HEALTH REPORT for 1953 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH Printed by RAYNES PARK PRESS Lambton Road London S,W,20 HEALTH REPORT for 1953 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. 1953. Public Health Committee. Chairman: R. N. Saunders. Councillor J. E. M. Dewey. Councillor Mrs. D. Pattison. „ H. W. Hayden, „ Miss J. C. Simpson. j.p., f.b.o.a., f.s.m.c. m.a., j.p. s. e. Littlechild. „ r. w. Kersey, „ C. J. Ffield, b.sc. b.sc., a.r.i.c. „ Mrs. K. M. Platt. „ A. H. Williams. Ex-officio: Councillor Col. F. N. Charlton, c.b.e., j.p. „ W. H. Glanville. Representatives on the South Eastern Divisional Health Sub-Committee. Councillor F. H. Collier. Councillor Mrs. K. M. Platt. „ Mrs. F. K. Grover. „ R. W. Kersey, R. N. Saunders. b.sc., a.r.i.c. 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. (until 30th August, 1953). *T. R. Bennett., M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector: W. Haworth, F.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 1953, this being my twenty-second 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 was a fraction lower than the very low level reached in the previous year, but the percentage of illegitimate births and the Stillbirth Rate also remained low. The Death Rate in respect of those who were formerly considered to have been the normal residents of this District improved to the post-war average, but unfortunately, as will appear later, the position has been somewhat confused by the Registrar General's new system of allocation, whereby all deaths occurring in the two mental hospitals are now attributed to this District, and not transferred to the place of former residence. Temporarily ignoring this artificial inflation, however, it has to be noted that there was again a further slight rise in the Cancer Death Rate, chiefly due to the increasing number of deaths from cancer of the lungs among males, but on the other hand the Tuberculosis Death Rate decreased as did that from heart and circulatory diseases. There was one maternal death after two clear years. Unfortunately, there was a further rise in the Infant Mortality Rate which was higher than the corresponding rate for the Country as a whole, which latter was once again the lowest ever. About a third of the infant deaths in the District were preventable, most of these being due to infections, and this fact presents an obvious challenge to all concerned, including parents. Apart from measles, which was very wide spread, the incidence of infectious disease was about the normal for recent years, scarlet fever and pneumonia showing a slight increase but dysentery and whooping cough being less common. Poliomyelitis was rather more prevalent nationally, but there were only 9 definite cases in the District and only one of these was severe. No death occurred, and 6 of the cases recovered with very slight paralysis, if any. It is satisfactory to be able to record a steady improvement in the hygienic conditions of the food supply, and particularly in the standard of cleanliness of the milk and ice cream sold in the District; also to note the decreased number of complaints received in respect of nuisances and the beneficial effect of the Council's action in reducing nuisances liable to be caused by gipsy encampments. As the problem of housing is entering a new phase and slum clearance and the rehabilitation of delapidated property are again to be treated as urgent matters, emphasis must be placed on the 4 health aspect of this important subject, which will inevitably absorb an increasing proportion of the time of the Sanitary Inspectors. As usual, the majority of this Report shows the steady but unspectacular work maintained, and in some instances improved by the various branches of the Local Authorities' Health Services, but important sections are only referred to briefly as the relevant statistics are incorporated in reports for the whole County. This would appear to be one of the weaknesses in the present administrative arrangements in spite of 'divisionalisation'. It is pleasing to be able to report, however, that liaison between the various branches of the Health and Social Services, the need for which has often been stressed in recent years, is steadily though sometimes slowly improving, and at officer level co-operation is normally quite good. Now that thought is again being given both locally and nationally to the future of Local Government, it may not be inappropriate to end this introduction by remarking on the amount of effort and time which is now required to effect true co-operation and understanding, owing to the complexity of the present administrative arrangements;— and this would appear to apply not only at officer level. Members will know of other examples, but one has sometimes thought that a more concerted policy between the Health and Sanitary Authorities on some health and social problems, e.g. caravan sites, housing and the treatment of "problem families", is desirable and should be practicable. Whether the solution lies in more improvements in the present "2 tier" system, in more delegation of powers or in the encouragement of more 'all' or 'most purpose' authorities of the optimum size, the desirable keynotes for any further reform would seem to simplification, associated as far as possible with the fostering of local interest and sense of responsibility. May I, in conclusion, again express my thanks to all associated with the local Health and Social Services, both official and voluntary, for their co-operation during the year, and in particular I would mention the contributions of the Chief Sanitary Inspector and my Administrative Assistant, not only towards the production of this report, but for their loyal help at all times. 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. 1953 64,810 Population, Census 1931 37,666 Population, Census 1951 63,770 Number of occupied houses, December, 1953 18,340 Number of occupied houses, 1931 9,533 Number of occupied houses, 1951 18,071 Rateable Value, December, 1953 £798,746 Sum represented by a penny rate £3,185 VITAL STATISTICS FOR THE YEAR 1953. Birth Rate per 1,000 of the Total M. F. estimated resident population Live Births—Legitimate 729 355 374 do. Illegitimate 21 13 8 11.6 Corrected Birth Rate 750 368 382 12.5 Rate per 1,000 (live and still) births. Still Births—Legitimate 13 9 4 do. Illegitimate 1 1 — 18.3 14 10 4 Crude Death Rate per 1,000 of the estimated resident population Deaths 990 451 539 15.3 Corrected Death Rate 13.3 Rate per 1,000 Deaths from puerperal causes (live and still) births. Puerperal Sepsis — — Other Puerperal causes 1 1.31 Total 1 1.31 Death Rates of Infants under one year of age:— All infants per 1,000 live births 29.3 Legitimate infants per 1,000 legitimate births 27.4 Illegitimate infants per 1,000 illegitimate births 95.2 Deaths from Cancer (all ages) 155 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years) 2 6 HEALTH REPORT FOR 1953. 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 38 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. 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 1953 being estimated by the Registrar-General to have been 64,810 which is 630 more 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 1953 were as follows:- Cane Hill Hospital 2,536 Netherne Hospital 2,085 Russell Hill School 238 Reedham Orphanage 268 7 In 1953 there were 18,340 occupied houses, distributed as follows:— Coulsdon East 2,901 Coulsdon West 3,096 Purley 2,570 Woodcote 1,719 Sanderstead North 2,262 Sanderstead South 2,483 Selsdon 1,881 Kenley 1,428 This suggests an average of 3.53 persons per occupied house in 1953, or 3.25 if the institutional population is excluded. The latter is comparable with 3.66 at the time of the 1931 Census, and the former with an average of 4.3 per house in 1915. VITAL 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 1952 and 1953. Rates per 1,000 population. 19201924. 19251929. 19301934. 19351939. 19401944. 19451949. 1952. 1953. Birth rate 13.5 12.9 11.6 12.8 15.2 15.2 11.7 11.6 Percentage illegitimate 3.4% 3.7% 2.8% 3.4% 3.9% 3.4% 1.9% 2.8% Stillbirth rate — — — 0.43 0.48 0.40 0.14 0.22 Death rate 7.4 7.0 7.4 8.3 11.4 9.7 10.2 15.3 Cancer death rate 0.96 1.15 1.35 1.19 1.70 1.75 1.78 2.39 Tuberculosis death rate (per 100,000 population) 57 36 38 35 48 36 22 29 Violence including Suicide 0.44 0.35 0.32 0.46 0.82 0.37 0.34 0.46 Maternal mortality rate per 1,000 live and still births 2.08 2.66 3.21 2.27 2.10 1.12 Nil. 1.31 Infant mortality rate (per 1,000 re gistered births) 28 38 32 38 40 26 24 29 Neo-natal mortality rate - - - 26 28 19 17 21 Estimated population 21,351 28,950 41,616 53,084 49,880 60,610 64,180 64,810 8 BIRTHS. During the year 1953, 750 births were registered as occurring in the District, of which 368 were male and 382 were female, compared with 751 in 1952. It will be seen by reference to the above table that this is equal to an annual birth rate of 11.6 per 1,000 population, as compared with 11.7, 12.2, 11.7, 13.0, 14.6 and 17.0 in the previous six years. The rate of 17.6 in 1946 was the highest birth rate experienced in this District, but that of 1953 was slightly below the lowest pre-war average rate. If this rate is corrected for the atypical constitution of the population it becomes 12.5 and this can be compared with the birth rates for England and Wales which were 15.5 in 1953 and 15.3, 15.5, 15.8, 16.7, 17.9, and 20.5 in the preceding six years. Illegitimacy.- In 1953, of the births registered, 21 were illegitimate (13 males and 8 females), this being 7 more than in the preceding year. The percentage of illegitimate births was thus the same as the lowest pre-war average. Stillbirths— The number of stillbirths registered during 1953 was 14 (10 males and 4 females), which is 5 more than last year. One of the stillbirths occurred in respect of an illegitimate child. The local stillbirth rate was 0.22 per thousand of population while that for England and Wales was 0.35 in 1953. DEATHS. The number of deaths registered during 1953 as belonging to this District was 990 (451 males and 539 females), which would appear to be 334 more than last year. This astonishing difference is due to a new system whereby the Register General now attributes to this District all the deaths occurring in the two large mental hospitals, it being suggested that as the majority of the inpatients in these hospitals are long stay cases, they should be regarded as forming part of the normal population. Numerically, of course, they are included in the population, but, their death rate being inevitably higher than the average, the effect on the local death rate is most misleading. Even the application of the "comparability factor" supplied by the Registrar General, which reduces the gross local death rate of 15.3 to a 'corrected' one of 13.3 gives an unfair comparison with the national death rate of 11.4 for 1953. From the point of view of continuity of the local records it would have appeared much sounder to have transferred the deaths of non-residents dying in these hospitals to their respective districts, as was previously the practice, and to have reduced the local population by the number of those hospital beds normally occupied by non-residents. In order to be able to compare more accurately the 1953 death rates, the records in respect of the normal residents have 9 been kept separate from those of the mental hospital patients who would previously have been transferred to their own districts, and as far as practicable throughout this Report a distinction has been made between them. It will be appreciated, however, that this procedure is inevitably cumbersome, time absorbing and apt to be somewhat confusing., Reverting to the total death rate for 1953, that for normal residents would have been 9.9 but for the new system, and this is the average crude death rate since the war and an improvement on the rate of 10.2 last year. Similarly, if it is still appropriate to use the "comparability factor" to this section of the population, the "corrected death rate" would have been 8.6. The death rate for England and Wales was 10.8 in 1948, 11.7 in 1949, 11.6 in 1950, 12.5 in 1951, 11.3 in 1952, and 11.4 in 1953. The principal causes of death locally during 1953 together with the rates per cent of total deaths, are shown in the following table, the deaths and comparable death rates among ordinary residents being shown in brackets:— Cause. Number of Deaths. Rate per cent, of Total Deaths. Heart and circulatory diseases 486 (321) 49.1 (50.2) Cancer, malignant disease 155 (128) 15.7 (20.0) Pneumonia 93 (22) 9.4 (3.4) Bronchitis 42 (38) 4.2 (5.9) Accidents 19 (9) 1.9 (1.4) Tuberculosis (all forms) 19 (12) 1.9 (1.9) (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. Among the ordinary residents the death rate from heart and other circulatory disease, 4.95, was lower than in 1952, 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 regretable if this particular rate remains high. Ignoring the mental hospital group, this year 83 per cent of residents dying from heart and circulatory disease were over 65 years of age at the time of death, compared with 79 per cent in 1952 and 81 per cent in each of the previous three years, while no less than 52 per cent were over 75 years of age. (Incidentally, 69 per cent of deaths from all causes were over 65 years, compared with 67, 71, 69, and 61 in the four preceding years). CANCER. The cancer death rate in respect of normal residents was 2.00 in 1953 compared with 1.78, 1.91, 1.84 and 1.73 in the last four years and an average of 1.78 since the war. In recent years there 10 11 CANCER DEATHS 1953. 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 - - - - - - - - 1 1 — — - 1 1 Brain and Thyroid - - - - 1 1 1(1) - - (1) - - - (1) 2(1) 1(2) Bone - - - - - 1 - - - - - - - - - 1 Pharynx and Oesophagus - — — - - - - - - - 2 - - - 2 - Stomach and Duodeum - —• — - - 1 1(1) 2(1) 1(1) - - 3 - 1 6(2) 8(1) Intestines - — — —(1) -(1) - 1 4(1) 4(1) 3(2) 5 3 2 1 12(2) 11(4) Liver - - - - - - - - - - - 2 1 - 1 2 Pancreas - — — — - - 1 — 1 1(1) 1 - (1) 2 3(1) 3(1) Lungs - - - —(1) 2 - - 1 7(1) 1(1) 3(1) 3 - - 20(2) 4(2) Bladder — — — — — — — — 2(1) — — 1 — 1 2(1) 3 Prostate — — — — 1 — — — -(1) — 4 — 3 — 8(1) — Uterus — — — — — — — 2 — 3 - - - - - 5 Vagina and Ovary - - - - - - - 3(1) 2(1) - 2 - - - 7(2) Breast - — — — - - - 2(2) 2(1) - 6(1 - 1 - 11(4) Ill-defined 2 3 1 - 2 - - 1 1 - 3 1 9 -(1) 9 5(1) Totals 2 3 1 -(2) 6(1) 3 12(2) 15(5) 16(5) 14(7) 23(1) 21(1) 6(1) 6(2) 66(10) 62(17) has been a tendency for this rate to become more stable after increasing more or less steadily for years, and it is hoped that the rise in 1953 will not persist. The previous table gives the age, sex and distribution of this disease in the fatal cases among ordinary residents which occurred in 1953, the mental hospital cases being added in brackets. Compared with recent years, there was a decrease in the number of deaths from breast cancer in females but a further increase of lung cases among males. For the second year in succession 30% of the male deaths from cancer were associated with the lung, whereas the comparable post-war average for this condition is 24%. Nationally it has been shown that the increase in deaths attributed to this cause is a true increase, even allowing for the ageing population, better diagnosis, etc., and research on the cause is proceeding. The suspected association with heavy cigarette smoking is now well known, and pending further evidence personal restrictive measures are justified. 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. Excluding 13 deaths among mental hospital inmates, previously transferable, there was a decrease in deaths from violence (including suicide) compared with 1952, the death rate being 0.26 per thousand of population compared with 0.34, 0.45 and 0.37 in the last three years and an average of 0.39 both for the interwar years and for the years since the war. Deaths on the road increased by one, four deaths being attributed to this cause. Three of these deaths were in fairly elderly pedestrians struck by motor cars and one resident was struck by a motor lorry when in an invalid tricycle. There were a variety of causes for the remaining 5 accidental deaths in the District, but all but one of the accidental deaths among the mental hospital patients were due to fractures following falls in the very elderly. The number of deaths attributed to suicide, 11, was 4 more than last year, but 3 of these were mental hospital patients. The nett figure is 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. 12 MATERNAL MORTALITY. After two successive years in which no maternal deaths occurred, one maternal death was reported in 1953, with a resultant maternal mortality rate of 1.31 per 1,000 live and stillbirths compared with that of 0.76 for England and Wales. This single death in three years was due to a rare combination of abnormalities. INFANT MORTALITY. During 1953 there were 22 deaths among children under one year of age, as compared with 18 last year, and an average of 20 in the last five years. Two of the deaths were in respect of illegitimate children. This record is, unfortunately, not very satisfactory and several of the deaths, particularly those due to infections, should have been preventable. The resultant infant mortality rate was thus 29.3 per 1,000 registered births, compared with 24.0, 21.7, and 17.2 in the previous three years, the rate in 1950 being the lowest ever recorded for this District. The infant mortality rate for England and Wales was the record of 26.8 in 1953, the lowest previously recorded being 27.6 in 1952. The 16 babies dying in the first month correspond with a neo-natal mortality rate of 21.3 (i.e. deaths in the first month per 1,000 live births), which is higher than the average for the past 8 years, which was 18. During the year 5 premature babies were notified as being born at home and 34 in institutions. Of the latter 7 died, 5 in the first day, one on the twentieth day and one at two months. This suggests that 20% of the premature babies died, compared with an average of 22% in the years since 1945. 13 The following table gives the causes of the 22 deaths which occurred during 1953 together with the age at death. 14 INFANTILE MORTALITY DURING THE YEAR 1953. 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 2 — — — 2 — — — 1 3 Gastro-enteritis - - - - - - 1 1 — 2 Tuberculosis — — — — — — — — 1 1 Congenital malformation 2 1 — — 3 1 — — — 4 Birth injury I — — — 1 — — — — 1 Prematurity and Atelectasis 9 — — — 9 1 — — — 10 Acute leukaemia 1 — — — 1 — — — — I Totals 15 1 — — 16 2 1 1 2 22 COMPARATIVE CRUDE BIRTH-RATES, CIVILIAN DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY AND CASERATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1953. 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 15.5 17.0 15.7 17.5 11.6 Still Births 0.35 0.43 0.34 0.38 0.23 22.4+ 24.8+ 21.4† 21.0† 18.3t Deaths All causes 11.4 12.2 11.3 12.5 15.3 Typhoid and paratyphoid 0.00 0.00 — — — Whooping cough 0.01 0.01 0.00 0.00 — Diphtheria 0.00 0.00 0.00 — — Tuberculosis 0.20 0.24 0.19 0.24 0.29 Influenza 0.16 0.15 0.17 0.15 0.46 Smallpox 0.00 0.00 0.00 — — Acute poliomyelitis and polioencephalitis 0.01 0.01 0.01 0.01 - Pneumonia 0.55 0.59 0.52 0.64 1.42 Notifications (Corrected) Typhoid fever 0.00 0.00 0.00 0.01 — Paratyphoid fever 0.01 0.01 0.01 0.01 — Meningococcal infection 0.03 0.04 0.03 0.03 — Scarlet fever 1.39 1.50 1.44 1.02 1.82 Whooping cough 3.58 3.72 3.38 3.30 1.02 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.04 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 20.35 Pneumonia 0.84 0.92 0.76 0.73 0.68 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.07 0.06 0.06 0.07 0.12 Non-paralytic 0.04 0.03 0.04 0.03 0.01 Food poisoning 0.24 0.25 0.24 0.38 0.03 Puerperal Pyrexia 18.23† 24.33† 12.46† 28.61† 3.92† Deaths Rates per 1,000 Live Births All causes under 1 year of age 26.8* 30.8 24.3 24.8 29.3 Enteritis and diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 2.6 Maternal Mortality t England and Wales. Rates per 1,000 Total (Live and Still) Births. Coulsdon and Purley Urban District. Rate per 1,000 Total (Live and Still) Births. Abortion with Sepsis.. 0.06 — Other abortion 0.04 — Toxaemia 0.25 — Haemorrhage 0.13 — Sepsis 0.10 — Other complicatons 0.18 1.31 A dash (—) signifies that there were no cases, t 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 1953, 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 118 33 — Erysipelas 3 1 — Puerperal pyrexia 3 3 — Pneumonia — primary 44 11 93* Typhoid fever — — — Paratyphoid fever — — — Dysentery 13 11 — Poliomyelitis 9 9 — Measles 1319 9 1 Whooping cough 66 2 — Food poisoning 2 1 — Totals 1577 80 94 * Deaths from all forms of pneumonia including mental hospital cases. 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 1923 is presented in Table III in the Appendix. It will be seen that measles was overwhelmingly the commonest notifiable infectious disease. Scarlet fever and pneumonia were slightly more prevalent than in the previous year, but fewer cases of whooping cough and dysentery occurred. 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 was slightly less than 2.8 per 1,000 population, which is rather higher than the post-war average of 2.3. SMALLPOX. No case of this disease occurred in the District during the year but on at least two occasions individuals who had been in contact with cases overseas had to be supervised. 16 DIPHTHERIA. For the seventh year in succession no case of diphtheria occurred in the District and for the second consecutive year no suspected case was admitted into hospital. As a result it is probably all the more necessary to maintain the immunity of the population by artificial means, bearing in mind that the natural stimulants to immunity are declining rapidly, as judged by the rarity with which any form of diphtheria organism is reported during the routine bacteriological examination of throat swabs. SCARLET FEVER. This disease remains of a very mild type. It is therefore not surprising that more cases were notified, viz 118, as compared with 80, 90, 149, 138, 78 and 62 in the previous six years. To what extent the number of these known cases represents the degree of infection in the District it is impossible to say. There is a good deal of evidence to show that while the disease remains so mild a number of missed cases occur, the mildest often not coming to the notice of the doctors or being regarded as due to other causes; moreover it is well known that for every case exhibiting a rash, others suffer from a temporary sore throat or slight upset without producing a rash, although they have been infected with the same organism. The question naturally arises whether all known cases of streptococcal infections should be notified, or alternatively whether the notification of scarlet fever and the measures associated therewith should be dropped. It is thought that wider notification would cause a great deal of inconvenience without materially affecting the spread of the infection, but on the other hand, in view of the tendency for scarlet fever to gradually vary in its severity, it is considered that it would be unwise to give up the present practice completely. Modifications in procedure have, however, gradually been introduced. The mildest cases are, for example, allowed to return to school earlier if they are normal clinically, though a mimimum exclusion of fourteen days is probably desirable in case complications arise. Similarly normal contacts return after a week irrespective of whether the case is being treated at home or in hospital. The disease has for some years been mainly associated with school children and particularly the 5-8 year old children, 64% being in this group in 1953 compared with 15% under school age and 20% aged 9-15 years. Only two cases occurred among adults. Almost all schools in the District, including a number of private schools, had one or more cases, the maximum in any one school being fifteen. Attention has been focussed on the examination of contacts at school and in general this policy appears justified, bearing in mind the factors mentioned above which foster the spread of this usually mild infection. 17 The hospitalisation of cases has justifiably decreased, only 33 cases being admitted in 1953 (Wandle Valley 17, Bletchingley 12, Cuddington 2 and Waddon and The Grove one each). Probably this proportion could be still further reduced without detriment to the cases or increasing the risk of spread. The possibility of serious complications occasionally arising should not be forgotten, however, when cases are being treated at home. Of the 85 cases treated at home 9 were secondary cases occurring in the same house, and the vast majority of these were infected before hospitalisation of the first case would have been practicable. ERYSIPELAS. Only three isolated cases occurred in the summer, one of which was admitted to Hospital. All recovered. PUERPERAL PYREXIA. There were three cases notified during the year, all of whom had been confined at home by midwives. Each was admitted to hospital and recovered. OPHTHALMIA NEONATORUM. For the third year in succession no case was notified. ENTERIC FEVER. No confirmed case was notified during the year, but two suspected cases of paratyphoid were admitted to hospital. In one the illness was shown to have been due to a pelvic abscess, while the other gave completely negative findings. DYSENTERY. A total of 13 cases of dysentery were notified, compared with 48 and 22 in the two preceding years. Of this number 7 were due to the Flexner bacillus and occurred among the inmates of one of the mental hospitals, 6 being notified in the first three months of the year and one in May. The remaining 6 cases were due to the milder Sonne bacillus, and of these two occurred simultaneously at one mental hospital. Of the other four, two were sisters attending a nursery school which had several cases of diarrhoea and they were admmitted to hospital in view of their home conditions. The remaining two cases were isolated ones, though one may have been associated with some unrecognised cases in Kenley in the Spring. FOOD POISONING. Not more than seven cases of suspected food poisoning were notified during the year, three being isolated individuals and the others, two couples. Four of the cases were admitted to hospital and one was shown to have had a staphylococcal infection 18 ing the consumption of some tinned pilchards which revealed the same organism. Another case in a child was found to be carrying S. Typhi murium after being operated on for an appendix, but there was no sign of the possible origin of the infection in the child's home. None of the other cases could be confirmed, chiefly due to delay in notification or the absence of confirmatory evidence from the suspected samples. POLIOMYELITIS. This disease was again rather more prevalent nationally and the number of cases in Surrey showed a decided increase. Locally, however, the number of confirmed cases only increased by one compared with 1952. Of the nine cases, eight were paralytic, one being very serious, but no deaths occurred, whereas there were three deaths in 1952. Six were left with no defect or only very slight residual paralysis. The cases were spread throughout the year, only May and the last three months yielding no case, while two occurred in September. None appeared to be interconnected. In addition to the nine definite cases, one mild transient case was recognised early in the year. In July three very young babies were admitted to various hospitals as suspects but were found to have different complaints, and the same applied to a child admitted on suspicion in December. The number of residents thought to have had non-paralytic poliomyelitis was thus comparatively low. On a further ten occasions individual residents or groups who had been in contact with recognised cases elsewhere were kept under supervision, but none developed the disease. PNEUMONIA. During the year 44 cases of acute primary or influenzal pneumonia were notified, compared with 21 and 51 in the two preceding years. Three quarters of the cases occurred in the first two months of the year when a number of cases of influenza of a mild type were occurring, and only 2 of the cases appeared to be interconnected. No less than 27 of the cases were notified by 2 general practitioners, 3 by another, and single cases by 14 other doctors. So far as is known only 9 were admitted to hospital and one to a nursing home, but the majority of the 93 deaths which resulted from some form of pneumonia were cases already resident in one of the local mental hospitals. MEASLES. This disease is usually prevalent in alternate years, hence after 810 notifications in 1951 and 170 in 1952 a large number of notifications was expected in 1953, but the total of 1,319 was much the largest experienced locally. 19 Doubtless in part this record is due to the increasing recognition that measles is a notifiable disease, while it is probable that the private doctors are more often consulted than they were before 1948. So far as is known, the disease was generally fairly mild in type but at least 9 cases were admitted to hospital and one child died as a result of a very unusual complication. The very high total number of notifications received reinforces the arguments previously expressed regarding the doubtful value of notification of this disease in a District such as this. The inevitable delay which occurs before notifications are received and the large numbers occurring simultaneously, very seriously limit the possibility of useful advice being given to individual families. In fact, only a very small proportion can be visited by the Health Visitors and reliance has to be placed on the general advice which is, of course, always broadcast during epidemic periods. By contrast it is almost certain that a greater proportion of cases are seen by their family doctors than ever before, and the doctors could spare more time for advice, where required, if they were saved the time taken in notifying normal cases; telephonic communications to the Health Department when nursing or other help is needed by the small minority would be much more valuable and less costly. WHOOPING COUGH. Similar remarks apply to the notification of this disease but are of much less importance, partly because the numbers concerned are usually so much smaller and the cases are normally more spread over the year, and partly because the results in well recognised cases can be so much more serious, although the interval between onset and notification is apt to be much longer. In 1953 only 66 notifications were received compared with 196, 204, and 242 in the three previous years, and of these only two cases are known to have been admitted to hospital and all recovered. A note on immunisation against whooping cough is included later in this Report, but it might be appropriate to mention here how desirable it is to encourage the acceptance of this form of preventive treatment as widely as possible and as early in life as this can be arranged. Infection in partially or completely immune older children is very difficult to recognise in time to prevent them from being a source of danger to young babies. The latter should, of course, in any case be kept away from any person who is indisposed or showing any catarrhal symptoms. 20 TUBERCULOSIS. The following table presents concisely the position with regard to tuberculosis in the District during 1953:— Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number of cases on register, 1st January, 1953 246 178 36 35 282 213 Additions, 1953:— New cases notified 22 15 1 2 23 17 Cases removed into District 15 17 1 2 16 19 Restored to register 1 1 — — 1 1 Total Additions 38 33 2 4 40 37 Removals, 1953:— Deaths from (a) Tuberculosis 10 12 — — 10 12 (b) Other causes — — — — — —. Removed from District 14 15 2 2 16 17 Recovered 1 — — 3 1 Non-tuberculous Total Removed from Register 27 28 2 2 29 30 Number of cases on register, 1st January, 1954 257 183 36 37 293 220 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 - - 1 and under 5 2 - - - - - - - 5 and under 10 — 1 - - - - - - 10 and under 15 1 2 - - - - - - 15 and under 20 3 2 1 - - - - - 20 and under 25 3 4 — 1 — — — — 25 and under 35 3 1 •—- — — 1 — — 35 and under 45 2 2 — — 1 2 — — 45 and under 55 5 1 — — — 4 — — 55 and under 65 3 1 — 1 6 1 — — 65 and over — 1 - 3 3 - - Totals 22 15 1 2 10 12 — — 21 The new cases were distributed amongst the wards as follows:— Localisation. Coulsdon East. Coulsdon West. Kenley Purley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 11 7 3 9 6 — 1 Non- pulmonary — — 2 1 — — — Totals 11 7 5 10 6 — 1 The following table illustrates the trend of this disease since the formation of the District. Average figures for the quinquennial periods 1915-1949, and annual figures for 1950-1953:— 19151924 19251934 19351944 19451949 1950 1951 1952 1953 Pulmonary— New cases notified 22 29 35 49 47 60 42 37 *Case rate 115 82 68 81 72 93 65 57 Deaths 12 13 21 27 20 16 11 22 *Death rate 65 37 42 44 31 17 17 34 Non-Pulmonary— New cases notified 3 6 7 8 7 4 4 4 *Case rate 15 18 15 13 11 6 6 6 Deaths 3 3 2 2 2 3 3 1 * Death rate 15 8 5 3 3 5 5 2 * (The rates in this table and the remainder of the section are in all cases per 100,000 population). During 1953 the number of new notifications of pulmonary tuberculosis was only 37 compared with an average of 51 in the previous five years. This corresponds with the case rate of 57, which is one of the lowest the District has known, and this in spite of the introduction of Mass Radiography and other means of early detection of the disease. While violent fluctuations are apt to occur in dealing with relatively small numbers the improvement noted above is quite encouraging. By contrast with the case rate the local death rate from pulmonary tuberculosis increased in 1953 to 34 but this is due to the inclusion of 7 deaths among mental hospital patients which in previous years would have been transferred to the Districts in 22 which they normally resided. Excluding these 7 deaths the local District rate would only have been 23. Nationally this rate has steadily decreased, being 40 in 1949 and 32, 28, 21 and 18 in the following years. The incidence of new cases of non-pulmonary tuberculosis remained at 6, while the corresponding death rate was less than the low post-war average. The Council is responsible for one of the most important measures aimed at combating this disease, viz., rehousing, and also for disinfection, but the County Council bears the responsibility for all other preventive measures except the treatment of cases, which is that of the Regional Hospital Boards. Schemes are being carried out for the immunisation of certain sections of the population, and for tracing contacts of infectious cases among school children. It is anticipated that a further extension of this policy will be inaugurated in the second half of 1954. The Mass X-Ray Unit operated for a period during June in Coulsdon with a reasonable response from local residents. The local Tuberculosis Clinic is held every Monday from 2-4 p.m. at the Surrey County Council Clinic, 62, Whytecliffe Road, Purley, and an additional session was added during the year. There is still no sign of progress in the erection of the anticipated self-contained Chest Clinic which it is hoped will be built in Purley Hospital grounds. The provision of this Clinic is urgently required as the County Council Clinic is being seriously over-used. 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. Apart from influenza, the group of non-notifiable infectious diseases again accounted for very few deaths. Excluding 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 only small outbreaks of chickenpox in Purley and the Chipstead Valley, and German measles in Kenley, with isolated cases of mumps. No case of ringworm was reported. 23 Home visitation and exclusion from school are still the two chief methods relied upon to prevent the spread of these diseases. Treatment in hospital is provided when required owing to social or physical complications being present, but records of these admissions are rarely received. INFESTATIONS. (a) Scabies. During 1953 only 2 adults were treated by the Health Department for this disease, compared with 4 last year, 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 12 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. THE CONTROL OF INFECTIOUS DISEASE. When practicable, immunisation is the most effective of the measures for the control of infectious disease, but its usefulness is proportional to the degree of public support and the standard of immunity which is maintained by reinforcing doses, when these are necessary. The comparatively small risk of inoculations influencing the onset of poliomyelitis is now well-recognised, especially when precautionary measures are instituted. 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, especially as subcutaneous injections are now standard practice locally. DIPHTHERIA IMMUNISATION. As previously stated 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. 24 The following table shows the treatment given during 1953, and the proportion of children estimated to have been immunised:- Centres and Clinics (including day nurseries). Number who completed Primary treatment 429 Number of "Booster" doses given 118 Schools. Number who completed Primary treatment 30 Number of "Booster" doses given 405 General Practitioners. Number who completed Primary treatment 248 Number given "Boosters" 285 Proportion of children estimated to have beenimmunised:- (a) from 1-5 years 62% (b) from 5-14 years 92% The total number of primary treatments is approximately the same as last year but about 100 more children received boosting doses. As a result the percentage of children aged 1 to 5 years estimated to have been immunised was slightly higher, but the proportion of school children who have been treated during the last 5 years and who can, therefore, be considered to be sufficiently immune, is only about 60%. There is obviously room for improvement in all age groups. VACCINATION. The following table shows the number of vaccinations performed in the District during 1953:- Welfare Centres. Primary vaccinations 275 General Practitioners. Primary vaccinations 0-15 years 247 „ „ over 15 years 19 Re-vaccinations 0-15 years 32 „ over 15 years 92 The number of primary vaccinations was almost the same as last year and it is good to find that about 60% of the babies born in 1952 and 1953 were vaccinated. If this percentage can be maintained it will be very satisfactory. 25 WHOOPING COUGH IMMUNISATION. Since August, 1952, all the private doctors in the District sending in reports of completed 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, This treatment was also ottered at the Welfare Centres from the beginning of 1953 and during that year the following numbers were treated:— Welfare Centres. Number who completed Primary treatment 229 Number of "Booster" doses given 111 General Practitioners Number who completed Primary treatment 381 Number of "Booster" doses given 29 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. Meanwhile as this treatment is not usually given after 2 years of age, it is not surprising to find that fewer children are being immunised against whooping cough than against diphtheria. 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 1953 reports were received on the following specimens:— Milk, ice cream, and water samples 419 Food utensils 328 Nose or throat swabs 54 Rectal, eye and urine swabs 9 Faeces 40 Food Samples of water requiring chemical analysis, and milk for biological examinations were 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. 26 For the convenience of ratepayers, the Council has decided to arrange disinfection even when this is not essential in the interests of public health, but in these cases the following charges are made:- £1 per load of bedding, etc., 5s. for the first room and 2s. 6d. for each additional room disinfected at the same time. During 1953 the following disinfections were carried out:— Free of cost. Upon payment. Total. Loads of bedding, etc 79 7 86 Houses disinfected 107 — 107 Parcels of clothing — 4 4 Library books 701 — 701 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 18 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 only utilised once during 1953, an elderly woman being removed to St. Anne's, Redhill, where she appreciated the attention she received. The one case dealt with under this Section in 1949 lived happily and voluntarily in a Home for elderly people in the neighbourhood until her death early in 1954. 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 2 burials were 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 the Department gave strong support to a Home and Family Week and Exhibition held in Purley in May. The material supplied by the Central Council for Health Education and other bodies proved extremely useful. 27 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:- Maternity Clinics. These are now held at 62, Whytecliffe Road, 1st, 3rd and 5th Wed- (Purley and Kenley Purley. nesday in each month, mothers). 10 a.m.—12 noon. 62, Whytecliffe Road, Every Thursday (Old Lodge Lane, Purley. 10 a.m.—12 noon. Coulsdon and Sand- 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, 10 a.m. Selsdon. —12 noon. It is open to any expectant or post-natal resident to attend for advice and, when necessary, examination. The facilities include the introduction of suitable cases to the maternity wards at the local hospitals, and routine blood examinations for Rh. factor, etc., which service may be of assistance to general practitioners. Domiciliary and Home Nursing Services. The Midwifery and General Nursing Services have now been divisionalised. Midwives. The County midwives can be found as follows:— Telephone: *Miss Neighbour, Flat 1, "Woodlands," Sanderstead Hill, Sanderstead SANderstead 3514 Miss Dale, Flat 2, "Woodlands," Sanderstead Hill, Sanderstead SANderstead 5654 *S.C.C. Nurses' Home, "Westview," Woodstock Road, Coulsdon Downland 4005 *Premature baby outfits are held by these officers for use throughout the Division. 28 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 Dale, Flat 2, "Woodlands," Sanderstead Road, Sanderstead SANderstead 5654 Mrs. St. John Smith, 14, Foxley Hill Road, Purley UPLands 0247 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 10.30a.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. Infant Welfare Centres The following Infant Welfare Centres are held regularly from 2-4p.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, Aldington Road, Selsdon Every Monday. Congregational Church, Sanderstead Road, Sanderstead Every Wednesday. Whitgift Sports Pavilion, Lime Meadow Avenue, Every other Sanderstead Thursday. Laing's Estate Office, Mitchley Avenue. Purley 2nd and 4th Monday in each month. Community Centre, Hooley 1st and 3rd Wednesday in each month. 29 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. Day Nurseries. The two local Day Nurseries, which are situated as follows, accept the children of residents for health reasons or if they come within certain very limited social groups. " Hazelglen " Day Nursery, Sanderstead Road, Sanderstead. (SANderstead 5329.) Matron: Miss 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 Fridays 9—11a.m. Baptist Church, Addington Road, Selsdon Mondays 1.30—2.0p.m. St. John's Hall, Bradmore Green, Old Coulsdon Wednesdays 1.45—2.0p.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 30 OTHER COUNTY SERVICES. Ambulances. The Ambulance Stations in this District are at present at:Ambulance Station, 115a, Brighton Road. Purley. Sanderstead Fire and Ambulance Station, Limpsfield Road, Sanderstead. Requests should be made to FAIrlands 8893, or in cases of emergency dial 999. The Area Superintendent, Mr. R. A. Cupit, is stationed at the S.C.C. Main Ambulance Station, St. Helier Hospital, Wrythe Lane, Carshalton. (FAIrlands 8893). Welfare Officers. The County Welfare Officers can be found at 115a, Brighton Road, Purley, (UPLands 0776), or in emergency as follows:— Telephone: Mr. W. J. Middleton (Principal Divisional Welfare Officers) BALham 5375 Mr. E. G. Griffiths, (Divisional Welfare Officer) WALlington 9237 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 31 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 7755), and the Redhill County Hospital, Earlswood Common, Redhill, (Tel. No.: Redhill 3581). 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-patients treatment is supplied by both Groups, while a proportion attend Out-patient's Departments at St. Helier's Hospital and the London Hospitals. CLINICS ADMINISTERED BY THE GROUP HOSPITAL BOARDS. Tuberculosis— 62, Whytecliffe Road, Purley Every Monday 1.30-3.30p.m. Venereal Disease— Croydon General Hospital Males: Tuesdays, 7p.m. Saturdays, 10.45a.m. Women and Children: Tuesdays, 11.0a.m. Fridays, 5.30—7.0p.m. Redhill County Hospital Males: Mondays, 5—7p.m. Females: Wednesdays, 5—7p.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 32 Coulsdon and Purley Old People's Welfare Association. Secretary: Miss D. M. Barnett, 2, Graham Road. Purley 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 SANderstead 3451 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 1953. (1) (a) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 243 (b) Number of inspections made for the purpose 1,324 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 10 (b) Number of inspections made for the purpose 15 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 192 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 192 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 13 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (a) By owners 4 (b) By Local Authority in default of owners 2 33 (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 (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 6 (2) Number of families dwelling therein 8 (3) Number of persons dwelling therein 41 (b) Number of new cases of overcrowding reported during the year 9 (c) (1) Number of cases of overcrowding relieved during the year 10 (2) Number of persons concerned in such cases 57 (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 247 By other persons 229 It should be noted that since the war 85 cases of overcrowding have been relieved but in not one single case has overcrowding recurred after the Local Authority has abated it. In fact, there has only been one case of recurrent overcrowding after the Council had provided alternative accommodation, and that was in 1936. During the year this most important problem of housing began to enter a new phase after the post-war period in which attention has been focussed on the provision of the maximum number of housing units, mainly by new building on the part of the Local Authorities. As compared with 1952 new building by the Council increased by 33% while that by private builders increased by 189%. It also became obvious that the amount of land in the District capable of large scale council house building of the conventional type was very limited in view of the proportion of the undeveloped part of the District allocated to the Green Belt or thought most suitable for private building. Emphasis swayed towards the encouragement of house purchase by those able to afford it. 34 Parallel with this, for the first time since the war, the Minister redirected attention to the necessity for repairing, improving or demolishing substandard dwellings and legislation was prepared for encouraging both these methods of approaching the housing problem. The Chief Sanitary Inspector writes:- "The 'repairs increase' provisions, envisaged in the Housing Repairs and Rents Bill, should encourage owners of basically sound properties to keep them in good condition given a fair rent, and greater use of the grant provisions of the Housing Act, 1949 as amended by the Bill, could be the means of prolonging the life of a good many houses at present lacking the amenities of more modern dwellings. Although the general standard of housing in the District is above the average throughout the country, there are quite a number of properties that would benefit by the pursuance of an active and progressive policy on the lines indicated by all concerned". As this next stage in tackling the housing problem is entered upon it may be desirable to stress two aspects from the point of view of the Health Service. Hitherto it has been appreciated that rehousing can be justified for a wide variety of social reasons and the claim for priority on health grounds has not been pressed as it has been in most districts. With the serious limitation in the number of new housing units likely to become available in future, however, it is submitted that the degree to which the health of the applicants' family will suffer if not rehoused is a paramount question, and more use might well be made of the knowledge and experience of the officers in the Health Department, whose advice is always readily available, when considering this matter. The other point it is felt desirable to emphasise is the undesirability of encouraging would-be tenants to accept a heavier financial responsibility for their accommodation than they can afford and this applies, of course, particularly to house purchase, although the shorter term responsibility for a heavy rental may also have serious repercussions. It is well recognised that other forms of improvidence and especially excessive hire purchase of furniture, etc. can produce similar repercussions but as Local Authorities have more direct influence on housing it may be well to stress the chain of undesirable sequelae, including the illhealth of the family, which too often follow the ill advised distribution of the family's economic resources. 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 this year two further samples were obtained, one being submitted to each of these examinations. 35 In addition, both the Water Companies and the Local Authorities sharing these public supplies provided the Department with copies of the reports on the samples taken by them. No complaints were received during the year with regard to the quality or quantity of water supplied by the Companies, and no unsatisfactory reports were received on the samples taken from the supplies to the District. The Cane Hill Hospital Management Committee has made arrangements with the Public Health Department of the London County Council for routine sampling and supervision of the water supply from the relatively shallow well in their grounds, which is used exclusively by this Hospital. Adequate chlorination is essential and steps have been taken to ensure this and to effect closer co-operation between the officers of the three authorities interested in the standard of this supply. The results of two chemical and two bacteriological examinations of the water in public supply are given below and these are fairly typical of the reports received:— Chemical Analysis. Sutton District Water Company. East Surrey Water Company. Parts per 100,000. Grains per Gallon. Parts per 100,000. Grains per Gallon. Total solids (dried at 180°C.) 21.0 14.7 23.0 16.1 Combined chlorine (CI) 1.7 1.2 1.6 1.1 equivalent to Sodium Chloride (Na CI). 2.8 2.0 2.6 1.9 Nitric nitrogen (Nitrates) 0.64 0.45 0.64 0.45 Nitrous nitrogen (Nitrites) minute trace minute trace Ammoniacal nitrogen Nil Nil 0.0044 0.0031 Albuminoid nitrogen 0.0004 0.0003 Nil Nil Oxygen absorbed in 4 hours at 27 °C. Nil Nil 0.003 0.002 Lead or Copper Nil Nil Nil Nil Temporary hardness equivalent 9.0 6.3 8.0 5.6 Permanent hardness 3.0 2.1 3.0 2.1 Total hardness CaC03 12.0 8.4 11.0 7.7 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. Forty-four 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. 36 RAINFALL. The rainfall registered by the automatic rain gauge installed at Alderstead Heath was 26.49 inches, this being a decrease of 3.61 inches compared with the previous year. The monthly totals throughout the year were as follows:- inches. January 0.84 February 1.64 March 0.48 April 2.88 May 2.16 June 1.86 July 3.95 August 2.28 September 3.49 October 4.17 November 1.98 December 0.76 DRAINAGE AND SEWERAGE. A total of 1,364 yards of new sewers was constructed during the year, and of this total, 1,154 yards were necessitated by the development of Council Estates and the construction of a relief sewer to prevent, if possible, surcharging and consequent flooding in one section of existing sewer. The balance of 210 yards was constructed in connection with a scheme for converting the cesspools of 11 houses to main drainage. Efforts were again made to find a solution to the periodical flooding at Purley Fountain due to surcharging of the sewers which occurs after very heavy rain. While it has never been shown that illhealth among the residents has resulted, these recurrences are obviously most undesirable and are potentially a danger to the public health. 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 were connected to the public sewer and 12 cesspools abolished. At the end of the year the following pail closets and cesspools remained in use:- Premises with pail closets 11 Number of cesspools 134 The contents of pail closets at private premises are disposed of in the gardens by the occupiers of the houses. 37 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 year, an unauthorised camp site for trailer caravans for residential and occasional use established on land at Dean Lane, Merstham, adjoining Alderstead Heath, was the subject of an appeal by the owner against the refusal of the Council, acting on behalf of Surrey County Council, to permit the use of the land for that purpose under the provisions of the Town and Country Planning Act, 1947. The Minister of Housing and Local Government, in his decision on the appeal, expressed his agreement with the Council that this type of development is out of place in the Metropolitan Green Belt, and he was not prepared to grant a permission which would perpetuate a residential colony in the heart of a downland area which should be kept for agricultural or recreational purposes. In view of special circumstances affecting the site, however, the Minister decided to allow the appeal to the extent that permission is granted for the use of the land as a caravan camp for residential and occasional use for a period of three years from November, 1953, "subject to the following conditions:- (1) The use shall be discontinued and the caravans removed at the expiration of the permitted period; 38 (2) No railway vehicle, tramcar, omnibus body, aeroplane fuselage or similar structure, whether on wheels or not and howsoever adapted shall be stationed or erected on the site; (3) The total number of caravans stationed on the land shall at no time exceed 140; (4) Water and electricity shall be made available throughout the camp in such manner as may be agreed with the Local Planning Authority or, in default of agreement, as shall be determined by the Minister; (5) The site shall be kept free of all litter and refuse." SWIMMING BATHS. There are two swimming baths in the District which are used by the general public, and during the year, 12 samples of water were obtained for chemical and bacteriological examination, with satisfactory results. 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 37 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. 39 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 22 - - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 139 309 4 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 2 2 -— — Total 179 333 4 — 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) 3 3 - - - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 2 2 - 1 - (b) Unsuitable or defective 5 7 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 2 2 — — — Total 12 14 — 1 — 40 PART VIII. OUTWORK. (Sections 110 and 111) Nature of Work. Section no. Section 111. 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. (Making, etc. 35 — — — — — Wearing apparel (Cleaning and washing — — — — — — Household linen 2 — — — — — Umbrellas, etc. 1 — — — — — Paper bags 1 — — — — — Carding, etc. of buttons etc 30 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 3 — — — — — Artificial flowers 1 — — — — — Lampshades 1 — — — — — Total 74 — — — — — SANITARY INSPECTIONS, ETC. The following is a summary of the complaints received and visits made, together with details of work carried out and defects remedied as a consequence of notices served during the year, 1953. The number of complaints recorded again showed a decrease on the previous year but the total number of visits made by the Sanitary Inspectors increased slightly, chiefly owing to surveys in non-sewered areas and the supervision of drainage repair works while in progress. Rodent control showed a slight decline. 41 Complaints Received. General disrepair and insanitary conditions 45 Dampness 23 Overcrowding Defective drainage systems 20 Blocked drainage systems 148 Defective drainage fittings 3 Defective W.C. pans and flushing apparatus 15 Defective service water pipes 1 Defective hot water systems 3 Defective chimney stacks 4 Absence of, or defective dustbins Insanitary pig waste bins 3 Accumulation of refuse, etc 17 Rats and mice 348 Keeping of animals 6 Insect pests, etc 31 Wasps' nests 42 Smoke nuisance 12 Noise nuisance 3 Contaminated food 9 Unsound food 89 Miscellaneous 50 Total 884 Summary of Visits Made. Number of houses visited 287 Number of reinspections and calls made 1,126 Verminous premises 34 Water supply Tents, vans and sheds 32 Schools 8 Places of entertainment 12 Licensed premises 29 Storage of refuse 566 Accumulation 66 Piggeries, fowls and other animals 96 Stables 6 Rats and Mice Destruction 5,583 Drainage inspected 2,488 Drainage tested 281 Pail closets Cesspools 424 Urinals 5 Sewers and street gullies 157 Cowsheds, dairies and milkshops 158 Ice-cream premises 169 Meat shops 132 Food preparing premises 448 Other food shops 481 Bakehouses—Power 1 65 „ Other 5 Slaughterhouses Food Inspection—Meat 57 „ „ Other Food 183 Factories—Power 244 „ Other 18 Workplaces 5 Outworkers 56 Merchandise Marks Act 1 Pet Animals Act 7 Shops Act 651 Infectious disease enquiries 160 42 Infectious disease contacts 76 Food poisoning enquiries 17 Disinfection 145 Disinfestation 109 Swimming baths 46 Sampling—Food and Drugs Act, 1938 264 „ Ice-cream 125 Milk (bacteriological) 270 „ Milk (biological) 50 „ Water 30 Interviews 1,522 Miscellaneous visits 774 Total 17,478 Work Carried Out and Defects Remedied. Drainage and Sanitary Fittings: Drains examined and tested 272 Drains repaired or reconstructed 58 Blocked drains cleared 169 Disused drains sealed off 3 Soil and vent pipes repaired or renewed 9 Inspection chamber covers renewed and frames rebedded 51 Inspection chambers repaired 42 Fresh air inlets repaired or renewed 37 New W.C. pans fixed 22 New W.C. accommodation provided 2 W.C. flushing cisterns repaired or renewed 17 Cesspools provided or enlarged 1 Cesspools cleansed, repaired or renewed 32 Cesspools abolished and house drains connected to sewer 10 Disused cesspools abolished 2 Soakaways reconstructed 13 Eaves gutters and stack pipes renewed or repaired 30 New lavatory basins fixed 6 Glazed sinks renewed or repaired 7 Waste pipes trapped, repaired or renewed 14 Sink gully curbs and dishings repaired 30 Urinals cleansed 1 Miscellaneous 1 General Housing Repairs: Defective roofs repaired 24 Yards paved, or paving repaired 4 Dampness in walls remedied 19 Brickwork repaired or repointed 14 Damp-proof courses provided 11 Additional sub-floor ventilation provided 5 Walls and ceilings repaired 21 New ceilings provided 6 Walls of rooms cleansed 7 Ceilings of rooms cleansed 8 Floors repaired or renewed 33 Ventilation and lighting of rooms improved 1 Windows repaired or renewed 20 Doors repaired or renewed 8 Firegrates repaired or renewed 8 New hot water boilers provided 1 Walls and ceilings of W.C. apartments cleansed 5 Portable dustbins provided 106 Accumulations removed 10 Miscellaneous 7 Ratproofing: Work carried out by occupiers of premises after completion of treatment 38 43 Food Premises: Accumulations removed 10 Refuse bins provided 3 Hot water supply provided for ablution purposes 12 Lavatory basins provided 2 Glazed sinks provided 2 Draining boards provided 3 Staff sanitary accommodation repaired 7 Staff sanitary accommodation cleansed 9 Staff sanitary accommodation provided 1 Drainage systems provided to foodshops 1 Drains reconstructed 3 Walls and ceilings cleansed and repaired 29 Floors repaired or relaid 8 Equipment repaired or renewed 6 Kitchens enlarged 1 Additional ventilation provided to kitchens 2 Windows repaired 1 Food stores provided 2 Yards paved 3 Roofs repaired 2 Blocked drains cleared 9 Miscellaneous 3 Notices Served. Preliminary Notices 526 Statutory Notices 32 Legal Proceedings. It was not necessary to take legal proceedings in connection with any public health matter in 1953, and the Chief Sanitary Inspector and his colleagues are to be congratulated on carrying out such a full and satisfactory year's work without requiring the support of the Courts. 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, and improvements are slowly being effected. Close co-operation exists between the School Health and Public Health Services in relation to the above and the prevention of the spread of infectious disease. DISINFESTATION. During the year only 7 houses needed to be, and were disinfested owing to the presence of bed bugs, but action was taken by the Department in 37 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. 44 PREVENTION OF DAMAGE BY PESTS ACT, 1949. The table on the following page is a tabular statement indicating the action taken in 1953 under this Act. During 1953, 69 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 detected. 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. 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. 45 46 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 workst i.eproofing. Primary and reinspections. Sewer treatment. Total. Local Authority 3 22 25 9 l 9 l — — 4,870 713 5,583 Dwelling Houses 293 197 490 251 28 236 25 — — Business Premises 45 53 98 32 21 28 21 — — Agricultural 4 36 40 18 — 15 — — — Total 345 308 653 310 50 288 47 — — 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 18 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 310 samples was submitted for bacteriological and biological examination, with the results set out in the following tables:— 47 BACTERIOLOGICAL. Tests required by the Milk (Special Designation) Regulations, 1949. Designation. Number. Methylene Blue. Phosphatase. Turbidity. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Pasteurised 209 208 1 209 - - - T.T. (Raw) 20 20 - — - — — T.T. (Pasteurised) 23 23 - 23 — - - Sterilised 19 — — — — 19 - Totals 271 251 1 232 — 19 — BIOLOGICAL. Designation. Number. Tubercle Bacillus. Present Absent Tuberculin Tested 14 — 14 Pasteurised 2 — 2 Ungraded 23 — 23 Totals 39 — 39 It is very satisfactory to record that all the samples of Pasteurised milk satisfied the Phosphatase test of the efficiency of pasteurisation, and only one sample failed to pass the Methylene Blue (keeping quality) test. 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 most satisfactory to be able to record that none of the 39 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 10 Sterilised 14 Pasteuriser's 2 Supplementary Tuberculin Tested 10 Pasteurised 10 Sterilised 8 ICE CREAM. Under the provisions of Section 64 of the Coulsdon and Purley Act, 86 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. During the year, 169 visits of inspection were made to these premises. The registration of two premises for the sale of ice cream was cancelled because of the change in character of the general business carried on thereat. 48 No manufacture was carried out at the premises registered for that purpose during the year, and thus, with a minor exception, all the ice cream retailed in the District was obtained by the vendors prepacked from large scale manufacturers whose premises are situated outside the District. A total of 127 samples of ice cream was examined for bacterial quality by submission to the methylene blue reduction test, and placed in the following provisional grades— Grade I 118 Grade II 4 Grade III 5 Grade IV Nil 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. On these standards the above results can be considered satisfactory, and to indicate that the steady improvement noted in recent years has been maintained. MEAT. The two private slaughterhouses in the District have not been licensed since 1940. In 1953 two licences were 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 7 cattle, 3 calves and 4 pigs were inspected for evidence of disease, and a small quantity of offal only was condemned as unfit for food. There are 30 butchers' shops in the District, all registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat under the provision of Section 64 of the Coulsdon and Purley Act. Meat is supplied to the shops from the Wholesale Meat Supply Association Depot, situated outside the District. Frequent inspections are carried out and, during the year, 132 visits were made for this purpose. 49 OTHER FOODS The routine inspection of food shops and other food premises has continued to form an important part of the work of the Sanitary Inspectors. A register of all such premises includes the following:— Confectioners 62 Butchers . 30 Fishmongers (Wet and Dry) 17 Fishmongers (Fried)) 7 Bakers 29 Greengrocers and Fruiterers 49 Cafes and Restaurants 66 Grocers 75 Two grocers' shops and one baker's premises are registered under the local Act for the preparation of preserved meat, etc., and all the fish friers' premises are similarly registered in respect of fish frying. During the year, the registrations of two premises, one for fish frying and the other for the preparation and cooking of shellfish, were cancelled because of the change in character of the business carried on thereat. The Chief Sanitary Inspector reports that "generally the standard of food premises in the District is good with some of the more recently established or modernised premises very good indeed. With the steadily increasing general interest in Food Hygiene it is becoming more and more apparent that the progressive trader will benefit accordingly from a discriminating public. Regular inspections are made of all food premises and particular attention is given to catering establishments. Every opportunity is taken, by discussion and example, of impressing on food handling personnel the importance of a high standard of cleanliness in equipment and person, coupled with improved methods. In the course of this advisory work, 125 swabs were taken from washed crockery and 7 samples of washing up water were taken for bacteriological examination. The results were varied but follow-up tests on adverse reports indicated quite clearly that greater attention to detail resulted in higher standards even with the most simple equipment. Miscellaneous samples of food submitted for bacteriological examination included synthetic cream, chocolate eclairs and cream buns, again with the object of illustrating the effects of careless handling on otherwise satisfactory foods." 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. 50 UNSOUND FOOD. The following unsound foods were surrendered during the year, the total bulk being substantially less than that surrendered in 1952:— cwts. lbs. ozs. Canned Soups — 8 15½ Canned Meat 2 60 1 Canned Fish — 25 3¾ Canned Vegetables 1 86 12 Canned Fruits 7 105 8½ Canned Milk — 67 4½ Meat, Bacon, Poultry, etc. 7 101 13 Fish 1 35 0 Meat and Fish Pastes — 1 0 Butter, Fats and Cheese — 67 12 Sugar, Jam, etc. 1 2 14½ Flour, Bread, Cereals and Biscuits — 13 4 Pickles and Sauces — 2 8 Dried Fruit — 50 9 Eggs 2 39 10 Coffee — 13 10 Assorted Frozen Foods — 52 7¾ Miscellaneous — 25 7 Total 27 87 12½ All unsound food, with minor exceptions, is disposed of at the Council's refuse destructor at Kenley. FOOD AND DRUGS ACT, 1938. The following samples were taken during 1953 and submitted to the Public Analyst, with the results shown:— Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Almonds, Ground l - l - - - Beer 4 - 4 — - - Beetroot, Tinned l - 1 - - - Bicarbonate-of-Soda — 1 1 - — - Blackcurrant Juice 1 - 1 — - - Bread 2 - 2 - - - Butter 1 - 1 - - - Cake l - 1 - - - Celery Cheese Spread — 1 1 - — - Cherries, Glace l 1 2 — — — Coconut, Dessicated l - 1 - — - Coffee and Chicory Essence 2 - 2 - - — Coffee, Pure - 1 1 — - — Cooked Meats 3 - 3 - - - 51 Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Cough Mixture - 2 2 - - - Cough Sweets - 1 1 — - — Crab, Dressed — 1 1 — — - Cream 2 2 4 1 - 1 Gelatine Powder — 1 1 — - - Gin 1 — 1 — — - Gravy Powder 1 — 1 — - — Health Salts 1 — 1 — - — Horseradish, Grated — 1 1 — — — Horseradish Sauce — 1 1 — - — Ice Cream 1 — 1 — - - Jelly Cream 2 — 2 — - — Jelly Crystals 2 — 2 — — — Kidneys in Gravy 2 — 2 — — — Lard 1 — 1 — - - Macaroni 1 — 1 — - — Margarine 1 — 1 — - — Marmalade 2 — 2 — — — Marshmallow Cream — 1 1 — - — Meat Paste 1 — 1 — - — Milk 55 — 55 1 - 1 Mincemeat 1 — 1 — - — Mint, Garden — 1 1 — - - Mustard — 2 2 — — - Orange Curd 1 — 1 — — — Orange Squash 1 — 1 — — - Parsley Sauce — 1 1 — 1 1 Peas, Tinned 3 — 3 — - - Pepper Flavoured Compound — 1 1 — - - Pepper, Ground White 1 2 3 — - - Pudding, Boiled 1 — 1 — - — Raspberries, Tinned 1 — 1 — — - Ravioli — 1 1 — — - Rennet, Essence of 1 — 1 — - - Sausages, Beef and Pork 7 1 8 — — - Sausage Meat, Beef and Pork 4 — 4 — - — Savoury Relish — 1 1 — - - Soup — 3 3 — 2 2 Spinach Puree 1 — 1 — — — Sponge Mixture 1 — 1 — — — Sweets 1 — 1 — — — Suet, Shredded Beef 1 — 1 — — — Tea 1 — 1 — — — Tonic Water 1 — 1 — — — Vinegar 1 — 1 — — — Vitamin Tablets 1 1 2 — — — Whisky 2 - 2 - - - Totals 122 28 150 2 3 5 It will be noted that adverse reports were received on 5 samples, including 1 milk sample, and the following is a summary of the action taken in respect thereof. 52 Sterilised Cream. This sample contained 0.2 per cent sugar and the Public Analyst commented that cream is defined as that part of milk rich in fat which has been separated by skimming or otherwise. In his opinion, the notice on the label of the addition of sugar to this article, was not conspicuously visible. Following correspondence with the manufacturers it was disclosed that the Ministry of Food, Food Standards and Labelling Division, had agreed that the use of the existing label might continue until existing stocks of labels were exhausted, in consideration of which, an undertaking was given by the manufacturers that when the label was re-printed, effect would be given to the requirements of the Labelling of Food Order. Milk. The Public Analyst reported that this sample was slightly deficient in milk solids other than milk fat, and that the freezing point (Hortvet) of the sample, namely, -0.528°C., was consistent with the presence of a small proportion of added water. The Public Analyst stated, however, that the deficiency was too slight for any action to be taken, and a warning letter was sent to the retailer concerned. Canned Soup. Technical labelling offences were evident in respect of the description of two tins of soup sampled informally. The attention of the manufacturers was directed thereto. Parsley Sauce. This sample was reported as an article of food containing rancid fat, edible starch, parsley, salt and bicarbonate-of-soda in that order. The article, when reconstituted according to the directions, produced a slightly rancid sauce with little if any of the odour or taste of parsley. A labelling offence was also evident. As a result of the correspondence that ensued, the manufacturer submitted further samples of his products for examination, and he was advised on the question of rancidity. He also agreed to amend the label. 53 54 TABLE I. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1953. 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 — - - - - - - - - - - - - - - - - - - - Paratyphoid fever — - - - - - - - - - - - - - - - - - - - Scarlet fever 118 - 1 3 4 10 84 14 - 2 — - - 14 30 14 7 46 5 2 Erysipelas 3 - - — — — — — - — 2 1 - 1 — — — — 2 — Puerperal pyrexia 3 - - — — — — — - 3 — - - 1 — — — 2 — — Pneumonia 44 - - — — 1 6 1 1 4 6 13 12 2 4 11 6 10 7 4 Dysentery 13 - - — 1 — 2 — - — 1 3 6 7 2 2 2 - — — Meningococcal meningitis — - - - - - - - - - - - - - - - - - - - Poliomyelitis 9 - - — — — 5 — 1 2 1 — — 1 — 1 3 3 1 — Measles 1319 20 68 122 144 173 712 36 18 17 7 2 — 223 223 267 154 315 121 16 Whooping cough 66 2 5 6 9 12 28 — 1 — 1 1 1 17 8 16 5 17 3 — Malaria — — — — - - - — - - - — - - - - - - - - Ophthalmia neonatorum — - - - - - - - - - - - - - - - - - - - Encephalitis — — — — — — — — — — - — — - — - - - — — Food Poisoning 2 — — — — — — — — — 1 1 — - — 1 - 1 — — Totals 1577 22 74 131 158 196 837 51 21 28 19 21 19 266 267 312 177 394 139 22 55 TABLE II. THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1953 Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Diphtheria - - - - - - - - — — — — — Typhoid fever - — - - - - - - - - - — — Paratyphoid - - - - - - - - - - - - - Scarlet fever 14 15 25 6 7 17 5 3 7 8 3 8 118 Erysipelas — — — — 2 - 1 - - - - - 3 Puerperal pyrexia — — — 1 — 2 - - - - - - 3 Pneumonia 9 22 6 2 - - - - 1 1 1 2 44 Dysentery 1 4 - 1 1 1 - - - - 3 2 13 Meningococcal infection — — - - - - - - - - - - - Poliomyelitis 1 1 1 1 - - 1 1 2 1 - - 9 Measles 90 357 598 217 42 9 3 2 - - 1 - 1319 Whooping cough 2 3 2 5 8 1 2 21 5 4 9 4 66 Malaria — — - - - - - - - - - - - Encephalitis — — - - - - - - - - - - - Food poisoning — - 1 - - 1 - - - - - - 2 Totals 117 402 633 233 60 31 12 27 15 14 17 16 1577 56 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1923 Disease 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 1953 Small pox - - - - - - 2 2 3 4 - - - - - - - - - - - - - - - - - - - - Scarlet fever 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 80 118 Diphtheria 77 101 14 17 11 23 76 17 8 21 16 24 52 35 8 10 10 25 7 9 7 19 15 8 - — - - - - - Erysipelas 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 - 3 Typhoid and paratyphoid fever 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 3 Poliomyelitis - 1 - - 1 1 — 1 — 2 — 1 1 — 3 1 1 1 2 3 - - 2 1 11 2 9 10 — 8 9 Polio-encephalitis - - - - - - - - - - - - - - 2 - - - - - - - - 1 - - - - - - Acute encaphalitis 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 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 44 Malaria — — — — — — — — — — — — — — — — — — — — — — — - — 1 — — — Measles 2 11 214 479 275 52 705 41 218 567 600 477 810 170 1319 Dysentery 17 - - 1 - - 5 - - - - - 6 — 1 2 10 85 224 121 21 42 172 82 43 71 14 28 22 48 13 Whooping cough 6 1 136 36 55 51 100 31 115 201 42 242 204 196 66 Food poisoning 2 6 2 5 2 Tuberculosis:— Pulmonary 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 37 Other forms 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 3 Totals 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 1617 TABLE IV. DEATHS OCCURRING DURING THE YEAR, 1953. Cause of death. Private Residents Hospital Cases Total. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and over. Males Females Males Females Respiratory tuberculosis 6 6 4 3 19 1 - - - - 4 8 6 Other tuberculosis - - - - - - - - - - - - - Syphilitic disease — — 1 — 1 - - - - - — 1 — Diphtheria - - - - - - - - - - - - - Whooping cough - - - - - - - - - - - - - Meningococcal infections — 1 — — 1 - - - - - — — 1 Poliomyelitis - - - - - - - - - - - - - Measles — 1 - - 1 - - 1 - - - - - Other infective and parasitic diseases - 2 - — 2 - 1 - - - - 1 - Cancer 66 62 10 17 155 - - - 3 - 6 63 83 Leukaemia 4 1 — — 5 1 - - — - 1 2 1 Diabetes - 4 - - 4 - - - - - - 1 3 Vascular lesions of nervous system 29 54 16 13 112 - - - - - 2 14 96 Coronary disease, angina 62 49 22 13 146 - - - - - 1 30 115 Hypertension with heart disease 7 7 5 2 21 - - - - - - 3 18 Other heart disease 40 53 19 56 168 - - - 1 - - 18 149 Other circulatory disease 10 10 8 11 39 - - - - 1 3 7 28 Influenza 8 7 — 14 29 - - - - - 1 4 24 Pneumonia 6 16 28 43 93 2 - - — - 1 23 67 Bronchitis 26 12 1 3 42 — - 1 — - 1 4 36 Other respiratory diseases 1 1 — — 2 — - 1 — - — — 1 Ulcer of stomach and duodenum 4 2 2 - 8 - - - - - - 4 4 Gastritis, enteritis and diarrhoea 2 - - 2 4 2 - - - - - 1 1 Nephritis and nephrosis 5 1 - 1 7 - - - - - 2 4 1 Hyperplasia of prostate 7 - - - 7 — - - — - - — 7 Pregnancy, childbirth, abortion - 1 - - 1 - - - - - 1 - - Congenital malformation 1 3 — — 4 2 - - - - - 2 — Other defined and illdefined diseases 28 17 14 30 89 14 1 1 1 2 5 15 50 Motor vehicle accidents 1 3 - - 4 - - - — - 1 1 2 All other accidents 2 3 1 9 15 - - - 1 - 3 1 10 Suicide 3 5 3 — 11 - - - - - 6 3 2 Homicide and operations of war - - - - - - - - - - - - - Totals 318 321 134 217 990 22 2 4 6 3 38 210 705 57 INDEX. Page Ambulances 31 Analysis of Mortality 13, 14 Area 7,8 Bacteriological work 26 Bed Bugs, Eradication of 44 Birth Rates 6,8,15 Births, Live, Illegitimate and Still 6, 8 Blind Welfare Worker 31 Camping Sites 38 Cancer 10, 11 Causes of Deaths 10,58 Chicken Pox 23 Children's Officer 31 Clinics : Diphtheria Imunisation 25 Family Planning 29 Infant Welfare 29 Maternity 28 School 30 Toddlers 30 Tuberculosis 32 Veneral Disease 32 Closet Accommodation 37 Consultant Service 32 Day Nurseries 30 Deaths and Death Rates 6,8,9,15,57 Dental Treatment 30 Diphtheria 17 Diphtheria Immunisation 24 Disinfection 26 Disinfestation 44 District Nursing Service 29 Drainage and Sewerage 37 Dysentery 18 Emergency Units 32 Enteric Fever 18 Erysipelas 18 Eye Defects 30 Factories 40,41 Family Planning Clinic 29 Food and Drugs Act 51,52 Food Supply : Milk 47 Meat 49 Unsound 51 Food Premises 50 Food Poisoning 18 Guild of Social Service 32 Health Visitors 29 Health Propaganda 27 Heart Disease, etc. 10 Home Helps 29 Hospitals 32 Houses, Inspection of 33 Houses, Inhabited 8 Housing 33,34 58 INDEX—continued Ice-Cream 48 Illegitimate Babies 9 Immunisation 24,26 Infantile Mortality 6,8,13,14 Infectious Disease : Cases Notified 15,54 Control of 24 Monthly incidence of 55 School Notifications 23 Inspection and Supervision of Food 47 Laboratory Facilities 26 Legal Proceedings 44 Marriage Guidance Council 33 Massage Establishments 27 Maternal Mortality 13 Maternity Clinics 28 Maternity and Child Welfare : Services 28,29 Centres 28 Hospital Accommodation 32 Measles 19 Meat 49 Mental Health Service 31 Midwifery Service 28 Milk and Dairies Regulations 47 Milk (Special Designations) Regulations 48 Milk, Sampling of 47 Moral Welfare Worker 32 Mortality : Analysis of 13 15 Infant 6,8,13,14 Maternal 13 Mumps 23 National Assistance Act, Sect 47 27 National Assistance Act, Sect 50 27 National Society for the Prevention of Cruelty to Children 32 Non-notifiable Infectious Disease 23 Nursing Service 29 Ophthalmia Neonatorum 18 Paratyphoid Fever 18 Pneumonia 19 Poliomyelitis 19 Population 6,7 Premature Babies 28 Public Cleansing 38 Public Health Committee 3 Puerperal Pyrexia 18 Rainfall 37 Rateable Value 6 Rats and Mice Destruction 45, 46 Rivers and Streams 38 Road Safety Committee 33 Sanitary Inspections, etc 41,42,43,44 Scabies 24 Scarlet Fever 17 Schools 44 School Clinics 30 Sewerage 37 59 INDEX—continued. Shops 39 Slaughterhouses 49 Smallpox 16 Smoke Abatement 38 Social Conditions 7 Staff 3 Statistics : Housing 33,34 Vital 6,8, 15 Still Births 6,15 Swimming Baths 39 Toddlers' Clinics 30 Tuberculosis 21,22 Typhoid Fever 18 Vaccination 25 Vermin 24 Violence, Deaths from 12 Vital Statistics 6,8,15 Water Supply 35,36 Welfare Homes 31 Welfare Officers 31 Whooping Cough 20 Whooping Cough, Immunisation 26 60