PRO Region 5 AC 4413 (3) Coulsdon & PURLEY COU 22 HEALTH REPORT for 1954 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 1954 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. 1954 Public Health Committee. Chairman: R. N. Saunders. Councillor F. W. Purvis. 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. n r w. Kersey, „ D. M. Weightman, m.a. b.sc., a.r.i.c. Mrs. K. M. Platt. „ A. H. Williams. Ex-officio: Councillor W. H. Glanville, j.p. „ „ H. Willis. Representatives on the South Eastern Divisional Health Sub-Committee. Councillor C. J. ffield, b.sc. 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: *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. (until 31st January, 1954). W. Rice-Jones, M.S.I.A. Additional Sanitary Inspectors: V. W. Ribbons, M.S.I.A. (until 1st March, 1954). E. R. Rogers, M.S.I.A. G. H. Bourne, M.S.I.A. D. G. Stripp, 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. Clark, (until 2nd January, 1954) *Mrs. P. M. Branch, (until 25th December, 1954). *Mrs. L. R. Proctor. F. J. Smith. (* Part-time appointment only to this Council.) 3 COULSDON AND PURLEY URBAN DISTRICT COUNCIL. Ladies and Gentlemen, I have pleasure in presenting my Annual Report for 1954, this being my twenty-third report as your Medical Officer of Health. As in previous years, this Report has been prepared in accordance with the instructions of the Minister, but on this occasion, in order to provide variety, the section on Maternity and Child Welfare has been slightly expanded, it being thought that members of the Council would be interested to note such variations as have occurred since they ceased to become directly responsible for this service. Similarly, to facilitate reference, most of the essential addresses and clinic arrangements have been tabulated together. It is hoped both innovations will be acceptable. Although the year 1954 will remain in our memories as a comparatively sunless one, with a wet summer and autumn, it was quite a good one from the point of view of the public health, as judged by the vital statistics. The Birth Rate was higher than in the preceding four years, and, although the Stillbirth Rate was slightly above the average for recent years, the percentage of illegitimacy remained at the lowest pre-war average. Similarly, although the Death Rate again appears to have been high, this is due to the recent inclusion of deaths in the mental hospitals; the death rate for normal residents was, in fact, the lowest since 1938. The total Cancer Death Rate remained fairly steady, if anything being slightly less in 1954, but the proportion of male cancer deaths attributed to cancer of the lungs continued to increase. On the other hand, the death rates from tuberculosis and other infectious diseases were well below the average, and, apart from whooping cough and food poisoning, the incidence of infectious disease was very low. Only one case of slight paralytic poliomyelitis was notified. The Maternal Mortality Rate was slightly lower, but the most spectacular feature of the year was the fall in the number of infant deaths, although even these might well have been fewer. The Infant Mortality Rate of 10.8 per 1,000 registered births is only slightly over half the lowest ever previously recorded in this District and, while a rate of this sort is apt to fluctuate violently, reflecting as it does such relatively small numbers, it is only natural to rejoice at this improvement even if, as is probable, this rate rises again to some extent next year. Even such temporary successes have their value in indicating what can be achieved, though of more permanent value is the steady decline in the average death rate from tuberculosis and the complete absence of diphtheria for eight successive years. 4 Unfortunately, in dealing with the public health, we have always to remember the possibility of the unexpected occurring, and of nature re-adapting itself to changing environmental conditions. With this in mind, modifications in the schemes for immunisation are welcomed as also the fairly satisfactory degree of public support received. The use of combined diphtheria and whooping cough immunising agents has now become the customary practice, although not accepted by quite as high a percentage of parents as could be wished. The vaccination of about two thirds of the babies represents a distinct improvement since 'compulsion' was dropped. This year for the first time the routine immunisation of school children of a specified age group against tuberculosis has been instituted and the results will be watched with interest. By contrast, it is rather regrettable to have to report an increase in deaths from accidents, mainly off the roads and two major outbreaks of food poisoning. Here there is no question of immunisation but of all members of the community taking the simple preventative measures which have been widely publicised. By cleanliness and the early consumption of cooked foods we can prevent not only food poisoning but the spread of dysentery which has become prevalent of late. The recent establishment of a local voluntary Council for the Prevention of Accidents in the Home is a very welcome development. In the Sanitary Inspector's section the year 1954 will be remembered for new legislation aiming at the clearance of unfit houses and the preservation of those which, although tending to deteriorate or become obsolete, can be saved. Increased inspection resulted forthwith but the outcome will be more obvious in my next Report. In brief, this summary of the year's activities and assessment of the state of the public health show grounds for some satisfaction and hope that, if all concerned continue to play their part, including primarily, of course, the residents themselves, we can anticipate still better achievements. 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. 1954 64,650 Population, Census 1931 37,666 Population, Census 1951 63,770 Number of occupied houses, December, 1954 18,895 Number of occupied houses, 1931 9,533 Number of occupied houses, 1951 18,071 Rateable Value, December, 1954 £818,926 Sum represented by a penny rate £3,240 VITAL STATISTICS FOR THE YEAR 1954. Birth Rate per 1,000 of the Total M. F. estimated resident population Live Births—Legitimate 811 405 406 12.9 do. Illegitimate 23 16 7 Corrected Birth Rate 834 421 413 13.9 Rate per 1,000 (live and still) births. Still Births—Legitimate 18 6 12 13.2 do. Illegitimate - - - 18 6 12 Crude Death Rate per 1,000 of the estimated resident population Deaths 914 402 512 14.1 Corrected Death Rate 12.3 Rate per 1,000 Deaths from puerperal causes (live and still) births. Puerperal Sepsis - - Other Puerperal causes 1 1.17 Total 1 1.17 Death Rates of Infants under one year of age :— All infants per 1,000 live births 10.8 Legitimate infants per 1,000 legitimate births 11.1 Illegitimate infants per 1,000 illegitimate births Deaths from Cancer (all ages) 142 Deaths from Measles (all ages) Nil. Deaths from Whooping Cough (all ages) Nil. Deaths from Diarrhoea (under 2 years) Nil. 6 HEALTH REPORT FOR 1954. 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 40 years. Situated on the North Downs immediately to the south of Croydon, this well-favoured "dormitory" suburb, has a very considerable proportion of its area reserved as part of the "Green Belt," and there is comparatively little dense development. 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 is thought to have increased slightly since, the mid-year population for 1954 being estimated by the RegistrarGeneral to have been 64,650 compared with 64,810 and 64,180 in the two previous years, but the latest figure is almost certainly an under estimate. These numbers include persons resident in Institutions in the District, the numbers of which at the end of 1954 were as follows:- Cane Hill Hospital 2,502 Netherne Hospital 2,091 Russell Hill School 244 Reedham Orphanage 267 7 In December, 1954 there were 18,895 occupied houses, distributed as follows:— Coulsdon East 3,081 Coulsdon West 3,163 Purley 2,604 Woodcote 1,762 Sanderstead North 2,293 Sanderstead South 2,642 Selsdon 1,884 Kenley 1,466 This suggests an average of 3.42 persons per occupied house in 1954, or 3.15 if the institutional population is excluded, compared with 3.53 and 3.24 in 1951. As there were more than 800 additional occupied houses in 1954 compared with 1951, the population must have increased by quite 2,400 in that time rather than just 880 as estimated by the Registrar-General, and have been at least 66,200 in 1954. 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 1953 and 1954. Rates per 1,000 population. 19201924. 19251929. 19301934. 19351939. 19401944. 19451949. 1953. 1954. Birth rate 13.5 12.9 11.6 12.8 15.2 15.2 11.6 12.9 Percentage illegitimate 3.4% 3.7% 2.8% 3.4% 3.9% 3.4% 2.8% 2.8% Stillbirth rate - — — 0.43 0.48 0.40 0.22 0.28 Death rate 7.4 7.0 7.4 8.3 11.4 9.7 15.3 14.1 Cancer death rate 0.96 1.15 1.35 1.19 1.70 1.75 2.39 2.19 Tuberculosis death rate (per 100,000 population) 57 36 38 35 48 36 29 15 Violence including Suicide 0.44 0.35 0.32 0.46 0.82 0.37 0.46 0.67 Maternal mortality rate per 1,000 live and still births 2.08 2.66 3.21 2.27 2.10 1.12 1.31 1.17 Infant mortality rate (per 1,000 registered births) 28 38 32 38 40 26 29 11 Neo-natal mortality rate - — - 26 28 19 21 8 Estimated population 21,351 28,950 41,616 53,084 49,880 60,610 64,810 64,650 8 BIRTHS. During the year 1954, 834 births were registered as occurring in the District, of which 421 were male and 413 were female, compared with 750 in 1953. It will be seen by reference to the preceding table that this is equal to an annual birth rate of 12.9 per 1,000 population, as compared with 11.6 in 1953, and an average of 12.0 in the last five years. If this rate is corrected in accordance with the RegistrarGeneral's assessment of the atypical constitution of the population it becomes 13.9 and this should be comparable with the birth rates for England and Wales which were 15.2 in 1954, 15.5 in 1953, and an average of 15.8 in the last five years. Illegitimacy.— In 1954, of the births registered, 23 were illegitimate (16 males and 7 females), this being 2 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 1954 was 18 (6 males and 12 females), which is 4 more than last year. None of the stillbirths was in respect of an illegitimate child. The local stillbirth rate was 0.28 per thousand of population while that for England and Wales was 0.36 in 1954. DEATHS. The number of deaths registered during 1954 as belonging to this District was 914 (402 males and 512 females), which is 76 less than last year, but still 258 more than in 1952. It will be remembered that in 1953 a new system was introduced 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 misleading. Applying the "comparability factor" supplied by the Registrar General, the gross local death rate of 14.1 is decreased to a corrected one of 12.3 but it is doubtful if this is really comparable with the national death rate of 11.3 for 1954. In order to be able to compare more accurately the 1953— 1954 death rates, the records in respect of the normal residents have 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. The total death rate for 1954 for normal residents would have been 8.6 but for the new system, compared with 9.9 and 10.2 in the two preceding years. 9 The principal causes of death locally during 1954 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 492 (299) 53.8 (53.4) Cancer, malignant disease 142 (117) 15.5 (20.9) Pneumonia 58 (24) 6.3 (4.3) Bronchitis 25 (11) 2.7 (1.9) Accidents 32 (19) 3.5 (3.4) Tuberculosis (all forms) 10 (3) 1.1 (0.5) (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 was 4.62 compared with an average of 5.17 in the preceding four years. As however, this group includes a high proportion of elderly people dying virtually of old age, it is not regrettable if this particular rate remains high. Ignoring the mental hospital group, this year 73 per cent of residents dying from heart and circulatory disease were over 65 years of age at the time of death, compared with an average of 81 per cent in the previous five years, while 41 per cent were over 75 years of age. (Incidentally, 68 per cent of deaths from all causes were over 65 years, compared with an average of 67 in the five preceding years). CANCER. The cancer death rate in respect of normal residents was 1.81 in 1954 compared with an average of 1.85 in the last five years and 1.82 since the war. The tendency to stabilisation noted in recent years has, therefore, continued. 10 11 CANCER DEATHS 1954. 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. Larvnx - - - - - - - - 1 - 1 - - - 2 — Brain and Thyroid 1 -(1) — -(1) 1 —(1) —(1) — 1 - - - - - 3(1) (3) Bone 1 - - - - - - - 1 —(1) — — — — 2 (1) Oesophagus — — — — — — — — — —(2) - — 1(1) 1 1(1) 1(2) Stomach and Duodenum - - - - - - 2 1 1 —(1) 3 1(1) - 6 6 8(2) Intestines — — — — 1(1) 1 1 1 3(1) 6(1) 6(1) 4 2 5 13(3) 17(1) Liver - - - - - - - - - 1(1) - - 1 —(1) 1 1(2) Pancreas - - - - - - 1 - - - - 1 1 - 2 1 Lungs — — — — 3 — 7 1 6 1 6 1 1 - 23 3 Bladder - - - - - - 1 - - - 1 1 1 - 3 1 Prostate - - - - - - - - - - - - 2 — 2 - Uterus - - - - - - - 1(1) - - - 1 - - - 2(1) Vagina and Ovary - - - - - 1 - - - 2(1) - - - - - 3(1) Breast — — — 1 — 1 — 3 - 3(2) - 2 - 1 - 11(2) Kidneys 2 - - - - - - - -(1) - - - - - 2(1) - Ill-defined - 1 — — —(1) 1 1 - 1 2(1) —(2) 2 - 1 2(3) 7(1) Totals 4 1(1) — 1(1) 5(2) 4(1) 13(1) 7(1) 14(2) 15(10) 17(3) 13(1) 9(1) 14(1) 62(9) 55(16) The previous table gives the age, sex and distribution of this disease in the fatal cases among ordinary residents which occurred in 1954, the mental hospital cases being added in brackets. Compared with recent years, the number of deaths from breast cancer in females was again below the average, but a further slight increase in the number of lung cases among males is noted. On the average, since the war 24 per cent of male deaths from cancer originated in the lungs, but in the last 2 years this percentage increased to 30 per cent and in 1954 it was 37 per cent. Research into the cause of the increase in this form of cancer is proceeding. While other carcinogenic factors may be involved the association with heavy cigarette smoking is very suspect and pending further evidence personal restrictive measures are justified. As previously stated, the younger generation would be wise to consider the 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 15 deaths among mental hospital inmates (previously transferable), mostly due to falls, there was a marked increase in deaths from violence (including suicide) compared with 1953, the death rate being 0.43 per thousand of population whereas it was 0.26 last year and averaged 0.39 both for the inter-war years and for the years since the war. Deaths on the road increased by two, six deaths being attributed to this cause, including two elderly mental hospital patients who were struck by motor cars. All four ordinary residents were young; three were pedestrians and one a motor cyclist. There was a variety of causes for the remaining 15 accidental deaths in the District, the most common being falls and gas poisoning in the elderly. The number of deaths attributed to suicide was again 11, but 2 of these were mental hospital patients. The nett figure is above the annual average of 6.5 since the war. TUBERCULOSIS AND PNEUMONIA. Deaths from tuberculosis and pneumonia are referred to in later sections of this report. MATERNAL MORTALITY. Unfortunately, as in 1953, there was one maternal death, with a resultant maternal mortality rate of 1.17 per 1,000 live and stillbirths compared with that of 0.69 for England and Wales. Death in this case resulted from post partum haemorrhage as a sequel to other abnormalities in a seventh pregnancy. 12 INFANT MORTALITY. During 1954 there were only 9 deaths among children under one year of age, as compared with 22 last year, and an average of 20 in the last six years. None of the deaths was in respect of an illegitimate child. While any death is regrettable, and at least 2 of these 9 might have been prevented, this is far and away the lowest number of infant deaths which has occurred in this District in any one year. The resultant infant mortality rate was only 10.8 per 1,000 registered births, compared with 29.3, 24.0, 21.7 and 17.2 in the previous four years, the rate in 1950 being the lowest previously recorded for this District. The infant mortality rate for England and Wales was the record of 25.5 in 1954, the lowest previously recorded being 26.8 in 1953. The 7 babies dying in the first month correspond with a neonatal mortality rate of 8.4 (i.e. deaths in the first month per 1,000 live births), whereas the average for the past nine years was over 18. During the year 8 premature babies were notified as being born at home and 41 in institutions. Of the latter 5 died, 2 in the first day, and one on each of the 2nd, 5th and 7th days after birth. This suggests that only 10 per cent of the premature babies died, compared with an average of 22 per cent in the years since 1945. The following table gives the causes of the 9 deaths which occurred during 1954 together with the age at death. 13 14 INFANTILE MORTALITY DURING THE YEAR 1954. 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. Congenital malformation 1 — — — 1 — — — — 1 Blood condition 1 — — — 1 — — — — 1 Prematurity and Atelectasis 4 1 — — 5 — — — — 5 Accidental Smothering — — — — — — 2 — — 2 Totals 6 1 — — 7 — 2 — — 9 INFECTIOUS DISEASE. The following table indicates the number of cases of infectious disease notified during 1954, 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 68 15 — Erysipelas 4 1 — Puerperal pyrexia — — — Pneumonia — primary 20 8 58* Enteric fever 1 1 — Encephalitis, acute 1 1 1 Dysentery 12 12 1 Poliomyelitis, paralytic 1 — — Measles 9 — — Whooping cough 131 4 — Food poisoning 74 72 — Totals 321 114 60 * 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 1924 is presented in Table III in the Appendix. It will be seen that whooping cough was the commonest notifiable infectious disease while measles, scarlet fever and pneumonia were much less prevalent than in the previous year. More cases of food poisoning occurred, due to two outbreaks. Excluding food poisoning, 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 only 1.5 per 1,000 population, which is much lower 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 three occasions individuals who had been in contact with cases overseas had to be supervised. DIPHTHERIA. For the eighth year in succession no case of diphtheria occurred in the District and only one suspicious but unconfirmed 15 case was admitted into hospital. 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, it is all the more necessary to maintain the immunity of the population by artificial means. SCARLET FEVER. This disease remains of a very mild type and only 68 cases were notified as compared with 80, 90 and 149 in the previous three 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, 52% being in this group in 1954 compared with 17% under school age and 20% older school children. Six cases occurred among adults, but half of these were connected with schools. Almost all schools in the District, including a number of private schools, had one or more cases, the maximum in any one school being ten. 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. The hospitalisation of cases has further decreased, only 15 cases being admitted in 1954, (Wandle Valley 8, Bletchingley 5, Queen Mary's 1 and Waddon 1). 16 Of the 53 cases treated at home 4 were secondary cases occurring in the same house, and these were probably infected before hospitalisation of the first case would have been practicable. ERYSIPELAS. Only four isolated cases occurred in the summer, one of which was admitted to Hospital. All recovered. ENTERIC FEVER. One confirmed case of paratyphoid fever (B. type) was notified during the year, and two suspected cases of paratyphoid were admitted to hospital. The latter gave completely negative findings and the source of the definite case could not be traced. DYSENTERY. A total of 12 cases of dysentery were notified, compared with 13, 48 and 22 in the three preceding years. Of this number 11 were due to the Flexner bacillus and occurred among the inmates of one of the mental hospitals, one of whom died from this disease. The remaining case was due to the milder Sonne bacillus and this cleared up in hospital. FOOD POISONING. During the year a total of 74 notifications of food poisoning were received which is much the largest number of cases notified in any single year. The number of outbreaks was about the normal, however, being not more than five. In three instances only one or two individuals were concerned, and in two of these the causal organism was not identified. The third, which affected two members of one family, was due to S. typhi murium, probably spread by mice. The largest outbreak resulting in 69 notifications, was in one of the mental hospitals and was due to CI. Welchii which had thrived in meat pies made on a Saturday, allowed to cool over night in meat tins in a warm atmosphere and reheated before consumption at lunch on the Sunday. In addition it is known that in October a large firm in the District had at least 29 of their employees affected by food poisoning although not one of the cases was notified. (Only a minority saw a doctor but one of them was correctly diagnosed in a neighbouring District, though not notified). As in the previous outbreak the causal organism was undoubtedly CI. Welchii resulting from meat being cooked on one day, allowed to cool slowly in a warm atmosphere and reheated before 17 being served a day later. (Fairly conclusive evidence was produced subsequently by similar joints being treated in exactly the same way as those causing the outbreak and being shewn to yield very heavy growths of CI. Welchii). These two major outbreaks illustrate vividly the risk which is taken when meat, and particularly large joints, is allowed to cool slowly in an improperly ventilated room overnight and reheated before being served. The warm moist conditions encourage the multiplication of any organism in the food. If it is essential to cook the previous day, cooling should be expedited and the food stored, if possible, in a refrigerator. Cooking immediately before serving is, however, greatly to be preferred. ACUTE ENCEPHALITIS. One adult resident unfortunately died of this disease in April in a General Hospital to which he had been admitted as possibly suffering from pneumonia. It was impracticable to trace the source of the infection which appeared to be limited to this solitary case. POLIOMYELITIS. This disease was less prevalent nationally and locally. Only 1 case was notified as a paralytic one, but the infection was slight and all symptoms soon cleared up. It was not considered necessary for the adult concerned to be admitted to hospital. On seven occasions individual residents or groups who had been in contact with recognised cases elsewhere were kept under supervision, but none developed the disease. The "Summer" of 1954 was generally considered to have been a wet one and this doubtless assisted in preventing the spread of this disease. PNEUMONIA. During the year 20 cases of acute primary or influenzal pneumonia were notified, compared with 44, 21 and 51 in the three preceding years. The cases occurred fairly uniformly throughout the year and only 2 of the cases appeared to be interconnected. Six of the cases were notified by one general practitioner and the remainder by seven other doctors. So far as is known only 8 of these cases were admitted to hospital and no deaths occurred among these notified cases. MEASLES. This disease is usually prevalent in alternate years and it was, therefore, expected that there would be fewer cases in 1954. What was surprising was that only 9 cases were notified compared with 1,319, 170 and 810 in the three preceding years. 18 So far as is known, the disease remained fairly mild in type and no cases were admitted to hospital. WHOOPING COUGH. In 1954 there was a moderate increase in notifications, 131 being received, compared with 66, 196, 204, and 242 in the four previous years. Of these only 4 cases are known to have been admitted to hospital and all recovered. The majority of the cases occurred between March and August, the incidence being highest in May and August. While Kenley produced the steadiest flow of cases, Sanderstead had the highest total with Purley a close second. Just over 40% were children under 5 years of age and 6 babies were under 1 year. It must here be emphasised, however, that this disease can be very serious and is often very debilitating. The immunisation of all children against it is strongly recommended and this treatment should be commenced by at least the sixth month of life. 19 TUBERCULOSIS. The following table presents concisely the position with regard to tuberculosis in the District during 1954:— Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number of cases on register, 1st January, 1954 257 183 36 37 293 220 Additions, 1954:— New cases notified 21 10 — 7 21 17 Cases removed into District 18 18 2 2 20 20 Restored to register — 2 1 — 1 2 Total Additions 39 30 3 9 42 39 Removals, 1954:— Deaths from (a) Tuberculosis 6 2 1 1 7 3 (b) Other causes — —. —. – — — Removed from District 18 23 3 1 21 24 Recovered 6 7 2 9 8 16 Non-tuberculous — — — — — — Total Removed from Register 30 32 6 11 36 43 Number of cases on register, 1st January, 1955 266 181 33 35 299 216 The following table shows the age-groups in which notifications and deaths occurred:– Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. Under 1 year – – – – – – – – 1 and under 5 – – – – – – – – 5 and under 10 — 1 – – – – – – 10 and under 15 — 1 – – – – – – 15 and under 20 2 — — 1 — — — — 20 and under 25 3 2 – – – – – – 25 and under 35 1 1 — 2 1 — — — 35 and under 45 3 1 — 1 — — — — 45 and under 55 7 4 — — 2 — — — 55 and under 65 2 – — 2 — 2 1 1 65 and over 3 – — 1 3 – — — Totals 21 10 — 7 6 2 1 1 20 The new cases were distributed amongst the wards as follows:— Localisation. Coulsdon East. Coulsdon West. Kenley Purley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 8 7 — 7 7 2 — Nonpulmonary 3 — 1 2 1 — — Totals 11 7 1 9 8 2 — The following table illustrates the trend of this disease since the formation of the District. Average figures for the quinquennial periods 1915-1954. 19151924 19251934 19351944 19451949 19501954 Pulmonary— New cases notified 22 29 35 49 43 *Case rate 115 82 68 81 67 Deaths 12 13 21 27 16 *Death rate 65 37 42 44 22 Non-Pulmonary— New cases notified 3 6 7 8 5 Case rate 15 18 15 13 8 Deaths 3 3 2 2 2 * Death rate 15 8 5 3 4 * (The rates in this table and the remainder of the section are in all cases per 100,000 population). During 1954 the number of new notifications of pulmonary tuberculosis was only 31 compared with an average of 43 in the last five years. This corresponds with a case rate of 48, which is 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 fluctuations are apt to occur in dealing with relatively small numbers the steady improvement in each of the last four years is quite encouraging. Similarly on the average the local death rate from pulmonary tuberculosis has steadily decreased as has the national death rate. The incidence of new cases of non-pulmonary tuberculosis and the corresponding death rate have remained fairly constant and at a low level for the last 20 years. 21 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. During the second half of 1954, the parents of children attending the County Council's schools who were 13 years of age, were asked if they would agree to their children being tested and, if necessary, given B.C.G. immunisation. As a result, 73% accepted and 89% of these children were immunised. In 1955 a similar offer will be made to the parents of local school children in this age group in further schools. The Mass X-Ray Unit operated for a period in Croydon during the year but a visit to this District could not be arranged. The local Tuberculosis Clinic is held every Monday from 2-4 p.m. at the Surrey County Council Clinic, 62 Whytecliffe Road, Purley, with one additional session each week. 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. The group of non-notifiable infectious diseases including influenza 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 scattered cases of chickenpox and mumps throughout the year with appreciable outbreaks of the former in Sanderstead in February/March and Selsdon and Chipstead Valley in November/December. Mumps was most marked in Sanderstead and Chipstead Valley in the Spring and in Old Coulsdon in the Summer and Autumn. Only one case of ringworm was reported and no serious outbreak of influenza occurred. 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. 22 INFESTATIONS. (a) Scabies. During 1954 only 2 adults and 2 children forming one family were treated by the Health Department for this disease, compared with 2, 4, 11 and 11 in the four 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 18 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 it can be used, 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, if and when these are necessary. The comparatively small risk of inoculations influencing the onset of poliomyelitis is now well-recognised, particularly 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, and especially if subcutaneous injections are used as these avoid damage to the muscles. This is 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. 23 The following table shows the treatment given during 1954, and the proportion of children estimated to have been immunised:– Centres and Clinics (including day nurseries). Number who completed Primary treatment 379 Number of "Booster" doses given 144 Schools. Number who completed Primary treatment 24 Number of "Booster" doses given 964 General Practitioners. Number who completed Primary treatment 385 Number given "Boosters" 484 Proportion of children estimated to have been immunised:— (a) from 1-5 years 67% (b) from 5-14 years 92% The total number of primary treatments was slightly more that last year but 784 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 73%. There is therefore room for improvement in all age groups. VACCINATION. The following table shows the number of vaccinations performed in the District during 1954:— Welfare Centres. Primary vaccinations 227 General Practitioners. Primary vaccinations 0-15 years 382 „ „ over 15 years 46 Re-vaccinations 0-15 years 27 „ over 15 years 107 The number of primary vaccinations was 87 more than last year, and it is good to find that about 64% of the babies born in 1954 were vaccinated compared with 60% in the 2 previous years. If this percentage can be maintained it will be very satisfactory. 24 WHOOPING COUGH IMMUNISATION. The year 1953 was the first in which this treatment was provided both by private Doctors and at the Infant Welfare Centres. The following numbers were treated during 1954 and it is pleasing to note that 104 more children were given primary courses and that reinforcing doses increased by 129. Welfare Centres. Number who completed Primary treatment 368 Number of "Booster" doses given 20 General Practitioners Number who completed Primary treatment 346 Number of "Booster" doses given 249 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 latest in the sixth month, and followed by a "booster" dose at 2 years, but with experience this time table may be varied. As this treatment is not usually given much after 2 years of age, there is a tendency for fewer children to be immunised against whooping cough than against diphtheria, but this year the difference is only 74, or about 10%. 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 1954 reports were received on the following specimens:— Milk, ice cream, and water samples 424 Food utensils 225 Nose or throat swabs 33 Food 22 Eye Swabs 2 Faeces 100 Vomit 13 Recta! swabs 10 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. 25 For the convenience of ratepayers, the Council has decided to arrange disinfection even when this is not essential to the 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 1954 the following disinfections were carried out::— Free of cost. Upon payment. Total. Loads of bedding, etc 42 2 44 Houses disinfected 82 — 82 Parcels of clothing — 4 4 Library books 579 – 579 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 not utilised during 1954. Periodically border line cases occur in which the Welfare Officers seek advice, but every endeavour is made to find a satisfactory solution without resorting to compulsory powers, especially as the latter are so limited in their application. 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 one burial was thus arranged. HEALTH PROPAGANDA. Constant attention is given to 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 each year a number of talks are given by the Officers to various organisations who request their assistance. If time permitted doubtless more of these could be given to advantage. The material supplied by the Central Council for Health Education and other bodies is extremely useful. 26 OTHER LOCAL AUTHORITY HEALTH SERVICES. Since 1948 the local Council has been represented on the S.E. Divisional Health Sub-Committee of the County Health Committee and the corresponding Educational Executive, which bodies have certain specified 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 the responsible officers for the Divisional Health Services, and deal to a limited extent, among other things with the maintenance and detailed organisation of the following branches. Maternity Clinics. Residents are welcome to attend the Clinics enumerated in tabular form at the end of this part of the Report, the arrangements for which have not been altered this year. Since the National Health Service Act has been implemented, prospective Mothers wishing to take advantage of its provisions may arrange for their confinements with (1) a doctor providing midwifery service and a maternity nurse, or (2) a midwife, the doctor of their choice being on call in emergency, or (3) a hospital, where a bed may be reserved in certain circumstances. Expectant mothers making arrangements (2) or (3) usually attend the Council's Maternity Clinics but private doctors can also refer their cases for special purposes, e.g., blood tests for Rhesus factor, etc. Conversely in some cases the District Midwives assist general practitioners at ante-natal sessions in their surgeries. It may be of interest to note some of the numerical effects of these arrangements. In 1947 the number of new ante-natal cases who attended the 3 local clinics was 434 representing 41% of the registered births (53% in 1945/6). In 1954 only 181 new cases attended these clinics (22%) but a few more may have attended the Warlingham and Caterham Hill clinics. The average attendance per session meanwhile dropped from 24 to 10, the reduction at Selsdon being the most marked. (To some extent the decrease in 1954 may have been due to changes in the staff and holding 3 morning instead of afternoon sessions.) Corresponding with this the number of residents who were confined in the Redhill County and Purley Hospitals rose from 335 in 1947 to 393 in 1954, the increase chiefly affecting the Purley Hospital admissions. (In 1954 approximately 28% of the local 27 births occurred in their own homes, 62% in hospitals and 10% in Nursing Homes.) Mothercraft and Relaxation Classes. Classes covering these subjects were commenced in Purley at the end of 1953 and the numbers attending have increased very rapidly. It is now necessary for expectant mothers wishing to join these classes to make application to the Divisional Health Visitor at 115 Brighton Road, Purley, who will inform them as soon as a vacancy occurs. Midwifery and Home Nursing Service. Apart from some changes in the personnel there were no alterations in this service during 1954. Only one of the former Coulsdon and Purley midwives remains and she is the only nurse now engaged solely in midwifery, hence it is difficult to indicate the trend in that service and impossible to give comparable figures for the Home Nursing Service, which was formerly undertaken by voluntary associations. District nursing has undoubtedly increased considerably in recent years as would be expected in an ageing population, with the greater number of injections now given and as a result of the difficulty of arranging hospital admissions. Home Help Service. This service had been given much encouragement and had expanded rapidly before it was transferred to the County Council. Slightly more cases have since been accepted annually and it would now appear to have come near to saturation point, 498 cases having been attended in 1954 compared with 414 in 1947. Priority is still given to maternity cases, but only 110 were assisted in 1954 (215 in 1947). A relatively high proportion of short or acute cases has always been accepted owing to the absence of any comparable service in the District, but the number of long or chronic cases has tended to increase in recent years. Family Planning. The local Clinic continues to give useful service to those cases in which, on medical grounds, it is undesirable for a further early pregnancy to occur. In 1954 advice was given to 51 such cases compared with 75 in 1947 when, in addition, 16 were advised on sub-fertility. Treatment for the latter is now, presumably, given at the hospitals, as only one case applied for help in this direction last year. Health Visitation. Eight Health Visitors are now employed in the District compared with 6 in 1947 of whom 5 were solely engaged in maternity 28 and child welfare work and one dealt mainly with the schools. All now have mixed duties which cover a wider field and it must be remembered that, although the number of births has decreased, the school population is much larger than it was in 1946. Infant Welfare Centres. No alterations have been made recently in the arrangements appertaining to the 9 Centres, all except one of which were established before 1947. The attendances in the different parts of the District tend to fluctuate from time to time as the constitution of the local population changes, but the following table indicates the trend in respect of the use of these centres. 1938 1947 1954 Total attendances 17,038 14,819 13,442 Total new cases 667 984 597 New cases as % of registered births in previous year 96% 95% 79% Sessions 239 315 405 Average attendance per session 71 47 33 Doctor's consultations 3,522 3,414 3,735 Doctor's consultations per Session attended 20.2 11.7 9.9 Unfortunately the statistics for the three years are not strictly comparable as, for example, in 1954 the 'new cases' were limited to children who on first attending had not celebrated their first birthday. In general, however, the variations provide food for thought. Day Nurseries. Since 1948 there have only been two Day Nurseries in the District and of these the one at Sanderstead, which accepts children of 0-5 years of age, is never full to capacity. The Old Coulsdon Nursery takes children of 0-3 years and is usually full. Children are only admitted when the mother is the sole wage earner or on grounds of health including unsatisfactory housing conditions. The result is a smaller demand than in War time and frequently shorter periods of attendance, but a very useful service for those affected. It is a pity from the point of view of training girls for nursing and for life generally that for several years neither of the local Nurseries has been a Training Nursery. School Health Service. The basis of this service is the periodical medical and dental inspection of all the children in attendance at the local schools who, in this Division, now number over 12,000 compared with 7,490 in 1946. Several full and part time doctors and one full time dentist are employed on the work in this District. Some of the defects noted need to be kept under observation and others are referred for treatment by private doctors, hospitals or specialist 29 clinics. Among the Clinics organised by the Education Authority are the dental, eye, speech, general medical, child guidance and remedial exercise clinics. Special attention is given to handicapped children, some of whom require to be admitted to special schools, e.g. those for the deaf, mentally or physically sub-normal. As is noted in other parts of this Report, the condition of the school premises and of the school meals service are kept under supervision and special steps are taken to prevent the spread of infectious diseases, including the immunisation of school children. This well established service performs a very useful function but does not often attract the attention of the majority of residents. Welfare Services. The members of the Health Services work in close cooperation with the local representatives of the County Council's Welfare, Children's and Education Departments and such voluntary bodies as the Guild of Social Service, N.S.P.C.C. and Marriage Guidance Council. The Divisional Medical Officer has become responsible for co-ordinating the activities of all concerned with "Problem Families" and children neglected in their own homes. Addresses for Ready Reference: Ambulances. 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). Authorised Officer for Mental Health Services. Telephone: Mr. D. E. Twivey, 44, Reigate Hill, Reigate Reigate 3357 Blind Welfare Worker. Telephone: Miss Mitchell, 53, Abbey Road, Selsdon SANderstead 2790 Children's Officer for the District. Telephone: Miss J. M. Vann, Children's Department, County Hall, Kingston-upon-Thames KINgston 1050 Day Nurseries. Telephone: "Hazelglen" Day Nursery, Sanderstead Road, Sanderstead. (Matron: Miss I. M. Bettridge) SANderstead 5329 Old Coulsdon Day Nursery, Bradmore Green, Old Coulsdon (Matron: Mrs. L. C. Bryan, S.R.N.) Downland 4071 30 Divisional Health and School Health Services, Immunisation and Family Planning. Telephone: Divisional Medical Officer, 115, Brighton Road, Purley. UPLands 9277 Divisional Education Executive. Telephone: 38 Grovelands Road, Purley UPLands 7601 Emergency Units ('Flying Squads'). Telephone: Redhill County Hospital, Earlswood Common, Redhill Redhill 3581 St. Helier Hospital, Wrythe Lane, Carshalton FAIrlands 6622 May Day Hospital, Mayday Road, Croydon THOrnton Heath 6999 Home Help Organiser. Telephone: 115 Brighton Road, Purley UPLands 7014 (Telephone preferably between 9.30/10.30 a.m.) (UPLands 9277) Hospital Groups. Telephone: Croydon General Hospital, London Road, Croydon CROydon 7755 Redhill County Hospital, Earlswood Common, Redhill Redhill 3581 Maternity Clinics. 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 Purley. 10 a.m.—12 noon. (Coulsdon and Sander- stead 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. Midwives. 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. Home Nursing Service. 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 Mrs. St. John Smith, 14, Foxley Hill Road, Purley UPLands 0247 31 School Clinics. S.C.C. Clinic, 62, Whytecliffe Road, Purley ... Fridays 9—11 a.m. Baptist Church, Addington Road, Selsdon Mondays 1.30—2.0 p.m. St. John's Hall, Bradmore Green, Old Coulsdon Wednesdays 1.45—2.0 p.m. School Dental Clinic. S.C.C. Clinic, 62 Whytecliffe Road, Purley Monday, 9.45 a.m. or by appointment. Welfare Officers. Telephone: 115a Brighton Road, Purley. UPLands 0076 Mr. W. J. Middleton (Principal Divisional Welfare Officers) BALham 5375 Mr. E. G. Griffiths, (Divisional Welfare Officer) WALlington 9237 Welfare Homes. Telephone: " Chipstead Lodge," Hazelwood Lane, Chipstead Downland 4811 " Santa Tecla," Stanstead Road, Caterham Caterham 2641 Voluntary Bodies. Moral Welfare Worker. Miss Scoones, 1 Sunnyrise, Caterham Caterham 3728 National Society for the Prevention of Cruelty to Children. Inspector R. Lee, 37, Hartley Road, Croydon THOrnton Heath 4250 Coulsdon and Purley Guild of Social Service. Miss Honeyman, 105, Brighton Road, Purley UPLands 6800 Coulsdon and Purley Old People's Welfare Association. Secretary: 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 Home Safety Council (Coulsdon and Purley). Secretary: Mrs. A. Pope, 34 Grasmere Road, Purley UPLands 8047 32 HOUSING. The following is a statistical record of work carried out in respect of the sanitary condition of dwelling houses, as required by the Minister. 1. Inspection of Dwelling Houses during the Year 1954. (1)(a) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 450 (b) Number of inspections made for the purpose 1,424 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 57 (b) Number of inspections made for the purpose 243 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 (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 200 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 179 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 3 (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 10 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 12 (b) By Local Authority in default of owners 4 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil 33 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (e) Local Government (Miscellaneous Provisions) Act, 1953:— (1) Closing Orders made under Section 10(1) 2 4. Housing Act, 1936, Part IV—Overcrowding:— (a) (1) Number of dwelling houses overcrowded at end of year 4 (2) Number of families dwelling therein 4 (3) Number of persons dwelling therein 14 (b) Number of new cases of overcrowding reported during the year 3 (c) (1) Number of cases of overcrowding relieved during the year 7 (2) Number of persons concerned in such cases 31 (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 83 By other persons 461 It will be noted that there was an appreciable increase in the number of dwellings inspected for housing defects and this reflects the coming into force of the Housing Repairs and Rents Act, 1954 on the 30th August. This Act makes further provision for the clearance and re-development of areas of unfit housing accommodation, and for securing or promoting the reconditioning and maintenance of houses, besides amending the enactments relating to housing, the exercise of certain powers relating to land, and rent control. An important provision in the Act is that requiring Local Authorities to submit to the Minister of Housing and Local Government within one year, proposals for dealing with houses within their Districts which appear to them to be unfit for human habitation, and with any other houses which are or in their opinion ought to be included in clearance areas. This has necessitated a general survey throughout the District of houses to which the provision might apply. The Chief Sanitary Inspector writes that "Although it is early yet to comment on the effect of the "rent increase" provisions of the Act, which were introduced with the well intentioned object of encouraging owners to keep property in good repair, there is increasing evidence that the possibility of a Certificate of Disrepair being issued on a house is having a restraining effect on owners of that type of property in most need of attention. This factor is bound up with the post-war problem of cost of repairs 34 in relation to the rent which is obtainable, even after the statutory increase allowable under the new Act is taken into consideration. On this question, the Act does not appear to offer any solution, although it is of interest to record that during the year under review, the Council decided to purchase a house under Section 3 in lieu of making a Closing Order where the owner failed to submit proposals in respect of the house, which required repairs estimated to cost in the region of £700". "Although this may not be the true intention of the Section, its increasing use may be necessary in order to preserve houses that would otherwise become obsolescent." During the year the Council also agreed, in approved cases, to operate the Housing Act provisions relating to Improvement Grants, but only in respect of works for the purpose of improving sub-standard properties. The Chief Sanitary Inspector, in consultation with the Engineer and Surveyor, was instructed to report upon any such applications to the Public Health Committee for their consideration and report to the Finance and General Purposes Committee. WATER SUPPLY. The water supply of the District was, as in previous years, provided by the Sutton District Water Company and the East Surrey Water Company, with a private supply supplementing, as necessary, at Cane Hill Hospital. Routine samples of the treated water in public supply were submitted quarterly for bacteriological and chemical examination. In addition, two samples were obtained for bacteriological examination only from the private supply at Cane Hill Hospital, making 18 samples in all. In addition, both the Water Companies and the Local Authorities sharing these public supplies provided the Department with copies of the reports on the samples taken by them. No complaints were received during the year with regard to the quality or quantity of water supplied by the Companies, and no unsatisfactory reports were received on the samples taken from the supplies to the District. The Cane Hill Hospital Management Committee has made arrangements with the Public Health Department of the London County Council for routine sampling and supervision of the water supply from the relatively shallow well in their grounds, which is used exclusively by this Hospital. Adequate chlorination is essential and steps have been taken to ensure this and to effect closer co-operation between the officers of the three authorities interested in the standard of this supply. 35 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 Million. Grains per Gallon. Parts per Million. Grains per Gallon. Total solid matter (dried at 180°C.) 175.0 - 125.0 - Chlorine present as chloride 14.5 - 16.0 - Ammonia, free 0.00 - 0.03 - Ammonia, albuminoid 0.002 - 0.002 - Nitrate nitrogen 5.3 - 5.3 - Nitrite nitrogen trace - 0.04 - Oxygen absorbed from permanganate solution in 4 hours at 27°C. 0.09 _ 0.06 _ Hardness —Temporary 93.0 - 31.0 - Permanent 32.0 - 40.0 - Total 125.0 8.75 71.0 5.0 Iron and other metals absent - absent - Residual chlorine at time of receipt 0.03 - 0.21 - pH 7.4 8.4 Electric conductivity at 20 °C. 255 units 165 units 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-six samples were taken from the supplies of the two Companies and examined for hardness by the Department, all of which were satisfactory in that adequate softening had been carried out. RAINFALL. The rainfall registered by the automatic rain gauge installed at Alderstead Heath was 29.54 inches, this being an increase of 3.05 inches compared with the previous year. The monthly totals throughout the year were as follows:— inches. January 1.43 February 2.42 March 2.08 April 0.38 May 2.70 June 3.33 July 2.68 August 3.14 September 2.20 October 2.04 November 5.12 December 2.02 36 DRAINAGE AND SEWERAGE. A total of 441 yards of new sewers was constructed during the year as a result of development by the Council and private builders. Although a scheme for the provision of a new sewer in Old Farleigh Road and Beech Way, Selsdon, was approved, commencement of the works was unfortunately delayed and operations had not commenced at the end of the year. This sewer will provide main drainage for 18 existing houses. CLOSET ACCOMMODATION. During the year, 3 houses were connected to the public sewer and 2 cesspools abolished. In addition, a large private school, situated in the neighbouring district of Banstead but served by an obsolete sewage disposal system situate within the area of the Council, was connected to the main sewer involving the construction of approximately 1,000 ft. of private drain. At the end of the year the following pail closets and cesspools remained in use:— Premises with pail closets 11 Number of cesspools 36 The contents of pail closets at private premises are disposed of in the gardens by the occupiers of the houses. PUBLIC CLEANSING. The collection of refuse was continued on a weekly basis throughout the year, and the charges for trade refuse collection and for cesspool emptying remained unchanged. SMOKE ABATEMENT. The chimneys of the small factories in the District give little trouble and no serious nuisance was recorded during the year. RIVERS AND STREAMS. From time to time inspections are made of the watercourses in the District, and they have been cleared whenever necessary. No particular difficulty has arisen in regard thereto. CAMPING SITES. The Boy Scouts' camping site at Featherbed Lane continues to be used, and is conducted in a very satisfactory manner. 37 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. The unauthorised camp site for trailer caravans for residential and occasional use established on land at Dean Lane, Merstham, adjoining Alderstead Heath, has continued to operate, subject to the conditions stipulated by the Minister of Housing and Local Government on appeal. SWIMMING BATHS. There are two swimming baths in the District which are used by the general public, and during the year 14 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 67 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. 38 FACTORIES AND WORKPLACES. Factories Acts, 1937 and 1948. PART I. 1. INSPECTIONS. Premises. Number on Register. Number of Inspections. Written notices. Occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 41 39 – – (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 146 280 2 – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 12 — — Total 190 331 2 — 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) – – – – – Overcrowding (S.2) – – – — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — – — — — Ineffective drainage of floors (S.6) — — — – — Sanitary Conveniences (S.7) (a) Insufficient 3 2 — – – (b) Unsuitable or defective 21 21 — 2 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 24 23 -- 2 — 39 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 (1) (c). No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwholesome premises. Notices served. Prosecutions. Wearing apparel Making, etc. 24 – – – – – Cleaning and washing — — – — — — Umbrellas, etc. 1 – – – – – Carding, etc. of buttons etc 24 – – — — — Cosaques, Christmas crackers, Christmas stockings, etc. 5 — — — — — Total 54 — — — — — 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, 1954:— Complaints Received. General disrepair and insanitary conditions 49 Dampness 18 Overcrowding 5 Defective drainage systems 20 Blocked drainage systems 160 Defective drainage fittings 1 Defective W.C. pans and flushing apparatus 15 Defective service water pipes 4 Defective hot water systems 4 Defective chimney stacks 4 Absence of, or defective dustbins 5 Insanitary pig waste bins 1 Accumulation of refuse, etc 17 Rats and mice 363 Keeping of animals 1 Insect pests, etc. 23 Wasps' nests 120 Smoke nuisance 6 Contaminated food 16 Unsound food 67 Miscellaneous 56 Tota 955 40 Summary of Visits Made. Number of houses visited 507 Number of reinspections and calls made 1,066 Verminous premises 53 Water supply 2 Tents, vans and sheds 10 Schools 4 Places of entertainment 5 Licensed premises 45 Storage of refuse 79 Accumulation 137 Piggeries, fowls and other animals 85 Stables 4 Rats and Mice Destruction 5,255 Drainage inspected 2,827 Drainage tested 340 Cesspools 83 Urinals 1 Sewers and street gullies 110 Cowsheds, dairies and milkshops 91 Ice-cream premises 72 Meat shops 128 Food preparing premises 455 Other food shops 650 Bakehouses—Power 55 „ Other 1 Slaughterhouses 18 Food Inspection—Meat 37 „ „ Other Food 163 Factories—Power 228 „ Other 38 Workplaces 24 Outworkers 124 Heating Appliances (Fireguards) Act 66 Merchandise Marks Act 21 Pet Animals Act 5 Rag Flock and Other Filling Materials Act 1 Shops Act 634 Infectious disease enquiries 78 Infectious disease contacts 26 Food poisoning enquiries 35 Disinfection 85 Disinfestation 233 Swimming baths 65 Sampling—Food and Drugs Act, 1938 233 „ Ice-cream 139 „ Milk (bacteriological) 302 „ Milk (biological) 74 „ Water 27 Interviews 1,990 Miscellaneous visits 1,050 Tota 17,761 Work Carried Out and Defects Remedied. Drainage and Sanitary Fittings: Drains examined and tested 591 Drains repaired or reconstructed 80 Flood valves inserted in drainage system 1 Blocked drains cleared 149 Soil and vent pipes repaired or renewed Inspection chambers provided or repaired Inspection chamber covers renewed and frames re-bedde 21 Fresh air inlets repaired or renewed and/or stoppers provided 23 41 New W.C. pans fixed 22 W.C. flushing cisterns repaired or renewed 16 Cesspools cleansed, repaired or renewed 7 Sewage disposal plant cleansed and repaired 1 Cesspools abolished 1 Cesspools abolished and house drains connected to sewer 2 Septic tanks abolished and house drains connected to sewer 1 Soakaways reconstructed 10 Eaves gutters and stack pipes renewed or repaired 30 New lavatory basins fixed 3 Glazed sinks renewed or repaired 2 Waste pipes trapped, repaired or renewed 8 Sink gully dishings repaired 7 Urinals cleansed 1 Miscellaneous 26 General Housing Repairs: Defective roofs repaired 18 Chimney stacks repaired or rebuilt 11 Yards paved, or paving repaired 7 Dampness in walls remedied 31 Damp-proof courses provided 7 Additional sub-floor ventilation provided 2 Walls and ceilings repaired 82 New ceilings provided 11 Walls of rooms cleansed 25 Ceilings of rooms cleansed 21 Floors repaired or renewed 25 Staircases repaired or renewed 1 Ventilation and lighting of rooms improved 2 Windows repaired or renewed 41 Doors repaired or renewed 9 Firegrates repaired or renewed 20 Service water pipes repaired or renewed 8 Cellars cleansed or filled in 1 Portable dustbins provided 18 Miscellaneous 31 Food Premises: Food shops reconstructed 4 Hot water supply provided for ablution purposes 13 Lavatory basins provided Glazed sinks provided 10 Draining boards provided 5 Waste pipes repaired 3 Staff rooms provided 1 Staff sanitary accommodation repaired 9 Staff sanitary accommodation cleansed 18 Staff sanitary accommodation provided 4 Walls and ceilings cleansed and repaired 113 Floors repaired or relaid 11 Staircases repaired 2 Rooms enlarged 1 Windows repaired Refrigerators provided 3 Dustbins provided 6 Yards paved 3 Roofs, gutters and rainwater pipes repaired 4 Drains cleansed or repaired 7 Accumulations removed 15 Miscellaneous 39 Ratproofing: Work carried out by occupiers of premises after completion of treatment 27 42 Notices Served. Preliminary Notices 526 Statutory Notices 21 Legal Proceedings. It was not necessary to take legal proceedings in connection with any public health matter in 1954. SCHOOLS. Matters affecting adversely the hygienic 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 1 house needed to be, and was disinfested owing to the presence of bed bugs, but action was taken by the Department in 98 cases of infestation with other pests such as crickets and wasps, the complaints regarding the latter increasing by nearly 80 compared with the previous year. In the majority of cases disinfestation was carried out by spraying with a proprietary insecticide. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The table on the following page is a tabular statement indicating the action taken in 1954 under this Act. During that year, 77 visits were made to the Council Depots at Millstock, Purley Oaks, Kenley and Old Lodge Lane, and land at Littleheath Woods, Selsdon. The Ministry of Agriculture and Fisheries agreed to dispense with the normal routine test baiting of sewers in the District as required in former years, but maintenance treatment was carried out as was necessary. The Council's charges for services rendered in the destruction of rats and mice remain the same, i.e. 6/3d. per hour, plus the cost of materials at premises other than private dwellings, and a flat rate charge of 5/0d. in respect of private dwellings. 43 The Council continues to undertake the routine disinfestation of schools and school canteens owned by the County Council within the District, as and when necessary, on a contract basis. Type of Property. Number of properties inspected by the Local Authority as a result of— Number of properties found to be infested by- Number of treatments carried out by Department by arrangement with occupier. Number of Notices served under Section 4. Number of inspections made. Notification Otherwise. Total. Rats. Mice. Rats. Mice. Treatment. Structural works, i.eproofing. Primary and reinspections. Sewer treatment. Total. Local Authority 3 21 24 8 — 8 — — — Dwelling Houses 307 313 620 272 38 246 37 — — Business Premises 45 69 114 35 21 33 21 — — 5,058 197 5,255 Agricultural 4 39 43 4 — 4 — — — Total 359 442 801 319 59 291 58 — — 44 INSPECTION AND SUPERVISION OF FOOD. MILK. Milk and Dairies Regulations, 1949 - 1954. 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 Dairie 2 During the year one of the registered Dairies stopped processing milk and obtained its supplies in bottles from outside the District. The remaining Dairy is equipped with pasteurising plant and is licensed by the Council under the provisions of the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953. By virtue of the Milk (Special Designations) (Specified Areas) Order, 1951, which came into operation on the 1st October of that year, the use of a special designation became obligtory in respect of all sales of milk within the Urban District. Milk Sampling. The routine sampling of milk was continued and a total of 326 samples was submitted for bacteriological and biological examination, with the results set out in the following tables:— BACTERIOLOGICAL. Tests required by the Milk (Special Designation) Regulations, 1949-54. Designation. Number. Methylene Blue. Phosphatase. Turbidity. Satisfactory. Unsatisfactory. Satisfactory. U nsatisfactory. Satisfactory. U nsatisfactory. Pasteurised 197 192 5 195 2 – – T.T. (Raw) 25 21 4 – – — — T.T. (Pasteurised) 20 20 — 20 — — — Sterilised 30 – – – – 30 — Totals 272 233 9 215 2 30 — 45 BIOLOGICAL. Designation. Number. Tubercle Bacillus. Present Absent Tuberculin Tested 25 — 25 Ungraded 29 — 29 Totals 54 — 54 Only a comparatively small number of samples failed to pass the Methylene Blue (keeping quality) test or Phosphatase test of the efficiency of pasteurisation, and subsequent samples taken of similar supplies proved satisfactory. 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 54 samples showed any evidence of the presence of the tubercle bacillus. Milk (Special Designation) Regulations, 1949- 1954. Licences to sell milk under the above Regulations were issued as follows :— Dealers: Tuberculin Tested 13 Pasteurised 12 Sterilised 16 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, 93 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 25 premises which are exempt from registration. During the year, 72 visits of inspection were made to these premises. One registration for the sale of ice cream was cancelled because of the change in character of the general business carried on at the premises concerned. 46 The manufacture of ice-cream was not carried out at any of 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 130 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 104 Grade II 15 Grade III 8 Grade IV 3 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. Although not quite up to the standard of recent years, the above results can be considered fairly satisfactory. MEAT. During the year the Council gave consideration to the question of providing slaughtering facilities in the District, following the decontrol of meat and livestock and cessation of rationing, which occurred during the summer. Having regard to the comparatively small numbers of livestock slaughtered in the two slaughterhouses licensed prior to the War, no action was taken in the matter. An application for a licence for the use and occupation of one of the two slaughterhouses referred to was refused in the interests of the public health. No appeal was made. The owner of the remaining slaughterhouse intimated that in the circumstances, he did not propose to apply for the renewal of his licence. One slaughterman's licence was issued under the Slaughter of Animals Act, 1933, for the purpose of slaughtering at a Public Institution in the District. The arrangements made to carry out post-mortem inspections of all animals slaughtered at Cane Hill and Netherne Hospitals for consumption by the inmates were continued, but in fact no slaughterings were recorded at the Cane Hill slaughterhouse during the year. At Netherne Hospital the carcases and offals of 5 cattle, 3 calves and 56 pigs were inspected for evidence of disease, and a small quantity of offal only was condemned as unfit for food. There are 31 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. Retailers now obtain supplies of fresh and imported meat from the Croydon Abattoir and Meat Market and the Smithfield Market, and in addition small quantities of fresh meat direct from Scotland. 47 Frequent inspections of shops are carried out and, during the year, 128 visits were made for this purpose. 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 63 Butchers 31 Fishmongers (Wet and Dry) 16 Fishmongers (Fried)) 6 Bakers 28 Greengrocers and Fruiterers 50 Cafes and Restaurants 64 Grocers 76 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, one registration for fish frying was cancelled because of the change in character of the business carried on at the premises concerned. The Chief Sanitary Inspector reports:— "Generally, the standard of food premises in the District is good, although a very small minority of traders lag behind in thought and deed in applying the principles of Food Hygiene to their premises and methods. The co-operation and discrimination of the public is relied upon to supplement the efforts of the Department in raising the standard of these premises. 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, 88 swabs were taken from washed crockery and 6 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, cream buns and frozen liquid egg." The Council has adopted the new Model Byelaws issued by the Ministry of Food in connection with the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, and copies have been circulated to all food traders in the District. 48 UNSOUND FOOD. The following unsound foods were surrendered during the year, the total bulk being less than that surrendered in 1953:— cwts. lbs. ozs. Canned Soups – 4 7½ Canned Meat 2 94 9 Canned Fish - 13 3½ Canned Vegetables - 94 10 Canned Fruits 3 108 8¾ Canned Milk and Cream - 67 8 Meat, Bacon, Poultry, etc. 11 103 10 Fish 1 97 14 Meat and Fish Pastes - - 5¼ Butter, Fats and Cheese 1 46 9½ Sugar, Jam, etc. - 36 - Flour, Bread, Cereals and Biscuits - 11 6 Pickles and Sauces - 5 10 Dried Fruit - 35 12 Eggs - 5 4 Coffee - 2 8 Miscellaneous - 18 4 Total 24 74 1½ 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 1954 and submitted to the Public Analyst, with the results shown:— Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Almonds, ground 1 — 1 — — — Apricots, dried 2 — 2 — — — Aspirin Tablets — 1 1 — — — Beans in tomato sauce 2 — 2 — — — Beer 3 — 3 — — — Bread 1 1 2 — — — Bread and Butter 1 — 1 — — — Butter 1 1 2 — — — Cake 2 — 2 — — — Cake decorations, edible 1 — 1 — — — Cheese 1 — 1 — — — Cherries, glace 1 — 1 — — — Coconut, dessicated 1 — 1 — — — Cod liver oil and malt 1 — 1 — — — 49 Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Coffee and chicory essence 1 — 1 — — — Colour, synthetic 1 — 1 — — — Cooking fat 1 — 1 — — — Cough mixture 2 1 3 1 — 1 Cream 1 1 2 — — — Dripping, beef 1 — 1 — — — Fish cakes 1 — 1 — — — Fruit, mixed dried 3 — 3 — — — Fruit, tinned 3 — 3 — — — Gin 1 — 1 — — — . Ginger, ground 1 — 1 — — — Herbs, mixed dried 2 — 2 — — — Honey 1 — 1 — — — Horseradish Ielish 1 — 1 — — — Jam 1 — 1 — — — Lard 2 — 2 — — — Lemonade crystals 1 — 1 — — — Margarine 2 — 2 — — — Marmalade 2 — 2 — — — Meringue powder 1 — 1 — — — Milk 60 — 60 — — — Mincemeat 1 — 1 — — — Mint in vinegar 1 — 1 — — — Orange drink 1 — 1 — — — Paraffin, liquid 1 — 1 — — — Paste, meat 1 — 1 — — — Peas, tinned 1 — 1 — — — Peas, split 1 — 1 — — — Pectin, fruit 1 — 1 — — — Peel, mixed cut 1 — 1 — — — Pepper, ground white 2 — 2 — — — Pie filling — 1 1 — — — Pudding, black 1 — 1 — — — Rice 2 — 2 — — — Rose hip syrup 1 — 1 — — — Rum 1 — 1 — — — Sago 1 — 1 — — — Salad cream 1 — 1 — — — Sardines, tinned — 1 1 — — — Sauce 1 — 1 — — — Sausages 11 — 11 — — — Soup 2 — 2 — — — Spice, mixed ground 1 — 1 — — — Steak, tinned 2 — 2 — — — Suet, shredded beef 3 — 3 — — — Sweets 2 1 3 — — — Tapioca 1 — 1 — — — Tea 1 — 1 — — — Tomato juice 1 — 1 — — — Whisky 2 — 2 — — — Totals 152 8 160 1 — 1 It will be noted that only one adverse report was received, and that on a sample of Cough Mixture, upon which a discrepancy occurred in the stated formula on the label. Representations were made to the vendors concerned, and an assurance was received that this error would be corrected. 50 TABLE I. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1954. 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 tinder 65. 65 and over. Coulsdon East. Coulsdon West. Purley. Kenley. Sanderstead. Selsdon and Farleigh. Woodcote. Diphtheria — — — — — — — — — — — — — — — — — — — — Typhoid fever — — — — — — — — — — — — — — — — — — — — Paratyphoid fever 1 — — — — — — — — — — — — — — — — — — — Scarlet fever 68 — — 1 2 8 41 9 4 2 1 — — 7 13 17 4 11 16 — Erysipelas 4 — — — — — — — — — 1 2 1 1 — 1 1 1 — — Puerperal pyrexia — — — — — — — — — — — — — — — — — — — — Pneumonia 20 — — — — — 3 1 2 2 3 5 4 — 3 8 3 4 2 — Dysentery 12 — — — — — — — — 1 — 4 7 11 1 — — — — — Encephalitis 1 — — — — — — — — 1 — — — — — — — — — — Poliomyelitis 1 — — — — — — — — 1 — — — — — — — — — — Measles 9 — 2 1 — — 3 2 — 1 — — — — 3 2 — 3 1 — Whooping cough 131 6 7 8 18 14 63 10 1 3 — 1 — 7 17 31 24 38 9 5 Malaria — — — — — — — — — — — — — — — — — — — — Ophthalmia neonatorum — — — — — — — — — — — — — — — — — — — — Food Poisoning 74 1 — 1 — — 1 — — 1 3 17 50 — 69 5 — — — — Totals 321 7 9 11 20 22 111 23 7 12 8 29 62 26 107 65 32 58 28 5 51 TABLE II. THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1954 Jan. Feb. Mar. A pril May June July Aug. Sept. Oct. Nov. Dec. Total Diphtheria — — — — — — — — — — — — — Typhoid fever — — — — — — — — — — — — — Paratyphoid — — — — — — — — — — — 1 1 Scarlet fever 4 6 14 7 11 9 4 3 1 2 2 5 68 Erysipelas — 1 — — — — 2 — — 1 — — 4 Puerperal pyrexia — — — — — — — — — — — — — Pneumonia 2 — 5 1 3 2 — 1 — — 4 2 20 Dysentery — — 3 — — 1 — — — 3 5 — 12 Poliomyelitis — — — — — — — — — 1 — — 1 Measles 1 — — 1 3 — 1 — — 1 2 — 9 Whooping cough 5 6 12 14 21 21 15 24 4 — 6 3 131 Malaria — — — — — — — — — — — — — Encephalitis — — — 1 — — — — — — — — 1 Food poisoning — — 2 2 69 — — — — 1 — — 74 Totals 12 13 36 26 107 33 22 28 5 9 19 11 321 52 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1924. Disease 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 1954 Small pox 2 2 3 4 — — — — — — — Scarlet fever 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 68 Diphtheria 101 14 17 11 23 26 17 8 21 16 24 52 35 8 10 10 25 7 9 7 19 15 8 — — — — — — — — Erysipelas 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 4 Typhoid and paratyphoid fever 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 — 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 1 Polio-encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute encaphalitis 1 1 — 1 1 — — — 1 — — — — — — — — — — 1 — — — — — — — — 1 — 1 Ophthalmia neonatorum _ _ 12 — 3 — 1 1 2 — 1 _ 1 1 1 _ 1 1 — 1 — 1 _ _ 1 — — — — Pneumonia 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 20 Malaria — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — Measles — — — — — — — — — — — — — — — 2 11 214 479 275 52 705 41 218 567 600 477 810 170 1319 9 Dysentery — — 1 — — 5 — — — — — 6 — 1 2 10 85 224 121 21 42 172 82 43 71 14 28 22 48 13 12 Whooping cough — — — — — — — — — — — — — — — 6 1 136 36 55 51 100 31 115 201 42 242 204 196 66 131 Food poisoning — — — — — — — — — — — — — — — — — — — — — — — — — 2 6 2 5 2 74 Tuberculosis :— Pulmonary 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 31 Other forms 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 7 Totals 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 359 53 TABLE IV. DEATHS OCCURRING DURING THE YEAR, 1954. 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 2 — 3 3 8 — — — — — 1 5 2 Other tuberculosis 1 — — 1 2 — — — — — — 1 1 Syphilitic disease 2 — 2 2 6 — — — — — — 1 5 Diphtheria — — — — — — — — — — — — — Whooping cough — — — — — — — — — — — — — Meningococcal infections — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — Measles — — — — — — — — — — — — — Other infective and parasitic diseases 1 1 — 1 3 — 1 — 2 — Cancer 62 55 9 16 142 — — 1 2 1 8 40 90 Leukaemia 1 3 1 — 5 — — — — — 1 3 1 Diabetes — — — 2 2 — — — — — — — 2 Vascular lesions of nervous system 27 52 20 29 128 — — — — — 2 28 98 Coronary disease, angina 60 36 18 16 130 — — — — — 1 38 91 Hypertension with heart disease 3 10 10 12 35 — — — — — 1 3 31 Other heart disease 31 51 9 44 135 — — — — — 2 22 111 Other circulatory disease 15 14 17 18 64 — — — — — 4 20 40 Influenza — — — — — — — — — — — — — Pneumonia 6 18 11 23 58 — — — — — — 15 43 Bronchitis 4 7 11 3 25 — — — — — — 4 21 Other respiratory diseases 1 — 4 — 5 — — — — — — 1 4 Ulcer of stomach and duodenum 6 1 1 2 10 — — — — — — 1 9 Gastritis, enteritis and diarrhoea — 1 1 — 2 _ _ — _ — — — 2 Nephritis and nephrosis 4 3 1 — 8 — — — — — — — 8 Hyperplasia of prostate 5 — — — 5 — — — — — — — 5 Pregnancy, childbirth, abortion _ 1 — — 1 — — — — — 1 — Congenital malformation 1 2 — 2 5 1 — — — — 1 1 2 Other defined and illdefined diseases 28 17 3 44 92 6 — — 1 — 6 21 58 Motor vehicle accidents 2 2 2 6 — — — — 2 2 2 All other accidents 10 5 1 10 26 2 — 1 — — 5 3 15 Suicide 6 3 2 — 11 — — — — — 5 2 4 Homicide and operations of war — — — — — — — — — — — — — Totals 278 282 124 230 914 9 — 2 4 3 42 209 645 54 INDEX. Page Addresses of Health and Welfare Services 30,31,32 Ambulances 30 Analysis of Mortality 12, 13, 14 Area 7,8 Bacteriological work 25 Bed Bugs, Eradication of 43 Birth Rates 6,8 Births, Live, Illegitimate and Still 6, 8 Camping Sites 37 Cancer 10, 11 Causes of Deaths 10,54 Clinics : Diphtheria Immunisation 23 Family Planning 28 Infant Welfare 29 Maternity 27 School 29 Mothercraft and Relaxation 28 Closet Accommodation 37 Day Nurseries 29 Deaths and Death Rates 6,8,9,54 Diphtheria 15 Diphtheria Immunisation 23 Disinfection 25 Disinfestation 43 Drainage and Sewerage 37 Dysentery 17 Encephalitis 18 Enteric Fever 17 Erysipelas 17 Eye Defects 30 Factories 40,41 Food and Drugs Act 49,50 Food Supply : Milk 45 Meat 47 Unsound 49 Food Premises 48 Food Poisoning 17 Health Visitors 28 Health Propaganda 26 Heart Disease, etc 10 Home Helps 28 Home Safety Council 32 Houses, Inspection of 33 Houses, Inhabited 8 Housing 33,34 Ice-Cream 46 Illegitimate Babies 9 Infectious Disease : Cases Notified 15,53 Control of 23 Monthly incidence of 52 School Notifications 22 Inspection and Supervision of Food 45 55 INDEX—continued. Laboratory Facilities 25 Legal Proceedings 43 Massage Establishments 26 Measles 18 Meat 47 Midwifery Service 28 Milk and Dairy Regulations 45 Milk (Special Designation) Regulations 46 Milk, Sampling of 45 Mortality : Analysis of 12 Infant 13 Maternal 12 Mumps 22 National Assistance Act, Sect. 47 26 National Assistance Act, Sect. 50 26 Non-notifiable Infectious Disease 22 Nursing Service 28 Pneumonia 18 Poliomyelitis 18 Population 6,7 Public Cleansing 37 Public Health Committee 3 Rainfall 36 Rateable Value 6 Rats and Mice Destruction 43,44 Rivers and Streams 37 Sanitary Inspections, etc 40,41, Scabies 23 Scarlet Fever 16 Schools 43 Sewerage 37 Shops 38 Slaughterhouses 47 Smallpox 15 Smoke Abatement 37 Social Conditions 7 Staff 3 Statistics : Housing 33,34 Vital 6,8 Swimming Baths 38 Tuberculosis 20,21 Typhoid Fever 17 Vaccination 24 Violence, Deaths from 12 Water Supply 35,36 Welfare Services 30 Whooping Cough 19 Whooping Cough, Immunisation 25 56