BED 24 Library BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1959 BOROUGH OF BEDDINGTON & WALLINGTON ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the YEAR 1959 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: Registered Causes of Death 13 Cancer of the Lung and Bronchus 14 Violence and Accident 14 Maternal Mortality 14 Infantile Mortality .. 14 General Provision of Health Services for the Area: (Including Transferred Functions under the National Health Service Act, 1946). Nursing in the Home 16 Domestic Help Service 16 Care of Mothers and Young Children 16 Immunisation and Vaccination 20 School Clinics 21 Cleansing of Persons 21 Laboratory Facilities 21 Hospitals 22 Ambulance Facilities 22 Disinfection 22 Sanitary Circumstances of the Area: Water Supplies 23 Drainage and Sewerage 23 Rivers and Streams .. 23 Closet Accommodation 23 Public Cleansing 23 3 Report of the Chief Public Health Inspector for the Year 1959: Housing 24 Milk and Dairies 24 Ice Cream 25 Slaughterhouses 26 Food Premises 26 Food and Drugs Act, 1955 27 Food Hygiene Regulations 1955 27 Unsound Food 27 Unsatisfactory Samples 29 Factories Act, 1937 30 Bakehouses 31 Workplaces, Shops and Offices 31 Complaints 32 Infectious Disease and Disinfection 32 Offensive Trades 32 Clean Air Act, 1956 32 Rats and Mice 35 Notices 36 Sanitary Improvements 36 Summary of work done during the year 38 Swimming Bath 39 Schools 40 Outbreaks of Food Poisoning and Clean Food Campaign 41 Nutrition 41 Shell Fish (Molluscan) 41 Adoptive Acts and Bye-Laws 42 Prevalence and Control over Infectious and other Diseases: Notifiable Diseases (other than Tuberculosis) 43 Incidence of Infectious Diseases in Age Groups and Wards 44 Monthly Incidence of Infectious Disease 45 Tuberculosis 46 4 BOROUGH OF BEDDINGTON AND WALLINGTON PUBLIC HEALTH COMMITTEE December, 1959 Members: Councillor E. W. Harding (Chairman) Councillor F. G. H. Sivyer (Mayor) Alderman T. G. Wakley Councillor Mrs. A. R. Barty Councillor Mrs. H. Bridger Councillor S. J. Dunwoodie Councillor A. G. Greenhead Councillor H. Haydon Councillor E. W. Popplestone Councillor Mrs. J. L. K. Thurston REPRESENTATIVES ON MID-EASTERN DIVISIONAL HEALTH SUB-COMMITTEE December, 1959 Members: Alderman D. H. de Voil Alderman H. Rennison Councillor Mrs. A. R. Barty Councillor Mrs. H. Bridger Councillor E. W. Popplestone REPRESENTATIVES ON THE WANDLE VALLEY JOINT SEWERAGE BOARD December, 1959 Members: Councillor F. G. H. Sivyer (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.l. Additional Public Health Inspectors: (a.b.) D. A. Eves, M.A.P.H.l. (a.) V. L. Lerigo, A.R.S.H., M.A.P.H.l. (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) Mrs. L. A. Capon C. I. Phillips Miss M. Edmonston 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. Maureen Adams, M.B., B.S., M.R.C.S., L.R.C.P. Norah G. Johns, 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 (Resigned 31.8.59) 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: Mrs. L. A. Capon Mrs. J. F. Smith Mrs. I. M. Kingsley (School Health) Mrs. M. Meadows (Part Time) Mrs. M. J. Osborne (Part Time) 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 1959. The report is drawn up in accordance with the suggestions made by the Minister of Health in his Circular 1/60. 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 Services 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 1959 is 32,250, and this figure is used in the compilation of the vital statistics. The figure shows a decrease of 140 compared with the Registrar-General's estimate for mid-year 1958. The census of population taken in 1951 was 32,751. The birth rate per 1,000 total population shows an increase at 14.16 in 1959, as compared with 12.97 in 1958. This rate is below that for England and Wales, which is 16.50. The stillbirth rate per 1,000 total births is 6.91, compared with 31.48 in 1958. This is lower than that for England and Wales, which is recorded as 21-00. The number of children stillborn in the district was 3, out of a total of 434 births, as compared with 13 in 1958 out of 413 births. This exceptionally low stillbirth rate will be noted with considerable satisfaction. The number of children stillborn, at 3, was the lowest we have yet recorded in this district. It is doubtful whether such a low figure as 6.91 of stillbirths, has ever been recorded elsewhere. The death rate from all causes per 1,000 total population is 9.92, compared with 9.81 in 1958 and 11.60 for England and Wales. Of the 333 deaths, diseases of the heart accounted for 86 (25.83 per cent of total deaths), cancer 80 (24.02 per cent of total deaths), and tuberculosis 3 (0.90 per cent of total deaths). It will be noted that the deaths from cancer have risen from 64 in 1958, to 80 in 1959. The distribution of growth in the cases affected, showed a generalised increase, and could not be allocated to any specific system of the body. 7 Diseases of the heart and circulatory system in 1959 continued to account for a very high proportion of total deaths. There were 47 deaths from coronary disease, as compared with 65 in 1958. 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. Three deaths were recorded from motor vehicle accidents, being one more than in 1958. All other accidents accounted for 5 deaths, compared with 8 in 1958. Suicides totalled 4 cases, compared with 2 in 1958. During the year, a Home Safety Committee was set up and put in a good deal of work in disseminating information concerning common accidents in the home. This Committee works in close association with the Road Safety Committee, whose excellent work was continued throughout the year. No mothers died in childbirth during 1959, and this gives a maternal mortality rate per 1,000 total births of nil, as compared with 0-38 for England and Wales. The infantile mortality rate shows an increase at 18.56 per 1,000 live births, as compared with 7.50 in 1958. Eight infants died under the age of 1 year in 1959 out of 431 live births. On page 15 will be found an analysis of the causes of death. When we recorded an infantile mortality rate of 7.50 in 1958, this was thought to be the lowest infantile mortality rate for any district. The figures, however, with which we deal in a Borough the size of Beddington and Wallington, are so small as to rob such a statement of much of its importance. This is clearly borne out by the infantile mortality rate quoted for 1959, at 18.56. An increase in the number of infants that have died, from 3 to 8, increases the mortality rate from 7.50 to 18.56 per 1,000 live births. The incidence of infectious disease generally throughout the year, has been low, with the exception of measles, 491 cases of this disease being notified in 1959. Scarlet fever, with 73 notified cases, was next in the order of incidence. Ten cases of whooping cough were notified during the year. Immunisation against whooping cough is practised on as wide a scale as possible, the immunising material being contained in the injection given for immunisation against diphtheria. The fact that we still record even a small number of cases of whooping cough, indicates that parents are not availing themselves of all the opportunities given to them for immunisation. The attention of parents, and all those having the care of children, should be drawn to these figures; if one hundred per cent of immunisation against whooping cough could be achieved, one feels that the number of notified cases should be reduced even further. 8 Most of the cases of infectious disease were nursed at home, but it was found necessary to remove 18 cases of scarlet fever, and 1 case of measles, to hospital, to ensure adequate isolation. There were no cases of poliomyelitis notified during the year. On page 21 will be found information concerning the campaign for immunisation against poliomyelitis. Immunisation was available in 1959 for children and young persons born between 1933 and 1959, expectant mothers, and recognised medical services. It is satisfactory to note that very many more people availed themselves of the immunisation procedure offered by the government. By the end of the year 8,157 persons had received two injections against poliomyelitis, and 6,241 a third injection. For the eleventh 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. The care of the aged was again, in 1959, a major part of the social work of the department. The Home Help Service continued to give considerable alleviation in the homes of the aged, and prevented many cases from being removed, to hospital. A close liaison exists with the Geriatric department of St. Helier Hospital, and also with the W.V.S., the latter having continued throughout the year, the Meals on Wheels Service. This proved very beneficial in maintaining standards of nutrition for old people, many of whom are unable to cook for themselves. An expansion of the scheme took place in September, 1959, when a Luncheon Club for the aged was opened on one day a week at the Baptist Church Hall, Queen's Road. This venture has proved very successful, and caters on an average for 40 old age pensioners. During the year, the local Council commenced a project in Maldon Road, for providing self-contained one-room flatlets, in a large house they acquired. It is hoped that this will be completed in 1960, and provide accommodation for 10 old people. An event took place in January of this year, of considerable importance to the health services in the Borough. I refer to the disastrous fire at the Grange Mansion, London Road, Hackbridge, on the night of January 9/10th. Although this fire took place in 1960, it was at the beginning of the year, and so close to 1959, as to make comment more valuable in this report, than in the report on 1960. As a result of the fire, new clinic facilities for school children, and children below the age of five years, as well as nursing and expectant mothers, had to be provided immediately. The following services were dealt with:— 9 Physiotherapy:—This service is temporarily accommodated at the Nurses' Home, 57 Montagu Gardens, Wallington. Every endeavour has been made to make the scope of the service as complete as it was at the Grange. This includes the provision of an ultra-violet lamp and facilities for remedial exercises. Relaxation exercises for expectant mothers, combined with talks and demonstrations on mothercraft, are also continued. School Medical Clinic:—This service is, at present, conducted in the clinic half of the Nurses' Home in Montagu Gardens. Clinics are held here every morning, except Wednesdays. A doctor is in attendance on Tuesdays and Thursdays and sees special cases by appointment. Dental Clinic:—Temporary accommodation, with new equipment, has been provided at the Rochester Road Clinic and the Dental Surgeon is continuing to follow up and accept new cases, as far as possible, here. The distance, of course, means that full acceptance of the service is at present limited. Orthodontic Service:—This service, too, is being accommodated in the Dental Department at the Rochester Road Clinic. Speech Therapy:—Mrs. Collins, the Speech Therapist, is temporarily accommodated in the Medical Inspection Room at the Holy Trinity School in Bute Road. This arrangement is operating satisfactorily at present. One further result of the disaster, was the speeding up of a project, which had been considered since 1956 by both the Surrey County Council, and the Borough of Beddington and Wallington, for providing clinic facilities on a site known as "Filstone", 59 Woodcote Road, Wallington. This project had not been given priority before the fire at the Grange, but is being actively pursued in 1960, and it is hoped to commence work on the clinic in 1961, with a view to opening in 1962. 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, 1960. 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 1959 32,250 Number of inhabited houses, 1931 7,092 Number of inhabited houses, 1959 10,224 Rateable Value £718,292 Sum represented by penny rate £2,900 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. 11 EXTRACTS FROM VITAL STATISTICS Resident Population—Estimated mid-year 1959 : 32,250 Live Births Males Females Total Legitimate 224 197 421 Illegitimate 4 6 10 228 203 431 Live Birth Rate per 1,000 population 13.36 Adjusted Birth Rate 14.16 England and Wales Live Birth Rate 16.50 Illegitimate Live Births per cent of total Live Births 2.32 Still Births Legitimate 3 — 3 Illegitimate — — — 3 — 3 Rate per 1,000 total Live and Stillbirths 6-91 England and Wales Stillbirth Rate 21*00 Total Live and Stillbirths Legitimate 227 197 424 Illegitimate 4 6 10 231 203 434 Deaths 168 165 333 (i) Death Rate per 1,000 population 10.33 Adjusted Death Rate 9.92 England and Wales Death Rate 11.60 (ii) Infant Deaths—under 1 year of age Total No. of Deaths 8 Infant Mortality Rate per 1,000 Live Births .. 18-56 Infant Mortality Rate per 1,000 Live Births: Legitimate .. 19-00 Illegitimate .. Nil Infant Mortality Rate for England and Wales 22*20 Neo Natal Mortality Rate per 1,000 Live Births 11*60 (Under 4 weeks of age) Early Neo-nata1 Mortality Rate per 1,000 Live Births 11.60 (Deaths under 1 week) Peri-natal Mortality Rate per 1,000 Live and Stillbirths 18.43 (Stillbirths and deaths under 1 week) (iii) Maternal Deaths (including abortion) total Nil Maternal Mortality Rate per 1,000 Live and Stillbirths Nil England and Wales Maternal Mortality Rate 0.38 12 REGISTERED CAUSES OF DEATH The following table, supplied by the Registrar-General, gives the causes of death of residents in the Borough during 1959: Causes of Death Males Females Total All Causes 168 165 333 1 Tuberculosis, respiratory 2 — 2 2. Tuberculosis, other 1 — 1 3. Syphilitic disease — — — 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — — — 7 Acute poliomyelitis — — — 8 Measles — — — 9. Other infective and parasitic diseases — 2 2 10 Malignant neoplasm, stomach 10 5 15 11. Malignant neoplasm, lung, bronchus 15 2 17 12. Malignant neoplasm, breast — 6 6 13. Malignant neoplasm, uterus — 4 4 14. Other malignant and lymphatic neoplasms 16 22 38 15. Leukaemia, aleukasmia — 1 1 16. Diabetes — 2 2 17. Vascular lesions of nervous system 20 37 57 18. Coronary disease, angina 27 20 47 19. Hypertension with heart disease 2 4 6 20. Other heart diseases 12 21 33 21. Other circulatory diseases 11 6 17 22. Influenza 8 — 8 23 Pneumonia 5 13 18 24. Bronchitis 11 2 13 25. Other diseases of respiratory system 1 2 3 26. Ulcer of stomach and duodenum — 1 1 27. Gastritis, enteritis and diarrhoea - — - 28. Nephritis and nephrosis 1 1 2 29. Hyperplasia of prostate 6 — 6 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 3 — 3 32. Other defined and ill-defined diseases 9 10 19 33. Motor vehicle accidents 2 1 3 34 All other accidents 3 2 5 35. Suicide 3 1 4 36. Homicide and operations of war — — — 13 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 86 25.83 Other Diseases of the Circulatory System 17 5.10 Vascular Lesions of Nervous System 57 17.12 Cancer 80 24.02 Bronchitis 13 3.90 Pneumonia 18 5.40 Influenza 8 2.40 Tuberculosis (All Forms) 3 0.90 Cancer of the Lung and Bronchus Males Females Total Number of deaths in 1959 15 2 17 Rate per 1,000 population 0.53 England and Wales Rate 0.46 VIOLENCE AND ACCIDENT Details of all deaths under this heading are as follows: Cause of Death Male Female Total Suicide 3 1 4 Other Violent Causes 5 3 8 Totals 8 4 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 0.38. INFANTILE MORTALITY The infantile mortality rate for 1959 was 18.56 per 1,000 live births. The comparable rate for England and Wales is 22.2. Great credit is due to the services operated in the Borough for the care of mothers and young children. Of the total of 431 live births, only 8 deaths of infants under one year of age (5 males and 3 females) were registered. 14 The following table gives the age and cause of death of each infant who died: Age Sex Cause of Death 3 hours M Atelectasis, Prematurity 6 hours M Prematurity 19 hours F Non-viability, gross-prematurity 24 hours M Atelectasis and prematurity 37 hours F Cerebral haemorrhage 4 weeks M Uraemia, Septicaemia, Wound infection 7 weeks M Broncho-pneumonia, Multiple congenital deformities, Hydrocephalus, Meningomycocele 9 months F Acute pneumococcal pneumonia 15 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, 57 Montagu Gardens, 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 884 cases, including 116 maternity and midwifery patients. A total of 22,343 visits was made. As pointed out in the preface, since the destruction of Grange Mansion, the school health service has been housed in the Nurses Home, and in addition, physiotherapy, and ante-natal relaxation exercises are carried out on the premises. 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 48 Chronic Sick (including aged and infirm) 175 Acute Sick 62 Tuberculosis 2 287 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, 132 women made 487 pre-natal attendances. This represents an attendance of 30.41 per cent of the total number of confinements which occurred during 1959. Post-natal examinations were also conducted at this clinic, 14 patients making 14 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. 16 Institutional Confinements. Three hundred and fourteen or 72.35 per cent, of births allocated to this district, took place in hospitals and nursing homes, compared with 73.1 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. All Saints Church Hall, New 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, Every Wednesday, 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. Physiotherapy Clinic, By appointment. 57 Montagu Gardens. Dental Clinic, Rochester Road, Carshalton. 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. 17 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 349 5,101 Children, 1-5 years 836 3,046 Total attendances .. 1,185 8,147 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. During the year under review, difficulty was experienced in maintaining the establishment of four health visitors. Following the resignation of one health visitor, to take up a senior appointment, no candidates came forward for a period of four months in response to repeated advertisements. In addition, one health visitor had a long period of sickness. Visits during the year were made as follows: First visits Total visits Expectant Mothers 217 399 Children, 0-1 year 452 1,913 Children, 1-5 years — 2,946 Other Cases — 28 Ineffectual — 628 669 5,914 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 1959. Equipment is kept at the District Nurses' Home, the headquarters of the local Midwives, where it is ready for immediate use when required. Twenty-five premature live births were notified during the year, 23 of which occurred in hospital. Two of the infants died within 24 hours of birth. One infant died before the 28th day. The remaining 22 children survived. 18 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. Fifty-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 15 Tonsils and adenoids 11 Orthopedic defects 7 Naevi and skin conditions 11 Circumcisions 4 Hernia 2 Dental. The year's work at the Grange Dental Clinic, which provided for school children and children below the age of five years, as well as nursing and expectant mothers, is summarised in the following table: No. of Cases Extractions Fillings Scaling & Gum Treatment Provision of Dentures Full Partial Expectant and Nursing Mothers 8 3 57 6 1 Children, 0-5 43 17 98 — — — Totals 51 20 155 6 — 1 As has been pointed out elsewhere, this service is now accomodated at Rochester Road, Carshalton, and will continue on these premises until the County Council's new clinic project is ready. Orthopaedic. Patients attending infant welfare centres who require treatment for orthopaedic defects are referred by the Clinic Medical Officer to orthopædic surgeons at St. Helier or other hospitals. During 1959, 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 continued to arrange classes for pregnant mothers desiring a course of relaxation exercises. 19 The following table gives details of attendances: Total attendances Irradiations Corrective treatments Children, 0-5 years 849 446 Children, 5-15 years 1,288 2,023 Expectant and Nursing Mothers 34 531 2,171 3,000 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., 1959 1,800 4,500 6,300 Number of children known to be immunised at 31st Dec., 1959 1,212 4,358 5,570 Percentage of children immunised 67.2 96.8 88.4 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, 333 children were immunised at County Council clinics or by their general practitioner. Tetanus Immunisation Children are immunised against Tetanus at County Council clinics, or by their general practitioner. During 1959, 171 children completed a primary course and 4 children received a reinforcing dose. 20 Poliomyelitis The Poliomyelitis vaccination scheme, introduced in January 1956 continued, within the prescribed age groups, throughout 1959. The following is a summary of the persons who had been vaccinated by the end of the year: Two Injections Three Injections Children born 1943—1959 6420 5444 Young persons born 1933—1942 1324 561 Expectant Mothers 353 207 General Practitioner and Ambulance Staff 60 29 8157 6241 It will be noticed from the above table, that very many more injections have been given during the year. The response within the age groups specified has increased, and it is to be hoped soon, that no young person will pass into adult life without having had these injections, either in infancy or during school life. 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 continued to be conducted at The Grange Mansion, Wallington, Rochester Road and Phoenix Flats, Carshalton. The services provided at these clinics were general medical inspection and treatment, dental treatment, speech therapy and physiotherapy. Cleansing of Persons During 1959 the Corporation continued to provide facilities for cleansing infested persons. During the year, the Corporation designed a new Public Lavatory, situated in London Road, in the grounds of the Grange Park. As the destruction of the old premises on which the lavatory was constructed, involved the pulling down of the Cleansing Station, a new Cleansing Station was incorporated in the new buildings. The whole scheme was completed, and the building opened in 1959. 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 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 1959, H. Amphlett Williams, Esq., Ph.D.(Lond.), A.C.G.F.C., F.R.T.C, Public Analyst, 1 Southwark Street, S.E.1, continued the arrangement made in 1946 for the examination of milk, water and ice-cream. 21 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. 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. 22 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 152 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 During the year under review, the Borough Surveyor was able to continue refuse collection on a weekly basis. 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. 23 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, 1959 HOUSING One hundred and fifty-nine houses were rendered fit as a result of informal or statutory action under the Public Health Act, 1936. Ten applications were received for Certificates of Disrepair (Rent Act, 1957). Ten notices of intention to issue Certificates of Disrepair were sent out. Four Certificates of Disrepair were issued. Number of inspections of dwelling-houses .. .. 477 Number of inspections recorded under Housing Regulations .. 36 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 4 Number of families dwelling therein 4 Number of persons dwelling therein 21 Number of new cases of overcrowding reported .. 2 Number of cases of overcrowding relieved .. 2 Number of persons concerned 8 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 5 24 Number of licences issued under Milk (Special Designation) Regulations: Tuberculin Tested Milk—Dealers' Licences 9 „ „ „ Supplementary Licences 16 Pasteurised Milk—Dealers' Licences 9 „ „ Supplementary Licences 16 Sterilized Milk—Dealers' Licences 11 „ „ Supplementary Licences 17 — 78 BACTERIOLOGICAL EXAMINATION OF MILK One hundred and one 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 66 66 — 66 — — — T.T. Pasteurized 15 15 — 15 — — — Sterilized 13 — — — — 13 — Tuberculin Tested (Farm Bottled) 7 7 — — — — — Six samples of Tuberculin Tested milk were submitted for biological examination - Tubercle bacilli were not isolated. CHEMICAL ANALYSES OF MILK Twenty samples of milk were submitted to the Public Analyst. All were reported genuine. The average composition was as follows: Fat % 3.68 Solids-not-fat % 8.64 Total Solids % 12.32 The samples included three of Channel Island Milk. The average composition of these samples was as follows: Fat % 4.5 Solids-not-fat % 8.9 Total Solids % 13.4 ICE CREAM Number of premises registered for the sale of ice cream 99 Number of manufacturers Nil Number of inspections of premises 28 25 Twenty-two 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 22 22 — — — Three samples of Ice lolly were submitted for bacteriological examination and passed the tests applied to them. 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 474 FOOD PREMISES IN THE DISTRICT Bakers 13 Butchers 25 Catering Establishments 84 Chemists 10 Confectioners (sweets) 44 Fishmongers (including friers) 10 Greengrocers 27 Grocers 67 Licensed Premises 11 Bakehouses 5 Food Factories 4 FOOD PREMISES REGISTERED UNDER SECTION 16 OF THE FOOD & DRUGS ACT, 1955 Sausage manufacturers 26 Fish friers 6 Jam manufacturers 1 Ice cream (sale only) 99 26 FOOD AND DRUGS ACT, 1955 Food Hygiene Regulations, 1955 The revisiting of food premises continued during 1959. The type of premises visited and number of inspections are set out below: Bakers 37 Butchers 53 Catering Premises 104 Confectioners (sugar) 35 Fishmongers 30 Greengrocers 23 Grocers 93 Milk Shops 5 Registered Premises 104 Other Food Premises 60 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. Fish, canned 2 Fish 101 Fruit, canned 77 Meat and Offal 151 Meat, canned 129 Milk, canned 168 Pickle 3 Preserves 24 Soup, canned 2 Vegetables, canned 21 Total 678 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 City of London Laboratories, King's Head Yard, Borough High Street, London, S.E.I, is Public Analyst for the Borough. 27 FOOD ANALYSES The following table gives details of samples submitted for analysis during the year: Totals 1959 Articles No. Examined Adulterated Prosecu tions Convic tions Formal. Informal Total Formal Informal Total Ale & Stout 2 1 3 - - - - - Baby Food, (canned) — 1 1 - - - - - Baking powder 1 — 1 - - - - - Beverage 1 — 1 - - - - - Biscuits — 1 1 - - - - - Bread — 9 9 - 5 5 1 1 Butter — 1 1 - - - - - Cake Mixture — 3 3 - - - - - Coffee — 2 2 - - - - - Confectionery: Flour 1 — 1 - - - - - Sugar 1 2 3 - - - - - Drink, soft 3 — 3 - - - - - Fish paste.. — 1 1 - - - - - Fruit, canned (pears) — 1 1 - - - - - Fruit, glace (cherries) — 1 1 - - - - - Fruit pie (apricot) — 1 1 — 1 1 — — Gin 1 — 1 - - - - - Ginger, crystallised — 1 1 - - - - - Gravy preparation — 1 1 - - - - - Ice cream 2 — 2 - - - - - Ice lolly — 1 1 - - - - - Jam — 4 4 - - - - - Jelly tablet — 2 2 - - - - - Margarine 1 — 1 — — — — — Marmalade 1 — 1 - - - - - Meat products 5 — 5 - - - - - Meat products, canned 2 4 6 - - - - - Milk 10 10 20 — 1 1 — — Mincemeat — 2 2 - - - - - Oats, breakfast 1 — 1 - - - - - Proprietary food (Groats) 1 — 1 — — — — — Proprietary Medicine (Beechams powders) - 1 1 - - - - - Puddings — 5 5 - - - - - R ice — 1 1 - - - - - Rum 1 — 1 - - - - - Salad cream — 1 1 - - - - - Sauce — 4 4 - - - - - Sausage rolls 1 — 1 - - - — — Sausages 3 4 7 1 - 1 — — Stuffing mixture — 1 1 — - — — — Sugar — 1 1 - - - - - Tea 1 1 2 - - - - - Tomatoes, Canned — 1 1 - - - - - Tomato juice cocktail 1 — 1 — - — — — Vinegar (malt) 2 — 2 - - - - - Whisky 2 — 2 - - - - - Wine, alcoholic 1 - 1 - - - - - Total 45 69 114 1 7 8 1 1 28 UNSATISFACTORY SAMPLES Informal Sample No. 6—Bread The bread contained small masses of foreign matter. This was composed of "fluff," i.e. matted fibres of vegetable and animal origin, some of which were dyed. A warning letter was sent to the manufacturer. Formal Sample No. 12—Preserved Pork Sausages The sausages contained 62% meat. Pork sausages ordinarily contain at least 65% of meat. A warning letter was sent to the manufacturer. Informal Sample No. 30—Cut and Wrapped Brown Loaf The bread contained several small masses of a grey substance, which was found to consist of baked dough discoloured by burnt flour and containing some woody particles and jute fibres. The manufacturer was prosecuted. A fine of £10 was imposed with 5 guineas costs. Informal Sample No. 35—Bread Roll The bread roll contained a number of charred jute fibres forming a broken line across the bottom crust, probably due to the presence of a piece of string under the dough when baking. A letter was sent to the manufacturer whose explanation was accepted. Informal Sample No. 36—Bread Roll The side of the roll was blackened by a deposit of charred bread. A letter was sent to the manufacturer whose explanation was accepted. Informal Sample No. 67—Channel Islands Milk The sample contained fat 3.45%, solids-not-fat, 8.84%. The milk submitted had been the subject of a complaint that it had a salt taste. No abnormal constituent was found and the salt was within the natural range. Channel Islands Milk should contain at least 4% of milk-fat, but it is not known whether the fat content had suffered any reduction after sale. A further sample was obtained from the same retailer and submitted for analysis on the following day. This sample satisfied the standard for Channel Islands Milk. Informal Sample No. 73—Fruit Pie (Apricot) The sample contained embedded in the apricot filling, a small steel turning weighing 2 grains. A warning letter was sent to the manufacturer. Informal Sample No. 89—Bread Roll (Buttered with Cheese) The sample contained a dead fly adhering to the crust at the bottom of the roll. It was decided to take no action in relation to this sample, which was submitted as the result of a complaint, in the absence of evidence as to the stage at which the fly came into contact with the roll. 29 FACTORIES ACT, 1937 The following tables give details of inspections made and defects found: Part I of the Act Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises (1) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3,4 and 6 are to be enforced by Local Authorities 5 6 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 159 144 7 - (ili) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 6 6 Total 170 156 7 — 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) Stuffed toys 3 — — — — — Total 3 — — — — — 30 Cases in which Defects were found Particulars (1) Number of cases in which defects were found 1 Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Refe To H.M. Inspector (4) rred By H.M. Inspector (5) Want of cleanliness (S.1) 1 1 - - - 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 - - - (b) Unsuitable or defective 8 8 - 1 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) Total 10 10 — 1 — BAKEHOUSES Number of bakehouses in district 6 Number of inspections 17 WORKPLACES, SHOPS AND OFFICES Number of inspections 233 Notices served 1 COMPLAINTS The total number of complaints received was 689. They were due to the following causes: Rats and Mice 127 Housing defects 63 Choked drains and sewers 105 Defective dustbins 68 Defective drainage (including closets) 18 Unsound or adulterated food 39 Atmospheric Pollution 34 Insect pests 179 Offensive accumulations 7 Miscellaneous 49 689 INFECTIOUS DISEASE AND DISINFECTION Number of visits re cases of infectious disease 242 Number of rooms disinfected 52 Number of library books disinfected 377 OFFENSIVE TRADES Number of offensive trade premises in district Nil CLEAN AIR ACT, 1956 SMOKE CONTROL AREAS In March 1959 the Council approved in principle the making of a Smoke Control Area comprising that part of the Borough bounded by the boundary with the Urban Districts of Carshalton and Coulsdon and Purley and by Woodcote and Heathdene Roads. At the same time it was decided that, subject to the results of experience gained in the area mentioned above and to being satisfied at each stage of the programme that the necessary quantities of suitable smokeless fuels would be available, to inform the Minister of Housing and Local Government that the Council proposed to include the whole Borough in Smoke Control Areas and that they proposed to do so over a period of ten years. Following the approval in principle of the Minister a survey of the first area was completed during the year by the Public Health Inspectors. In October the Council declared a Smoke Control Order in respect of this part of the Borough subject to the approval of the Minister. Information obtained during the survey is summarised below. In November 1959, following a survey of 191 buildings in the area, the Minister was asked to approve in principle the making of a Smoke Control Order comprising the area bounded by the County Borough of Croydon and the Urban District of Coulsdon and Purley and by Woodcote Road, Sandy Lane South and Stafford Road. This area adjoins an area in the County Borough of Croydon to which a Smoke Control Order applies. The survey of the buildings was commenced during the year. 32 SUMMARY Total number of dwellings 359 (including dwellings built since July, 19561 Industrial premises Nil Commercial and other premises 3 Present annual tonnage of bituminous coal and other smoky fuels 354 tons Estimated additional fuels required annually: (1) Electricity 16,000 kws. (2) Gas 3,000 therms. (3) Oil etc. .. Nil (4) Solid smokeless fuel (open fires) 274 tons (5) Solid smokeless fuel (stoves and boilers) 6 tons Schedule of Estimated Costs of Adapting and Replacing Fireplaces Number of existing appliances requiring replacement or adaptation (appliances in regular use only): (1) Open fires 297 (including new properties) (2) Open fires with boilers 4 (3) Combination grates and solid fuel cookers Nil (without boilers) (4) Combination grates and solid fuel cookers 1 (with boilers) (5) Washboilers Nil Numbers and costs of new appliances required: New Appliances Open Fires Gas or Electric Fires Open Fires with Boilers Other Appliances Totals No. of Appliances 220 8 3 5 236 Total Cost of Appliances £1.259 £73 £17 £94 £1,443 Range of cost per appliance £4—£30 £4—£13 £5-10-0 £13—£24 — Total cost of other works attributable to installation of new appliances £1,042 £25 £29 £35 £1,131 33 Cost of other work not attributable to installation of new appliances: Adaptation of Existing Appliances Provision of Gas and Electric Points No. of Appliancee Total cost No. of points Total cost £185 31 £104 INDUSTRIAL PREMISES During the year observations were made on the chimneys of Industrial premises. It is felt that since the Clean Air Act was passed a considerable improvement has been effected, both from the point of view of the density of smoke and the periods of emission of smoke, from the chimneys of this class of buildings. The Public Health Inspectors advised when consulted, on the heights of new chimneys and new furnaces to be installed. Number of visits made in relation to Smoke Control Areas 924 Number of observations of Industrial chimneys 181 Number of contraventions 2 34 Prevention of Damage by Pests Act, 1949 Report for 12 months ending 31st December, 1959 Type of Property Local Authority Dwelling Houses Business (& other premises) Total Agricultural Number of Properties in Local Authority's district 37 10,192 1,456 11,685 33 Number of inspections as a result of: (a) Notification 2 99 24 125 — (b) Survey under the Act ... 271 149 284 704 66 (c) Primarily for some other purpose 11 524 878 1,413 51 Properties found to shew major rat infestations — — — — — Properties found to shew minor rat infestations 26 81 21 128 1 Properties found to shew major mice infestations — — — — — Properties found to shew minor mice infestations — 18 12 30 — Total Infestations 26 99 33 158 1 SEWER RAT CONTROL During the year, two maintenance treatments were carried out. These were in the months of February, and May. The results are summarised below: February Treatment May Treatment Manholes baited 90 19 Manholes in which takes were recorded 20 Percentage of manholes showing infestations 22 — 65 manholes were test baited during May and 28 in August. No takes were recorded. 35 NOTICES Number of informal notices served (including verbal intimations) 162 Number of statutory notices served Public Health Act, 1936—Section 93 (Nuisances) 20 —Section 39 (Drainage) 2 —Section 45 (Water closets) 1 —Section 24 (Drainage) 8 Prevention of Damage by Pests Act, 1949—Section 4 1 — 32 SANITARY IMPROVEMENTS (1) Dwelling Houses Brickwork repaired or repointed ... .. 31 Ceilings— Repaired, renewed or cleansed 20 Chimneys— Stacks and flues repaired 15 Dampness remedied— (a) Roofs repaired 30 (b) Damp-proofing works 33 (c) Gutters and rainwater pipes repaired and unstopped 40 Doors—repaired or renewed 18 Drainage— (a) Obstructions cleared 60 (b) Repaired and relaid 20 (c) Inspection chambers provided and repaired 5 (d) F.A.I. provided, etc. 3 (ie) Waste-pipes repaired and renewed 14 (/) Rainwater drainage provided, repaired or renewed 11 Dustbins provided 76 Fireplaces and stoves repaired or renewed 3 Floors— (a) Repaired or renewed 27 (b) Ventilation provided or improved 2 Sinks renewed, etc. 9 Stairs— Repaired or renewed 1 Walls- (a) Repaired or rebuilt 74 (b) Plaster repaired and redecorated 33 Water supply— Pipes repaired or renewed 3 36 W.C. Accommodation— (a) Cisterns repaired or renewed 6 (b) Flush pipe joint repaired 2 (c) Pans provided or replaced 3 (d) Seats repaired or renewed 6 (e) Structural repairs 13 Windows— (a) Frames and sashes repaired or renewed 54 (b) Sashcords and beading renewed 50 (c) Glazing and putties renewed 17 (d) Cills repaired 21 Yard paving repaired or renewed 6 Other Sanitary improvements 50 (2) Factories Cleansed 1 Sanitary Accommodation— Provided 1 Improved 8 Redecorated 1 Artificial lighting 1 Other Improvements 9 (3) Food Premises Fittings & equipment improved 3 Protection for food stuff provided 1 Displays improved 5 Sanitary accommodation improved 4 Sanitary notices provided 1 Water supplies improved 1 Ablution facilities provided or improved 4 First aid equipment provided 1 Sinks and hot water provided 4 Premises repaired 5 Cleaned and redecorated 16 Lighting and ventilation improved 2 Flooring improved 11 Yards paved 1 Other unsatisfactory conditions remedied 11 (4) Shops Repairs and redecoration 3 Forms exhibited 3 37 SUMMARY OF WORK DONE DURING THE YEAR Number of inspections of dwelling-houses 524 Number of re-inspections of premises 739 Number of visits to work in progress 80 Number of miscellaneous visits and inspections 209 Number of visits to food premises 474 Number of visits to factories 150 Number of visits to shops, offices and workplaces 233 Number of visits to watercress beds, smallholdings, etc. 40 Number of inspections of public conveniences 21 Number of visits to piggeries 11 Number of visits re infectious diseases 242 Number of visits re insect pests 70 Number of inspections re rats and mice 2808 Number of sewer manholes treated 202 Number of visits to streams 25 Number of visits re clean air 1105 Number of inspections of swimming bath 11 Number of complaints received and investigated 680 Number of informal notices served 162 Number of statutory notices served 32 Number of interviews re nuisances, etc. 304 Number of visits re drainage 677 Number of drains tested 77 Number of drainage obstructions cleared 68 Number of rooms disinfected 52 Number of lots of bedding and clothing disinfected 55 Number of library books disinfected.. 377 Number of samples of foodstuffs, water, etc., taken for examination 418 Number of visits re food and other samples 370 Number of visits to premises used for the storage of Petroleum Spirit 93 H. G. CRIPPS, Chief Public Health Inspector. 38 SWIMMING BATH The Corporation rented from the Surrey County Council (for the 1959 Summer season) the open-air swimming bath situated in the grounds of what was formerly the Royal Female Orphanage, now the Carew Manor School. Sessions are arranged for the general public, school children, and youth organisations in the Borough. During the 1959 season, which covered a period of 18 weeks, the following attendances were recorded: Youth organisations 3,860 School children 7,083 Season Ticket Holders, etc. Adults 24,371 Children 6,000 Total 41,314 The bath is now quite old, and the work of maintenance becomes increasingly difficult. Such remedial work as is required to keep it going, is being done by the Surrey County Council, who have been responsible for the maintenance of the Bath, since they acquired it. Considerable enterprise is being shown in the provision of swimming pools constructed in school grounds, for school children, to give them an opportunity to learn to swim. Financial arrangements are usually based on a grant of fifty per cent of the cost, from the Education Authority, the remainder being raised by public subscription. This is a very desirable additional amenity for school children, but interest and enthusiasm should not be allowed to obscure the dangers associated with public swimming baths. One safeguard, which must be watched in this connection, concerns the standard of purity of the water. The County Medical Officer has already drawn the attention of the County Council to this need and a model system of standards has been issued, which, it is hoped, will be followed throughout the County. The need for adequate filtration and chlorination cannot be over emphasized, if such an attractive plan is not to encourage the spread of infectious disease. The Minister of Health has also shown considerable interest in swimming bath development, and this year, in his Circular 1 /60, has asked for a paragraph describing the public swimming baths in the district, the source of the water used for filling, the method of treatment and the frequency or changing the water together with commentary on bacteriological examinations, The water supply for the Carew Manor School Swimming Bath is drawn from a well sunk in the grounds of the institution. After filling up, the water is only topped up, and complete emptying of the bath does not take place during the whole of the season. Chlorination is by means of a chlorine gas injector; the standard of chlorination maintained is 0.7 parts per million in the shallow end, and 0.4 parts per million in the middle of the bath. Filtration is carried out by pressure through a sand filter. Samples of the swimming bath water are submitted for bacteriological examination throughout the season. Those submitted in 1959 (14), were returned as bacteriologically sterile. 39 Owing to growths of algae in the deep end of the bath, it was found necessary to use Liquid Chloros; as a result, the water is now reasonably free from algae. 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. In order to further the interests of hygiene, and encourage washing after the use of the toilet, all Infants' schools in the Mid-Eastern Division have now been provided with a constant hot water supply to the taps supplying the wash basins in the school cloak rooms. 40 OUTBREAKS OF FOOD POISONING, AND CLEAN FOOD CAMPAIGN No cases of food poisoning were notified during the year. During the year, one prosecution was brought against a baker, for supplying a cut and wrapped brown loaf, in which was embedded small masses of greyish brown foreign matter. These were reported by the Public Analyst as baked dough, discoloured by a small quantity of burnt flour, and containing small particles of woody and jute fibres. A fine was imposed by the Wallington magistrates, before whom the case was brought, of £10; five guineas costs, and the Public Analyst's fee of £2 10s. Od. 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. 41 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. 42 PREVALENCE AND CONTROL OVER INFECTIOUS AND OTHER DISEASES The following table shows the incidence of infectious disease in th Borough in 1959, the number of cases removed to hospital and th number of deaths attributed to these diseases, excluding Tuberculosis Disease Number Notified Removed to Hospital Deaths Scarlet Fever 73 18 Measles 491 1 - Whooping Cough 10 — Pneumonia 7 — 18* Dysentery 5 — — Erysipelas 3 Totals 589 19 18* * Includes deaths from all forms of pneumonia. f Includes deaths of residents in homes and institutions outside the Borough. 43 Cases of Infectious Disease Notified During the Year 1959 (excluding Tuberculosis) The succeeding table shows the age incidence of the diseases and the distribution throughout the Wards of the Borough of the various infections: Disease Total Number of Cases Number of Cases Notified At Ages—Years Number of Cases Notified in each Ward Cases removed to Hospital Deaths (including deaths of residents outside the Borough) Under 1 year 1 to 2 years 2 to 5 years 5 to 10 years 10 to 15 years 15 to 25 years 25 to 45 years 45 to 65 years 65 and over Beddington Wallington North West Central South North Central South Scarlet Fever 73 - - 16 44 12 1 - - - 8 16 5 6 27 9 7 18 - Measles 491 5 34 159 13 ? 1 - - 58 57 79 69 99 54 75 1 - Whooping Cough 10 1 4 4 1 - - - - 4 1 3 - - 2 - - - Pneumonia 7 - — - 1 - - 1 2 3 2 - 1 2 - 1 1 - 18* Dysentery 5 - 1 2 1 - - 1 - - - 4 - - 1 - - - - Erysipelas 3 - — — — — — - 1 2 1 - 1 — 1 — — — - Totals 589 6 35 181 327 26 3 3 3 5 73 78 89 77 128 66 78 19 18* *Includes all forms 44 The Monthly Incidence of Infectious Disease, 1959 (excluding Tuberculosis) Disease Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec.  Scarlet Fever 1 6 8 7 6 6 2 1 2 8 14 12 73 Measles 18 33 149 221 58 7 2 2 1 — — — 491 Whooping Cough — 4 — — — — — 2 4 — — — 10 Pneumonia 1 2 3 - - - - - - - - 1 7 Dysentery — — — 1 — — — 3 1 — — — 5 Erysipelas 1 - - - - 1 1 - - - - - 3 Totals 21 45 160 229 64 14 5 8 8 8 14 13 589 45 Tuberculosis There were 10 new eases notified during the year, this being a decrease of 3 on the number of cases notified in 1958. The following table gives the number of new cases notified during the past five years: New Cases 1955 1956 1957 1958 1959 M. F. M. F. M. F. M. F. M. F. Pulmonary 9 3 17 5 11 5 6 6 7 2 Non-Pulmonary — 1 — — — — 1 1 — Totals 9 4 17 5 11 5 6 7 8 2 Annual case rate per 1,000 of the estimated population: 1955 1956 1957 1958 1959 Pulmonary 0.37 0.68 0.49 0.37 0.28 Non-pulmonary 0.03 0.00 0.00 0.03 0.03 The following table gives the number of deaths from this disease during the past five years: Deaths 1955 1956 1957 1958 1959 M. F. M. F. M. F. M. F. M. F. Pulmonary 4 - 3 - 1 - 2 1 2 - Non-Pulmonary — — — — 1 — — — 1 — Totals 4 — 3 — 2 — 2 1 3 — It will be seen from the foregoing table that 3 Tuberculous patients died during the year, this being the same as 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: 46 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 3 - - - - - - - 45 to 64 years 4 - - - 1 - - - 65 and over - - 1 - 1 - 1 - Totals 7 2 1 - 2 - 1 - The new cases were distributed amongst the Wards as follows: North Beddington West Cent. South Wallington North Cent. South Pulmonary 2 1 3 1 — — 2 Non-Pulmonary 1 - - - - - - Totals 3 1 3 1 — — 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. 47 BERTRAM JOHNSON LTD. 11, Manor Road, wallington.