Cou 2 HEALTH REPORT for 1925 FOR THE Coulsdon and Purley Urban District BY THE MEDICAL OFFICER OF HEALTH. REDHILL: S. C. Jennings & Sons, Ltd., High Street and Ladbroke Road, HEALTH REPORT for 1925 FOR THE Coulsdon and Purley Urban District by the MEDICAL OFFICER OF HEALTH. REDHILL: S. C. Jennings & Sons, Ltd., High Street and Ladbroke Road, Printers. URBAN DISTRICT COUNCIL OF COULSDON & PURLEY. PUBLIC HEALTH COMMITTEE: Chairman : Dr. A. C. Lankester. Mrs. M. E. Coventry. Mr. F. W. Mitchell Mrs. J. S. Forsdyke. Mr. H. T. Morgan, J. P. Mr. C. F. Best. Mr. J. Pettengill Mr. K. V. Dolleymore. Mr. E. J. Revill. Mr. F. H. B. Ellis. Mr. W. Robinson. Mr. A. Graham-King. Mr. J. H. White. Mr. A. Maitland. MATERNITY AND CHILD WELFARE COMMITTEE : Mrs. M. F. Coventry. Miss Groome. Mrs. J. S. Forsdyke. Miss Tucker. Miss Hall. Mrs. Turner. Mrs. Tierney. Miss Webb. Mrs. Camber. Mrs. Older. REPRESENTATIVES ON THE WANDLE VALLEY JOINT HOSPITAL BOARD : Mrs. Forsdyke. Mr. H. T. Morgan, J.P. Dr. Lankester. Mr. E. J. Saunders. REPRESENTATIVES ON THE JOINT SMALL POX HOSPITAL BOARD : Mr. A. Graham-King. Mr. F. W. Mitchell. REPRESENTATIVES ON THE PURLEY WAR MEMORIAL HOSPITAL COMMITTEE : Mrs. M. F. Coventry. Mr. H. T. Morgan, J.P. STAFF: Medical Officer of Health : C. M. Fegen, D.P.H., etc. Assistant Medical Officer of Health : R. J. O. Taylor, D.P.H. (first part of year). E. C. Loudon, D.P.H. (second part of year). Sanitary Inspector : T. Payne, C.R.S.I. Assistant Sanitary Inspector : S. E. Crisp, C.R.S.I. Health Visitor: H. J. N. Andrew, C.M.B. Clerks : S. E. Crisp, C.R.S.I. Miss M. C. Bullock. STATISTICS. 1. GENERAL. Area (acres), 8,577. Population (1921), 21,493 ; (1925), 23,870. Number of inhabited houses (1921), 4,426; (1925), 5,645. Rateable Value, £292,074. Sum represented by a penny rate, £1,130. 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Births Legitimate 346 176 170 Birth-rate, 14.9 Illegitimate 11 5 6 Deaths 175 Death-rate, 7.3 Number of women dying in, or in consequence of, childbirth :— From Sepsis Nil. From other causes Nil. Deaths of infants under one year of age :— Per 1,000 legitimate births 43 Per 1,000 illegitimate births 90 Total 44 Deaths from :— Measles (all ages) Nil. Whooping Cough (all ages) 2 Diarrhoea (under 2 years) 1 Urban District Council of Coulsdon and Purley. HEALTH REPORT FOR 1925. Ladies and Gentlemen, I have much pleasure in submitting my twenty-eighth Annual Report upon the health and sanitary services of the District. The year has been a satisfactory one from the point of view of incidence of Infectious Disease, with the exception of an outbreak of Paratyphoid Fever. The Birth Rate for the year was 14.9, and the Death Rate 7.3 per thousand of population, as against 18.8 and 12.2 respectively for England and Wales. I have again to place on record the kind help and assistance I have received from the Council and all its Officers with whom my work has brought me into contact. I am, Ladies and Gentlemen, Your obedient servant, C. M. FEGEN, Medical Officer of Health. 24, London Road, West Croydon. Health Report for 1925. The Urban District of Coulsdon and Purley has an area of 8,577 acres, and is divided into five wards, viz. :—Coulsdon, Kenley, Purley, Sanderstead and Woodcote. At the time of the Census in 1921 the population was 21,493 ; while for 1924 it is estimated to be 23,870. The number of occupied houses in the District was 5,645, the number in each ward being— Coulsdon Ward 1,503 Kenley Ward 497 Purley Ward 1,596 Sanderstead Ward 1,022 Woodcote Ward 1,027 The average number of persons per house is 4.2. The number of inmates in the Institutions within the District are:— institution males females total Cane Hill Mental Hospital 915 1,455 2,370 Reedham Orphanage 185 127 312 Russell Hill Schools ... 55 197 252 Total 1,155 1,779 2,934 VITAL STATISTICS. The number of Births registered as belonging to this District was 357 (181 males and 176 females), as against 257 last year. This gives a Birth Rate of 14.9 per thousand of population, as against 11.2 last year. The Birth-rate in England and Wales was 18.3 and 18.8 respectively. The number of Births registered as being illegitimate was 11, as against 8 last year. The illegitimate rate per cent, of total births was 3.0, as against 3.1 last year. WARD. Estimated Population. Births. Birth Rates. Males. Females. Total. Coulsdon 6360 62 43 105 16.5 Kenley 2120 24 16 40 18.8 Purley 6760 27 30 57 8.4 Sanderstead 4320 19 14 33 7.6 Woodcote 4310 16 19 35 8.1 Births occurring outside District — 33 54 87 — Totals 23870 181 176 357 14.9 8 Birth-rate, Death-rate, and Analysis of Mortality during the year 1925. Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Influenza. Violence. Diarrhoea & Enteritis (under Two years) Total Deaths under One year. England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 105 County Boroughs and Great Towns, including London 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 157 Smaller Towns (1921 Adjusted Populations 20,000-50,000) 18.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 0.31 0.38 7.6 74 London 18.0 11.7 0.01 — 0.8 0.03 0.19 0.11 0.23 0.46 10.6 67 Coulsdon and Purley 14.9 7.3 0.04 0.00 0.00 0.04 0.08 0.04 0.12 0.33 2.7 44 9 deaths. The number of Deaths registered as belonging to this District was 175 (89 males and 86 females), as against 183 last year. This number excludes Deaths occurring within the District, but belonging outside, but includes those Deaths which occurred outside, but belong to this District. These latter Deaths, which numbered 66, occurred chiefly in the Infirmary and General Hospital, at Croydon, the Purley Memorial Hospital, the County Asylum at Netherne, and the Wandle Valley Joint Isolation Hospital at Beddington Corner. The mortality corresponds to a Death-rate of 7.3 per thousand of population, as against 7.4 last year. The Death-rate in England and Wales was 12.2 and 12.2 respectively. INFANTILE MORTALITY. Deaths registered as occurring in infants under one year of age numbered 16, the Infantile Mortality Rate being 44 per thousand births, as against 35 last year. The Infantile Mortality Rate for England and Wales was 75. The following Table shows the number of deaths at various ages, together with the rate per cent. of total deaths. AGE PERIODS DEATHS RATE PER CENT. OF TOTAL DEATHS Under 1 year 16 9.14 1 and under 2 2 1.14 2 „ „ 5 8 4.57 5 „ „ 15 2 1.14 15 „ „ 25 5 2.85 25 „ „ 45 20 11.42 45 „ „ 65 43 24.57 65 and over 79 45.14 It will be seen that over 45 per cent. of the deaths occurred in persons of 65 years and upwards. 10 The following Table shows the principal causes of deaths together with the rate per cent. of total deaths :— CAUSE OF DEATH NUMBER OF DEATHS RATE PER CENT. OF TOTAL DEATHS Enteric Fever 1 0.57 Scarlet Fever 1 0.57 Whooping Cough 2 1.14 Diphtheria 1 0.57 Influenza 3 1.71 Tuberculosis of Respiratory System 11 6.28 Cancer 28 15.99 Heart Disease 21 11.99 Cerebral Haemorrhage 8 4.57 Arterio Sclerosis 10 5.71 Bronchitis 7 4.00 Pneumonia 10 9.14 Other Respiratory Diseases 5 2.85 Appendicitis 4 2.28 Cirrhosis of Liver 2 1.14 Nephritis 2 1.14 Congenital Debility, etc. 12 6.85 Violence 8 4.57 INFECTIOUS DISEASE. The year 1925 has been an extremely satisfactory one from the point of view of incidence of Infectious Disease, with the exception of an outbreak of Paratyphoid Fever which occurred during the months of August, September and October. The Council, while recognising that the prevention of all diseases is a material factor in raising the general standard of health in the District, is necessarily concerned in the early diagnosis or many diseases. Such early recognition is primarily of the greatest importance to the patient ; but it is also, of course, of importance to those brought in contact with the sufferer, and therefore to the public at large. Arrangements have existed for many years whereby the medical practitioner can secure assistance for making an early diagnosis in suspicious or doubtful cases of such diseases as Diphtheria and Tuberculosis, by having swabs and sputum examined at the Wandle Valley Isolation Hospital, Beddington Corner, free of all cost. Special outfits for collecting such specimens for examination are also provided. Antitoxin, for use in suspected cases of diphtheria or suspicious throat illness, is also provided free of cost to the Medical Practitioner for his or her use pending the receipt of the result of the bacteriological examination. 11 It cannot be too strongly urged that in all cases of throat illness bacteriological examination of the throat secretions should be made at the earliest possible moment, and that pending such examination antitoxin should at once be administered. No ill result from such administration can occur in cases which are found on examination afterwards not to be diphtheria, but the time gained in cases of diphtheria by such early administration is of the very greatest importance in checking at its early stages the virulence of this disease. The earlier diphtheria is diagnosed the better it is for the patient so that adequate treatment can be given, isolation carried out, and for the prevention of any extension of this disease. Extension of the disease means not only risk of life to those attacked, but it also means increase in cost of hospital treatment for such cases. One of the largest items in the treatment of such cases is that of antitoxin, and it is not unusual for a patient sent in to the Hospital after the disease is established to cost over £5 for antitoxin alone. It is well to emphasise the fact that before the employment of antitoxin the mortality rate was over 40 per cent. of actual cases ; to-day that rate has fallen to between 4 and 5 per cent. But in these lower rates are included cases which are not recognised in their early stages as being diphtheria, and so miss early treatment. With regard to the early diagnosis of tuberculosis, here again the examination of sputum is of the utmost assistance to the Medical Practitioners, and consequently to the material advantage of the sufferers. It will be seen from the report of page 16 to what extent this valuable service is used in the District, and the Council desires that the very fullest use shall be made of the facilities so afforded for the diagnosis of certain bacterial diseases. The following are the number of cases notified during the year, together with the number removed to Hospital:— DISEASE NOTIFIED REMOVED TO HOSPITAL Scarlet Fever 35 23 Diphtheria 14 13 Erysipelas 10 2 Typhoid and Paratyphoid Fever 24 5 Penumonia 11 — Encephalitis Lethargica 1 — 12 ' Reference to Table I at the end of the Report will show :— Firstly: the number of cases notified, with ages of incidence, and the nature of the infectious disease ; Secondly: the number of cases and nature of the disease in each Ward ; Thirdly : the number of cases removed to the Isolation Hospital at Beddington Corner. Table II will show the number of cases notified since this District was constituted. SCARLET FEVER. A decrease in the number of cases of Scarlet Fever noifietd took place, there being 35 as against 58 last year. One case occurred in Russell Hill Schools. Twenty-three (65 per cent.) of the cases were removed to the Hospital. One death was registered. DIPHTHERIA. A very large decrease in the number of cases of Diphtheria occurred, there being only 14 cases as against 101 last year, and is the lowest number notified in any year since 1918. Two cases occurred in Reedham Orphanage. Thirteen, being 92.8 per cent. of the cases, were removed to the Isolation Hospital. One death occurred from this complaint during the year. During the year 103 swabs were examined at the Isolation Hospital from suspected cases in the District. TYPHOID FEVER. During the year 24 cases of Typhoid or Paratyphoid Fever notified. Of these cases 5 occurred in Cane Hill Mental Hospital, and three were definitely found to have contracted the disease away from the District. In August an outbreak of Paratyphoid Fever (B) occurred in this and neighbouring Districts. Exhaustive enquiries were made, and the source of infection pointed to a pastrycook's bakery outside the District. 13 It was found that nine out of a total staff of fifteen employed in various capacities at the shop had had symptoms similar in type, but varying in severity, such as headache, abdominal pain, and diarrhoea. Also that four members of the manager's household, living in a house not in the immediate neighbourhood of the bakery, had developed precisely similar symptoms. The almost simultaneous occurrence of cases of illness among the pastrycook's staff pointed to a common source of infection, probably through food or drink. The many alternative sources of infection might have needed further investigation, but was limited by the fact that a second group of cases had occurred at precisely the same time in the house of the manager of the shop. Investigations were made inter alia as to :— Milk Supply : enquiry showed that the milk supply was not common to all. Water Supply : this could be set aside as non-suspect. Provisions : the provisions regularly bought from the shop for the manager's house were bread, madeira cakes, small fancy cakes and veal and ham pies. The provisions consumed in common with the shop staff and the manager's house were limited to bread and meat pies, the latter of course being the more likely means of infection. Attention was thus concentrated on the meat pies, and the manner in which these might possibly have been infected. The meat pies were not prepared at the shop, but at a central bakehouse serving a number of branch shops. The pies were delivered ready-made at the shop, and sold over the counter. Briefly, the main possibilities of infection seemed to be :— Contamination of Pies at Shop by Assistants serving them. This appeared to be very unlikely the method of infection, as the occurrence of groups of cases suggested more massive infection of the interior 01 the pies. Contamination of Pies by Mice or Rats.—This arose from the fact that a bacterial virus was in regular use at the shop for the extermination of these vermin. Investigations made, however, at the Ministry of Health's laboratories showed that the bacterial virus did not correspond in cultural features with the organism isolated from the blood of the first known patient ; in other words, the bacterial virus used at the bakery was not the organism of Paratyphoid Fever B. 14 Human Source of Infection.—Unfortunately the foreman pastrycook was away on holiday at the time of the enquiry. It was found that this man was known to have had a temporary illness early in August. He had been on duty during the period in which all the confectionery so far suspected had been at the bakery, and was capable to have helped in some way in their preparation. Investigations proved that this man's history was very suggestive of an enteric group infection, and his blood gave a strongly positive reaction in regard to Paratyphoid B. This man, apart from general supervision, was personally responsible for making the paste of the veal and ham pies and during a part of August he took the unusual course of filling the pies with gelatine. He was also responsible for making the butter cream and whipped cream for various kinds of fancy cakes which had produced infection. On the return of the pastrycook from holiday, the following interesting information was yielded. For convenience, I will designate the pastrycook as A. A and Mrs. A lived in a cottage on the bakery premises and had been pastrycook for some twelve years. From the 23rd July to the 3rd August a family of relations were staying with him, and to celebrate the occasion A arranged for a large veal and ham pie to be made at the bakery on the 30th July, and together with a cream gateau, also prepared at the bakery, were eaten by Mr. and Mrs. A and five guests. Two of them developed abdominal symptoms on the third day, and two on the fourth day. A himself developed diarrhoea with headache on the fourth day. The diarrhoea continued for two days, after which he felt fairly well again. He kept at work throughout. It was thus clear that A had suffered from a mild and unrecognised attack of Paratyphoid Fever B, and had been capable of infecting foodstuffs. This outbreak of Paratyphoid Fever B, affecting probably many persons spread over a number of Districts, was definitely traced to veal and ham pies and fancy cakes, infected at a late stage of their preparation by a pastrycook who had suffered from an unrecognised attack of the complaint. Unfortunately, the source of his own infection could not be traced, but that source was within the bakery, through either infected materials or an infective person. 15 The symptoms of most cases were very alike—severe headache, often occipital in position, abdominal pains, nausea or vomiting, chilliness with subsequent fever of 100°F lasting from one to three weeks, early diarrhoea, often with constipation later, and profound lassitude and debility. In some cases epitaxis within the first few days of the illness was a frequent feature. I am glad to say that none of the cases associated with this epidemic proved fatal. I am greatly indebted to Dr. Newsholme, Medical Officer of Health, Croydon, for the foregoing facts and the minute investigations which were carried out by him, the bakery in question being within the Count}' Borough of Croydon. The following shows the number of cases tabulated for each week of the year :— Week ending 9th March 18th April 4th May 8th August 15th August 29th August 5th September 12th September 26th September 3rd October 10th October 17th October 24th October 31st October 12th December Number of cases notified 1 1 1 2 1 2 2 1 2 4 1 2 2 1 1 The age periods were: Age periods Under 5 5 and under 10 10 and under 15 15 and under 20 20 and under 35 35 and under 25 45 and under 65 Cases 2 1 2 4 7 5 3 ENCEPHALITIS LETHARGICA. One case was notified as occurring in a female aged 52 years residing in Sanderstead. The patient was removed to the May Day Road Hospital, and unfortunately the case terminated fatally. ERYSIPELAS. Ten cases were notified as against 12 last year. One of the cases occurred in Cane Hill Mental Hospital. PNEUMONIA. Eleven cases were notified, of which 2 occurred in Cane Hill Mental Hospital. 16 TUBERCULOSIS. A large decrease in the number of new cases of Tuberculosis notified took place, there being 19 as against 30 last year. Of the 19 cases, 14 were pulmonary, and 5 were other forms of Tuberculosis. The Deaths from Tuberculosis numbered 12, 11 being Pulmonary and 1 from non-pulmonary Tuberculosis. The sanatorium and dispensary treatment of Tuberculosis is under the control of the Surrey County Council. During the year 29 specimens of sputum were examined at the Isolation Hospital from suspected cases within the District. The following Table shows the total number of cases notified at various age periods, both for pulmonary and non-pulmonary cases, and also the total deaths. TUBERCULOSIS. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. m. f. m. f. m. f. m. f. Under 1 year ... ... ... ... ... ... ... ... 1 and under 5 ... ... ... ... ... ... ... ... 5 and under 10 ... ... 2 ... ... ... ... ... 10 and under 15 ... ... 1 ... ... ... 1 ... 15 and under 20 ... ... ... 1 ... ... ... ... 20 and under 25 ... 2 ... ... 2 ... ... ... 25 and under 35 3 2 ... ... ... 1 ... ... 35 and under 45 3 ... ... ... 2 ... ... ... 45 and under 55 2 1 ... ... 2 1 ... ... 55 and under 65 ... 1 ... 1 1 2 ... ... 65 and upwards ... ... ... ... ... ... ... ... Totals 8 6 3 2 7 4 1 ... 17 The cases were distributed amongst the following wards: Localisation of Diseases. Coulsdon. Kenley. Purley. Sanderstead. Woodcote. Totals. Pulmonary 3 2 4 4 1 14 Nonpulmonary 1 1 2 ... 1 5 Totals 4 3 6 4 2 19 SCHOOLS. Medical Inspection.—The medical inspection of school children is carried out by the Education Department of the Surrey County Council. When necessary, however, the Medical Officer of Health is called in to examine children suspected to be suffering from infectious or contagious disease. School Closure.—On no occasion during the year was it found necessary to close a School owing to the prevalence of infectious disease amongst the scholars. Visits paid to Schools.—The following number of visits have been paid to schools :— Number of ordinary visits 5 Number of special visits 4 Number of schools disinfected 3 HEALTH VISITOR. The Council employs one full-time Health Visitor, who works under the supervision of the Medical Officer of Health. During the year Miss Andrew paid the following visits :— Primary visits to infants 137 Subsequent visits to infants 1,750 Visits to children between 1 and 5 679 ,, re Measles 12 „ „ Whooping Cough 22 „ „ Mumps 6 „ „ Tuberculosis 79 Ante-natal visits 96 Visits re Deaths under one year 2 Total visits 2,783 18 MATERNITY AND CHILD WELFARE CENTRES. The Council has established two Maternity and Child Welfare Centres, one being at Coulsdon and the other at Kenley. The attendances at the Centres have been well maintained, and there is an increased number of children on the register at each Centre. The following attendances, etc., have been made during the year:— Coulsdon Centre. Number of children on register 126 Number of meetings held 44 Number of consultations 270 Total attendances 1,276 Average attendance 29 Cases receiving hospital treatment 2 Kenley Centre. Number of children on register 154 Number of meetings held 43 Number of consultations 354 Total attendances 1,721 Average attendance 40 Cases receiving Hospital treatment 9 HOME HELPS. During the year the nine cases were attended by the Home Helps. WATER SUPPLY. The whole of the District has a constant water supply supplied by two Companies, viz., the East Surrey Water Company, and the Sutton Water Company. WATER COURSES. All the water courses within the District receive constant supervision. 19 HOUSING, Etc. This District is a good residential one, and the general standard of houses is of a high class. Defects, found existing in unfit houses, generally are of a structural nature in many of the very old houses still existing. Other defects of a general character are due to neglect of internal decorations, which in most instances are due to lack of proper management and supervision by owners or agents. Housing Statistics for the Year. Number of new houses erected during the year :— (a) Total (including numbers given separately under (b) ) 570 (b) With State assistance under the Housing Acts :— (i) By the Local Authority 54 (it) By other bodies or persons 516 1. Unfit Dwelling Houses :— Inspection :— (1) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 231 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidation Regulations, 1925 103 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling houses (excluding those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 94 2. Remedy of Defects without service of Formal Notices :— Number of defective dwelling houses rendered fit in consequence of the Local Authority through their Officers 91 20 3. Action under Statutory Orders :— a. Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling houses of which notices were served requiring repairs 10 (2) Number of dwelling houses which were rendered fit after service of formal notice :— (a) By owners 10 (b) By Local Authority in default of owners Nil. (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. b. Proceedings under the public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 93 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 91 (b) By Local Authority in default of owners ... Nil. Proceedings under Sections 11, 14, and 15 of Housing Act, 1925 :— (1) Number of representations made with view to making of a Closing Order Nil. (2) Number of dwelling houses in respect of which Closing Orders were made Nil. (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling house having been rendered fit Nil. (4) Number of dwelling houses in which Demolition Orders were made Nil. (5) Number of dwelling houses demolished in pursuance of Demolition Order Nil. CLOSET ACCOMMODATION. The general type of closet in use is on the water carriage system connected to the public sewer, but there are approximately 134 cesspools and 45 privies, owing generally, to lack of sewers within the statutory distance of the house. Based on the number of occupied houses, 97 per cent. are connected to the public sewer. During the year 11 cesspools have been abolished, 9 at Hollyme Oak Road by reason of the extension of the sewer, one at Woodplace Lane, Coulsdon, and one at Selsdon Road, Sanderstead. During the year 21 cesspools were constructed. 21 SCAVENGING. The collection of house refuse is carried out by the Council by direct labour, a weekly collection being made. REGULATED TRADES. Dairies, Cowsheds and Milkshops.—There are '21 registered premises within the District, of which 7 are Dairies and 14 are Cowsheds. During the year 114 visits of inspection have been paid. The number of licences granted under the special milk designations was (I. SLAUGHTERHOUSES. There are four Slaughterhouses within the District all of which are licensed. The only registered slaughterhouse fell into disuse during the year. During the year 230 visits of inspection were paid. The number of slaughterhouses at various times were :— In January, In December, In 1920. 1925. 1925. Registered 1 1 0 Licensed 4 4 4 SALE OF FOOD AND DRUGS ACTS. The administration of Sale of Food and Drugs Acts is under the control of the Surrey County Council. The following Table shows the number of samples taken from this District during the year :— Articles. Analysed. Adulterated or Deteriorated. Proseoutions. Convictions. Formal. Informal. Total. Formal. Informal. Total. Milk 52 — 52 2 2 2 1 Cream 9 — 9 - - - - - Butter 7 — 7 - - - - - Cheese 1 — 1 - - - - - Margarine 2 — 2 - - - - - Lard - - — - - - - - Bread - - - - - - - - Flour — — - — — — — — Tea - - - - - - - — Coffee - - - - - - - - Cocoa — — — — — — — — Sugar 2 — 2 — — — — — Mustard - — — — — — — — Confectionery & J am - - - - - - - - Pepper - — — — — — — — Wine - — — — — — — — Beer - — - — — — — - Spirits - — — — — — - - Drugs - — — — — — - - Other articles 2 — 2 — — — — — Totals 75 — 75 2 — 2 2 1 22 TABLE I.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1925. Disease. Number of Cases notified. Total Cases notified in each Ward. at all Ages. At ages—Years. 65 and over. Coulsdon. Kenley. Purley. Sanderstead. Wood cote. T otal cases removed to Hospital Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. Scarlet Fever 35 1 ... 2 ... 2 8 10 6 5 1 ... ... 10 5 13 4 3 23 Diphtheria 14 ... ... 1 ... 3 3 1 3 2 1 ... ... ... 10 3 ... 1 13 Erysipelas 10 1 ... ... ... ... ... 1 ... ... 1 6 1 4 1 3 1 1 2 Typhoid Fever 24 ... ... ... 1 1 1 2 4 7 5 3 9 4 3 2 6 5 Pneumonia 11 ... ... ... 1 ... 1 1 1 1 ... 2 4 2 1 1 7 ... ... Encephalitis Lethargica 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Totals 95 2 ... 3 2 6 13 15 14 15 8 12 5 25 21 23 15 11 45 The above numbers include 5 Typhoid Fever, 2 Pneumonia and 1 Erysipelas in Cane Hill Mental Hospital, 2 Diphtheria in Reedham Orphanage, and 1 Scarlet Fever at Russell Hill School. 23 TABLE II.—DEATHS REGISTERED DURING THE CALENDAR YEAR 1925, CLASSIFIED BY AGE & CAUSE Cause of Death. Net Deaths at the subjoined ages of " Residents," whether occurring within or without the District. At all ages. Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and over. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Enteric Fever 1 ... ... 1 ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... Scarlet Fever 1 ... ... 1 ... ... ... ... ... Whooping Cough 2 1 ... 1 Diphtheria 1 ... ... 1 ... ... ... ... ... Influenza 3 ... ... ... ... ... 1 1 1 Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... Tuberculosis of the Respiratory System 11 ... ... ... ... 2 3 6 ... Other Tuberculous Diseases 1 ... ... ... 1 ... ... ... ... Cancer—Malignant Disease 28 ... ... ... ... ... 1 11 16 Rheumatic Fever ... ... ... ... ... ... ... ... ... Diabetes 2 ... ... ... ... ... ... 1 1 Cerebral hœmorrhage, etc. 8 ... ... ... ... ... ... 3 5 Heart Disease 21 ... ... ... ... ... 4 3 14 Arterio-sclerosis 10 ... ... ... ... ... ... 3 7 Bronchitis 7 ... ... 1 ... ... ... 2 4 Pneumonia (all forms) 16 1 ... ... ... 1 2 1 11 Other Respiratory Diseases 5 ... ... ... ... ... ... 1 4 Ulcer of Stomach or Duodenum 2 ... ... ... ... ... 1 ... 1 Diarrhoea, etc. (under 2 years) 1 ... 1 ... ... ... ... ... ... Appendicitis and typhlitis 4 ... ... 1 ... ... 1 1 ... Cirrhosis of Liver 2 ... ... ... ... ... ... 1 1 Acute and chronic Nephritis 2 ... 1 ... ... ... ... 1 ... Puerperal Sepsis ... ... ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition ... ... ... ... ... ... ... ... ... Congenital debility and malformation. Premature Birth 12 12 ... ... ... ... ... ... ... Suicide 4 ... ... ... ... 1 2 1 ... Other deaths from violence 4 ... ... ... 1 ... 3 ... ... Other defined diseases 26 2 ... 2 ... ... 2 6 14 Causes ill defined or unknown ... ... ... ... ... ... ... ... ... Totals 175 16 2 8 2 5 20 43 79 24 TABLE III.—IN1ECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1915. Disease. 1915. (nine mths.) 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. Scarlet Fever 28 16 20 10 55 129 136 59 40 58 35 Diphtheria 7 38 17 4 26 44 62 70 27 101 14 Erysipelas 9 11 12 8 12 5 8 9 2 12 10 Typhoid & Paratyphoid Fever 27 7 18 73 31 15 5 16 11 5 24 Cerebro-spinal Fever 1 - 3 1 - - 1 - - - - Puerperal Fever - 2 1 1 - - 2 - - - - Poliomyelitis - 1 - - 1 1 - 1 - 1 — Encephalitis Lethargica - - - - - 1 1 1 1 1 1 Ophthalmia Neonatorum - 2 1 1 — 1 - - 1 - — Pneumonia — — — — 18 8 9 21 6 16 11 Malaria - - - - 5 - - - - - - Measles — 151 468 33 12 - - - - - - _ Dysentery - - - - - - - - 17 - - Chicken Pox — - - - 4 7 7 7 5 11 -_ Tuberculosis Pulmonary 18 25 17 25 28 24 12 29 16 24 14 Other Forms 1 2 4 2 2 2 3 5 3 6 5 Totals 91 255 571 158 194 237 246 218 129 235 114 25 ANNUAL REPORT OF THE SANITARY INSPECTOR. Ladies and Gentlemen, I beg to present my eleventh Annual Report. The following tabulated summary shows the amount and character of the sanitary work accomplished:— Tabulated Summary of Sanitary Work Completed during 1925. Total number of visits paid 2,082 Number of complaints received and investigated 96 Number of premises inspected 272 Number of nuisances discovered 115 Number of nuisances abated without report 95 Number of nuisances abated after report 10 Preliminary Notices served 107 Legal Notices served 16 Character of Work done. Houses dealt with under the Housing of the Working Classes Act 2 Houses inspected under the Housing and Town Planning Act 103 Houses repaired and cleansed generally 63 Overcrowding abated 2 Defective roofs repaired 31 Eaves guttering renewed or repaired 8 Water Closets renewed or repaired 13 Damp-proof courses inserted or damp walls remedied 21 Water Closets provided with water for flushing purposes 6 Yards of Houses paved with impervious material 8 Paving of Yards repaired 8 Floors of Sculleries paved or repaired 4 Houses at which drains were tested 19 Houses at which Drains were found defective 11 Houses at which drains were reconstructed or new provided 4 Houses at which drains were cleansed, trapped or repaired 31 Premises at which animals improperly kept were removed 2 Number of inspections of food exposed for sale 115 Urinals cleansed or repaired 2 Offensive accumulations removed 6 26 Piggeries repaired, improved, or abolished 3 Infected houses disinfected and cleansed 66 Number of visits to infected houses 127 Number of visits to Dairies, Cowsheds and Milkshops 114 Number of complaints as to uncleanliness and neglect of Regulations 3 Number of Visits to Slaughterhouses 230 Number of Visits to Bakehouses 10 Number of Complaints as to Uncleanliness 1 General Sanitary Work:—During the year 272 premises were inspected and 115 nuisances were discovered. Of these, including those outstanding at the end of last year, 105 were abated, leaving 10 outstanding. As in previous years, most of the work was carried out after a letter or preliminary notice, and in 16 cases only was it necessary to ask for legal notices to be served. Slaughterhouses:—There are now 4 licensed slaughterhouses. The registered one in Whytecliffe Road has been abolished. During the year I have examined the carcases and organs of the following animals:— Bulls and Bullocks 0 Heifers 0 Cows 0 Calves 23 Sheep 894 Pigs 83 Total 1,000 230 visits were made to Slaughter houses, and in addition 115 visits were made to premises where food is sold. Dairies and Cowsheds:—There are 7 Dairies and 14 Cowsheds in the district, to which 114 visits have been made. A good standard of cleanliness has been maintained, although in one or two cases I have found it necessary to complain of want of cleanliness or neglect of regulations. I am, Ladies and Gentlemen, Your obedient Servant, THOS. PAYNE, Sanitary Inspector. APPENDICES. 29 APPENDICES. ISOLATION HOSPITAL. This District is one of the constituent Authorities forming part of the Wandle Valley Joint Isolation Hospital, the other Authorities being the Beddington and Wallington, Mitcham, and Merton and Morden Urban District Councils. The Hospital, which was established by the Croydon Rural District Council, was first opened for the reception of patients at the beginning of March, 1899. The accommodation then provided was 10 beds for Scarlet Fever cases, 10 beds for Diphtheria cases, 4 beds for Typhoid Fever cases, and 4 beds for doubtful cases. The nominal number of beds is now 78, but on many occasions a much larger number of patients have been under treatment at the same time. The enlargements and additions made to the Hospital since its first erection have been :— 1904. Scarlet Fever pavilion for 22 beds, which was opened in June, 1905. Additional dormitory to administrative block. Hand laundry converted to a steam laundry. 1910. Cubicle block for 12 beds. Quarters for Resident Medical Officer. 1922. Cubicle block for 16 beds. 1925. Electric lighting installed. By arrangement with the Surrey County Council, cases of Tuberculosis have been admitted, but in November, owing to the large number of cases of ordinary infectious diseases being under treatment, it was deemed advisable to suspend the admittance of cases of Tuberculosis. Since the Hospital was opened, 9,909 patients have been under treatment. The following Table shows the percentage number of cases admitted tor the past four years :— Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. 1922 61 37 — 1 1923 57 33 5 3 1924 40 49 7 3 1925 42 45 5 7 30 During the year 558 patients were admitted to the Hospital, of which 38 died. The lowest number under treatment at one time was in September, there being only 32 patients, and the highest number was in November, with 117 patients. The following table shows the number of cases admitted, the number of deaths, and case mortality for each complaint. Disease. Cases. Deaths. Case Mortality (per cent.). Scarlet Fever 237 3 1.26 Diphtheria 254 10 3.93 Pneumonia 3 1 33.00 Erysipelas 10 — — Typhoid Fever 11 1* 9.09 Measles 5 — — Cerebro-spinal Fever 2 1 50.00 Chicken Pox 1 — — Puerperal Fever 2 1 50.00 Encephalitis Lethargica 1 1 100.00 Tuberculosis 28 20 71.42 No Disease 4† — — Total 558 38 6.80 * Patient died from Acute Nephritis, † Babies admitted with their mothers. BACTERIOLOGICAL LABORATORY. During the year the following number of examinations have been made by the Resident Medical Officer:— Number of swabs for diphtheria 1,690 Number of specimens of sputum 198 These were divided amongst the constituent Authorities, and patients at the Hospital as under :— Swabs for Diphtheria. Sputa. Beddington and Wallington 130 35 Coulsdon and Purley 103 29 Mitcham 675 86 Cases in Hospital 782 48 1,690 198 31 Patients Admitted to Hospital during 1925. District. Scarlet Fever. Diphtheria. Pneumonia. Erysipelas . Typhoid Fever. Measles. Cerebrospinal Fever. Chicken Pox. Puerperal Fever. Encephalitis Lethargica. Tuberculosis. No Disease. Totals. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Beddington and Wallington 30 ... 10 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 ... Coulsdon and Purley 23 ... 13 1 ... ... 2 ... 5 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 45 1 Mitcham 95 1 198 7 3 1 1 ... 5 1† ... ... ... ... ... ... 2 1 1 1 ... ... 4‡ ... 309 12 Merton and Morden 70 1 23 ... ... ... 2 ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 97 2 Caterham 18 1 7 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 26 3 Surrey ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 20 ... ... 28 20 Other Districts 1 ... 3 ... ... ... 1 ... 1 ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... 9 ... Totals | 237 3 254 10 3 1 10 ... 11 i 5 ... 2 1 1 ... 2 1 1 1 28 20 4 ... 558 48 † Patient died from acute nephritis. ‡ Babies admitted with their mothers.