Cou 16 LIBRARY 4413 (3) Coulsdon HEALTH REPORT FOR 1948 FOR THE COULSDON AND PURLEY URBAN DISTRICT BY THE MEDICAL OFFICER OF HEALTH HEALTH REPORT FOR 1948 FOR THE COULSDON AND PURLEY URBAN DISTRICT BY THE MEDICAL OFFICER OF HEALTH URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. 1948 Public Health Committee. Chairman: Councillor Mrs. D. May, J.P. Councillor Mrs. G. M. Bluett, J.P. Councillor Mrs. L. J. Nesbitt „ A. J. Crisp „ E. R. Nicholson, A.C.A. „ F. jobbins „ R. H. pullen „ Mrs. M. Mayes „ R. N. Saunders Representatives on the Wandle Valley Joint Hospital Board (until 5th July, 1948). Councillor W. H. Glanville „ Mrs. D. May, J.P. „ F. Jobbins „ S. E. Littlechild, J.P. (ex-officio Member) Representatives on the Purley War Memorial Hospital Committee (until 5th July, 1948). Councillor Mrs. L. J. Nesbitt „ F. G. L. Moir, M.M.T.Struct.E., I.Mar.E. Public Health Department. STAFF: Medical Officer of Health: F, R. Edbrooke, M.B., Ch.B., D.P.H. Chief Sanitary Inspector: W. Haworth, M.S.I.A. Deputy Chief Sanitary Inspector: G. H. Cockell, M.S.I.A. Additional Sanitary Inspectors: S. E. Crisp, Cert.R.S.I. V. W. Ribbons, M.S.I.A. Assistant to Sanitary Inspectors: W. H. Sands. Rodent Operative: H. M. Key. 3 Nurse for Scabies Treatment: Miss E. B. Hicks. Chief Clerk: A. A. Edwards (resigned 31st October, 1948) Clerks: *J. R. Richardson, Mrs. G. Edmonston. *Miss P. Jenner. *Mrs. K. M. Owen. *Mrs. B. F. Clarke. F. J. Smith. *Mrs. M. Norman. (*Transferred to County Council as from 5th July, 1948.) 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 11,142 Registrar-General's estimate of population, 1948 62,730 Population, Census 1931 37,666 Number of occupied houses, December, 1948 17,203 Number of occupied houses, 1931 9,533 Rateable Value, December, 1946 £748,709 Sum represented by a penny rate £3,017 VITAL STATISTICS FOR THE YEAR 1948 Total M. F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 887 478 409 do. Illegitimate 30 14 16 917 492 425 14.6 Rate per 1,000 (live and still) births. Still Births—Legitimate 16 8 8 do. Illegitimate — — — 17.1 Death Rate per 1,000 of the estimated resident population Deaths 545 269 276 8.7 Rate per 1,000 (live and still) births. Deaths from Puerperal causes:Puerperal Sepsis .. .. - - Other Puerperal causes .. .. 1 1.07 Total .. 1 1.07 Death Rates of Infants under one year of age:— All infants per 1,000 live births 26 Legitimate infants per 1,000 legitimate births 26 Illegitimate infants per 1,000 illegitimate births 33 Deaths from Cancer (all ages) 92 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) 1 5 COULSDON AND PURLEY URBAN DISTRICT COUNCIL. Ladies and Gentlemen, I beg to present to you my Annual Report for 1948, this being my seventeenth report as your Medical Officer of Health. In general it will be found to correspond to its predecessors, with the exception that certain parts, and particularly the section on Maternity and Child Welfare, necessarily reflect the influence of the National Health Service Act and the transfer of responsibilities which resulted from its implementation. Here I have taken the opportunity to include details of the present arrangements instead of reporting the numerical results of activities of this service during the final six months under the control of your Council, which it is hoped will prove more useful. Reviewing the state of the public health in this District during 1948 it is very pleasing to note that as judged by the vital statistics, improvement has occurred in almost every important rate. The general Death Rate, Tuberculosis, Cancer and Maternal Mortality Death Rates all decreased considerably, while the Infantile and Neo-natal Mortality Rates remained at a low level. The incidence of infectious disease, with the exception of measles and whooping cough among the general public, and dysentery in the mental hospitals, was as low as it ever has been in the history of this District. Particularly satisfactory is the absence of a case of diphtheria among the local residents for the second year in succession. In spite of the first visit of the Mass Radiography Unit to the District, which resulted in the detection of a number of early cases of pulmonary tuberculosis, a decrease in the incidence of this disease occurred, but this was partially offset by a further slight increase in the incidence of non-pulmonary tuberculosis. The marked fall in the Birth Rate in 1948 was also a feature which is not generally considered commendable. The year 1948 is thus both locally and nationally a good one to serve as a datum line by which to measure, as time goes on, the effect of the National Health Service on the prevention of disease and its influence on the public health generally. It would obviously be premature to consider yet the results of this new organisation. Time must elapse before it can be expected to work smoothly and at its maximum efficiency. It is difficult not to express regret that so little attempt-appeared to be made to modify the impact of this revolutionary measure; the lesson which should have been learned from the impossibility of implementing the Education Act, 1944, in accordance with an unreasonable and over- 6 optimistic timetable, apparently passed unnoticed. As a result 1948 will be remembered by all concerned as a period of upheaval and uncertainty resulting in hard work on reorganisation with but little hope that the health of the public could be directly benefited thereby for years. Certain beneficial results were, of course, produced comparatively rapidly, for example, the provision of spectacles and dentures for many who needed them, although it is unfortunate that the priority classes specified in the Act have been adversely affected by the rush to obtain treatment. It is conceivable, however, that these benefits could have been provided without at the same time attempting to re-organise so many other branches of health work. It is much regretted, for instance, that the transfer of the Maternity and Child Welfare responsibilities from a District such as this should have been considered necessary, presumably solely for reasons of tidiness in national administration. By this decision, to a very large extent the local interest and control of one of the most important, spectacular and successful of the Council's activities has been removed. Divisionalisation, which is being tried with commendable sincerity in Surrey, cannot retain the interest of the local Council, few of whose members can know what is being recommended locally, and the final outcome. The immediate effects appear to have been the creation of a more cumbersome organisation, the complication of administration, and a suspicion that the District Council has, in future, no important contribution to make towards improving the public health. It is apt to be forgotten that responsibility remains for the control of infectious disease, for health education, and for dealing with the factors in our environment which are liable to have a profound influence on health, including the supervision of our food supply, the disposal of sewage and refuse, control of pests, housing and general sanitation. With the removal of the numerically stronger Child Welfare and Ambulance Services, the service of the Sanitary Inspectors has tended inevitably and rightly to monopolise local attention. One of the purposes of an Annual Report such as this is to attempt a survey of the whole field of public health activity in the District, and it will be unfortunate if Medical Officers of Health who hold multiple responsibilities are not encouraged to continue their attempt at a balanced presentation, not only of the condition of the health of the area, but of the attempts of the various branches of the health service to improve it. Whatever its advantages or disadvantages, however, the new organisation is in being, and all concerned must use, and where necessary adapt it wisely. The general public must appreciate its limitations, which are, at least temporarily, inevitable and not make unfair demands on its limited resources. All involved ki its working need, not only patience and perseverance under irksome conditions, which must be allowed to be only transitional, but to retain the humanitarian urge which has inspired the medical and allied professions so successfully in the past. We need to keep also a sense of perspective which recognises the part others are attempting to play, and to give them helpful co-operation rather than discouraging criticism. Undue concentration on the main- 7 tenance and improvement of the standard of working conditions, coupled with unsympathetic criticism of the activity and mistakes of others is most debilitating, not only in the health service, but in other walks of life. One of the needs of the time is unselfish concentration on, and devotion to the job in hand. May I, in conclusion; Ladies and Gentlemen, express my appreciation of the sympathetic consideration given by members of the Council and my colleagues to the problems and frustration we have experienced during the last year, and tender my thanks to the Chief Sanitary Inspector who has assisted me in the preparation of the section of this report in which he is most interested. He and his staff, affected but little by recent reorganisation, have made a very useful contribution to the health of the District, and will, I am sure, have an increasing influence as part of the more closely welded team which is in process of construction. I am, Ladies and Gentlemen, Your obedient Servant, F. R. EDBROOKE, Medical Officer of Health. 8 HEALTH REPORT FOR 1948 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 therefore been a separate District for just over 32 years. Situated on the North Downs immediately to the south of Croydon, it is a well-favoured "dormitory" suburb with a very considerable part of its area as yet undeveloped. Thanks to successful Town Planning Schemes in the past there is comparatively little dense development, most of the houses being well spaced, while it is hoped that as an outcome of the Town and Country Planning Act, 1947, it will continue to possess very extensive open spaces. The majority of the residents who are employed work in London or Croydon, travelling to and fro daily. Locally there are no really large manufacturing or other industries, most of the residents employed in the District being connected with building and decorating, with the provision of food and the other wants of the inhabitants, or attached to the mental hospitals. The amount of unemployment, apart from temporary unemployment pending transfer, is negligible, 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. In mid-1948 the Registrar-General estimated that 62,730 persons were residing in the District, and 62,980 at the end of the year, compared with 62,440 in 1947. 9 This number includes persons resident in Institutions in the District, the numbers of which at the end of 1948 were as follows:— Cane Hill Hospital 2,426 Netherne Hospital 2,156 Russell Hill School 250 Reedham Orphanage 260 In 1948 there were 17,148 occupied houses, distributed as follows:— Coulsdon East 2,594 Coulsdon West 2,961 Purley 2,606 Woodcote 1,637 Sanderstead 4,385 Selsdon and Farleigh 1,691 Kenley 1,274 This suggests an average of 3.36 persons per occupied house in 1948. VITAL STATISTICS. The following table gives the average population, birth, death, maternal and other important mortality rates for the quinquennial periods 1915-1944, together with the actual figures for 1946, 1947 and 1948:— Rates per 1,000 population. 19151919. 19201924. 19251929. 19301934. 19351939. 19401944. 1946. 1947. 1948. Birth rate 13.9 13.5 12.9 11.6 12.8 15.2 17.6 17.0 14.6 Percentage illegitimate 5.7% 3.4% 3.7% 2.8% 3.4% 3.9% 3.4% 3.1% 3.2% Stillbirth rate — — — — 0.43 0.48 0.49 0.49 0.25 Death rate 8.5 7.4 7.0 7.4 8.3 11.4 9.8 10.8 8.7 Cancer death rate 1.18 0.96 1.15 1.35 1.19 1.70 1.93 1.89 1.47 Tuberculosis death rate (per 100,000 population) 72 57 36 38 35 48 44 37 33 Violence (including Suicide) 0.19 0.44 0.35 0.32 0.46 0.82 0.24 0.56 0.30 Maternal mortality rate (per 1,000 live and still births) 3.20 2.08 2.66 3.21 2.27 2.10 2.71 1.83 1.07 Infant mortality rate (per 1,000 registered births) 44 28 38 32 38 40 25 23 26 Neo-natal mortality rate - - - - 26 28 19 15 18 Estimated population 19,073 21,351 28,950 41,616 53,034 49,880 60,390 62,440 62,730 BIRTHS. During the year 1948, 917 births were registered as occurring in the District of which 492 were male and 425 were female. It will be seen by reference to the above table that this is equal to an annual birth rate of 10 14.6 per 1,000 population, as compared with 17.0 in 1947. The rate of 17.6 in 1946 was the highest birth rate experience in this District and it will be interesting to see whether the recent downward trend continues, and if so, to what extent. The birth rate for England and Wales was 17.9 in 1948, which was a decrease of 2.6 compared with 1947. Illegitimacy.—In 1948, of the births registered, 30 were illegitimate (14 males and 16 females), this being three less than in the preceding year. The post-war decrease in the percentage of illegitimate births which corresponds with that which occurred after 1918, has halted this year, it is hoped only temporarily. Stillbirths.—The number of stillbirths registered during 1948 was 16 (8 males and 8 females), as compared with 31 in 1947 and 40 in 1946. All the stillbirths occurred in legitimate children. The local stillbirth rate was thus 0.25 per thousand of population, compared with 0.49 in each of the two preceding years, which is a great improvement. The stillbirth rate for England and Wales was 0.42 in 1948. DEATHS. The number of deaths registered during 1948 as belonging to this District was 545 (269 males and 276 females), as compared with 672 in 1947. These numbers exclude deaths which, although occurring within the District, belonged to other districts, but include 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. The latter group has increased of recent years, being 24 in 1948 and 32 in 1947. It will be seen from the table of vital statistics that the crude death rate for the year was equal to 8.7 per thousand of population, as compared with 10.8 in 1947, representing a return to little more than the pre-war rate. The crude death rate for England and Wales similarly fell from 12.0 in 1947 to 10.8 in 1948. The principal causes of death locally during 1948, 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 17 3.1 Cancer, malignant disease 92 16.9 Heart disease 169 31.0 Cerebral haemorrhage 72 13.2 Other circulatory diseases 25 4.6 Pneumonia 24 4.4 Violence (including suicide) 19 3.5 11 (A full list of the causes of the deaths and the ages at which they occurred is given in Table IV in the Appendix.) On analysis it is found that there was a decrease in the number of deaths from all the chief causes. HEART AND CIRCULATORY DISEASE. The death rate from heart and other circulatory diseases showed a slight decrease on last year's figure. As this group is largely composed of deaths occurring in elderly people from what is really old age, it is always hoped that the proportion coming under this heading will remain relatively high. The slight decrease in 1948 associated with a marked decrease in the crude general death rate suggests that the distribution of age groups is returning to pre-war proportions, although with some bias in favour of the higher age groups. In 1948, 77 per cent. of deaths from heart disease, etc., were over 65 years of age at the time of death (a decrease of 4 per cent. on 1947), while 40 per cent. were over 75 years of age. Similarly, of deaths from all causes, over 64 per cent. were over 65 years of age, which is slightly more than last year. CANCER. The cancer death rate for the year 1948 was 1.47, which is an appreciable reduction on the rate for 1947, which was 1.89. This rate has tended to increase more or less steadily since 1920 partly owing to better notification, but in part due to a true increase in some forms of the disease. The decrease this year may be only due to one of the fluctuations which is liable to occur when dealing with comparatively small numbers and it will be interesting in this respect to note the rate next year. The following table gives the age, sex and distribution of the disease in the 92 deaths which occurred during 1948. A welcome decrease in the number of fatal cases of breast cancer is noted, but there was a further slight increase in the proportion of cases of cancer of the lungs, particularly in males. The numbers concerned are so small, however, that generalisations must be avoided. 12 CANCER DEATHS, 1948. Localisation. 30-40. 40-50. 50-60. 60-70. 70-80. Over 80. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Skin - - - - - - - - - 1 - - - 1 Tongue - - - - - - - - 1 - - - 1 — Larynx — — — — 1 — — - 1 — 1 — 3 — Pharynx and oesophagus - - - - - - - 1 - 3 - - - 4 Stomach and duodenum - - 1 - 2 1 1 2 2 3 1 1 7 7 Intestines 1 — — — — 1 — 5 8 1 1 4 10 1 I Liver - 1 - 1 - — — 1 - — - - - 3 Pancreas — — 1 — 2 — — 2 — — — — 3 2 Lungs 1 — 1 — 2 — 3 2 3 — — — 10 2 Mediastinum - - - - - - - 1 - - - - - 1 Kidney - - - - - - 1 - - - - - 1 — Bladder — — — — 1 — — — 1 — — — 2 — Prostate — — — — - — 2 — — — 1 — 3 — Uterus — — — 1 — 3 — 1 — 1 — 2 — 8 Ovary — — — 2 — — — — — — — — — 2 Breast — 1 — — — 2 1 2 — 4 — 1 1 10 Totals 2 2 3 4 8 7 8 17 16 13 4 8 41 51 13 VIOLENCE. Deaths from violence (including suicide), showed an appreciable decrease during 1948, the death rate being 0.30 per thousand of population, compared with 0.56 last year and an average of 0.39 for the inter-war years. (The chief cause of the high rate in 1947 was the unfortunate train accident in October of that year.) There was also a welcome decrease in the number of deaths following falls in the more or less elderly, which has accounted for a very appreciable proportion of this group of deaths in recent years. Deaths on the road were again less than in pre-war years, being three, which is the same as last year. All resulted from motor car accidents. In two instances the persons killed were pedestrians, the other being a cyclist. Unfortunately the suicide death rate was nearly double that in 1947, but about the average for the decade 1919-29 and slightly less than the following 10 years. TUBERCULOSIS AND PNEUMONIA. Deaths from tuberculosis and pneumonia are referred to in later sections of this report. MATERNAL MORTALITY. There was only 1 death associated with childbirth during 1948, compared with 2, 3, nil, 2 and 1 in the preceding five years. This death really resulted from a pre-existing chronic disease which was accelerated by pregnancy. The local maternal mortality rate was 1.17 per 1,000 live and stillbirths compared with 1.02 for England and Wales, which was the lowest yet recorded. INFANT MORTALITY. During 1948 there were 24 deaths among the children under one year of age, as compared with 24, 27, 25, 28 and 32 in the preceding five years. Only one of the deaths was in respect of an illegitimate child. The resultant infant mortality rate was thus only 26 per 1,000 registered births, which is one of the lowest recorded for the District. The infant mortality rate for England and Wales was 34 in 1948, compared with 41 in 1947, which was the lowest hitherto recorded. 14 The following table gives the causes of the deaths which occured during 1918 and of which records are available, together with the age at death. INFANTILE MORTALITY DURING THE YEAR 1948. Cause of death. 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 12 months. Total deaths under 1 year. Cerebro-spinal meningitis — — — — — — - 1 — 1 Tuberculosis - — — - - - - — 1 1 Broncho-pneumonia - 1 - - 1 - 1 1 1 4 Congenital malformation 2 - - - 2 1 - - - 3 Congenital blood condition 4 - - - 4 - - - - 4 Prematurity and atelectesis 6 - - - 6 - — - - 6 Birth injury 1 - - - 1 - - - - 1 Maternal defect 2 - - - 2 - — - - 2 Cerebral oedema — — — - — - 1 - - 1 Intussusception - - - - - - — - 1 1 Totals 15 1 - - 16 1 2 2 3 24 15 The relatively large number of deaths from respiratory infections again emphasises that the prevention of the spread of colds and coughs, particularly to young babies, is of the greatest importance. The 16 babies dying in the first month correspond with a neo-natal mortality rate of 17 (i.e., deaths in the first month per 1,000 live births). The rate of 16 in 1947 was the lowest recorded in this District since 1936, when this rate was first noted, the previous lowest being 18 in 1944. The average for the past 12 years is 25.7. During the year 6 premature babies were notified as being born at home and 28 in institutions. Of the former one died within a few hours of birth, in hospital. Altogether 8 deaths occurred in premature babies, and 7 of them were in respect of babies born in hospital or in a nursing home outside the District, and before their discharge home. These numbers suggest that 23 per cent. of the premature babies died, which is a slight improvement on 1947. 16 COMPARATIVE CRUDE BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY MATERNAL MORTALITY AND CASERATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1948. 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: Births: Live Births 17.9(a) 20.0 19.2 20.1 14.6 Still Births 0.42(a) 0.52 0.43 0.39 0.25 Deaths: All causes 10.8(a) 11.6 10.7 11.6 8.7 Typhoid and paratyphoid .. 0.00 0.00 0.00 0.00 — Whooping cough 0.02 0.02 0.02 0.01 — Diphtheria 0.00 0.00 0.00 0.01 — Tuberculosis 0.51 0.59 0.46 0.63 0.13 Influenza 0.03 0.03 0.04 0.02 0.03 Smallpox — — — — — Acute poliomyelitis and polioencephalitis 0.01 0.01 0.01 0.00 - Pneumonia 0.41 0.38 0.36 0.54 0.38 Notifications (Corrected): Typhoid fever 0.01 0.00 0.01 0.00 — Paratyphoid fever 0.01 0.01 0.01 0.01 0.03 Cerebro-spinal fever 0.03 0.03 0.02 0.03 0.01 Scarlet fever 1.73 1.90 1.82 1.37 0.99 Whooping cough 3.42 3.51 3.31 3.13 3.20 Diphtheria 0.08 0.10 0.09 0.10 — Erysipelas 0.21 0.23 0.21 0.22 0.13 Smallpox — — — — — Measles 9.34 9.75 8.84 9.17 9.04 Pneumonia 0.73 0.84 0.60 0.57 0.21 Acute poliomyelitis 0.04 0.05 0.04 0.04 0.03 Acute polioencephalitis 0.00 0.00 0.00 0.00 — Rates per 1,000 Live Births: Deaths: All causes under 1 year of age 34(b) 39 32 31 26 Enteritis and diarrhoea under 2 years of age 3.3 4.5 2.1 2.4 1.1 i Rates per 1,000 Total (Live and Still) Births: Notifications (Corrected): Puerperal fever and pyrexia 6.89 8.90 4.71 7.34(c) 2.14 Maternal Mortality: England and Wales. Rates per 1,000 Total (Live and Still) Births. Coulsdon and Purley Urban District. Rat s per 1,000 Total (Live and Still) Births. Abortion with sepsis 0.11 — Abortion without sepsis 0.05 — Puerperal infections 0.13 — Other maternal causes 0.73 1.07 (a) Rates per 1,000 total population. (b) Per 1,000 related births. (c) In London puerperal fever alone was 0.61. A dash (—) signifies that there were no cases. 17 INFECTIOUS DISEASE. The following table indicates the numbers of cases of infectious disease notified during 1948, the number thought to have been treated in hospital and the deaths which resulted. Owing to the change in the method of admission to hospital after 5th July, 1948, and the impossibility of visiting all the cases of measles and whooping cough, the figures in the second column may not be quite accurate, but the proportion of missed cases is probably very small. The following table indicates the numbers of cases of infectious disease notified during 1948:- Disease Numbers Notified. Treated in Hospital. Total Deaths. Diphtheria — — Paratyphoid fever 2 2 2 Scarlet fever 62 28 — Erysipelas 8 1 — Puerperal pyrexia 2 2 — Pneumonia 13 4 24* Dysentery 71 70 1 Cerebro-spinal fever 1 1 1 Poliomyelitis 2 1 — Measles 567 6 — Whooping cough 201 9 - Totals 929 124 28 * Includes deaths from all forms of pneumonia. A full statement of the cases of Infectious Disease notified since 1918 is presented as Table III in the appendix. Excluding the cases of dysentery occurring in the mental hospitals and the cases of measles and whooping cough, which diseases were only notifiable during the two war periods and since 1945, it is pleasing to note that the incidence of the remaining acute infectious diseases among the general population is less than 1.5 cases per 1,000 population, which is one of the lowest, if not the lowest rate yet recorded locally. Diphtheria. During the year five cases from this District were admitted to an isolation hospital on suspicion that they were suffering from diphtheria, but fortunately in not one of them was the tentative diagnosis confirmed. The final diagnoses were whooping cough, chickenpox, quinsy, and non-diphtheritic tonsilitis in two instances. All these patients recovered. It is most satisfactory to contemplate the saving of life, ill health, manpower and money which the absence of any confirmed case of diph theria in the District for two successive years implies. 18 Scarlet Fever. As in 1947, a decrease occurred in the number of notified cases of Scarlet Fever while the disease continued to be very mild in character. Of the 62 known cases 48 were children attending schools in or near the District and 11 were under school age, three of them contracting it from their older brothers or sisters. Most of the school cases were apparently unconnected, no less than 27 schools being involved, 22 having single cases from this District and the others 2, 3, 4, 5 and 13 respectively. Only in the school with most case's was there evidence of direct infection between the children and this was chiefly due to the very mild nature of the infection causing unsuspected or incorrectly diagnosed cases to be allowed to attend the school in the early stages of the outbreak. In four instances the multiple cases in a house resulted from home contact; in one case a pre-school child infected two school children and in the other three cases, a school child, a toddler, and, on one occasion, two pre-school children were infected by another school child. Thirtyfour of the cases were treated at home and 28 in hospital, all but two in the Wandle Valley Isolation Hospital. Most of the former occurred after 5th July, when an attempt was made to limit admissions to complicated cases only. The result on the whole was fairly satisfactory. In 22 cases nursed at home there were other children in the house, yet in only 4 of these did secondary cases occur, including the one in which the nature of the disease had not been recognised before the infection spread. The policy of admitting only physically or socially complicated cases from the District appears to be justifiable while this disease remains as mild as at present, especially if at the time there is a shortage of hospital beds, but there would appear to be justification for considering the admission of an uncomplicated case when a bed is available and a younger child or a public food handler is apparently uninfected in the home. No deaths and but few complications were caused by this disease during the year. Erysipelas. Eight cases of erysipelas were notified during the year, this being three more than in 1947, but two of the notifications concerned the same person, being received six months apart. All the cases were adults and none appeared to be connected with another known case. One only was admitted to hospital and all recovered. Puerperal Pyrexia. Two cases were notified, both in December, while a third resident was also affected following her confinement in a North London hospital that month. Both the notified cases were admitted to hospital where they recovered. Enteric Fever. No cases of typhoid fever and only two of para-typhoid fever were notified. Investigations following one of these showed that the particular 19 strain of organism is apparently endemic in the London area, as the very few isolated cases which were notified in that area had not partaken of anything in common, nor as far as could be traced had they been associated with each other. The local patient recovered in hospital. The other notified case was a paratyphoid B. infection affecting an inmate of one of the mental hospitals were 2 deaths from this disease occurred during the year. Dysentery. The number of cases of dysentery notified increased again, from 48 in 1947 to 71 in 1948, but only one of these was a normal resident in the District, viz., a child who, as a result of a pathological examination in February, was diagnosed as suffering from Sonne dysentery. The other cases were of the Flexner type and all occurred in the mental hospitals (68 in one and 2 in the other), one death resulting. As has been previously stated, once such cases become numerous in a mental hospital, as occurred in war-time when, in the year 1941 alone, 224 cases were notified, it is very difficult indeed to eradicate it. Gradually, however, though erratically, the number of cases is falling locally. Of the 68 cases in one of the mental hospitals, 40 occurred in August, only one or two cases occurring in each of the last three months of the year. Cerebro-Spinal Fever. Only one notification of this disease was received and unfortunately this was based on the post-mortem findings on a resident who died in hospital during January. Poliomyelitis. Only two cases of poliomyelitis were notified as having occurred in the District during 1948 as compared with 11 definite cases in 1947. The former is about the average number which has occurred locally each year since 1937. Of these two cases one was a young child with suggestive symptoms, but no paralysis, and the other a young adult with extensive paralysis for which he was still in hospital at the end of the year, although slowly improving. Pneumonia. The number of cases of acute primary or influenzal pneumonia notified dropped from 20 in 1947 to 13, this being less than the average occurring during recent years. The cases were apparently unconnected and scattered over the District. Nine of the cases were young children, the others being mostly elderly adults. Four of the cases were admitted to hospital, one being originally thought to be a case of scarlet fever. A total of 24 deaths from all forms of pneumonia occurred in the District during the year, but it is believed that no death occurred in respect of the 13 notified cases. 20 Measles. This disease was again prevalent, 567 cases being notified compared with 218 in 1947, 141 in 1946, and 705 in 1945, the peak again occurring after three years, the previous highest number of cases being 479 in 1942. The increase this year may to some extent reflect the fact that notification of measles and whooping cough became comparable with that of other notifiable infectious diseases in April, the normal notification fee replacing the previously inadequate reward. The fact that both locally and nationally the number of notifications rose sharply that month suggests that this is at least a partial explanation. The number of cases notified was so high that only a relatively small proportion could be visited. The disease was most prevalent in the Coulsdon West and East, and Sanderstead and Selsdon wards, although it first became conspicuous in the Purley and Kenley wards. Curiously enough the final group of cases in August and September was also in the Kenley ward. Unfortunately in the District generally a high proportion of the cases was in pre-school children, possibly due to the fact that in 1947 the disease occurred mainly among school children who were thus not susceptible in 1948. The occurrence of at least four cases in each month of the year illustrates the way this infection persists among the community. It is also interesting to note that, although major waves appear to affect the District as a whole at about three yearly intervals, sections and sub-sections of the child population experience their own cycles of increasing and decreasing prevalence, irrespective of the general trend, and that in a District in which at least the older children and adults mix comparatively easily. This observation would suggest that the conveyance of infection by the immune sections is of negligible importance compared with the direct association of the non-immune children themselves. As our present aim is to postpone the onset of such diseases as this until the children are at least five years of age, the influence of Nursery Schools, Child Welfare Centres or other places at which these young children are brought together needs to be considered. Only a minority of cases among the younger children apparently resulted from contact with an older brother or sister who might have become infected at school. It is very difficult, however, to segregate toddlers and the solution of the problem is anticipated to lie in the eventual introduction of a form of immunisation capable of general use. Whooping Cough. The number of notifications during the year, 201, was the highest yet reported locally, the previous record being 136 in 1941, but it may be that this latest figure has also been influenced by the change in the notification policy introduced in April, although the more even spread of cases throughout the year tends to discredit this suggestion. The secondary wave of cases in the Autumn is unusual. The greatest prevalence was in Sanderstead, where cases occurred chiefly at either end of the year and again the proportion of pre-school 21 children affected was high. Unfortunately well over half the notifications for the District as a whole were in respect of children under school age. The remarks made with regard to the spread of measles apply equally to that of whooping cough. No deaths have occurred locally from either of these diseases for the last four years. Tuberculosis. The following table presents concisely the position with regard to tuberculosis in the District during 1948:— Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number'of cases on register, 1st January, 1948 191 127 23 37 214 164 Additions, 1948:— New cases notified 27 21 5 8 32 29 Cases removed into District 20 15 4 3 24 18 Restored to register 1 — 1 — 2 — Total Additions 48 36 10 11 58 47 Removals, 1948:— Deaths 11 7 — 3 11 10 Removed from District 22 7 3 3 25 10 Recovered 1 4 - — 1 4 Non-tuberculous - 1 — - - 1 Total Removed from Register 34 19 3 6 37 25 Number of cases on register, 1st January, 1949 205 144 30 42 235 186 The following table shows the age-groups in which notifications and deaths occurred:— Age Periods. New Cases. Deaths. Pulmonary. Non. pulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. Under 1 year - - - - - - - 1 1 and under 5 1 — — 1 — — — — 5 and under 10 — 1 2 3 - - - - 10 and under 15 1 1 - 1 - - - - 15 and under 20 2 2 — - - 1 - - 20 and under 25 3 7 1 1 2 1 - - 25 and under 35 7 7 - 1 1 1 - - 35 and under 45 4 - 1 1 — 1 - 1 45 and under 55 6 2 1 - 4 - - - 55 and under 65 1 — — — 3 1 — — 65 and over 2 1 — — 1 2 — 1 Totals 27 21 5 8 11 7 — 3 22 The new cases were distributed amongst the wards as follows:— Localisation. Coulsdon East. Coulsclon West. Kenley. Purley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 7 14 2 6 11 5 3 Non- pulmonary 4 2 - - 4 2 1 Totals 11 16 2 6 15 7 4 The number of new notifications of pulmonary tuberculosis diminished in 1948, compared with 1947, to about the average for recent years, which is fairly satisfactory considering that the Mass Radiography Unit first visited the District in November, resulting in the discovery of a number of early cases. The case rate of 76 per 100,000 population does not compare unfavourably with previous rates for this District. The death rate from pulmonary tuberculosis is even better when compared with previous years, being lower than any similar annual rate since the beginning of the War or any quinquennial average rate for the District since 1915. Turning to the non-pulmonary forms of the disease it is noted that the number of new cases again increased with a case rate of 21 per 100,000 population, which is nearly double that of two years ago and the highest since 1930-34. The numbers concerned are, however, relatively small and probably attributable to more early diagnosis and better notification. On the other hand the death rate from non-pulmonary tuberculosis of 5 per 100,000 population was about the average and, taken in conjunction with the absence of deaths from this cause in 1947, suggests a tendency towards improvement. The Council is still responsible for certain measures to prevent the spread of this disease, including rehousing and disinfection. The County Council is responsible for other preventive measures, including the examination of contacts and after care, but the hospital or sanatorium treatment of cases has passed to the Regional Hospital Boards. The majority of home visitations is undertaken by a County Health Visitor appointed specifically for this purpose while the appointment of Care Almoners has been of great help to the patients and to the Voluntary Care Committee, which, supported by very substantial contributions from the County Council, does very useful work in helping in many varied ways individual cases and their relatives. The Local Tuberculosis Clinic is held every Monday from 2-4 p.m. at the Surrey County Council Clinic, 62, Whytecliffe Road, Purley. 23 PUBLIC HEALTH ACT, 1936, SECTION 172. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1926. 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 2 deaths were attributed in 1948. There was only one death in children under two years of age from infantile diarrhoea. Apart from the death returns, the only information as to the presence of outbreaks of non-notifiable infectious disease is obtained from the returns from the nurseries and public elementary schools. As judged by these, chicken pox was most prevalent in Kenley (46) and Old Coulsdon (25) in January and February, and in Purley (60) and Selsdon (46) from April to July. In 1947 Selsdon School had had 50 cases of mumps towards the end of the year but the outbreak soon ceased in 1948, only 10 more cases being reported, mostly in January, with odd cases in June and October. Similarly Sanderstead only had a few isolated cases, but the Purley schools produced 40 cases chiefly in April/July, and Kenley (17) in the second half of the year. The disease was, however, most prevalent in the Chipstead Valley where 29 cases occurred in October/November, together with 7 in the Coulsdon Nursery school in November/December and 32 at Smitham in December. Only a very few cases of "German measles" were reported and these were scattered over the District, some doubtless being mild cases of scarlet fever. Fortunately the cat ringworm which was so common in Old Coulsdon in 1947 died out, only 2 cases being reported during the early part of the year. Home visitation and exclusion from school are still the two chief methods relied upon to prevent or postpone the onset of the majority of the above-mentioned 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 of these admissions records are rarely received. 24 INFESTATIONS. (a) Scabies. During 1948 the number of persons treated at the Scabies Treatment Centre, Lion Green, Coulsdon, was only 60, of which number 10 were schoolchildren and 31 adults and children under 5 years of age, while 19 persons had preventative treatment only. Altogether 133 baths were given. The number of cases showed such a marked reduction on previous years, as shown by the following table, and decreased so steadily during the year that by December the continued use of the Centre was no longer justified and it was closed. When considered necessary cases are treated at their homes by a visiting nurse, arrangements being made by the Medical Officer of Health to whom cases needing supervised treatment should be referred. Year. Number of Baths given. Number of Persons treated. 1942 (May-December) 695 237 1943 1,217 326 1944 905 399 1945 768 349 1946 805 250 1947 316 172 1948 133 60 (b) Vermin. The number of cases of infestation was again very small and was mostly limited to cases of head lice discovered at the schools. Three cases were treated at the Scabies Treatment Centre. As far as possible, these cases are dealt with as family units. THE CONTROL OF INFECTIOUS DISEASE. The place of immunisation among the measures for the control of infectious disease remained very much as in recent years. The National Health Service Act, 1946, made one outstanding change in that vaccination ceased to be compulsory, reliance being placed in future on voluntary acceptance of preventive inoculation, this having proved so successful in the diphtheria immunisation campaign. The Act also ensured general practitioners a share in all immunisation schemes and the Surrey County Council in its proposals included a recommendation, which was approved, to pay an agreed fee for all notifications received from general practitioners of immunisation against diphtheria, and vaccination against smallpox, carried out by them. Unfortunately, although it is now more than a year since the Act came into force, the dimensions of these fees have not been agreed upon, nor has any payment been made, and there are adverse signs which should be noted. 25 Diphtheria Immunisation. The following table shows the treatment given during 1948, and the proportion of children estimated to have been immunised in that year:— Clinics. Number of sessions held during the year 26 Number of children who commenced treatment 292 Number who completed treatment 313 Number of Schick tests made 1 Number of "Booster" doses given 41 Total number of attendances 647 Welfare Centres. Number of children who commenced treatment 321 Number who completed treatment 328 Number of "Booster" doses given 101 Schools. Number of visits made 39 Number commencing treatment 126 Number completed treatment 136 Number of Schick tests made 2 Number of "Booster" doses given 900 General Practitioners. Number completed treatment 76 Number given "Boosters" 29 Proportion of children estimated to have been immunised:- (a) from 1-5 years 53% ' (b) from 5-14 years 88% The above figures differ from their predecessors, not only as a result of the inclusion of the cases treated by the general practitioners, but by the spreading of the work formerly undertaken at special clinics over all the child welfare centres, while as far as practicable the diphtheria immunisation of school children is undertaken by the Assistant School Medical Officers in conjunction with their visits to the schools for other purposes. As a result, the number of clinic sessions was a little less than half that in 1947, but the numbers of children who were treated at the child welfare centres and at the schools were trebled compared with last year. The estimated proportion of children who had been immunised in December showed a 5 per cent. increase in those under 5 years of age, but a 3 per cent. decrease among those from 5 to 14 years. It is not easy to report simply the proportion of the older children who had received such reinforcing doses as they needed, but in general the position is considered satisfactory. The system of giving appointments at the centres at which treatment is provided, which has always been the practice in this District, was maintained. 26 Vaccination. Before the 5th July, 1948, no statistics relating to vaccination were available locally, hence no comparison can be made with the following figures which relate only to the second half of the year:- Welfare Centres. Primary vaccinations 12 General Practitioners. Primary vaccinations 0-15 years 195 „ „ over 15 years 16 Re-vaccinations 0-15 years 20 „ over 15 years 50 Bearing in mind the increasingly rapid transport facilities throughout the world, which increase the chances of outbreaks of smallpox, and the comparatively slight effect of vaccination on younger children compared with the risks of primary vaccination in older children or adults, it is as desirable for babies to be vaccinated as immunised, and a bigger response than hitherto is most desirable. Whooping Cough Immunisation. While the trials which have been carried out on a large scale during recent years give grounds for hope that the supply of a reliable agent will justify the introduction before very long of an official scheme for the immunisation of children against whooping cough, it is considered locally that the time for this has not yet arrived. They can, however, if parents so wish, obtain combined diphtheria and whooping cough immunisation from general practitioners, and many are in fact doing so under the provisions of the Health Service Act, DIABETES. The Council continued to provide a small number of persons with insulin during the first half of the year, but this scheme ceased in July as all the persons needing this treatment were thereafter able to obtain it as part of the normal medical service. AMBULANCES. The same arrangements as existed in 1947 were continued until July, 1948, but with the implementation of the National Health Service Act the ounty Council became responsible for the ambulance service. The effect of a free service for all persons genuinely needing it was to about double tne demands on the general service. Meanwhile the greater use of the Hospital Bed Service in arranging the admission of infectious disease cases resulted in a greater variety of infectious disease ambulances being employed, and the distribution of the cases over more hospitals, which complicated preventive and administrative work considerably. 27 HOSPITALS. Similarly, while the same hospitals as hitherto were used to about the same extent during the first half of the year, latterly a transitional readjustment has been occurring with Redhill "County" Hospital taking the majority of all cases and particularly the maternity cases from this District. The special arrangement with Purley Hospital for the reception of local maternity cases came to an end towards the end of the year and the the future arrangement has not yet been definitely decided. As, however, the average stay of maternity cases was reduced, the actual number of such cases admitted increased slightly during 1948. MASSAGE ESTABLISHMENTS. The provisions of Part IV of the Surrey County Council Act, 1931, relating to the registration and management of massage establishments, are in operation. There are seventeen such establishments in the Urban District. BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS. Until July the examination of swabs for diphtheria and sputa for tuberculosis was carried out chiefly by the Medical Officers of the Wandle Valley Isolation Hospital, and during 1948 the following numbers of specimens were examined:— Swabs for diphtheria 41 Sputa for tuberculosis 61 In addition, specimens submitted to detect and classify streptococci were sent to the Emergency Service Laboratory, Westhill House, Westhill Road, Epsom, while an arrangement existed whereby other pathological specimens, the examination of which was of importance to the public health, were examined by the Pathologist to the Croydon General Hospital. The scope of the Emergency Medical Service Laboratory has now been widened, and most samples are sent there for examination. In 1948 the following specimens were examined:— At Epsom:— swabs for streptococci 177 fasces 3 miscellaneous 6 At Croydon General Hospital:— blood for Widal test 1 fasces for typhoid, paratyphoid, etc. 1 nasal swab for meningococci 1 DISINFECTION The disinfection of bedding, etc., is undertaken at the Wandle Valley Hospital, while the disinfection of premises is carried out by the officers of the Public Health Department. 28 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 1948 the following disinfections were carried out:— Free of cost. Upon payment. Total. Loads of bedding, etc. 119 12 131 Houses disinfected 101 1 102 NATIONAL ASSISTANCE ACT, 1948, SECTION 50. Under the above section, as from 5th July, 1948, the Council became responsible for the disposal of the remains of any person dying in the District, where suitable arrangements would not otherwise be made, and before the end of the year one burial had been arranged. HEALTH PROPAGANDA. Steady use was 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 employed. MATERNITY AND CHILD WELFARE. From 1915 until 5th July, 1948, this Council was responsible for the maternity and child welfare work in the District, and had built up a service which was recognised as being second to none in the County. With the implementation of the National Health Service Act, however, it was transferred to the County Council, the only consolations being that the officers concerned were also transferred en bloc, while certain of the responsibilities were immediately decentralised to Divisional Sub-Committees thus retaining to a limited extent local influence and interest. It is hoped with considerable justification that the County Maternity and Child Welfare Service will become a richer and more useful one as a result of the absorption of the heterogeneous services of the hitherto autonomous Authorities, but much will depend on the degree of real decentralisation and the encouragement given to Divisional initiative. There appears to be no point in recording the relevant statistics for only six months of the year, nor in dealing with the arrangements which then pertained, particularly as in future reference can presumably only be nade to the effectiveness of these services in so far as they influence the vital statistics and public health of the District. It might, however, be useful to enumerate the arrangements now in operation for the guidance of residents who may have access to this Report. 29 Maternity Clinics. These are now held at:— 62, Whytecliffe Road, Every Wednesday, (Lower Sanderstead, Purley Purley. 2—4 p.m. and Kenley mothers), 62, Whytecliffe Road, Every Thursday, (Old Lodge Lane and Couls- Purley. 2—4 p.m. don mothers). Westway, Caterham- 1st and 3rd Monday in (Old Coulsdon mothers). on-the-Hill. each month, 2—4 p.m. The Baptist Church, 2nd and 4th Wednesday Addington Road, in each month, 10 a.m. Selsdon. —noon and 2—4 p.m. It is open to any expectant or post-natal resident to attend for advice and, when necessary, examination. The facilities include the introduction of suitable cases to the maternity wards at the local hospitals, and routine blood examinations for Rh. factor, etc., which service may be of assistance to general practitioners. Midwives. The County midwives can be found as follows:— Telephone: The Coulsdon Nursing Association, "Westview," Woodstock Road, Coulsdon Downland 4005 Mrs. Noakes, 44, Purley Park Road, Purley UP Lands 5825 Miss Neighbour, 21, Brent Road, Selsdon SANderstead 3514 Relief Midwife:— Miss P. Joachim, 31, Edgar Road, Sanderstead SANderstead 0630 Premature baby outfits are held by the two first-named for use in suitable cases. General Nursing Service. The services of general trained nurses employed by the County Council can be obtained by application to:- Telephone: Coulsdon Nursing Association, "Westview," Woodstock Road, Coulsdon Downland 4005 Purley and Kenley Nursing Association:— 39, Brighton Road, Purley UPLands 6815 8, Oaks Road, Kenley UPLands 6715 Sanderstead Nursing Association, Flat 3, Llandaff House, Sanderstead Hill SANderstead 1969 Selsdon Nursing Association, 77, Foxearth Road. Selsdon .. SANderstead 2188 (Note.—Neither the midwifery nor general nursing 'services have been divisionalised.) 30 Consultant Service. The general practitioners have been supplied by the Regional Hospital Board with particulars of the specialists whose services are available in the District. Emergency Units. The Emergency Units or "Flying Squads" based on Redhill (County), St. Helier and May Day Hospitals are available at any time for bona fide. service in this District. Home Help Service. Applications for the service of a Home Help should be addressed to the Home Help Organiser, c/o Council Offices, Purley. In case of emergency the following telephone numbers may be used:—UPLands 7014 or 4844, preferably between 9.30 and 10.30 a.m. Home Helps can only be supplied to cases genuinely needing their assistance in which illhealth or old age are involved; the capacity of the Service is limited, but preference is given to those in the greatest need, the degree of help varying with the physical and social circumstances of the family. Family Planning. The local Family Planning Clinic is now held at the Surrey County Clinic, Westway, Caterham-on-the-Hill. Residents needing advice are seen only by appointment and this should be obtained by application to the Divisional Medical Officer at the Council Offices, Purley. Health Visitors. The local Health Visitors are based on 69, Brighton Road, Purley Uplands 7014/4844), and should normally be contacted through the Divisional Medical Officer or Divisional Health Visitor (Miss K. M. O'Connor), INFANT WELFARE CENTRES The following Infant Welfare Centres are held regularly from 2—4 p.m.:— 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. Whitgift Sports Pavilion, Lime Meadow Avenue, Sanderstead Every other Thursday. Laing's Estate Office, Mitchley Avenue, Purley 1st and 3rd Tuesday in each month. The first session in each month at those centres which are held weekly (except at Old Coulsdon), is chiefly devoted to the supervision of toddlers. 31 Eye Defects and Dental Treatment. Children under 5 years of age suffering from eye defects are referred by appointment from the Infant Welfare Centres to the County Council eye clinics held at 62, Whytecliffe Road, Purley. Similarly, ante-natal or nursing mothers unable to make other arrangements to obtain dental treatment under the National Health Service Act, and children under 5 years needing dental treatment are referred for treatment to the dental clinic sessions held in the same premises. School Clinics. The County Council also provide the following clinics which, with the exception of the last, are held at the Clinic at 62, Whytecliffe Road, Purley. Minor ailment clinic Thursdays 9 a.m.—11a.m. School dental clinic Fridays 1.30 p.m. or by appointment. School eye clinic Speech therapy clinic By appointment. Remedial exercise clinic Day Nurseries. The two Day Nurseries at present functioning in the District are situated as follows "Hazelglen" Day Nursery, Sanderstead Road, Sanderstead. (SANderstead 5329.) Matron: Miss J. Davison. Old Coulsdon Day Nursery, Bradmore Green, Old Coulsdon. (Downland 4071.) Matron: Mrs. L. C. Bryan, S.R.N. HOUSING. The following table is a statistical record of work carried out in respect of the sanitary condition of dwelling houses:— 1. Inspection of Dwelling Houses during the Year 1948. (1) (a) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 616 (6) Number of inspections made for the purpose 2,139 (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 287 32 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 365 3. Action under Statutory Powers during the Year:— (o) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling houses which were rendered fit after service of formal notices: (a) By Owners 1 (b) By Local Authority in default of Owners Nil (b) Proceedings under the Public Health Acts: (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 20 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By Owners 27 (b) By Local Authority in default of Owners Nil (3) Proceedings under sections 11 and 13 of the Housing Act, 1936: (a) Number of dwelling houses in respect of which Demolition Orders were made Nil (b) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (4) Proceedings under Section 12 of the Housing Act, 1936: (a) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (b) 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 6 (2) Number of families dwelling therein 7 (3) Number of persons dwelling therein 36 (b) Number of new cases of overcrowding reported during the year 6 (c) (1) Number of cases of overcrowding relieved during the year 16 (2) Number of persons concerned in such cases 89 (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 202 By other persons 166 33 The number of houses inspected for defects was 82 more than in the preceding year in spite of the fact that the actual number of inspections made decreased by 343. Altogether 393 houses were rendered fit in consequence of action taken by the Health Department and, in addition, 3 cottages not repairable at "reasonable cost" were purchased by the Council at site value and subsequently renovated. These figures represent an appreciable increase on those for 1947. It was necessary, however, for this work to be confined again to remedying the most urgent defects, as, although the supply of building materials and labour improved, other factors have made it more difficult to obtain a satisfactory standard of fitness in working class houses. The relaxation of licensing limits has to some extent caused a diversion of the building trade to more remunerative and attractive work, while it is becoming increasingly difficult to determine what should be considered a reasonable expense at which such property can be made fit, a requirement which has to be borne in mind in actions under the Housing or Public Health Acts, having regard to the present-day cost of repairs in relation to the value of such dwellings, based on pre-war controlled rents. In addition, in view of the present-day shortage of houses and the need for retaining every house which is not in a dangerous condition, it is necessary to determine and pursue a policy of compromise between the two extremes of demolition and extensive repair. Fortunately in this District this problem is not so acute as that in the more industrial and congested areas of the Country. The most pressing need in this District is for more housing units and, in this respect, it is pleasing to record the increasing co-operation with the Council's newly created Housing Department in the relief of the more serious cases of overcrowding, and the provision of 368 new houses. WATER SUPPLY. As in previous years the water supply of the District was provided by the Sutton and District Water Company and the East Surrey Water Company, with a private supply supplementing, as necessary, at Cane Hill Hospital. No samples of raw water were taken during the year, but routine samples were taken quarterly for bacteriological and chemical examination of the treated water. The Water Companies and the Local Authorities affected also supplied copies of reports on the samples taken by them. No complaints were received during the year with regard to the quality or quantity of water supplied by the Companies, and locally no unsatisfactory samples were taken. The results of two chemical examinations and two bacteriological examinations are given below and these are fairly typical of the reports received:— 34 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 180º C.) 23.0 16.1 19.0 13.3 Combined chlorine (C1) 1.6 1.1 1.6 1.1 equivalent to Sodium Chloride (Na C1) 2.6 1.9 2.6 1.9 Nitric nitrogen (Nitrates) 0.74 0.52 0.70 0.49 Nitrous nitrogen (Nitrites) traces present a minute trace present Ammoniacal nitrogen 0.0018 0.0013 0.0024 0.0017 Albuminoid nitrogen 0.0010 0.0007 0.0006 0.0004 Oxygen absorbed in 4 hours at 27°C. 0.002 0.001 0.002 0.001 Lead or Copper Nil Nil Nil Nil Temporary hardness ( equivalent ) 10.5 7.4 4.0 2.8 Permanent hardness ( to ) 1.9 1.3 2.4 1.7 Total hardness ( CaCO3 ) 12.4 8.7 6.4 4.5 Bacteriological Examination. Probable number of coliform bacilli, MacConkey 2 days, 37°C. 0 per 100 ml. 0 per 100 ml. There are no private wells in use in the District; all houses are provided with a mains supply laid into the house, and there are no standpipes for common use. The Analyst's reports suggested that the statutory maximum limit for hardness was exceeded by a small margin on four occasions, but the method of estimation used exaggerated the degree of hardness, and was not that required by statute. Forty-five samples were taken and examined for hardness by the Department, all of which were satisfactory. RAINFALL. The rainfall registered by the automatic rain gauge installed at Alderstead Heath was 30.95 inches, this being an increase of 5.53 inches compared with the previous year. The monthly totals throughout the year were as follows:— January 4.29 inches February 1.39 „ March 0.84 „ April 1.48 „ May 1.71 „ June 3.01 „ July 1.86 „ August 5.30 „ September 2.00 „ October 2.25 „ November 2.24 „ December 4.58 „ DRAINAGE AND SEWERAGE. During the year 640 yards of new sewers were constructed in connection with the development of Council Housing Estates. 35 CLOSET ACCOMMODATION. The approximate number of each type of closet accommodation in use at the end of the year was:— Premises with water closets drained to sewers 15,971 Premises with pail closets 32 Number of cesspools 168 The contents of pail closets at private premises are disposed of in the gardens by the occupiers of the houses. PUBLIC CLEANSING. Refuse collection was carried out at fortnightly intervals until the 1st March, when it reverted to a weekly collection, which continued until the end of the year. The charges for trade refuse collection and for cesspool emptying remain the same. 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. RIVERS AND STREAMS. From time to time inspections are made of the watercourses in the District, and they have been cleared whenever necessary. No particular difficulty has arisen in regard thereto. CAMPING SITES. The Boy Scouts' camping site at Featherbed Lane continues to be used, and is conducted in a very satisfactory manner. Tents and caravans are not a serious problem in the District, but constant supervision is necessary to prevent undesirable conditions arising through uncontrolled development. SWIMMING BATHS. The swimming bath at Reedham Orphanage was only used on a modified scale during 1948, and solely by the children of that institution. SHOPS AND OFFICES. As far as possible 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. Further reference is made to food premises later in this Report. 36 FACTORIES AND WORKPLACES. I. INSPECTIONS for purposes of provisions as to health made by sanitary inspectors. Premises. (1) Number on Register. (3) Number of Inspections. (4) Written notices. (5) Occupiers prosecuted. (6) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 15 13 - - (ii) Factories not included in (i) to which Section 7 applies: (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 - - - - (b) Others 85 92 3 - (iii) Other Premises under the Act (excluding out-workers' premises) — — — — Total 100 105 3 — 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found Remedied Referred To H.M. Inspector. By H.M. Inspector. (1) (3) (4) (5) (6) (7) Want of cleanliness (S.1) 8 8 — 1 - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 1 1 1 — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7): (a) Insufficient 1 1 - — — (b) Unsuitable or defective — — — — — (c) Not separate for sexes — — — — — Other offences (not including offences relating to Homework) — — — — — Total 10 10 1 I - 37 OUTWORK. (Sections 110 and 111) Nature of Work. Section 110 Section 111 No. ot our-workers in August list required by Sect. HO (l)(c). No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served. Prosecutions. (1) (3) (4) (5) (6) (7) (8) Wearing f making, etc. 6 — — — — — apparel Cleaning and washing - - - - - - The making of boxes or parts thereof made wholly or partially of paper 1 - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 1 — — — — — Total 8 - - — — - Part IV of the Act (Section 53): Underground Workroom. As a result of representations made to H.M. Inspector of Factories regarding the establishment of a factory in a basement room, the necessary action was taken to obtain cessation of the business on the grounds of the unsuitability of the premises. SANITARY INSPECTIONS, ETC. The following is a summary of the complaints received, visits made, notices served and defects remedied during the year 1948. The number of complaints received decreased by 102, the most marked fall in numbers being in respect of general disrepair, defective drainage, offensive pig bins and unsound food. On the other hand, complaints regarding insect pests and dilapidated dustbins increased considerably. The number of visits made, excluding those in relation to Rats and Mice, increased by 2,714, which was made possible by the increased staff available. There were 119 more houses visited, the number of visits, however, decreasing by 584. The most marked increases were in the number of visits to food premises, including particularly premises on which ice cream is prepared or sold, and in connection with drainage inspections. Visits dealing directly with cases of infectious disease decreased. The number of defects remedied showed a corresponding increase, the preliminary notices increasing by 174, but statutory notices decreasing by 28. In general the effect of strengthening the staff of Sanitary Inspectors will be noted, and it is commendable to see the increase in the work accomplished without resorting to legal action and especially the concentration on improved hygiene in the preparation of food stuffs. 38 Complaints Received. General disrepair and insanitary conditions 176 Dampness 52 Obstruction of light by trees 5 Overcrowding 21 Defective drainage systems 31 Blocked drainage systems 92 Defective drainage fittings 2 Defective sinks and lavatory basins 8 Defective W.C. pans and flushing apparatus 21 Defective service water pipes 8 Defective hot water systems 4 Defective chimney stacks 7 Absence of, or defective dustbins 21 Insanitary pig waste bins 1 Accumulation of refuse, etc. 35 Insanitary A.R.P. shelters 4 Rats and mice 243 Keeping of animals 18 Insect pests, etc. 46 Unsound food 52 Miscellaneous 7 Total 854 Summary of Visits Made. Number of houses visited 643 Number of re-inspections and calls made 1,898 Verminous premises 18 Water supply 18 Tents, vans and sheds 18 Schools 2 Places of entertainment 8 Licensed premises 5 Storage of refuse 76 Accumulation 80 Piggeries, fowls and other animals 103 Stables 4 Rats & Mice Destruction Act 3,488 Drainage Inspected 1,027 Drainage tested 100 Cesspools 195 Urinals 11 Sewers and street gullies 39 Cowsheds, Dairies and Milk shops 73 Ice-cream premises 221 Meat shops 27 Food preparing premises 161 Other food shops 344 Bakehouses—power 65 „ other 8 Food Inspection -meat 19 „ „ other food 143 Factories—power 27 „ other 5 Workplaces 6 Outworkers 29 Shops Acts 13 Infectious disease enquiries 136 „ ,, contacts 20 Food poisoning enquiries 2 Disinfection 105 Disinfestation 148 39 40 Swimming Baths 1 Sampling—Ice-cream 77 Food and Drugs 200 Milk (bactl.) 116 Water 16 Milk (biological) 22 Miscellaneous visits and interviews 1,370 11,087 Defects Remedied. Drainage and Sanitary Fittings: Drains examined and tested 29 Drains reconstructed 60 Blocked drains cleared 97 Soil and vent pipe repaired or renewed 22 Inspection chamber covers renewed and frames re-bedded 55 Fresh air inlets repaired or renewed 23 New W.C. pans fixed 49 W.C. flushing cisterns repaired or renewed 49 Cesspools provided or enlarged 2 Cesspools cleansed, repaired or renewed 8 Cesspools abolished and house drains connected to sewer 1 Soakaways reconstructed 6 Eaves gutters and stack pipes renewed or repaired 95 New lavatory basins fixed 9 Baths renewed 1 Glazed sinks renewed or repaired 21 Waste pipes trapped, repaired or renewed 25 Sink gully dishings repaired 22 Pail closets abolished 1 Urinals cleansed 2 General Housing Repairs: Defective roofs repaired 113 Yards paved, or paving repaired 21 Dampness in walls remedied 134 Damp-proof courses provided 10 Additional sub-floor ventilation provided 8 Walls and ceilings repaired 208 New ceilings provided 162 Walls of rooms cleansed 136 Ceilings of rooms cleansed 202 Floors repaired or renewed 50 Ventilation and lighting of rooms improved 2 Windows repaired or renewed 138 Doors repaired or renewed 73 Firegrates repaired or renewed 40 Coppers repaired or renewed 17 Public water supply laid on to house 1 Service water pipes repaired or renewed 15 Cellars cleansed 11 Additional ventilation and light provided to ments 4 Walls and ceilings of W.C. apartments cleansed 40 Portable dustbins provided 27 Food Premises: Bakehouses reconstructed 2 New fish preparing room provided 1 Foodshops reconstructed 2 Hot water supply provided for ablution purposes 23 41 Lavatory basins provided 10 Glazed sinks provided 9 Draining board provided 1 Waste pipes repaired 2 Staff sanitary accommodation repaired 6 Staff sanitary accommodation cleansed 4 Staff sanitary accommodation provided 2 Walls and ceilings cleansed and repaired 60 Floors repaired or relaid 8 Staircase repaired 1 Kitchen enlarged 1 Additional ventilation provided to kitchens 3 Windows repaired 4 Food store provided 1 Yards paved 5 Roofs repaired 3 Blocked drains cleared 4 Miscellaneous 18 Notices Served. Preliminary Notices 538 Statutory Notices 21 Legal Proceedings. It was not necessary to take legal proceedings in connection with public health work in 1948. DISINFESTATION. During the year only 2 houses needed to be and were disinfested owing to the presence of bed bugs, one of which was a Council house, but action was also taken by the Department in 33 cases of infestation with other pests such as fleas, crickets and wasps. In the majority of cases disinfestation was carried out by spraying with a proprietary insecticide, and it was not found necessary to disinfest any bedding by steam. RATS AND MICE DESTRUCTION ACT, 1919. INFESTATION ORDER, 1943. The following is a summary of the work carried out during the year under the above heading:— Number of complaints received 243 Number of complaints investigated 231 Number of premises inspected 441 Number of premises found infested 277 Number of premises treated by the Council 231 Number of premises treated privately 46 Total number of visits in connection with Rats and Mice Destruction 3,488 These figures are very similar to those reported in respect of the closing months of 1947. During 1948, 35 visits were made to the Council Depots at Millstock, Purley Oaks, Kenley and Old Lodge Lane. In accordance with the requirements of the Ministry of Agriculture and Fisheries, a routine test baiting of the sewers in the District was carried out, with subsequent treatment as necessary. A total of 202 manholes was baited and it was found necessary to lay poison at 8 points only. The Council's policy of making a charge of 3s. 6d. per hour (minimum charge 5s.) to occupiers of premises for services rendered in the destruction of rats and mice was continued during the year. SCHOOLS. The Medical Officer of Health, as Divisional School Medical Officer, visited most of the public Primary and Secondary Schools in the area during the year, reporting to the Divisional Executive on their sanitary condition, etc. In addition, the Sanitary Inspectors visit such Schools as they are requested or find it desirable to inspect. Close liaison also exists between the Public Health and School Medical Services with a view to preventing the spread of infectious disease. INSPECTION AND SUPERVISION OF FOOD. MILK. Milk and Dairies Order, 1926 The entries in the registers required to be kept in accordance with this Order were as follows:— Cowkeepers 7 Dairymen and retail purveyors with premises in the District 4 Retail purveyors with premises outside the District 5 Retail purveyors of bottled milk only sold in general shops 11 Dairies (including 1 Receiving Depot) 4 The following is a list of dairy farms in the District:— Hooley Farm, Woodplace Lane, Coulsdon. Dean Farm, Brighton Road, Hooley. Elm Farm, Farleigh. Moorcroft Farm, Farleigh. Elmgrove Farm, Old Lodge Lane, Kenley. Hayes Farm, Hayes Lane, Kenley. Farleigh Court Farm, Farleigh. 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) Regulations, 1936/46. Milk Sampling. A total of 138 samples was submitted for bacteriological and biological examination, an increase of 62 compared with 1947, with the results set out in the following tables:— 42 Tests required by Milk (Special Designations) Regulations, 1936 to 1946, and the Heat-Treated Milk (Prescribed Tests) Order, 1944. BACTERIOLOGICAL. Designation and Number of Samples. Methylene Blue. Phosphatase. Coliform Bacteria. Turbidity. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. + - Pasteurised: 43 42 1 43 - — - - - Heat Treated: 54 51 3 52 2 — - - - Raw: 3 3 - — — 3 — — - Sterilised: 4 1 3 4 — — - - 4 Tuberculin Tested: 3 2 1 — — 2 1 - — T.T. (Certified): 9 6 3 — — 7 2 - — Totals 116 105 11 99 2 12 3 — 4 BIOLOGICAL. Designation. Tubercle Bacillus. + ] Ungraded: 18 - 18 Tuberculin Tested: 1 — 1 T.T. (Certified): 3 — 3 Totals: 22 — 22 The percentages of samples of Pasteurised and Heat Treated milk which were satisfactory for the Methylene Blue (keeping) test, and Phosphatase (pasteurisation) test compared very favourably with those for 1947, but the proportion of Tuberculin Tested and Tuberculin Tested (Certified) samples which were unsatisfactory as judged by the keeping and contamination tests was higher than it should have been. The samples tested biologically for the presence of tubercle bacilli were all satisfactory. Milk (Special Designations) Regulations, 1936/46. Licences to sell milk under the above Regulations were issued as follows:— Dealers: Tuberculin Tested 6 Pasteurised 8 Supplementary: Tuberculin Tested 7 Pasteurised 6 43 ICE-CREAM. A total of 71 samples of ice-cream was examined for bacterial quality by submission to the methylene blue reduction test. In addition 6 samples of coloured ice-cream were submitted for a plate count test. The samples submitted for the methylene blue test were placed in the following provisional grades:— Grade I 32 samples Grade II 16 „ Grade III 15 Grade IV 8 „ Grade I and II samples can be considered satisfactory; only about a fifth of the samples taken from any dealer should be of Grade III quality, and none of Grade IV. In a table such as the above the proportion of unsatisfactory samples will, of course, be influenced by the percentage taken from suspected sources. It is, however, interesting to note that all 8 Grade IV samples were taken from 4 retailers purchasing their supplies from outside the District. Representations were made to the vendors concerned and resulted in a change of supplier in one instance and, in the remainder, to much improved results on subsequent sampling. Of the 6 plate count tests, only one was considered unsatisfactory. This was a sample manufactured on his own premises by a cafe proprietor who subsequently ceased the practice. MEAT. The two slaughterhouses in the District have not been licensed since 1940. In 1948 one licence was issued under the Slaughter of Animals Act, 1933, for the purpose of slaughtering at a public institution in the District. The only carcases examined were occasional cottagers' pigs and meat delivered to local butchers' shops from the Wholesale Meat Supply Association situated outside the District. FOOD PREMISES. During the year considerable time was devoted to the routine inspection of food shops and other premises where food is prepared. A register of all such premises has been compiled and includes the following:— Confectioners 47 Butchers 29 Fishmongers (Wet and Dry) 11 Fishmongers (Fried) 8 Bakers 21 Greengrocers 40 Ice-cream premises 75 Cafes and Restaurants 64 Grocers 71 Inspections are based on Sections 13 of the Food and Drugs Act, 1938, and considerable progress can be recorded in overtaking the large arrears of work arising as a result of the war years. 44 Particular attention has been given to ice-cream premises, of which only 4 are now used for manufacturing purposes, the remainder being vendors only. Section 14 of the Food and Drugs Act relating to the registration of certain food premises is not in force in the District but similar provisions obtain in the Coulsdon & Purley U.D.C. Act, 1937. An application made by an owner for the registration under the local Act of premises for the purpose of frying fish was refused on the grounds of the unsuitability of the premises. An Appeal to the Magistrate's Court was dismissed and the Council's decision upheld. UNSOUND FOOD. The following unsound foods were surrendered during the year:— Cwt. lbs. ] Canned Soups — 31 6½ Canned Meat — 64 12 Canned Fish — 82 8 Canned Vegetables 1 62 11 Canned Fruits 2 12 6 Canned Milk — 103 15 Meat, Bacon, Poultry, etc. 1 101 8 Fish 27 26 0 Meat and Fish Pastes — 4 7 Butter and Fats — 43 8 Sugar, Jam, etc. — 111 13 Flour, Bread and Cereals 3 24 9½ Pickles and Sauces - 9 3 Fresh Fruit and Vegetables 3 5 6 Frosted Fruit and Vegetables 4 58 0 47 70 1 45 FOOD AND DRUGS ACT. The following samples were taken during 1948 and submitted to the Public Analyst, with the results shown:— Articles. Analysed. Non-Genuine. Remarks. Formal. informal. Total. Formal. Informal. Total. Aspirin, tablets — 1 1 — — - - Brawn 1 —. 1 — - - — Barley flakes 1 - 1 — — - - Bronchial mixture - 1 1 - - - — Batter powder 1 - 1 — - - - Cake mixture — 3 - 3 — - - - Coffee and chicory 3 - 3 - - - - Coffee essence 1 1 2 — — - - Chocolate cup 1 - 1 — - - - Cooking fat 4 - 4 — - - — Curry powder 1 — 1 — — - - Cocoa 1 —. 1 — — - - Candied peel 2 - 2 — — - - Chocolate spread 1 - 1 — — - - Canned beer — 1 1 - - - - Canned soup — 3 3 - 1 1 Incorrectly labelled. Castor oil — 1 1 — — - — Frozen fruit relish — 1 1 — — - — Fish paste 1 — 1 —. - - — Ginger 1 — 1 —.. - - — Gelatine 2 — 2 — — - — Gravylet tablets 1 — 1 — — - — Jelly crystals — 1 1 — — - — Jam 1 — 1 — — - — Licorice wood 1 — 1 — — - — Lemonade powder 3 1 4 1 - 1 Quantities of various ingredients unsuitable for children's use. Lemon squash 2 — 2 — — - — Margarine 2 — 2 — — - — Milk 50 — 50 — — - — Orange squash 1 — 1 — — - — Olive oil — 2 2 — — - — Pepper 1 — 1 — — - — Rennet essence 1 — 1 - — - — Self-raising powder 1 — 1 — — - — Sausages—beef 4 1 5 1 — 1 Deficient in meat. Sausage meat—beef 3 — 3 1 — 1 Deficient in meat. Spaghetti in meat sauce - 1 1 - - - - Spaghetti (cut) 1 — 1 — - - — Salad dressing — 2 2 — — - — Sage - — 1 1 — - - — Salt 1 — 1 — — - — Sweetening tablets — 1 1 - — - — Self-raising flour — 3 3 — - - — Sauce 1 — 1 — —. — — Sponge mixture 1 — 1 1 — 1 Incorrectly labelled. Tea 3 — 3 — — — — Vinegar 3 1 4 1 — 1 Added salt. Total 105 23 128 5 1 6 46 Six samples were reported upon adversely. Two related to defects in labelling, and representations were made to the firms concerned which resulted in the provision of new labels. Two traders received warnings from the Council in respect of deficiencies in the meat content of beef sausages or beef sausage meat. A sample of vinegar containing a small percentage of added salt was reported upon unfavourably, but the manufacturers stated that they held a dispensation from the Ministry of Food to add salt without declaration. In the remaining case, a sample of lemonade powder contained ingredients unsuitable for children's use. The local stocks were destroyed and, after warning, the Manufacturer altered the formula and the labels on the new packets were amended accordingly. 47 48 TABLE I. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1948. Disease. Number of cases notified. At Ages—Years. Total cases notified in each Ward. At all ages. 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. Purlev. Kenley. Sanderstead. Selsdon and Farleigh. Woodcote. Diphtheria - - - - - - - - - - - - - - - - - - - - Typhoid fever - - - - - - - - - - - - - - - - - - - - Paratyphoid fever 2 - - - — — — - - 1 — - 1 1 — - - - — 1 Scarlet fever 62 - 2 5 4 4 37 9 1 — — - - 6 11 3 10 22 7 3 Erysipelas 8 - - - - - - - - 1 2 3 2 — 1 3 — 2 2 — Puerperal pyrexia 2 - — — — — — — — 1 1 — — — 1 1 — — — — Pneumonia 13 - 1 — 1 1 5 — 1 — 1 3 — 2 2 1 1 5 — 2 Dysentery 71 - — — — 1 — — 14 13 25 18 68 2 - — — 1 — Cerebro-spinal fever 1 1 - - - - - - - - - - - - - 1 - - - - Poliomyelitis 2 - — — 1 — — — l — — — — 1 — - — 1 — — Measles 567 23 51 42 56 200 165 16 9 3 1 1 — 110 131 49 35 120 74 48 Whooping cough 201 21 23 17 20 35 75 5 — 2 2 — 1 27 12 13 25 89 29 6 Totals 929 45 77 64 82 240 283 30 12 22 20 32 22 215 160 71 71 239 113 60 49 TABLE II THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1948. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Diphtheria - - - - - - - - - - - - - Typhoid fever - - - - - - - - - - - - - Paratyphoid 1 — — — 1 — — — — — — — 2 Scarlet fever 5 4 3 5 1 6 1 — 2 19 13 3 62 Erysipelas 3 1 — — 1 1 2 - - - - - 8 Puerperal pyrexia - - - - - - - — - - - 2 2 Pneumonia 2 3 4 1 2 — — — — - — 1 13 Dysentery 2 3 6 - 3 — 6 40 5 2 3 1 71 Cerebro-spinal fever 1 — — — — — — — — — — — 1 Poliomyelitis — — — — — - — — 1 1 — — 2 Measles 2 25 22 78 199 133 72 6 12 15 1 2 567 Whooping cough 14 18 23 37 28 19 9 8 3 20 14 8 201 Totals 30 54 58 121 235 159 90 54 23 57 31 17 929 50 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1917. Disease. 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 1946 1947 1948 Small pox - - - - - - - - - - - 2 2 3 4 - - - - - - - - - - - - - - - - Scarlet fever 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 93 78 62 Diphtheria 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 8 — — Erysipelas 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 8 5 8 Typhoid and paratyphoid fever 73 31 15 5 16 11 5 24 9 9 9 6 4 4 7 5 5 1 3 26 5 1 53 12 3 1 6 4 4 2 2 Cerebro-spinal fever 1 - - 1 - - - - - - - 1 - - - - - 1 1 - - 4 8 6 1 4 2 1 3 1 1 Puerperal fever 1 — — 2 — — — — 1 — — 1 — 1 1 — 1 1 1 5 — — Puerperal pyrexia 1 1 1 1 3 5 1 2 1 — 2 5 3 2 — 2 3 1 2 2 1 2 Poliomyelitis — 1 1 — 1 — 1 — — 1 1 1 — 2 — 1 1 — 3 1 1 1 2 3 — — 2 1 11 2 Polio-encephalitis - - - - - - - - - - - - - - - - - - - 2 - - - - - - - - 1 - - Encephalitis — — 1 1 1 1 1 1 — 1 1 - - - 1 - - - - - - - - - - 1 - - - - - lethargica Ophthalmia neonatorum 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 16 20 13 Malaria — 5 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 33 12 2 11 214 479 275 52 705 141 218 567 Dysentery — 4 7 7 7 17 - - 1 - - 5 - - - - - 6 — 1 2 10 85 224 121 21 42 172 82 43 71 Whooping cough 6 1 136 36 55 51 100 31 115 201 Tuberculosis:— Pulmonary 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 38 59 48 Other forms .. 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 7 11 13 Totals 158 194 237 246 218 124 224 114 113 153 174 232 162 135 154 196 235 265 213 197 162 207 323 743 809 632 337 1137 435 564 990 TABLE IV. DEATHS OCCURRING DURING THE YEAR 1948. Cause of death. Males. Females. Total. 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 — 1 1 - - - - - - - Scarlet fever - - - - - - - - - - - Whooping cough - - - - - - - - - - - Diphtheria - - - - - - - - - - - Respiratory tuberculosis 4 2 6 — - - - 2 1 3 — Other tuberculosis 1 1 2 1 - - - - - 1 — Syphilis 2 1 3 - - - - - - 1 2 Influenza 1 1 2 - - - - - - 1 1 Measles - - - - - - - - - - - Poliomyelitis and polioencephalitis - - - - - - - - - - - Ac. inf. encephalitis — 1 1 - - - - - - - 1 Cancer 41 51 92 - - - - - 7 27 58 Diabetes 1 3 4 — - - - - - 1 3 Intra-cranial lesions 30 42 72 - - - - - 1 19 52 Heart disease 82 87 169 - - - - - 2 32 135 Other diseases of circulatory system 13 12 25 - - - - - 1 7 17 Bronchitis 10 7 17 - - - - - 1 6 10 Pneumonia 14 10 24 3 - 1 - — — 3 17 Other respiratory diseases 5 2 7 — - 1 1 — — 1 4 Ulcer of stomach or duodenum 4 2 6 - - - - - - 3 3 Diarrhœa under 2 years 1 — 1 1 - - - - - - - Appendicitis 5 2 7 — 1 - - — —. 2 4 Other digestive diseases 8 9 17 - - - - - 2 5 10 Nephritis 6 7 13 - - - - - 3 3 7 Puerperal sepsis - - - - - - - - - - - Other maternal causes — 1 1 — - - - — 1 — — Premature birth 4 — 4 4 - - - - - - - Congenital debility, etc. 8 5 13 13 - - - - - - - Suicide 3 4 7 - - - - - 2 4 1 Road traffic accidents 1 2 3 - - 1 - 1 1 — - Other violent causes 4 5 9 - - - - - 1 3 5 All other causes 20 19 39 1 - - - - 2 13 23 Totals 269 276 545 24 1 3 1 3 25 135 353 51 INDEX Page Ambulances 27 Analysis of Mortality 11,12 Area 5, 9 Bacteriological work 28 Bed Bugs, Eradication of 41 Birth Rates 5, 10, 17 Births, Live, Illegitimate and Still 10, 11 Camping Sites 36 Cancer 12,13 Causes of Deaths 11,51 Cerebro-Spinal Fever 20 Clinics: Diphtheria Immunisation 26 Family Planning 31 Infant Welfare 31 Maternity 30 School 32 Toddlers 31 Tuberculosis 23 Closet Accommodation 36 Consultant Service 31 Dairies and Cowsheds 42 Day Nurseries 32 Deaths and Death Rates 11,17,51 Dental Treatment 32 Diabetes 27 Diptheria 18 Diphtheria Immunisation 26 Disinfection 28, 29 Drainage and Sewerage 35 Dysentery 20 Emergency Units 31 Enteric Fever 19 Erysipelas 19 Eye Defects 32 Factories 37, 38 Family Planning Clinic 31 Food and Drugs Act 46 Food Supply: Milk 42 Meat 44 Food Preparing Places 44 General Nursing Service 30 Health Visitors 31 Health Propaganda 29 Heart Disease, etc. 12 Home Helps 31 Hospitals 28 Houses, Inspection of 32 Houses, Inhabited 5, 10 Housing 32, 33 Ice-Cream 44 Illegitimate Babies 11 Immunisation 26 Infantile Mortality 5, 14 Infectious Disease: Cases notified 18, 47 Monthly incidence of 48 School Notifications 24 Inspection and Supervision of Food 42 52 Page Laboratory Facilities 28 Legal Proceedings 41 Massage Establishments 28 Maternal Mortality 14 Maternity Clinics 30 Maternity and Child Welfare: Services 29,30,31 Centres 30, 31 Hospital Accommodation 28 Measles 21 Meat 44 Midwifery Service 30 Milk (Special Designations) Regulations 43 Milk, Sampling of 42 Mortality: Analysis of 11,12 Infant 5, 14 Maternal 14 Mumps 24 National Assistance Act, Sect. 50 29 Non-notifiable Infectious Disease 24 Nursing Service 30 Paratyphoid Fever 19 Pneumonia 20 Polio-myelitis 20 Population 5, 9 Premature Babies 30 Public Cleansing 36 Public Health Committee 3 Puerperal Pyrexia 19 Rainfall 35 Rateable Value 5 Rats and Mice Destruction - 41 Rivers and Streams 36 Sanitary Inspections, etc. 38 Scabies 25 Scarlet Fever 19 Schools 42 School Clinics 32 Sewerage 35 Shops 36 Slaughterhouses 44 Small Pox 17,27,50 Smoke Abatement 36 Social Conditions 5, 9 Staff 3, 4 Statistics: Housing 32,33, 34 Vital 5, 10, 17 Still Births 5, 11 Swimming Baths 36 Toddlers'Clinics 31 Tuberculosis 22, 23 Tuberculosis Care Committee 23 Typhoid Fever 19 Vaccination 27 Violence, Deaths from 14 Vital Statistics 5, 10, 17 Water Supply 34 Whooping Cough 21 „ „ Immunisation 27 53