Tested (Farm Bottled) 3 3 — — — — — Six samples of Tuberculin Tested milk were submitted for biological examination - Tubercle bacilli were not isolated. CHEMICAL ANALYSES OF MILK Twenty-four samples of milk were submitted to the Public Analyst. All were reported genuine. The average composition was as follows: Fat % 3.85 Solids-not-fat % 8.70 Total Solids % 12.55 The samples included six of Channel Island Milk. The average composition of these samples was as follows: Fat % 4.4 Solids-not-fat % 8.95 Total Solids % 13.35 ICE CREAM Number of premises registered for the sale of ice cream 98 Number of manufacturers Nil Number of inspections of premises 68 27 Forty 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 40 40 — — — CHEMICAL ANALYSES OF ICE CREAM Three samples of ice cream were submitted for analysis. All complied with the standard. SLAUGHTERHOUSES Number of licensed slaughterhouses Nil FOOD PREMISES Total number of visits 677 FOOD PREMISES IN THE DISTRICT Bakers 15 Butchers 24 Catering Establishments 84 Chemists 11 Confectioners (sweets) 40 Fishmongers (including friers) 10 Greengrocers 27 Grocers 60 Licensed Premises 11 Bakehouses 6 Food Factories 3 FOOD PREMISES REGISTERED UNDER SECTION 16 OF THE FOOD & DRUGS ACT, 1955 Sausage manufacturers 27 Fish friers 6 Jam manufacturers 1 Ice cream (sale only) 98 28 FOOD AND DRUGS ACT, 1955 Food Hygiene Regulations, 1955 The revisiting of food premises continued during 1958. The type of premises visited and number of inspections are set out below: Bakers 59 Butchers 59 Catering Premises 97 Confectioners (sugar) 50 Fishmongers 9 Greengrocers 64 Grocers 131 Milk Shops 6 Registered Premises 144 Other Food Premises 58 As a result of these visits, shopkeepers were persuaded to carry out the improvements listed on page 37. It was not necessary to institute legal proceedings. UNSOUND FOOD Destroyed or released for animal feeding:— lbs. Cheese 4 Confectionery, Flour 9 Confectionery, Sugar 2 Fish, canned 6 Fish 98 Fruit, canned 149 Ham, canned 44 Meat and Offal 68 Meat, canned 47 Milk, canned 30 Pickle 7 Preserves 18 Soup,canned 10 Syrup 2 Vegetables, canned 75 Total 569 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.l, is Public Analyst for the Borough. 29 FOOD ANALYSES The following table gives details of samples submitted for analysis during the year: Totals 1958 Articles No. Examined Adulterated Prosecu tions Convic tions Formal. Informal Total Formal Informal Total Ale & Stout 2 - 2 - - - - - Baby Food, (carrots) — 1 1 - - - - - Beer, Canned — 1 1 - - - - - Black Pudding 1 — 1 - - - - - Brandy — 1 1 — — — — — Bread — 2 2 — 2 2 - — Bun — 1 1 — 1 1 — — Butter 1 - 1 - - - - - Cake Mixture 1 — 1 - - - - - Castor Oil — 1 1 - - - - - Cherry Brandy — 1 1 - - - - - Cocoa — 1 1 - - - - - Coffee & Chicory essence 1 1 2 - - - - - Confectionery: Flour 2 — 2 1 — 1 — — Sugar 3 5 8 — 1 1 — — Cream 1 1 2 — — — — — Curry powder 1 — 1 - - - - - Drink, soft 3 — 3 - - - - - Fish canned — 1 1 - - - - - Flavouring essence 1 — 1 - - - - - Flour self raising — 1 1 - - - - - Fruit (apples) Fruit, can'd (strawberries) — 1 1 - - - - - —- 1 1 - - - - - Fruit curd (lemon) — 1 1 - - - - - Gin — i 1 - - - - - Honey 1 — 1 - - - - - Ice cream 3 — 3 - - - - - Ice lollipop — 1 1 - - - - - Jam (plum) — 1 1 — — — — — Jelly tablet 1 1 - — — — — — Lard 1 — 1 - - - - - Margarine 1 — 1 - - - - - Meat product (steak pies) 1 — 1 — — — — — Meat product, canned - 2 2 - — — - — Medicines — 3 3 - - - - - Milk 15 9 24 — — — — — Milk, evaporated 1 — 1 — — — — — Olive Oil — 1 1 — — — — — Pepper 1 — 1 — — — — - Pickle — 1 1 — — — — - Proprietary food (Instant postum) - 1 1 - - - - - Rice 1 — 1 - - - - - Rum 1 — 1 - - - - - Sausages 4 3 7 - - - - - Soup, canned — 1 1 - - - - - Suet, shredded 4 1 5 2 1 3 — — Sugar 2 — 2 - - - - - Syrup, golden — 1 1 - - - - - Tapioca flakes 1 — 1 - - - - - Tea 1 1 2 — — — — — Tomatoes, Canned - 1 1 - - - - - Vegetables, canned (peas) — 1 1 - - - - - Vinegar 1 — 1 1 - 1 — — Whisky 1 — 1 - - - - - Yoghourt 1 — 1 — — — — — Total 59 51 110 4 5 9 - — 30 UNSATISFACTORY SAMPLES Formal Sample No. 1—Bread The interior of the loaf was discoloured by the presence of a small quantity of charred flour saturated with grease. A warning letter was sent to the manufacturer. Formal Sample No. 5—Vinegar The sample consisted of a non-brewed substitute made from acetic acid, colouring and flavouring. A warning letter was sent to the vendor. Informal Sample No. 8—Bread Roll The sample contained embedded in the dough a piece of thick rusty iron wire. Warning letter sent to manufacturer. Formal Sample Nos. 11, 23—Informal No. 24—Shredded Beef Suet The samples contained fat 82%, 81-7% and 82% respectively. By the provision of the Food Standards (Suet) Order 1952, shredded suet should contain not less than 83% fat. A warning letter was sent to the manufacturer. A further sample was obtained three months later this contained suet fat 92-1 %. Formal Sample No. 49—Cream Slices The sample contained imitation cream in place of cream. A letter was sent to the vendor who had exhibited a notice giving information concerning the fillings used. Informal Sample No. 55—Chocolate-Orange Flavoured The bars of chocolate were contaminated by dust. A letter was sent to the manufacturer and investigations were carried out at the place of manufacture with a view to preventing a repetition. Informal Sample No. 91—Bun The bun contained foreign matter consisting of a mass of jute fibres burnt bread and grease. A warning letter was sent to the manufacturer. 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 11 2 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 160 100 2 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 4 4 - - Total 175 106 2 — Part VIII of the Act Outwork Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sect. 110 (l)(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) Stuffed toys 3 — — — — — Total 3 — — — — — 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 (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) 1 2 - - - Overcrowding (S.2) — — - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7): - - - - - (a) Insufficient 1 1 - 2 - (b) Unsuitable or defective 2 3 - 1 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 4 6 — 3 - BAKEHOUSES Number of bakehouses in district 6 Number of inspections 25 WORKPLACES, SHOPS AND OFFICES Number of inspections 388 Notices served 4 33 COMPLAINTS The total number of complaints received was 631. They were due to the following causes: Rats and Mice 132 Housing defects 64 Choked drains and sewers 93 Defective dustbins 212 Defective drainage (including closets) 11 Unsound or adulterated food 19 Atmospheric Pollution 28 Insect pests 20 Offensive accumulations 8 Miscellaneous 44 631 SMOKE ABATEMENT Number of observations 271 Nuisances observed 2 INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 148 Number of rooms disinfected 34 Number of library books disinfected 196 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, 1958 Type of Property Local Authority Dwelling Houses Business (& other premises) Total Agricultural Number of Properties in Local Authority's district 37 10,159 1,404 11,600 33 Number of inspections as a result of: (a) Notification 4 101 17 122 - (b) Survey under the Act 317 137 329 783 33 (c) Primarily for some other purpose 25 503 1,531 2,059 32 Properties found to shew major rat infestations — — — — — Properties found to shew minor rat infestations 28 1ll 28 167 — Properties found to shew major mice infestations — — — — — Properties found to shew minor mice infestations — 19 11 30 — Total Infestations 28 130 39 197 — SEWER RAT CONTROL During the year, three maintenance treatments were carried out. These were in the months of February, August and December. The results are summarised below: February Treatment August Treatment December Treatment Manholes baited 77 133 132 Manholes in which takes were recorded 22 42 39 Percentage of manholes showing infestations 28 32 30 35 NOTICES Number of informal notices served (including verbal intimations) 297 Number of statutory notices served Public Health Act, 1936—Section 93 (Nuisances) 30 —Section 39 (Drainage) 3 —Section 45 (Water closets) 1 —Section 75 (Dustbins) 3 Housing Act, 1957—Section 9 1 — 38 SANITARY IMPROVEMENTS (1) Dwelling Houses Brickwork repaired or repointed. 17 Ceilings— Repaired, renewed or cleansed 56 Chimneys— Stacks and flues repaired 9 Dampness remedied— (a) Roofs repaired 61 (b) Damp-proofing works 37 (c) Gutters and rainwater pipes repaired and unstopped 74 Doors—repaired or renewed 25 Drainage— (a) Obstructions cleared 55 (b) Repaired and relaid 8 (c) Inspection chambers provided and repaired 1 (d) F.A.I, provided, etc. 2 (e) Waste-pipes repaired and renewed 12 (f) Rainwater drainage provided, repaired or renewed 30 Dustbins provided 65 Fireplaces and stoves repaired or renewed 22 Floors— (a) Repaired or renewed 33 (b) Ventilation provided or improved 16 Sinks renewed, etc. 5 Stairs— (a) Repaired or renewed 9 (b) Lighting improved 1 Walls- (a) Repaired or rebuilt 115 (b) Plaster repaired and redecorated 21 Water supply— Pipes repaired or renewed 15 36 W.C. Accommodation— (a) Cisterns repaired or renewed 4 (b) Flush pipe joint repaired 2 (c) Pans provided or replaced 1 (d) Seats repaired or renewed 1 Windows— (a) Frames and sashes repaired or renewed 81 (b) Sashcords and beading renewed 50 (c) Glazing and putties renewed 17 (d) Cills repaired 32 Yard paving repaired or renewed 10 Other Sanitary improvements 62 (2) Factories Cleansed 2 Sanitary Accommodation— Provided 1 Improved 2 Redecorated 1 Other Improvements 4 (3) Food Premises Fittings & equipment improved 24 Protection for food stuff provided 14 Displays improved 8 Drainage improved or repaired 10 Sanitary accommodation improved 11 Sanitary notices provided 6 Water supplies improved 12 A blution facilities provided or improved 8 First aid equipment provided 3 Accommodation for assistants clothing provided 15 Sinks and hot water provided 28 Premises repaired 10 Cleaned and redecorated 38 Lighting and ventilation improved 18 Accumulations removed 1 Refrigeration provided or control of temperature improved 1 Dustbins provided 6 Personal cleanliness improved 5 Flooring improved 18 Other unsatisfactory conditions remedied 25 (4) Shops Washing accommodation provided 1 Ceilings, etc., repaired and redecorated 2 Forms exhibited 5 37 SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 680 Number of re-inspections of premises 1188 Number of visits to work in progress 95 Number of miscellaneous visits and inspections 314 Number of visits to food premises 677 Number of visits to factories 102 Number of visits to shops, offices and workplaces 388 Number of visits to watercress beds, smallholdings, etc. 32 Number of inspections of public conveniences 64 Number of visits to piggeries 12 Number of visits re infectious diseases 148 Number of visits re insect pests 54 Number of inspections re rats 3,029 Number of sewer manholes treated 342 Number of visits to streams 64 Number of visits re clean air 335 Number of inspections of swimming bath 18 Number of complaints received and investigated 631 Number of informal notices served 297 Number of statutory notices served 38 Number of interviews re nuisances, etc. 273 Number of visits re drainage 574 Number of rooms disinfected 34 Number of lots of bedding and clothing disinfected 36 Number of library books disinfected 196 Number of samples of foodstuffs, water, etc., taken for examination 364 Number of visits re food and other samples 580 H. G. CRIPPS, Chief Public Health Inspector. 38 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1958 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 2,494 School children 5,951 Season Ticket Holders, etc.: Adults 16,274 Children 4,284 Total 29,003 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 three notifications of food poisoning were received. Two of the cases belonged to the same family, and the incident took place following a meal in a London restaurant. The officers of the Metropolitan Borough in which the case occurred, carried out all the investigations at the restaurant, and it was confirmed that both patients suffered from staphylococcal food poisoning, following dinner in the evening. One other case which occured in the Borough, was investigated, the source of food suspected being fish fingers, sold from a fish shop in the town. The probable origin of infection or contamination of the food was not ascertained. 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 1958, 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 33 13 - Measles 10 — — Whooping Cough 34 2 — Pneumonia 12 2 16* Dysentery 2 1 — Poliomyelitis— Paralytic — — — Non-paralytic 1 1 — Puerperal Pyrexia 2 — — Food Poisoning 3 2 — Erysipelas 4 — — Totals 101 21 16* * Includes deaths from all forms of pneumonia. † Includes deaths of residents in homes and institutions outside the Borough. 42 43 Cases of Infectious Disease Notified During the Year 1958 (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 33 - 3 9 19 1 - 1 - - 3 4 2 3 13 7 1 13 - Measles 10 - 6 2 1 1 - - - - 4 2 1 — 3 — - - — Whooping Cough 34 3 4 6 17 2 1 1 - - 16 3 2 1 5 5 2 2 - Pneumonia 12 1 - 1 2 1 - 1 6 - 4 1 - 2 1 2 2 2 16* Dysentery 2 — - 1 - - - - 1 - - 1 1 - - - - 1 - Poliomyelitis— Paralytic - - - - - - - - - - - - - - - - - - - Non-paralytic 1 - - - 1 - - - - - - 1 - - - - - 1 — Puerperal Pyrexia 2 — - — - - 1 1 — - - 1 - — - - 1 - — Food Poisoning . . 3 — - 1 - - - - 1 1 - — — — - 1 2 2 — Erysipelas 4 - - - - - - - 2 2 — 1 1 — 1 1 — — — Totals 101 4 13 20 40 5 2 4 10 3 27 14 7 6 23 16 8 21 16* *Includes all forms The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections: 44 The Monthly Incidence of Infectious Disease, 1958 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 6 — 5 4 2 — 1 1 2 3 — 9 33 Measles — — — — — 1 2 4 — — — 3 10 Whooping Cough 11 4 4 5 1 7 2 — — — — — 34 Pneumonia 4 4 1 2 — — — — — 1 — — 12 Dysentery — — — — — — — — 1 — — 1 2 Poliomyelitis— Paralytic — — — — — — — — — — — — — Non- Paralytic — — — — — — 1 — — — — — 1 Puerperal Pyrexia 1 — — — — — — 1 — — — — 2 Food Poisoning — — 3 — — — — — — — — — 3 Erysipelas — — — 1 1 — — — — 1 1 — 4 Totals 22 8 13 12 4 8 6 6 3 5 1 13 101 Tuberculosis There were 13 new cases notified during the year, this being a decrease of 3 on the number of cases notified in 1957. The following table gives the number of new cases notified during the past five years: New Cases 1954 1955 1956 1957 1958 M. F. M. F. M. F. M. F. M. F. Pulmonary 8 8 9 3 17 5 11 5 6 6 Non-Pulmonary — — — 1 — — — — 1 Totals 8 8 9 4 17 5 11 5 6 7 Annual case rate per 1,000 of the estimated population: 1954 1955 1956 1957 1958 Pulmonary 0.50 0.37 0.68 0.49 0.37 Non-pulmonary 0.00 0.03 0.00 0.00 0.03 The following table gives the number of deaths from this disease during the past five years: Deaths 1954 1955 1956 1957 1958 M. F. M. F. M. F. M. F. M. F. Pulmonary 4 1 4 — 3 — 1 — 2 1 Non-Pulmonary — 1 — — — —- 1 — — — Totals 4 2 4 — 3 — 2 — 2 1 It will be seen from the foregoing table that 3 Tuberculous patients died during the year, this being an increase of one on the corresponding figure for the previous year. The figures correspond to a death rate per 1,000 of population of 0 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: 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 — 2 - - - - - - 25 to 44 years 5 2 — 1 1 — — — 45 to 64 years — 1 — — 1 — — — 65 and over 1 1 - - - 1 - - Totals 6 6 — 1 2 1 — — The new cases were distributed amongst the Wards as follows: Beddington Wallington North West Cent. South North Cent. South Pulmonary 3 - 2 — 3 3 1 Non-Pulmonary - - - - - - 1 Totals 3 — 2 — 3 3 2 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 BERTRAM JOHNSON LTD. 11, Manor Road, Wallington. BERTRAM JOHNSON LTD. 11, Manor Road, Wellington.