COU 13 HEALTH REPORT for 1945 and the years 1939—1944 FOR THE COULSDON AND PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH REDHILL: The Surrey Fine Art Press, Cavendish Road. HEALTH REPORT FOR 1945 and the years 1939 — 1944 FOR THE COULSDON AND PURLEY URBAN DISTRICT BY THE MEDICAL OFFICER OF HEALTH REDHILL: The Surrey Fine Art Press, Cavendish Road. URBAN DISTRICT COUNCIL OF COULSDON AND PURLF.Y. 1945 Public Health Committee. Chairman: Councillor S. E. Littlechild. Councillor j. H. Allen Councillor A. E. Hpwcroft „ Mrs. Bluett ,, A. J. Crisp ,, Mrs. Hooley ,, F. Jobbins „ F. T. Q. Mason „ Mrs. May „ Mrs. Mennell Wartime Nurseries Committee. Chairman: Councillor Mrs. Bluett. Councillor Mrs. Bartleet „ R. Hill „ Mrs. Hooley Councillor F. Jobbins ,, Mrs. May ,, Mrs. Mennell Co-opted Members : Mrs. W. N. Crowley and Mrs. W. H. Finn. Representatives on the Wandle Valley Joint Hospital Board. Councillor F. G. L. Moir, M.M.I.Struct.E., I.Mar.E. Councillor J. Newton (ex-officio member). Representatives on the Purley War Memorial Hospital Committee. Councillor Mrs. Mennell. Councillor W. H. Pearson, L.R.I.B., M.I.P.A. Representative on the Purley and District Day Nursery. Councillor Mrs. Hooley. Representative on the Coulsdon and District Day Nursery. Councillor Mrs. Bartleet. Public Health Department. STAFF: Medical Officer of Health: F. R. Edbrooke, M.B., Ch.B., D.P.H. *Medical Officers of Ante-Natal Clinics : Winifred M. Small, M B., Ch.B. (left District February, 1943). Muriel J. W. Dobbin, M.B., Ch.B. (July, 1942—December, 1944). Elspeth M. Whitaker, M.B., Ch.B. (January, 1945—December, 1945). Isabel May, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. (appointed January, 1946). Sylvia E. Collingwood, M.B., Ch.B. (appointed March, 1945). 3 *Medical Officers of Child Welfare Centres: Constance Hildred, M.B., Ch.B. (left District March, 1946). Gladys Lenanton, M.R.C.S., L.R.C.P. Janet E. D. Michael, M.D., M.R.C.P., M.R.C.S. Gordon Lindsay, M.B., B.S., M.R.C.S., L.R.C.P. Isabel May, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. (appointed March, 1946). *Medical Officer of Family Planning Clinic: Constance Hildred, M.B., Ch.B. (left District March, 1946). Gwyneth M. Cotterell, M.B., Ch.B. (appointed March, 1946). *Medical Officer of Wartime Nurseries: Constance Hildred, M.B., Ch.B. (left District March, 1946). Isabel May, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. (appointed March, 1946). *Consulting Obstetric Specialist: Douglas Lindsay, M.D., Ch.B., F.R.F.P.S. *Consulting Paediatrician: J. N. O'Reilly, D.M., M.R.C.P. Sanitary Inspector: H. Buxton, M.R.S.I. Additional Sanitary Inspectors: L. E. Snelling, A.R.S.I, (resigned October, 1945). J. N. [enkinson, A.R.S.I. (H.M. Forces February, 1940—December, 1945). S. E. Crisp, C.R.S.I. Assistant to Sanitary Inspector: W. H. Sands. Senior Health Visitor: Miss E. T. White, S.R.N., S.C.M., I.S.T.M., H.V.C. (retired May, 1944V Miss L. E. Letts, S.R.N., S.C.M., H.V.C. (promoted May, 1944). Health Visitors: Miss S. G. Paddle, S.R.N., S.C.M., H.V.C. Miss G. E. Thompson, S.R.N., S.C.M., H.V.C. (August, 1939—October, 1939). Miss M. Steward, S.R.N., S.C.M., H.V.C. (November, 1939—May, 1946). Mrs. M. I. Pointer, S.R.N., S.C.M., H.V.C. (appointed May, 1944). Miss M. Newton, S.R.N., S.C.M., H.V.C. (May, 1944—August, 1945). Miss E. V. Bell, S.R.N., S.C.M., H.V.C. (appointed October, 1945). Miss K. A. Taylor, S.R.N., S.C.M., H.V.C. (appointed May, 1946). Midwives: Miss A. E. G. Neighbour, S.R.N., S.C.M. Mrs. C. Noakes, S.R.N., S.C.M. Home Help Organiser: *Mrs. C. Savidge (appointed October, 1945). Clerks: G. A. Lee (H.M. Forces February, 1941—January, 1946). J. R. Richardson (H.M. Forces March, 1942—March, 1946). Temporary Clerks: Mrs. J. E. Hodge (June, 1939—*after March, 1946). Miss M. McComb (February, 1941—joined H.M. Forces March, 1942). Mrs. D. Weekes (January, 1942—December, 1944). Miss C. Wilmot (May, 1942—March, 1946). Miss M. I.angton (February, 1944—January, 1946). *Part-time Officials. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 11,142 Registrar-General's estimate of population, 1945 53,460 Population, Census 1931 37,666 Number of occupied houses, December, 1945 16,458 Number of occupied houses, 1931 9,533 Rateable Value, December, 1945 £744,393 Sum represented by a penny rate £3,003 VITAL STATISTICS FOR THE YEAR 1945. Total. M. F. Birth Rate per 1,000 of the estimated resident population. Live Births—Legitimate 702 353 349 do. Illegitimate 48 24 24 750 377 373 14.0 Rale per 1,000 (live and still) births. Still Births—Legitimate 16 5 11 do. Illegitimate 2 1 1 23.4 18 6 12 Death Rate per 1,000 of the estimated resident population. Deaths 549 276 273 10.2 Deaths from Puerperal causes Rate per 1,000 (live and still) births. Puerperal Sepsis Nil Other Puerperal causes Nil Death Rates of Infants under one year of age:— All infants per 1,000 live births 32 Legitimate infants per 1,000 legitimate births 29 Illegitimate infants per 1,000 illegitimate births 62 Deaths from Cancer (all ages) 94 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) Nil 5 COULSDON AND PURLEY URBAN DISTRICT COUNCIL. Ladies and Gentlemen, I beg to present to you my Annual Report for 1945, this being my fourteenth Report as your Medical Officer of Health. As you are aware, for the last six years it has only been permissible to present a duplicated Interim Report annually, from which many statistics have been omitted for security and other reasons. The relevant facts have, however, been preserved and I have taken this first opportunity of presenting them in a comprehensive and printed form. As your District had in 1945 completed 30 years as a separate Urban District, it appeared opportune to review the stages in its development and the trends in the sphere of its public health, at the same time bringing up to date the vital statistics to cover the war years. During the preparation of the Report, however, it became obvious that it would become too voluminous if the full 30 years were surveyed, hence the present Report has been limited to a record of the years 1939 to 1945. It is hoped that the survey may be completed in the 1946 Report. It is inevitable that in presenting a Report such as this a large volume of statistics must be included for record purposes, but as far as possible these have been collected in tabular form to facilitate reference for those who are interested and avoidance by those who have not a statistical bent. It is hoped that by judicious attention to, or disregard of, less important detail the Report will prove interesting and helpful, particularly to those Councillors who have only joined the Council during recent, years. It will be found that during the war years the health of residents has been remarkably good as judged by the generally accepted standards. The Birth Rate has increased markedly, although 1945 saw a sudden and probably temporary fall, coinciding with the absence overseas of the maximum number of young men and women. The Infant Mortality Rate has steadily decreased after a rise in 1941. The Maternal Mortality Rate has remained at a low level, and in fact no maternal deaths at all occurred in 1945. It is true the Death Rate has remained steadily above the pre-war level but this was to be expected with the absence of the younger sections of the population. Unfortunately it is impossible to standardise this and similar rates to avoid unfair comparisons of the relatively elderly war-time population with its younger pre-war counterpart. The history of infectious disease in the District during the last seven years is a little confused by the inclusion of measles and whooping cough among the notifiable diseases since 1939, and by the influence on the statistics of the mental hospitals, where infectious disease has almost inevitably increased. In the District as a whole, however, the position has been extremely satisfactory, there having occurred only one outbreak of note, namely, a wave of mild scarlet fever in 1943 which affected the whole country. The degree of immunity of the population of the District against diphtheria is believed to be much higher than in pre-war days, thanks to the success of the Immunisation Scheme from 1941 onwards. 6 Only one child and one adult have died from this disease in the seven years of war. Notifications of Pulmonary Tuberculosis have increased steadily but this is partly due to better means of diagnosis, particularly Mass Radiography. After an initial rise, however, the death rate from this disease has fallen both nationally and locally, in marked contrast with what happened in the 1914-18 period. Not only have residents reason to be thankful for the low incidence of the endemic diseases but for the absence of other well-recognised diseases, such as smallpox and typhus, and this in spite of the arrival of many contacts in the District from time to time. With the speed of modern transport the risk of such diseases spreading beyond their former boundaries has greatly increased. While it is impossible to apportion fairly such credit as can be given to the human agencies which have contributed to this satisfactory condition of the public health in war-time, mention should be made of the wise decisions on policy of the Ministries of Health and Food and their skilful application, in spite of so many difficulties. The recently published report of the Chief Medical Officer of the Ministry of Health On the State of the Public Health during six years of War " gives a most interesting and comprehensive picture of the problems faced and overcome so successfully, of the national trends and the many ramifications of the health services. Against this wide background the part played by local agencies seems trivial and unworthy of mention were it not that the efficiency of a machine is dependent on the strength of the individual cogs. The parts played locally by the Doctors, Nurses and Midwives have frequently called forth well-deserved comment on their endurance and self-sacrifice. While endorsing these most heartily and expressing the hope that the real co-operation which existed in war-time between all branches of the health services may continue in the future, it is hoped that the inclusion of a final paragraph for record purposes on the contribution of the staff of the Public Health Department will be condoned. When war commenced this staff consisted of one Medical Officer, assisted at the clinics, etc., by several part-time Doctors, four Sanitary Inspectors, three Health Visitors, two Midwives and three Clerks. A rapid survey of some of the work and responsibilities undertaken, in spite of some depletion and many changes in personnel, additional to the routine duties of the Department, will, it is hoped, speak for itself. The Civil Ambulance Service was taken over from the Fire Department from the first and doubled its service to the community; the First Aid and Casualty Service was organised and maintained with a maximum strength of approximately 290 whole-time paid and 550 part-time voluntary members and a final establishment of about 80 whole-time and 100 part-time workers; large numbers of volunteers were enrolled for the Civil Nursing Reserve; the Mortuary and Food Decontamination Services were organised and maintained, and, in addition, considerable Control Centre duties were undertaken; three War-time Nurseries, with a total staff of about 40 persons, were established and administered, 7 while closer liaison with the two Voluntary Nurseries was created; a major Diphtheria Immunisation Campaign was carried through and the prewar service permanently extended; a successful Rodent Destruction Campaign was inaugurated; extensions were made in the various clinics and a Scabies Treatment Service established. The year 1945 saw the disbandment of the First Aid and Casualty Service, and here a special word of thanks is due to the many leaders who gave yeoman service and for the willing co-operation of almost all the personnel, not only in carrying out their main function, but in assisting in many forms of public health work. The Mortuary, Food Decontamination and Control Centre Services also ended officially, though the duties relating to these Services by no means ceased. As these war-time interests receded, however, the post-war reconstructive activities increased, but it will be wise to defer consideration of these developments until the 1946 Report. May I, in conclusion, express thanks to all who have assisted in any way during these difficult years in furthering the cause of good health. They are far too numerous to mention individually and include my colleagues in other Departments of the Council's Service, many of whom have co-operated most happily. Special words of gratitude must be given to the Chief Sanitary Inspector, who has been a most loyal and stalwart colleague throughout, to the Senior Health Visitors, who have maintained their department most successfully and, like the Sanitary Inspector, assisted in the preparation of this and preceding Reports, and, finally, to my former Chief Clerk and present part-time Secretary, who has for seven years given of her best unstintingly and taken great interest in the preparation and production of this Report. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, F. R. EDBROOKE, Medical Officer of Health. 3 HEALTH REPORT FOR 1945. 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. It has thus been a separate District for 30 years and it is hoped in the next report to review its development during that time. Space will only permit the inclusion this year of statistics relating to the state of the Public Health in the District from 1939 to 1945 inclusive. At the time war broke out the District, which had for many years been developing as a comparatively well-planned "dormitory suburb," possessing many natural advantages, had about a third of its area built over. About one-fifth of the District had been reserved as public open space, chiefly as a result of the Green Belt Scheme inaugurated in 1937. Fortunately the original development consisted chiefly of large dwellings with fairly extensive grounds, while the later and more dense development was influenced by the Town Planning Scheme. There still remain extensive portions of the area which are comparatively rural, and these it is hoped will remain unspoilt in accordance with the recommendations of the Abercombie Plan for Greater London. The open development of the District proved a blessing during the periods of air attack to which it was subjected, although the proximity of Croydon and Kenley aerodromes attracted undesirable attention during the earlier phases. All parts of the area were alternately partially emptied and refilled by the ebb and flow of population, varying to some extent with the weight of enemy air attack but also modified by the periodical influx of troops who were billeted in the area, and later by workmen engaged in repair work. With the diminution of available houses owing to war damage and destruction or the removal of many from the market by requisitioning for various purposes, coupled with the influx of bombed-out persons from more severely damaged parts of the London area, there has been a tendency towards lowered social conditions in parts of the District, with a considerable amount of crowding in individual premises though with little statutory overcrowding. Since the cessation of hostilities there has been a steady improvement in these conditions. Similarly there has been a tendency for the relatively small number of war-time industries set up in the District to diminish, and evacuated offices to leave it. No large manufacturing concerns have been introduced, the chief occupations now, as in prewar days, being building and the retailing of the necessities of life, both of which have recently received a new impetus. 9 AREA AND POPULATION. The District has an area of 11,142 acres, these being distributed among the wards as follows:— Coulsdon East 2,812 Coulsdon West 1,253 Kenley 1,292 Purley 685 Sanderstead 2,311 Selsdon and Farleigh 1,924 Woodcote 865 This is 2,507 acres more than in 1915, owing to revisions of the boundaries, the last of which was in 1933. When the Urban District came into existence the population was estimated to have been 17,920 and this had increased to 21,493 by the time of the Census in 1921 and to 37,666 by the 1931 Census. As the war commenced the population had reached its peak of approximately 60,000, but after an initial reduction by one-third, owing to voluntary evacuation, gradually recovered, only to be followed by a drop in 1941 to 46,820. Similarly, after a gradual and fairly steady recovery until 1944, when the estimated population was 50,240, voluntary and official evacuation probably reduced this figure to its lowest war-time level. By mid-1945, however, the Registrar-General considered recovery had taken place to the extent of 53,460. The number of persons resident in the Institutions in the District at the end of 1945 was as follows:— Cane Hill Hospital 2,422 Netherne Hospital 2,213 Russell Hill School 172 Reedham Orphanage 241 This represents an increase in proportion to the general population, owing to the crowding which has had to be permitted in the hospitals through shortage of accommodation elsewhere. In 1915 there were 4,141 occupied houses, chiefly in Purley and Woodcote, whereas in 1945 there were 16,427 occupied houses distributed as follows:— Coulsdon East 2,768 Coulsdon West 2,270 Purley 2,544 Woodcote 1,544 Sanderstead 4,100 Selsdon & Farleigh 1,749 Kenley 1,128 Hooley 324 This suggests an average of 3.2 persons per occupied house in 1945, compared with 3.5 in 1938 and 4.3 in 1915, but in actual fact comparison cannot be fairly made as so many of the "occupied" houses were used for purposes other than housing the civil population in 1945. 10 VITAL STATISTICS. The following table gives the population, and birth, death, maternal and other important mortality rates for the last seven years:— Rates for 1,000 population: 1939. 1940. 1941. 1942. 1943. 1944. 1945. Birth rate 13.5 12.3 12.6 17.1 17.4 16.9 14.0 Percentage illegitimate 3.4% 3.0% 5.7% 4.8% 5.7% 4.6% 5.0% Stillbirth rate 0.42 0.35 0.42 0.56 0.66 0.42 0.43 Death rate 8.9 11.5 11.6 10.7 10.5 12.9 10.2 Cancer death rate 1.58 1.45 1.92 1.74 1.51 1.91 1.75 Tuberculosis death rate (per 100,000 population) 21 43 55 40 38 65 29 Violence (including suicide) 0.49 1.18 0.75 0.40 0.42 1.35 0.41 Maternal mortality rate 2.62 4.66 1.68 1.10 1.07 2.21 - Infant mortality rate (per 1,000 registered births) 43 37 52 45 36 33 32 Neo-natal mortality rate 29 32 36 31 23 18 28 Estimated population (in thousands) 56,400 50,920 46,820 49,760 51,660 50,240 53,460 BIRTHS. During the year 1945, 750 births were registered as occurring in the District, of which 377 were male and 373 were female. It will be seen by reference to the above table that this is equal to an annual birth rate of 14.0 per 1,000 population, as compared with 16.9 in 1944 and 17.4 the previous year. The fluctuations in the local birth rate appear to reflect the course of the war and its influence on the younger age groups. With initial uncertainty and the retrogressive military situation the rate fell, but with comparative stabilisation and the encouragement of young women by propaganda and frequently the alternative of compulsory service, the rate became abnormally high in 1942-4. The drop in 1945 may reflect the absence of the maximum number of men overseas. These surmises as to the causes of the local variations are supported by the steady increase which has occurred nationally from 14.8 in 1939 to 17.7 in 1944 and 16.1 in 1945. This District having but few industries, a relatively large proportion of the younger residents were in the services or evacuated. Illegitimacy.—In 1945, of the births registered, 48 were illegitimate (24 males and 24 females), this being nine more than in the preceding year. The percentages shown in the preceding table reveal the increase which is expected in war-time, but compared with the period 1915-19, when the average percentage was 5.7, the increase was not as great as might have been anticipated. The proportion of illegitimate births fell steadily after the first world war and it is hoped this will be the tendency in future. 11 Stillbirths.—The number of stillbirths registered during 1945 was 18 (6 males and 12 females), as compared with 21 in the preceding year. All but two of the stillbirths occurred in legitimate children. The local stillbirth rate was thus 0.43 per thousand of population, as compared with 0.42 for the preceding year and a national stillbirth rate of 0.46. The percentages of total births which were stillbirths from 1939 to 1945 are as follows:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. 3.4 3.0 5.7 4.8 5.7 4.6 2.4 DEATHS. The number of deaths registered during 1945 as belonging to this District was 549 (276 males and 273 females), as compared with 651 in 1944. This number excludes deaths which, although occurring within the District, belonged to other districts, but includes deaths of residents who died outside the District and also non-residents dying in the District who have previously had no permanent place of abode. As will be seen from the table of vital statistics the crude death rate for the year was equal to 10.2 per thousand of population, as compared with 12.9 in the preceding year and was well below the average for the war years, though considerably above the pre-war average of 7.8. Undoubtedly the local war-time increase in the death rate is chiefly due to the absence of the younger age groups in the Forces, etc., which has caused the local rate to approximate to the national rate for civilians, which has not varied greatly and averaged 12.8 for the war years. The principal causes of death during 1945, together with the rates per cent. of total deaths, are shown in the following table:— Cause. Number of Deaths. Rate per cent. of Total Deaths. Bronchitis 22 4.18 Influenza 5 0.91 Tuberculosis of respiratory system 16 2.91 Cancer, malignant disease 94 17.12 Heart disease 164 29.82 Cerebral haemorrhage 59 10.74 Other circulatory diseases 23 4.18 Pneumonia 17 3.09 Violence (including suicide) 22 4.18 A full list of the causes of the deaths, and the ages at which they occurred, is given in Table IV in the Appendix. 12 For comparative purposes the following table is of more value as giving the death rates per 1,000 population during the war years for the chief individual diseases and groups of diseases:— Death Rates per 1,000 Population from Chief Diseases, 1939-1945. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Influenza, bronchitis and pneumonia 0.59 1.46 1.08 1.28 0.99 1.40 0.85 Tuberculosis, pulmonary 0.24 0.41 0.55 0.44 0.46 0.61 0.33 Cancer 1.58 1.45 1.92 1.74 1.51 1.91 1.75 Violence (including suicide) 0.49 1.18 0.75 0.40 0.42 1.35 0.41 Heart and other circulatory, including cerebral haemorrhage 3.08 3.84 4.26 4.57 4.40 5.04 5.15 HEART DISEASE, ETC. It will be seen that the death rate from heart and other circulatory diseases has increased steadily. In so far as this group is largely composed of deaths occurring in elderly people from what is really old age, the increase obviously reflects the ageing population with which this Report deals, and it is hoped that the proportion of deaths coming under this heading will remain relatively high. The following table shows the percentages of deaths from this cause during the years 1939 to 1945 which were in respect of persons over 65 years of age at the time death occurred:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. 78% 73% 80% 76% 81% 78% 82% Naturally the higher this percentage the more satisfactory the position. CANCER. The cancer death rate was 1,75 per thousand of population in 1945, which is slightly above the average for the war years though less than the rate for 1944. It will be appreciated that the smaller the annual totals under consideration the more the corresponding rates are liable to fluctuate from year to year. In the case of cancer, however, it is obvious that the average rate during the recent years has been higher than in the earlier pre-war years. To what extent this increase is attributable to the increasing age of the population or to better diagnosis it is impossible to say, although both have been undoubtedly contributory influences, the latter probably to a diminishing extent. 13 14 The following table gives the age, sex and distribution of the disease in the 94 deaths which occurred during 1945:— CANCER DEATHS, 1945. Age 10-20 20-30 30-40 40-50 50- 60 60-70 70- 80 Over 80 Totals. Sex M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Skin - - - - - - - - - - - - - 1 - - - 1 Mouth - - - - - - - - - 1 - - - - - - - 1 Ear - - - - - - - - - - - - - 1 - - - 1 Larynx - - - - - - - - - - - - 2 - - - 2 - Oesophagus - - - - - - - - - - - 1 1 - - - 1 1 Stomach - - - - - - - - - 1 2 1 1 1 - 1 3 4 Intestines - - - - 1 - 1 - - 1 2 5 4 5 1 1 9 12 Liver - - - - - - - 1 - - 3 - 2 1 - - 5 2 Pancreas - - - - - - - - - - 1 - 1 1 - - 2 1 Lungs - - - - - - - - 5 1 7 1 1 3 - - 13 5 Kidney - - - - - - - - 2 - - - - - - - 2 - Bladder - - - - - - - - 2 - 1 - - - - - 3 - Prostate - - - - - - - - - - 1 - 1 - 1 - 3 - Uterus - - - - - - - 2 - 1 - 2 - - - - - 5 Ovary - - - - - - - - - 1 - 2 - 1 - - - 4 Breast - - - 1 - 1 - - - 2 - 4 - 2 - 1 - 11 Gall bladder - - - - - - - - - - - - - 3 - - - 3 Totals - - - 1 1 1 1 3 9 8 17 16 13 19 2 3 43 51 Apart from emphasising the well-recognised tendency for this disease to increase with advancing years, there is little which can be deduced from such relatively small figures nor from comparison with similar tables for each of the war years. There are, however, two outstanding points which coincide with national trends, viz., the abnormally large proportion of cases of cancer of the lung, particularly in men, this being a form of the disease which is steadily increasing, and the number of deaths in young women as a result of cancer of the breast. Although cancer of the breast is relatively accessible from the point of view of diagnosis and treatment, deaths from this cause in women from 25 to 55 years of age still tend to increase, and emphasise how important it is for all suspicious lumps to be examined by a doctor as soon as they are noticed. VIOLENCE. It will be seen by reference to the table giving the death rates during the war years that there were three years in which the death rate from violence was abnormally high, viz., 1940, to a lesser degree 1941, and, highest of all, 1944. These years, of course, correspond with the peak periods of enemy air attack, to which the increases are definitely attributable and the results of which are given in the following table:— 1939. 1940. 1941. 1942. 1943. 1944. Number of residents killed Nil 36 16 2 2 50 Number of persons killed in the District Nil 38 13 Nil Nil 47 Number recorded as injured in the District: (a) Slightly Nil 83 9 Nil 3 111 (b) Seriously Nil 141 43 Nil 6 379 The most deadly form of attack as far as this District was concerned was obviously the flying bombs, of which at least 70 fell in or near the boundaries of the District, causing 30 deaths and at least 368 injured. The one rocket which fell in the District caused 2 deaths and 8 injured, while the majority of the remaining 66 deaths were caused by high explosive bombs, of which more than 2,000 fell in the District. A few deaths were caused by anti-aircraft fire, explosive incendiaries, etc. Apart from enemy action in 1940-41 and 1944 the death rate from violence was less than in pre-war years, the number of deaths from road accidents showing a welcome reduction after 1939, when 8 were killed, the number of deaths from this cause being 4 in 1940, 4, 2, 4, 4 in the following years and 3 in 1945 (1 pedestrian and 2 cyclists). The deaths from suicide increased at first, being 14 in 1939, 11 in 1940 and 17 in 1941, but decreased later, being 10, 9, 4 and 6 in 1945. TUBERCULOSIS AND PNEUMONIA. Deaths from tuberculosis and pneumonia are referred to in later sections of this Report. 15 MATERNAL MORTALITY. There were no deaths associated with childbirth during 1945, compared with 2, 1, 1, 1, 3 and 2 in the preceding war years. As will be seen in the table of vital statistics, with the exception of 1940 the maternal mortality rate has remained consistently at a low level and has compared favourably with the national rates which have broken low level record after record. The lowest maternal mortality rate for England and Wales was in 1944, when at 1.92 it was slightly higher than the average of the local rates for the war years. When the difficulties are considered against which midwives, doctors and hospital staffs have worked during these years, this achievement is all the more remarkable and commendable. The causes of the maternal deaths during the years 1939-1945 are given in the following table:— Causes. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Puerperal sepsis 1 1 1 — — — — Eclampsia - 2 — — — — — Complication following Caesarian section 1 - - - - 1 - Toxaemia — — — — — 1 — Heart failure following subacute nephritis - - - 1 - - - Rupture of tubal pregnancy - — — — 1 — — Totals 2 3 1 1 1 2 — INFANT MORTALITY. During 1945 there were 25 deaths among the children under one year of age, as compared with 28, 32, 38, 29, 23 and 34 in the preceding war years. The national infantile mortality rate, which had been dropping steadily until the war, had a temporary set-back lasting until 1941 but has since been consistently falling to beat all records with rates of 49 in 1943, 45 in 1944 and 46 in 1945. While the local rate fluctuated more and was rather high at 52 in 1941, the average rate of 39.7 for the war years was only slightly more than in the five years immediately preceding the war and compares quite favourably with the national rate. During the last five years it has steadily decreased, being 52, 45, 36, 33 and 32 in 1945. 16 17 The following table gives the causes of these deaths during 1945, together with the age at death:— INFANTILE MORTALITY DURING THE YEAR 1945. Under 1 week. 1- 2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12months. Total deaths under 1 year. Broncho-pneumonia - 1 - - 1 - 1 - - 2 Meningitis - 1 - 1 2 - 1 - - 3 Birth injury - 1 - - 1 - - - - 1 Haemorrhagic disease 1 - - - 1 - - - - 1 Congenital malformation - 1 - - 1 1 - 1 - 3 Marasmus 4 1 - - 5 - - - - 5 Premature birth 9 1 - - 10 - - - - 10 Totals 14 6 - 1 21 1 2 1 - 25 These figures are typical of the causes of death in each of the war years, the most outstanding cause being prematurity, followed by congenital deformities and debility, broncho-pneumonia and other infections. Altogether during the seven years 40 have died from bronchitis and pneumonia and 23 from other preventable infections. The necessity for taking every precaution, by cleanliness and particularly by avoiding infection of the young by the common cold, is again emphasised. (In England and Wales during this period more than one child in 100 died from respiratory infections when less than a year old, and more than one in 200 from diarrhoea or enteritis.) The neo-natal mortality rate (i.e., deaths in the first month per 1,000 live births) was 28 in 1945, this being the average for the war years and only slightly in excess of the pre-war rate. It is, however, only the same as the corresponding national rates were in 1938 and 1939, when records were created which have been reduced since 1941, being 24.4 in 1944. 18 COMPARATIVE CRUDE BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL DEATH-RATES, AND CASE-RATES for certain Infectious Diseases in the Year 1945. England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Population 25,000— 50,000 at 1931 Census. London Administrative County. Coulsdon and Purley Urban District. Rates per 1,000 Civilian Population: Live births 16.1* 19.1 19.2 15.7 14.0 Still births 0.46* 0.58 0.53 0.40 0.43 Deaths: All causes 11.4* 13.5 12.3 13.8 10.2 Typhoid and paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet fever 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.02 0.02 0.01 0.02 0.00 Diphtheria 0.02 0.02 0.02 0.01 0.01 Influenza 0.08 0.07 0.07 0.07 0.09 Smallpox - - - - - Measles 0.02 0.02 0.02 0.01 0.00 Notifications: Typhoid fever 0.01 0.01 0.01 0.01 0.03 Paratyphoid fever 0.01 0.00 0.01 0.00 0.03 Cerebro-spinal fever 0.05 0.05 0.05 0.06 0.01 Scarlet fever 1.89 2.02 2.03 1.57 1.25 Whooping cough 1.64 1.65 1.47 1.25 1.87 Diphtheria 0.46 0.52 0.56 0.31 0.28 Erysipelas 0.25 0.28 0.24 0.31 0.07 Smallpox 0.00 0.00 — 0.00 — Measles 11.67 10.89 11.19 9.03 13.18 Pneumonia 0.87 1.03 0.72 0.78 0.31 Kates per 1,000 live births: Deaths under 1 year of age 46† 54 43 53 32 Deaths from diarrhoea and enteritis under 2 years of age 5.6 7.8 4.5 7.6 — Rates per 1,000 live and still births: Maternal mortality: 0.24 1.22 1.46 Not available — Puerperal sepsis Others Total Notifications: 9.93 12.65 8.81 2.66 Puerperal fever 3.60 Puerperal pyrexia 15.87 *Rates per 1,000 total population. †Per 1,000 related births. ‡Includes puerperal fever. A dash (—) signifies no deaths or notifications. 19 INFECTIOUS DISEASE. Before 1939 it was widely believed by those who had studied the subject that, in the event of war, infectious disease generally would increase to a marked degree, owing to the inevitable movements of population, overcrowding and similar alterations in environment and habit, but fortunately these fears were not fully justified. In this Country the only serious epidemic was that of cerebro-spinal fever, fortunately met by new methods of treatment which reduced the case mortality. It is true that infective jaundice (not generally notifiable) increased at home and abroad, as did also tuberculosis (referred to later in this report) in the early war years, and the venereal diseases, while there were occasional outbreaks of paratyphoid fever. That annoying infestation, scabies, continued its pre-war increase in prevalence, as did dysentery, both aided by war conditions. The majority of " infectious diseases," diphtheria, scarlet fever, etc., did not increase abnormally however, and some even decreased in prevalence. While the overworked and depleted public health organisation can claim a little credit for the curtailment of certain of the diseases, and known factors can be deduced to have caused benefit in others, it is difficult to explain many of the phenomena, which have, however, been noted with gratitude. An examination of Table III in the Appendix will indicate the position in this District both before and during the war. It does not, however, distinguish between the cases of infectious disease which occurred in the local institutions and those affecting the general population. Inevitably, overcrowding and understaffing in the mental hospitals, together with the interchange of patients between such institutions, was conducive to the increase of infectious disease, particularly of dysentery and enteric fever. Apart from this factor, however, the position in the District was remarkably good. It is true that there was an increase in scarlet fever, reaching its peak in 1943, as in the Country as a whole, and a relative but slight increase in cerebro-spinal fever, but even these increases might well have occurred under pre-war conditions. In general it may be stated that we in this District were epidemiologically as well off during the war as before that event, and have much for which to be thankful. 20 Turning to 1945 in particular before considering the individual diseases, the following table presents the main facts:— Disease. Numbers Notified. Removed to Hospital. Total Deaths. Diphtheria 15 3 1 Typhoid fever 2 2 — Paratyphoid fever 2 2 — Scarlet fever 67 48 — Erysipelas 4 1 — Puerperal pyrexia 2 2 — Pneumonia 17 1 17* Dysentery 172 — — Cerebro-spinal fever 1 1 2 Ophthalmia neonatorum 1 — 1 Poliomyelitis 2 2 — Measles 705 4 .- Whooping cough 100 1 — Totals 1,090 67 21 *Includes deaths from all forms of pneumonia. Excluding measles and whooping cough, which were not notifiable in the years between the wars, and cases occurring in the mental hospitals, it is found that the incidence of infectious disease in the District generally was only 1.8 cases per 1,000 population in 1945, which is slightly less than in 1938, in which year the incidence was one of the lowest for pre-war years. Diphtheria. During the seven years 1939-45, there were 92 notifications of diphtheria, but of these eight were found not to be suffering from the disease. The more definite cases were distributed as follows: 7 in 1939, 24 in 1940, followed by 7, 8, 6, 19 and 15 in 1945. It should be noted, however, that in the last two years the majority of the cases (i.e., 15 and 12) have occurred among the adult patients and staff of one of the mental hospitals in an outbreak which appeared to die out during the first six months of 1944, following passive and active immunisation, but, with the admission of new patients, continued to produce cases sporadically throughout 1945. If the cases thus occurring among a relatively self-contained community are excluded, it is interesting to note the contrast between the 31 cases among the general population in 1939-40, and the 26 cases which occurred in the five years 1941-45 after the extensive immunisation of the child population which was achieved in 1941 and improved upon in later years. In 1939-40, 58 per cent. of the cases were among children, whereas in 1941-45 only 10 cases (38 per cent.) occurred in childhood. The tendency for an increasing proportion of the cases to occur among adults, and particularly among teachers (two cases in 1945) and nurses ( two in 1941 and others in the mental hospitals since), emphasises the desirability of immunisaion, if they are not already negative to the 21 Schick test, of those special sections of the adult population who come into closest contact with groups of young children. On the efficacy of immunisation against the disease, although the numbers concerned are small and therefore not conclusive, it is suggestive that during the last six years only one child in 1,000 of the estimated immunised child population of the District has contracted the disease, whereas one in 400 of the corresponding unimmunised group of children has suffered from diphtheria. The national figures are even more impressive. In the seven war years only two deaths have occurred in this District from this disease, viz., one child in 1942 and one adult in 1945. To summarise the position in 1945, there were 15 notifications, 12 in a mental hospital and three, including two adults, among the general population. All three cases were treated at the Wandle Valley Isolation Hospital, where one adult unfortunately died. The only juvenile case was in an unimmunised child, and in his case no secondary cases arose in the school, while neither his older sister, previously immunised, nor baby brother, unimmunised, contracted the disease. A further note on the Immunisation Scheme is to be found later in the Report. Scarlet Fever. During the war years the fluctuations in the number of cases of scarlet fever notified annually have corresponded with the variations experienced nationally, the most prominent feature being the sudden increase in 1943, in which year 184 cases were notified locally. This was the highest number of cases ever notified in the District and followed a succession of years in which the prevalence had been low. The only other interesting point locally was an outbreak which affected Reedham Orphanage in 1940, when overcrowding in the shelters was a contributory factor. Sulphonamide tablets were administered as a preventive measure, and only 20 cases occurred. It has been noted during and since the 1943 epidemic that a greater proportion of children has been affected than in previous outbreaks, but the most important tendency in recent years, and the one which has greatly complicated preventive measures, has been the mildness of the disease, coupled with the large proportion of persons infected who have failed to show the characteristic rash. It is only when this symptom is present that notification is required, whereas isolation and treatment are equally desirable for all forms of the infection. No death has occurred in the District from this disease since 1932, although it was the cause of five deaths in the previous 10 years. A further decline in the prevalence of scarlet fever occurred during 1945, when the number of cases notified was 67, as compared with 88 in the preceding year and 184 in 1943. The disease, which remained very mild in type and was most prevalent among children of school age, was fairly evenly distributed throughout the District and throughout the year. Towards the end of the year a considerable amount of tonsillitis 22 occurred in the Coulsdon end of the District, but not being accompanied by the characteristic rash, cases were not notified, and only detected in the course of routine school examination. Erysipelas. Of the 94 cases which occurred during the seven war years, 54 occurred in the mental hospitals while the remainder, of which 10 were admitted to hospital, were all isolated cases occurring throughout the District. No deaths from this disease were reported. There were only four cases of erysipelas during 1945 and of these one occurred in a mental hospital. One case was admitted to the Isolation Hospital and all recovered. As this disease is, like scarlet fever and puerperal fever, caused by a streptococcus, it is interesting to note that increases in the number of cases of erysipelas occurred in 1932 and 1941/2, thus tending to precede the peak periods for scarlet fever, which occurred in 1929, 1935 and 1943. Puerperal Pyrexia. Only two cases of puerperal pyrexia were notified in 1945, and this is the average number for each of the seven war years. These two cases, one mild and one serious, occurred in Purley Hospital and were removed to the Wandle Valley Isolation Hospital, where both recovered. All but two of the cases which have occurred since 1938 have been similarly admitted, and only one death has been registered, that occurring in 1939. Enteric Fever. Two cases of typhoid and two cases of paratyphoid fever were notified during the year, all of which occurred in one or other of the mental hospitals. No deaths resulted. During the last seven years, a total of 22 cases of typhoid has been notified, of which 18 occurred in the mental hospitals, the largest number in any one year being eight in 1940. Only one death from the disease occurred, viz., in 1944. During the same period 62 cases of paratyphoid were notified, of which 55 were in the mental hospitals. The chief outbreak was in 1940, when 45 cases were detected, 44 being mental hospital cases infected with Bacillus paratyphosus B., approximately half of these cases being only carriers, however. Four deaths occurred. In addition, of the seven normal residents of the District who contracted the disease between 1939 and 1945, one died in 1943. All the usual precautions were taken to prevent outbreaks of these diseases in the mental hospitals, including inoculation. Unfortunately the source of the 1940 outbreak could not be traced. Dysentery. The number of cases of dysentery notified during 1945, viz., 172, was the second highest recorded in the District. Of these cases, 171 23 originated in the mental hospitals, where overcrowding and the type of inmates have made it very difficult to arrest the spread of infection. Between the wars very few cases occurred, the highest being 17 cases in 1923, whereas during the last seven years a total of 675 cases has been notified (651 by the mental hospitals), with a minimum in any one year of 21 and a maximum of 224 cases in 1941. Most of the mental hospital cases were infected by one or other of several types of Flexner's dysentery bacilli. It is hoped that the release of military hospitals and the gradual increase in hospital accommodation generally will produce a corresponding reduction in the number of cases of dysentery reported annually from these hospitals. The largest number of ordinary residents suffering from this disease was in I940, when 17 cases were reported from Selsdon. The diagnosis was not confirmed bacteriologically in these cases, which were much milder in type and probably caused by the Sonne bacillus, which caused the only case of dysentery notified in the District in 1945. It is probable that many more cases of this milder type of dysentery have occurred, but not been diagnosed, owing to the difficulty in obtaining bacteriological confirmation, particularly during the earlier war years. Dysentery was the terminal infection which caused the death of three mental hospital patients in 1941, otherwise no deaths have occurred. Cerebro-Spinal Fever. Only one case of this disease was notified in 1945, which is a decrease on recent years, but two deaths occurred in young babies, born outside the District, from meningococcal meningitis. There was no connection between either of these cases. The young adult who was notified in the District recovered after treatment at the Redhill County Hospital. The maximum number of cases of this disease occurring in the District in any one year was eight in 1940, preceding and following which there was a slight increase, the total number of cases in the war years being 28. The peak in 1940 corresponded with the maximum incidence nationally, but the disease was only half as prevalent locally as in the Country as a whole. Poliomyelitis. Two cases of poliomyelitis were notified during 1945, both cases being young adults, who were treated in hospital and recovered. There was no increase in this disease during the war years, when nine local cases occurred, the maximum number in any one year being three. Pneumonia. Seventeen cases of acute primary or influenzal pneumonia were notified in 1945, this being a slight increase on the preceding year, but considerably less than the average of 28 for the war years. One case was admitted to the Isolation Hospital for treatment. Only one case occurred in the mental hospitals, compared with an average of 11 for the last five years. 24 More than half the cases were in adults over 65 years of age. A total of 17 deaths from pneumonia of all types occurred during 1945. Ophthalmia Neonatorum. Only one case of ophthalmia neonatorum was notified in 1945. The baby was born in hospital and fortunately the disease was mild, the child recovering without any permanent effect upon the vision. Only three other cases of this disease have been notified since 1939, and all of these have recovered without permanent effects, thus bearing testimony to the prophylactic measures taken by the midwifery service during a period when gonorrhoea, a common cause of this disease, has increased in prevalence. Measles. The number of cases of measles notified during 1945, namely 705, was by far the largest experienced in the District, the previous highest being 479 in 1942 and 468 in 1917. The increase was probably due in part to better realisation of the statutory obligation to notify this disease, which, like whooping cough, was not notifiable from 1919 to 1939. As has been stated in the interim reports, although the practice may be helpful in some areas, compulsory notification of measles has no great value at the present time in a District such as this for the following reasons:— (1) Only a proportion of the cases are notified, as an appreciable percentage of parents do not consider it necessary to call in a doctor, and it is the very cases which most need visitation which are least likely to seek medical advice. (2) There is a very considerable delay between the onset of the disease and notification being received, thus reducing the value of visitation. (3) This disease is very apt to occur in waves of widely-spread infection, as a result of which the numbers of cases occurring simultaneously are such that only a small proportion can be visited. (Locally it has only been practicable to visit a proportion of children in the youngest age groups suffering from or in contact with measles.) (4) When visitation is practicable the only advice which can be given is to emphasise the importance of isolation and good nursing, arranging for the latter to be given where necessary. In this District it is found that in almost all cases notified and visited, satisfactory arrangements have already been made. The fact that special arrangements made in 1933 for the treatment of chronic ear discharge in young children seen at the Welfare Centre have not proved necessary, suggests that adequate after-treatment is also being provided. (5) Unfortunately at present there is no reliable and practicable preventive treatment which can be encouraged as a result of 25 information gleaned from notification. When such treatment is available its efficacy will most probably depend on its use prior to an outbreak or its early use by the doctor attending the case, irrespective of notification. Fortunately very few deaths from this disease have occurred locally (9 in the 14 years before the war and 1 during the last 7 years). As it is impossible to state what percentage of actual cases these figures represent, it would be unwise to attempt to deduce from them any improvement or deterioration which may have resulted from notification. Whooping Cough. During 1945, notifications of this disease numbered 100, this being rather more than in either of the previous three years, though less than the number notified in 1941. As in the case of measles, it is probable that only a proportion of the cases are notified, partly owing to the fact that a doctor is not always called in. The position with regard to the usefulness of notification of whooping cough in a District such as this is very similar to that stated above in respect of the notification of measles. If anything can be deduced from the death returns, it is that the position worsened during the seven war years, as five deaths occurred in that time, compared with four in the 14 years before the war, but with such small numbers it would not be fair to make any deductions. Tuberculosis. The following tables present concisely the position with regard to tuberculosis in the District during 1945:— Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number of cases on register, 1st January, 1945 136 109 22 31 158 140 Additions, 1945:— New cases notified 26 18 1 2 27 20 Cases removed into District 20 11 1 2 21 13 Restored to register 2 4 — 1 2 5 Total Additions 48 33 2 5 50 38 Removals, 1945:— Deaths 14 6 — 1 14 7 Removed from District 9 14 6 4 15 18 Recovered 1 3 2 2 3 5 Non-tuberculous 1 — - - 1 — Total Removed from Register 25 23 8 7 33 30 Number of cases on register, 31st December, 1945 159 119 16 29 175 148 26 The following table shows the age-groups in which notifications and deaths occurred:— Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - - 1 and under 5 1 - - - - - - - 5 and under 10 — — 1 - - - - - 10 and under 15 1 1 - - - - - - 15 and under 20 2 2 - - - - - - 20 and under 25 6 2 — 1 2 — — - 25 and under 35 8 6 — 1 1 2 — - 35 and under 45 2 2 — - 1 1 — — 45 and under 55 2 2 — - 3 1 — — 55 and under 65 2 2 - - 3 2 — 1 65 and over 2 1 - - 4 — — — Totals 26 18 1 2 14 6 — 1 The new cases were distributed amongst the wards as follows:— Localisation. Coulsdon East. Coulsdon West. Kenley. Purley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 9 13 3 9 5 2 3 Non- pulmonary 3 — — — — — — Totals 12 13 3 9 5 2 3 27 In order to present a complete picture of the trend of this disease during the war years a more comprehensive table has been prepared and is included below:— TUBERCULOSIS, 1939-1945. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Pulmonary. New cases notified 31 31 32 50 39 51 44 Case rate per 100,000 population 56 61 68 90 75 101 82 Deaths 12 21 26 22 21 31 20 Death rate per 100,000 population 25 43 55 40 38 65 37 No. on register at end of year 181 162 163 201 214 245 278 Non-pulmonary. New cases notified 12 8 11 7 9 7 3 Case rate per 100,000 population 21 16 23 14 17 14 5 Deaths 4 5 5 4 1 1 1 Death rate per 100,000 population 9 6 11 8 7 2 1 No. on register at end of year 44 41 47 50 55 53 45 It will be noted that the case rate for pulmonary tuberculosis more or less steadily increased until 1944, with an improvement in 1945, whereas the corresponding rate for the non-pulmonary form has decreased steadily after an initial rise until 1941. This is very similar to the national trends and is probably attributable in part to improved methods of detection, particularly by mass radiography, in which case the increase in notifications is not so serious as at first would be imagined. On the other hand, examination of the death rates reveals that, with the exception of 1944, there has been a steady tendency to improvement in the death rate from pulmonary tuberculosis after an initial rise in *1940-41. This rate has not, however, yet steadied to pre-war levels either locally or nationally, although it is encouraging to observe the improvement which has occurred even during war-time by contrast with the experience in the 1914-19 war. The non-pulmonary death rate is even more satisfactory as this has steadily declined after the slight rise in 1941 and is now below the pre-war rate. As, however, very small numbers are involved it remains to be seen whether this apparent success can be maintained. Of the deaths which occurred from tuberculosis in 1945, 13 were in previously notified cases, i.e., 65 per cent. Three of the remainder were notified posthumously and a further two were diagnosed after post mortem examination. 28 The Council is responsible for measures to prevent the spread of this disease, including rehousing where necessary. Arrangements have been made for the examination, free of charge, of sputa in cases or suspected cases of tuberculosis, 35 such examinations being made during 1945. Similarly disinfection and visitation are provided to secure the removal of unhygienic conditions, the examination of contacts, etc. The treatment of cases of tuberculosis is under the control of the Surrey County Council, which provides both sanatorium and dispensary treatment, but their resources have been very strained during the war years, owing to the lack of staff and other demands for hospital beds. The dispensary for the diagnosis and observation of cases is situated in Whytecliffe Road, Purley, and sessions are held there every Monday from 2-4 p.m. The County Council makes a very substantial contribution towards the financial resources of a Voluntary Care Committee, which serves the area of the Urban District and most of the Caterham and Warlingham Urban District. It does very useful work in helping individual cases and their dependants. The Council has been represented thereon by the Medical Officer of Health and, in addition, in 1945 appointed a member of the Council to serve on the Committee. PUBLIC HEALTH ACT, 1936, SECTION 172. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action has been required under these powers during recent years. NON-NOTIFIABLE INFECTIOUS DISEASE. The group of non-notifiable infectious diseases accounts for very few deaths, with the exception of influenza, to which five deaths were attributed in 1945, compared with an average of nine deaths per annum during the war years. The highest number of deaths in any one year from influenza was 20 in 1943, which was the one year in which this disease caused some perturbation, though fortunately it never increased to anything approaching the proportions of the 1918-19 outbreak. In addition, one or two children under two years of age have died from diarrhoea each year. Apart from the death returns the only information as to the presence of outbreaks of non-notifiable infectious disease are the returns from the nurseries and public elementary schools. As judged by these there have been no exceptionally widespread outbreaks during the war years excepting possibly one of german measles in 1940. Mumps and chicken pox occasionally became epidemic but not on a serious scale. In 1942-3 there was an appreciable number of cases of infective jaundice, while occasional cases have occurred each year since. Home visitation and exclusion from school are still the two chief methods relied upon to postpone the onset of the above-mentioned 29 diseases until the most favourable age is reached at which they can be withstood. Treatment in hospital is provided when required owing to social or physical complications being present, but no cases coming under this heading were admitted to the Isolation Hospital during 1945. Some cases may have been admitted to the County Hospitals but of these no records are available. A weekly statement of the number of cases of notifiable and known non-notifiable infectious disease arising in the District has been sent since 1938 to all medical practitioners serving the District. INFESTATIONS. (a) Scabies. The increase in this disease commenced before the onset of hostilities but was most notable in the earlier war years. Special arrangements were introduced for its prevention and treatment chiefly because it was causing great inconvenience and diminishing the capacity for work of the population. After preliminary attempts to abate the disease with such remedies as sulphur, derris powder, etc., it was fortunate that the discovery of benzyl benzoate made it practicable for this annoying infestation to be cured much more expeditiously. Owing to the incipient character of the infestation and the comparative lack of severity of the symptoms produced, it has only been practicable gradually to reduce its incidence, progress being complicated also by the movements of population which have occurred but which are now diminishing gradually. Locally the treatment of this disease was centralised at the Coulsdon First Aid Post, where the Civil Defence Staff voluntarily assisted most effectively from 1942 onwards. With the disbandment of the Civil Defence Services it became necessary to appoint on a part-time basis a Nurse and Male Assistant, who have continued to use the same premises until recently, when they were transferred to the Cleansing Centre, Lion Green, Coulsdon. Treatment sessions are held every morning, excluding Sunday and Monday, from 9.30 a.m. until noon, and on Tuesday and Saturdayevenings from 5-7 p.m. The following table portrays statistically the work which has been undertaken:— Number of Baths. Number of Persons treated. 1942 (May-December) 695 237 1943 1,217 326 1944 905 399 1945 768 349 30 The eradication of this disease depends upon the treatment of the family as a unit, it being essential for contacts to be given preventive treatment at the same time as the cases who show symptoms. With the full co-operation of the family the disease can be rapidly and completely cured. It is necessary, however, for the Department to become aware of these cases as they occur, and in this respect the co-operation of all doctors, nurses, chemists and the general public is needed. There has been observed an increasing tendency for cases to be supplied with benzyl benzoate in various forms with inadequate instructions as to its use or advice on the necessity for contacts being treated. The results are not only unnecessary expense to the family as a result of secondary cases occurring over a prolonged period but cases are likely to be treated excessively, with resultant secondary symptoms. It should be more generally known that symptoms in a new case frequently do not appear until five weeks after infection has occurred, hence the disease can spread from person to person for an indefinite period unless concerted preventive action is taken. (b) Vermin. The number of cases of infestation with body vermin discovered during the year continued to be very small and almost all cases found by the School Nurses were of head lice. Apart from casual infestations there are just a few families in which it has been found difficult permanently to eradicate head lice, the position being complicated in most cases by physical or mental defects, usually of the mother. Since the war the Council has supplied Sacker's combs to persons found to have been infested, usually at full cost though repayable by instalments, and in recent years ''Lethane Special'' has also been given free of cost, together with advice on the measures to be taken. Where necessary the Medical Officer of Health has visited personally and encouraged the treatment of the whole family as a unit. THE CONTROL OF INFECTIOUS DISEASE. The usual measures have been taken during the war years in an attempt to limit the spread of infectious diseases, including health propaganda adapted to war-time problems. As previously stated, in one outbreak of scarlet fever prophylactic use of sulphonamides was made with apparently some degree of success. Similarly penicillin lozenges have been tried recently on a small scale. The use of preventive inoculations has been limited to those aiming to prevent typhoid and paratyphoid fevers at the mental hospitals, to the supply of immune globulin for use by general practitioners in special cases in whom it is particularly important to avoid or minimise attacks of measles, and to immunisation against diphtheria referred to below. Unfortunately it has not been possible to collect evidence on the effectiveness of the measures against measles and it is now impracticable to supply immune globulin. 31 Inoculation against whooping cough has been widely practised by general practitioners but no local evidence has been shown in support of its usefulness. Carefully controlled research does not appear to justify official encouragement of this procedure at present. Before official recognition can be given unreservedly to new measures of this type it is usually desirable that a high degree of immunity can be guaranteed which will remain effective for years. This does not, of course, preclude small scale trials being made as in the cases referred to above. The position is kept under review as closely as practicable and it is hoped that further extensions will be possible in the future. Diphtheria Immunisation. As it was generally recognised that this form of inoculation could be depended upon to give reliable results, two immunisation clinics were established in April, 1937, at Purley and at Selsdon, but with the inauguration of the National Campaign by the Government in 1941, aided by all the modern methods of propaganda, including the use of broadcasting, a much more comprehensive scheme has been practicable. The following table presents statistically the development of the work in this District during the war years:— DIPHTHERIA IMMUNISATION, 1939-1945. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Clinics. Number of sessions held during the year 29 59 129 126 141 71 74 Number of children who commenced treatment 39 166 872 806 666 433 666 Number who completed treatment 35 140 920 903 619 326 668 Number of Schick tests made 32 19 258 557 573 62 7 Number of "Booster" doses given - - - - - - 98 Tota. number of attendances 145 476 3,404 3,685 3,579 1,199 1,427 Schools. Number of visits made - - 89 70 52 5 - Number commencing treatment - - 2,410 572 194 1 - Number completed treatment - - 2,367 546 165 17 - Number of Schick tests made - - 1,218 652 440 4 - Proportion of children estimated to have been immunised:— (a) from 1-5 years 4% 7% 15% 30% 45% 39% 56% (6) from 5-14 years 8% 10% 60% 76% 85% 77% 90% It will be seen that the number of clinics has been considerably increased and these have been scattered over the District in order to save residents travelling unnecessarily, the number of sessions at each varying with the 32 demand. At present monthly sessions are held at Selsdon, Sanderstead and Old Coulsdon with weekly sessions at Purley. Similarly a very considerable amount of immunisation has been carried out at the schools, particularly during the initial stages of the Campaign in 1941 and 1942. Owing to the nature of the air attack and to evacuation in 1944, followed by the demands on the Department at the end of hostilities, and the movement of population occurring in 1945, very little was attempted during these two years, but an attempt has been made in 1946 to increase the standard of immunity in the schools, which is now thought to be reasonably satisfactory. Two alterations in procedure which should be noted are the more general use of the prophylactic material known as Alum Precipitated Toxoid (A.P.T.), instead of Toxoid Anti-toxin Floccules (T.A.F.), the use of which is now limited to older children and adults, and the introduction of reinforcing doses, or "boosters," after an interval of 3-5 years has elapsed from the initial course of treatment or the administration of a previous enhancing dose. The main advantages of the change to A.P.T. are that only two doses are required at one month's interval, thus reducing the inconvenience to the parent, the shock to the child, and administrative work, together with the probable production of a higher degree of immunity in a shorter period of time. The introduction of the reinforcing dose, which it now appears desirable to give usually at about the ages of five years and ten years, has meant a very considerable increase in the administrative and clinical work of the department, which increase will, of course, be of a permanent character. Since 1941 no charge has been made for the treatment of any child residing in the District, but the children of persons residing outside the District who apply for treatment and who are occasionally assisted in this way are charged 12s. 6d. for the initial course. Originally an attempt was made to Schick test all children about 3-6 months after the end of the initial course, but this standard, which is not now recommended, had to be reduced and testing is now limited to special cases or samples of the population. The doctors practising in the District have been asked to co-operate by forwarding information regarding the children who are immunised privately and have recently been offered a notification fee, while they can obtain supplies of the immunising agents either free or at cost price. Actually very little information has been received from this source but it is probable that only a small proportion of the immunisation in the District is carried out in this way. DIABETES. Following the issue of the Ministry of Health Circular 2734, of 4th January, 1943, the Council introduced a scheme for the supply of insulin at reduced cost to those persons who are unable to obtain such supply through other agencies under existing legislation. Only a few cases have needed to be helped in this way and during 1945 four cases were given assistance. 33 AMBULANCES. For Infectious Disease Cases.—The Wandle Valley Joint Hospital Board has provided two motor ambulances for the removal of cases of infectious disease to hospital. The use of these ambulances is limited to the area served by the Hospital Board. Accident and General Cases.—The Council has continued to provide a minimum of three motor ambulances for the removal of accident and general cases throughout the war years, and thanks to the generosity of a resident has also a very useful reserve ambulance. In 1939 this Service was under the control of the Fire Superintendent but since the beginning of the war the ambulances have been the responsibility of the Medical Officer of Health. Until 1945 the drivers and attendants for the Civil Ambulance Service were members of the Civil Defence Service and when required Civil Defence ambulances were used as reinforcements. The demand on the Civil Ambulance Service practically doubled during the war years, partly owing to the limitations of public transport and private hire vehicles under war conditions. In at least one respect an improved service was provided during this period in so far as it was practicable to arrange for a trained female attendant to accompany all maternity cases, a service which cannot be continued economically since the disbandment of the Civil Defence Services. During 1945 the three civil ambulances were staffed by whole-time ex-Civil Defence men employed solely for this purpose, aided in the first half of the year by Civil Defence staff and based upon the Civil Defence depots. In the second half of the year the ambulances were based on the Sanderstead and Purley Fire Stations by the courtesy of the National Fire Service, which also assisted by providing meals for the personnel, etc. The high standard achieved by the ambulance service was maintained throughout the year, although uncertainty with regard to the future of the Fire and Ambulance Services has been very unsettling for the personnel and has increased administrative difficulties. Special facilities have been arranged for the conveyance of maternity cases to hospital, for their subsequent return home and for the conveyance with special precautions of premature babies when necessary. HOSPITALS. Infectious Disease.—This Council is one of the constituent authorities of the Wandle Valley Joint Hospital Board, and cases of infectious disease (other than smallpox) occurring in this District are admitted to the Board's hospital at Beddington Corner, Mitcham. Extensions to this hospital were commenced in 1936, but unfortunately completion was delayed until 1939, when the onset of war complicated matters by diminishing the available accommodation, as a result of the arrangements which had to be made for the treatment of 34 any gas-contaminated cases, and later in preparation for any cases of typhus which might possibly occur in the Board's area. In common with other hospitals, the situation has been further aggravated by a shortage of domestic and nursing staff. Smallpox.—Under arrangement with the Surrey County Council, cases of smallpox are admitted to the Smallpox Hospital at Clandon, but fortunately no cases of this disease have occurred in this District since 1932, although numerous contacts with the disease elsewhere are visited annually when arriving in this District. General Hospitals.—The general hospitals chiefly serving this area are the Redhill County Hospital, Croydon General Hospital and the Purley War Memorial Hospital, but a considerable number of residents receive treatment at various London hospitals and other County hospitals. All accommodation has been severely taxed during the war period and the position is still acute. Maternity Hospital Accommodation.—There is an arrangement with the Purley War Memorial Hospital whereby the Council has the call on three beds, and if accommodation permits additional cases can be admitted. A large proportion of cases from this District are, however, admitted to the County Hospital at Redhill, while a considerable number of residents make arrangements with private nursing homes or more distant hospitals. An analysis showing the percentages admitted to institutions for their confinements is included in a later section of this Report. With the increasing number of births and limitation of accommodation, the competition to obtain admission has become increasingly keen, while the qualifications imposed upon applicants have had to be correspondingly restrictive. When considered in conjunction with the housing situation, which limits the proportion of expectant mothers who can conveniently arrange for their confinements in their own homes, the present position is far from satisfactory, and is in fact one demanding and, it is hoped, receiving priority of consideration in the post-war era. BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS. The examination of swabs for diphtheria and sputa for tuberculosis is carried out by the Medical Officers of the Wandle Valley Isolation Hospital, and during 1945 the following numbers of specimens were examined:— Swabs for diphtheria 56 Sputa for tuberculosis 35 In addition, specimens submitted to detect and classify streptococci are sent to the Emergency Laboratory at Epsom College, while an arrangement exists whereby other pathological specimens; the examination of which is of importance to the public health, are examined by the Pathologist to the Croydon General Hospital. 35 Under these arrangements the following specimens were examined during 1945:— At Epsom for streptococci 62 At Croydon General Hospital:— Blood for Widal test 5 Faeces for typhoid, paratyphoid, etc. 3 The Council has been assisted further by the Emergency Medical Service Laboratory at Epsom, which since 1942 has examined all samples of milk and carried out the bacteriological examinations of water. The chemical examination of samples of water has been undertaken by the Clinical Research Association. Prior to 1942 Messrs. Rideal, Rideal and Server undertook all examinations of both milk and water. DISINFECTION. The disinfection of bedding, etc., is undertaken by the Wandle Valley Joint Hospital Board, while the disinfection of premises is carried out by the Officers of the Public Health Department. For the convenience of ratepayers, the Council has decided to arrange disinfection even when this is not essential in.the interests of public health, but in these cases the following charges are made: 10s. per load of bedding, etc., 5s. for the first room, and 2s. 6d. for each additional room disinfected at the same time. During 1945 the following disinfections were carried out:— Free of cost. Upon payment. Total. Loads of bedding, etc. 76 23 99 Houses disinfected 106 3 109 HEALTH PROPAGANDA. Steady use has been made of the opportunities for health propaganda at the clinics and centres arranged by the Council, and during the visitation of the Health Visitors and Sanitary Inspectors. The material provided by the Central Council for Health Education and other bodies has been extremely useful and is widely used. The following are a few , of the many subjects which have received particular attention during the war: The care of the health in the black-out; the choice of foods in wartime; cleanliness; the prevention of venereal and other infectious diseases; and the prevention of scabies, including the display of a film on the latter for the information of doctors, nurses, and other suitable persons. MATERNITY AND CHILD WELFARE. The Council has been responsible, since it was constituted, for the maternity and child welfare work of this District, and in its endeavours to minimise the risks of childbirth and secure the care and healthy 36 development of all children born or residing in the areas has taken the following measures:— Maternity Clinics. The first ante-natal clinic was established by the Council in June, 1931, and since then an increasing number of sessions has been required. For a period separate post-natal clinics were held but it was found in practice that all sessions became partly ante-natal and partly postnatal clinics, hence the attempt to divide the two has been abandoned and all sessions now deal with both types of case and are therefore termed Maternity Clinics. At present clinics are held from 2 p.m. to 4 p.m. as follows:— (a) 69, Brighton Road, Purley, each Monday and on the first and third Tuesdays in each month. (b) Methodist Church, Sylverdale Road, Purley, on the first and third Wednesdays in each month. (c) Baptist Church, Addington Road, Selsdon, on the second and fourth Wednesdays in each month. The total number of new ante-natal cases presenting themselves at the clinics steadily increased from 106 in 1932 to 248 in 1938 and during the war years the following numbers have attended:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. New ante-natal cases 248 207 438 431 388 359 391 Percentage of registered births 33% 33% 74% 50% 41% 41% 52% Post-natal attendances 223 136 169 203 225 148 210 Number of sessions 71 70 91 108 115 118 120 Average attending per session 22 19 24 26 23 19 22 It will be seen that a very considerable increase has occurred in the proportion of ante-natal mothers attending the Council's clinics in the war years, due to a number of factors, including the shortage of doctors, the difficulty of obtaining admission to hospital and changes in the types resident in the District. The phenomenal increase in the percentage of mothers attending in 1941 was partly artificial, being caused by an influx from surrounding Districts which had inadequate ante-natal facilities. These had to be excluded in October, 1941, as they were overtaxing the local clinics. Excluding this particular year it will be noted that about half the ante-natal mothers have for several years attended the Council's clinics, a tendency which will probably increase as a consequence of the demand for institutional confinements. Mothercraft Classes. An experiment was made during 1945 of holding special sessions at which talks on mothercraft were given to the ante-natal mothers 37 invited to attend. Six sessions were held with a total attendance of 32, but while the experiment had value in the more detailed advice which could be given to those who attended, the support was not such as to justify continuation of the experiment, reliance being placed upon the instruction given by the Health Visitors to individual mothers, as hitherto. Post-Natal Examinations. By comparison with the increase in ante-natal attendances the proportion of mothers presenting themselves for post-natal examination has tended to diminish, although the total number of attendances has not varied greatly. In part this can be attributed to lack of appreciation of the need for the examination, coupled with the increased demands on mothers in war-time and the overcrowding of the ante-natal clinics. This is one aspect of the maternal welfare work requiring special attention in the future, as it is most desirable that all mothers should be examined at least once after their confinements, the ideal being an examination by the doctor who attended the confinement at the end of the lying-in period and another examination six weeks after the birth has occurred. Much inconvenience and suffering, which in the past has often resulted from neglect following childbirth, could be avoided if mothers would only co-operate by the use of the facilities provided by the Council. If the higher birth rate is maintained and improved post-natal attendance is encouraged, an increase in the number of maternity clinic sessions will be an inevitable corollary. Maternity Cases. The following table presents concisely the position regarding institutional confinements arranged under the Council's Scheme and those attended by the Council's Midwives in their own homes during the war years:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. Confined in Purley Hospital 64 62 55 71 73 58 72 Confined in Redhill County Hospital 98 98 170 203 150 107 129 Attended by Selsdon Midwife 38 50 37 45 42 49 33 Attended by Purley Midwife 49 46 39 51 61 50 39 Supplied with Home Help 18 26 28 25 56 73 142 Midwifery Service. T.he Council, acting as agents for the Surrey County Council, appointed two midwives in December, 1937, to serve the Sanderstead/ Selsdon and Purley/Kenley areas. In addition, the Coulsdon District Nursing Association has, for several years, employed two midwives to attend confinements in the homes of residents in the Coulsdon area. 38 In 1938 the Council midwives attended 56 cases and the Coulsdon Nurse 105 cases. In addition, there were seven midwives acting privately in the Urban District. In 1945 the Council's midwives attended 72 cases and other domiciliary midwives 89 cases. Most of the latter were attended by the Coulsdon Nurses as only a very small number of midwives now attend privately. The analysis included in the following section indicates the proportion of the total births confined by midwives. Hospital Accommodation for Maternity Cases. In 1929 the Council contributed towards the provision of a maternity block of six beds at the Purley Hospital, three of which beds were reserved for the use of cases referred to the Hospital by the Council's ante-natal clinics. In this way provision was made for the institutional confinements of a small proportion of the residents, but from the number of applications it was obvious that increased accommodation would be required. During the pre-war years an attempt was made to obtain sanction to the establishment of a municipal maternity home but this was not approved in view of the maternity accommodation being provided (68 beds) at St. Helier County Hospital, the foundation stone of which was laid in March, 1938. The Hospital was opened in March, 1941, but immediately and repeatedly suffered war damage. Unfortunately more recently acute shortage of staff at the hospitals has limited very severely the advantages anticipated from this provision of maternity accommodation by the County Council. Pending the erection of St. Helier Hospital an arrangement was made with Queen Charlotte's Hospital and in 1938 ten cases were admitted, while 61 were admitted to Purley Hospital and 64 to Redhill County Hospital. During the war period the use of maternity accommodation at the London Hospitals has been negligible and greater use has therefore been made of the County Hospitals and especially of the private Nursing Homes, as can be seen from the following analysis:— Percentage of annual births confined by various agencies. Year. Nursing Homes. Midwives. County Hospi tals. Purley Hospital London Hospitals Number of Births registered. Council. Others. Redhill. Others. 1938 21 8 39.5 11 1 17 2.5 592 1939 30 12 30 13 —. 14 1 762 1940 24 15.5 23.5 14 1.5 20.5 1 626 1941 17 13 20 31 1 18 — 592 1942 27.5 10 20 22.5 1.5 17.5 1 852 1943 34.5 12 20 10.5 1.5 15.5 .5 953 1944 31 9 23.5 19.5 .5 15 1.5 853 1945 35 8.5 12 23.5 — 19.5 1.5 750 It will be noted that the domiciliary midwives Have dealt with a steadily declining proportion of the births. in spite of the restricted hospital accommodation. 39 The increasing tendency of residents to seek accommodation in institutions for their confinements was very obvious before the war. The shortage of housing accommodation and domestic assistance has increased this trend, to meet which not only is more maternity accommodation required, necessitating building, but the corresponding nursing and domestic staffs must be found or trained. Clearly time must elapse before the demand for institutional confinements can be fully met, but fortunately pending such provision the local Midwifery and Home Help Services, which are rendering a most valuable service, can undertake more work if required. In view of the proportion of maternity cases who must travel outside the Urban District for their confinements, the Council makes a uniform charge of 5s. for each maternity case transported to or from any of the County or London Hospitals. Cases confined at Nursing Homes are charged at the normal ambulance rate. Home Help Service. The Council instituted a Home Help Service in 1920 but until 1944 assistance was limited to maternity cases. During the winters of 1943/4 and 1944/5 voluntary assistance was organised to assist residents during times of sickness and, following the issue of the Ministry of Health Circular 179/44, dated the 14th December, 1944, additional Home and Domestic Helps were employed, largely on a part-time basis, for cases in which sickness or old age made assistance in the home essential. From 1920 to 1941 only one permanent Home Help was employed by the Council, occasional additional part-time help being obtained as and when required. The number of cases in which assistance could be given was relatively small and only 31 cases were attended in 1938. Even in 1945, when a really determined effort was made to obtain additional Home Helps, the number employed whole or part-time was not more than six until the late summer, when a campaign in this and neighbouring Districts resulted in the enrolment by this Council of at least 17 Home Helps, which number has since been increased. In October, 1945, the amount of organising work involved made it impossible for the Senior Health Visitor to cope with this work in addition to her other duties and the Council has since employed a halftime paid Organiser, which arrangement has made it practicable to deal with a larger number of cases much more adequately. While the District has been fortunate in obtaining so much assistance, it appears desirable for even larger numbers of Home Helps to be enrolled and employed by the Council, particularly while the present shortage of domestic assistance persists, in order to see that help is provided for those cases most needing it, irrespective of their ability to pay fully the cost of this Service. Obstetric Specialists. In 1934 the Council first appointed Obstetric Specialists, who were attached to the London Hospitals, but these were called upon 40 tively rarely, chiefly owing to the difficulty in obtaining their services when needed. In 1937 a third name was added to the list, the specialist in question residing within easy reach of the District. The number of occasions on which these specialists have been called to the District has always been comparatively small, and in 1938 the Council decided to make no attempt to recover any part of the fees of the specialists from the patients, which practice has been continued to date. During 1945 the local specialist, who has been the only one called in during the war period, attended seven cases, this being the highest number of calls in any one of the war years. Emergency Unit. In 1938 an arrangement was made, thanks to the generosity of the County Borough of Croydon, whereby an Emergency Unit or "Flying Squad" based on Mayday Hospital, Croydon, was made available to residents in this District. Although fortunately very little used, it is a great advantage to the District to have this Service available for use when required. During the war years it has only been called upon on two occasions viz., once in 1943 and once in 1944. Care of Premature Babies. Detailed consideration was given to the special needs of premature babies during 1944 and a number of additional arrangements were made. The services of a Consultant Pædiatrician were made available, but during 1945 he was not called upon for consultation by any local practitioner. On the other hand considerable use was made of the special cots, electric cradles and other equipment provided by the Council for this purpose. Particular care has also been given to the transport of premature infants by ambulance. Care of Illegitimate Infants and Their Mothers. Special consideration was given during 1944 and 1945 to the prob lems attaching to this group of mothers and babies, but while this has had the advantage of focussing the attention of the Health Visitors to the peculiar needs of these cases, no special arrangements have resulted which can be reported at this time. Individual cases have been given assistance in various ways. Family Planning. Since 1936 the Council has made an annual grant to the Croydon Mothers' and Infants' Welfare Association, in return for which residents requiring advice have been able to obtain this at Croydon on financially advantageous terms. 41 During 1945, however, it became impossible for the Croydon Association to cope with the large number of cases seeking advice from this and other Districts. As a result the Council established a Family Planning Clinic at 69, Brighton Road, Purley, the sessions being held on the second Tuesday in each month, when cases are seen by appointment. At the two sessions held in 1945, 23 attendances were made. Unfortunately the scope of the work has had to be curtailed as compared with previous years, owing to the fact that only cases in which birth control is justified on medical grounds can be advised on this subject. This, however, is not the only aspect of family planning which is dealt with at the Council's clinic, cases of sterility being the next most important group seeking advice. Health Visitation. The Council had just appointed a fourth Health Visitor as the war broke out, but the effect of this increase was not felt until 1940. With the increasing number of births further staff became necessary and from 22nd May, 1944, five Health Visitors have been employed, who work under the general supervision of the Medical Officer of Health. The following table gives a statistical statement of their work during the war years:— 1938. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Number of births notified 738 762 626 592 852 901 853 750 N umber of Health Visitors 3 3-4 4 4 4 4 4-5 5 Total visits by Health Visitors 6,677 7,024 9,192 7,888 7,924 8,341 10,309 8,340 Percentage of births visited 92 87 86 82 91 93 91 94 Primary visits made 681 666 540 487 777 836 788 707 Visits to children under 1 year 1,579 1,628 1,910 1,470 1,729 1,815 2,315 1,695 Average number of visits per baby visited 2.3 2.4 3.5 3.0 2.3 2.2 3.0 2.4 Visit to children from 1-5 years 3,613 3,990 5,724 4,774 4,387 4,685 6,449 4,937 In partial explanation of the decrease in the total number of visits in 1941, it should be noted that during the national Diphtheria Immunisation Campaign, the Health Visitors were called upon to attend a number of sessions at schools and clinics (215 in 1941), which reduced the time during which they could pay home visits. After 1941 the Health Visitors were relieved of this work by the Civil Defence volunteers, several of whom have continued to give yeoman service since the disbandment of that organisation. 42 The reduction in the number of visits in 1945 compared with 1944 is partly due to fewer births having occurred, but chiefly owing to the fact that for several months the staff was one short owing to illness and a resignation. The following is a list of the visits paid by the Health Visitors in 1945:— 707 first visits to babies 1,695 visits to babies under 1 year. 4,937 visits to children from 1-5 years 292 ante-natal visits—- 254 first visits. 38 re-visits 99 visits to cases of tuberculosis:— 67 first visits. 32 re-visits. 86 visits to cases of whooping cough:— 82 first visits. 4 re-visits 209 visits to cases of measles:— 208 first visits. 1 re-visit. 4 visits re Schick readings. 10 investigations of infant deaths. 13 investigations of still births. 1 investigation of puerperal pyrexia. 1 investigation of ophthalmia neonatorum. 286 miscellaneous visits. 8,340 Total Infant Welfare Centres. Six Infant Welfare Centres have been established by the Council which are held from 2 to 4 p.m. at the following places:— Methodist Church, Brighton Road, Coulsdon Every Thursday. Church of St. Francis, Rickman Hill, Coulsdon Every Tuesday. St. John's Hall, Bradmore Green, Old Coulsdon Every Wednesday. Methodist Church, Sylverdale Road, Purley Every Friday. Baptist Church, Addington Road, Selsdon Every Monday. Congregational Church, Sanderstead Road, Sanderstead Every Friday. The following statistical statement gives a clear picture of the increasing use of these Centres before the war and the war-time fluctuations which have occurred:— 43 TABLE A. ATTENDANCES AT INFANT WELFARE CENTRES. 1933-1945. Brighton Road, Coulsdon. Rickman Hill, Coulsdon. *Bradmore Green, Old Coulsdon. Sylverdale Road, Purley. Addington Road, Selsdon. Sanderstead Hill, Sanderstead. TOTALS. 1945. 1944. 1943. 1942. 1941. 1940. 1939. 1938. 1937. 1936. 1935. 1934. 1933. New cases 169 79 102 146 124 148 768 681 811 848 717 667 811 667 594 502 423 368 329 Other cases 2,188 1,470 2,222 1,926 2,341 2,201 12,348 10,130 13,093 12,328 10,315 10,245 13,093 16,371 14,064 12,017 10,309 8,710 7,490 Total attendances 2,357 1,549 2,324 2,072 2,465 2,349 13,116 10,811 13,904 13,176 11,032 10,912 13,904 17,038 14,658 12,519 11,732 9,078 7,819 Consultations with doctor 716 515 375 440 635 397 3,078 2,973 3,601 3,466 3,477 3,243 3,412 3,522 2,866 2,403 2,099 2,013 1,876 Referred to hospital — 4 5 3 10 5 27 21 38 59 68 10 38 41 21 16 17 - 21 Number of sessions 48 47 48 49 48 48 288 277 261 243 244 237 261 239 220 195 191 192 177 Average attendance per session: 1945 49 33 48 42 51 49 45* 1944 49 29 40 31 42 40 38* 1943 65 38 57 44 59 56 53* 1942 65 43 53 44 63 53 53* 1941 52 31 43 46 51 45 44* 1940 48 40 38 43 50 53 45* 1939 65 38 57 44 59 56 53* 1938 81 67 51 69 81 62 71* 1937 75 64 42 59 79 49 67* 1936 69 56 — 53 81 69 64* 1935 58 57 — 49 61 - 61* 1934 49 46 - 42 52 - 47* 1933 45 46 - 42 49 - 44* * Average attendance per session for all Centres. 44 The growth of this Service is a feature in civic life which is apt to be overlooked. Child welfare centres and health visitation have come to be regarded as part of the normal service of a local authority needing no special consideration or remark. The steady solid work which is given annually to make them so successful in improving the health of the youngest residents should not be accepted without comment, and all who assist deserve appreciation and congratulation on their continued devotion to this valuable work. Toddlers' Clinics. In 1938 the Council decided to devote regular sessions at each of the infant welfare centres to supervising the health of children over two years of age who attended but who are otherwise apt to be overlooked on account of the attention claimed by the newly born. Unfortunately the institution of these toddlers' clinics had to be postponed until 1939 owing to the extra work resulting from the Munich crisis and then, before the habit of submitting these older children for regular examinations could be sufficiently encouraged, the disturbing influence of the war began to tell. The following table indicates the numbers of children who have been examined in this way since the inception of these clinics:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. Number of toddlers' sessions held 23 44 46 41 44 45 43 Number of children examined 247 237 164 198 241 165 169 Total number of examinations 276 450 404 459 564 454 469 Now that the influence of the war is passing it is hoped to concentrate again on this important aspect of child welfare work, the volume of which will in due course be reduced by the routine examinations of children between the ages of two and five years attending nursery schools. The Provision of Milk. In 1939 the Council arranged for the delivery of milk, free of charge or at reduced price, to the homes of 160 parents who were known to be in necessitous circumstances and the children in need of milk, compared with 139 in 1938 and 89 in 1937. In 194° rnilk was supplied to 158 cases, but with the Government's acceptance of full responsibility for the supply of milk to all children, the responsibility of the Public Health Department was superseded by the wider scheme under the Ministry of Food. 45 The Provision of Specialist Treatment. The Council has made arrangements for Specialists' advice and, if necessary, treatment in respect of any child attending the child welfare centres. Such cases are usually first referred to their own private doctors and, subject to their consent, are subsequently referred to hospital. The number of cases treated in this way fluctuates slightly from year to year but is never very great. It is generally appreciated that child welfare centres are not for the treatment of the sick but for the periodical examination and observation of the apparently healthy child, in order to check any minor defects or detrimental tendencies, and for instruction on rearing children along sound lies. Eye Defects and Treatment. Arrangements were made during the year 1938 whereby children suffering from eye defects could be referred by appointment to special sessions for young children held at the Surrey County Council's Clinic in Whytecliffe Road, Purley, and these facilities have continued throughout the war years. During the year 1945 appointments were made for ten children to attend, which is about the average number referred annually since the inception of the scheme. Dental Treatment. The scheme for the dental treatment of ante-natal and nursing mothers and children under five years of age, which was launched in 1934, has continued to provide useful service during the war years. The number of cases treated during 1945 was 47, compared with 47 in 1944 and 97, 100, 85, 67 and 90 in the preceding five years. The Council reconsidered the scheme during 1945, as it was felt that too few children were receiving treatment in this way, chiefly owing to the lower scale of charges applied to similar children at the school clinics. As a result the parents were postponing treatment until the children commenced school. It was decided to reduce very substantially the charges in respect of the children referred to private dental surgeons through the Council's scheme, the new rates being comparable with those which were then being used at the school clinics. Day Nurseries. Two Voluntary Day Nurseries had been established in this District before the war and each was in receipt of an annual grant from the Council equivalent to approximately one-third of the total cost of the nursery, recognition of these grants being made in the block grant received from the Government. Parents' contributions accounted for about the same proportion of the cost. In 1942, in view of the need for women to work in the national interest, the Council established three War-time Nurseries, one at Purley 46 (40 places) and at Selsdon and Old Coulsdon (60 places each). (The Voluntary Nurseries had accommodation for approximately 21-26 children in each.) The Government met the net expenditure in relation to the wartime nurseries, which have made a very marked contribution, not only to the war effort directly and indirectly, but to the education and physical needs of the children. In general it can be stated that the applications for admission to the Old Coulsdon, Coulsdon and Purley Nurseries have always exceeded the number of available places, although at times, owing to outbreaks of infectious disease or war conditions, each of the nurseries has, for a short period, only been partially filled. Owing to the Government grant, which in the later months of the war was extended to give additional financial assistance to the voluntary nurseries, no consideration was given to municipal boundaries, children from Caterham and Croydon being willingly accepted, the chief factor in deciding priority of admission being the amount of time the mother worked. At the Selsdon Nursery the local demand proved small, on an average only one-third of the places being occupied by children from that area. As a result an ambulance service, originally staffed by the Civil Defence personnel, was instituted for the conveyance of children from South Croydon and Sanderstead to and from the Selsdon Nursery, the number of children on the roll being thus maintained at approximately 50, except in epidemic periods. During the latter half of 1945 considerable anxiety was felt by the Staff as to the uncertain future of the nurseries, although the demand for accommodation by women going out to work increased rather than diminished. In December, 1945, the Government decided to reduce its grant in respect of the War-time Nurseries as from the 1st April, 1946, to less than 50 per cent., with the result that readjustments had to be considered which have since resulted in an increase in Nursery Schools and a diminution in nursery facilities throughout the District. Parallel with these alterations there has been a change in policy with regard to the training of nursery staffs, a new syllabus being introduced which will eventually provide much more adequate training for the students. Unfortunately, owing to the great demands being made for extension in all directions under the Education Act, the transitional period preceding the establishment of many more nursery schools is likely to be prolonged, and meanwhile the future of nurseries as such has been so uncertain that it has not been justifiable to encourage likely candidates to take up nursery work. It is felt that eventually at least one good nursery will be needed for this District to accommodate the children of parents who must work or who, for health reasons, are unable to look after their children, and whose needs cannot be met by the normal nursery school hours and age limits. Every consideration, however, is being given to this and similar problems, which will be reported upon more fully in the Health Report for the year 1946. 47 Child Life Protection. The Health Visitors are all Infant Life Protection Officers and during the war years have had under supervision the following numbers of foster-mothers and children:— Number of Foster Mothers. Number of children in their care. 1939 21 39 1940 24 41 1941 16 28 1942 25 41 1943 24 41 1944 18 23 1945 21 39 No relaxation of the minimum standard expected of foster-parents has been permitted, and on the whole a welcome co-operation between them and the Health Visitors has existed. HOUSING. The following is a statement of housing statistics for the year 1945, below which, for comparison sake, is inserted a table giving the comparable figures for each of the sections during the war years:— 1. Inspection of Dwelling Houses during the Year 1945. (1) (a) Total number of houses inspected for housing defect (under Public Health or Housing Acts) 538 (b) Number of inspections made for the purpose 563 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 453 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 377 3. Action under Statutory Powers during the Year:— (a) Proceedings under sections 9, 10 and l6 of the Housing Act, 1936: (1) Number of dwelling houses in respect of which notices were served requiring repairs 8 (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By Owners 6 (b) By Local Authority in default of owners 1 (b) Proceedings under the Public Health Acts: (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 48 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By Owners 37 (b) By Local Authority in default of owners 1 48 (c) Proceedings under sections 11 and 13 of the Housing Act, 1930: (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling house demolished in pursuance of Demolition Orders Nil (d) Proceedings under section 12 of the Housing Act, 1936 : (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1936, Part IV—Overcrowding:— (a) (1) Number of dwelling houses overcrowded at end of year 4 (2) Number of families dwelling therein 9 (3) Number of persons dwelling therein 33 (b) Number of new cases of overcrowding reported during the year 4 (c) (1) Number of cases of overcrowding relieved during the year 2 (2) Number of persons concerned in such cases 19 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority has taken steps for the abatement of overcrowding Nil Number of New Houses erected during the Year:— By the Local Authority Nil By other persons Nil 49 HOUSING STATISTICS, 1939-1945. 1939. 1940. 1941. 1942. 1943. 1944. 1945. 1. Inspection of Dwelling Houses:— (1) (a) Houses inspected 540 310 467 488 453 317 538 (b) No. of inspections — 315 517 496 475 342 563 (2) (a) 15 — — — 2 — — (b) — — - - 2 — — (3) Unfit houses - - 4 - - — - (4) Partially unfit 132 128 360 418 413 259 453 2. Remedy of Defects during the Year without Service of Formal Notices 166 85 249 425 366 206 377 3. Action under Statutory Powers during the Year :—- (a) Housing Act, 1936, Sec. 9, 10 and 16: (1) - 1 7 3 7 3 8 (2) (b) - - 6 3 3 5 6 (b) - 1 — — — — 1 (ft) Public Health Acts : (1) 21 23 44 33 56 14 48 (2) (a) 18 — 58 27 43 26 37 (b) 2 9 — 3 7 1 1 (c) Housing Act, 1936, Sec. 11 and 13: (1) - - - - - - - (2) - - - - - - - (d) Housing Act, 1936, Sec. 12: (1) - - - - - - - (2) - - - - - - - 4. Housing Act, 1936, Part IV—Overcrowding:— (a) (1) Houses overcrowded 6 3 3 3 2 2 4 (2) Families therein 7 3 4 6 2 2 9 (3) Persons therein 54 25 24 23 20 14 33 (b) New cases in the year 8 2 6 4 — 3 4 (c) (1) Cases relieved 6 5 6 4 1 3 2 (2) Persons concerned 35 32 52 34 6 22 19 (d) Again overcrowded ... 1 - 1 1 — - — Number of New Houses Erected during the Year:— By the Local Authority - - - - - - - By other persons 338 11 - - - - - It will be seen that the number of houses inspected for housing defects diminished from 1940-44, although the number found not to be in all respects reasonably fit for human habitation greatly increased. The reason was, of course, that owing to the shortage of labour and materials there was less purpose in making many routine inspections 50 which could only result in the raising of false hopes. The chief function of the Sanitary Inspectors with regard to repairs during the war period has been to differentiate the urgent from the less urgent for the guidance of those who subsequently undertake the work. Meanwhile, in spite of phenomenal accomplishments in the matter of war damage repairs, the arrears of maintenance, repair and redecoration have steadily accumulated. The statistics with regard to overcrowding are, of course, apt to be misleading, chiefly owing to the very low standard set by the Housing Act, 1936. (In passing, it should be noted that even that standard when applied to this District revealed 23 cases of overcrowding during the war years.) This index of present housing conditions would suggest that but little deterioration has occurred. Unfortunately there are no definite statistics to present, but it is generally recognised that with the present acute shortage of houses far more families are now living under crowded conditions than in the pre-war period. It is very common to find more than one family and often several families living in the same house with all the attendant disadvantages, but until more houses become available but little can be done to assist them. Well before the ending of hostilities the Council began hard work on the preparation of plans for the early erection of houses and it was hoped that the maintenance of health would be the first consideration when determining priority for rehousing. At the end of 1946 it will be possible to give the first review of what has been accomplished. WATER SUPPLY. The water supply of the District is provided by the Sutton District Water Company and the East Surrey Water Company, with a private supply supplementing as required at Cane Hill Hospital. There are no other private wells in the District. The Old Coulsdon Estate supply was taken over by the East Surrey Water Company on 1st August, 1939. All houses are served by public water mains and there are no standpipes for common use, each house having its own supply within the house. Throughout the war years the quantity provided has been adequate and the quality has been kept at a high level. Routine quarterly samples have been taken for bacteriological and chemical examination by the Local Authority and, in addition, special samples when required. Samples were also taken when necessary following damage by enemy action to the water mains of the District and throughout the war the closest co-operation between the Suppliers and the Public Health Department existed. Detailed plans were made to meet the most stringent limitation of supply by enemy action but fortunately very few of these had to be applied. Both Companies maintained free chlorine in their supplies as a precautionary measure, which practice it is hoped will be continued. 51 Altogether II samples of water were taken for bacteriological examination and eight for chemical examination during 1945, including one special sample owing to a complaint. Two unsatisfactory bacteriological reports were received but these were due to a defect in the fitting from which the samples were taken, as later samples taken from the same and adjoining premises were satisfactory. There was no other sign of contamination. No samples of raw water were taken during the year. The statutory maximum limit for hardness in the water supplied by the Sutton District Water Company is 9 degrees, while the East Surrey supply has also to be softened. Thirty samples were examined by the Department during 1945 to ascertain the hardness and in all cases this was found to be satisfactory, as has been the position generally during the war. The rainfall during the war years is given below and there was no shortage of water supply, except early in 1944, when it was found necessary to issue warnings of water shortage to consumers. The watering of gardens was checked but it was not found necessary to impose further restrictions. RAINFALL. The rainfall in 1945 registered by the rain gauge at the Refuse 52 The following are typical results of chemical and bacteriological examinations made in 1945, from which the remainder varied but little:— Chemical Analysis. Sutton and District Water Company. East Surrey Water Company. Parts per 100,000. Grains per gallon. Parts per 100,000. Grains per gallon. Total solids (dried at 180°C.) 16.0 11.2 15.0 10.5 Combined chlorine (C1) 1.4 1.0 1.5 1.1 Equivalent to sodium chloride (NaC1) 2.3 1.6 2.5 1.7 Nitric nitrogen (nitrates) 0.56 0.39 0.58 0.41 Nitrous nitrogen (nitrites) Nil Nil Nil Nil Ammoniacal nitrogen 0.0060 0.0042 0.0044 0.0031 Albuminoid nitrogen 0.0005 0.0004 0.0002 0.0001 Oxygen absorbed in 4 hours at 27°C. 0.005 0.004 0.002 0.001 Lead or copper Nil Nil Nil Nil Temporary hardness (equivalent to CaCO3) 11.0 7.7 8.0 5.6 Permanent hardness do. 1.0 0.7 1.0 0.7 Total hardness do. 12.0 8.4 9.0 6.3 Bacteriological Examination. Plate count. Yeastrel agar 3 days 22°C. aerobically 0 per cc. 0 per cc. do. do. 2 days 37°C. aerobically 3 per cc. 4 per cc. Probable number of coliform bacilli MacConkey 3 days 37°C. 0 per 100 cc. 0 per 100 cc. DRAINAGE AND SEWERAGE. Owing to the great difficulty of obtaining labour and materials beyond the requirements for remedying war damage, only repairs to drainage systems were carried out during 1945. The approximate numbers of each type of closet accommodation at the end of the year were:— Premises with water closets drained to sewers 15,202 Premises with pail closets excluding temporary buildings used for A.R.P. purposes 216 Number of cesspools 164 The number of cesspools was reduced by 46 in 1939 to a total of 171, which has since been slightly reduced. Similarly nine pail closets were abolished in 1939, though the total was considerably increased for temporary use at shelters, wardens' posts, etc. Four were abolished in 1940, a few after that, while in 1945 the majority of the temporary closets were discarded. PUBLIC CLEANSING. Until 1941 a weekly collection of house refuse was in vogue but this had to be reduced to a fortnightly collection which it had been impracticable to improve upon by the end of 1945. From time to time special drives for salvage purposes were made during the war years. The charges for trade refuse removal and for cesspool emptying have remained unaltered throughout. SMOKE ABATEMENT. The chimneys of the small factories in the District give little trouble and observation of these and the few large chimney stacks has never resulted in any major problem. 53 Destructor was 28.32 inches, the monthly totals and annual rainfall during the war years being as follows:— 1945. Annual Totals. January 2.66 inches 1939 36.49 inches February 2.22 do. March 1.23 do. 1940 30.03 do. April 1.41 do. May 3.01 do. 1941 30.41 do. June 2.27 do. July 3.69 do. 1942 28.93 do. August 1.96 do. September 2.09 do. 1943 25.01 do. October 3.81 do. November 0.31 do. 1944 26.94 do. December 3.66 do. Total 28.32 inches 1945 28.32 do. RIVERS AND STREAMS. From time to time inspections are made of the water courses in the district, but, apart from clearing them as frequently as is necessary, no particular difficulty has arisen. CAMPING SITES. No major problems have arisen from camping sites during the war years. In 1939 two Scouts' camping sites were approved and two caravan sites were licensed at Coulsdon, one for six months only. SWIMMING POOLS. There are no public swimming baths in the district and most of the private swimming pools have only been used sporadically or utilised for fire protection purposes. The bath at Reedham Orphanage, which is used by children from some of the elementary schools in the District, was used again for a short period in 1945 after the children returned from evacuation. One sample of water was taken which was satisfactory. SHOPS AND OFFICES. During the war regular inspections have been made of the sanitary accommodation, washing facilities, heating and ventilation of shops and offices, and improvements have been effected as circumstances have permitted. SANITARY INSPECTIONS, ETC. The following is a list of the complaints received, visits made, notices served, and defects reported and remedied during the year 1945. Compared with the previous year, there was an increase of 97 in the number of complaints received, the most common cause being choked drains in premises where bomb damage repairs had been carried out and solid matter had gained access to the drains:— Summary of Visits Made. Number of houses inspected 538 Re-inspections and calls made 3,018 Inspections : Workshops 94 Factories 65 Bakehouses—Workshops 28 —Factories 34 Cowsheds 43 Dairies and Milkshops 87 Slaughterhouses 6 Meat and other foods ... 428 Stables and Stable yards 20 Food Premises 145 Yards, outbuildings, drains, etc. 1,141 Piggeries, fowls and other animals 88 Under Rats and Mice (Destruction) Act, 1919 515 Carried Forward 6,250 54 Brought Forward 6,250 Revisits under Rats and Mice (Destruction) Act, 1919 1,135 Inspections, Shops Acts 22 Drains tested with water 77 Drains tested with colour 7 Infectious disease enquiries 79 Infectious disease contacts 43 Disinfections carried out 96 Disintestations of verminous premises 10 Workplaces 3 A.R.P. shelters 1 Sewers baited for rats 200 Workmens' billets 3 Static water tanks 7 Miscellaneous 77 Total 8,010 Notices Served. Preliminary notices 542 Statutory notices 74 Final circulars and letters 167 Defects Reported. Cesspools requiring to be emptied 6 Unclean walls and ceilings 14 Choked drains 178 Defective drains, inspection chambers and covers 66 Defective fresh air inlets 9 Defective plaster 24 Defective firegrates 33 Defective floors 21 Defective woodwork 19 Defective paintwork 1 Defective paling 4 Defective dustbins 87 Defective waste pipes 22 Defective kerbs around gullies 9 Defective water closet fittings 33 Defective water closet pedestals 23 Defective eaves, guttering and rain water pipes 21 Broken sashcords 4 Dampness through roofs 39 Dampness through other causes 41 Animals so kept as to be a nuisance 2 Offensive accumulations 125 Verminous premises. 4 Lack of domestic cleanliness 7 Burst water pipes 29 Brickwork and pointing 14 Absence of water supply 7 Rat infestations 118 Insufficient light and ventilation 2 Insufficient ventilation beneath floors 9 Glazing 8 Unclean bakehouse walls 4 Overcrowding 4 Miscellaneous 10 Total 997 55 It is impracticable to give a comparative statement for the war years in such detail as set out above, but the following is a summary which may prove interesting:— 1938. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Number of complaints 423 385 278 265 413 483 453 550 Number of visits made 9.164 9,227 7,641 9,236 8,536 11,471 8,656 8,010 Number of notices served: (a) Preliminary 770 654 340 440 719 702 450 542 (b) Statutory 87 92 52 65 48 73 54 74 (c) Final 591 324 206 276 172 141 141 167 Defects reported 1,422 941 820 983 1,073 1,086 818 997 Defects remedied 1,436 1,312 791 1,076 1,137 1,090 847 1,054 The chief variations which have been experienced during the last six years have resulted from war damage, from the number of A.R.P. and other premises needing supervision, including billets and public shelters, from the inspections consequent upon the increased keeping of poultry and animals for domestic consumption, and particularly the Rats and Mice Campaign from 1943 onwards, which vermin have 56 Defects Remedied. Cesspools cleansed 6 Drains cleared 195 Drains repaired or relaid 78 Fresh air inlet provided 11 Walls and ceilings cleansed 26 Plaster repaired 30 Firegrates repaired or replaced 27 Floors repaired 22 Sashcords replaced 6 Woodwork repaired 19 Paintwork renewed 2 Paving relaid 6 Dustbin provided 74 Waste pipes 23 Kerbs 9 Water closet fittings 36 Water closet pedestals 22 Eaves, gutterings, etc. 23 Roofs repaired 40 Dampness remedied 44 Animals 3 Offensive accumulations 131 Verminous premises. 5 Domestic cleanliness improved 4 Water pipes repaired 25 Brickwork and pointing 12 Water supply laid on 6 Rat disinfestations 137 f.ight and ventilation provided 1 Ventilation beneath floors provided 10 Glazing repaired 7 Bakehouses cleansed 4 Overcrowding abated 2 Miscellaneous 8 Total 1,054 accounted for a large proportion of the complaints received. It has also been more desirable than ever to keep a close watch on the quality of the food supplied to the public. These varying demands, together with regular Civil Defence duties, have kept the Chief Sanitary Inspector especially very fully occupied. The staff of the Sanitary Inspector's Department has, of course, been depleted during these years and is still slightly less than its pre-war complement. It is anticipated, however, that as the practicability of constructive work increases so the staff will be correspondingly enlarged. ERADICATION OF BED BUGS. The methods used for the eradication of bed bugs, which had proved successful before the war, have not been varied and the work is still carried out by the Local Authority. The number of houses dealt with during the last seven years, all of which were successfully disinfested, was as follows:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. Council houses: Infested 3 2 1 1 3 3 Nil Disinfested 3 2 1 1 3 3 Nil Other houses: Infested 11 2 3 4 10 8 6 Disinfested 11 2 3 4 10 8 6 Fumigation was carried out by sulphur candles and spraying by "Vermicine" Insecticide. If it is considered desirable the homes of applicants for Council houses are inspected with a view to obtaining some knowledge of their suitability as tenants, and if the houses and furniture are found to be infested, steps are taken, as indicated above, before entry is permitted. It was not found necessary to disinfest any bedding by steam during 1945. RATS AND MICE DESTRUCTION. In the years preceding the war the Sanitary Inspector and his Assistants attempted to effect the destruction of vermin, chiefly by giving householders advice and encouragement. With the inauguration of the Rat Campaign by the Ministry of Food in 1943 these efforts were intensified, and The following table illustrates the increased activity which has occurred. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Complaints received 59 48 40 74 202 180 147 Number of inspections 367 215 658 667 3,815 2,142 1,750 57 In recent years two re-inspections have been paid on the average after each primary visit. This work has absorbed an increasing proportion of the time of the sanitary inspectors and has compensated for the diminution in the amount of useful work which could be done in the inspection of housing conditions. In 1945 it was again noted that there were no major or reservoir infestations in the District but a large number of minor infestations, chiefly associated with poultry and rabbit keeping. It was impracticable to do much in connection with the sewers, which had received considerable attention but with very little result in 1944, only a few small infestations being found to exist. As in previous years, poison baits, including barium carbonate, phosphorous preparations, and arsenic, and also cyanide gas, were used but very few rats were found after poisoning, probably about 300, although in view of the quantity of poisons consumed it is estimated that at least twice this number were killed. It is again emphasised that it is the responsibility of occupiers to eradicate rats but the Council is prepared to assist, and the work is undertaken by the Public Health Department on request at a charge equal to the cost of the time, labour and materials used. LEGAL PROCEEDINGS. Proceedings were taken during 1945 under the Food and Drugs Act, 1938, against a firm of jam manufacturers and a fine of £15, together with £10 costs, was imposed. No legal proceedings were taken under the Public Health Acts. The following proceedings were taken successfully in the war years:— 1939 Housing Act, 1936. Overcrowding. Abated in 14 days. Public Health Act, 1930. Nuisance. Abated in 21 days. 1940 Nil. 1941 Public Health Act, 1930. Two cases of nuisance in respect of seven houses. Abated after Court Order. Food & Drugs Act, 1938. Four cases. Fines of £61 and £20 costs. 1942 Food & Drugs Act, 1938. Two cases. Fines of £7 and 7 guineas costs. 1943 Public Health Act, 1936. Nuisance. Abated after Court Order. 1944 Public Health Act, 1936. Rats & Mice (Destruction) Act, 1929. Food & Drugs Act, 1938. One case. Court Order. Fine of £5 plus costs. Fine of £2 and £3 costs. 1945 Food & Drugs Act, 1938. Fine of £15 plus £10 10s. 0d. costs. 58 SCHOOLS. School Closure.—While the procedure with regard to the closure of schools on account of the prevalence of infectious disease amongst the scholars has remained unaltered, in effect no public elementary school has been closed for this reason during the war years. In 1942 the periods of exclusion of individual children from school were reduced following the issue of a memorandum by the Ministry of Health and Board of Education, and the new procedure has proved to have been justified. A closer liaison between the Local Authority and the School Medical Service can be anticipated with the appointment of the Medical Officer of Health of the District as Divisional School Medical Officer as from xst September, 1945. Medical Inspection.— No marked alteration has taken place during the war years in the standard or method of medical inspection of school children at public elementary and secondary schools, which is the responsibility of the County Council as the Local Education Authority. School Clinics.— The County Council provides the following clinics for the treatment of school children at the Surrey County Dispensary, Whytecliffe Road, Purley:— General Medical Clinic : Thursdays 9.30 to 11 a.m. School Dental Clinic : Fridays 1.30 p.m. or by appointment. School Eye Clinic: By appointment. Sanitary Services.— The water supply, including the condition of the reserve storage tanks, the drainage and the sanitary accommodation of the public elementary and secondary schools have been kept under observation throughout the war period, and advice given when necessary on any matter requiring attention. REGULATED TRADES. Cowsheds and Dairies. The following is a list of dairy farms which were in existence at the end of 1945:— Hooley Farm, Woodplace Lane, Coulsdon. Dean Farm, Brighton Road, Hooley. Elm Farm, Farleigh. Moorcroft Farm, Farleigh. Welcomes Farm, Farthing Downs. Elmgrove Farm, Old Lodge Lane, Kenley. Hayes Farm, Hayes Lane, Kenley. There were no alterations on the previous year but as compared with 1938 there was an increase of two, the two last named having been added. 59 In addition, the hospitals at Netherne and Cane Hill are supplied chiefly by their own private farms, while a few cows are kept by private individuals. Elm Farm, Farleigh, and Dean Farm, Hooley, are licensed as "Accredited," and Hayes Farm, Hayes Lane, Kenley, for the production of "Tuberculin Tested" milk by the Surrey County Council under the Milk (Special Designations) Order, 1936. At the end of the year there were 11 registered dairies, 7 registered cowkeepers, 14 registered retailers, of whom 5 were out of the District, and 4 shops registered to sell bottled milk. These numbers have steadily decreased during the war years owing to the milk distribution policy of the Government, e.g., there were 44 registered retailers in 1938 as compared with 14 in 1945. Slaughterhouses . Similarly the policy of centralised slaughtering has meant that the two slaughterhouses in the District have not been licensed since 1940. In 1945 two licences were issued under the Slaughter of Animals Act, 1933 and these men were employed at private slaughterhouses at the public institutions in the District. Bakehouses. Again, whereas there were 15 bakehouses in the District in 1938, 8 of which were used for making bread, in 1945 there were only 7 bakehouses, chiefly engaged in making bread and confectionery. At 28 other places confectionery was produced fcfr sale or consumption on the premises. In addition there are bakehouses at private institutions, hotels and schools, all of which are inspected from time to time. Other Food Premises. In 1945 fish frying was carried on at the following premises:— 135, Addington Road, Selsdon. 131, Brighton Road, Coulsdon. Taunton Lane, Old Coulsdon. Valley Restaurant, 322, Chipstead Valley Road, Coulsdon. 8, High Street, Purley. Fish frying is not scheduled as an offensive trade but registration of such premises is required under Section 64 of the Coulsdon and Purley Act, 1937. A considerable amount of work was necessitated during the war years in visiting the canteens which were set up, the majority of which ceased to exist or curtailed their activities during 1945 with a corresponding reduction in the number of visits. Factories and Workplaces. In 1945 there were 161 factories and 22 workplaces in the District. These figures show a slight increase on the previous year and are only slightly greater than the number in existence in 1938. 60 The number of premises used by outworkers in 1945 was 43. All these premises have been inspected regularly and such defects as have been found have been dealt with satisfactorily. INSPECTION AND SUPERVISION OF FOOD. Milk. The following table gives the position with regard to the examination of milk during the war years:— 1939. 1940. 1941 1942. 1943. 1944. 1945. Bacteriological: Total count of all bacteria: Under 30,000 per ml. 56 36 30 30 25 32 52 30,000 to 200,000 per ml. 17 23 20 24 14 13 30 300,000 to 400,000 do. 5 4 6 9 6 6 9 Over 400,000 per ml. 1 4 6 18 12 3 — Coliform Bacillus : Absent in 1 ml — — — 11 — — — do. .1 ml. 41 28 26 5 —. — —■ do .01 ml. 16 13 12 20 39 35 — do. .001 ml. 18 14 10 45 18 19 — do. .00001 ml. 4 11 14 — — — — do. .0000001 ml — 1 — — — — — Biological Test for Tubercle Bacilli Negative 11 5 3 5 8 8 6 Positive — — 1 — — —• — Methylene Blue Test of Keeping : Satisfactory — — — 23 10 29 68 Unsatisfactory — — — 13 16 2 13 Phosphatase Test of Pasteurisation : Below 2.3 Lovibond Blue Units 6 16 22 30 26 28 45 Above 2.3 ditto 7 6 5 3 —' 2 - 9 The chief purpose of these examinations is to keep the work of the producers and distributors under observation, drawing their attention to any tendencies to deterioration in quality, advising methods of improvement, and, if necessary, taking steps to restrict their supply. The results of the biological tests were almost uniformly satisfactory, while on the whole the standard of pasteurisation improved, although the producers have often worked against great difficulties—changes in staff, deterioration in plant with difficulty in replacing parts, the blackout and enemy air attack, being among their handicaps. Unfortunately changes in some of the tests or method of reporting make it impossible to compare results from year to year, while the proportion taken from sources which are most suspect is apt to vary, e.g., after the installation of a new plant a relatively large number of samples may be taken during the period of adjustment. 61 Milk (Special Designations) Order, 1936. Licences to sell milk under the above Order were issued as follows during the war years:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. Principal: Tuberculin Tested 10 8 5 7 5 5 5 Accredited 2 2 2 2 1 1 — Pasteurised 10 11 10 9 10 10 10 Supplementary: Tuberculin Tested 4 3 3 4 3 3 3 Accredited — — - - - - - Pasteurised 4 3 3 3 3 3 4 Ice-Cream. After 1941 no ice-cream was manufactured in the District owing to the Government restriction, but on the 10th December, 1944, this Order was withdrawn and in 1945 the manufacture of ice-cream was resumed, four samples being taken during the year. Two of the samples were unsatisfactory but when sterilisation of the cold mix was adopted, repeat samples were satisfactory. Meat. Since January, 1940, no licences have been issued for the two slaughterhouses in the District. The only carcases examined have been those of a few pigs kept by private individuals or clubs and killed for their own consumption, for which a permit to slaughter was granted by the local Food Office. Unsound Foods. The following unsound foods were surrendered during the year 1945 the total representing a decrease of 17 per cent, on 1944:— lbs. ozs. Meat, bacon and poultry 631 8 Canned meat 150 13 Condensed milk 121 8 Fish 2,360 0 Canned fish 106 1½ Sugar, jam, etc. 98 6 Canned peas, beans and vegetables 166 3½ Flour, bread, cereals, fishcakes, pastries, etc. 214 4 Canned fruit 9 8 Eggs 5 4 Fruit 264 12 Soup 6 2 Pickles 5 0 Butter and fats 29 12 Flavouring (Oxo, etc.) 13 8 Miscellaneous 8 1 Total 4,196 10¾ 62 The quantities surrendered during the war years are as following Meat and fish. Other foodstuffs. T otal. lbs. lbs. lbs. 1939 433 23 456 1940 450 143 593 1941 165 205 370 1942 632 1,928 2,500 1943 1,138 1,972 3,110 1944 1,705 3,277 4,983 1945 3,254 942 4,196 The general policy has been to dispose of unsound foods by using them as animal or poultry food largely through the Ministry of Food Salvage Organisation. Public Analyst's Report. The following tables indicate the amount of sampling which was undertaken during the war years, together with a full statement of the samples taken during the year 1945:— 1939. 1940. 1941. 1942. 1943. 1944. 1945. Milk. Number of samples: Formal 48 43 54 29 31 33 32 Informal 3 — .— 1 —. .— Number adulterated or deteriorated : Formal 2 4 8 6 1 2 4 Informal — - - - - - - Prosecutions - - 2 3 - - - Convictions — — 2 2 — - — Other Foods. Number of samples: Formal 30 132 97 133 113 117 114 Informal 4 3 6 4 I - 2 Number adulterated or deteriorated: Formal 2 8 9 14 12 4 6 Informal 3 — 1 1 1 — —. Prosecutions — - 2 - - 1 1 Convictions - - 2 — - 1 1 63 SAMPLES TAKEN DURING 1945. Articles. Analysed. Adulterated or det eriorated. Prosecutions. Conviction. Formal Informal . Total. Formal Informal. T otal. Arrowroot 3 — 3 - - - - - Aspirin 2 — 2 - - - - - Baking powder 3 — 3 - - - - - Barley crystals 1 — 1 - - - - - Barley powder 1 — 1 - - - - - Bicarbonate of soda 2 — 2 - - - - - Black pudding 1 — 1 - - - - - Bread 4 — 4 - - - - - Butter 1 — 1 - - - - - Cake (ginger) 1 — 1 - - - - - Cake mixture 1 — 1 - - - - - Celery salt - — 1 - - - - - Cheese 1 — 1 - - - - - Cheese cake mixture 1 — 1 - - - - - Cocktail tonic 1 — 1 - - - - - Coffee 1 - 1 - - - - - Coffee essence 1 — 1 - - - - - Cocoa 5 —- 5 - - - - - Cheese and savoury 1 - 1 - - - - - Chocolate cup 1 — 1 - - - - - Charcoal biscuits 1 — 1 - - - - - Curry - — - 2 — 2 — — Custard flavouring 1 — 1 — — — — — Custard powder 1 — 1 - - - - - Cinnamon 1 — 1 - - - - - Digestive tablets 1 — 1 - - - - - Dried eggs - 2 2 - - - - - Egg substitute 1 — 1 - - - - - Fish paste - — - - - - - - Fish roll 2 — 2 - - - - - Flour, self raising 1 — 1 - - - - - Flour mixture 1 — 1 1 — 1 — —• Fruit tart 1 — 1 - - - - - Gelatine 3 — 3 — — — — — Ginger, ground 2 - 2 - - - - - Ginger beer powder 1 — 1 - - - - - Glauber salts 1 — 1 1 — 1 - — Horseradish sauce 1 — 1 - - - - - Ham and tongue paste 1 - 1 - - - - - Icing sugar 1 — 1 - - - - - Jam 6 — 6 1 — 1 1 ] Junket, rennet 1 — 1 - - - - - Lemexa 1 — 1 - - - - - Lemonade crystals 1 - 1 - - - - - Lemon curd 2 — - - - - - - Malt and chocolate spread 1 - 1 - - - - - Marmalade 2 — 2 - - - - - Meat extract 1 — 1 - - - - - Meat paste 1 - 1 - - - - - Meat pies 2 — 2 - - - - - Carried Forward 79 2 81 5 — 5 1 1 64 Articles. A nalysed. Adulterated or deteriorated. Prosecutions. Conviction. Formal Informal. T otal. Formal Informal. Total. Brought forward 79 2 81 5 - 5 1 1 Milk 32 — 32 4 - 4 — — Malted milk tablets 1 — 1 - - - - - Mince and beans 1 — 1 - - - - - Mustard mixture 1 — 1 - - — — — Meat soup 1 - 1 — — — — — Mushroom ketchup 1 — 1 - - - - - " N.R.G." cocktail 1 — 1 - - - - - Peas 2 — 2 - - - - - Pease pudding 1 — 1 - - - - - Prepared meal 1 — 1 — — — — —• Pudding mixture 1 — 1 - - - - -— Sauce 2 — 2 - - - - - Sardines 4 .- 4 - - - - - Salad cream 1 — 1 - - - - - Semolina 2 - 2 - - - - - Scotch broth 1 - 1 - - - - - Sausage meat 1 — 1 - - - - - Sausages 4 — 4 - — — - — Scots M.O.F. oats 1 — 1 - - - - - Sponge mixture 1 — 1 - - - - - Smoked herring butter 1 - 1 - - - - - Soup powder 1 — 1 - - - - - Sulphur tablets 1 — 1 - - - - - Sunny spread 1 — 1 - - - - - Tea 1 — 1 - - - - - Vinegar 2 — 2 1 — 1 — — Totals 146 2 148 10 — 10 1 1 25 TABLE 1. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1945. Disease. At all ages. Number of cases notified At Ages—Years. Total cases notified in each Ward. Total cases removed to Hospital. Deaths. Under 1 year. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Coulsdon East. Coulsdon West. Purley. Kenley. Sanderstead. Selsdon and Farleigh. Wood cote. Diphtheria 15 - - - - - 1 — 1 1 4 3 5 12 - 1 1 1 - — 3 1 Typhoid fever 2 - - - - - - - - - - - - 2 - - - - - - - - Paratyphoid fever 2 - - - - - - - - - - 2 - 2 - - - - - - - - Scarlet fever 67 — 1 2 2 2 35 10 5 5 5 — — 9 10 15 10 11 11 1 48 — Erysipelas 4 — — — — — — — 1 — — 1 2 2 — 1 — — 1 1 — Puerperal pyrexia 2 - - - - - - - - 2 - - - - 1 1 - - - - 2 — Pneumonia 17 — — — - — 2 — — 2 2 1 10 3 1 5 - 8 — — 1 17* Dysentery 172 — — — - 1 - - 2 26 24 69 50 170 1 — —- — 1 — —■ — Cerebro-spinal fever 1 - - - - - - - 1 - - - - - - - - 1 - - - 2 Ophthalmia neonatorum 1 1 - - - - - - - - - - - - - - - 1 - - - - Poliomyelitis 2 — — — - - — — 1 1 - - - - - - 1 1 - 2 - Measles 705 12 47 62 66 70 365 51 15 7 8 2 — 180 66 158 66 149 51 35 4 — Whooping cough 100 2 11 8 14 16 48 1 — - - - — 13 12 7 1 5 44 17 2 1 —• Totals 1,090 15 59 72 82 89 451 62 26 44 43 80 67 393 91 88 82 216 81 39 62 20 *Includes deaths from all forms of pneumonia. 66 TABLE II. THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1945. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Diphtheria - - 1 1 7 1 - 1 3 1 15 Typhoid fever — —- 2 — — - - - - - — — 2 Paratyphoid fever — - - — 2 — - - - - — — 2 Scarlet fever 3 6 9 4 5 7 5 4 1 9 6 8 ErysipelasP uerperal pyrexia 1 - - — 1 1 1 1 1 - - - 2 Pneumonia 5 4 2 —■ — — 1 — 1 - 2 2 17 Dysentery 1 3 41 46 19 2 —. 2 20 10 20 8 172 Cerebro-spinal fever - 1 - — — — —. - - - - - 1 Ophthalmia neonatorum - - - - - - - 1 - - — — 1 Poliomyelitis - — — — — — 1 —• - 1 - - 2 Measles 20 107 278 129 76 80 10 1 2 705 Whooping cough 1 15 6 3 5 35 15 13 1 3 1 100 Totals 31 136 339 183 116 126 33 22 26 27 31 20 1,090 67 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1919. Disease. 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 Small pox - - - - - - - - - - - - 2 2 3 4 - - - - - - - - - - - - - Scarlet fever 20 10 55 129 136 59 40 58 35 48 74 94 125 69 45 29 69 119 124 117 62 71 65 61 39 45 184 88 67 Diphtheria 17 4 26 44 62 70 27 101 14 17 11 23 26 17 8 21 16 24 52 35 8 10 10 25 7 9 7 19 15 Erysipelas 12 8 12 5 8 9 2 12 10 4 13 8 3 11 8 11 23 17 11 12 14 13 10 17 27 22 5 9 4 Typhoid and Paratyphoid fever 18 73 31 15 5 16 11 5 24 9 9 9 6 4 4 7 5 5 1 3 29 5 1 53 12 3 1 6 4 Cerebro-spinal fever 3 1 - - 1 - - - - - - - 1 - - - - - 1 - - 4 8 6 1 4 2 1 Puerperal fever 1 1 - - 2 — — — — 1 — — 1 — 1 1 — 1 1 1 5 — — Puerperal pyrexia 1 1 1 1 3 5 1 2 — 2 5 3 2 - 2 3 1 2 Poliomyelitis - — 1 1 - 1 — 1 — — 1 1 - 1 — 2 — 1 1 - 3 1 1 1 2 3 — — 2 Polio-encephalitis - - - - - - - - - - - - - - - - - - - - 2 - - - - - - - - Encephalitis lethargica - - - 1 1 1 1 1 1 - 1 1 - - - 1 - - - - - - - - - - 1 - - Ophthalmia neonatorum 1 1 — 1 — — 1 — — 12 — 3 — 1 1 2 — 1 — 1 1 1 — 1 1 — 1 — 1 Pneumonia — — 18 8 9 21 6 16 11 — 9 7 38 11 14 29 28 20 32 13 30 12 52 19 32 38 27 9 17 Malaria - — 5 - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 468 33 12 2 11 214 479 275 52 705 Dysentery - - 4 7 7 7 17 - - 1 — - 5 - — — — - 6 — 1 2 10 85 224 121 21 42 172 Whooping cough 6 1 136 36 55 51 100 Tuberculosis :— Pulmonary 17 25 28 24 12 29 16 24 14 19 25 23 22 38 44 36 44 28 30 27 36 32 31 31 32 43 39 51 44 Other forms 4 2 2 2 3 5 3 6 5 2 9 4 2 7 4 6 10 17 5 3 7 10 12 8 11 7 9 7 3 Totals 561 158 194 237 240 218 124 224 114 113 153 174 232 162 135 154 196 235 265 213 197 162 207 323 743 809 632 337 1137 68 TABLE IV. DEATHS OCCURRING DURING THE YEAR 1945. Cause of death. Males. Females. T otal. 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. - - - - - - - - - - - Cerebro-spinal fever 1 - 2 2 - - - - - - - Scarlet fever - - - - - - — — — — - Whooping cough - - - - - - - - - - - Diphtheria — 1 1 — — — — — 1 — — Respiratory tuberculosis 12 4 16 — — —. — 2 5 6 3 Other tuberculosis — 2 2 - - - - - - 2 - Syphilis 2 - 2 - - - - - - 2 - Influenza 3 2 5 - - - - - - 1 4 Measles - - - - - - - - - - - Encephalitis 1 — 1 — — — — — — 1 - Cancer 43 51 94 - - - - - 4 35 55 Diabetes 2 3 5 - - - - - - 1 4 Intra-cranial lesions 22 37 59 - - - - - 2 13 44 Heart disease 87 77 164 - - - - 1 3 24 136 Other diseases of circulatory system 10 13 23 - - - - 1 - 5 17 Bronchitis 8 14 22 - - - - - 1 2 19 Pneumonia 10 7 17 1 - 1 — - 2 4 9 Other respiratory diseases 1 5 6 - - - - - - 2 4 Ulcer of stomach 4 1 5 - - - - - - 3 2 Diarrhoea under 2 years - - - - - - - - - - - Appendicitis 1 1 2 — - 1 - - - 1 - Other digestive diseases 5 6 11 - - - - - - 7 4 Nephritis 9 9 18 - — 1 — - - 5 12 Puerperal sepsis - - - - - - - - - - - Other maternal causes - - - - - - - - - - - Premature birth 7 3 10 10 - - - - - - - Congenital debility, etc. 8 4 12 11 1 - - - - - - Suicide 2 4 6 - - - - - 1 5 — Road traffic acc. 2 1 3 - - - - - - 1 2 Other violent causes 7 6 13 - — 2 1 — 1 — 9 All other causes 29 21 50 1 — 2 — 2 — 12 33 Totals 276 273 549 25 1 7 1 6 20 132 357 69 WANDLE VALLEY JOINT HOSPITAL BOARD. Cases Admitted to Hospital during the Year ended 31st December, 1945. Disease. Beddington and Wallington. Couldson and Pur ley. Merton and Mor den. Mite ham. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Diphtheria 5 — 3 1 10 - 67 - Scarlet fever 25 — 48 - 68 - 97 - Erysipelas 5 — 1 - 1 - 5 1* Tonsilitis or Quinsy 5 — 5 - 10 - 15 - Measles 4 — 4 - 15 - 26 - Influenza — — — - 2 - 2 - Whooping cough — 1 - — - 4 - Rubella 2 —■ —• - 2 - 3 - Mumps - - 1 - Chicken-pox ... 3 - - 4 - Meningitis and cerebrospinal meningitis ... 2 1 - 3 - 3 - Tuberculous meningitis — — — - 1 1 —• - Puerperal fever (sepsis) 2 —• 3 - 2 - 4 - Admitted with mother 3 —. 2 - 2 - 3 - Admitted with baby... ,—- —. —• - — - 2 - I nfantile-paraly sis ... 5 1 2 - 1 - 3 - Dermatitis — — 1 -- 3 - 3 - Enteritis and typhoid — —• —. - 7 - 5 - Laryngitis — —• 1 - — - 1 - Streptococcal infection and impetigo . - 1 - 2 - No obvious disease ... —. 1 - - - Pneumonia ... 2 — 1 - — - 2 1 Mastoid abscess — —- 1 - —■ -- —• - Jaundice — —• 1 - — - —■ - Conjunctivitis - - 1 - Brain tumour — — — - — - 1 1 Purpura - - 1 - Pyelitis — — — - 1 - 1 —- Totals 63 2 75 1 129 1 256 6 * Erysipelas and cerebral embolus. 70 INDEX. Page Ambulances 34 Area 10 Bacteriological Work 35 Bakehouses 60 Bed Bugs, Eradication of 57 Birth Rates 19 Births, Live, Illegitimate and Still 11 Camping Sites 54 Cancer 13, 14 Care of Premature Babies 41 Care of Illegitimate Children 41 Causes of Deaths 12, 13 Cerebro-Spinal Fever 24 Child Life Protection 48 Clinics: Ante-natal 37 Diptheria Immunisation 32, 33 Family Planning 41 Infant Welfare 44 Post-natal 38 School 59 Toddlers 45 Tuberculosis 29 Closet Accommodation 53 Cowsheds and Dairies 59,60 Day Nurseries 46,47 Deaths and Death Rates 12, 19, 69 Dental Treatment 46 Diabetes 33 Diptheria 21 Diptheria Immunisation 22,32,33 Disinfection 36 Drainage and Sewerage 53 Dysentery 23, 24 Emergency Unit 41 Enteric Fever 23 Erysipelas 23 Eye Defects 46 Factories 60 Food and Drugs Act 64, 65 Food Supplv: Milk 61 Meat 62 Food Preparing Places 60 Health Visitation 42 Health Visitors, Visits by 43 Health Propaganda 36 Heart Disease, etc. 13 Home Helps 40 Hospitals 34 Houses, Inspection of 54,55 Houses, Inhabited 10 Housing 48, 49 Housing Statistics 48,49,50 Ice Cream 62 Infantile Mortality 16,17,18 Infectious Disease: Cases notified 21,66,68 Monthly Incidence of 67 Control of 31,32,33 School Notifications 29 71 Page Inspection and Supervision of Food 61 Laboratory Facilities 36 Legal Proceedings 58 Maternal Mortality 16 Maternity Cases 38 Maternity and Child Welfare: Centres 36 Hospital Accommodation 39 Measles 24 Meat 62 Midwifery Service 38 Milk, Provision of 45 Milk (Special Designations) Order 62 Milk, Sampling of 63 Mothercraft Classes 37 Mortality: Analysis of 19 Infant 16. 17, 18 Maternal 16 Mumps 29 Non-notifiable Infectious Disease 29 Obstetric Specialists. 40 Ophthalmia Neonatorum 25 Paediatrician 41 Paratyphoid Fever 23 Pneumonia 15 Polio-myelitis and Polio-encephalitis 24 Population 5, 9, 10 Prevention of Deafness 25 Public Cleansing 53 Public Health Committee 3 Puerperal Pyrexia 23 Rainfall 52 Rateable Value 5 Rats and Mice Destruction 57 Rivers and Streams 54 Sanitary Inspections, etc. 54 Scabies 30 Scarlet Fever 22 Schools 59 Sewerage 53 Shops Acts 54 Slaughterhouses 60 Small Pox 35 Smoke Abatement 53 Social Conditions 5 Specialist Treatment 46 Staff 3, 4 Still Births 11 Swimming Pools 54 Tuberculosis 15, 26, 27, 28 Tuberculosis Care Committee 29 Typhoid Fever 23 Vermin 31 Violence, Deaths from 15 Vital Statistics 5, 11 Wandle Valley Isolation Hospital 35, 70 Water Supply 51 Whooping Cough 26 72