HEALTH REPORT for 1951 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH Printed by RAYNES PARK PRESS, Lambton Road, London, S.W.20. Tel. WIM. 1388. HEALTH REPORT for 1951 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. 1951. Public Health Committee. Chairman: R. N. Saunders. Councillor Miss A. R. Lamb. Councillor Mrs. L. J. Nesbitt. „ R. H. Pullen. „ E. R. Nicholson, A.C.A. H. J. Smith. „ H. W. Hayden, „ F. Jobbins. S.P., F.B.O.A., F.S.M.C. „ S. E. Littlechild. » R- w- Kersey, B.Sc., A.R.I.C. Ex-officio: Councillor A. G. V. Page, J.P. „ Col. F. N. Charlton, C.B.E., M.A. (oxon). Representatives on the South Eastern Divisional Health Sub-Committee. Councillor E. R. Nicholson, A.C.A. Councillor Mrs. L. J. Nesbitt. „ S. E. Littlechild. „ R. H. Pullen. R. N. Saunders. Public Health Department. STAFF: Medical Officer of Health: *F. R. Edbrooke, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health: *Mary Sutcliffe, M.A., M.B., B.Ch., M.R.C.S., L.R.C.P., 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: V. W. Ribbons, M.S.I.A. W. Rice-Jones, M.S.I.A. Assistant to Sanitary Inspectors-. W. H. Sands. Rodent Operative: H. M. Key. Chief Clerk: *D. V. Prothero. Clerks: Mrs. G. Edmonston. 'Mrs. B. F. Clarke. F. J. Smith. (* Part-time appointment only to this Council.) 3 COULSDON AND PURLEY URBAN DISTRICT COUNCIL. Ladies and Gentleman, I have the pleasure to present to you my Annual Report for 1951, this being my twentieth report as your Medical Officer of Health. It is similar in its arrangement to its predecessors, but the section giving particulars of the other branches of the local health and welfare services has been slightly expanded for the assistance of Councillors, Officers and members of the public. It will be noted that on the whole, and as judged by the vital statistics, the health of the District continued to be reasonably satisfactory throughout 1951. For the first time since the War the Birth Rate, which has been steadily decreasing, showed a slight increase. Although the Death Rate increased correspondingly, it remained well below the national rate, which also increased somewhat, while the increase was mainly due to more deaths among adults over 65 years of age. It is very pleasing to report that, as in 1949, there were no maternal deaths during the year. It was not surprising that the Infant Mortality Rate increased above the exceptionally low record rate in 1950, but it was still much lower than the national rate, which was a record for the Country as a whole. The incidence of infectious disease continued at a fairly low level, the only exceptions being measles, which produced the highest number of notifications known in this District, scarlet fever and whooping cough, which were slightly less common than in 1950, and the pneumonias, which mainly resulted from the slight wave of influenza in the early months of the year. With the exception of the last mentioned, all these diseases were of a milder type than formerly. No case of poliomyelitis was notified, nor, for the fifth year in succession was there a case of diphtheria, but it must be stressed that this satisfactory record does not justify any relaxation in diphtheria immunisation. Although the incidence of non-pulmonary tuberculosis decreased and the death rate from pulmonary tuberculosis dropped markedly, as it has nationally, there was an increase in the number of new cases of pulmonary tuberculosis. In so far as this reflects more efficient means of detecting this disease in its early stages, or an appreciation of the advantages gained by early notification and the commencement of the more hopeful modern forms of 4 treatment, this increase is to be welcomed. On the other hand, as the majority of cases occur among the most active age groups of the working population, a reduction in the incidence of tuberculosis would have a substantial effect on the manpower situation, fully justifying priority for a concerted effort to diminish its prevalence. It is on these lines, coupled with preventive action against the airborne and respiratory diseases in general, that there is most hope of improvement in the near future, but mention is made in various parts of this Report of preventive measures against other forms of illhealth. In concluding may I suggest that, while this Report attempts to fulfil its primary function of assessing the health of the District, indicating trends and opportunities for improvement, it might have a greater value if, your Medical Officer of Health being also Divisional Medical Officer for the area, official encouragement was given to the inclusion of more information regarding at least the other local branches of the Preventive Health Service. Your Council is represented on the Divisional Education Executive, to whom an annual report on the School Health Service is presented, and the South Eastern Divisional Health Sub-committee, which deals with the local Maternity and Child Welfare, District Nursing and allied Services, but only a few Councillors know of their activities. Although these bodies only cover the majority but not all the local Services of the County Council as the Health Authority, local interest would possibly be greater if a more comprehensive report on the Health Services in the District was made available in this way. Finally, I would like to take this opportunity of thanking the Council and all who have been associated with the health services for their encouragement and co-operation during the year, and particularly the Chief Sanitary Inspector, his Deputy and my Administrative Assistant for their contributions towards the friendly team spirit which has been maintained in the local Health Service, and for their assistance in the preparation of this Report. I am, Ladies and Gentlemen, Your obedient Servant, • F. R. EDBROOKE, Medical Officer of Health. 5 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 11,142 Registrar-General's estimate of population, mid. 1951 64,200 Population, Census 1931 37,666 Population, Census 1951 63,770 Number of occupied houses, December, 1951 18,071 Number of occupied houses, 1931 9,533 Rateable Value, December, 1951 £773,981 Sum represented by a penny rate £3,110 VITAL STATISTICS FOR THE YEAR 1951. Total M. F. Birth Rate per 1,000 of the estimated resident population Live Births—Legitimate 758 388 370 ) ! 12.2 Corrected Birth Rate 12.9 do. Illegitimate 24 12 12 782 400 382 Still Births—Legitimate 23 13 10 Rate per 1,000 (live and still) births. 28.5 do. Illegitimate — — — Deaths 739 349 390 Crude Death Rate per 1,000 of the estimated resident population 11.5 Corrected Death Rate 10.6 Deaths from puerperal causes :— Rate per 1,000 (live and still) births. Puerperal Sepsis — — Other Puerperal causes — — Total — — Death Rates of Infants under one year of age:— All infants per 1,000 live births 21.7 Legitimate infants per 1,000 legitimate births 21.1 Illegitimate infants per 1,000 illegitimate births 41.7 Deaths from Cancer (all ages) 123 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) Nil 6 HEALTH REPORT FOR 1951 The Urban District of Coulsdon and Purley was constituted by an Order of the Local Government Board dated 1st November, 1914, and came into existence on the 7th April, 1915. It has therefore been a separate District for just over 36 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 and forming part of the "Green Belt." Thanks to successful Town Planning Schemes in the past there is comparatively little dense development, most of the houses being well spaced. It is hoped that, as an outcome of the Town and Country Planning Act, 1947, it will continue to possess extensive open spaces, but constant vigilence is very necessary if the claims on land for housing and other forms of development are not to be allowed to destroy the green belt which London has tried, but failed to ensure for the last 300 years. The majority of the residents who work, do so 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 still 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 In mid-1950 the Registrar-Genleral estimated that 64,490 persons were residing in the District, but the result of the 1951 census, 63,770, showed that he had slightly over-estimated the population recently. His mid-year estimate for 1951 was 64,200. These numbers include persons resident in Institutions in the District, the numbers of which at the end of 1951 were as follows:— 7 Cane Hill Hospita 2,514 Netherne Hospital 2,273 Russell Hill School 235 Reedham Orphanage 269 In 1951 there were 18,071 occupied houses, distributed as follows Coulsdon East 2,805 Coulsdon West 3,140 Purley 2,690 Woodcote 1,650 Sanderstead 4,701 Selsdon and Farleigh 1,764 Kenley 1,321 This suggests an average of 3.55 persons per occupied house in 1951, or 3.25 if the institutional population is excluded. The latter is comparable with 3.66 at the time of the 1931 Census, and the former with an average of 4.3 per house in 1915. VITAL STATISICS. The following table gives the average population, birth, death, maternal and other important mortality rates for the quinquennial periods 1920-1949, together with the actual figures for 1950 and 1951. Rates per 1,000 population. 19201924. 19251929. 19301934. 19351939. 19401944. 19451949. 1950. 1951. Birth rate 13.5 12.9 11.6 12.8 15.2 15.2 11.7 12.2 Percentage illegitimate 3.4% 3.7% 2.8% 3.4% 3.9% 3.4% 2.9% 3.1% Stillbirth rate — — — 0.43 0.48 0.40 0.20 0.36 Death rate 7.4 7.0 7.4 8.3 11.4 9.7 9.5 11.5 Cancer death rate 0.96 1.15 1.35 1.19 1.70 1.75 1.84 1.91 Tuberculosis death rate (per 100,000 population) 57 36 38 35 48 36 26 33 Violence including Suicide 0.44 0.35 0.32 0.46 0.82 0.37 0.37 0.45 Maternal mortality rate per 1,000 live and still births 2.08 2.66 3.21 2.27 2.10 1.12 2.60 Nil. Infant mortality rate (per 1,000 re gist ered births) 28 38 32 38 40 26 17 22 Neo-natal mortality rate — — — 26 28 19 11 18 Estimated population 21,351 28,950 41,616 53,084 49,880 60,610 64,490 64,200 8 BIRTHS. During the year 1951, 782 births were registered as occurring in the District, of which 400 were male and 382 were female, compared with 755 in 1950. It will be seen by reference to the above table that this is equal to an annual birth rate of 12.2 per 1,000 population, as compared with 11.7, 13.0, 14.6 and 17.0 in the previous four years. The rate of 17.6 in 1946 was the highest birth rate experienced in this District, but having fallen to the lowest pre-war average rate last year, it is interesting to note the first sign of post-war stabilising in 1951. The corresponding birth rates for England and Wales were 15.5 in 1951, and 15.8, 16.7, 17.9 and 20.5 in the preceding four years. Illegitimacy.—In 1951, of the births registered, 24 were illegitimate (12 males and 12 females), this being slightly more than in the preceding year. The percentage of illegitimate births in 1950 was only slightly above the lowest pre-war average. Stillbirths.—The number of stillbirths registered during 1951 was 23 (13 males and 10 females), as compared with 13, 20, 16.31 and 40, in the preceding five years. None of the stillbirths occurred in respect of illegitimate children. The local stillbirth rate was thus 0.36 per thousand of population, compared with 0.20, 0.33, 0.25 and 0.49 in the four preceding years. The stillbirth rate for England and Wales was 0.36 in 1951. DEATHS. The number of deaths registered during 1951 as belonging to this District was 739 (349 males and 390 females), as compared with 615, 622, 545 and 672 in the preceding four years. 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 40 in 1951, and 22, 35, 24 and 32 in the preceding 4 years. It will be seen from the table of vital statistics that the crude death rate for the year was equal to 11.5 per thousand of population, as compared with 9.5 last year, and an average of 9.7 since the war. The age and sex distribution of the population of this District not being typical of that of the country as a whole, a correction is necessary. Using the comparability factor supplied by the Registrar General it is found that the corrected death rate was 10.6, compared with 8.8 last year. 9 The crude death rate for England and Wales was 10.8 in 1948, 11.7 in 1949, 11.6 in 1950, and 12.5 in 1951. The principal causes of death locally during 1951 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. Cancer, malignant disease 123 16.6 Heart disease 104 14.1 Cerebral haemorrhage 87 11.8 Other circulatory diseases 182 24.6 Bronchitis 36 4.9 Pneumonia 33 4.5 Accidents 20 2.7 Tuberculosis (all forms) 11 1.5 (A full list of the causes of the deaths and the ages at which they occurred is given in Table IV. in the Appendix.) HEART AND CIRCULATORY DISEASE. The death rate from heart and other circulatory diseases, 5.81, was slightly higher than in 1950, but as this group is composed chiefly of elderly people dying virtually of old age, this increase is not regrettable. As in the last two years, 81 per cent of deaths from heart disease, etc. were over 65 years at the time of death, while no less than 54 per cent were over 75 years of age. (Incidentally, 71 per cent of deaths from all causes were over 65 years, which is 2 per cent more than last year and 10 per cent more than in 1949.) CANCER. The cancer death rate for the year 1950 was 1.91 compared with 1.84 and 1.73 in the last two years and an average of 1.75 since the war. This rate has tended to increase more or less steadily and is now double what it was in 1920, partly owing to better notification, but in part due to a true increase in some forms of the disease. The following table gives the age, sex and distribution of this disease in the fatal cases which occurred in 1951. No marked variation is observable compared with recent years. The number of deaths from breast cancer in females was the same as in 1950, but there was a further slight increase in the number of male lung cases, more than compensated, however, by a decrease in this form in females. 10 11 CANCER DEATHS, 1951. Localisation. 0-20. 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. M. F. Skin and Tongue — — 1 — — — — — — — — — — — 1 — Brain and Thyroid 1 — — — — — — — — — — 1 — — 1 1 Bone — — — — — — — — 1 — — — — 1 1 1 Pharynx and Oesophagus — — — — — — — 1 — — — 1 — — — 2 Stomach and Duodeum — — — — — — 1 3 1 3 2 2 2 2 6 10 Intestines — — — — 1 — 2 2 1 7 8 8 — 2 12 19 Liver — — — — 1 — — — 1 2 1 — 1 1 4 3 Pancreas — — — — — — — — 1 — 2 — — — 3 — Lungs — — — — 2 — 5 1 3 — 2 3 1 — 13 4 Bladder — — — — — — — — 1 — 1 -> — — 2 2 Prostate — — — — — — — — — — 4 — — — 4 — Uterus — — — — — — — 1 — 2 — 1 — 2 — 6 Vagina and Ovary — — — — — — — 3 — 1 — — — 1 — 5 Breast — — — — — — — 6 — 4 2 2 — 2 2 14 Ill-defined — — — — 1 — 1 1 2 — 1 1 — — 5 2 Totals 1 — 1 — 5 — 9 18 11 19 23 21 4 11 54 69 The opportunity is again taken to emphasize that early medical opinion should be obtained in respect of any persistent lump, haemorrhage or pain, the relief of a negative finding being almost as important as an early diagnosis. VIOLENCE. Deaths from violence (including suicide) showed a further slight increase compared with 1950 and 1949, the death rate being 0.45 per thousand of population compared with 0.37 and 0.33 in the last two years and an average of 0.39 both for the inter-war years, and for the years since the war. Deaths on the road increased slightly, five deaths being attributed to this cause compared with three last year. Two of these deaths were associated with motor car accidents and three with motor bicycles. Most of the remaining 15 accidental deaths were in the elderly, 7 being due to falls in elderly women, 3 of whom were in mental hospitals, as were 2 in whom death resulted from asphyxia due to inhalation of the stomach contents. The number of deaths attributed to suicide, 9, was 2 more than last year, and slightly above the average for the inter-war years. TUBERCULOSIS AND PNEUMONIA. Deaths from tuberculosis and pneumonia are referred to in later sections of this report. MATERNAL MORTALITY. It is pleasing to report that as in 1949, no maternal death occurred during the year, which compensates for the two deaths from this cause in 1950. The maternal mortality rate for England and Wales was 0.79 per 1,000 live and stillbirths, which is the lowest yet recorded. INFANT MORTALITY. During 1951, there were 17 deaths among children under one year of age, as compared with 13 last year, and an average of 21 in the last four years. One of the deaths was in respect of an illegitimate child. The resultant infant mortality rate was thus 21.7 per 1,000 registered births, compared with 17.2 in 1950, the latter being the lowest ever recorded for this District. The infant mortality rate for England and Wales was the record of 29.6 in 1951, compared with 29.8 in 1950 which was the lowest previously recorded. 12 13 INFANTILE MORTALITY DURING THE YEAR 1951. 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. Pneumonia — — — — — 1 — — — 1 Congenital Malformation 4 — — — 4 1 1 — — 6 Prematurity 4 1 — — 5 — — — — 5 Atelectasis 2 — — — 2 — — — — 2 B. Coli Meningitis — 1 — — 1 — — — — 1 Birth Injury 1 — — — 1 — — — — 1 Unknown I — — — 1 — — — — 1 Totals 12 2 — — 14 2 1 — — 17 The following table gives the causes of the 17 deaths which occurred during 1951, together with the age at death. It is satisfactory to note the small number of deaths due to infection, and that congenital malformation, the cause of which is unknown, produced over a third of the total deaths. There are, however, opportunities for improvement in the remaining groups. The 14 babies dying in the first month correspond with a neo-natal mortality rate of 17.9 (i.e. deaths in the first month per 1,000 live births). The average for the past 6 years was 18. During the year 7 premature babies were notified as being born at home and 23 in institutions. Of the former one died during the first day and of the latter 5 died within three days and before their discharge to their homes. This suggests that 20 per cent of the premature babies died, which is 8 per cent more than last year. 14 COMPARATIVE CRUDE BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY AND CASERATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1951. 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. Births Rates per 1,000 Home Population: Live Births 15.5 17.3 16.7 17.8 12.2 Still Births 0.36 0.45 0.38 0.37 0.36 Deaths: All causes 12.5 13.4 12.5 13.1 11.5 Typhoid and paratyphoid 0.00 0.00 0.00 — 0.02 Whooping cough 0.01 0.01 0.01 0.01 — Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.31 0.37 0.31 0.38 0.33 Influenza 0.38 0.36 0.38 0.23 0.23 Smallpox 0.00 0.00 0 00 — — Acute poliomyelitis and polioencephalitis 0.00 0.01 0.01 0.00 — Pneumonia 0.61 0.65 0.63 0.61 0.51 Notifications (Corrected) Typhoid fever 0.00 0.00 0.00 0.01 0.12 Paratyphoid fever 0.02 0.03 0.02 0.01 0.05 Meningococcal infection 0.03 0.04 0 03 0.03 — Scarlet fever 1.11 1.20 1.20 1.10 1.39 Whooping cough 3.87 3.62 4.00 3.11 3.18 Diphtheria 0.02 0.02 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.15 0.05 Smallpox 0.00 0.00 0.00 — — Measles 14.07 13 93 14.82 14.64 12.60 Pneumonia 0.99 1.04 0.96 0.72 0.79 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 — Non-paralytic 0.02 0.02 0.03 0.02 — Food poisoning 0.13 0.15 0 08 0.23 0.03 Deaths: Rates per 1,000 Live Births: All causes under 1 year of age 29.6* 33.9 27.6 26.4 21.7 Enteritis and diarrhoea under 2 years of age 1.4 1.6 1.0 0.7 — Notifications (Corrected)): Puerperal fever and pyrexia Rates per 1,000 (Live and Still) Births: 10.66 13.77 8.08 14.90 3.72 England and Wales. Rates per 1,000 Total (Live and Still) Births. Coulsdon and Purley Urban District. Rates per 1,000 Total (Live and Still) Births. Maternal Mortality: Abortion with Sepsis 0.09 — Other abortion 0.05 — Toxaemia 0.24 — Haemorrhage 0.13 — Sepsis 0.10 — Other complications 0.18 — A dash (—) signifies that there were no cases. * per 1,000 Related Live Births. 15 INFECTIOUS DISEASE. The following table indicates the numbers of cases of infectious disease notified during 1951, the number thought to have been treated in hospital, and the number of deaths which occurred. Disease. Numbers Notified. Treated in Hospital. Total Deaths. Diphtheria Scarlet fever 90 43 — Erysipelas 3 1 — Puerperal pyrexia 3 2 — Pneumonia — primary 51 16 33* Typhoid fever 8 8 1 Paratyphoid 3 3 — Dysentery 22 19 — Poliomyelitis — — — Measles 810 9 — Whooping cough 204 3 — Food poisoning 2 Totals 1,196 104 34 * Includes deaths from all forms of pneumonia. A further analysis of these cases by age, wards and the months during which they occurred is given in Tables I and II in the Appendix, while a full statement of the cases of infectious disease notified since 1921 is presented in Table III in the Appendix. It will be seen that measles was by far the commonest notifiable infectious disease; in fact 1951 was a peak year for this infection. Scarlet fever, now also a relatively mild disease, was however less prevalent, and no cases of poliomyelitis or diphtheria were notified. Excluding measles and whooping cough, which were not notifiable between the two wars, and the hospital cases of dysentery, which have remained at a comparatively low level, it is noted that the incidence of the remaining acute infectious diseases decreased from 3.1 per 1,000 population in 1950 to 2.6, which is lower than the pre-war average, though still slightly higher than in recent years, due this year to the increase in cases of pneumonia. SMALLPOX. On three occasions during the year individuals or groups of persons were notified who had moved into the District, having recently been in contact with a case of smallpox. They were all kept under surveillance, and contacts were encouraged to obtain vaccination or revaccination. No case of the disease resulted. 16 DIPHTHERIA. For the fifth year in succession no confirmed case of diphtheria has occurred in the District, and this year only one suspected case was sent to hospital. While this achievement, which is chiefly attributable to the health services, is one of the most satisfying in recent years, particularly when the saving of life, illhealth, manpower and money is considered, there has been evidence of late that the germ of this disease has not been absent from this neighbourhood, hence the standard of immunity of the population must not be permitted to decline. SCARLET FEVER. There was a recession in the prevalence of scarlet fever in the District during 1951, as was expected after two successive years in which the number of cases was relatively high. The actual number of cases was 90 compared with 149, 138, 78 and 62 in the preceding four years. Judging by previous experience the incidence should not increase greatly during the next year or two. The disease remains of a very mild type, resulting in an increase in the number of missed cases, and it is, therefore, the more difficult to limit its spread, or to forecast the number of cases which can be expected. In fact, when it is remembered that, associated with each case there are almost always other persons carrying the germ and sometimes showing symptoms of illhealth but not developing a rash, it is remarkable that the number notified as scarlet fever remains relatively constant from year to year. Similarly, it is surprising that for the last 4 years almost all the cases have been young children. It would appear that with advancing years an immunity is developed to the rash producing elements, though not to the same extent to the invasion of the actual germs. In 1951 only one case was over school age and only 7 others were 10 years of age or older. While contact at school is not the only way of spreading the infection, it is obvious from the distribution of the cases that this has probably the greatest influence. (No less than 24 of the cases attended Selsdon school). Of the 90 cases, 47 were treated at their homes and 43 in a variety of Isolation Hospitals. (Wandle Valley 16, Bletchingly 9, Cuddington 6, Croydon 4, Dorking 4 and The Grove 2). On only one occasion was a second case notified from the same house as a primary case, and then the infection may well have been passed before the original case, which was being treated at home, was diagnosed. It is clear that in the majority of cases treatment can well be provided at home. There appeared to be justification for all 17 cept 4 of the admissions to hospital, however, during 1951, which is fewer than in the previous year. Unnecessary hospitalisation should obviously be avoided in view of the risks of cross infection for the patient, the absorption of bed space and nursing manpower which might be otherwise utilised, and the cost to the community. ERYSIPELAS. Only 3 cases of erysipelas were notified, compared with 4 in each of the preceding two years. They were in no way connected with each other, and, except for one who was a Mental Hospital patient, were treated at their homes. All recovered. PUERPERAL PYREXIA. There were 3 cases notified as suffering from puerperal pyrexia, compared with the recent average of 2 per annum. One had been confined in hospital, another in a nursing home and the third at her home. All recovered without being removed to another type of establishment. OPHTHALMIA NEONATORUM No case of ophthalmia neonatorum was notified. ENTERIC FEVER. Eight cases of typhoid were notified, but seven of these all being Phage Type A, occurred in the early Summer in one of the Mental Hospitals where they were treated. The other who had Phage Type D.l. contracted the disease in Italy and was treated in a Nursing Home. One of the Mental Hospital cases died. Three cases of Paratyphoid B infections were notified, two being children and one a Mental Hospital case. All were treated in hospital and recovered. One of the children was Phage Type 1, but the organism from the other child could not be typed. There was no connection between the cases, and the source of infection could not be traced. In addition three residents were among a party who mostly suffered from a gastro-intestinal infection while in Paris. Some were found to be suffering from paratyphoid on returning to this Country, but the local residents had all recovered on their return. DYSENTERY. There were 22 notifications of dysentery compared with 28 in 1950, but of these 16 were inmates of one of the Mental Hospitals and one a patient of the other Mental Hospital. All 18 these were infected by the Flexner type of dysentery bacillus. By contrast the 5 cases notified from among the residents in the District were all isolated cases of the milder Sonne type of dysentery. FOOD POISONING. Only two cases were notified which might have suffered from food poisoning, a husband and wife who had eaten a meal a quarter of an hour before the onset of symptoms. The most suspicious article in their diet was some bottled fruit, which may possibly have caused chemical poisoning. A series of gastro-intestinal upsets in another family was investigated, the vomit of one member having shown the presence of pathogenic staphylococci. As the cases occurred at intervals over a period of eight days and no special food could be incriminated, it was concluded that an infection was being spread from hand to mouth and that it did not originate from food. POLIOMYELITIS. Only one resident is known to have contracted Poliomyelitis during the year, and the infection probably originated at a seaside resort. As the diagnosis was made in a Croydon general hospital notification was accepted by Croydon. Three other residents were treated in hospital for suspected poliomyelitis, but one, who had been similarly suspected in 1950 when exhibiting the same symptoms, proved to be a case of pereneal muscular atrophy. Another had acute toxic poly-neuritis and the third may have had a virus meningitis. At least three residents had rather unusual meningitic symptoms complicating mumps early in the year when the disease was very prevalent, while a young child was admitted to hospital in February with suspected meningitis which proved to be a case of pneumonia. PNEUMONIA. During 1951, at least 51 cases of acute primary or influenzal pneumonia are known to have occurred, the majority in January and February when some residents suffered from influenza. This is twice the highest number of notifications received in any recent year, but the apparent increase in cases resulted from an attempt to assess the extent to which influenza was occurring. The admission of any case of pneumonia to hospital by ambulance was followed up and the correct diagnosis ascertained. At least 16 of the cases are known to have been treated in hospital, including 4 Mental Hospital patients. 19 One advantage of tracing the hospital cases was that a more complete picture of the prevalence of primary pneumonia was obtained, for as usual notification was most spasmodic, two doctors notifying more than half the cases. On the other hand as patients were already in hospital when notified, no useful preventive measures could be instituted. None of the cases appeared to be interconnected. A total of 33 deaths from all forms of pneumonia occurred but only a few of them were among the notified cases. MEASLES. In the Annual Report for 1950 it was noted that a rapid increase in the number of cases of measles had occurred in the last two months when 371 of a total of 477 cases had been notified. This wave, which began in October, 1950, continued until August, 1951, the peak being in March, 1951 when 231 cases were notified out of a total of 810 cases notified during the year. This total is 105 more than the previous highest number of notifications, which was in 1945. All parts of the District had a large number of cases except Selsdon and, as usual, it was the 5-10 year old children who were chiefly affected, but a large number of the 2-5 year old children also suffered. Fortunately, the disease was of a fairly mild type with few complications, only 9 being admitted to hospital. As waves of whooping cough, chickenpox and mumps occurred more or less concurrently with the measles epidemic, measures to limit its spread were mostly impracticable and only the most important cases could be visited by the Health Visitors. Doubt has previously been expressed in these Reports as to the usefulness of compulsory notification of measles and whooping cough in a District such as this, and recent experience has tended to confirm this view. Payment of the full notification fee has given a more complete picture of the number of cases, but less preventive work is practicable. Owing to the National Health Service Act almost all cases are seen by private doctors and at an earlier stage than hitherto, while modern methods of treatment reduce the risks and combat the results of complications. WHOOPING COUGH. This disease was again fairly prevalent. In 1950 there had been 242 cases with the peak in August, while in 1951 there were 204 cases with a slightly smaller peak in March. Only occasional cases were occurring at the end of the year. The ages and geographical distributions were very similar to those for measles, Selsdon having remarkably few cases. 20 Only 3 cases were admitted to Hospital, and no death occurred from this disease. Research in respect of preventive inoculations is producing favourable results and it is anticipated that an official scheme will become practicable in the near future. TUBERCULOSIS. The following table presents concisely the position with regard to tuberculosis in the District during 1951:— Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number of cases on register, 1st January, 1951 206 142 32 37 238 179 Additions, 1951:— New cases notified 38 22 3 1 41 23 Cases removed into District 10 10 1 2 11 12 Restored to register 1 1 — — 1 1 Total Additions 49 33 4 3 53 36 Removals, 1951:— Deaths from (a) Tuberculosis 10 1 — — 15 4 (b) Other causes 4 1 1 2 Removed from District 9 9 1 2 10 11 Recovered 6 1 2 2 8 3 N on-tuberculous Total Removed from Register 29 12 4 6 33 18 Number of cases on register, 1st January, 1952 226 163 32 34 258 197 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 — — — — — — — — 5 and under 10 — — 1 — — — — — 10 and under 15 1 — — — — — — — 15 and under 20 3 3 — — — — — — 20 and under 25 5 3 — — 1 — — — 25 and under 35 5 6 1 — 3 — — — 35 and under 45 8 4 — — 2 1 — — 45 and under 55 8 5 — — 3 1 — 1 55 and under 65 6 1 1 2 — — — 65 and over 2 1 3 — 1 1 Totals 38 22 3 1 14 2 1 2 21 The new cases were distributed amongst the wards as follows:— Localisation. Coulsdon East. Coulsdon West. Kenley Parley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 11 15 7 9 13 7 3 Non- pulmonary 1 1 — — 1 — 1 Totals 12 16 2 9 14 7 4 The number of new notifications of pulmonary tuberculosis was 60, compared with 47, 57, 48 and 59 in the previous four years. This corresponds with a case rate of 93 per 100,000 population, which is above the average for the last 5 or 10 years, and a considerable increase on last year. The fact that this rate is now much higher than it was in the years immediately before the war, is, however, partly due to the influence of Mass Radiography etc. in detecting more cases in their earlier stages, and partly because the success of modern treatment encourages early notification. The incidence of this disease can be further reduced if more hospital beds are made available, immunisation and segregation of contacts is encouraged, and preferential treatment is given in rehousing and rehabilitation. By contrast with the case rate, the death rate from pulmonary tuberculosis has again dropped to a low level, as it has nationally, being only 17 per 100,000 population in 1951, compared with 31, 64 and 29 in the three preceding years, and a post-war average of 43. (Nationally it was 40 in 1949, 32 in 1950 and 28 in 1951.) The incidence of new cases of non-pulmonary tuberculosis decreased (6 per 100,000 population compared with 11 last year and the post-war average of 12), while there were no deaths from this form of tuberculosis compared with the post-war average of 3 per 100,000. The Council continues to be responsible for two measures aimed at combating this disease, viz., rehousing and disinfection, but the County Council bears the responsibility for all other preventive measures except the treatment of cases, which has passed to the Regional Hospital Boards. A scheme for the immunisation of certain sections of the population is being instituted, and it is hoped that still more beds for treatment will be made available. The Mass X-ray Unit operated for a period during the Autumn in South Croydon, this being the best site which could be obtained to deal with those most needing examination in the area. More Units will be required if the practice of annual reexaminations is to be encouraged. 22 The local Tuberculosis Clinic is held every Monday from 2-4 p.m. at the Surrey County Council Clinic, 62, Whytecliffe Road, Purley. 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 again accounted for very few deaths, with the exception of influenza, to which 15 deaths were attributed in 1951. 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, waves of chickenpox and mumps coincided approximately with those of measles and whooping cough in the Spring. No case of ringworm was reported. Home visitation and exclusion from school are still the two chief methods relied upon to prevent the spread of these diseases. Treatment in hospital is provided when required owing to social or physical complications being present, but records of these admissions are rarely received. INFESTATIONS. (a) Scabies. During 1951 the number of persons treated by the Health Department for this disease was only 11, (5 adults, 4 school children and 2 children under 5 years), while a few contacts were provided with a special soap now used as a preventative. A total of 20 treatments was carried out, almost all in the patients' own homes by the Medical Officer or a Nurse. The welcome decrease in the prevalence of this disease is shown by the following table:— 23 Year. Number of Baths given. Number of Persons treated. 1943 1,217 326 1944 905 399 1945 768 349 1946 805 250 1947 316 172 1948 133 60 1949 49 15 1950 20 11 1951 20 11 It would be preferable if, in order to deal effectively with contacts, more of the apparently isolated cases which occur from time to time were referred to the Medical Officer of Health. (b) Vermin. The number of cases of infestation noted remained small and was limited to 24 children found to have head nits in school. Almost all of these were only casual infestations which immediately responded to the treatment mainly provided by the parents. A concerted effort is being made to deal with the few families most prone to reinfestation. THE CONTROL OF INFECTIOUS DISEASE. The place of immunisation among the measures for the control of infectious disease remained much as in recent years, and it is still very important that the parents of all children should ensure that they are kept as highly immune as possible against diphtheria by early immunisation and periodical enhancing doses. The comparatively small risk of this treatment influencing the onset of poliomyelitis is now well-recognised and precautionary measures can be instituted as and when these are indicated. It should certainly not deter parents from agreeing to immunisation against diphtheria, which treatment will only be given if the time is considered opportune by the doctor concerned. DIPHTHERIA IMMUNISATION. The following table shows the treatment given during 1951, and the proportion of children estimated to have been immunised in that year:— 24 Centres and Clinics (including day nurseries). Number who completed Primary treatment 321 Number of "Booster ' doses given 118 Schools. Number who completed Primary treatment 3 Number of " Booster" doses given 685 General Practitioners. Number who completed Primary treatment 71 Number given "Boosters" 420 Proportion of children estimated to have been immunised:— (a) from 1-5 years 49.3% (b) from 5-14 years 92.4% The above figures suggest a decrease of about 200 in the number receiving primary immunisation, mainly from general practitioners, compared with the corresponding figures in 1950, but a substantial increase in "boosting " among the older children. The percentage of the children aged 1 to 5 years, who were estimated to have been immunised was the same as in the previous year, but the proportion of school children who had been treated probably increased by 1 per cent. To repeat, it is incumbent upon parents to co-operate in ensuring that diphtheria is not allowed to reappear in our midst. VACCINATION. The following table shows the number of vaccinations performed in the District during 1951:— Welfare Centres. Primary vaccinations 273 General Practitioners. Primary vaccinations 0-15 years 443 „ „ over 15 years 166 Re-vaccinations 0-15 years 90 „ over 15 years 377 All these figures show a very substantial increase on those for 1950, which was probably due to the proximity of the Brighton outbreak of smallpox, with which a number of residents were indirectly in contact. WHOOPING COUGH IMMUNISATION. It is known that an appreciable proportion of children are now given combined whooping cough and diphtheria immunisation treatment by their private doctors under the 25 National Health Service Act, but no records are called for or available to the Medical Officer of Health. Until recently it has been thought unwise to introduce an official scheme of whooping cough immunisation pending the production of materials which can be guaranteed as being reliable, but it is probable that a scheme for this form of immunisation will soon be introduced. BACTERIOLOGICAL AND CHEMICAL EXAMINATIONS. Almost all the specimens requiring bacteriological examination in the interests of the public health are sent to the Public Health Laboratory, West Hill House, West Hill Road, Epsom, and during 1951 reports were received on the following specimens:— Milk, ice cream, and water samples 396 Nose or throat swabs 40 Sputum 1 Faeces Urine Vomit 77 Blood Food Samples of water requiring chemical analysis, and milk for biological examinations are sent by the Local Authority to The Clinical Research Association, while Food and Drug samples are submitted to the Public Analyst. 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. 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:— £1 per load of bedding, etc., 5s. for the first room and 2s. 6d. for each additional room disinfected at the same time. During 1951 the following disinfections were carried out:— Free of cost. Upon payment. Total. Loads of bedding, etc 101 7 108 Houses disinfected 93 7 100 26 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 16 such establishments in the Urban District. NATIONAL ASSISTANCE ACT, 1948, SECTION 47. The powers given under this section for securing the removal of aged persons from insanitary conditions were not utilised during 1951, but the threat of action in one borderline case and alternative measures in another resulted in admission to a Home or improved conditions. The one case dealt with under this Section in 1949 is now living happily and voluntarily in a Home for elderly people in the neighbourhood. 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 during the year 3 burials were thus arranged. HEALTH PROPAGANDA. Steady use was made of the opportunities for health propaganda at the Clinics and Centres in the area, and during the visitation of the Health Visitors and Sanitary Inspectors. In addition, a number of talks was given by the Officers to voluntary organisations. The material provided by the Central Council for Health Education and other bodies proved extremely useful and was widely employed. OTHER HEALTH SERVICES. The local Council is represented on the S.E. Divisional Health Sub-Committee of the County Health Committee, which body has considerable delegated powers and responsibilities for some of the allied Health Services. The Medical Officer of Health for this District and his Deputy, who hold similar positions in the Caterham and Warlingham Urban District, are also the responsible officers for the Divisional Health Service, which deals with the maintenance and detailed organisation of the following branches:- 27 Maternity Clinics. These are now held at:— 62, Whytecliffe Road, 2nd, 4th and 5th Wed- (Purley and Kenley Purley. nesday in each month, mothers). 2—4 p.m. 62, Whytecliffe Road, Every Thursday (Old Lodge Lane, Purley. 2—4 p.m. Coulsdon and Sand- erstead mothers). Westway, Caterham- 1st, 3rd and 5th Mon- (Old Coulsdon on-the-Hill. day in each month, mothers). 2—4 p.m. The Baptist Church, 2nd and 4th Wednesday Addington Road, in each month, 2—4 Selsdon. 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. Domiciliary and Home Nursing Services. The Midwifery and General Nursing Services have now been divisionalised. Midwives. The County midwives can be found as follows:— Telephone: *Miss Neighbour, Flat 1, "Woodlands," Sanderstead Hill, Sanderstead SANderstead 3514 Miss Dale, Flat 2, "Woodlands," Sanderstead Hill, Sanderstead SANderstead 5654 *S.C.C. Nurses' Home, "Westview," Woodstock Road, Coulsdon Downland 4005 *Premature baby outfits are held by these officers for use throughout the Division. Disrict Nursing Service. The services of general trained nurses employed by the County Council can be obtained by application to:— Telephone: S.C.C. Nurses Home, "Westview," Woodstock Road, Coulsdon Downland 4005 Miss Dickinson, 58, Brighton Road, Purley UPLands 6815 Miss Lansdell, 32, Higher Drive, Purley UPLands 6715 Miss Hawking, Flat 1, The Quest, Sanderstead Road, Sanderstead SANderstead 1969 Miss Dale, Flat 2, "Woodlands," Sanderstead Road, Sanderstead SANderstead 5654 28 Home Help Service. Applications for the service of a Home Help should be addressed to the Home Help Organiser, 115, Brighton Road, Purley. In case of emergency the following telephone numbers may be used:— UPLands 7014 or 9277, preferably between 9.30 and 10.30 a.m. Home Helps can only be supplied to cases genuinely needing their assistance in which ill-health or old-age are involved; the capacity of the Service is limited, but preference is given to those in 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 Council 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 115, Brighton Road, Purley. Health Visitors. The local Health Visitors are based on 115, Brighton Road, Purley (UPLands 9277), and should normally be contacted through the Divisional Medical Officer or the 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. Community Centre, Hooley 1st and 3rd Wednesday 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, while a Toddlers' Session is held at the Selsdon Centre from 10-12 noon on the 2nd and 4th Wednesday in each month. 29 Day Nurseries. The two local Day Nurseries, which are situated as follows, accept the children of residents for health reasons or if they come within certain very limited social groups. " 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. 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 clinic held at 62, Whytecliffe Road, Purley. Similarly, ante-natal or nursing mothers and children under 5 years needing dental treatment are referred for treatment to the dental clinic sessions held in the same premises. SCHOOL HEALTH SERVICE. The Surrey County Council is also responsible for this service, the responsible officer locally being the Divisional Medical Officer, 115, Brighton Road, Purley, but representatives of the local Council serve on the South Eastern Divisional Executive, which is based on 38, Grovelands Road, Purley. (UPLands 7601). School Clinics. The following minor ailment clinics are held weekly at:— S.C.C. Clinic, 62, Whytecliffe Road, Purley Thursdays 9—11 a.m. Baptist Church, Addington Road, Selsdon Mondays 1.30—2.0 p.m. St. John's Hall, Bradmore Green, Old Coulsdon Wednesdays 1.45—2.0 p.m. The following clinics for school children are also held at 62, Whytecliffe Road, Purley. School dental clinic Fridays 1.30 or by appointment. School Eye clinic By appointment. Speech therapy clinic Remedial exercise clinic OTHER COUNTY SERVICES. Ambulances. The Ambulance Stations in this District are at present at:— Telephone: Purley Fire and Ambulance Station, Brighton Road, Purley UPLands 2222 Sanderstead Fire and Ambulance Station, Limpsfield Road, Sanderstead SANderstead 2222 30 The Area Superintendent, Mr. R. A. Cupit, is stationed at the S.C.C. Main Ambulance Station, Smallfield, Horley (Smallfield 271). Welfare Officers. The County Welfare Officers can be found as follows:— Telephone: Mr. W. J. Middleton (Principal Divisional Welfare Officer), 108, Windermere Road, Coulsdon UPLands 0776 Mr. E. G. Griffiths, (Divisional Welfare Officer), 108, Windermere Road. Coulsdon UPLands 0776 Welfare Homes. These are situated in the Chipstead and Caterham areas, adjoining the Coulsdon and Purley District, namely:— Telephone: "Chipstead Lodge," Hazel wood Lane, Chipstead Downland 4811 "Santa Tecla," Stanstead Road, Caterham Caterham 2641 Duly Authorised Officer for Mental Health Service. The Duly Authorised Officer for this District can be found as follows:— Telephone: Mr. D. E. Twivey, 44, Reigate Hill, Reigate Reigate 3357 Children's Officer. The care of children apart from their parents is the responsibility of the County Council under the provisions of the Children's Act, 1948. The Children's Welfare Officer for this area is as follows:— Telephone: Miss J. M. Vann, Children's Department, County Hall, Kingston-upon-Thames KINgston 1050 Blind Welfare Worker. Telephone: Miss Mitchell, 53, Abbey Road, Selsdon SANderstead 2790 HOSPITALS. This District comes within the ambit of two Hospital Groups of the S.W. Metropolitan Regional Hospital Board, viz., the Croydon and Redhill Groups, which are centred on the Croydon General Hospital, London Road, Croydon, (Tel. No.: CROydon 3425), and the Redhill County Hospital, Earlswood Common, Redhill, (Tel. No.: Redhill 3581). 31 The majority of the local residents needing in-patient hospital treatment are admitted to the Redhill County Hospital, especially the local maternity cases, but out-patient treatment is supplied by both Groups, while a proportion attend Out-patients' Departments at St. Helier's Hospital and the London Hospitals. CLINICS ADMINISTERED BY THE GROUP HOSPITAL BOARDS. Tuberculosis— 62, Whytecliffe Road, Purley Every Monday 1.30—3.30 p.m. Venereal Disease— Croydon General Hospital Males: Tuesdays, 7 p.m. Saturdays, 10.45 a.m. Women and Children: Wednesdays, 2.30 p.m. Thursdays, 11.0 a.m. Fridays, 5.30—7.0 p.m. Redhill County Hospital Males: Mondays, 5—7 p.m. Females: Wednesdays, 5—7 p.m. 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. ASSOCIATED VOLUNTARY BODIES. Moral Welfare Worker. Miss Pottinger, 1, Sunnyrise, Caterham Caterham 3728 National Society for the Prevention of Cruelty to Children. Inspector R. Lee, 37, Hartley Road, Croydon THOrnton Heath 4250 coulsdon and purley guild of social service. Miss Honeyman, 105, Brighton Road, Purley UPLands 6800 coulsdon and purley old people's welfare association. Secretary: Mr. A. Lever, 4, Britton Crescent, Sanderstead SANderstead 1171 coulsdon and purley marriage guidance council. Secretary: Mrs. H. W. Pritchard, 38, Russell Hill, Purley UPLands 9029 Road Safety Committee (Coulsdon and Purley). Secretary: Mr. A. E. Hartnall. 137, Coulsdon Road, Old Coulsdon. 32 HOUSING. The following is a statistical record of work carried out in respect of the sanitary condition of dwelling houses, as required by the Minister. 1. Inspection of Dwelling Houses during the Year 1951. (1)(a) Total number of houses inspected for housing defects (under Public Health or Housing Acts) . 319 (b) Number of inspections made for the purpose 1,440 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3 (b) Number of inspections made for the purpose 10 (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 282 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 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 Nil (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 11 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 7 (b) By Local Authority in default of owners 6 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses 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 33 (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 9 (2) Number of families dwelling therein 13 (3) Number of persons dwelling therein 49 (b) Number of new cases of overcrowding reported during the year 6 (c) (1) Number of cases of overcrowding relieved during the year 8 (2) Number of persons concerned in such cases 39 (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 114 By other persons 82 The Chief Sanitary Inspector reports that "In spite of increasing difficulties associated with the repair of unfit houses a considerable measure of repair work has been carried out during the year and a total of 390 houses were rendered fit in consequence of action taken by the Department. This number compares favourably with the figure of 217 recorded in the previous year, despite the fact that fewer houses were inspected. This trend emphasizes the policy being pursued of dealing only with the more urgent items of disrepair under the provisions of the Public Health Act in preference to action visualised under the provisions of the Housing Act, 1936. Nevertheless, it is becoming more and more apparent that only complete revision of the legislation dealing with the repair and maintenance of houses will resolve the problem presented by high cost repairs in relation to low controlled rents. With the need at the present time for more and more houses, it is virtually impossible to consider demolition, except in extreme cases, yet such action would be inevitable in many cases if the statutory steps to be taken under the Housing Act were pursued. These factors are no doubt of much more concern in many areas in the country, but the gradual deterioration in the condition of the class of property under consideration, even in districts such as this where the general level of housing is of a much higher standard than the average, points to the urgency of the problem. The Housing Department have again shown their readiness to assist where possible in the more acute cases of overcrowding." 34 WATER SUPPLY. The water supply of the District was, as in previous years, provided by the Sutton District Water Company and the East Surrey Water Company, with a private supply supplementing, as necessary, at Cane Hill Hospital. Routine samples of the treated water in public supply were submitted quarterly for bacteriological and chemical examination. In addition, two samples were obtained for bacteriological examination only from the private supply at Cane Hill Hospital, making 18 samples in all. In addition, both the Water Companies and the Local Authorities sharing these public supplies provided the Department with copies of the 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 no unsatisfactory reports were received on the samples taken from the supplies to the District. The Cane Hill Hospital Management Committee has made arrangements with the Public Health Department of the London County Council for routine sampling and supervision of the water supply from the relatively shallow well in their grounds, which is used exclusively by this Hospital. Adequate chlorination is essential and steps have been taken to ensure this and to effect closer co-operation between the officers of the three authorities interested in the standard of this supply. The results of two chemical and two bacteriological examinations of the water in public supply are given below and these are fairly typical of the reports received:— Chemical Analysis. Sutton District Water Company. East Surrey Water Company. Parts per 100,000. Grains per Gallon. Parts per 1OO,OOO. Grains per Gallon. Total solids (dried at 180°C.) 20.0 14.0 17.0 11.9 Combined chlorine (CI) 1.7 1.2 1.8 1.3 equivalent to Sodium Chloride (Na CI). 2.8 2.0 3.0 2.1 Nitric nitrogen (Nitrates) 0.30 0.21 0.58 0.41 Nitrous nitrogen (Nitrites) Minute trace present. Minute trace present. Ammoniacal nitrogen Nil Nil 0.0004 0.0003 Albuminoid nitrogen 0.0002 0.0001 0.0004 0.0003 Oxygen absorbed in 4 hours at 27°C. Nil Nil Nil Nil Lead or Copper Nil Nil Nil Nil Temporary hardness equivalent CaC03 9.0 6.3 4.0 2.8 Permanent hardness 3.0 2.1 4.0 2.8 Total hardness 12.0 8.4 8.0 5.6 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. A total of 46 samples were taken from the supplies of the two Companies and examined for hardness by the Department, all of which were satisfactory, in that adequate softening had been carried out. RAINFALL. The rainfall registered by the automatic rain gauge installed at Alderstead Heath was 44.45 inches, this being an increase of 12.67 inches compared with the previous year. The monthly totals throughout the year were as follows:— inches. January 3.86 February 7.11 March 3.95 April 3.49 May 2.52 June 1.66 July 2.25 August 4.90 September 3.40 October 1.22 November 6.89 December 3.20 DRAINAGE AND SEWERAGE. A total of 915 yards of new sewers was constructed during the year, and of this total 635 yards were in connection with a scheme for converting the cesspools of 24 houses to main drainage. A further 250 yards were constructed by joint agreement between the owners concerned and the Council, in order to provide main drainage in connection with a group of 5 houses, a catering establishment and a piggery on Farthing Downs. The remaining 30 yards were necessitated by the development of Council Housing Estates. CLOSET ACCOMMODATION. During the year the Council continued, to a limited extent, the implementation of their long standing policy of eliminating cesspool drainage in the District wherever possible. As a result, 36 30 houses, in addition to the piggery and catering establishment referred to above were connected to the public sewer and 28 cesspools abolished. At the end of the year the following pail closets and cesspools remained in use:— Premises with pail closets 14 Number of cesspools153 The contents of pail closets at private premises are disposed of in the gardens by the occupiers of the houses. PUBLIC CLEANSING The collection of refuse was continued on a weekly basis throughout the year, and the charges for trade refuse collection and for cesspool emptying remain unchanged. SMOKE ABATEMENT. The chimneys of the small factories in the District give little trouble and no serious nuisance was recorded during the year. 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 have not hitherto been a serious problem, but during the early part of the year an influx of gipsies into two parts of the District gave rise to serious nuisance owing to the depositing of litter and lack of sanitary conveniences, the amenities of the adjoining areas being adversely affected. Action was taken under Section 57 of the Surrey County Council Act, 1931, as amended, and complaint was made to the Court in accordance with the provisions of the Act. As a result, Orders were made by the Court requiring the removal of the moveable dwellings and prohibiting any further placing of such dwellings within areas defined on maps attached to the Orders. This action appears to have had the desired effect, and no further trouble has been experienced. 37 SWIMMING BATHS. There are two swimming baths in the District which are used by the general public, and during the year 9 samples of water were obtained for examination. Four were reported as unsatisfactory, including two which were taken at the same time for chemical and bacteriological examination. Representations were made that insufficient chlorination had been provided, and subsequent samples proved satisfactory. 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. The Chief Sanitary Inspector reports that "Surveys are carried out as and when necessary to observe compliance with the Shops Act in respect of general closing hours, half day closing and Sunday trading, with individual inspections as necessary in respect of conditions of employment of young persons. In addition, advice is given to traders on the operation of the Shops Act as related to specific trades. It is anticipated that, in due course, amended legislation to that existing will be introduced in the light of the Report of the Gowers Committee on this subject. This will necessitate a complete review of the position and, with this in mind, a new register has been prepared and tabulated." 38 FACTORIES AND WORKPLACES. Factories Acts, 1937 and 1948. PART I. 1. INSPECTIONS. Premises. Number on Register. Number of Inspections. Written notices. Occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 39 51 6 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 139 200 15 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 4 7 4 — Total 182 258 25 — 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. Refe To H.M. Inspector. rred By H.M. Inspector. Want of cleanliness (S.l) 8 5 _ 1 Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) - — Ineffective drainage of floors (S.6) — — - — — Sanitary Conveniences (S.7) (a) Insufficient 3 3 1 1 — (b) Unsuitable or defective 14 14 - — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 25 22 1 2 — 39 PART VIII. OUTWORK. (Sections 110 and 111) Nature of Work. Section no. Section hi. No. of out-workers in August list required by Sect. 110 (i) (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. Wearing apparel Making, etc. Cleaning and washing 33 — — — — — Household linen 2 — — — — -- Paper bags 1 — — — — — Carding, etc. of buttons etc. 29 — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 8 — — — — — Total 73 — — — — — SANITARY INSPECTIONS, ETC. The following is a summary of the complaints received, visits made, notices served and defects remedied during the year 1951. There was again an increase in the number of complaints received, mainly due to more complaints of unsound food, wasps' nests and infestation by rats and mice. The total number of visits made by the Sanitary Inspectors compared very favourably with the previous year, and those premises in which food is prepared and stored for sale continued to receive special attention. The Chief Sanitary Inspector and his colleagues can again be congratulated on a very full and useful year's work. 40 Complaints Received. General disrepair and insanitary conditions 78 Dampness 56 Obstruction of light by trees 2 Overcrowding 8 Defective drainage systems 27 Blocked drainage systems 138 Defective drainage fittings 9 Defective sinks and lavatory basins 2 Defective W.C. pans and flushing apparatus 19 Defective service water pipes 3 Defective hot water systems 4 Defective chimney stacks 6 Absence of, or defective dustbins 6 Insanitary pig waste bins 2 Accumulation of refuse, etc. 17 Insanitary A.R.P. shelters 1 451 Rats and mice Keeping of animals 10 Insect pests, etc 39 Wasps' nests 84 Unsound food 145 Miscellaneous 48 Total 1,155 Summary of Visits Made. Number of houses visited 337 Number of reinspections and calls made 1.127 Verminous premises 38 Water supply 10 Tents, vans and sheds 380 Schools 3 Places of entertainment 20 Licensed premises 15 Storage of refuse 36 Accumulations 103 Piggeries, fowls and other animals 110 Stables 11 Rats and Mice Destruction 5,757 Drainage inspected 1,893 Drainage tested 224 Pail closets 5 Cesspools 204 Urinals 3 Smoke observations 5 Sewers and street gullies 187 Cowsheds, dairies and milkshops 150 Ice-cream premises 150 Meat shops 101 Food preparing premises 254 Other food shops 399 Bakehouses—Power 55 „ Other 5 Slaughterhouses 25 Food Inspection—Meat 27 „ „ Other Food 219 Factories—Power 152 Other 42 Workplaces 4 Outworkers 25 Shops Act 576 Infectious disease enquiries 137 Infectious disease contacts 38 41 Food poisoning enquiries 1J Disinfection 133 Disinfestation 155 Swimming baths 14 Sampling—Food and Drugs Act, 1938 212 „ Ice-cream 98 „ Milk (bacteriological) 251 „ Water 22 „ Milk (biological) 46 Interviews 1,463 Miscellaneous visits 929 Total 16,161 Defects Remedied. Drainage and Sanitary Fittings: Drains examined and tested 408 Drains repaired 19 Drains reconstructed 71 Blocked drains cleared 169 Soil and vent pipes repaired or renewed 16 Inspection chamber covers renewed and frames rebedded 93 Fresh air inlets repaired or renewed 49 New W.C. pans fixed 22 New W.C. seats provided 6 W.C. flushing cisterns repaired or renewed 13 Cesspools provided or enlarged 4 Cesspools cleansed, repaired or renewed 6 Cesspools abolished 28 House drains disconnected from cesspools and connected to sewer 30 Sewage treatment plant repaired 1 Soakaways constructed 18 Eaves gutters and stack pipes renewed or repaired 51 New lavatory basins fixed 3 New baths fixed 1 Glazed sinks renewed or repaired 3 Waste pipes trapped, repaired or renewed 10 Sink gully surrounds repaired 37 Pail closets abolished 2 New urinals provided 2 Miscellaneous 7 General Housing Repairs: Defective roofs repaired 58 Chimney stacks repaired 26 Yards paved, or paving repaired 14 Dampness in walls remedied 33 Damp-proof courses provided 12 Additional sub-floor ventilation provided 10 External walls repaired 3 Walls and ceilings repaired 87 New ceilings provided 34 Walls of rooms cleansed 67 Ceilings of rooms cleansed 66 Floors repaired or renewed 41 Ventilation and lighting of rooms improved 6 Larders provided 3 Windows repaired or renewed 37 Doors repaired or renewed 17 Steps repaired 3 Firegrates repaired or renewed 15 Coppers repaired or renewed 2 Boiler flues repaired 3 Service water pipes repaired or renewed 6 42 Additional ventilation and light provided to W.C. apartments 1 Walls and ceilings of W.C. apartments cleansed 10 Portable dustbins provided 7 Accumulations removed 15 Miscellaneous 4 Ratproofing: Work carried out by occupiers of premises after completion of treatments 32 Food Premises: Ice Cream conservators cleansed 1 New cold store provided to butcher's shop 1 Food shops reconstructed 5 Hot water supply provided for ablution purposes 22 Lavatory basins provided 4 Glazed sinks provided 7 Drainage boards provided 2 Sinks and draining boards cleansed 11 Waste pipes repaired 3 Staff sanitary accommodation repaired 9 Staff sanitary accommodation reconstructed 2 Staff sanitary accommodation cleansed 10 Staff sanitary accommodation provided 7 Walls and ceilings cleansed and repaired 55 Floors repaired or relaid 11 Floors cleans 2 Food preparation rooms enlarged 3 New vegetable preparation room provided 1 Additional ventilation provided to kitchens 3 Windows cleansed and repaired 14 Food store provided 1 Yards paved 6 Blocked drains cleared 4 Accumulations removed 14 Miscellaneous 5 Notices Served. Preliminary Notices . 563 Statutory Notices 11 Legal Proceedings. In addition to the action in respect of moveable dwellings, referred to previously in this Report, legal proceedings were instituted in the following cases:— Shops Act, 1950— Contravention of the provisions relating to Sunday Trading in Shops. Defendant fined £1. 0s. 0d. and £1. 1s. 0d. costs. Food and Drugs Act, 1938, Section 9—Unfit Food— Defendant fined £5. 0s. 0d. and £1. 1s. 0d. costs for selling a cake containing a foreign body. 43 SCHOOLS. Matters affecting adversely the hygenic conditions of the schools are normally reported by the Divisional Medical Officer to the Divisional Executive or, in the case of the canteens, to the Central Committee concerned. Improvements are slowly being effected, but progress is retarded by the dimensions of the problems and the economic condition of the Country. Close co-operation exists between the School Health and Public Health Services in relation to the above and the prevention of the spread of infectious disease. DISINFESTATION. During the year only 2 houses needed to be, and were disinfested owing to the presence of bed bugs, including one which was fumigated with Hydrogen Cyanide by an Operating Company in accordance with Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938. Action was also taken by the Department in 67 cases of infestation with other pests such as cockroaches, crickets and wasps. In the majority of cases disinfestation was carried out by spraying with a proprietary insecticide. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The table on the following page is a tabular statement indicating the action taken in 1951 under this Act. During 1951, 41 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 maintenance treatment as necessary. Only minor infestations were recorded. During the year the Council's charges for services rendered in the destruction of rats and mice were revised. A charge of 6/3d. per hour, plus the cost of materials is now made for carrying out this service at premises other than private dwellings, and a flat rate charge of 5/-d. in respect of private dwellings. 44 The Council continue to undertake the routine disinfestation of schools and school canteens owned by the County Council within the District, as and when necessary, on a contract basis. Type of Property. Number of properties inspected by the Local Authority as a result of— Number of properties found to be infested by- Number of treatments carried out by Department by arrangement with occupier. Number of Notices served under Section 4. Number of inspections made. Notification Otherwise. Total. Rats. Mice. Rats. Mice. Treatment. Structural works, i.e• proofing. Primary and reinspections. Sewer treatment. Total. Local Authority 4 17 21 4 1 5 l — — Dwelling Houses 387 161 548 258 29 262 30 — Business Premises 54 52 106 39 12 38 12 — 1 4,291 1,460 5,757 Agricultural 2 — 2 2 — 4 — — — Total 447 230 677 303 42 309 43 — 1 INSPECTION AND SUPERVISION OF FOOD. MILK. Milk and Dairies Regulations, 1949. In accordance with these Regulations, the handling, distribution and sale of milk after leaving the point of production continued to receive the necessary supervision. The entries in the register, which is required to be kept, were as follows:— Distributors of Milk in the district 13 Premises registered as Dairies 2 The two registered Dairies are equipped with pasteurising plant and are licensed by the Council under the provisions of the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. By virtue of the Milk (Special Designations) (Specified Areas) Order, 1951, which came into operation on the 1st October, 1951, the use of a special designation became obligatory in respect of all sales of milk within the Urban District. Milk Sampling. The routine sampling of milk was continued and a total of 306 samples was submitted for bacteriological and biological examination, with the results set out in the following tables:— BACTERIOLOGICAL. Tests required by the Milk (Special Designation) Regulations, 1949. Designation. Methylene Blue. Phosphatase. Turbidity. ber. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Pasteurised 200 198 2 200 - - - T.T. (Raw) 15 12 3 — — — — T.T. (Pasteurised) 31 30 1 31 — — - Sterilised 19 — — — — 19 — Totals 265 240 6 231 — 19 — 46 BIOLOGICAL. Designation. Number. T ubercle Bacillus. + — Tuberculin Tested 21 — 21 Ungraded 20 — 20 Totals 41 — 41 It is satisfactory to record that all the samples of Pasteurised milk satisfied the Phosphatase Test of the efficiency of pasteurisation. The small number of adverse reports referred only to the Methylene Blue (keeping quality) test. During the year the question of human tuberculosis caused by the bovine type of tubercle bacilli was again considered by the Medical Officers in the County, and a standard practice for the routine biological testing of all milk (including T.T. milk) which is sold to the public without heat treatment was agreed. As a minimum it was considered that samples should be taken from each producer four times a year, additional samples being taken if considered necessary. Chiefly owing to the increased sampling elsewhere in the County application of this practice had the effect of reducing considerably the number of samples taken in this District, but the standard of supervision was maintained. Milk (Special Designation) Regulations, 1949. Licences to sell milk under the above Regulations were issued as follows :— Dealers: Tuberculin Tested 11 Pasteurised 12 Sterilised 13 Supplementary Tuberculin Tested 10 Pasteurised 10 Sterilised 7 ICE CREAM. Under the provisions of Section 64 of the Coulsdon and Purley Act, 75 premises within the District are registered for the sale of ice cream and 3 in respect of the manufacture and sale of this commodity, the latter being one less than in 1950. In addition, the sale of ice cream is carried on from 22 premises exempt from registration. 47 The bulk of the ice cream retailed in the District is obtained by the vendors from manufacturers whose premises are situated outside the District. A total of 104 samples of ice cream were examined for bacterial quality by submission to the methylene blue reduction test, and placed in the following provisional grades— Grade I 68 Grade II 22 Grade III 13 Grade IV 1 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. By this standard the above results can be considered very satisfactory; apparently the gradual improvement in the bacterial quality of ice cream noted in recent years is continuing. MEAT. The two private slaughterhouses in the District have not been licensed since 1940. In 1951 two licences were issued under the Slaughter of Animals Act, 1933, for the purpose of slaughtering at two Public Institutions in the District. At the request of the South-West Metropolitan Regional Hospital Board, post-mortem inspections have been made of all animals slaughtered at Cane Hill Hospital for consumption by the inmates, and a similar arrangement appertains in respect of Netherne Hospital. The carcases and offals of 25 cattle, 2 calves and 62 pigs were inspected for evidence of disease, and the carcase and organs of one cow, together with a small quantity of other offals, were condemned as unfit for food. No animals were affected with tuberculosis. Meat delivered to local butchers' shops from the Wholesale Meat Supply Association Depot situated outside the District was inspected on frequent occasions. During the year the Council made representations to the Ministry of Food in regard to the delivery of meat within the Urban District, expressing the opinion that the present system of meat delivery and the type of vehicle used is far from ideal, and that in their view meat should not be laid on the floors of delivery vans, but should be properly suspended. In their reply the Ministry stated that they are very much alive to the problem, but whilst they cannot promise the introduction of the hanging gear in vehicles as suggested by the Council, the suggestion will be borne in mind in the light of the Report of the Inter-Departmental Committee on Meat Inspection, which deals amongst other things with the transport and handling of meat. 48 FOOD PREMISES. The routine inspection of food shops and other premises where food is prepared continued to form an important part of the work of the Department. A register of all such premises includes the following :— Confectioners 58 Butchers 29 Fishmongers (Wet and Dry) 14 Fishmongers (Fried)) 8 Bakers 25 Greengrocers 47 Ice-cream premises 100 Cafes and Restaurants 65 Grocers 72 With very few exceptions all these premises can be considered to comply with the minimum requirements based on Section 13 of the Food and Drugs Act, 1938, but the standard in many premises is, of course, much higher than the minimum. It has been found in practice that the maintenance of a reasonably high standard of Food Hygiene in food premises, and amongst food handlers, can only be attained by regular and frequent inspections. This policy is being pursued as far as possible and there is increasing evidence that the required results are being achieved. Every opportunity is taken of discussing the subject of Food Hygiene with food handlers and others and a number of local organisations have been addressed on the subject, the talks being supported with film strips and sound films. The Council has adopted the new Model Byelaws issued by the Ministry of Food in connection with the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, and copies have been circulated to all food traders in the District. UNSOUND FOOD. The following unsound foods were surrendered during the year, the total bulk being substantially more than that surrendered in 1950:— 49 cwts. lbs. ozs. Canned Soups — 27 13 Canned Meat 10 52 1 Canned Fish — 44 3½ Canned Vegetables 2 73 8 Canned Fruits 2 16 12¾ Canned Milk — 106 0¾ Meat, Bacon, Poultry, etc. 8 99 11 Fish 5 102 0 Meat and Fish Pastes — 1 15 Butter, Fats and Cheese 5 19 6 Sugar, Jam, etc. 17 62 15½ Flour, Bread, Cereals and Biscuits 6 19 9 Pickles and Sauces — 27 15½ Fresh Fruit and Vegetables 2 24 0 Dried Fruit - 54 0 Miscellaneous 1 0 1½ Total 66 60 0 50 FOOD AND DRUGS ACT, 1938. The following samples were taken during 1951 and submitted to the Public Analyst, with the results shown :— Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Aspirin Tablets — l 1 — — — Bread 3 — — — — Beef Sausage Meat 5 — 5 — — — Beef Sausages 2 — — — — Brawn 1 — 1 — — — Bicarbonate-of-Soda — l 1 — — — Barley Flour 1 l 1 — — — Bilberries in Syrup — 1 — — — Beer 2 — 2 — — — Cherries in Syrup — 2 2 — 2 2 Crab Paste — 1 1 — — — Cake Fruit Mixture 1 — 1 — — — Chocolate Roll 1 — 1 — — — Cream Powder (Synthetic) — 1 1 — — — Chicken Noodle Soup — 1 1 — — — Cornflour — 1 1 — — — Coffee and Chicory Essence — 1 1 — — — Cream 1 — 1 — — — Double Cream — 1 1 — — — Dressed Crab 1 — 1 — — — Eucalyptus Oil — 1 1 — — — Fish Paste 1 1 2 — — — Fancy Crab Meat — 1 1 — — — Glycerine, Honey and Lemon Balsam 1 1 — — Garden Mint in Vinegar — 1 1 — — — Golden Crumbs — 1 1 — — — Ground Mixed Spice 1 1 — — — Ice Cream 3 1 4 — — — Jam 2 — — — — Lung Tonic — 1 1 — — Lemon Juice — 1 1 — Lemon Mousse 1 — 1 — — Milk 45 15 60 2 13 15 Marmalade 1 — 1 — — Malt Vinegar 3 — 3 — — — Meat Paste —- 1 1 — — Mincemeat 1 — 1 — — — Non-Brewed Condiment 1 — 1 — — — Orange Flavoured Vantas Drink 1 — 1 — — — Pepper Flavoured Compound — 2 2 — — — Processed Peas — 1 1 — — — Pork Pie 1 — 1 — — — Pineapple Juice 1 — 1 — — — Pate de Foie — 1 1 — — — Rice 1 — 1 — — — Rice Shaped Macaroni 1 — 1 — — — Rheumatism Tablets — 1 1 — — — Sweets 6 — 6 1 — 1 Steamed Pudding Mixture 1 — 1 1 — 1 Sponge Mixture 1 — 1 51 Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Self-Raising Flour — 2 2 - — — Soup — 1 1 - — — Soup Mix — 1 1 — — — Spaghetti with tomato sauce and Cheese — 1 1 — — — Sponge Mixture 1 — 1 — — — Sugar Sweetened Cake Flour — 1 1 - 1 1 Saccharin Tablets — 1 1 - — — Strawberries in Syrup — 1 1 - - — Travel Sickness Tablets — 1 1 — — - Vita-Glucose Tablets — 1 1 — — — Whisky 2 — 2 — — — Yoghourt 1 1 - - ~ Totals 92 53 145 4 16 20 Adverse reports were received on 20 samples, including 15 milk samples, and the following is a summary of the action taken in respect thereof. Canned Cherries in Syrup. (1) A sample was submitted to chemical and bacteriological examination in response to complaints made by the retailer. The reports indicated contamination with sulphuretted hydrogen and sulphides of iron, and the Public Analyst submitted that the condition of the fruit was such as to render it unfit for human consumption. In view of this report the shopkeeper surrendered his remaining stock for destruction, and as the product was of Italian origin imported into this Country, particulars were submitted to the Food Hygiene Division of the Ministry of Food. (2) This sample was submitted to chemical and bacteriological examination as a result of a routine inspection at a fruiterer's shop in the District. It was noted that the tins were unlabelled and a high percentage appeared to be in a blown condition. The Public Analyst reported that the fruit was contaminated with metals and possessed a metallic taste. He indicated that the amount of iron found in solution was sufficient to account for a " hydrogen swell," and the condition of the can was consistent with this. Although the contents of the can were not injurious to health, the Public Analyst submitted that the strong metallic taste and the appearance of the cans would be likely to give rise to complaint if the article were sold direct to the public. 52 In the meantime the remaining stock of this product was removed to the retailer's wholesale premises in an adjoining District, where all that remained of the whole consignment was subsequently surrendered as unfit for human consumption. In view of the above, representations were made to the canners concerned with a view to preventing the further sale of canned fruits to the general public in a similar condition, and the retailer was warned by the Council in respect of the labelling offence. Milk. (1) A sample of bottled milk, obtained from a roundsman in the street showed a deficiency in milk solids other than milk fat to the extent of 1 per cent, although the freezing point did not indicate the presence of added water. The retailer concerned was advised to take check samples from all his suppliers, and as a result the consignments of two producers were strongly suspect. Informal samples of these latter supplies were taken by the Department at the place of delivery, i.e. at the local dairy, and of 7 samples taken the Public Analyst reported deficiences in solids not fat ranging from 2 per cent to 30 per cent in 6 samples, with added water to the extent of 5, 16, 19, 20, 20 and 30 per cent respectively. One sample was genuine. As the premises of these two producers were outside the Council's area, and as it was considered more satisfactory to sample at the place of production, arrangements were made with the two Food and Drugs Authorities concerned for their officers to sample formally at the farms referred to, with results similar to those outlined above. Proceedings were instituted by these Authorities, and convictions were obtained in each case. Arising out of this incident, arrangements have been made whereby the Sanitary Inspectors of this Council, as Sampling Officers, are permitted to obtain milk samples within the areas of the Surrey County Council and the Reigate Borough Council in accordance with Section 68 (6) of the Food and Drugs Act, 1938. Similar facilities have been afforded to enable Sampling Officers of the Borough of Reigate to enter this Urban District to procure samples of milk. (2) Five samples of milk were taken, four of them informally as a result of reports received by a retailer on samples taken by him from one of his sources of supply. All the samples were deficient in milk solids, other than milk fat, but the freezing point did not indicate the presence of 53 added water. The milk fat content was satisfactory, and there was no reason to believe that the milk was other than as received from the cow. (3) Two further samples of milk were taken informally as a result of reports received by a retailer, and the Public Analyst reported deficiences in milk fat and solids not fat. On calculation, however, the whole of the yield showed a deficiency in solids not fat only; there was no evidence of added water, and no reason to believe that the milk was other than as received from the cow. (4) One of a number of samples of milk taken at a Hospital Farm at the request of the Secretary of the Hospital concerned, showed a slight deficiency in milk fat, but subsequent samples proved satisfactory. Sweets. These sweets contained sulphur dioxide as an added preservative to the extent of 140 parts per million by weight. The manufacturers were warned of the need to satisfy themselves in their own interests that the preparation of the different ingredients used, their sulphur dioxide content and the temperature and time of boiling sweets were not contributing to this relatively high residual sulphur dioxide content. Steamed Pudding Mixture. Sugar Sweetened Cake Flour. The reports on these two samples referred to defects in labelling and representations were made to the manufacturers concerned, which resulted in the provision of new labels. 54 55 table i. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1951. Disease. At all ages. Number of cases notified. At Ages—Years. Total cases notified in each Ward. 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. 1 35 and under 45. 45 and under 65. 65 and over. Coulsdon East. Coulsdon West. Purley. Kenley. Sanderstead. Selsdon and Farleigh. Woodcote. Diphtheria Typhoid fever 8 2 i 1 4 1 — — 1 Paratyphoid fever 3 — — — — 2 — — i — — 1 1 1 — Scarlet fever ... 90 1 1 2 6 5 67 6 1 1 — — — 1 1 1 / 7 3 73 11 ? Erysipelas 3 — — — — — — — — 3 — 1 — 2 Puerperal pyrexia 3 — — — — — — 2 i — — — 1 1 1 Pneumonia 51 1 2 2 3 4 3 3 3 12 18 10 16 10 2 7 1 5 Dysentery 22 2 1 1 2 3 6 7 16 3 1 — 1 1 Cerebro-spinal fever — Poliomyelitis — — — — — — — — — — — — — — — — — Measles 810 13 32 83 87 Ill 421 30 8 18 6 1 — 133 90 178 150 189 27 43 Whooping cough 204 6 13 22 19 28 102 3 — 1 5 5 — 26 20 40 50 56 4 8 Malaria — — — — — — — — — — — — — — — — — — — — Ophthalmia neonatorum ... — Food poisoning 2 ~~ ~ ~ ~ ~ ~ 1 1 ~ 2 — Totals ... 1,196 21 46 109 114 147 598 43 10 30 21 28 29 196 1x5 238 209 280 59 59 56 TABLE II. THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1951. Jan. Feb. Mar. A pril May June July Aug. Sept. Oct. Nov. Dec. Total Diphtheria — — — — — — — — — — — — — Typhoid fever — — — 3 3 1 1 — — 8 Paratyphoid — 1 1 — — 1 — — — _ — 3 Scarlet fever 7 4 8 10 12 14 5 7 2 3 11 7 90 Erysipelas 1 — — — 1 — — — — — — 1 3 Puerperal pyrexia — — — — — — — — 1 — 1 1 3 Pneumonia 18 12 8 1 — — 4 1 4 3 — 51 Dysentery 3 2 1 — — 7 — 1 1 7 22 Cerebro-spinal fever — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — Measles 69 149 231 96 149 67 39 10 — 810 Whooping cough 27 28 60 16 11 4 24 21 6 2 1 4 204 Malaria — — — — — __ .— — — — — Ophthalmia neonatorum — — —• — — — — Food Poisoning — — — — — — — — — — 2 — 2 Totals 125 196 309 126 176 93 74 39 10 9 19 20 1,196 57 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1921. Disease 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 1949 1950 1951 Small pox — — — — — — 2 2 3 4 — — _ _ — — — — — — — — — — Scarlet fever 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 62 138 149 90 Diphtheria 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 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 4 4 3, Typhoid and paratyphoid fever 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 7 2 2 1 11 Cerebro-spinal fever 1 — — — — — — — 1 — — — — — 1 1 — — 4 8 6 1 4 2 1 3 1 1 _ Puerperal fever 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 2 2 3 Poliomyelitis — 1 — 1 — — 1 1 — 1 — 2 — 1 1 — 3 1 1 1 2 3 — — 2 1 11 2 9 10 — Polio-encephalitis — — — — — — — — — — — — — — — — 2 — — — — — — — — — — — — — Encephalitis lethargica 1 1 1 1 1 — 1 1 — — — 1 — — — — — — — — — — 1 — — — — — — — — Ophthalmia neonatorum _ 1 _ _ 12 — 3 _ 1 1 2 — 1 — — 1 1 — 1 1 — 1 — 1 — — — — 1 — Pneumonia 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 5 23 51 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — Measles 2 11 214 479 275 52 705 41 218 567 600 477 810 Dysentery 7 7 17 — — 1 — — 5 — — — — — 6 — 1 2 10 85 224 121 21 42 172 82 43 71 14 28 22 Whooping cough 6 1 136 36 55 51 100 31 115 201 42 242 204 Food Poisoning 2 6 2 Tuberculosis :— Pulmonary 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 57 47 60 Other forms 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 5 7 4 Totals 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 435 564 990 880 998 1260 TABLE IV. DEATHS OCCURRING DURING THE YEAR, 1951. 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. Respiratory tuberculosis 10 1 11 — — — — 1 5 2 3 Other tuberculosis — — — — — — — — — — — Syphilitic disease 2 3 5 — — — — — — 2 3 Diphtheria — — — — — — — — — — — Whooping cough — — — — — — — — — — — Meningococcal infections — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — Measles — — — — — — — — — — — Other infective and parasitic diseases 1 1 2 — — — — — 1 — 1 Cancer 54 69 123 — — — — 1 4 49 69 Leukaemia 1 3 4 — — — — — 1 2 1 Diabetes 2 3 5 — — — — — — 2 3 Vascular lesions of nervous system 32 55 87 — — — — — — 15 72 Coronary disease, angina 64 40 104 — — — — — — 34 68 Hypertension with heart disease 11 9 20 — — — — — — 4 16 Other heart disease 5 1 14 1J1 — — — — — — 9 120 Other circulatory disease 13 18 31 — — — — — — 4 21 Influenza 7 8 15 — — — — — 1 2 12 Pneumonia 10 23 33 1 — — — — — 3 29 Bronchitis 24 12 36 — — — 1 — — 5 30 Other respiratory diseases 4 3 7 — — — — — — 1 6 Ulcer of stomach and duodenum 4 1 5 — — — — — — 1 4 Gastritis, enteritis and diarrhoea 1 — 1 — — — — — — 1 Nephritis and Nephrosis 4 7 11 — — — — 1 1 — 9 Hyperplasia of prostate 4 — 4 — — — — — — — 4 Pregnancy, childbirth, abortion — — — — — — — — — — — Congenital malformation 5 4 9 6 — 1 — — — — 2 Other defined and illdefined diseases 28 38 66 10 — 2 1 2 4 12 35 Motor vehicle accidents All other accidents 3 3 2 12 5 15 — — — — — — — — — — 1 1 2 4 2 9 Suicide 5 4 9 — — — — — 1 6 2 Homicide and operations of war — — — — — — — — — — — Totals 349 390 739 17 — 3 3 5 24 160 527 58 INDEX. Page Ambulances 30 Analysis of Mortality 12, 13 Area 6, 7 Bacteriological work 26 Bed Bugs, Eradication of 44 Birth Rates 6, 8, 15 Births, Live, Illegitimate and Still6, 8 Blind Welfare Worker 31 Camping Sites 37 Cancer 10, 11 Causes of Deaths 10, 58 Chicken Pox 23 Children's Officer 31 Clinics : Diphtheria Imunisation 25 Family Planning 29 Infant Welfare 29 Maternity 28 School 30 Toddlers 29 Tuberculosis 32 Veneral Disease 32 Closet Accommodation 36 Consultant Service 32 Day Nurseries 30 Deaths and Death Rates 6,8,9,15,58 Dental Treatment 30 Diphtheria 17 Diphtheria Immunisation 24 Disinfection 25 Disinfestation 44 District Nursing Service 28 Drainage and Sewerage 36 Dysentery 18 Emergency Units 32 Enteric Fever 18 Erysipelas 18 Eye Defects 30 Factories 39, 40 Family Planning Clinic 29 Food and Drugs Act. 51, 52 Food Supply Milk 46 Meat 48 Unsound 49, 50 Food Premises 49 Food Poisoning 19 Health Visitors 29 Health Propaganda 27 Heart Disease, etc. 10 Home Helps 29 Hospitals 31, 32 Houses, Inspection of 33, 34 Houses, Inhabited 6, 8 Housing 33, 34 59 INDEX—continued. Ice-Cream 47, 48 Illegitimate Babies 9 Immunisation 24 Infantile Mortality 6,12,13,14 Infectious Disease : Cases Notified 16, 55 Monthly incidence of 56 School Notifications 23 Inspection and Supervision of Food 46 Laboratory Facilities 26 Legal Proceedings 43 Marriage Guidance Council 32 Massage Establishments 27 Maternal Mortality 12 Maternity Clinics 28 Maternity and Child Welfare: Services 28,29,30 Centres 28, 29 Hospital Accommodation 31 Measles 20 Meat 48 Midwifery Service 28 Milk and Dairies Regulations 46 Milk (Special Designations) Regulations 47 Milk, Sampling of 46 Moral Welfare Worker 32 Mortality : Analysis of 12, 13 Infant 6,12,13,15 Maternal 12 Mumps 23 National Assistance Act, Sect. 47 27 National Assistance Act, Sect. 50 27 National Society for the Prevention of Cruelty to Children 32 Non-notifiable Infectious Disease 23 Nursing Service 28 Ophthalmia Neonatorum 18 Paratyphoid Fever 18 Pneumonia 19 Poliomyelitis 19 Population 6, 7 Premature Babies 28 Public Cleansing 37 Public Health Committee 3 Puerperal Pyrexia 18 Rainfall 36 Rateable Value 6 Rats and Mice Destruction 44,45 Rivers and Streams 37 Road Safety Committee 32 Sanitary Inspections, etc 40,41,42,43 Scabies 23 Scarlet Fever 17 Schools 44 School Clinics 30 Sewerage 36 Shops 38 60 INDEX—continued. Slaughterhouses 48 Smallpox 16 Smoke Abatement 37 Social Conditions 6, 7 Staff 3 Statistics: Housing 33, 34 Vital 6, 8, 15 Still Births 6, 15 Swimming Baths 38 Toddlers' Clinics 29 Tuberculosis 21, 22 Typhoid Fever 8 Vaccination 25 Vermin 24 Violence, Deaths from 12 Vital Statistics 6, 8, 15 Water Supply 35, 36 Welfare Homes 31 Welfare Officers 31 Whooping Cough 20, 21 Whooping Cough, Immunisation 25 61