Coulsdon Durley LIBRARY Ac-4413 (3) Coolsdon Cou/20 Purley HEALTH REPORT for 1952 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH Printed by RAYNES PARK PRESS, Uamblon Road, London, S.W.20. Tel.: WIM. 1388. HEALTH REPORT for 1952 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. 1952. Public Health Committee. Chairman: R. N. Saunders. Councillor J. E. M. Dewey. Councillor E. R. Nicholson, a.c.a. H. W. Hayden, ” mes. K. M. Platt. j.p., f.b.o.a., f.s.m.c. ” H. T. Smith. „ R. W. Kersey, ” S. E. Littlechild. b.sc., a.r.i.c. „ Mrs. L. J. Nesbitt. „ A. H. Williams. 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 Mrs. L. J. Nesbitt. Councillor Mrs. K. M. Platt. „ E. R. Nicholson, a.c.a. „ R. N. Saunders. „ A. H. Williams. 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 pleasure in presenting my Annual Report for 1952, this being my twentyfirst report as your Medical Officer of Health. It will be noted that, in general and as judged by the vital statistics, the health of the District remained good. The Birth Rate again dropped to the low level reached in 1950 and was almost as low as the average for 1930-34. On the other hand the percentage of illegitimate births was nearly the lowest, and the Stillbirth Rate was in fact the lowest known locally. Similarly the general Death Rate was slightly better than in 1951 and the Corrected Death Rate was well below that for the Country as a whole. While the death rate from all types of cancer showed a welcome decrease after a series of annual increases, there was again an increase in the proportion of women dying from cancer of the breast and of men who succumbed to cancer of the lungs. As death from at least the former condition should be preventable, if only reported and treated early enough, the opportunity must be taken of again stressing the importance of obtaining medical opinion on any persistent lump in the female breast at an early date. The relief of a negative finding can be almost as beneficial as the prompt treatment of a case. One of the most pleasing items to report this year is that no maternal death occurred for the second year in succession. In fact there have been no deaths connected with childbirth in three of the last four years. While the Infant Mortality Rate was again fairly low, it was not so good as in the two preceding years, and with the national rate breaking its previous record annually the gap between these two rates is becoming steadily less marked. This year at least five of the deaths in babies might well have been prevented, four being due to infections and one to an accident. In view of the present interest in the prevention of accidents in the home, it should be noted that of 15 deaths resulting from accidents during 1952, only 3 were due to road accidents, while the commonest cause was falls in the elderly or in very young children. The incidence of almost all forms of infectious disease remained at a low level, the most marked decrease in notifications being in measles, followed by pneumonia, tuberculosis and scarlet fever. Only dysentery showed a substantial increase and that in the Mental Hospitals. Nationally, poliomyelitis was again rather more prevalent but only 8 cases occurred locally, of which unfortunately 3 proved fatal, 2 being adults. Only one of the remainder, however, had any appreciable permanent paralysis. 4 As usual the majority of this Report records the unspectacular but steady maintenance of the various branches of the Local Authorities' Health Services. Apart from minor improvements in these and attempts at various levels to strengthen liason between the three main sections of the National Health Service, in this District most thought recently has been given to Health Education. That serious consideration of this subject is justified is supported by the following comment by the Chief Medical Officer of the Ministry of Health in his introduction to his Annual Report for 1951:— "We have, in fact, arrived at a time when the citizen himself must actively participate in the campaign for better health if substantial progress is to be made. We are leaving the era of Sanitary Engineering and are entering into that of personal hygiene, in which each person must definitely contribute to the commonweal". From the official point of view this challenge to stimulate and inform public opinion involves time being spent on absorbing the relevant sections of the vast amount of research work which is continuously being published, and simplifying it in order that it can be presented in an interesting manner. From the point of view of the Local Authorities it must be recognised that, unless the available professional manpower is to be increased the existing staff will have to be relieved of some of the least essential of their former duties if they are to devote more time to this increasingly important subject. The public also will need to help, not only by being prepared to abandon some preconceived ideas, habits and prejudices, but by taking a greater share in the education of all age groups, and in providing opportunities for consideration of health topics. When it is remembered that positive health, which should be our ideal, involves not only the absence of disease but complete physical, mental and spiritual fitness, it will be seen that a campaign of this type calls for a concerted effort by all types of educationalists and not only by the medical profession. For some time there has been general concern about the heavy cost of the National Health Service. Should not our aim be to reduce the cost of the relatively expensive curative services by continually focusing on the prevention of illhealth and the encouragement of positive measures toward true Health ? In this readjustment we can all contribute our quota. In conclusion, Ladies and Gentlemen, I would again express my thanks to all who have been associated with the Health Services for their sympathetic co-operation during the year, and I must mention particularly the contributions of the Chief Sanitary Inspector, his Deputy, and my Administrative Assistant, who have not only helped to maintain a friendly team spirit, as have all members of the Divisional Health Service, but have given valuable 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. 1952 64,180 Population, Census 1931 37,666 Population, Census 1951 63,770 Number of occupied houses, December, 1952 17,798 Number of occupied houses, 1931 9,533 Number of occupied houses, 1951 18,071 Rateable Value, December, 1952 £785,353 Sum represented by a penny rate £3,145 VITAL STATISTICS FOR THE YEAR 1952. Total M. Birth Rate per 1,000 of the F. estimated resident population Live Births—Legitimate 737 370 367 11.7 do. Illegitimate 14 9 5 751 379 372 Corrected Birth Rate 12.4 Rate per 1,000 (live and still) births. Still Births—Legitimate 8 8 — 11.9 do. Illegitimate 1 — 1 9 8 1 Crude Death Rate per 1,000 of the estimated resident population Deaths 656 319 337 10.2 Corrected Death Rate 9.4 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 24.0 Legitimate infants per 1,000 legitimate births 24.4 Illegitimate infants per 1,000 illegitimate births Nil Deaths from Cancer (all ages) 114 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) Nil 6 HEALTH REPORT FOR 1952. 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 37 years. Situated on the North Downs immediately to the south of Croydon, it is a well-favoured "dormitory" suburb, with a very considerable proportion of its area 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 At the time of the 1951 census the population was shown to be 63,770 and this has only increased slightly since, the mid-year population for 1952 being estimated by the Registrar-General to have been 64,180 which is 20 less than his estimate for the preceding year. These numbers include persons resident in Institutions in the District, the numbers of which at the end of 1952 were as follows:- 7 Cane Hill Hospital 2,486 Netherne Hospital 2,145 Russell Hill School 238 Reedham Orphanage 265 In 1952 there were 17,798 occupied houses, distributed as follows:— Coulsdon East 2,749 Coulsdon West 3,109 Purley 2,622 Woodcote 1,644 Sanderstead 4,649 Selsdon and Farleigh 1,738 Kenley 1,287 This suggests an average of 3.61 persons per occupied house in 1952, or 3,32 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 STATISTICS. 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 1951 and 1952. Rates per 1,000 population. 19201924. 19251929. 19301934. 19351939. 19401944. 19451949. 1951. 1952. Birth rate 13.5 12.9 11.6 12.8 15.2 15.2 12.2 11.7 Percentage illegitimate 3.4% 3.7% 2.8% 3.4% 3.9% 3.4% 3.1 %' 1.9% Stillbirth rate — — — 0.43 0.48 0.40 0.36 0.14 Death rate 7.4 7.0 7.4 8.3 11.4 9.7 11.5 10.2 Cancer death rate 0.96 1.15 1.35 1.19 1.70 1.75 1.91 1.78 Tuberculosis death rate (per 100,000 population) 57 36 38 35 48 36 33 22 Violence including Suicide 0.44 0.35 0.32 0.46 0.82 0.37 0.45 0.34 Maternal mortality rate per 1,000 live and still births 2.08 2.66 3.21 2.27 2.10 1.12 Nil. Nil. Infant mortality rate (per 1,000 re gistered births) 28 38 32 38 40 26 22 24 Neo-natal mortality rate - - - 26 28 19 18 17 Estimated population 21,351 28,950 41,616 53,084 49,880 60,610 64,200 64.180 8 BIRTHS. During the year 1952, 751 births were registered as occurring in the District, of which 370 were male and 367 were female, compared with 782 in 1951. It will be seen by reference to the above table that this is equal to an annual birth rate of 11.7 per 1,000 population, as compared with 12.2, 11.7, 13.0, 14.6 and 17.0 in the previous five years. The rate of 17.6 in 1946 was the highest birth rate experienced in this District, but in 1952 it was again equivalent to the lowest pre-war average rate. The corresponding birth rates for England and Wales were 15.3 in 1952 and 15.5, 15.8, 16.7, 17.9 and 20.5 in the preceding five years. Illegitimacy.—In 1952, of the births registered, 14 were illegitimate (9 males and 5 females), this being 10 less than in the preceding year. The percentage of illegitimate births was thus well below the lowest pre-war average, and one of the lowest noted in the District. Stillbirths.—The number of stillbirths registered during 1952 was only 9 (8 males and 1 female), which is also much lower than in any recent year. One of the stillbirths occurred in respect of an illegitimate child. The local stillbirth rate of 0.14 per thousand of population was the lowest recorded locally. The stillbirth rate for England and Wales was 0.35 in 1952. DEATHS. The number of deaths registered during 1952 as belonging to this District was 656 (319 males and 337 females), as compared with 739, 615, 622, 545 and 672 in the preceding five 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 37 in 1952 and 40, 22, 35, 24 and 32 in the preceding 5 years. It will be seen from the table of vital statistics that the crude death rate for the year was equal to 10.2 per thousand of population, as compared with 11.5 last year, and an average of 9.9 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 9.4 compared with 10.6 last year; this is also comparable with the crude death rate for England and Wales which was 10.8 in 1948, 11.7 in 1949, 11.6 in 1950, 12.5 in 1951, and 11.3 in 1952. 9 The principal causes of death locally during 1952 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. Heart and circulatory diseases 330 50.3 Cancer, malignant disease 114 17.4 Pneumonia 37 5.6 Bronchitis 33 5.0 Accidents 15 2.3 Tuberculosis (all forms) 14 2.1 (A full list of the causes of 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, 5.14, was lower than in 1951, but higher than in 1949 and 1950. As, however, this group includes a high proportion of elderly people dying virtually of old age, it is not regrettable if this particular rate remains high. This year 79 per cent were over 65 years of age at the time of death, compared with 81 per cent in each of the previous three years, while no less than 54 per cent were over 75 years of age. (Incidentally, 67 per cent of deaths from all causes were over 65 years, compared with 71, 69, and 61 in the three preceding years.) CANCER. The cancer death rate for the year 1952 was 1.78 compared with 1.91, 1.84 and 1.73 in the last three years and an average of 1.75 since the war. The tendency for this rate to become more stable after increasing more or less steadily for years is a welcome change, although, unfortunately the improvement did not affect all types of the disease. In general this death rate compares not unfavourably with that for the Country as a whole. The following table gives the age, sex and distribution of this disease in the fatal cases which occurred in 1952. Compared with recent years a regrettable increase in the number of deaths from breast cancer in females is noted and a further increase of lung cases among males. (This year 30% of the male deaths from cancer were associated with the lung, while over 34% of the female deaths were due to breast cancer, whereas the comparable post-war averages for these conditions were 23% and 24% respectively). The sudden increase in deaths from breast cancer calls for a further reminder that any persistent lump in the female breast should be reported to a doctor without delay, as successful remedial measures can be applied. 10 CANCER DEATHS, 1952. Localisation. 0-30 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 - - - - - - - - - - - - - - - - Brain and Thyroid - - - - - - - - - - - - — 1 1 1 Bone — 1 — — — — — — — — — 1 — 1 — 3 Pharynx and Oesophagus - - 1 - - 1 - - 1 1 Stomach and Duodeum — — 1 — 1 1 1 1 — 2 — 3 2 2 5 9 Intestines - - - - - - 1 4 2 — 5. 1 3 1 11 6 Liver — — — — — — 2 — — — 2 1 1 — 5 1 Pancreas — — — — — — — — 1 — — — 1 — 2 — Lungs — — — — 2 — 4 — 6 2 4 1 — 1 16 4 Bladder - - - - - - - - 1 1 2 — — — 3 1 Prostate - - - - - - - - - - - - - - 4 — Uterus - - - - - - - - - - - - - - - 4 Vagina and Ovary — 1 — 1 — — — 1 — 1 — — — — — 4 Breast — — — — — 4 — 7 — 4 — 4 — 2 — 21 Ill-defined 1 1 — ^— — — 3 1 — 1 1 2 - 1 5 6 Totals 1 3 1 1 4 5 11 15 11 14 17 14 8 9 53 61 11 Unfortunately the position with regard to male cancer of the lung is not so satisfactory, and nationally it has been shown that the increase in deaths attributed to this cause is a true increase, even allowing for the aging population, better diagnosis, etc. Research on the cause is proceeding and the suspected association with heavy cigarette smoking is being investigated. Meanwhile, the evidence is such as to justify personal restrictive measures. The younger generation would be wise to consider this unnecessary risk before they become addicted to what is at the least a foolish and uneconomic habit and one which most probably contributes to other forms of illhealth. VIOLENCE. Deaths from violence (including suicide) showed a slight improvement compared with 1951, the death rate being 0.34 per thousand of population compared with 0.45 and 0.37 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 decreased slightly, three deaths being attributed to this cause, compared with five last year. Two of these deaths were in elderly pedestrians struck by motor cars and one was a motor-cyclist. There were a variety of causes for the remaining 12 accidental deaths, the only cause producing multiple deaths being falls in the elderly, 4 being women. The two deaths in young children from preventable accidents emphasise the importance of the prevention of accidents in the home, upon which the nation's attention is now being focussed. The number of deaths attributed to suicide, 7, was 2 less than last year and very slightly above the annual average since the war. 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 for the third time in four years, no maternal death occurred during the twelve months under review. The maternal mortality rate for England and Wales was 0.72 per 1,000 live and stillbirths, which is the lowest yet recorded. INFANT MORTALITY. During 1952 there were 18 deaths among children under one year of age, as compared with 17 last year, and an average of 20 in the last five years. None of the deaths was in respect of an illegitimate child. 12 INFANTILE MORTALITY DURING THE YEAR 1952. 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. Bronchitis and Pneumonia — 1 — 1 2 — 2 — — 4 Congenital Malformation 2 4 — — 6 1 — — — 7 Prematurity and Atelectasis 5 — — — 5 — — — — 5 Pneumococcal Meningitis — — — — — 1 — — — 1 Accidental Strangulation — — — — — — — — 1 1 Totals 7 5 — 1 13 2 2 — 1 18 The folowing table gives the causes of the 18 deaths which occurred during 1952, together with the age at death. 13 The resultant infant mortality rate was thus 24.0 per 1,000 registered births, compared with 21.7 in 1951 and 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 27.6 in 1952, compared with 29.6 in 1951, which was the lowest previously recorded. It is relatively satisfactory to note that congenital malformation, the cause of which is unknown, produced over a third of the total deaths, but the number of deaths due to infection could be improved upon, while the one death due to accidental strangulation was very regrettable. The 13 babies dying in the first month correspond with a neo-natal mortality rate of 17.3 (i.e. deaths in the first month per 1,000 live births), which is a very slight improvement on 1951 but not unlike the average for the past 7 years, which was 18. During the year 6 premature babies were notified as being born at home and 27 in institutions. Of the former one died during the first day and of the latter 4 died, 2 in the first day and 2 within fourteen days. This suggests that 15 per cent of the premature babies died, compared with 20% in 1951 and an average of 22% in the years since 1945. 14 COMPARATIVE CRUDE BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY AND CASERATES FOR CERTAIN INFECTIONS DISEASES IN THE YEAR 1952. England and Wales. 160 County Boroughs and Great Towns including London. 160 Smaller Towns (Resident Population 25,000-50,000 at 1951 Census London Administrative County. Coulsdon and Purley Urban District. Births: Rates per 1,000 Home Population: Live Births 15.3 16.9 15.5 17.6 11.7 Still Births 0.35 0.43 0.36 0.34 0.14 Deaths: All causes 11.3 12.1 11.2 12.6 10.2 Typhoid and paratyphoid 0.00 0.00 0.00 — 0.00 Whooping cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.24 0.28 0.22 0.31 0.22 Influenza 0.04 0.04 0.04 0.05 0.03 Smallpox 0.00 — — — — Acute poliomyelitis and polioencephalitis 0.01 0.01 0.00 0.01 0.05 Pneumonia 0.47 0.52 0.43 0.58 0.57 Notifications (Corrected) Typhoid fever 0.00 0.00 0.00 0.00 0.01 Paratyphoid fever 0.02 0.02 0.03 0.01 — Meningococcal infection 0.03 0.03 0.03 0.02 0.01 Scarlet fever 1.53 1.75 1.58 1.56 1.25 Whooping cough 2.61 2.74 2.57 1.66 3.05 Diphtheria 0.01 0.01 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.14 — Smallpox 0.00 0.00 0.00 — — Measles 8.86 10.11 8.49 9.23 2.64 Pneumonia 0.72 0.80 0.62 0.57 0.33 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.10 Non-paralytic 0.03 0.03 0.02 0.03 0.01 Food poisoning 0.13 0.16 0.11 0.18 0.08 Puerperal Pyrexia 17.87† 23.94† 10.224 30.77† 2.63† Deaths: Rates per 1,000 Live Births : All causes under 1 year of age 27.6* 31.2 25.8 23.8 24.0 Enteritis and diarrhoea under 2 years of age 1.1 1.3 0.5 0.7 — Maternal Mortality: England and Wales. Rates per 1,000 Tota (Live and Still) Births Coulsdon and Purley Urban District. Rates per 1,000 Total (Live and Still) Births. Abortion with Sepsis 0.09 — Other abortion 0.04 — Toxaemia 0.23 — Haemorrhage 0.09 — Sepsis 0.09 — Other complications 0.20 — A dash (—) signifies that there were no cases. † per 1,000 Total (Live and Still Births). * per 1,000 Related Live Births. 15 INFECTIOUS DISEASE. The following table indicates the number of cases of infectious disease notified during 1952, 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 80 24 — Erysipelas — — — Puerperal pyrexia 2 — — Pneumonia — primary 21 14 37* Typhoid fever 1 1 — Paratyphoid fever — — — Dysentery 48 40 — Poliomyelitis 8 7 3 Meningococcal infections 1 1 1 Encephalitis, acute 1 1 — Measles 170 1 — Whooping cough 196 1 — Food poisoning 5 3 — Totals 533 93 41 * 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 1922 is presented in Table III in the Appendix. It will be seen that whooping cough was the commonest notifiable infectious disease, 1952 being a relatively good year for measles. Scarlet fever was also slightly less prevalent, and dysentery, which was as usual mainly associated with the Mental Hospitals was the only infectious disease to show any marked increase. Excluding measles and whooping cough which were not notifiable between the two Wars, and the hospital cases of dysentery, the incidence of the remaining acute notifiable infectious diseases decreased from 3.1 per 1,000 in 1950 and 2.6 in 1951 to 2.0, which is well below the pre-war average and slightly below the post-war average of 2.2. SMALLPOX. Three times during the year contacts with cases of smallpox overseas were under surveillance in the District. On two occasions the contacts had arrived by plane and once by liner. No cases developed, however. 16 DIPHTHERIA. For the sixth year in succession no confirmed case of diphtheria occurred in the District, and this was the first year during which no case was sent to hospital as being even suspected of having this disease. 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 was evidence during the Spring that the germ of this disease was not absent from this neighbourhood. It is, therefore, still very important to ensure that the standard of immunity of the population is not permitted to decline. SCARLET FEVER. There was a further recession in the prevalence of scarlet fever in the District during 1952, as was expected after the wave of infection in 1949-50 in which years the number of cases was relatively high. The number of cases notified was 80 compared with 90, 149, 138, 78 and 62 in the preceding five years. Judging by previous experience the incidence should not increase greatly during 1953. 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 5 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 germs. In 1952 eight cases were over school age, which is a slightly higher proportion than of late, but no less than 53 were of the 5-10 year age group. 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. (The Hamsey Green area was most affected early in the year, and the Chipstead end of the District in the Autumn.) Of the 80 cases, 56 were treated at their homes and 24 in a variety of Isolation Hospitals. (Wandle Valley 13, Bletchingly 3, Cuddington 1, Croydon 4, Carshalton 2 and The Grove 1.) The proportion treated at home is steadily increasing and this policy appears to be fully justified by experience. Unnecessary hospitalisation should obviously be avoided in view of the risks of cross infection for the patient, the absorption 17 of bed space and nursing manpower which might be otherwise utilised, and the cost to the community. ERYSIPELAS. For the first time no case of erysipelas was notified during the year. PUERPERAL PYREXIA. There were 2 cases notified as suffering from puerperal pyrexia, which is the average for recent years. Both were mild cases following confinement at their homes, and they recovered quickly without admission to hospital. OPHTHALMIA NEONATORUM. No case of ophthalmia neonatorum was notified. ENTERIC FEVER. Only one case of typhoid fever was notified, and no cases of paratyphoid fever. The patient developed the disease in August while working in Rhodesia and had not fully recovered when he landed in England in December. As a result of an exacerbation of symptoms he was admitted to the Hospital for Tropical Diseases, all the usual measures for the prevention of the spread of the disease being taken locally. The type of the organism was Viphage D.l. DYSENTERY. There were 48 notifications of dysentery compared with 22 in 1951, but of these 35 were inmates of one of the Mental Hospitals and 4 were patients at the other Mental Hospital. All but one of the mental hospital cases were infected by the Flexner type of dysentery bacillus and in the second half of the year only occasional cases were occurring in one hospital. All but one of the 9 cases notified from among the residents in the District were cases of the milder Sonne type of dysentery. The majority of these were associated with an outbreak in the Spring in the Kenley/ Whyteleafe part of the District in which most probably many more cases of dysentery occurred than suggested by the number of notified cases. FOOD POISONING. During the year 5 single cases were notified, all of whom were excreting S.typhi murium. In only one case was the probable source of the infection identified, viz. ducks' eggs and in that instance two other members of the family had similar symptoms. Three of the cases were admitted to hospital, and all recovered, but one persisted in excreting the causal organism for about six months. 18 In addition to the above, during the Autumn a number of schools reported cases of diarrhoea and/or vomiting among the children and staff, but these were probably not caused by infected food. Similarly a number of cases experiencing gastro-intestinal upsets was noted in the District as a whole still later in the year, but no reports being received of any special organism being found, both outbreaks were attributed to "epidemic vomiting". POLIOMYELITIS. This disease was more prevalent nationally during the year than in 1951 and locally 8 notifications were received and the diagnosis confirmed, but of these one adult case had developed the disease while en route from Australia. By contrast a local adult resident first became ill 14 days after she had gone to the North of England in October and did not return until almost all signs of her moderately severe attack had gone. Of the other 7 local cases the first (a child) and the last (an adult) died from polio-encephalitis, while another adult died from poliomyelitis in September. Three of the remaining four cases (three of whom were school children) had some paralysis but only one of these was left with some incapacitating paralysis. The above cases were distributed throughout the year, July being the only month with two cases, and there appeared to be no connection between them or the four suspected cases which were sent into hospital during the year, three of whom were subsequently diagnosed as suffering from "meningism", "influenza" and "Haemophilus influenzal meningitis". MENINGOCOCCAL INFECTIONS. It was decided after a post mortem examination that one school child who died suddenly in May had suffered from a pneumonic condition and meningococcal meningitis. Two other children who were admitted to hospital in June and July, one being a suspected case of poliomyelitis, were said to have suffered from "meningism". ACUTE ENCEPHALITIS. One adult was notified in November as suffering from acute encephalitis but the final diagnosis after admission to hospital was meningitis complicating glandular fever. PNEUMONIA. During the year 21 cases of acute primary or influenzal pneumonia were notified compared with 51 in 1951. None of the cases appeared to be interconnected. At least 14 are known to have been treated in hospital, and of these only one died of the disease. There were, however, 37 deaths from all forms of pneumonia. 19 MEASLES. This disease is usually prevalent in alternate years and it was therefore not unexpected when only 170 notifications were received in 1952 compared with 810 in 1951. The previous outbreak extended from October, 1950, until August, 1951, and the build up for the next wave can be observed in the gradual increase in the number of cases noted each month in 1952, the maximum being 40 in December. Only one case is known to have been admitted to hospital during the year, the disease remaining of a fairly mild type. The lack of value of notification of measles and whooping cough in a District such as this has been commented upon for a number of years without any official recognition. WHOOPING COUGH. Whooping cough was slightly less prevalent in 1952, 196 notifications being received compared with 204 and 242 in the two previous years. Most cases occurred in March and June with very few in the second half of the year. Only one case is believed to have been admitted to Hospital and all recovered. A note on immunisation against whooping cough is included later in this report. TUBERCULOSIS. The following table presents concisely the position with regard to tuberculosis in the District during 1952:— Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number of cases on register, 1st January, 1952 226 163 32 34 258 197 Additions, 1952:— New cases notified 26 16 3 1 29 17 Cases removed into District 15 12 2 1 17 13 Restored to register 1 1 — - 1 1 Total Additions 42 29 5 2 47 31 Removals, 1952:— Deaths from (a) Tuberculosis 7 4 — 3 7 7 (b) Other causes — — — — — — Removed from District 10 8 — — 10 8 Recovered 5 1 1 — 6 1 Non-tuberculous — 1 — — — 1 Total Removed from Register 22 14 1 3 23 17 Number of cases on register, 1st January, 1953 246 178 36 33* 282 213* * As at 31st January, 1953. 20 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 2 — — 1 — — — — 5 and under 10 — — 1 — — — — — 10 and under 15 — — 1 — — — — — 15 and under 20 — 1 — — — — — — 20 and under 25 4 5 — — — 2 — 1 25 and under 35 3 1 — — — — — — 35 and under 45 7 2 — — — — — — 45 and under 55 7 2 — — 2 1 — 1 55 and under 65 1 4 1 — 1 — — — 65 and over 2 1 — — 4 1 — 1 Totals 26 16 3 1 7 4 — 3 The new cases were distributed amongst the wards as follows Localisation. Coulsdon East. Coulsdon West. Kenley Parley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 3 14 5 11 14 9 5 Nonpulmonary 1 1 — 1 1 1 2 Totals 4 15 5 12 15 10 7 The number of new notifications of pulmonary tuberculosis was 42, compared with an average of 54 in the previous five years. This corresponds with a case rate of 65 per 100.000 population, which is below the average for the last 10 years and the pre-war averages. The fact that this rate is still higher than it was in the years immediately before the war. is 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 by extensions of the present policy, aiming at early detection and treatment, the immunisation and supervision of contacts, and preferential treatment in rehousing and rehabilitation. By contrast with the case rate, the death rate from pulmonary tuberculosis has dropped to a low level, both locally and nationally, being only 17 per 100,000 population in 1951 and 1952, compared with 31, 64 and 29 in the three preceding years and a 21 post-war average of 39. (Nationally it was 40 in 1949, 32 in 1950, 28 in 1951 and 21 in 1952.) The incidence of new cases of non-pulmonary tuberculosis remained at 6 per 100,000 population compared with 11 in 1950, and the post-war average of 12. There were 3 deaths from this form of tuberculosis, which is slightly above the post-war average of 2.5. 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 practised, while special measures are taken to examine all contacts among school children of infectious cases. 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. The local Tuberculosis Clinic is held every Monday from 2-4 p.m. at the Surrey County Council Clinic, 62 Whytecliffe Road, Purley, while an additional session has been added. The selfcontained Chest Clinic which it is proposed to build in the Purley Hospital grounds is long overdue and badly needed. 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, even influenza only causing 2 deaths during 1952. 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, there were no severe outbreaks, and the only waves of note were chickenpox, which chiefly affected Old Coulsdon and Purley in the late Spring, and mumps, chiefly at Coulsdon and Old Coulsdon in the Spring and Kenley in the Summer, with some cases of rubella at Kenley, Purley and Sanderstead in early Summer. 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. 22 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 1952 only 4 adults were treated by the Health Department for this disease, compared with 11 in each of the two preceding years and a maximum of 399 in 1944. In view of the very small number of isolated cases now occurring it would be preferable for them to be referred to the Medical Officer of Health in order that the contacts can be dealt with really effectively. (b) Vermin. The number of reported cases of infestation also remained small and was limited to 34 children found to have head nits in school. Almost all of these were only casual infestations which immediately responded to the treatment which was 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. Immunisation when practicable is the most effective of the measures for the control of infectious disease, and during 1952 the experimental work on whooping cough immunisation reached a stage at which it became justifiable to inaugurate an official scheme for the provision of this treatment. The comparatively small risk of innoculations influencing the onset of poliomyelitis is now well-recognised, especially when precautionary measures are instituted as soon as the necessity arises. It should certainly not deter parents from agreeing to immunisation against diphtheria and whooping cough, which treatment will only be given if the time is considered opportune by the doctor concerned. DIPHTHERIA IMMUNISATION. 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 following table shows the treatment given during 1952, and the proportion of children estimated to have been immunised 23 Centres and Clinics (including day nurseries). Number who completed Primary treatment 379 Number of "Booster" doses given 97 Schools. Number who completed Primary treatment 14 Number of " Booster" doses given 328 General Practitioners. Number who completed Primary treatment 307 Number given "Boosters" 267 Proportion of children estimated to have been immunised:— (a) from 1-5 years 60.0% (b) from 5-14 years 94.0% When the above figures are compared with those for 1951 there appears to have been an increase of about 300 in the number receiving primary immunisation, mainly as a result of treatment by general practitioners, but a very substantial decrease in "boosting" among the older children. The latter is probably due to arears of work which were done in 1951. The percentage of children aged 1 to 5 years estimated to have been immunised was much better than in the previous year, while the proportion of school children who had been treated probably increased by at least 1 per cent. VACCINATION. The following table shows the number of vaccinations performed in the District during 1952:— Welfare Centres. Primary vaccinations 230 General Practitioners. Primary vaccinations 0-15 years 295 „ „ over 15 years 46 Re-vaccinations 0-15 years 37 „ over 15 years 138 Although all these figures are substantially smaller than those for 1951, in which year acceptances were encouraged by the proximity of the Brighton outbreak of smallpox, it would appear that more primary vaccinations were carried out than in 1949 and 1950. The most important observation is that about 60% of the babies born in 1952 were vaccinated. If this percentage can be maintained it will be very satisfactory. 24 WHOOPING COUGH IMMUNISATION. From the beginning of August all the private doctors in the District sending in reports of complete courses of immunisation against whooping cough with a prescribed vaccine have been paid a similar fee to that which has been payable for years in respect of diphtheria immunisation. It was not practicable, however, to offer this treatment at the Welfare Centres until January, 1953. By the end of the year 79 records of completed primary courses had been received and 10 of booster doses which had been given. At present it is recommended that 3 doses of whooping cough vaccine should be given (usually combined with a diphtheria immunisation agent) at monthly intervals, commencing at the sixth month, and a 'booster' dose at 2 years, but with experience this time table may be varied. 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 1952 reports were received on the following specimens :— Milk, ice cream, and water samples 414 Nose or throat swabs 60 Sputum 1 Faeces Food 27 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. 25 During 1952 the following disinfection were carried out:- Free of cost. Upon payment. Total. Loads of bedding, etc 76 8 84 Houses disinfected 123 - 123 Parcels of clothing — 5 5 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 17 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 1952. The one case dealt with under this Section in 1949 is still 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 1 burial was thus arranged. HEALTH PROPAGANDA. Increasing use is made of the opportunities for health propaganda at the Clinics and Centres in the area and during the visits made by the Health Visitors and Sanitary Inspectors. In addition a number of talks were given by the Officers to various organisations and a Health Exhibit dealing chiefly with the prevention of various infectious diseases and accidents in the home was displayed at the Regal Cinema for a week, thanks to the courtesy of the management. The material supplied by the Central Council for Health Education and other bodies proved extremely useful, but the sudden dissolution of the Ministry of Information's Mobile Film Units was a great loss to those engaged in Health Education. 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:- 26 Maternity Clinics. 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. 27 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 erstead mothers). Westway, Caterham- Every Tuesday, 2—4 p.m. (Old Coulsdon on-the-Hill. mothers). 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. District 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 Mrs. Hill, 42 Beaumont Road, Purley UPLands 8077 Miss Hawking, Flat 1, The Quest, Sanderstead Road, Sanderstead SANderstead 1969 Miss Dale, Flat 2, "Woodlands," Sanderstead Road, Sanderstead SANderstead 5654 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. 28 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, Every other Sanderstead 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. 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.) Acting Matron: Miss I. M. Bettridge. 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 Monday 9.45 a.m. or by appointment. School Eye clinic Speech therapy clinic By appointment. 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 29 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), Mr. E. G. Griffiths, (Divisional Welfare Officer), 115a Brighton Road, Purley UPLands 0776 Welfare Homes. These are situated in the Chipstead and Caterham areas, adjoining the Coulsdon and Purley District, namely:— Telephone: "Chipstead Lodge," Hazelwood 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). 30 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: Tuesdays, 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: Major A. Melling, 17 Briton Crescent, Sanderstead. 31 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 1952. (1) fa) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 272 (b) Number of inspections made for the purpose 1,516 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 7 (b) Number of inspections made for the purpose 25 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 263 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 195 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 9 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 8 (b) By Local Authority in default of owners 1 (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 32 (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 7 (2) Number of families dwelling therein 11 (3) Number of persons dwelling therein 38 (b) Number of new cases of overcrowding reported during the year 5 (c) (1) Number of cases of overcrowding relieved during the year 6 (2) Number of persons concerned in such cases 25 (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 185 By other persons 79 The Chief Sanitary Inspector reports that "The work carried out during the year in respect of the sanitary condition of dwelling houses has followed the pattern of recent post-war years and, although there has been a drop in the total number of houses made fit, the number of inspections has been well maintained. The policy of dealing only with the more urgent items of disrepair under the provisions of the Public Health Act has been continued with moderate success. A more positive attitude towards house repair, as envisaged by the Housing Act, 1936, must be preceded by amendment of the law dealing with rent control, and there are indications that this problem will be tackled in the near future. An example of the difficulties being experienced in this connection is illustrated by the following case. During the year, consideration was given by the Council to the condition of an eight-roomed house reported upon as unfit and not capable at a reasonable expense of being made fit. It was estimated that it would cost approximately £750 to carry out the minimum repairs necessary, and the value of the property after these repairs had been completed would be approximately £375, based on the existing rent and on a 12| years' purchase. In the circumstances, the owner was unwilling to incur any expenditure and eventually the property was sold to the tenant for a small sum on the understanding that he would carry out the repairs." 33 "Fortunately, the general level of housing in this district is of a much higher standard than the average throughout the Country and consequently such cases are not so common as in many local authority areas. The Council's Housing Department continues to assist where possible in the more acute cases of overcrowding and were responsible for five of the six cases relieved." 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, and two further samples were obtained solely for bacteriological examination. 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 Grains per Parts per Grains per 100,000. Gallon 100.000. Gallon. Total solids (dried at 180°C.) 20.0 14.0 19.0 13.3 Combined chlorine (C1) 1.6 1.1 1.7 1.2 equivalent to Sodium Chloride (Na C1). 2.6 1.9 2.8 2.0 Nitric nitrogen (Nitrates) 0.54 0.38 0.58 0.41 Nitrous nitrogen (Nitrites) Faint trace present. Nil Nil Ammoniacal nitrogen 0.0004 0.0003 Nil Nil Albuminoid nitrogen Nil Nil 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 6.5 4.6 5.5 3.9 Permanent hardness to 5.0 3.5 4.0 2.8 Total hardness CaC03 11.5 8.1 9.5 6.7 34 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 44 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 30.10 inches, this being a decrease of 14.35 inches compared with the previous year. The monthly totals throughout the year were as follows:— inches. January 2.38 February 0.98 March 3.78 April 1.77 May 1.68 June 1.69 July 0.75 August 3.18 September 3.22 October 3.67 November 3.72 December 3.28 DRAINAGE AND SEWERAGE. A total of 3,282 yards of new sewers was constructed during the year, and of this total, 3,157 yards were necessitated by the development of Council Housing Estates. The balance of 125 yards was constructed in connection with a scheme for converting the cesspools of 9 houses to main drainage. 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, 10 houses and 2 other premises were connected to the public sewer and 13 cesspools abolished. 35 At the end of the year the following pail closets and cesspools remained in use:— Premises with pail closets 11 Number of cesspools 144 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 remained 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. The action under Section 57 of the Surrey County Council Act, 1931, as amended, which was taken by the local Council in 1951 to obtain prohibition orders in respect of certain areas in the District has continued to prove effective in preventing nuisance arising from gipsy encampments. During the latter part of the year an unauthorised camp site for trailer caravans for residential and occasional use was established on land at Dean Lane, Merstham, adjoining Alderstead Heath. Planning permission has been refused by the Council and an appeal against this decision is pending. SWIMMING BATHS. There are two swimming baths in the District which are used by the general public, and during the year, 17 samples of water were obtained for chemical and bacteriological examination, with satisfactory results. 36 Both baths are privately controlled and regular routine inspections are carried out for the purpose of making residual chlorine and pH. tests of the bath water. During the year 43 such combined tests were made and the appropriate action taken. 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. 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. 37 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 38 103 4 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 146 272 16 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 7 2 - Total 187 382 22 - 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars. Number of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Remedied. Referred To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) 5 4 - - — Overcrowding (S.2) 1 1 — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 4 4 — — — Ineffective drainage of floors (S.6) — — — — - Sanitary Conveniences (S.7) (a) Insufficient 6 4 - 3 - (b) Unsuitable or defective 43 38 — 1 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 16 16 1 - — Total 75 67 1 4 — 38 PART VIII. OUTWORK. (Sections 110 and 111) Nature of Work. Section no. Section in. 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. 34 — — — — — washing — — - — — — Household linen 2 — — — — — Paper bags 1 — — — — — Carding, etc. of buttons etc. 31 - - - - - Cosaques, crackers, stockings Christmas Christmas etc. 5 - - - - - Artificial flowers 1 — — — — — Total 74 — — — — — SANITARY INSPECTIONS, ETC. The following is a summary of the complaints received, visits made, notices served and defects remedied during the year 1952. The number of complaints of almost all types showed a decrease on the previous year, but the total number of visits made by the Sanitary Inspectors continued at a satisfactory level, particularly in respect of those premises in which food is prepared and stored for sale. The Chief Sanitary Inspector and his colleagues can again be congratulated on a very full and useful year's work. 39 40 Complaints Received. General disrepair and insanitary conditions 68 Dampness 26 Overcrowding Defective drainage systems 44 Blocked drainage system 1ll Defective drainage fittings 6 Defective W.C. pans and flushing apparatus 6 Defective service water pipes 8 Defective hot water systems 2 Defective chimney stacks 4 Absence of, or defective dustbins 2 Insanitary pig waste bins 2 Accumulation of refuse, etc 25 Insanitary A.R.P. shelters 1 Rats and mice 362 Keeping of animals 4 Insect pests, etc. 31 Wasps' nests 93 Unsound food 116 Miscellaneous 38 Total 956 Summary of Visits Made. Number of houses visited 301 Number of reinspections and calls made 1,255 Verminous premises 45 Water supply 12 Tents, vans and sheds 86 Schools Places of entertainment 4 Licensed premises 29 Storage of refuse 66 Accumulations 117 Piggeries, fowls and other animals 109 Stables Rats and Mice Destruction 6,360 Drainage inspected 2,059 Drainage tested 307 Cesspools 158 Urinals 5 Sewers and street gullies 85 Cowsheds, dairies and milkshops 144 Ice-cream premises 145 Meat shops 131 Food preparing premises 322 Other food shops 537 Bakehouses—Power 47 „ Other 4 Slaughterhouses 13 Food Inspection—Meat 46 „ „ Other Food 230 Factories—Power 225 „ Other 96 Workplaces 10 Outworkers Rag Flock and Other Filling Materials Act Pet Animals Act 11 Shops Act 292 Merchandise Marks Act Infectious disease enquiries 136 Infectious disease contacts 32 Food poisoning enquiries 7 Disinfection 151 Disinfestation 190 Swimming baths 59 Sampling—Food and Drugs Act, 1938 248 „ Ice-cream 114 „ Milk (bacteriological) 266 „ Milk (biological) 64 „ Water 34 Interviews 1576 Miscellaneous visits 836 Total 17,062 Defects Remedied. Drainage and Sanitary Fittings: Drains reconstructed 46 Drains repaired 42 Blocked drains cleared 158 Disused drainage sealed off 3 Soil and vent pipes repaired or renewed 15 Inspection chamber covers renewed and frames rebedded 42 New stoppers provided to interceptor traps 12 Fresh air inlets repaired or renewed 34 New W.C. pans fixed 17 New W.C. seats fitted 6 W.C. flushing cisterns repaired or renewed 20 Cesspools provided or enlarged 2 Cesspools cleansed, repaired or renewed 6 Cesspools abolished and house drains connected to sewer— 12 Cesspools abolished 1 Soakaways reconstructed 10 Eaves gutters and stack pipes renewed or repaired 32 New lavatory basins fixed 4 Baths provided 1 Glazed sinks renewed or repaired 1 Waste pipes trapped, repaired or renewed 10 Sink gully curbs and dishings repaired 26 Pail closets abolished 3 General Housing Repairs: Defective roofs repaired 29 Yards paved, or paving repaired 22 Dampness in walls remedied 43 Damp-proof courses provided 4 Brickwork of walls repaired 4 Chimney stacks repaired or rebuilt 6 Additional sub-floor ventilation provided 14 Walls and ceilings repaired 45 New ceilings provided 23 Walls of rooms cleansed 49 Ceilings of rooms cleansed 36 Floors repaired or renewed 34 Internal staircase repaired i Ventilation and lighting of rooms improved 1 Windows repaired or renewed 78 Doors repaired or renewed 10 Firegrates repaired or renewed 12 Domestic boilers repaired or renewed 5 Hearths repaired 1 Service water pipes repaired or renewed 5 Cellars cleansed 1 External staircases repaired 5 Additional ventilation and light provided to W.C. apartments 1 Portable dustbins provided 8 Accumulations removed 8 Miscellaneous 9 41 Ratproofing: Ratproofing: Work carried out by occupiers of premises after completion of treatments 47 Food Premises: Hot water supply provided for ablution purposes 18 Lavatory basins provided 2 Glazed sinks provided 4 Waste pipes repaired 2 Drains repaired 6 Staff sanitary accommodation repaired 4 Staff sanitary accommodation cleansed 4 Staff sanitary accommodation provided 2 Walls and ceilings cleansed and repaired 43 Floors repaired or relaid 5 Additional ventilation provided to food rooms 4 Windows repaired 1 Food store provided 1 Equipment repaired or renewed 3 Yards paved 3 Roofs repaired 2 Blocked drains cleared 3 Covered refuse bins provided 6 Accumulations removed 9 Miscellaneous 2 Notices Served. Preliminary Notices 450 Statutory Notices 14 Legal Proceedings. It was not necessary to take legal proceedings in connection with the public health in 1952. 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. DISINFEST ATION. During the year only 8 houses needed to be, and were disinfested owing to the presence of bed bugs, but action was taken by the Department in 85 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. 42 PREVENTION OF DAMAGE BY PESTS ACT, 1949. The table on the following page is a tabular statement indicating the action taken in 1952 under this Act. During 1952, 80 visits were made to the Council Depots at Millstock, Purley Oaks, Kenley and Old Lodge Lane, and land at Littleheath Woods, Selsdon. 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 such subsequent maintenance treatment as was necessary. Only minor infestations were recorded. The Council's charges for services rendered in the destruction of rats and mice remain the same, i.e. 6/3d. per hour, plus the cost of materials at premises other than private dwellings, and a flat rate charge of 5/0d. in respect of private dwellings. 43 The Council continues 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.eproofing. Primary and reinspections. Sewer treatment. Total. Local Authority 1 25 26 11 — 11 — - - Dwelling Houses 319 231 550 292 20 279 19 — — Business Premises 53 75 128 47 17 41 17 — — 5,708 652 6.360 Agricultural — — — — — — — — — Total 373 331 704 350 37 331 36 — — 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 has to be kept, were as follows:— Distributors of Milk in the district 16 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 314 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. Number. Methylene Blue. Phosphatase. Turbidity. Satisfactory. Unsatisfactory. Satisfactory. U nsatisfactory. Satisfactory. Unsatisfactory. Pasteurised 216 213 3 214 2 - - T.T. (Raw) 15 13 2 - — — — T.T. (Pasteurised) 25 25 — 25 — — - Sterilised 17 - - - - 17 - Totals 273 251 5 239 2 17 — 45 BIOLOGICAL. Designation. Number. Tubercle Bacillus. Present A bsent Tuberculin Tested 19 - 19 Pasteurised 2 — 2 Ungraded 20 — 20 Totals 41 — 41 Of the total samples taken only a comparatively small number failed to pass the prescribed test. The two samples of pasteurised milk that failed to pass the Phosphatase test, thus indicating inadequate pasteurisation, were obtained from a retailer having plant outside the District. Representations were made to the Company concerned and to the Authority in whose district the premises were situate, with the result that the necessary remedial measures were taken, and subsequently the existing plant was discarded in favour of one incorporating the H.T. S.T. process. In accordance with a standard practice throughout the County samples of all milk (including T.T. milk) which is sold to the public without heat treatment are submitted to routine biological testing, and it is very satisfactory to be able to record that none of the 41 samples showed any evidence of the presence of the tubercle bacillus. Milk (Special Designation) Regulations, 1949. Licences to sell milk under the above Regulations were issued as follows :— Dealers: Tuberculin Tested 11 Pasteurised 12 Sterilised 14 Supplementary Tuberculin Tested 10 Pasteurised 10 Sterilised 7 ICE CREAM. Under the provisions of Section 64 of the Coulsdon and Purley Act, 81 premises within the District are registered for the sale of ice cream and a further 3 for the manufacture and sale of this commodity. In addition, the sale of ice cream is carried on from 23 premises which are exempt from registration. 46 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 114 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 92 Grade II 14 Grade III 4 Grade IV 4 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. Two of the Grade IV samples came from one salesman who gave up his business shortly afterwards. The other 2 samples were of wrapped ice cream which had been manufactured outside this District. By comparison with recent years the above results can be considered reasonably satisfactory; apparently the gradual improvement in the bacterial quality of ice cream which has been noted for some years is continuing. The two private slaughterhouses in the District have not been licensed since 1940. In 1952 one licence was issued under the Slaughter of Animals Act, 1933, for the purpose of slaughtering at a Public Institution in the District. The arrangements made to carry out post-mortem inspections of all animals slaughtered at Cane Hill and Netherne Hospitals for consumption by the inmates were continued, but in fact no slaughterings were recorded at the Cane Hill slaughterhouse during the year. At Netherne Hospital the carcases and offals of 4 cattle, 1 calf and 15 pigs were inspected for evidence of disease, and a small quantity of offal only was condemned as unfit for food. Meat delivered to local butchers' shops from the Wholesale Meat Supply Association Depot situated outside the District was inspected on frequent occasions. The delivery of meat within the Urban District continues to be made in a type of vehicle which is not conducive to its hygienic handling. In 1951 the Council made representations to the Ministry of Food on this matter, suggesting the introduction of hanging gear in such vehicles, but so far no improvement has been noted. MEAT. 47 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 Sanitary Inspectors. A register of all such premises includes the following:— Confectioners 61 Butchers 29 Fishmongers (Wet and Dry) 18 Fishmongers (Fried)) 8 Bakers 27 Greengrocers 48 Ice-cream premises 107 Cafes and Restaurants 67 Grocers 71 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. The Inspectors 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 and during the year 1,215 visits were made for this purpose. Every opportunity is taken of discussing the subject of Food Hygiene with the food handlers and others, and a number of local organisations have been addressed on the subject, the talks being supported by film strips and sound films. The Chief Sanitary Inspector reports that "as a further measure of control and advisory work, increasing attention has been given to the standard of washing up in catering premises. For this purpose, swabs have been taken from washed crockery and the varying results obtained have provided very useful evidence of the need for improved technique and closer attention to this aspect of the meals service. It is hoped to pursue this line of action with combined tests of utensils and washing-up water, and already there is evidence that interest has been stimulated and consequently better standards obtained." 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. 48 UNSOUND FOOD. The following unsound foods were surrendered during the year, the total bulk being substantially less than that surrendered in 1951:— cwts. lbs. ozs. Canned Soups — 23 7 Canned Meat 6 101 13½ Canned Fish — 31 9¼ Canned Vegetables 4 35 6 Canned Fruits ... 11 82 1¼ Canned Milk — 13 0 Meat, Bacon, Poultry, etc. 9 38 2 Fish 7 19 0 Whalemeat — 50 0 Meat and Fish Pastes — 13 12¾ Butter, Fats and Cheese — 75 12½ Sugar, Jam, etc. 1 5 12½ Flour, Bread, Cereals and Biscuits — 62 9¾ Pickles and Sauces — 47 1 Dried Fruit - 30 8 Miscellaneous — 81 2 Total 44 39 1½ 49 FOOD AND DRUGS ACT, 1938. The following samples were taken during 1952 and submitted to the Public Analyst, with the results shown :— Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total Almonds, Ground 1 - 1 - - - Butter l - 1 — - — Banana Curd 1 - 1 — — - Beans in Tomato Sauce 1 — 1 — - - Bisurated Magnesia — 1 1 — — - Beef, Minced 1 - 1 — - - Beef Suet, Shredded l - 1 - - - Beer 1 - l - — — Cherries, Tinned — 1 1 — - — Cherries, Glace 1 - 1 — — — Coconut, Dessicated l 1 - — - - Curry Powder — 1 1 — — — Cherryade Table Water l - 1 — - — Cake, Fruit l - 1 — — — Cough Syrup — 3 1 — — - Custard Powder l — 1 — - - Dessert Powder 1 — 1 — — - Epsom Salts l — 1 — - - Fish Paste — 1 l — - — Gooseberries, Tinned 1 — 1 — - - Ginger Beer 1 — l — - - Gravy Thick 1 — 1 — — - Golden Crumbs — 1 1 — - - Ginger Wine 1 — 1 — - — Honey l — 1 — - — Ice Cream 4 — 4 — - - Ice Cream Powder — 1 1 — 1 1 Jelly Crystals 1 2 3 — - — Jam 3 — 3 - - - Lard 1 — 1 — - — Lemonade Powder 1 — 1 — — - Lemon and Barley Water 1 — 1 — — - Lemon Juice — 1 1 — - — Milk 62 2 64 — 1 1 Marshmallow Creme — 1 1 — - - Mincemeat 2 1 3 — - - Marzipan 1 — 1 — - - OliveOil — 1 1 — — - Orange Juice 1 — 1 — - - Orangeade Powder 1 — 1 — - - Peel, Mixed 1 — 1 — — - Peas, Tinned 1 — 1 — - — Pudding Mixture 1 — 1 — - — Pepper, White 1 — 1 — - — Pepper Flavour Condiment — 1 1 — - — Pineapple Pulp, Tinned 1 — 1 — - — Pickle — 1 1 — 1 1 Pickling Spice 1 — 1 — - — Peppermint Cordial 1 — 1 — - — Sausages 9 — 9 — - — Sausage Meat 1 - 1 - - - 50 Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Semolina Pudding Mixture - 1 l - - - Soup. Tinned — 1 l — — - Soup Mix — 1 l — — — Sweets 2 — 2 — - — Sugar 1 - 1 - - - Stewed Steak - 1 1 - - - Sparkling Clarade 1 - 1 — — — Soya Flour 1 — 1 — — — Tea 1 — 1 — — — Vinegar 2 1 3 — l l Welsh Rarebit 1 - 1 — — — Whisky 2 - 2 - - - Totals 125 25 150 — 4 4 It will be noted that adverse reports were received on 4 samples, including 1 milk sample, and the following is a summary of the action taken in respect thereof. Ice Cream Powder. The Public Analyst reported that the use of this powder in the preparation of ice cream according to the instruction on the label would have produced an article containing only 3 per cent of fat, whereas the legal minimum standard for the fat content of ice cream was 5 per cent. Investigation revealed that the manufacturers had at a later date received the approval of the Food Standards and Labelling Division of the Ministry of Food to a modification of the label which was attached to this particular sample, together with an intimation that in the opinion of the Ministry the Foods Standards (Ice Cream) Order, 1952 did not apply to ice cream powders retailed as such. Although the modified label, which called for the addition of milk together with evaporated milk or cream, covered the Analyst's original objection, he was of the opinion that the utmost prominence should have been given to this requirement in order to avoid any misconception. Representations were made to the Ministry of Food and the manufacturers accordingly, and the necessary assurances obtained. Milk. An informal sample of milk taken from bulk supplies being delivered to a Public Institution in the District was reported as deficient in milk solids other than milk fat to the extent of 2 per 51 cent. and the freezing point indicated 4 per cent of added water. On receipt of this report, formal samples were taken from a similar bulk consignment in course of delivery, but these samples proved satisfactory. Pickle. In response to a complaint by a resident, a jar of pickle alleged to contain fragments of glass was submitted for analysis, and the presence of glass splinters was confirmed, thus rendering the article unfit for human food. The glass jar itself was completely intact but as the complainant was unable to say when or where this jar of pickle was purchased, no further action was taken apart from informing the manufacturers of all the circumstances. Malt Vinegar. This sample contained 0.6 per cent of added salt and the Public Analyst commented that added salt is not a natural ingredient of malt vinegar. The manufacturers did not hold a special dispensation from the Ministry of Food to add salt without declaration and following representation the bottlers concerned arranged for new labels to be supplied. 52 TABLE I. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1952. 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. 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 1 - - - - - - - - 1 - - - - 1 - - - - - Paratyphoid fever — - - - — - — - - — - - - — — - - — - — Scarlet fever 80 1 - 1 8 5 53 4 2 4 1 1 - 17 9 10 9 26 10 4 Erysipelas — - - - - - - - - - - - - - - - - - - - Puerperal pyrexia 2 - - - — — — — - 2 - - - - - — - 1 1 — Pneumonia 21 1 - - 1 — 4 — - 4 4 4 3 7 2 4 2 2 1 3 Dysentery 48 - - 1 — 4 2 1 11 6 6 17 35 6 2 5 — — — Meningococcal Meningitis 1 - - - - - 1 - - - - - - - - 1 - - - - Poliomyelitis 8 - - - — — 3 1 1 3 — — — 3 3 — — 1 — 1 Measles 170 2 10 16 15 22 98 5 1 1 - - - 25 33 95 9 74 - 1 Whooping cough 196 12 8 14 24 34 91 4 - 2 6 1 — 21 22 23 29 37 60 4 Malaria - — — — - — - — - - — — — - - — - - — - Ophthalmia neonatorum - - - - - - - - - - - - - - - - - - - - Encephalitis 1 - - - - - - - - 1 - - - - - - - - 1 - Food Poisoning 5 — 1 — - — 3 — 1 — — — — 1 1 - 1 - - - Totals 533 16 19 31 49 61 257 16 6 29 17 12 20 104 77 66 55 141 77 13 53 54 TABLE II. THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1952. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Diphtheria - - - - - - - - - - - - - Typhoid fever - - - - - - - - - - - 1 1 Paratyphoid — — — — — — — — — — — - — Scarlet fever 5 9 13 12 — 5 3 1 2 9 7 14 80 Erysipelas — — — — — — — — — — — — — Puerperal pyrexia — — 1 — — 1 — — — — — 2 Pneumonia 4 3 1 1 1 3 1 — 1 1 1 4 21 Dysentery 4 15 11 6 3 2 1 — 1 3 — 2 48 Meningococcal infection — — — — 1 — — — — — — — 1 Poliomyelitis — — 1 — — — 2 1 1 1 — 2 8 Measles — — 2 4 5 2 15 26 12 33 31 40 170 Whooping cough 16 20 33 16 23 37 24 9 9 5 4 — 196 Malaria — — — — — — — — — — — — Encephalitis - - - - - - - - - - 1 - 1 Food poisoning - - - 1 1 - - 3 - - - - 5 Totals 29 47 62 40 34 50 46 40 26 52 44 63 533 55 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1922 Disease 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 1952 Small pox - - - - - - 2 2 3 4 - — - — — — — — — — - — — — — — — — — Scarlet fever 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 80 Diphtheria 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 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 16 11 5 24 9 9 9 6 4 4 7 5 5 1 3 26 5 1 53 12 3 1 6 4 4 2 2 2 1 11 1 Meningococcal infections - - - - - - - 1 - - - - - 1 1 - - 4 8 6 1 4 2 1 3 1 1 - - - 1 Puerperal fever — — — — 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 2 Poliomyelitis 1 — 1 — — 1 1 — 1 — 2 — 1 1 — 3 1 1 1 2 3 — — 2 1 11 2 9 10 — 8 Polio-encephalitis - - - - - - - - - - - - - - - 2 - - - - - - - - 1 - - - - - — Acute encaphalitis 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 - - - 1 - - Pneumonia 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 21 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — Measles 2 11 214 479 275 52 705 41 218 567 600 477 810 170 Dysentery 7 17 - - 1 - - 5 - - - - - 6 — 1 2 10 85 224 121 21 42 172 82 43 71 14 28 22 48 Whooping cough 6 1 136 36 55 51 100 31 115 201 42 242 204 196 Food poisoning 2 6 2 5 Tuberculosis :— Pulmonary 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 42 Other forms 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 4 Totals 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 579 TABLE IV. DEATHS OCCURRING DURING THE YEAR, 1952. Cause of death. Males. Females. T otal. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and over. Respiratory tuberculosis 7 4 11 - - - - - 3 3 5 Other tuberculosis — 3 3 — - - — 1 - 1 1 Syphilitic disease 3 — 3 - - - - - - 1 2 Diphtheria - - - - - - - - - - - Whooping cough - - - - - - - - - - - Meningococcal infections — 1 1 — - - 1 - - - - Poliomyelitis 2 1 3 — - - 1 - 2 — - Measles — - - - - - - - - - - Other infective and parasitic diseases 3 - 3 - - - - - - 1 2 Cancer 53 61 114 — - - 1 2 5 47 59 Leukaemia 7 1 8 — - - 2 — - 3 3 Diabetes 1 — 1 - - - - - - - 1 Vascular lesions of nervous system 30 59 89 1 - 1 - - 2 15 70 Coronary disease, angina 65 35 100 - - - - - 2 23 75 Hypertension with heart disease 4 5 9 - - - - - - 7 7 Other heart disease 33 61 94 - - - 1 - 1 10 82 Other circulatory disease 19 19 38 - - - - - - 9 29 Influenza 1 1 2 - - - - - - 1 1 Pneumonia 16 21 37 1 - - - 1 3 6 26 Bronchitis 70 13 33 1 - - - - - 2 10 Other respiratory diseases 3 2 5 3 - - — — 1 — 1 Ulcer of stomach and duodenum 6 1 7 - - - - - - 4 3 Gastritis enteritis and duodenum 6 1 7 - - - - - - - 4 Nephritis and nephrosis 2 1 3 - - - - - - 1 2 Hyperplasia of prostate 7 — 7 - - - - - - 2 5 Pregnancy, childbirth, abortion - - - - - - - - - - - Congenital malformation 5 2 7 6 - - - - - 1 - Other defined and illdefined diseases .. 71 31 52 5 3 - 1 1 1 17 24 Motor vehicle accidents 3 — 3 - - - - - 1 - 2 All other accidents 5 7 12 1 — 1 - 2 2 1 5 Suicide 2 5 7 - — - 7 4 1 Homicide and operations of war - - - - - - - - - - - Totals 319 337 656 18 3 2 7 7 25 154 440 56 INDEX. 57 Page Ambulances 29,30 Analysis of Mortality 12, 13, 14 Area 6, 7 Bacteriological work 25 Bed Bugs, Eradication of 42 Birth Rates 6,8, 15 Births, Live, Illegitimate and Still 6,8.9 Blind Welfare Worker 30 Camping Sites 36 Cancer 10, 11, 12 Causes of Deaths 10,12,56 Chicken Pox 22 Children's Officer 30 Clinics : Diphtheria Imunisation 24 Family Planning 28 Infant Welfare 28 Maternity 27 School 29 Toddlers 28 Tuberculosis 31 Veneral Disease 31 Closet Accommodation 35,36 Consultant Service 31 Day Nurseries 29 Deaths and Death Rates ,8,9,15,56 Dental Treatment 29 Diphtheria 17 Diphtheria Immunisation 23,24 Disinfection 25 Disinfestation 42 District Nursing Service 27 Drainage and Sewerage 35 Dysentery 18 Emergency Units 31 Encephalitis 19 Enteric Fever 18 Erysipelas 18 Eye Defects 29 Factories 38,39 Family Planning Clinic 28 Food and Drugs Act 50,51,52 Food Supply: Milk 45 Meat 47 Unsound 48,49 Food Premises 48 Food Poisoning 18 Guild of Social Service 31 Health Visitors 28 Health Propaganda 26 Heart Disease, etc 10 Home Helps 28 Hospitals 30,31 INDEX—continued. Houses, Inspection of 32 Houses, Inhabited 6,8 Housing 32,33,34 Ice-Cream 46,47 Illegitimate Babies 9 Immunisation 24 Infantile Mortality 6, 12, 13, 14 Infectious Disease: Cases Notified 16,53 Control of 23 Monthly incidence of 54 School Notifications 22 Inspection and Supervision of Food 45 Laboratory Facilities 25 Legal Proceedings 42 Marriage Guidance Council 31 Massage Establishments 26 Maternal Mortality 12 Maternity Clinics 27 Maternity and Child Welfare Services 27,28,29 Centres 28,29 Hospital Accommodation 30,31 Measles 20 Meat 47 Meningococcal Infections 19 Mental Health Service 30 Midwifery Service 27 Milk and Dairies Regulations 45 Milk (Special Designations) Regulations 46 Milk, Sampling of 45,46 Moral Welfare Worker 31 Mortality: Analysis of 12, 13, 14 Infant 6, 12, 13, 14 Maternal 12 Mumps 22 National Assistance Act, Sect. 47 26 National Assistance Act, Sect. 50 26 National Society for the Prevention of Cruelty to Children 31 Non-notifiable Infectious Disease 22 Nursing Service 27 Ophthalmia Neonatorum 18 Paratyphoid Fever 18 Pneumonia 19 Poliomyelitis 19 Population 6,7,8 Premature Babies 27 Public Cleansing 36 Public Health Committee 3 Puerperal Pyrexia 18 Rainfall 35 Rateable Value 6 Rats and Mice Destruction 43,44 Rivers and Streams 36 Road Safety Committee 1 58 INDEX—continued. Sanitary Inspections, etc 39,40,41,42 Scabies 23 Scarlet Fever 17 Schools 42 School Clinics 29 Sewerage 35 Shops 37 Slaughterhouses 47 Smallpox 16 Smoke Abatement 36 Social Conditions 6,7 Staff 3 Statistics: Housing 32,33 Vital 6,8, 15 Still Births 6, 15 Swimming Baths 36,37 Toddlers' Clinics 28 Tuberculosis 20,21,22 Typhoid Fever 18 Vaccination 24 Vermin 23 Violence, Deaths from 12 Vital Statistics 6,8,15 Water Supply 34,35 Welfare Homes 30 Welfare Officers 30 Whooping Cough 20 Whooping Cough, Immunisation 25 59