cou 3 1006/4201/3 Health report FOR 1935 FOR THE COULSDON AND PURLEY URBAN DISTRICT BY THE MEDICAL OFFICER OF HEALTH S. C. JENNINGS & SONS, LTD., Red hill, Surrey. health report FOR 1935 FOR THE COULSDON AND PURLEY URBAN DISTRICT BY THE MEDICAL OFFICER OF HEALTH S. C. JENNINGS & SONS, LTD., Red Hill Surrey. URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. Public Health Committee. Chairman : Councillor A. Sciver, B.Sc., A.I.C. Councillor W. H. S. Aplin, A.F.C., Councillor J. I. Conway. A.M.I.C.E., A.I.P.C. ,, T. A. Harrison. „ Mrs. Bartleet. ,, E. O. Hughes. Mrs. Bluett. ,, A. L. Mitchell. „ D. A. BowErman. Maternity and Child Welfare Committee. Coun. Mrs. Bartleet. „ Mrs. Bluett. Mrs. E. Adams. Mrs. E. L. Clark. Mrs. E. Davie. Mrs. M. Davison. Mrs. R. J. Everett. Mrs. E. B. Farrow. Mrs. W. H. Finn. Mrs. H. K. Freeman. Mrs. A. Morse. Mrs. G. Phillips. Mrs. M. G. Pillow. Mrs. H. M. Ransome, M.A. Mrs. M. J. Read. Mrs. J. Saunders. Mrs. D. E. tierney. Mrs. P. Towes. Mrs. I,. M. Turner. Representatives on the Wandle Valley Joint Hospital Board. Coun. S. B. Gillespie, J.P. Coun. A. Sciver, B.Sc., A.I.C. ,, J. W. K Nichols. „ F. White. STAFF: Medical Officer of Health : F. R. Edbrooke, M B., Ch.B., D.P.H. *Assistant Medical Officer of Health : E. C. Loudon, M.B., Ch.B., D.P.H. *Medical Officer of Ante-natal Clinics : Winifred M. Small, M.B., Ch.B. * Assistant Medical Officers for Child Welfare Centres : Amy M. Thoms, M.D., Ch.B., M.R.C.P. Constance Hildred, M.b., Ch.b. J. D. E. Michael, M.D., M.R.C.P., M.R.C.S. * Consulting Obstetric Specialists : Leslie Williams, M.D., M.S., F.R.C.S. A. Joseph Wrigley, M.D., F.R.C.S. Sanitary Inspector : H. Buxton, M.r.S.i. Assistant Sanitary Inspectors : *S. E. Crisp, C.R.S.I. L. snelling, a.r.s.i. Health Visitors : Miss E. T. White, S.R.N., C.M.B., i.S.T.M., H.V., C.R.S.I. Miss D. E. LETTS, S.R.N., C.M.B., H.V. (M. of H.). Miss S. G. Paddle, S.R.N., C.M.B., H.V. (M. of H.). Clerks : *S. E. Crisp. G. A. LEE. * Part-time Official. 3 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 11,182 Registrar-General's estimate of population, 1935 48,570 Population, Census, 1931 37,666 Number of occupied houses, December, 1935 12,749 Number of occupied houses, 1931 8,533 Rateable Value £622,905 Sum represented by a penny rate £2,473 VITAL STATISTICS. Birth Rate per 1,000 of the estimated resident population. Total. M. F. Live Births—Legitimate 568 290 278 ,, ,, —Illegitimate 25 11 14 12.2 593 301 292 Rate per 1,000 (live and still) births. Still Births .. .. 28 12 16 45.1 Death Rate per 1,000 of the estimated resident population. Deaths 388 195 193 7.9 Rate per 1,000 (live and still) births. Deaths from Puerperal causes :— Puerperal Sepsis Nil — Other Puerperal causes 1 1.61 Death Rates of Infants under one year of age :— All Infants per 1,000 live births 32 Legitimate Infants per 1,000 legitimate births 31 Illegitimate Infants per 1,000 Illegitimate births 40 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) 1 4 URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. HEALTH REPORT FOR 1935. Ladies and Gentlemen, I beg to present to you the Annual Report for 1935, this being my fourth Report as your Medical Officer of Health. The general arrangement adopted in previous Reports will be found to have been retained to facilitate reference, while the impression gained will probably be one of gradual development and, in general, the steady improvement of the public health of your Urban District during the 21 years of its history. The year 1935 compared favourably with its predecessors as judged by the generally accepted standards. The Birth Rate again increased slightly, while the Maternal, Infant Mortality and Death Rates remained low, although the latter is tending to increase, probably with the advancing age of the population of the District. The wave of mild Scarlet Fever, which commenced in 1934, continued in the early part of the year, but is gradually diminishing, as is also an outbreak of Diphtheria, which was chiefly confined to one Ward of the District. Most other forms of Infectious Disease showed a diminished incidence. Extensions in the work of the Department included the Housing Survey and work under the Shops Act, 1934, investigations into the condition of ice cream sold in the District and into an outbreak of infectious Diarrhoea, and the establishment of a new Ante-Natal Clinic at Selsdon. Finally, the Council having to consider for the first time in its history measures for the protection of the District against possible attack by hostile aircraft, a considerable amount of time has been given to this subject. Plans have been made, the detailed application of which continues to demand the attention of your Officers. While it must not be considered inevitable that this danger will arise, and undue alarm is to be deprecated as being physically and mentally detrimental, a false sense of security is equally unjustified, and it should be realised that safety through air raid precautions can only be a matter of degree. The way is strewn with practical difficulties, many of which are inevitably insurmountable. Only by removing the possibility of the misuse of aircraft for the settlement of international disputes can absolute safety from the air be secured. 5 Ultimately, as has been noted in previous Reports, the resposibility rests on each individual resident of the District if concerted action to remove the possible causes of ill-health is to culminate in an experience of the joy of really robust health. Similarly, the utmost endeavour of each member of the community is required if this latest menace to the public health is to be met satisfactorily by the removal of its root cause, and complete safety obtained from the air, which will otherwise present an increasing potential danger. May I, in conclusion, express my thanks to the Members of the Committee, and to my colleagues and staff, for their co-operation throughout the year which has made my work a pleasure. Special thanks are due to the Sanitary Inspector for his aid in reporting upon certain sections of the work in which we have closely collaborated. I am, Ladies and Gentlemen, Your obedient servant, F. R. EDBROOKE, Medical Officer of Health. Public Health Department, 69, Brighton Road, Purley. 6 HEALTH REPORT FOR 1935. 1 The Urban District of Coulsdon and Purley was constituted by an Order of the Local Government Board, dated the 1st November, 1914, and came into existence on the 7th April, 1915. Situated some 12-18 miles from the centre, and to the South of London, on a portion of the North Downs, it is one of the most beautiful Districts within easy reach of London. Chiefly residential in character, and with a population that has increased in a remarkable manner since 1921, it still contains large rural areas. No large manufacturing concerns exist, the chief occupations being building and the retailing of the necessities of life to the residents. Unemployment is comparatively low, and in fact a steady influx of labour from more distressed areas has taken place. AREA AND POPULATION. The District has an area of 11,182 acres, this being 2,547 acres more than before the last revision of boundaries in 1933. The acreage of each Ward is :— Coulsdon East 2,812 Coulsdon West1,253 Selsdon and Farleigh 1,963 Kenley 1,292 Sanderstead 2,312 Woodcot 865 Purley 685 Twenty-one years ago when the Urban District came into existence the population was estimated to be 17,920, and this had increased to 21,493 by the time of the Census in 1921. By the 1931 Census this figure had become 37,666, while in mid-1935, the Registrar-General estimated the population to be 48,570, this representing an increase of 2,230 in the last twelve months. Only about 3,000 of this total can be attributed to the area added in 1933, which is still chiefly rural. The number of inmates in the Institutions in the District in 1935 was— : Males, Females. Total. Cane Hill Mental Hospital 898 1543 2441 Netheme Mental Hospital 664 1095 1759 Reedham Orphanage 186 136 322 Russell Hill Schools 62 192 254 Totals 1810 2966 4776 7 In 1915 there were 4,141 occupied houses, chiefly situated in Purley and Woodcote, whereas in 1935 there were 12,749 houses, distributed amongst the Wards as follows :— Coulsdon West 2,587 Coulsdon East 1,022 Kenley 1,105 Purley 2,386 Selsdon and Farleigh 1,356 Sanderstead 2,802 Woodcote 1,491 There were thus 3.8 persons per house in 1935, as compared with 4.3 in 1915. VITAL STATISTICS. During the year 593 Births were registered as belonging to the District, of which 301 were males and 292 were females, as compared with 547 in 1934. This is equal to an Annual Birth Rate of 12.2 per thousand of population, as compared with 11.8 last year and 11.1 in 1933. The average Birth Rate for this District steadily declined during the four quinquennial periods 1915-1934, viz., 13.9, 13.5, 12.9 and 11.6, but slight rises occurred in this District and in the country as a whole in 1934, suggesting that a turning point had been reached. The year 1935 has, however, seen a very slight fall nationally, though the local rate has continued to increase. The Birth Rates in England and Wales were 14.7 in 1935, 14.8 in 1934, 14.4 in 1933, and 15.3 in 1932. There were 25 illegitimate births (11 males and 14 females) registered in 1935, this being more than in any previous year, the figure for 1934 being 9. Expressed as a percentage of total births, 4.2 were illegitimate. The proportion of illegitimate births showed a marked decline from 1915 to 1934, the averages for the five yearly periods being 5.7, 3.4, 3.7, and 2.8. The number of still births has only been recorded during the last 5 years. In 1935 there were 28 registered (12 males and 16 females), this being 19 more than in 1934. DEATHS. The number of Deaths registered during the year as belonging to this District was 388 (195 males and 193 females), as compared with 355 the previous year. This number excludes deaths which, although occurring within the District, belonged to other districts, but includes deaths of residents who died outside the District. 8 The Death Rate for the year was equal to 7.9 per thousand of population, as compared with 7.6, 7.1 and 8.5 in the preceding three years. A slight modification is, however, necessary if the number is to be compared with that of England and Wales, the age and sex distribution being not quite typical of the country as a whole. The corrected crude Death Rate for 1935 thus becomes 7.7 per thousand of population. The Death Rates for England and Wales were 11.7 in 1935, 11.8 in 1934, 12.3 in 1933 and 12.0 in 1932. In considering the last 20 years there has been a tendency for the Death Rate to decline, as in the Country as a whole, the averages for the four quinquennial periods being 8.5, 7.4, 7.0 and 7.4. During the past five years there has been a slight rise, probably due to the population of this District being more elderly. Of the 388 Deaths which occurred in Coulsdon and Purley in 1935, 54 per cent, were in persons over 65 years of age. This is about the same percentage as in the last two years, and compares favourably with the average of 45 per cent, for the five years 1926-30. The principal causes of Death, with the rates per cent, of total deaths, are shown in the following Table. For the full list of causes of death and the ages at which the deaths occurred see Table IV in the Appendix. Cause. Number of Deaths. Rate per cent, of Total Deaths. Influenza 14 3 6 Tuberculosis of respiratory system 19 4.9 Cancer, malignant disease 62 15.9 Heart Disease 87 22.4 Cerebral Haemorrhage 18 4.6 Other circulatory diseases 25 6.4 Pneumonia 15 3.9 Nephritis 12 3.1 Violence (including Suicide) 22 5 7 It will be seen that the chief causes of death in the District were Heart and other circulatory diseases (including Cerebral Haemorrhage) 130 and Cancer 62, followed by Violence (including Suicide) 22, Pulmonary Tuberculosis 19, Pneumonia (all forms) 15, Influenza 14, and Nephritis 12. 9 HEART DISEASE, etc. The percentage of deaths due to heart and other circulatory diseases was slightly more than in 1934, constituting just over one-third of all deaths. As has been previously stated, in so far as this group includes deaths in the elderly from what is virtually senility, it is to be hoped that the proportion of deaths coming under this heading will increase. The proportion over 65 years of age was 72 per cent., that being the same as in 1934, while 43 per cent, were over 75 years of age at the time of death. Of the remaining 28 per cent, under 65 years of age only about 1 or 2 per cent, were connected with Rheumatism, the chief cause of Heart disease in the young, or were congenital in origin. It is probable, however, that Rheumatism was responsible for the original damage in a much larger proportion, although not mentioned in the Death Certificate. Once again, about one-fifth of this group of deaths was in respect of persons under 65 years of age, in whom the postponement of death might reasonably have been expected had a sound mode of life been adopted ; undue strain, excess, and the exigencies of modern life continue to take their toll. CANCER. Cancer produced 15.9 per cent, of the deaths as compared with 19.4 in 1934 and 18.8 in 1933 ; expressed another way the Cancer Death Rate was 1.28 per thousand of population in 1935, 1.49 in 1934 and 1.30 in 1933, the corresponding figures for England and Wales being 1.58, 1.56 and 1.52. The average Annual Cancer Death Rate for Coulsdon and Purley for 1915-24 was 1.13, and that for 1925-34, 1.26 per thousand of population, the averages for England and Wales for these periods being 1.21 and 1.44. It will be noted that this District has, in common with the Country as a whole, experienced an increased Death Rate attributed to this cause. It is doubtful, however, whether the disease is becoming more common among the age and sex groups concerned, or simply that the apparent increase is due to more deaths being attributed to this cause owing to better diagnosis, etc. 10 The following Table gives the age, Sex and distribution of the disease in the 62 deaths which occurred during 1935. 30-40 40-50 50-60 60-70 70-80 80 & over Total. M. F. M. F. M. F. M. F. M F. M. F. Eye - - - - - - - - - 1 - - - 1 Larynx - - - - - - - - 1 - - - 1 - Thyroid - - - - - 1 - - - - - - - 1 Oesophagus - - - - 1 1 - - - - - - 1 1 Lymphatic Glands - - 1 - - - 1 - - - - - 2 - Small Intestines - 1 - 1 4 1 2 5 5 3 2 2 13 13 Liver - - - - 2 - - - - - - 1 2 1 Pancreas - - - - 1 - - - - - - - 1 - Lungs - - - - - - 2 - - - - - 2 - Uterus - - - 1 - - - - - - - - - 1 Ovary - - - 1 - - - - - - - - - 1 Breast - - - 2 - 2 - 3 - 2 - - - 9 Vulva - - - - - - - 1 - - - - - 1 Prostate - - - - 1 - - - 2 - - - 3 - Bladder - - 1 - - - 1 - 1 - 1 - 4 - Kidneys - 1 - - - - - - 1 - - - 1 1 Testicles 1 - - - - - - - - - - - 1 - Bone 1 - - - - - - - - - - - 1 - Totals 2 2 2 5 9 5 6 9 10 6 3 3 32 30 The usual features are present, viz., the increasing frequency with advancing age, and high proportion in which the stomach and intestines or breast is affected. The fact that Cancer is curable if recognised early enough and efficiently treated must be again stressed. Abnormal or persistent symptoms, especially in persons of middle and old age, should receive early medical attention. Apart from the danger of delay, much ill-health frequently results from the mental agony caused by postponing examination. The reassurance of a negative finding is almost as important as an early positive result. The symptoms which call for most attention are persistent or repeated pain, haemorrhage, swelling, early morning diarrhœa, increasing constipation and difficulty in micturition. In view of the number of deaths from breast Cancer, perhaps it would be as well to emphasize the need for investigation of any lump in the breasts of females, especially over 30 years of age, which does not subside in a very short time. 11 VIOLENCE. Violence, including suicide, accounted for nearly 6.0 per cent of the total deaths, or in other words nearly as many deaths as there were from all the notifiable diseases including Tuberculosis. In 1935 there were 13 deaths from violence other than suicide, this being 2 less than in 1934, which saw the highest number of deaths from this cause that had been experienced since the formation of the District. Of these 13 deaths, 8 were from road accidents in which mechanically propelled vehicles were involved (2 less than in 1934), 5 were due to falls, mostly in elderly persons, 2 were post operative, and 2 were from suffocation in babies, which are specially to be regretted. On the other hand, deaths from suicide increased in number, there being 9 as compared with 6 in 1934 and 3 in 1933. The death rate from this cause was thus 18 per 100,000 of population as compared with an average of 11 and 12 in the two preceding decades. Two of the deaths were in females under 30 years of age, the remaining 7 being in males of ages from 27 to 81. In 3 cases coal gas poisoning, in 3 lysol poisoning, in 2 strangulation, and in the remaining case drowning was the immediate cause of death. MATERNAL MORTALITY. Only one death occurred following childbirth during 1935, the Maternal Mortality Rate being 1.61 per thousand total births, as compared with 4.10 in England and Wales. The local Maternal Mortality Rate has not varied greatly during the past 20 years, the average rate per thousand live births for the 4 five-yearly periods 1915—1934 being 3.20, 2.08, 2.66 and 3.21 The tendency in the Country has been for this number to increase, although a reduction in the Rate has occurred this year. The death which occurred locally was classified as a maternal death which should be preventable. Attendance at the Ante-natal Clinic had been made on one occasion, but the advice then given, and also subsequently by a general practitioner, was not accepted, hence responsibility for the fatal termination, at least in part, rested on the patient. A flaw in the local Maternity Service detected as a result of the enquiry made by the Medical Officer of Health subsequent to the occurrence of death has since been removed. While undue alarm on the part of expectant mothers is undesirable and largely unjustifiable, the need remains for their co-operation in securing adequate ante-natal supervision, and treatment at the time of childbirth if the event is to be the natural phase in life which it should be, and fundamentally is. 12 INFANT MORTALITY. number of deaths occurring in children under one year of age was 19, as compared with 14 last year and 10 in 1933, all except 1 being in legitimate children. The Infantile Mortality Rate was thus 32, as compared with 26 in 1934 and 20 in 1933. As previously pointed out, this Rate is liable to violent fluctuations owing to the small numbers concerned. Even five-yearly grouping does not abolish this, as the average figures for the four quinquennial periods, 1915-34, demonstrate, viz., 44, 28, 38 and 32. The Infantile Mortality Rate for England and Wales was 57 in 1935, 59 in 1934 and 64 in 1933, the latest figure being the lowest on record. The averages for 1915-24 and 1925-34 were approximately 83 and 67. The causes of death in the 19 infants under one year of age who died in 1935 were :— Acute Bronchitis 2 Broncho-pneumonia 1 Gastro-enteritis 1 Prematurity 4 Respiratory failure 1 Birth injury 2 Spina Bifida 1 Congenital heart disease 3 Marasmus 1 Pyloric Stenosis 1 Suffocation 2 Of these children, 15 were under three months and 9 not more than one week old at death. The two deaths due to suffocation have already been referred to in the section under Violence. The following Table shows the Populations, Births, Birth Rates, Deaths, Death Rates and Infantile Mortality Rates for each of the past ten years :— 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Population 27,500 29,370 31,520 32,490 40,000 37 300 40,050 44,390 46,340 48,750 Births 317 371 393 436 433 472 474 486 547 593 Birth Rate 11,5 12.6 12 4 13.4 10.8 12.6 11 8 11.1 11.8 12.2 Deaths 163 198 208 278 259 288 342 313 355 388 Death Rate 5.9 6.7 6.6 8.5 6.4 7.7 8.5 7.1 7.6 7.9 Infant Deaths 10 10 15 22 19 11 22 10 14 19 Infantile Mortality Rate 31 26 38 50 43 23 46 20 26 32 13 COMPARATIVE CRUDE BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL DEATH-RATES, AND CASE-RATES for certain Infectious Diseases in the year 1935. England and Wales. 121 County Boroughs aud Great Towns including London. 140 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London A dministrative County. Coulsdon and Purley Urban District. Rates per 1,000 Population. Births :— Live 14.7 14.8 14.8 13.3 12.2 Still 0.62 0.68 0.64 0.52 0.57 Deaths All Causes 11.7 11.8 11.2 11.4 7.9 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 — Smallpox -— — — — — Measles 0.03 0.04 0.03 0.00 — Scarlet fever 0.01 0.01 0.01 0.01 — Whooping Cough 0.04 0.04 0.03 0.04 — Diphtheria 0.08 0.09 0.07 0.06 0.06 Influenza 0.18 0.16 0.17 0.11 0.29 Violence 0.52 0.45 0.41 0.51 0.45 Notification :— Smallpox — — — — — Scarlet Fever 2.96 3.19 2.75 2.64 2.55 Diphtheria 1.60 1.96 1.34 2.25 1.07 Enteric Fever 0.04 0.04 0.06 0.05 0.02 Erysipelas 0.42 0.48 0.37 0.45 0.22 Pneumonia 1.15 1.36 0.98 0.89 0.65 Rates per 1,000 Live Births. Deaths under 1 yr. of age 57 62 55 58 32 Deaths from Diarrhoea and Enteritis under 2 years of age 5.7 7.9 3.8 11.2 1.6 Maternal Mortality: Puerperal Sepsis 1.68 Not available. Others 2.42 1.68 Total 4.10 1.68 Rates per 1,000 Total Births (i. e., Live and Still). Maternal Mortality : Puerperal Sepsis 1.61 Not available. Others 2.32 1.61 Total 3.93 1.61 Notifications :— Puerperal Fever 3.60 4.55 2.76 4.32 1.61 Puerperal Pyrexia 9.44 11.14 8.25 11.89 1.61 14 INFECTIOUS DISEASE. the year 1935 compared fairly favourably with its predecessors from the point of view of the incidence of notifiable Infectious Disease (excluding Tuberculosis), although the total number of cases notified (230, as compared with 190 in 1934, and 142 in 1933) had been exceeded on only two occasions. On one of these occasions, 1917, the excess was due to Measles, which ceased to be notifiable in 1920. On the other occasion, in 1921, when 231 cases occurred, this total was due to a similar cause to that which pertained in 1935, i.e., a wave of Scarlet Fever coinciding with one of Diphtheria. Slight increases were also experienced in 1935 in the number of cases of Pneumonia and Dysentery notified, compensated for in part by a diminution in Erysipelas and Typhoid Fever notifications. Although 1935 was a " peak " year compared with the last ten years, the incidence of Infectious Disease of 4.7 per 1,000 population was well below the average for the ten years 1915-24 of 6.7, and only slightly exceeded the 4.5 of the period 1925-29. The following Table shows the number of cases notified, together with the number removed to Hospital, and the total deaths :— Disease. Number Notified. Removed to Hospital. Total Deaths. Scarlet Fever 124 79 — Diphtheria 52 48 3 Erysipelas 11 2 — Typhoid Fever 1 — — Cerebro - spinal Meningitis 1 — — Acute Poliomyelitis 1 — — Puerperal Fever 1 1 — Puerperal Pyrexia 1 — — Dysentery 6 — — Pneumonia 32 1 *15 Totals 230 131 18 * Includes deaths from all forms of Pneumonia. Further Tables (I. and II.) will be found in the Appendix showing the ages at which the infection occurred, the municipal wards in which the cases were resident, and the monthly incidence of the disease. SMALT POX. No cases occurred during the year, and very few contacts with cases in other areas required to be kept under supervision. The years 1929-32 were the only ones during which this Urban District has experienced the disease, and then in very small numbers. 15 DIPHTHERIA. There were 52 cases of Diphtheria notified during 1935, as compared with 24 in 1934, and an average of 18 cases per annum since the formation of the Urban District, with the exception of the period 1920-24, when the average was 60. The increased incidence was almost entirely confined to one Ward, where 73 per cent, of the cases occurred. The history of this epidemic is an interesting one : first, in the limitation of the outbreak to this locality, which is not otherwise isolated from the remainder of the Urban District; second, in the comparatively small number of cases which occurred compared with the large number exposed to the risk of infection, especially when it is realised that no epidemic has occurred in this district during the last 11 years. Further, this is not a highly urbanised population such as is usually associated with a good percentage of normally immunised individuals. The outbreak in this part of the District began in June, and at an early stage affected 4 out of 5 children of one family who were admitted to Hospital with positive swabs in that month. Six further contacts were admitted before the end of July, when a break in the epidemic occurred lasting until September. Meanwhile, after giving a series of negative swabs, the family referred to had returned from Hospital and continued to give negative swabs off and on until the end of October. By that time 13 more children from the schools or locality frequented by the returned children had been admitted to Hospital. Two of the original children were then found to be still harbouring Diphtheria bacilli, and, together with the fifth child who had previously avoided detection, returned to Hospital, to be joined a fortnight later by a further member of the family, who had been negative in September and October. Six more direct or indirect contacts with these children were admitted in November and December, one of whom unfortunately died. The epidemic appears to have died out gradually in the early months of 1936. It is, of course, not assumed that all the carriers were detected, as general swabbing was not resorted to in the schools. On the contrary, it is highly probable that a number of other children acted as temporary carriers. What is remarkable is that with a presumably unimmunised population, which mixes freely in and out of school, more clinical cases did not occur. The value of the removal of definite carriers is once more confirmed, but the difficulty associated with the detection of intermittent carriers is also well illustrated. (While several members of the unfortunate family presented sore noses or nasal discharge from time to time, which eventually cleared up with treatment, no member was ever ill from the disease). It is interesting to surmise what would have been the cffect on the outbreak had a section of the population been immunised. 16 The only point of note in the remainder of the cases in the District is that those in the Ward next most highly affected were associated with an outbreak in a neighbouring Urban District. In both outbreaks the disease was of average severity, though, in addition to the death referred to in the main outbreak, two deaths occurred early in the year in isolated cases, delayed admission to Hospital being partly responsible for one of these. During the year there has been some change in outlook on the question of immunisation in the District, due in part to the number of cases which have occurred, and more especially to the facilities recently provided in neighbouring districts, and the spread of information on the subject. While it is still felt that general immunisation cannot be strongly urged, there is undoubtedly a case for the provision of facilities for those who wish to avail themselves, especially in view of the action of neighbouring Authorities. With this in mind, it is probable that some provision will be made for the commencement of an Immunisation Scheme during 1936. ENTERIC FEVER. Only one case of Enteric Fever was notified as compared with an average of 5 cases per annum for the past five years. The case, which was one of Paratyphoid, occurred in January, was treated at home, and recovered. DYSENTERY. There were 6 cases notified during the year, all being cases of " Hospital Dysentery " occurring in one of the Mental Hospitals, and caused by the Flexner type of bacillus. It is probable that a number of mild cases of dysentery occurred among the general population towards the end of the year, associated with a comparatively unrecognised, but widespread outbreak in and around London. An investigation was made, but unfortunately as far as this District was concerned it proved impossible to obtain definite information. The organism found in other neighbouring Districts among the general public was not that causing " Hospital Dysentery SCARLET FEVER. As anticipated in the Annual Report for 1934, the wave of Scarlet Fever which occurred in that year was carried through into 1935. During the year 124 cases were notified as compared with 119 in 1934, and 69 in 1933. 17 The number of cases occurring among the general public showed a reduction, however, and had it not been for 29 cases which occupied in one of the residential schools in the early months of the year, the total number of cases would have shown a decrease, which, it is hoped, will be noted in 1936. Apart from the 29 cases referred to, 10 other cases occurred in two institutions. Of the remaining 83 notified cases, 5 were not confirmed, while the others were very evenly distributed throughout the district, the only feature of note being that about one-third contracted the disease following definite contact outside the District. The majority of the cases were treated at the Wandle Valley Isolation Hospital, only one doubtful "return" case occurring. There were 16 cases treated in their own homes, one of which resulted in three further cases. Thirty-four cases were treated in the institutions in which they occurred, while 2 cases were " return " cases of other infectious disease hospitals outside the District. The disease remained of a mild type, no deaths occurring from this cause. As a result there were a number of " missed " cases. However, on three occasions only did secondary cases result in the home, one being that in which the primary case was nursed at home to which reference has already been made. ERYSIPELAS. There was a reduction in the number of cases notified during the year, there being only 11 as compared with 23 in 1933, and 17 in 1934. Of these, 5 occurred in patients in the two Mental Hospitals, the remaining 6 being unconnected cases scattered over the District. Two cases were removed to Hospital, and no deaths occurred from this disease. PUERPERAL FEVER. One case was notified. The patient was removed to Hospital and recovered. PUERPERAL PYREXIA. There was only 1 case of Puerperal Pyrexia. This case occurred in an institution, and was due to the patient contracting Pneumonia. CEREBRO SPINAL MENINGITIS AND ACUTE POLIOMYELITIS. One notification of each of these diseases was received, but the diagnosis was not confirmed in either case, though both cases terminated fatally. It is probable that the Meningitis was of streptococcal origin. 18 PNEUMONIA. There were 32 cases of Acute Influenzal or Primary Pneumonia notified as compared with 20 in 1934, and 28 in 1933. As, however, 18 of these occurred in the two Mental Hospitals, the number of cases notified in the remainder of the District was 14 as compared with 6, 7, 12, and 8 in the preceding four years. One case was removed to Hospital. OPHTHALMIA NEONATORUM. There were no cases notified during 1935. It will be seen by the Table at the beginning of this Section that the case-rates for infectious disease have remained low compared with the Country as a whole. As pointed out in previous Reports, it is difficult to prevent these diseases in a District such as this, having very frequent contact with London, Croydon and the surrounding districts, especially with the mild and often unrecognised form of Scarlet Fever now prevalent. The fact that during the year in only 10 instances did secondary cases follow primary ones in the home (several of these being swab positive only), suggests that the limitation of cases has continued satisfactorily. NON-NOTIFIABLE INFECTIOUS DISEASES. The group of non-notifiable Infectious Diseases, with the exception of Influenza, caused no deaths during the year 1935, which was a fairly mild year as far as these diseases were concerned. Influenza accounted for 14 deaths in adults, almost all of whom were over 50 years of age. Apart from the death returns, the only source of information as to the presence of outbreaks of non-notifiable Infectious Diseases are the returns received from the public elementary schools. As judged by these, the only outbreaks of note were:— CHICKEN POX was present in Purley in January, Coulsdon in March and April, and Selsdon in June and July, in each case being moderately widespread. MUMPS.—Isolated cases occurred throughout the District until April, followed from February to July, by a fair number of cases in Purley, with a few cases in Kenley and Coulsdon. MEASLES.—Comparatively few cases occurred scattered over most parts of the District between January and May. WHOOPING COUGH.—A moderate outbreak occurred in Selsdon, chiefly in June and July. Home visitation and exclusion from school are the two chief measures relied upon to postpone the onset until a more favourable age is reached to stand the disease. Treatment in Hospital is provided for a limited number of cases, and 2 cases of Measles were admitted to the Isolation Hospital during the year under this arrangement, social or physical complications being present. 19 A further step towards the prevention of these diseases was taken during the year in the making of an arrangement with the Immunization Centre of Great Ormond Street Hospital, whereby cases in which special reasons for immunisation against Measles or Whooping Cough exist may be referred to this Clinic by the Medical Officer of Health. The Council, however, reserve the right to recover all, or part, of the cost of treatment. Similar facilities have also been arranged for immunisation against Diphtheria and Scarlet Fever. TUBERCULOSIS. During the year 35 new cases were notified, as compared with 45 and 54 in the last two years. The 35 cases comprised:— Localisation. Males. Females. Total. Pulmonary 18 12 30 Non-Pulmonary 2 3 5 Totals 20 15 35 The number of deaths registered as occurring from Tuberculosis was 22, viz.:— Localisation. Males. Females. Total. Pulmonary 13 6 19 Non-Pulmonary 1 2 3 Totals 14 8 22 With regard to Pulmonary Tuberculosis, the number of new cases notified in 1935 remained at the low level experienced last year. The case-rate per 100,000 population was 60, which compares very favourably with the average rates of 115 for 1915-24, and 88 for 1925-34. It is also satisfactory to note a fall this year in the number of new cases of non-pulmonary Tuberculosis, viz., 5, which compensates for the 17 new cases in 1934 and 10 in 1933. The incidence per 100,000 of population was very low, being 10, the average for the previous decades being 15 and 18. There were rather more deaths from Pulmonary Tuberculosis in 1935 than in the preceding two years, viz., 22 as compared with 14 and 20. The Death Rate of 4.5 per 100,000 of population also showed an increase, although the tendency has been for this gradually to diminish as indicated by the figures for the four quinquennial periods 1915-34, viz., 72, 57, 36 and 38. A similar tendency has been noted in the non-pulmonary DeathRate, the corresponding figures being 20, 9, 7 and 8 per 100,000 of population. The 3 deaths from the non-pulmonary form of this disease in 1935 gives a Death-Rate of 6, thus continuing the downward tendency of this Rate. 20 The following Table shows the number of new cases of Tuberculosis notified during the year, together with the deaths, at various age periods: Age Periods. New Cases. Deaths. Pulmonary NonPulmonarv Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year – – – – – – – – 1 and under 5 – – – – – – 1 1 5 and under 10 – – – 1 – – – – 10 and under 15 — 1 — — — — — 15 and unper 20 1 – 1 1 – — – – 20 and under 25 5 3 — _ — 1 — — 25 and under 35 4 5 — 1 6 4 — 1 35 and under 45 2 3 _ - 3 — — 45 and under 55 4 – – – 2 1 — — 55 and under 65 2 – – – 2 — — — 65 and upwards — 1 — – — — — — totals 18 12 2 3 13 6 1 2 These eases were distributed amongst the Wards as follows :— Localisation. Coulsdon East Coulsdon West Kenley Purley Sanderstead Selsdon & Farley Woodcote Pulmonary 1 8 3 4 7 6 1 Non- Pulmonary 1 1 1 2 — — — Of the deaths which occurred from Tuberculosis in 1935, 68 per cent. were in previously notified cases. Of the remainder four cases died outside the District, two cases had been previously notified to a neighbouring Authority, and one death occurred in an Institution. The Council has made arrangements for the examination, free of charge, of sputa from cases or suspected cases of Tuberculosis, and during the year 58 such examinations were made. Visitation is also provided to prevent the spread of the disease where possible, by disinfection, removal of unhygienic conditions, etc. Treatment for cases of Tuberculosis is under the control of the Surrey County Council, who provide both Dispensary and Sanatorium treatment. A Dispensary, available for this District, has been established at Whytecliffe Road, Purley, where sessions are held on the 2nd, 3rd, 4th and 5th Mondays in each month at 2.0 p.m., and on the 1st Monday at 5.30 p.m. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was required during the year, under the powers conferred by the above Regulations, in respect of tuberculous employees in the milk trade. 21 PUBLIC HEALTH ACT, 1925, SECTION 62. No occasion arose during the year necessitating the taking of ???ps by the Council to secure an Order for the compulsory removal to hospital of a person suffering from Pulmonary Tuberculosis. AMBULANCES. For Infectious Disease Cases.—Two motor ambulances have been provided by the Wandle Valley Joint Hospital Board for the removal of cases of Infectious Disease to the Isolation Hospital. For Accident and General Cases.—The Council has provided two motor ambulances for the removal of accident and general cases. These ambulances are under the control of the Fire Superintendent. Special facilities are provided for the conveyance of maternity cases to the Purley Memorial Hospital, which were extended in 1935 to include cases going to the Epsom Public Assistance Hospital. HOSPITALS. For Infectious Diseases.—This Council is one of the constituent Authorities forming the Wandle Valley Joint Hospital Board, and cases of Infectious Disease (other than Small Pox) occurring in this District are admitted to the Board's Hospital at Beddington Corner. Building extensions are expected to be made during 1936, and the provision of additional cubicle blocks for observation purposes will be specially welcomed in this District. Small Pox.—Under an arrangement with the Surrey County Council, cases of Small Pox from this area are admitted to the Small Pox Hospital at Clandon. General Hospitals.—The Croydon General Hospital and the Purley War Memorial Hospital receive patients from this District, but a number of residents receive treatment at the London Hospitals. Public Assistance Hospitals.—Patients from this area are admitted to the Public Assistance Hospitals at Epsom and Kingston. Maternity Hospital Accommodation.—The Council has an agreement with the Purley Memorial Hospital whereby the Council has the call on four beds. If accommodation permits, additional cases can be admitted. Under this scheme, 80 cases were confined at this Hospital during the year 1935. A number of maternity cases from this area are confined at the Public Assistance Hospital at Epsom. Reference is made in the section on Maternity and Child Welfare to the need for extending this accommodation. 22 BACTERIOLOGICAL WORK. The bacteriological work in connection with this District is carried out by the Resident Medical Officer of the Wandle Valley Joint Isolation Hospital. The following numbers of specimens from this District were examined there during the year:— Swabs for Diphtheria 388 Sputa for Tubercle 58 INSECT PESTS. There were no widely spread complaints with regard to insect pests during the year, although annoyance caused in isolated instances by a variety of insects required the attention of the Department. MATERNITY AND CHILD WELFARE. The Council is responsible for the Maternity and Child Welfare work in this District, and in its endeavour to minimise the risks of childbirth, and to secure the healthy development of all children born, or residing in the area, the following measures are taken:— Ante-Natal Clinics. An Ante-Natal Clinic was established by the Council in 1931, the first session being held on the 24th June in that year. In 1932 the number of sessions had to be increased owing to the great appreciation of this facility, while in 1933 Clinics were established at Purley and Coulsdon. During the current year a further Clinic has been established at Selsdon. Sessions are now being held from 2.30 to 4.0 p.m. at:— (a) The Methodist Church, Brighton Road, Coulsdon, on the second and fourth Monday in each month. (b) The Methodist Church, Sylverdale Road, Purley, on the first and third Wednesday in each month. (c) The Baptist Church, Addington Road, Selsdon, on the second Wednesday in each month. It will be seen from the following tabular statement of attendances that 187 new cases presented themselves during 1935, as compared with 143 in 1934, and 114 in 1933. This suggests that in approximately 35 per cent. of the births notified in the Urban District the mothers had previously been examined under the Council's scheme, the corresponding figures for 1934, 1933, and 1932, being 31, 27, and 23 per cent. respectively. The majority attending are subsequently confined by midwives or at the Purley Memorial Hospital, but a number are referred to the Clinic by local Doctors for a second opinion, or for observation during the early months of pregnancy, where this would not otherwise be forthcoming. 23 ANTE-NATAL CLINICS. Attendances. Brighton Road, Coulsdon. Month. Sessions. New Cases. Total. Ante-Natal Post-Natal Ante-Natal Post-Natal J anuary .. 2 12 1 33 1 February 2 11 — 37 1 March 2 6 — 30 4 April 2 7 — 30 6 May 2 4 — 29 1 June 2 5 — 25 1 July 2 15 — 46 2 August 2 10 — 33 3 September 2 10 — 31 — October 2 13 — 32 2 November 2 6 1 40 2 December 2 7 — 33 3 Totals 24 106 2 399 26 Sylverdale Road, Purley. Month, Sessions. New Cases. Total. Ante-Natal Post-Natal Ante-Natal Post-Natal January 1 3 _ 18 _ February 1 5 _ 18 _ March 1 7 _ 20 4 April 1 6 2 23 2 May 1 6 _ 25 3 June 1 5 _ 23 2 July 2 6 _ 35 1 August 2 3 1 27 2 September 2 6 _ 21 6 October 2 4 2 Gynaecological. 19 2 Gynaecological 4 November 2 7 _ 17 3 December 2 — _ 19 _ Totals 18 58 2 Gynaecological. 3 265 2 Gynaecological. 27 24 Baptist Hall, Selsdon. Month. New Cases. Total. Sessions. Ante-Natal Post-Natal Ante-Natal Post-Natal October 1 6 (two being transfers from Coulsdon) — 6 — November 1 4 _ 10 — December 1 6 — 14 — Totals 3 16 (two being transfers from Coulsdon). 30 Totals at all Clinics. New Cases. Totals, New and Old. Post-Natal 5 Post-Natal 53 Ante-Natal 180 Ante-Natal 694 Gynaecological 2 Gynaecological 2 Dr. Winifred Small is the Medical Officer of the Ante-Natal Clinics, and is to be congratulated upon the success of the Ante-Natal work. All cases attending are seen by her personally. Obstetric Specialists. In November, 1934, the Council appointed Mr. Leslie Williams and Mr. Joseph Wrigley, both of whom are Specialists in this work attached to London Hospitals, as Obstetric Specialists to the Council. Their services are available for advice, and, if necessary, treatment in any case in which obstetrical difficulty is anticipated or realised, or Puerperal Pyrexia or Fever develops, in any ratepayer in the District. The Council reserves the right to recover part, or all of the cost involved from the family. During 1935 only one case required the services of one of these Specialists. Maternity Cases. During the year arrangements were made for the admission of 80 cases to the Purley Memorial Hospital for their confinement under the Council's scheme, as compared with 86 and 68 in 1934 and 1933. The Hospital is situated just within the boundary of the County Borough of Croydon, and hence its supervision as a Maternity Home is the responsibility of the Medical Officer of Health for that area. The Council had the call on three beds in this Hospital, but owing to the number of applications for admission a request for this to be increased to four beds was made at the end of 1934. It was also suggested at that time that, with the growing need of the District, consideration should be given to the question of enlarging or building a new maternity ward. 25 In view of the fact that a large percentage of applications from all sources are being refused owing to lack of accommodation, a good deal of attention has been paid to this question during 1935. Various difficulties have delayed progress, but it is hoped that in the near future some concrete scheme for providing adequate maternity accommodation will be forthcoming. Meanwhile arrangements have been made with Queen Charlotte's and St. Mary's Hospitals, London, to take any emergency cases which cannot be accommodated in the Purley or Epsom Hospitals. Special facilities for transport to all of these hospitals are available. There are, in addition, five private Maternity Homes. Home Helps. The Council has made arrangements for the supply of Home Helps in necessitous maternity cases since 1920, and during the year 25 cases were assisted in this way, as compared with 13 in 1934. Health Visitation. In May, 1935, it became necessary to appoint an additional Health Visitor. The Council thus employs the services of three full-time Health Visitors, who work under the supervision of the Medical Officer of Health. It will be seen from the following detailed list of visits paid by the Health Visitors during 1935, that a total of 6,725 visits have been paid, this being 1,557 more than in 1934. The additional visits were due to the increased assistance available, and it is satisfactory to be able to report that not only was it possible to provide more adequate visitation per child, but also to increase the number of Ante-Natal Clinics and sessions, and the amount of fully-qualified help in the Child Welfare Centres. Nearly all the houses at which births were notified in the District were visited at least once, and in the vast majority the advice given then, and at subsequent visits, or at the Maternity and Child Welfare Centres, has been much appreciated. Visits paid by Health Visitors. 555 first visits to Babies. 15 investigations of Infant Deaths. 22 investigations of Still Births. 1,691 visits to Babies under 1 year. 8,718 visits to Children from 1 to 5 years. 2X2 Ante-Natal visits (122 first visits, 90 re-visits) 86 visits to eases of Tuberculosis (39 first visits, 47 re-visits). 41 visits to cases of Whooping Cough (21 first visits, 20 re-visits). 7 visits to cases of Measles (4 .'irst visits, 3 re-visits). 7 visits to cases of Chicken Pox (6 lirst visits, 1 re-visit). 1 visit to a case of Puerperal Sepsis 370 Miscellaneous visits. 6,725 Total. 26 Child Welfare Centres. Four Maternity and Child Welfare Centres have been established by the Council, of which details are tabulated on the following pages. It will be seen that 423 new cases attended during the year, this being 55 more than in 1934, while the total attendance of new and old cases was 10,732, this being 1,654 more than in 1934, and 2,913 more than in 1933. The increase in new cases was most marked at Kenley, where 26 more new babies attended in 1935 than in 1934, although the Brighton Road Centre experienced the highest number of new attendances, with 115, this being slightly more than at the two remaining Centres. The increase in total attendances was distributed fairly evenly over the four Centres, Ricknian Hill being the highest with an increase of 498, compared with Kenley, the lowest, which had 331. Selsdon continues to maintain the highest average attendance per session with 61, though only slightly more than the 58 at Brighton Road and 57 at Rickman Hill. The number of consultations have increased slightly, except at Selsdon, the most marked being 40 at Kenley. As previously stated, the number of consultations per session having more or less reached the maximum without risking the loss of efficiency, it is undesirable to expect this number to increase without more frequent attendance on the part of the Medical Officer concerned. While this may become desirable in the future, it is probable that the establishment of a new Centre should first be undertaken. With this latter possibility in mind, and in view of the steady development of the District, financial provision has been made for the establishment of one extra Centre in 1936. There can be no doubt of the importance and appreciation of this work, for which there is no similar provision by any other agency in the District. The fact that approximately 59 per cent. of the newlyborn babies notified as being born in the District attended one or other of the Centres during 1935 is sufficient evidence. Dr. Amy Thorns resigned from the position of Consultant to the Selsdon Centre in September, and Dr. Constance Hildred is now filling that post. Owing to increase in duties the Medical Officer of Health was released from attending the Brighton Road Centre in November, 1935, Dr. Janet Michael undertaking the work there at present, but he continues as Medical Officer to the Kenley and Rickman Hill Centres, 27 sELsdon Infant welfare centre (Established 1928). Sessions held at the Baptist Hall, Addington Road, Selsdon, on each Monday afternoon from 2.30 to 4.0 p.m. Doctors attend first and third Monday in each month. Month. Sessions. Attendances. Consultations. New Cases. Old Cases. Total New & Old January 4 3 190 193 16 February 4 13 212 225 34 March 4 7 224 231 47 April 4 9 233 242 57 May 3 5 161 166 14 J une 3 11 145 156 35 July 5 16 260 276 53 August 2 12 127 139 23 September 5 12 316 328 48 October 5 8 305 313 54 November 4 4 314 318 53 December 5 13 320 333 49 Totals 48 113 2807 2920 483 RICKMAN HILL INFANT WELFARE CENTRE (Established 1929). Held at the Church of St. Francis, Rickman Hill, Coulsdon, on every Tuesday afternoon from 2.30 to 4.0 p.m. Doctor attends second and fourth Tuesday in each month. Month Sessions Attendances. Consultations. New Cases. Old Cases. Total New & Old J anuary 5 8 246 254 59 February 4 7 229 236 47 March 4 6 236 242 49 April 4 7 197 204 54 May 4 7 218 225 51 J une 3 3 148 151 20 July 5 7 283 290 60 August 2 10 121 131 19 September 4 11 207 218 55 October 5 5 299 304 49 November 4 10 260 270 55 December 4 5 196 201 39 Totals 48 86 2640 2726 557 28 KENLEY INFANT WELFARE CENTRE (Established 1917). Held at the Methodist Schoolroom, Sylverdale Road, Purley, on every Friday afternoon from 2.30 to 4.0 P.M. Doctor attends second and fourth Friday in each month. Month. Sessions. Attendances. Consultations. New Cases. Old Cases. Total New & Old J anuary 4 12 208 220 61 February 4 7 168 175 47 March 5 7 251 258 51 April 3 4 140 144 49 May 5 12 211 223 45 June 4 16 193. 209 52 July 4 10 203 213 45 August 3 14 108 122 30 September 4 11 232 243 48 October 4 8 213 221 52 November 5 7 213 220 31 December 3 1 117 118 18 Totals 48 109 2257 2366 529 BRIGHTON ROAD INFANT WELFARE CENTRE (Established 1916). Held at the Methodist Schoolroom, Brighton Road, Coulsdon, every Thursday afternoon from 2.30 to 4.0 p.m. Doctor attends second and fourth Tuesday in each month. Month. Sessions. Attendances. Consultations. New Cases Old Cases. Total New & Old J anuary 5 9 250 259 46 February 4 9 216 225 47 March 4 10 238 248 44 April 3 3 118 121 41 May 5 9 250 259 47 J une 4 10 196 206 46 July 4 17 209 226 54 August 3 10 182 192 27 September 4 16 259 275 61 October 5 11 320 331 55 November 3 5 166 171 31 December 3 6 201 207 31 Totals 47 115 2605 2720 530 Provision of Milk and Specialist Treatment. During the year 71 cases in which the parents were known to be in necessitous circumstances, and the children in need of milk were provided with a supply of milk delivered to their homes, free or at a reduced price, the expense being borne by the Council. 29 While throughout the District the children are, generally speaking, well nourished, and in many cases above the average development, there are in attendance at each Centre children who bear witness to the impoverished condition of their homes. In the majority of these cases the child has shown great improvement as a result of the investment of public money in thus providing extra nourishment. A few cases, however, have shown that the provision of milk is not the only need. In addition, in certain cases, concentrated foods or drugs are provided free, or at a reduced cost. During the year 17 cases were referred to hospitals from the Centres, 13 being to Purley Hospital for Ultra Violet Ray treatment, massage or minor operations, and 4 to Croydon General Hospital for orthopaedic advice or treatment. A number of cases have also been referred to their own Doctors for treatment. These numbers remain low, however, thanks to the appreciation of the fact that the Child Welfare Centres are not for the treatment of the sick, but for periodical examination and observation of the apparently healthy child in order to detect any minor defects, or detrimental tendencies, and for instruction on how to rear children along sound lines. On the other hand, the number of children circumcised at Purley Hospital prior to the mother's discharge after her confinement has become very high, 68 per cent. of the male babies born in 1935 being so treated. While the agreement with the Croydon General Hospital for the treatment of cases suffering from, or liable to develop deafness, has remained in force, no cases have had to be referred for such treatment. This would appear to be due to the securing of early and efficient treatment in the early stages through the family Doctor or some other agency. The scheme for the dental treatment of Ante-Natal and nursing mothers and children under 5 years of age, which was launched in 1934, increased slightly in efficiency and popularity. During the year 33 cases were treated by those Dental Surgeons in the District who had signified their willingness to serve under the Scheme, as compared with 15 cases in the latter half of 1934. While the Scheme still remains slightly ponderous and rather more expensive for the individual than could be desired, the numbers treated hardly justify other arrangements as yet, the present Scheme appearing to be the best that can be evolved to deal with the demand experienced to date in this District. CHILDREN ACTS, 1908—1932. The Health Visitors are all recognised Infant Life Protection Officers. During the year 20 Foster Parents have been under supervision, 39 children being distributed among the Homes, 8 of which homes were registered for the first time during the year. 30 During the same period one Foster Mother removed from the Dis???t, and one Home ceased to be registered owing to the child attaining the age of 9 years. Under the most recent Act, Boarding Schools become liable to registration when children under the age of 9 years are resident. Hence among the new registrations are 5 such Boarding Schools, 4 being iii Purlev and 1 at Kenlev. The Homes were situated as follows:— Selsdon 2 Coulsdon 5 Old Coulsdon 2 Purley 6 Kenley 2 Hooley 1 Sanderstead 2 20 HOUSING. The year 1935 was outstanding on th; question of housing, as a survey was made at the end of the year under the Housing Act, 1935, with a view to ascertaining what overcrowding existed in the District, and how this could be remedied. It has previously been reported that the majority of the houses in the District are good class dwellings in very good condition, over 60 per cent. of which have been built in the last 20 years, hence very little congestion is to be found. The survey was confined to those houses where overcrowding was suspected, or where the rateable value was below a certain agreed figure. A questionnaire was sent by post to the occupants of these houses requesting correct information as to the number, sex, and ages of the residents, together with the number of rooms available. Temporary staff was employed on the distribution of these questionnaires, and the collecting of further information where required. Altogether approximately some 4,800 letters were sent out with prepaid addressed envelopes for replies. The result was interesting in that approximately 4,250 of the recipients replied. The results were tabulated according to the prescribed standard, further enquiries being made when doubt occurred as to the exact position. It was finally ascertained that 21 cases of overcrowding according to the prescribed standard existed, and within the first few months of 1936 the majority of these have been remedied. While it is satisfactory to some extent to be able to record the small figure for local overcrowding, it should be realised that, for a District such as this, the standard is a very low one, the inclusion of living rooms as potential bedrooms being one of several factors limiting the scope of the survey. 31 The further requirements of the Act relating to the fixing of definite numbers of occupants per house, and the inspections necesssary for ascertaining that the standard is not exceeded, necessitates a considerable amount of work on the part of the Sanitary Department. It is, however, beneficial to have a definite standard which can be required. Further building of Council houses to meet the position revealed by the survey has not proved necessary, but the tendency in parts of the District to divide private dwelling houses into separate tenements has provided a subject for deep and prolonged consideration, affecting as it does not only the Public Health, but also the Town Planning schemes of the Council. At the end of the year there were about 200 applicants on the list for Council houses, but this figure included a large proportion who are resident, or work outside the Urban District, or whose familic3 are small and not requiring urgent attention on the grounds of health. HOUSING STATISTICS. Number of houses erected during 1935 1,063 1. Inspection of Dwelling Houses, during the Year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 331 (b) Number of inspections made for the purpose 340 (2) (a) Number of dwelling houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 54 (b) Number of inspections made for the purpose .. 58 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 180 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 343 3. Action under Statutory Powers during the Year:— (a) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 8 32 (2) Number of dwelling houses which were rendered fit after the service of formal notices:— (a) by Owners 10 (b) by Local Authority in default of owners (b) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 92 (2) Number of dwelling houses in which defects were remedied after the service of formal notices:— (a) by Owners 79 (b) by Local Authority in default of owners — (c) Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made — (2) Number of dwelling houses demolished in pursuance of Demolition Orders 2 (d) Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — WATER SUPPLY. The District is supplied with water by the Sutton and District Water Company, whose mains supply that part of the District on the north-west side of Brighton Road and Chipstead Valley Road, and by the East Surrey Water Company, who supply the remainder of the area, with the exception of a small private supply* to premises on the Old Coulsdon Estate, Coulsdon. The mains of each Company were extended during the year to meet the housing developments in various parts of the district. The reports upon the bacteriological examinations of the East Surrey Water Company's, and Sutton and District Water Company's supplies showed that these softened waters had maintained their usual good quality for drinking and domestic purposes. No repetition of the drought of 1934 was experienced, and the excessive rainfall compensated in some measure for the dry season of the previous year. Frequent examinations were made of the private supply of the Old Coulsdon Estates, Ltd. From January to May all reports were satisfactory, when one sample was reported upon adversely. From 33 June to the middle of September further satisfactory samples were taken, but on the 12th September the report was unsatisfactory, and in November two samples were again unsatisfactory. This fluctuation in the quality of the water is a very undesirable feature and the Council have been in communication with the Company with regard to the matter. During the year 19 samples of water were submitted for examination. In addition, 44 samples of the East Surrey Water Company's and the Sutton and District Water Company's supplies were examined for hardness by the Medical Officer of Health. The statutory limit for hardness in these waters is 9 degrees, which in no case was exceeded. The private supply has about 26 degrees of hardness. The source of the water supply is from deep wells sunk into the chalk in various parts of this and adjoining districts. CLOSET ACCOMMODATION. The major portion of the District is on the water carriage system connected to the public sewers. In the more rural parts of the District a number of houses are drained into cesspools, but these are being abolished as new sewers are provided. In most of these cases the houses are already provided with water closets. During the year one pail closet was converted to a water closet, one pail closet was abolished through the demolition of the building, and one privy was also abolished. Eleven cesspools were abolished, and the drains of 12 houses connected to the public sewer. One common cesspool was situated outside the District, but the house connected with it now drains to the sewer. The approximate number of each type remaining at the end of the year were:— Water closets drained to sewers 12,627 Water closets drained to cesspools 372 Earth closets 2 Pail closets 52 The total number of cesspools throughout the District is approximately 348. PUBLIC CLEANSING. No difficulties have arisen in dealing with the collection of house and trade refuse in the District, but owing to the considerable increase in the volume of house refuse it is proposed to construct two additional cells at the Refuse Disposal Works. The emptying of cesspools has been continued by the Council's tanks upon the usual application and payment of charges. The contents of the cesspools are, for the most part, disposed of in the public sewers, but in cases where the cesspools are emptied privately, the sewage is spread over the surface of the ground, 34 SMOKE ABATEMENT. The number of complaints received was slightly higher than the number for 1934, and these were duly dealt with. There is almost a complete absence of large chimney stacks in the District, and the furnaces of the smaller factories and workshops have been generally well kept. There has been no diminution in the number of complaints arising from the indiscriminate burning of trade and garden refuse, and greater care will be necessary before the discomfort and nuisance arising therefrom are suppressed. The Council has made special arrangements for the disposal of trade and garden refuse at the rate of 6d. per bin, and, to avoid the unnecessary pollution of the atmosphere in proximity to dwelling houses, residents are urged in future to take fuller advantage of the facilities offered, or alternatively, to dry garden refuse properly before burning, if it cannot be buried. Books of twenty 6d. tickets can be obtained from the Accountant, Council Offices, Purley, or single fid. tickets can be had from the foreman scavenger. The Council also undertakes, free of charge, the collection of waste paper, which if kept clean and parcelled up will be collected apart from the house refuse. RIVERS AND STREAMS. All watercourses receive careful supervision, and during the year it was not found necessary to take any action for nuisances arising therefrom. DRAINAGE AND SEWERAGE. There was no great extension of public sewers during the year. Attention was directed to the abolition of isolated cesspools, 11 of which ceased to exist, the drains of the respective premises being connected to the public sewer. Two new houses were erected with drains connected to new cesspools. Towards the end of the year a length of 9in. sewer was laid from Brighton Road to Church Dane Avenue, Hooley, through private land to connect up with the sewers to be laid in Church Dane Avenue and Church Lane Drive, Hooley. Estate developers continued to lay sewers on private estates, and some of these were taken advantage of by existing premises. The disposal of the sewage of the District is dealt with by the County Borough of Croydon and the West Kent Main Drainage Board. 35 SHOPS. The whole of the shops in the District have been re-inspected in view of the requirements of the Shops Act, 1934, with regard to the sanitary provisions of the Act, viz., ventilation, lighting, temperature, washing facilities, and facilities for meals. In a few instances it has been necessary to call the attention of the occupiers to some deficiency, and notices have been served for improved heating of premises, additional or improved facilities for taking meals on the premises, improved ventilation and additional sanitary accommodation. The plans of all proposed shops are now required to show the sanitary provisions required by the Act as far as can be deduced prior to the establishment of the business. SWIMMING POOLS. There are no public swimming baths or pools in the District, but the private swimming bath at Reedham Orphanage, Old Lodge Lane, Purley, is used by the children of the Home and by the scholars of local elementary schools, and occasionally by scholars of secondary schools. The bath is small and covered in, while the water supply is from the public mains. The water is changed as frequently as has been found to be necessary. Hitherto tests of the water have not been made by this Department. SANITARY INSPECTIONS, Etc. The following is a statement of the complaints received, inspections paid, defects remedied, etc. Compared with 1934, there were 82 more complaints received and 153 more defects remedied, while the number of visits paid increased by 685. The increase in the work undertaken by the Sanitary Department may be deduced from the following Table:— Years. Number of complaints received Number of visits paid. Number of preliminary notices served. Average 1921-25 97 1919 129 Average 1926-30 133 2720 292 Average 1932-34 163 3495 333 1935 303 4465 527 In each of the three periods quoted the staff comprised one Sanitary Inspector, a different one in each case, assisted part-time by the Clerk to the Medical Officer of Health, who is also Assistant Sanitary Inspector. In the Autumn of 1935 an additional Sanitary Inspector was appointed, the figures above and below fully justifying the increase in staff. 36 The year 1935 was also noteworthy for the increased demand on the Department made by the Housing Survey, and the additional shops inspections with regard to sanitary conditions, etc., which were required under the Shops Act, 1934. The Sanitary Inspector is to be congratulated on a very good year's work in spite of difficulties in that section of his duties which lies outside the scope of this Report. COMPLAINTS. Offensive smells 31 Defective dustbins 8 Accumulations 15 Choked or defective drains 26 Insanitary condition of premises 38 Dampness 21 Burning of refuse 14 Improper keeping of animals 4 Caravans and sheds 1 Verminous condition of premises 14 Other infestations 8 Overcrowding 2 Non-collection of house refuse 9 Rats 86 Smoke from chimney 1 Noise 6 Fouling of Street by Dogs 4 Weeds 5 Miscellaneous 10 Total 303 Inspections. Number of houses inspected 277 Re-inspections and calls made 1,705 Inspections under the Housing Acts 54 Inspections of factories, workshops and workplaces 145 Inspection of bakehouses 38 Inspections of cowsheds 45 Inspections of Dairies and Milkshops 56 Inspections of slaughterhouses 114 Inspection of meat and other foods 254 Inspections of stables and stable yards 41 Inspections of yards, outbuildings, drains, etc. 922 Inspections of piggeries, fowls and other animals 40 37 Inspections re Rats and Mice Destruction Act 141 Inspections re Shops Act 361 Number of drains tested with water 105 Infectious Disease investigations 143 Miscellaneous 24 Total , 4,465 Notices served. Preliminary Notices 527 Statutory Notices 89 Letters and Final Circulars 118 Defects Reported. Insufficient or defective drainage 35 houses. Improperly drained yards 12 „ Cesspools required emptying 75 „ Defective cesspools 7 „ Choked drains 36 „ Defective fresh air inlets 52 „ „ ventilating shafts 6 „ Wire Cages to vent shafts missing 24 „ Unclean walls and ceilings 113 „ Defective plaster 69 „ „ floors 40 „ „ firegrates and washboilers 55 „ ,, sashcords 31 „ „ or choked rainwater pipes 38 „ „ woodwork 56 „ „ paving 55 „ „ dustbins 157 „ „ sinks and sink waste pipes 25 „ „ kerbs around gullies 31 „ Dampness through defective roofs 66 ,, Dampness through other causes 64 „ Defective W.C. fittings 31 „ Accumulations 21 „ Animals kept so as to be a nuisance 3 „ Verminous conditions 10 „ Lack of domestic cleansing 8 „ Overcrowding 5 „ Insufficient lighting and ventilation 11 ,, Defective outbuildings 28 „ 38 Defective brickwork and pointing 45 houses. Defective paintwork 30 „ Defective glazing 37 „ Unclean outdoor premises 26 „ No proper sanitary accommodation 4 „ Without water supply 4 „ Rats 33 premises Insufficient water closets 7 ,, Cowsheds require cleansing 4 ,, Miscellaneous 42 ,, 1,396 Defects Remedied. Drainage repaired or provided 33 houses. Yard drainage provided or improved 12 „ Cesspools emptied 66 „ „ abolished 11 „ „ constructed 2 „ Drains cleansed 34 „ Fresh air inlets provided 52 „ Vent shafts provided or repaired 7 „ Wire cages to vent shafts provided 18 „ Pail closet converted to water closet 1 house. Drains connected to sewer 12 houses. New water closets 2 „ Gully traps, etc., provided 34 „ Inspection chambers provided 27 „ Walls and ceilings cleansed 119 „ Plaster repaired 52 „ Floors repaired 31 „ Firegrates and wash-boilers repaired 40 „ Sashcords repaired 34 „ Rainwater pipes and eaves guttering repaire 130 „ Woodwork repaired 43 „ Paving repaired 62 „ Dustbins provided 179 „ Sinks and sink waste pipes replaced or repaired 18 „ Kerbs around gullies repaired 25 „ Dampness remedied through defective roofs 60 „ Dampness remedied through other causes 56 „ W.C. fittings repaired 22 „ 39 Accumulations removed 20 houses. Nuisances from improper keeping of animals abated 5 „ Verminous conditions abated 12 „ Improved domestic cleanliness 4 „ Overcrowding abated 2 „ Lighting and ventilation provided or improved 8 „ Outbuildings repaired 30 „ Defective brickwork repaired or re-pointed 35 „ Paintwork renewed 30 „ Glazing of windows 30 „ Outdoor premises cleansed 19 „ Sanitary accommodation provided 4 „ Rat infestations abated 18 premises. Water supply laid on 7 Cowsheds limewashed 4 „ Miscellaneous 22 „ 1,332 SCHOOLS. School Closure.—It has not been necessary during the year to close any Public Elementary School on account of the prevalence of infectious disease among the scholars. Infectious disease contacts of school age are excluded from school for a period of time which varies with the nature of the disease. The head teachers of Secondary, Public Elementary and Private Schools are notified immediately any scholar attending their schools develops or is in contact with an infectious disease. The advice of the Medical Officer of Health as to further action is available should this be requested, and disinfection is provided when required. Medical Inspection.—The medical inspection of school children is carried out by the Education Department of the Surrey County Council. Sanitary Services.—The water supply, drainage, and sanitary accommodation in all the public elementary schools were inspected from time to time and found to be satisfactory. LEGAL PROCEEDINGS. It was not found necessary to institute legal proceedings during the year to enforce the abatement of nuisances. 40 REGULATED TRADES. DAIRIES AND COWSHEDS. During the year two dairy farms ceased to be occupied as such, but only one was removed from the register. One dairy has also been removed from the register. There are now six registered dairy farms in the area, which are as follows:— Hooley Farm, Woodplace Dane, Coulsdon. Deans Farm, Hooley. Farleigh Court Farm, Farleigh. Elm Farm, Farleigh. Moorcroft Farm, Farleigh. Farleigh House Farm, Farleigh. At the last mentioned farm, milk for sale is not at present being produced. There are, in addition, two other farms which supply milk to private Institutions by which they are owned, viz.:—Woodplace Farm, Woodplace Fane, Coulsdon, which supplies milk to Netherne Mental Hospital, and the Farm, Cane Hill, Coulsdon, which supplies milk to Cane Hill Mental Hospital. There are also a small number of private persons who own two or more cows and use the milk for their own consumption. Frequent inspections are made of the cowsheds and dairies, which are usually kept and maintained in a cleanly condition. The attention of several milk producers has been called to contraventions of the requirements of the Milk and Dairies Order, 1926, with reference to their herds and premises, and the necessary improvements have been effected. A quarterly veterinary inspection of all cows in the District is undertaken by the Surrey County Council, but in addition the local Council secures a further examination periodically by a local Veterinary Surgeon. There were at the end of the year 11 registered dairies in the district, all of which are satisfactory. The number of registered retailers was 45, of whom 24 reside outside the district. SLAUGHTER-HOUSES. There are two slaughter-houses within the District, both of which are licensed annually. The number of sheep, pigs and calves slaughtered in them during the year was approximately 730. Section 1 of the Slaughter of Animals Act, 1933, came into operation on 1st January, 1934, and superseded the byelaws with regard to the stunning of all animals with a mechanically operated instrument. No alteration in the stunning of animals was involved thereby in this District. The Cash Captive Bolt Killer and the Greener Safety Killer are the instruments used. 41 Licences to slaughter animals, as required by the Act, were issued to nine slaughtermen. Notifications of intention to slaughter are forwarded regularly by the occupiers of the licensed slaughter-houses, and the Sanitary Inspector makes an inspection of all carcases before they are placed upon the market. bakehouses. There are sixteen bakehouses within the District, seven of which are used for the making of bread as well as confectionery. In the remainder chiefly confectioner}7 is made. No new bakehouse was erected during the year, but one bakehouse closed. All the premises were inspected periodically and are generally well kept. OTHER FOOD PREMISES. There are six premises where the trade of fish frier is carried on; one in Selsdon, three in Coulsdon, one in Kenley and one in Purley. Inspections were made from time to time and few avoidable nuisances were found. The business is not scheduled as an offensive trade in the district. All shops and other places where food is prepared or sold are inspected and action taken as may be necessary. FACTORIES AND WORKSHOPS. There are 145 Factories and Workshops within the District, of which 45 are Factories and 98 are Workshops. In addition there are 19 workplaces. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors op Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (Including Factory Laundries) 45 – – Workshops (Including Workshop Laundries) 133 _ – Workplaces (Other than Outworkers' premises) 5 – – Total 183 – – 42 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND £ WORKPLACES. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 15 15 – – Want of ventilation 1 2 – – Overcrowding – – – – Want of drainage of floors – – – – Other nuisances 13 15 – – Sanitary accommodation insufficient 4 1 – – unsuitable or defective 4 5 – – not separate for sexes 1 0 – – Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 101) – – – – Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) – – – – Total, 38 38 – _ * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. INSPECTION AND SUPERVISION OF FOOD. Milk. During the year 53 samples of milk were submitted for examination, and of these 31 samples were also submitted for biological examination. One sample was reported upon adversely as the result of the biological examination, although the microscopical examination failed to reveal any tubercle bacilli, while another sample was reported upon microscopically as showing "the presence of acid alcohol fast bacilli identical with T.B." In the first of the above cases immediate notification, with copies of the reports, were forwarded to the County Veterinary Officer. He reported later that between the time of taking the sample and the date of the report upon it, a part of the herd had been sold in the market for slaughter; further examination of the remaining cows did not reveal any animal likely to produce milk containing tubercle bacilli. This occurred at a farm within the District. 43 In the second case investigation failed to reveal the animal responsible for the adverse report. In that case, too, certain annals had been sent to market. This occurred at a farm outside the District but within the County. The following is a summary of the results of the 53 samples examined bacteriologically:— TOTAL, COUNT. Under 30,000 33 30,000—200,000 17 200,000—400,000 3 COLIFORM BACILLUS. Absent in 1 c.c. 3 Present in 1 c.c. 21 ,, .1 c.c. 14 ,, .01 c.c. 9 ,, .001 c.c. 4 .0001 c.c. 2 The results obtained may be compared with the standard required of " Grade A " milk, which has not to contain more than 200,000 organisms per c.c., nor any coliform bacillus in .01 c.c. Total Count and B. Coli. Total Count only. Number of samples of bacterial standard of "Certified" Milk 23 33 Number of samples of bacterial standard of " Grade A " milk 29 50 It will be seen that 54.7 per cent. of the samples conformed to "Grade A" standard. This percentage does, however, vary so much with the proportion taken from doubtful sources, or which have been previously subject to commercial pasteurisation, the former tending to reduce and the latter to increase the proportion of the " Grade A " standard, that it is difficult to compare the condition of the milk supply from year to year on these figures. In cases where the reports showed that the milk was bacteriologically unsatisfactory, the attention of the dealer or producer was called to the matter, and subsequent samples showed improvement. No samples of Graded Milk were taken under the special instructions of the Ministry of Health, but the 53 samples examined bacteriologically included one sample of "Pasteurised" and one of "Grade A (T.T.)", both of which complied with the prescribed standard. During the year the Council granted the following number of licences under the Milk (Special Designations) Order, 1923:— Ordinary. Supplementary Grade A (T.T.) 9 7 Grade A 2 2 Certified 7 8 Grade A Pasteurised 1 1 Pasteurised 11 5 44 ICE CREAM. ^^lring the summer months samples of ice cream were taken from shops and street barrows. The earliest reports showed that all of the well-known manufacturers produced ice-creams having a high degree of bacterial purity, but the products of some of the local manufacturers were less satisfactory. The process of manufacture was examined in almost all cases where the bacteriological standard was low, with the result that subsequent samples proved more satisfactory. The results are set out in the table below :— Sample. No. of bacteria per 1 c.c. on agar at 37° C. in 48 hours. Coliform Bacillus Present in Absent in 1. 27,000 .001 – 2. (Repeat of 1.) 37,900 .01 .001 3. 4,500 .1 .01 4. 1,200,000 .01 .001 5. (Repeat of 4.) 3,300 .1 .01 6. 3,100 .1 — 7. 700 .1 .01 8. 25,800 — .1 9. 1,640,000 .01 .001 10. (Repeat of 9.) 28,000 .01 .001 11. 6,900 .1 .01 12. 84,000 — .1 13. (Repeat of 12.) 2,500 — .1 14. (Repeat of 13.) 1,500 — .01 15. 268,000 .001 — 16. (Repeat of 15.) 1,660 .1 .01 17. 88,000 — .001 18. 256,000 — .001 19. 28,100 — .1 MEAT. The carcases of all animals slaughtered in the District for human consumption are inspected before being placed on the market. No contraventions of the Public Health (Meat) Regulations, 1924, occurred during the year. Condemned meat and other food is destroyed at the Council's Refuse Destructor. FOOD AND DRUGS (ADULTERATION) ACT, 1928. The duties under the abovenamed Act are carried out by the Surrey County Council. 45 The following samples were collected from this area during the year : Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convictions . Formal. Informal. Total. Formal. Informal. Total. Milk 33 2 35 7 – 7 5 4 Cream 3 – 3 – – – – – Butter – – – – – – – – Cheese – – – – – – – – Margarine – – – – – – – – Lard – – – – – – – – Meat 3 – 3 – – – – – Flour – – – – – – – – Tea – – – – – – – – Coffee – – – – – – – – Cocoa – – – – – – – – Sugar – – – – – – – – Sausages 4 – 4 – – – – – Confectionery and J am – – – – – – – – Sausage Meat – – – – – – – – Wine – – – – – – – – Beer – – – – – – – – Spirits – – – – – – – – Drugs – 1 1 – – – – – *Other articles 4 – 4 – – – – – Totals 47 3 50 7 – 7 5 4 *Details of other articles Orange Wine 2 – 2 – – – – – Mincemeat 2 – 2 – – – – – The total number of samples taken was considerably less than in previous years, and while this was in part due to the greater consumption of standardised articles produced by large wholesale firms, it is hoped that an increase will be noted in the number of samples taken from this District in future years. CHEMICAL AND BACTERIOLOGICAL, EXAMINATION OF FOOD. Samples of food and water for analysis are sent to the following Laboratories :— WATER SAMPLES:— Messrs. Rideal, Rideal & Sciver, 28 Victoria Street, S.W.I. Counties Public Health Laboratories, Queen Victoria Street, E.C.4. MILK:— Counties Public Health Laboratories, Queen Victoria Street, E.C.4. Royal Surrey County Hospital, Guildford. ICE CREAM:— Messrs. Rideal, Rideal & Sciver. 46 adoptive acts and byelaws in force within the URBAN DISTRICT. acts. Investing Authority Statute. Date of Order. Croydon Union Section 160, P.H.A. 1875 (ruinous and dangerous bridges) 15th Aug., 1887 Croydon Union P.H.A. 1875:— Sec. 153. ,, 157 (so far as it is not already in force) „ 160 (so far as it relates to the Towns Improvement Clauses Act, 1847, with respect to naming of streets and numbering the houses) 20th Jan., 1892 P.H.A.A. Act, 1890 Sections 20, 22, 24, 26 (1), 27, 34, 36 and 23. Croydon Union P.H.A.A. Act, 1890, adopted Part iii. Croydon R.D.C. P.H.A., 1875, 39, 44, 45, 49, 50 P.H.A.A. Act, 1890, sec. 39 1875 (Coulsdon only), 42 1875 (Sanderstead) 42 and 161 (1st par.) 4th May, 1896 1875 (Purley) 155 P.H. (Buildings in Streets) Act, 1888, Sec. 3 (Purley) Croydon R.D.C. P.H.A. 1875, Section 66 28th Dec., 1896 Croydon R.D.C. P.H.A. 1875, Section 47 28th Sept., 1902 Croydon R.D.C. P.H.A. 1875, 112, 113, 114, 115 30th May, 1906 Croydon R.D.C. P.H.A. 1875,169 (second par. and third par.) 26th Dec., 1907 P.H.A. 1875, 170 P.H.A.A. Act, 1890, 29, 30 and 31 47 Croydon R.D.C. P.H.A.A. Act, 1907, 15,16,17, 18, 20, 21, 22, 23, 24, 25*, 26, 27*, 28, 29, 30, 31, 32 and 33 in Part II, Part III (but 35 and 38 as amended by Order). Part IV (but 59 as amended by Order). Part VI 28th Apr., 1909 Coulsdon and Purley U.D.C. P.H.A. 1925. Parts II, III, IV, V 1st Dec., 1925 *Same proviso. BYELAWS. 1921—Byelaws with respect to Slaughter-houses. 1926—Byelaws with respect to New Streets and Buildings. 1928—Byelaws with respect to Pleasure Grounds. 1931—Byelaws with respect to Nuisances. 1931—Byelaws with respect to Tents, Vans, Sheds and rimilar structures. 1931—Byelaws with respect to Houses let in Lodgings. 1932—Byelaws with respect to Ventilation of Buildings. 49 TABLE I.—CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1935. ^ Disease, Number of Cases Notified. Total Cases notified in each Ward. Total Cases removed to Hospital Deaths. At Ages—Years. Coulsdon East. Coulsdon West. Kenley. Purley. Sanderstead. Selsdon and Farleigh. Woodcote. At all Ages. Under 1 Year 1 and under i 2 and under 3. 3 and under 4. 4 und 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. 65 and over. Scarlet Fever 124 – 1 3 5 4 43 39 9 11 6 3 – 9 28 14 13 14 8 38 79 – Diphtheria 52 – 1 – 3 5 23 15 1 3 1 — – 4 38 7 – 2 1 – 48 3 Erysipelas 11 – – – – – 1 – 1 – 1 5 3 2 5 – – 2 1 1 2 – Typhoid Fever 1 – – – – – – 1 – – – – – – – – – – – 1 – – Cerebro-spinal Meningitis 1 – 1 Acute Poliomyelitis 1 – – – – – – – – 1 – – – – – – – 1 – – – – Puerperal Fever 1 – – – – – – – 1 – – – – – 1 – – – – – 1 – Puerperal Pyrexia 1 – – – – – – – – – 1 – – 1 – – – – – — — – Dysentery 6 – – – – – – – – 1 1 2 2 – 6 – – – – – — – Pneumonia 32 – 1 –1 – – – 1 11 2 9 7 10 12 – 2 6 2 – 1 *15 Totals 230 – 4 3 9 i 9 1 67 55 13 27 12 19 12 26 90 21 15 26 12 40 131 18 * All forms. The above figures include:— Cane Hill Mental Hospital.—5 Scarlet Fever, 4 Erysipelas, 10 Pneumonia and 6 Dysentery. Nethekne Mental Hospital.—1 Erysipelas, 8 Pneumonia and 1 Puerperal Pyrexia. Reedham Orphanage.—5 Scarlet Fever. Russell Hill Schools.—29 Scarlet Fever. 50 TABLE II.—THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE. Disease. Jan. Feb. March. April. May. June July. August. Sept. Oct. Nov. Dec. Total. Scarlet Fever 7 8 46 3 9 5 3 9 12 8 9 5 124 Diphtheria 1 3 3 1 — 6 7 3 9 11 5 3 52 Erysipelas — — 1 1 2 2 — _ — — 3 2 11 Typhoid Fever 1 — — — — — — — _ — — — 1 Cerebrospinal Meningitis 1 — — — — — — — — — — 1 Acute Poliomyelitis — — — — — — — 1 — — — — 1 Puerperal Fever — — — — — — 1 — — — — — 1 Puerperal Pyrexia — — — — — — 1 — — — — — 1 Dysentery — — 3 — — — 1 — — — 1 1 6 Pneumonia 2 7 5 3 3 1 3 — 2 2 1 3 32 Totals 12 18 58 8 14 14 16 13 23 21 19 14 230 SI TABLE III.—INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1915. W Disease. 1915 (nine months) 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Small Pox – – – – – – – – – – – – – – 2 2 3 4 – – – Scarlet Fever 28 16 20 10 55 129 136 59 40 58 35 48 74 94 125 69 45 29 69 119 124 Diphtheria 7 38 17 4 26 44 62 70 27 101 14 17 11 23 26 17 8 21 16 24 52 Erysipelas 9 11 12 8 12 5 8 9 2 12 10 4 13 8 3 11 8 11 23 17 11 Typhoid & Paratyphoid Fever 27 7 18 73 31 15 5 16 11 5 24 9 9 9 6 4 7 5 5 1 Cerebro-spinal Fever .. 1 – 3 1 – – 1 – – – – – – – 1 – – – – – 1 Puerperal Fever – 2 1 1 - - 2 – – – – 1 – – 1 – 1 1 – 1 1 Puerperal Pyrexia – - – - - – – – – – – – 1 1 1 1 3 5 1 2 1 Poliomyelitis – 1 - – 1 1 – 1 – 1 – – 1 1 – 1 – 2 – 1 1 Fn cephalitis Lethargica .. – – – – – 1 1 1 1 1 1 – 1 1 – – – 1 – – – Ophthalmia Neonatorum . . – 2 1 1 – 1 – – 1 – – 12 – 3 – 1 1 2 – 1 – Pneumonia – – – – 18 8 9 21 6 16 11 – 9 7 38 11 14 29 28 20 32 Malaria – – – – 5 – – _ – – – – – – – – – – – – – Measles – 151 468 33 12 – – – – – _ – – – – – – – – – – Dysentery – – – – 4 7 7 7 17 — _ 1 — – 5 – – – – – 6 Chicken Pox – – – – – – – – 5 11 – – – – – – – – – – – T uberculosis— Pulmonary 18 25 17 25 28 24 12 29 16 24 14 19 25 23 22 38 44 36 44 28 30 Other Forms .. 1 2 4 2 2 2 3 5 3 6 5 2 9 4 2 7 4 6 10 17 5 Totals .. 91 255 561 58 194 237 246 218 129 235 114 113 153 174 232 162 135 154 196 235 265 TABLE IV.—DEATHS OCCURRING DURING THE YEAR 1935. Cause of Death. All M. Ages. F. Under 1 year. 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. Typhoid Fever,etc. – – – – – – – – – – Measles _ _ _ _ _ _ _ – _ _ Scarlet Fever _ _ _ _ _ _ _ _ _ Whooping Cough. _ _ _ _ — _ _ _ — — Diphtheria 2 1 _ 1 1 1 – – – – Influenza 9 5 _ — _ _ 1 1 7 5 Encephalitis Lethargica – – – – – – – – – – Cerebro-spinal Fever – – – – — _ — _ _ – Respiratory Tuberculosis 13 6 – – — _ 1 13 5 _ Other Tuberculous Diseases I 2 _ _ 2 _ _ 1 _ _ Syphilis – – – – – — – _ _ – General Paralysis of Insane,etc. 1 1 – – – – – – I 1 Cancer 32 30 – – – – – 5 25 32 Diabetes 4 5 – – – – – – 2 7 Cerebral Hemorrhage 7 11 – – – – – – 1 17 Heart Disease 43 44 – – 1 1 – 3 22 60 Aneurysm 2 1 – – – _ – – 1 2 Other Circulatory Diseases 10 15 – – – _ – 1 7 17 Bronchitis 4 4 2 – – — – — 6 Pneumonia 9 6 – – – _ 1 1 2 11 Other respiratory Diseases 5 – – – – 3 2 Peptic Ulcer – – – – – – – – – – Diarrhoea (under 2 years) - 1 1 Appendicitis 2 2 – – – – 1 1 1 1 Cirrhosis of Liver _ — – – – – – – – – Other Liver Diseases 1 3 – – – – 1 – – 3 Other Digestive Diseases 3 5 – – 1 – 1 1 4 1 Nephritis 5 7 – – – – – – 5 7 Puerperal sepsis – – – – – – – – – – Other Puerperal Causes - 1 - - - - — 1 - - Congenital Causes 6 7 13 Senility 4 5 9 Suicide 7 2 – – – – 1 3 3 2 Other Violence 6 7 2 – – 1 1 3 3 3 Other Defined Causes 19 22 1 1 – – 3 8 12 16 Ill-defined Causes Totals 195 193 19 2 5 3 11 42 104 202 52 table v.—wandle valley joint hospital board. Cases Submitted to Hospital during the Year ended 31st December, 1935 Disease. Beddington and Wallington. Coulsdon and Purley. Merton and Morden. Mitcham cases deaths cases deaths cases deaths cases deaths Diphtheria 18 - 52 - 47 5 82 2 Scarlet Fever 83 - 78 - 134 - 130 1† Typhoid Fever - - - - 5 lb 2 - Erysipelas 3 - 2 - 1 - 7 1‡ Other Diseases. Measles - _ 2 _ - - _ — Rubella - _ _ - - - 1 _ Influenza - _ _ _ 3 - 1 _ Tonsillitis 8 1* 5 - 13 - 11 1§ Pneumonia 1 - 1 - - - _ - Tuberculous Meningitis - - - - - - 1 1 Whooping Cough and Pneumonia - - - - 2 1 2 Bronchitis 1 _ _ _ _ - - - Rhinitis - _ - _ _ - 1 _ No Disease _ _ - _ 1 - - - Babies (no disease admitted with mother) - - - - 1 - - - Septicæmia 1 - - - - - - - Encephalitis Lethargica - - - - - - 1 la Cerebrospinal Fever - - - - - - 2 1 Nephritis - - - - 1 - - - Rheumatism - - 1 - _ - _ - Septic Bursitis - - - - _ - 1 - Pemphigus - - - - - - 1 - Enteritis - - 1 - 1 - - - Malta Fever - - 1 - - - - - Otitis Media - - - - - - 1 - Totals 115 1 143 2 209 7 244 8 * Tonsilitis with Chronic Bronchitis, b Typhoid with Broncho-pneumonia, † Scarlet Fever with Enteritis. ‡ Erysipelas with Cerebral Embolus. § Streptococcal Septicaemia, a Cerebral Tumour. 53