STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 11,182 Registrar-General's estimate of population, 1939 55,060-56,400. Population, Census 1931 37,666. Number of occupied houses, December, 1939 15,425. Number of occupied houses, 1931 9,533. Rateable Value, December, 1939 £738,614. Sum represented by a penny rate £2,380. VITAL STATISTICS. Birth Rate per 1,000 of the estimated resident population. Total. M. F. 13.5 Live Births - Legitimate 736 349 387 -do- Illegitimate 26 11 15 762 360 402 Rate per 1,000 (live and still) births. Still Births - Legitimate 23 15 8 31.5 Illegitimate 1 1 - Death Rate per 1,000 of the estimated resident population. Deaths 492 247 245 8.9 Rate per 1,000 (live and Still birhts) Deaths from Puerperal causes Puerperal Sepsis 1 1.31 Other Puerperal causes 1 1.31 Death Rates of Infants under one year of age:- All infants per 1,000 live births 43 Legitimate infants per 1,000 legitimate births 39 Illegitimate infants per 1,000 illegitimate births 154 Deaths from Cancer (all ages) 86 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) 2 ; • -3- THE HEALTH REPORT OF COULSDON AND PURLEY IN 1939 (Interim Report). 1. AREA AND POPULATION. There was no alteration in the area of the Urban District during 1939. A diminution in the population occurred, however, in September following the outbreak of war. At the time of the National Register 46,057 were residing in the District, (excluding Some 4,358 in the two mental hospitals) as compared with a probable population of 58,000 in mid-1938. A movement back into the District occurred towards the end of the year. The Registrar General has estimated the population in mid 1939 to have been 55,060 for the purpose of ascertaining the Death Rate and 56,400 for the calculation of the Birth Rate. Both figures are, of course, considerably more than the actual population during the last four months of the year, though slightly less than that for the first eight months. The number of occupied houses was also reduced from 15,899 in mid-1939 to 15,425 at the end of the year. VITAL STATISTICS, BIRTHS. During the year 762 births were registered as belonging to the District, of which 360 were males and 402 females, as compared with 738 births in 1938. This is equal to an annual birth rate of 13.5 per 1000 population, which is 0.1 per 1000 higher than in the previous year. The number of illegitimate births reported was 26, being 6 more than in 1938 but the same as in 1937. This number represents 3.4% of the total births. The total number of stillbirths was 24 (16 male and 8 female) which was 3 more than in 1938 and gives a local stillbirth rate of 0.42 per 1000 population. One of the male stillbirths only was an illegitimate child. DEATHS. The number of deaths registered during the year as belonging to the District was 492 (247 males and 245 females) as compared with 434 in 1938. The crude death rate for the year was equal to 8.9 per 1000 population, which is 1.0 higher than in the previous year. Corrected for age and sex distribution the death rate becomes 8.7 per 1000 population. Both rates are very much below the national rate of 11.9 for the year. CAUSES OF DEATH. HEART AND CIRCULATORY DISEASE. This was, as usual, the largest group, representing more than 1/3 of the deaths from all causes. However, 78% of these deaths were in persons over 65 years of age. CANCER. The proportion of deaths due to cancer was almost exactly the average for the previous 6 years viz. 17.4%, the actual number of deaths being 86. The cancer death rate was 1.58 per 1000 population, which was approximately that for the country as a whole but slightly higher than the average local rate for recent years. VIOLENCE. The death rate from violence, including suicide was the same as in 1938, viz. 0.49 per 1000 population, there being 8 deaths from suicide and 19 from other forms of violence. The death rate from suicide was 14 per 100,000 population, which, like that of other forms of violence was slightly above the normal for the years preceding 1938. MATERNAL MORTALITY. With regard to deaths associated with childbirth, the local mortality rate was 2.62 per 1000 total births, which is slightly less than the national rate of 2.82. One death was due to sepsis and the other to broncho-pneumonia following a caesarian section. INFANT MORTALITY RATE. The number of deaths occurring in children under 1 year of age was 33 (18 males and 15 females) compared with 38 in 1938 and an average of 17 for the preceding 5 years. Four of the deaths were in illegitimate children. The infant mortality rate was thus 43 per 1000 registered births, as against a figure of 51 for 1938. The national rate of 50 was the lowest yet recorded. The local neo-natal mortality rate was 29, which was 2 more than in the previous year. Infectious disease. The number of cases of infectious disease was again very low, there being 165 cases other than tuberculosis, compared with 120 in 1938, while the infectious disease rate of 3.0 per 1,000 of population was one of the lowes.t recorded. The figure of 165 would have been even better but for the inclusion of Measles and Whooping Cough (8) at the end of the year, and the increased number of cases of pneumonia notified, (52 as compared With 12 in 1938). 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 65 43 - Diphtheria 10 10 — Typhoid Fever 1 1 - Paratyphoid Fever 1 - - Erysipelas 10 6 — Puerperal pyrexia 3 1 1 Pneumonia 52 — 18 x Cerebro-spinal fever 4 4 3 Poliomyelitis 1 1 - Dysentery 10 10 — Whooping cough 6 2 - Measles 2 2 - 165 80 22 x Includes deaths from all forms of Pneumonia. -4- -5- DIPHTHERIA. As was anticipated the incidence of this disease remained at a very low level throughout 1939, although a small outbreak occurred at the end of the year. Only 10 cases were notified, compared with 10, 8, 35, 52 and 24 in the preceding 5 years. Of the 10 cases one was not confirmed being found to suffer from Scarlet Fever on admission to Hospital, two were swab positive only, while another with laryngeal symptoms was only a suspected case of Diphtheria. The low incidence of Diphtheria should not be attributed to immunisation as only a very small proportion of the population have been so treated. The numbers treated at the local immunisation clinics during the year were as follows:- Number of sessions 29 Number subjected to primary Schick Test 8 Number found positive 4 Number found negative 4 Number who received or completed the full course of treatment during 1939 35 Under 5 years 29 Over 5 years 6 Number tested in 1939 by the Schick Test after receiving treatment 32 Number found negative 30 Number found positive 2 Number of cases treated or tested during the year 64 TYPHOID FEVER. Only one case of typhoid fever was notified, this being an inmate of one of the Mental Hospitals. PARATYPHOID FEVER. There was only one case of paratyphoid fever notified, the origin of which could not be traced. The patient was treated at home and recovered. SCARLET FEVER. This disease continued at a low level during 1939, there being only 65 cases compared with 71 and 62 in 1937-38, and an average of 120 in each of the three preceding years. Four cases were not confirmed on admission to Hospital. Fifteen of the cases were treated at their homes. The disease remained mild in type, no deaths having occurred locally in the last seven years compared with five in the preceding ten years. ERYSIPELAS. There were 10 notifications of Erysipelas which is slightly below the average for recent years. Four were patients in the Mental Hospitals, the remaining 6 being unconnected cases scattered over the District of which 2 were admitted to Hospital. PUERPERAL PYREXIA. Three cases of Puerperal Pyrexia were notified, one of which was only a case of cystitis. Of the other two cases, one followed a miscarriage. One death occurred from puerperal Sepsis but this related to a further resident whose confinement and death occurred in Croydon. OPHTHALMIA NEONATORUM. No cases of ophthalmia neonatorum were notified. CEREBRO - SPINAL FEVER. Four cases were notified., one case occurring in each of the following months: January, March, October and December. The first and last cases, were in respect of children only one year old, both of whom died from the disease. The second case was an adult who Was visiting the District and the third case was 3½ years old. All four cases were "admitted to Redhill County Hospital. A further death was attributed to the late results of this disease but the case was not notified in the acute stage. POLIOMYELITIS. The only case of Poliomyelitis a boy of 9 years , was notified in February, but the diagnosis was not confirmed on admission to Hospital. DYSENTERY. Ten cases were notified of which 8 occurred in January. All were inmates of one of the Mental Hospitals in the Urban District. TUBERCULOSIS. regard to tuberculosis in this District during 1939:- PULMONARY. NONPULMONARY. TOTALS M. F. M. F. M. F. Number on register 1st January, 1939. 87 79 18 24 105 103 ADDITIONS, 1939. New cases notified 15 16 6 6 21 22 Cases removed into District 8 10 1 2 9 12 Restored to register 3 2 - - 3 2 TOTAL ADDITIONS 26 28 7 8 33 36 REMOVALS, 1939. Died 7 5 3 1 10 6 Removed from District 11 8 0 1 13 9 Recovered 3 3 1 3 4 6 Non-Tuberculous 1 1 1 1 2 2 TOTAL REMOVED FROM REGISTER 22 17 7 6 29 23 Number on register 31st December, 1939 91 90 18 26 109 116 -6- -7- The number of new cases was almost exactly the sane as in the two previous years. No noteworthy change was made in the arrangements for preventing Tuberculosis or other infectious diseases locally, the position being generally satisfactory. AMBULANCES. The ambulances for infectious disease cases remain the same, but the three ambulances for civil cases were staffed by A.R.P. personnel after August 1939. and could if necessary be augmented by the twelve A.R.P. ambulances. HOSPITALS. The infectious disease hospitals remained as in previous years, and provided adequate accommodation. The general and county hospitals were enlarged under the Emergency Hospital scheme. The admission of. maternity cases was. restricted to Purley and Redhill Hospitals, which were, however, able to take all cases needing to be admitted. BACTERIOLOGICAL WORK. The arrangements for bacteriological work and disinfection remain unaltered, the proposal for an independent laboratory serving adjacent authorities failing to materialise. HEALTH PROPAGANDA was proceeded with as hitherto. THE PUBLIC HEALTH ADVISORY COMMITTEE, consisting of representative of the General Practitioners practicing in the District and the Public Health Committee net on two occasions, and considered the Council's scheme for maternity and Child welfare. The Committee made recommendations as to the procedure which should be followed when appointing new medical officers for the clinics or centres and on the terms of the appointments. These were adopted by the Council. A recommendation that Obstetric Specialist Clinics should be instituted was to have been considered further, as also the staffing of the Ante-Natal Clinic, but with the approaching onset of hostilities these matters had to be deferred and it was later decided to Call further meetings of the Advisory Committee only as and when required. MATERNITY AND CHILD WELFARE. The numbers attending the Ante-Natal, Post- Natal and Child Welfare Centres showed every sign that the steady increase in attendances recorded in previous years would have been maintained but for the war. When this commenced it appeared very undesirable for numbers of mothers and children to congregate without adequate means being provided for their protection. Normal Child Welfare sessions were therefore suspended until sufficiently large shelters had been constructed in the vicinity of each Centre. The Health Visitors were, however, still present at the normal times to issue free milk etc. to the relatively small number of mothers who attended, and to give advice in urgent cases. In two cases new premises were utilised owing to the original buildings being used by the military or A.R.P. services. Normal sessions were resumed at three Centres in November, at two in mid-December and at the other Centres early in 1940. The Ante-Natal and Post- Natal Clinics were continued in the normal manner and showed an increase of nearly 60% in the total attendance on that in the- previous year. Special sessions were devoted to the inspection and welfare of toddlers from March to September, 1939, six sessions being held at each of three Centres and five at another Centre. A total of 247 toddlers were examined and 29 re-examinee. -8- In general their condition was found to be very satisfactory, and it was unfortunate that this extension in the service had to be discontinued at such an early stage. Sessions were, however, resumed early in 1940. The Health Visitors paid an increased number of visits during the year. STAFF. The Council appointed a fourth Health Visitor in July 1939, and following her resignation in October, appointed her successor in November, 1939. Slight alterations were also made in the medical personnel staffing the Child Welfare Centres. THE OBSTETRICAL EMERGENCY UNIT was not required for service in this District during 1939, but is still available as are the Obstetric Specialists, one of whom was called in on 11 occasions during the year. The practice of not attempting to recover fees incurred for their services commenced in September, 1938, for a trial period of 1 year and was continued for a further period of twelve months. MATERNITY CASES. The number admitted to Purley Hospital increases by 3 to 64 and admissions to Redhill County Hospital by 34 to 98, but only 2 went to Queen Charlotte's Hospital as compared with 12 in 1938. The Cornell's midwives attended 87 cases, this representing an increase of 31 on 1938. No alterations were made in the arrangements for Home Helps birth control, the provision of milk, specialist treatment and convalescent treatment. The numbers availing themselves of the services of the Home Helps diminished by 13 to 18. There were 11 fewer cases treated in hospital for minor operations, etc., the total so treated being 32; the number of orthopaedic cases treated increased from 3 to 7, while the number of cases which received free or part cost milk increased by 21 to l6l. On the other hand the number of dental cases treated diminished by 14 to 76 cases. THE DAY NURSERIES ceased to function in September 1939 but, with the provision of shelter accommodation by the Council for both children and staff, work was resumed in 1940. CHILD LIFE PROTECTION. Inspections under Section 209 of the Public Health Act 1936 continued uninterruptedly, 21 foster mothers being supervised. The conditions found were generally satisfactory. HOUSING. The number of inspections made with a view to detecting housing defects during the year fell from 1,135 in 1938 to 540 in 1939. No proceedings were taken under the Housing Act 1936, sections 11 to 13. Eight now cases of overcrowding Were found during 1939 making a total of 12 cases, of which 6 were relieved. One case was a recurrence after previous abatement. Steps were taken during the last 4 months of the year to avoid overcrowding in billets, depots, etc. WATER SUPPLY. The only innovations with regard to the water supply were; (1) the private supply to the Old Coulsdon Estate was replaced by an extension of the East Surrey Water Company' supply on the 1st August, 1939, after very prolonged negotiations; (2) preceding and following the onset of hostilities the Companies have maintained a slightly greater percentage of free chlorine in the water against the increased war risk of damage to the mains. All samples of the public supplies examinee were -9- satisfactory, and the supply to private houses was adequate. CLOSET ACCOMMODATION. Nine pail closets were abolished during the year, but the total number was increased considerably owing to the number of Warden's posts, public and private shelters. The number of cesspools was reduced by 46 to l7l. The contents of the pail closets are collected in the Council's tanks and disposed of in the public sewers. THE PUBLIC SEWERS were extended by 3,516 yards of which 2,749 yards were at Old Coulsdon and 723 yards at Hooley. No alterations were made in arrangements for Refuse Disposal, Smoke Abatement, Supervising Rivers and Streams, Shops, School Premises, Dairies and Cowsheds Slaughter houses (prior to September), Bakehouses and other food premises, and Rat and Mice destruction. SANITARY INSPECTIONS were maintained as in previous, years but with the War more of the time of the Sanitary Inspectors was given to A.R.P. work and to inspecting billets, depots, etc. Two fewer houses had to be disinfested (i.e. 14, including 3 council houses) no change being made in method, used In addition two new private houses were fumigated privately by cyanide gas. TWO CAMPING SITES used by Scouts were improved by the installatior of suitable drainage, etc., and two licences granted for caravan sites, one for a period of 6 months only. LEGAL PROCEEDINGS were instituted in two cases, one for overcrowding, which was subsequently abated, and the other far- the abatement of a nuisance which was effected within 21 days. MILK AND ICECREAM. Rather more samples of milk were examined bacteriologically and biologically than previously, and on the whole the results were slightly better. In addition 13 samples of the milk sold by a firm holding the sole licence for pasteurising issued by the Council were submitted to the phosphatase test, 6 being satisfactory and 7 unsatisfactory. Steps were taken to improve the process following recent, of the unsatisfactory reports. The phosphatase test was also application to other pasteurised milk sold in the District. Two more samples of icecream were examined than in 1938, viz. 29. As a result of the advice given, at least four supplies were definitely improved. In one case the Council cancelled their registration of the premises and the manufacture of icecream ceased. MEAT. The quantity of unsound meat and fish destroyed increased from l84¾ lbs. to 432¾ lbs. but less of other foodstuffs was destroyed (22¾ lbs. compared with 55 lbs.). The number of animals killed and carcases inspected was fewer than in 1938 (38 calves and 73 pigs compared with 57 and 219) with the exception of sheep and lambs (992 compared with 777). The proportions affected by disease including tuberculosis, were about the same as in the previous year -10- INSPECTIONS OF FACTORIES AND WORKPLACES. Including inspections made by Sanitary Inspectors PREMISES. NUMBER OF INSPECTIONS WRITTEN NOTICES OCCUPIERS PROSECUTED (1) (2) (3) (4) FACTORIES with mechanical power. 100 - - WORKSHOPS without mechanical power. 110 - - OTHER PREMISES under the Act (including works of building and engineering construction but not including outworkers' premises) 17 — — DEFECTS FOUND IN FACTORIES. AND WORKPLACES. PARTICULARS NUMBER OF DEFECTS. NUMBER of DEFECTS IN RESPECT of WHICH PROSECUTION WERE INSTITUTED FOUND. REMEDIED REFERRED TO H.m. INSPECTOR (1) (2) (3) (4) (5) Want of Cleanliness (S.l) 4 6 Overcrowding (S.2) - - Unreasonable temperature (S.J) - - Inadequate ventilation (S.4) 2 Ineffective drainage-of floors (S.6) 1 - Sanitary Conveniencies (Sec.7) insufficient 1 _ unsuitable or defective 6 3 not separate for sexes Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the. Third Schedule to the Factories Act, 1937). 6 6 TOTAL 20 15 -11- FOOD AND DRUGS ACT. 1938. The powers under this Act were taken over by the Council from the Surrey County Council in October 1939 and the following table shows the samples taken during the year. FOOD AND DRUGS ACT. 1938. ARTICLES. FORMAL. ANALYSED TOTAL. ADULTERATED OR DETERIORATED. PROSECUTIONS. CONVICTIONS INFORMAL. FORMAL. INFORMAL . TOTAL. Milk. 48 3 51 2 2 Butter. 1 - 1 Margarine. . 3 - 3 Lard. 1 - 1 Sugar. 2 - 2 Sausages. 7 - 7 1 — 1 Jam. 3 - 3 Ginger. wine. l - l. Drugs. 4 - 4 Bleach ointment. 2 4 6 1 3 4 Loganberries (tinned) 1 - 1 Bread. 4 — 4 Currants 1 — 1 Lemon cheese 1 — 1 Mincemeat 1 — 1 Mustard mixture. 1 1 Pickles. 1 1 Vinegar, malt. 2 - 2 TOTALS 84 7 91 4 3 7 ! ■ I !