AC 4413(3) HEALTH REPORT for 1955 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 1955 for the COULSDON & PURLEY URBAN DISTRICT by the MEDICAL OFFICER OF HEALTH URBAN DISTRICT COUNCIL OF COULSDON AND PURLEY. 1955. 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. „ r. w. Kersey, „ D. M. Weightman, m.a. b.sc., a.r.i.c. Mrs. K. M. Platt. „ A. H. Williams. „ W. H. Glanville, j.p. Ex-officio: Councillor H. Willis, j.p. „ „ M. D. West, a.l.b. 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: W. Rice-Jones, M.S.I.A. Additional Sanitary Inspectors: 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. J. M. Smyth. *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 1955, this being my twenty-fourth 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 it had been hoped to experiment with a re-arrangement of its contents and to give more positive advice on the achievement of good health. Unfortunately, owing to the increasing demands on the service this proved impracticable this year. Nevertheless it is hoped that it will be found to contain food for thought, even in the maligned statistics, although it is less appetisingly presented than one would have wished. Last year it was noted that 1954 would be remembered as being comparatively sunless with a wet Summer and Autumn, but in spite of this a good one from the point of view of the public health. Meteorologically 1955 apparently provided a marked contrast with a dry and sunny Spring and Summer, although for the third year in succession there was but little difference in the total rainfall. On the whole the public health remained good as judged by the usual standards, but some of the infectious diseases were more prevalent. The birth rate remained at a slightly higher level, while illegitimacy and the proportion of still births were less, and there were no maternal deaths. As was expected, the infant mortality rate increased after the exceptionally low level reached in 1954, and similarly, the general death rate among ordinary residents increased slightly, although still well below the recent average. The cancer death rate again decreased slightly, but the proportion of male deaths due to lung cancer was again relatively high. Deaths due to accidents in the home showed a welcome decrease, but those caused by road accidents were relatively high. Slightly more new cases of pulmonary tuberculosis were notified, possibly attributable in part to earlier detection due to a visit of the Mass X-ray Unit. Counterbalancing this is the steady improvement in the death rates from all forms of tuberculosis. The year was indeed a "measles year" with the extraordinary contrast of 1,012 notified cases compared with only 9 in 1954, and 1,319 in 1953. The other very prevalent infectious disease was a mild form of dysentery. Poliomyelitis also increased but, although the number of notified cases (17) was the highest yet reached locally, it is doubtful whether the District did in fact experience its greatest prevalence. There were only 3 really serious cases, all in adults, including one isolated fatal case in January; the remainder had very slight paralysis, if any, after treatment. 4 It may be that the unjustified publicity given to any case of poliomyelitis is one of the reasons for the slight decline in the percentage accepting diphtheria and whooping cough immunisation and vaccination. If so, it can be stated quite categorically that the risks of immunisation provoking paralytic poliomyelitis are very slight indeed given the precautions now taken as a routine. Primary immunisation was continued steadily throughout 1955, the only exception being a break of one month at one Infant Welfare Centre, without any untoward sequelae. The introduction of two new forms of vaccination and the absence of diphtheria from the District for nine consecutive years must not distract attention from the desirability of maintaining these earlier forms of immunisation. From the point of view of the improvement of the sanitation of the District, the most publicised activities have been those aimed at the removal of the cause of the periodical flooding at Purley Corner. While the hope that these will bear fruit in the not very distant future is warmly welcomed, of at least as much importance are the unspectacular but continued maintenance of satisfactory water supplies to the District, the Council's policy of steadily extending the sewerage system and abolishing local cesspools, the improving hygiene in food handling combined with the corrective effect of vigilance in applying the Food and Drugs Acts, the removal of any unsound food, etc. The beneficial effects of these and other measures will be noted later in the report. Much good work was again done by the Sanitary Inspectors with a view to improving sub-standard housing and securing the removal of the relatively small number of houses which have already become unfit for human habitation. The Chief Sanitary Inspector has reported in the section on Housing how unrewarding much of his preventive work is, partly owing to weaknesses in the present legislation, but even so some progress is recorded. From this brief summary of the year's activities and assessment of the state of the Public Health it will be seen that there are some grounds for 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 1955 65.420 Population, Census 1931 37,666 Population, Census 195163,770 Number of occupied houses, December, 1955 19,401 Number of occupied houses, 19319,533 Number of occupied houses, 1951 18,071 Rateable Value, December, 1955 £838,282 Sum represented by a penny rate £3,350 VITAL STATISTICS FOR THE YEAR 1955. Birth Rate per 1,000 of the Total M. F. estimated resident population Live Births—Legitimate 822 424 398 12.9 do. Illegitimate 21 10 11 Corrected Birth Rate 843 434 409 13.9 Rate per 1,000 (live and still) births. Still Births—Legitimate 17 6 11 19.8 do. Illegitimate - 17 6 11 Crude Death Rate per 1,000 of the estimated resident population Deaths 917 401 516 140 Corrected Death Rate 12.2 Rate per 1,000 Deaths from puerperal causes:- (live and still) births. Puerperal Sepsis -- Other Puerperal causes - - Total - - Death Rates of Infants under one year of age:— All infants per 1,000 live births 23.7 Legitimate infants per 1.000 legitimate births 24.3 Illegitimate infants per 1,000 illegitimate births Deaths from Cancer (all ages) 143 Deaths from Measles (all ages) Nil. Deaths from Whooping Cough (all ages) Nil. Deaths from Diarrhoea (under 2 years) Nil. 6 HEALTH REPORT FOR 1955. 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 41 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 apparently this is thought to have increased only slightly since, the mid-year population for 1955 being estimated by the Registrar-General to have been 65,420 compared with 64,650 last year. The latest figures are. however, almost certainly underestimates. These numbers include persons resident in Institutions in the District, the number of which at the end of 1955 were as follows:- Cane Hill Hospital 2,454 Netherne Hospital 2,127 Russell Hill School 222 Reedham Orphanage 271 7 In December, 1955 there were 19.401 occupied houses, distributed as follows:- Coulsdon East 3,200 Coulsdon West 3,180 Purley 2,639 Woodcote 1,784 Sanderstead North 2,361 Sanderstead South 2,839 Selsdon 1,889 Kenley 1,509 This suggests an average of 3.37 persons per occupied house in 1955, or 3.11 if the institutional population is excluded, compared with 3.53 and 3.24 in 1951. As there were more than 1,300 additional occupied houses in 1955 compared with 1951, the population must have increased by quite 3,900 in that time rather than just 1,650 as estimated by the Registrar-General, and have been at least 67,670 in 1955. VITAL STATISTICS. The following table gives the average population, birth, death, maternal and other important mortality rates for the quinquennial periods 1920-1954 together with the actual figures for 1955. Rates per 1,000 population. 19201924. 19251929. 19301934. 19351939. 19401944. 19451949. 19501954. 1955. Birth rate 13.5 12.9 11.6 12.8 15.2 15.2 12.0 12.9 Percentage illegitimate 3.4% 3.7% 2.8% 3.4% 3.9% 3.4% 2.7% 2.5% Stillbirth rate - - - 0.43 0.48 0.40 0.24 0.26 Death rate 7.4 7.0 7.4 8.3 11.4 9.7 12.1 14.0 Cancer death rate 0.96 1.15 1.35 1.19 1.70 1.75 2.02 2.19 Tuberculosis death rate (per 100,000 population) 57 36 38 35 48 36 25 21 Violence including Suicide 0.44 0.35 0.32 0.46 0.82 0.37 0.46 0.59 Maternal mortality rate per 1,000 live and still births 2.08 2.66 3.21 2.27 2.10 1.12 1.01 Nil Infant mortality rate (per 1.000 registered births) 28 38 32 38 40 26 21 24 Neo-natal mortality rate - - - 26 28 19 15 20 Estimated population 21,351 28,950 41,616 53,084 49.880 60,610 64,466 65,420 8 BIRTHS. During the year 1955, 843 births were registered as occurring in the District, of which 434 were male and 409 female, compared with 834 in 1954. 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, which was the same as last year. The average for the last five years was 12.0. 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 was 15.2 in 1954, 15.0 in 1955, and an average of 15.3 in the last five years. Illegitimacy.— In 1955, of the births registered, 21 were illegitimate (10 males and 11 females), this being 1 less than in the preceding year. The percentage of illegitimate births was thus below the lowest pre-war average. Stillbirths.— The number of stillbirths registered during 1955 was 17 (6 males and 11 females), which is 1 less than last year. None of the stillbirths was in respect of an illegitimate child. The local stillbirth rate was 19.8 per thousand live and still births while that for England and Wales was 23.1 in 1955. DEATHS. The number of deaths registered during 1955, as belonging to this District was 917, (401 males and 516 females), which is 3 more than last year, and 261 more than in 1952. It will be remembered that in 1953 a new system was introduced whereby the Registrar 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 0 is decreased to a corrected one of 12.2 but it is doubtful if this is really comparable with the national death rate of 11.7 for 1955. In order to be able to compare more accurately the 1953— 1955 death rates with similar rates prior to 1953, 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 1955 for normal residents would have been 9.2 but for the new system, compared with 8.6, 9.9 and 10.2 in the three preceding years. 9 The principal causes of death locally during 1955 together with the rates per cent of total deaths, are shown in the following table, the corresponding figures in respect of ordinary residents only being shown in brackets:— Cause. Number of Deaths. Rate per cent, of Total Deaths. Heart and circulatory diseases 459 (274) 50.1 (48.6) Cancer, malignant disease 143 (108) 15.6 (19.1) Pneumonia 89 (30) 9.7 (5.3) Bronchitis 26 (20) 2.8 (3.5) Accidents 30 (18) 3.3 (3.1) Tuberculosis (all forms) 14 (8) 1.5 (1.4) (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 4.50 compared with an average of 5.06 in the preceding five years. As 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 80 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 79 per cent in the previous five years, while 52 per cent were over 75 years of age. (Incidentally, 67 per cent of deaths from all causes were over 65 years, which is the same as the average for the five preceding years). CANCER. The cancer death rate in respect of normal residents was 1.77 in 1955 compared with an average of 1.87 in the previous five years. This is the second consecutive year in which there has been a slight decline in this rate and, allowing for the variations apt to occur when dealing with comparatively small numbers, at least a tendency to stabilisation can be justifiably assumed. 10 11 CANCER DEATHS 1955. 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. Larynx - - - - - - - - - - - - - - - 1 Brain and Thyroid - - - - - - - 1 2(1) -(2) - - - - 2(1) 1(2) Bone - - - - - - - -(1) - - - - - - - -(1) Oesophagus - - - - - - - -(1) - -(1) - - 1 1 1 1(2) Stomach and Duodenum. - - - - 1 - -(1) 1 1(1) - 2 -(2) - 2 4(2) 3(2) Intestines 2 -(1) 2 4(1) -(1) 1(1) 3 6 7(1) 11(3) Liver - - - - - - - 1 - 1 - 1 1 -(1) 1 3(1) Pancreas - - - - - - 1 - 1(1) - 1 - - - 3(1) - Lungs - - - - 2 1 4(1) 1 8(1) 1 2(1) 4 - - 16(3) 7 Bladder - - - - - -(1) - - 3(1) - - 3(2) 4 1 7(1) 4(3) Prostate - - - - - - - - 2 - 2 - 1(1) - 5(1) Uterus - - - - - 1 - 1(1) - -(1) - - - - - 2(2) Vagina and Ovary - - - - - - - 1 - 1 - 2(1) - 1(1) - 5(2) Breast - -» - - - 3 - 6(1) - -(1) - 1(1) - 4 - 14(3) Kidneys - - - - - - - - - - - - - - - - Ill-defined - - 1 - 1(1) - - 1 3 1(l) 1 1(2) - 1 6(1) 4(3) Totals - - 1 - 4(1) 5(1) 7(2) 13(5) 22(5) 8(7) 8(2) 14(9) 10(1) 16(2) 52(11) 56(24) The previous table gives the age, sex and distribution of this disease in the fatal cases among ordinary residents which occurred in 1955, the mental hospital cases being added in brackets. Compared with recent years, the number of deaths from breast cancer in females was the average for the last 10 years, but the number of lung cases among males was relatively high. On the average, since the war 24 per cent of male deaths from cancer originated in the lungs, but in the last 3 years this percentage has increased to 30 per cent or more. 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 cirgarette smoking is very suspect and pending further evidence personal restrictive measures are well 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 11 deaths among mental hospital inmates (previous ly transferable), 8 of which were due to falls in the elderly, the number of deaths from violence (including suicide) was about the average, the death rate being 0.38 per thousand of population compared with 0.43 last year and an average of 0.39 both for the inter-war years and for the years since the war. Deaths on the road again increased by two, eight deaths being attributed to this cause which is the highest since the 8 road deaths in 1939. Four were pedestrians, three elderly, knocked down by a motor car, a lorry or, in two cases by a motor cyclist. One only was a car driver in collision with another car, two were on motor cycles, one being a pillion rider, and the last was riding a motor assisted pedal cycle. All but one were ordinary residents. There was a variety of causes for the remaining 11 accidental deaths in the District, the most common being falls in the elderly. Attention is now being focussed on the prevention of such accidents by the Home Safety Council. The number of deaths attributed to suicide decreased from 11 to 7, and 3 of the latter were mental hospital patients. The nett figure was thus below 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. After one maternal death having occurred in each of the last two years, it is very pleasing to be able to report a clear year. The maternal mortality rate for England and Wales was 0.64 per 1,000 live and still births which is the lowest to date. 12 INFANT MORTALITY. During 1955 there were 20 deaths among children under one year of age, as compared with 9 last year, and an average of 20 in the last six years. None of the deaths was in respect of an illegitimate child. The resultant infant mortality rate was 23.7 per 1,000 registered births, compared with an average of 20.6 for the previous five years. The rate in 1954 was much the lowest recorded for this District, hence an increase this year was anticipated. The infant mortality rate for England and Wales was the record of 24.9 in 1955, the lowest previously recorded being 25.5 in 1954. The 17 babies dying in the first month correspond with a neonatal mortality rate of 20.2 (i.e. deaths in the first month per 1,000 live births), whereas the average for the past five years was 17.0. During the year 4 premature babies were notified as being born at home and 43 in institutions. Of the latter 9 died, all within the first twenty-four hours after birth. This suggests that 19 per cent of the premature babies died, compared with an average of about 22 per cent in the years since 1945. The following table gives the causes of the 20 deaths which occurred during 1955 together with the age at death. In the present stage of our knowledge the deaths from pneumonia and the accidental death which was primarily due to a cold, are the most to be regretted as they might have been prevented had adequate measures been taken to prevent the infection. As is usual, however, the commonest cause is prematurity and, in an attempt to diminish this risk, investigations are now proceeding. 13 14 INFANTILE MORTALITY DURING THE YEAR 1955. 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 Asphyxia neonatorum 1 - - - 1 - - - - 1 Congenital malformation 2 — — — 2 — — — — 2 Pneumonia — — — 1 1 — — 1 — 2 Prematurity and atelectasis 13 1 — — 14 — — — — 14 Accident — — - — - - - - 1 1 Totals 16 1 — 1 18 — — 1 1 20 INFECTIOUS DISEASE. The following table indicates the number of cases of infectious disease notified during 1955, 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 46 18 - Erysipelas 4 - - Puerperal pyrexia 3 1 - Pneumonia — primary 31 3 89* Enteric fever 3 2 - Encephalitis, acute — — - Dysentery 98 35 - Poliomyelitis 17 16 1 Measles 1,012 2 - Whooping cough 64 — — Food poisoning ... 5 3 - Totals 1.283 80 90 *Deaths from all forms of pneumonia including 59 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 1925 is presented in Table III in the Appendix. It will be seen that measles was again much the commonest notifiable infectious disease while whooping cough, scarlet fever and food poisoning were much less prevalent than in the previous year. More cases of dysentery and pneumonia occurred, and to a lesser extent poliomyelitis. 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 2.6 per 1,000 population, which is slightly above the post-war average of 2.3, chiefly due to the wave of Sonne dysentery. SMALLPOX. No case of this disease occurred in the District during the year but 6 individuals who might have been in contact with a case on a liner at Suez at the end of February were under surveillance for a period. DIPHTHERIA. For the ninth year in succession no case of diphtheria occurred in the District and only two suspicious but unconfirmed cases 15 were admitted into hospital, both proving to be cases of glandular fever. Bearing in mind that the natural stimulants to immunity have now virtually disappeared, as judged by the absence of any form of diphtheria organism in the routine bacteriological examinations 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 46 cases were notified as compared with 68, 80, 90 and 149 in the previous 4 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 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 it is now proposed that contacts should normally continue at school 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, 58% being in this group in 1955 compared with 15% under school age (nearly half of whom attended Day Nurseries or Nursery Schools), and 19% older school children. Three cases occurred among adults. Almost all schools in the District, including a few private schools, had one or more cases, the maximum in any one school being four. Relatively the hospitalisation of cases increased, 39% being admitted compared with 22% last year. Of the 18 cases admitted in 1955, (Wandle Valley 4, Bletchingley 7, Queen Mary's 1 and Waddon 5), a third were sent in by one doctor. On the available facts this tendency would not appear to be justified. In only one instance did a secondary case follow 16 treatment of the initial case at home whereas one definite case followed hospitalisation of the first case for ear trouble. ERYSIPELAS. Only four isolated cases occurred in the summer, none of which were admitted to Hospital. All recovered. PUERPERAL PYREXIA. Three cases were notified, two being due to influenza and another to phlebitis. One occurred in hospital and all recovered. ENTERIC FEVER. Three confirmed cases of paratyphoid fever (B. type) were notified during the year, two being admitted to hospital. Two were due to the Taunton strain and while the source of the infection could not be traced, they were almost certainly associated directly or indirectly with cases which occurred on the South Coast in the summer and early autumn. The third case was type B.A.O.R. and again the source of the infection could not be traced. DYSENTERY. The total of 98 notifications received was the highest known in this District except during the war years. Of this number 32 were in respect of mental hospital cases caused by the Flexner bacillus during the early months of the year, a relatively high figure for peace time. The number of cases occurring among ordinary residents was abnormally high and even so does not give a true picture of the extent to which the milder forms of Sonne dysentery affected the District, particularly during the first half of the year. In the early stages the local infection was mostly associated with the new infants school in Woodcote then taking children from Carshalton and Old Coulsdon, but a large proportion of the resulting cases were probably unnotified. Those which were notified lived chiefly in the Southern half of the District. In May more cases occurred in Sanderstead and Selsdon and were associated with a wave of the disease north of the District. Others followed thereabouts during the next two months but gradually the disease died down except for 15 cases which occurred in a residential nursery in Kenley in July. Adult cases associated with the preparation of food were excluded from work and propoganda was concentrated on the need for scrupulous cleanliness following the use of the toilet and before handling food. Only one school was seriously affected and in the circumstances the limitation of the outbreak was not considered too unsatisfactory. 17 FOOD POISONING. During the year two notifications of food poisoning were received which were confirmed, one being a child who was probably infected with S. typhi murium when on holiday. The other was an adult infected by S. thompson but the source of infection could not be found. In addition a mother and her two children who were admitted to hospital were found to be infected with S. typhi murium, but again, the source of infection was not discovered. Apart from these 5 definite cases, investigations were carried out in respect of 5 families, in which one to three members had suffered from diarrhoea and vomiting. In all cases the bacteriological findings were completely negative and no doubt in two of the families the cause was epidemic vomiting. POLIOMYELITIS. This disease was more prevalent nationally in 1955 and once again this increased incidence coincided with a Summer which was mainly dry and sunny. The total of 11 paralytic and 6 non-paralytic cases was thi highest recorded locally, the next highest being in 1947 when there were 8 paralytic and 3 non-paralytic cases. There can be but little doubt, however, that in 1955 the signs thought to justify a positive diagnosis were more numerous and it is very doubtful whether the disease was really more prevalent. One isolated fatal case occurred in January followed in May by another severe adult paralytic case. All the other cases occurred in September to November and the first three of these were also adults. Altogether 8 were over 20 years of age (1 non-paralytic), 2 were pre-school children, (1 non-paralytic) and 7 were school children, 4 of whom were non-paralytic. Of the 11 paralytic cases only 3 were severe, all adults, and of the 10 survivors only 2 had any pronounced residual paralysis after treatment, the majority finishing only with slight paralysis, if any. In addition to the above, 6 persons were admitted to hospital as suspected cases but were found to be suffering from other diseases. Similarly, as is usual at such times, a number of contacts with cases outside the District had to be followed up. MENINGOCOCCAL INFECTIONS. One young child who died suddenly was diagnosed postmortem as having suffered from meningococcal meningitis but the case was unnotified. PNEUMONIA. During the year 31 cases of acute primary or influenzal pneumonia were notified, compared with 20, 44, 21 and 51 in the 4 18 preceding years. The cases occurred fairly uniformly throughout the year and, although mainly in the Purley Ward, few of them appeared to be interconnected. So far as is known only 3 of them 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 more cases in 1955. Actually 1,012 were notified compared with 9, 1,319, 170 and 810 in the four preceding years. So far as is known, the disease remained faily mild in type and only 2 cases were admitted to hospital. No deaths occurred and in fact only 2 with very exceptional complications have died since the war. The value of the compulsory notification of measles in a District such as this, has previously been questioned on several occasions. General propaganda during times of epidemics is all that is practicable as notifications are received too late to be of any use and in such numbers as to make the visitation of all, almost impossible without severely limiting the other health visiting at the peak of the epidemic. WHOOPING COUGH. In 1955 there was a decrease in notifications, 64 being received compared with 131, 66, 196, 204 and 242 in the 5 previous years. None of the cases are known to have been admitted to hospital and all recovered. The majority of the cases occurred between June and August, the incidence being highest in July and August. Purley had much the highest number of cases. Just over 40% were children under 5 years of age and 3 babies were under 1 year. It must again be emphasised 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 daring 1955:- Pulmonary. Nonpulmonary. Total. M. F. M. F. M. F. Number of cases on register, 1st January, 1955 266 181 33 35 299 216 Additions, 1955:- New cases notified 31 16 2 1 33 17 Cases removed into District 17 23 1 1 18 24 Restored to register - 4 - - - 4 Total Additions 48 43 3 2 51 45 Removals. 1955:- Deaths from (a) Tuberculosis 4 7 1 - 5 7 (b) Other causes Removed from District 14 16 1 2 15 18 Recovered 13 9 6 4 19 13 Non-tuberculous 1 - 1 Total Removed from Register 32 32 8 6 40 38 Number of cases on register, 1st January, 1956 282 192 28 31 310 223 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 1 - - - - - - 10 and under 15 2 - - - - - - - 15 and under 20 4 2 1 - - - - - 20 and under 25 3 i 1 - - - - - 25 and under 35 6 5 - - - 2 - - 35 and under 45 6 2 - 1 - 1 - - 45 and under 55 6 3 - - 4 - 1 - 55 and under 65 2 2 - - - 2 - - 65 and over 1 - - - - 2 - - Totals 31 16 2 1 4 7 1 - 20 The new cases were distributed amongst the wards as follows Localisation. Coulsdon East. Coulsdon West. Kenley Parley. Sanderstead. Selsdon and Farleigh. Woodcote. Pulmonary 6 15 6 4 12 2 2 Nonpulmonary - 1 - - 2 - - Totals 6 16 6 4 14 2 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 1955 Pulmonary— New cases notified 22 29 35 49 43 47 *Case rate 115 82 68 81 67 72 Deaths 12 13 21 27 16 11 *Death rate 65 37 42 44 22 17 Non-Pulmonary— New cases notified 3 6 7 8 5 3 *Case rate 15 18 15 13 8 5 Deaths 3 3 2 2 2 1 *Death rate 15 8 5 3 4 1 * (The rates in this table and the remainder of the section are in all cases per 100,000 population). During 1955 the number of new notifications of pulmonary tuberculosis increased to 47 compared with 31 last year, and an average of 43 in the last five years. This increase may be due to a fluctuation such as is apt to occur in dealing with relatively small numbers or the result of the visit of the Mass X-ray Unit. The steady improvement in the death rate from pulmonary tuberculosis is encouraging as is the decreasing prevalence and death rate from non-pulmonary tuberculosis. 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 Health Boards. 21 Schemes are being carried out for the immunisation of certain sections of the population, and for tracing contacts of infectious cases among school children. Reference is made later in this Report to the B.C.G. immunisation of certain school children. The Mass X-Ray Unit which last visited the District in June, 1953, revisited Purley and Coulsdon in June, 1955. Nearly 4,000 persons attended and at least 4 new cases of active pumonary tuberculosis were discovered. In addition it is known that an appreciable proportion of the residents take advantage of X-Ray facilities in London or the surrounding districts each year. There is still no sign of progress in the erection of the anticipated self-contained Chest Clinic which it is hoped will be built in Purley Hospital grounds. The provision of this Clinic is urgently required as the County Council Clinic is being seriously over-used. PUBLIC HEALTH ACT, 1936, SECTION 172. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action has been required under these powers during recent years. NON-NOTIFIABLE INFECTIOUS DISEASE. 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 very few cases of german measles and mumps in the schools, only one small outbreak of the latter occuring in Kenley. On the other hand quite a number of cases of chicken-pox occurred, mainly in Old Coulsdon in the Spring and Autumn and to a smaller extent in the Chipstead Valley where the previous Autumn's outbreak subsided in the Spring. 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 1955 no cases were treated by the Health Department for this disease, compared with an average of 6 in the preceding 5 years and a maximum of 399 in 1944. In view of the very small number of isolated cases now occurring it would be preferable for them to be referred to the Medical Officer of Health in order that the contacts can be dealt with really effectively. (b) Vermin. The number of reported cases of infestation also remained small and was limited to 12 children found to have head nits in school. Almost all of these were only casual infestations which immediately responded to the treatment which was mainly provided by the parents. THE CONTROL OF INFECTIOUS DISEASE. When it can be used, immunisation is the most valuable of the measures for the control of infectious disease, but its usefulness naturally depends on the effectiveness of the vaccine, and otherwise 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 against diphtheria and whooping cough 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 these diseases, 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. With the introduction of two more official schemes for vaccination against tuberculosis and poliomyelitis the question of spacing becomes more complex and close co-operation between all concerned is very desirable. 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. This can still be the most deadly of the infectious diseases but immunisation against it has proved more effective than any other form of vaccination. 23 The following table shows the treatment given during 1955 and the proportion of children estimated to have been immunised:- Centres and Clinics (including day nurseries). Number who completed Primary treatment 393 Number of "Booster" doses given 117 Schools. Number who completed Primary treatment 9 Number of "Booster" doses given 587 General Practitioners. Number who completed Primary treatment 398 Number given "Boosters" 339 Proportion of children estimated to have been immunised:— (a) from 1-5 years 67% (b) from 5-14 years 84 % The total number of primary treatments was slightly less than last year and 549 fewer children received boosting doses. As a result the percentage of children aged 1 to 5 years estimated to have been immunised was about the same, 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 68%. There is therefore room for improvement particularly in the maintenance of immunity by boosting doses at about 5 and 10 years of age. VACCINATION. The following table shows the number of vaccinations performed in the District during 1955:— Welfare Centres. Primary vaccinations 280 General Practitioners. Primary vaccinations 0-15 years 292 „ „ over 15 years 24 Re-vaccinations 0-15 years 20 „ over 15 years 104 The number of primary vaccinations was 37 fewer than last year, but it is good to find that at least 60% of the babies born in the District in each of the last 4 years were vaccinated. If this percentage can be maintained it will be very satisfactory. 24 WHOOPING COUGH IMMUNISATION. The following numbers were treated during 1955 and it is noted that 62 fewer children were given primary courses and 5 fewer received reinforcing doses than in 1954. Welfare Centres. Number who completed Primary treatment 309 Number of "Booster" doses given 94 General Practitioners Number who completed Primary treatment 343 Number of "Booster" doses given 170 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, and this year the difference is 148 or about 24%. IMMUNISATION AGAINST TUBERCULOSIS. During the second half of the year parents of children who were 13 years of age and who were attending any County Council School or a grant aided school were asked if they would agree to their children being tested and, if necessary, given B.C.G. immunisation against tuberculosis. As a result, in this Division 63% of them accepted and 80% of these were inoculated, i.e. 49% of all the eligible children. The scheme is being extended in 1956 to any private school which is prepared to co-operate. It is of interest to note that in the last 2 years about 13% of these children who were Mantoux tested proved positive, indicating that they had already been in contact with tuberculosis. 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 1955 reports were received on the following specimens :— Milk, ice cream, and water samples 434 Food utensils 150 Nose or throat swabs 27 Food 19 Faeces 414 Sputum 4 Rectal swabs 1 25 Samples of milk for biological examination are sent by the Local Authority to the Public Health Laboratory Service, while samples of water requiring chemical analysis and Food and Drug samples are submitted to the Public Analyst. DISINFECTION. The disinfection of bedding, etc., is undertaken at the Wandle Valley Hospital, while the disinfection of premises is carried out by the officers of the Public Health Department. For the convenience of ratepayers, the Council has decided to arrange disinfection even when this is not essential 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 1955 the following disinfections were carried out: Free of cost. Upon payment. Total. Loads of bedding, etc 49 3 52 Houses disinfected 67 — 67 Parcels of clothing — — — Library books 893 — 893 MASSAGE ESTABLISHMENTS. The provisions of Part IV of the Surrey County Council Act, 1931, relating to the registration and management of massage establishments, are in operation. There are 16 such establishments in the Urban District. NATIONAL ASSISTANCE ACT, 1948, SECTION 47. The powers given under this section for securing the removal of aged persons from insanitary conditions were not utilised during 1955. 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 the Council dealt financially with one case of this type. 26 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. 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 following Clinics, the specified times at which they are held being those now in operation. Maternity Clinics. 62. Whytecliffe Road, Purley. 1st. 3rd and 5th Wednesday in each month, 10 a.m.—12 noon, and every Thursday 2 p.m.—4 p.m. Westway, Caterhamon-the-Hill. Every Tuesday, 2—4 p.m. (Old Coulsdon mothers). The Baptist Church, Addington Road, Selsdon 2nd and 4th Wednesday in each month, 10 a.m. —12 noon. 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. 27 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. Every case has an X-ray examination of the chest, and a full examination including weighing and examination of the urine, blood, blood pressure, etc. Arrangements have been made in some cases for the District Midwives to assist general practitioners at ante-natal sessions in their surgeries. The results of this arrangement of alternative services are now being reviewed with the aim of ensuring that every ante and post-natal mother gets the full advantage of modern knowledge, and that no gaps exist or inferior standards of practice are permitted, but that the closest co-operation between all branches of the Health Service is secured. During 1955, 209 residents had their babies in their own homes, some 248 at 10 hospitals in the County, including 229 at Redhill County, some 287 at 25 hospitals outside the County including 150 at Purley Hospital and 76 at Mayday, while about 95 were confined in private nursing homes. Only 25% arranging for home confinements is a low proportion but one for which there are a number of reasons. 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, hence it is hoped to extend the facilities in the near future. 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 marked alterations in this service during 1955. As considerable changes in the staff are now occurring it is probably wise only to mention the following Home which acts when necessary as a co-ordinating centre for the District: viz. Surrey County Council Nurses Home, Westview, Woodstock Road, Coulsdon. Tel. No.: Downlands 4005. 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, which, in the case of the elderly is probably more acute in this area than in most parts of the County. 28 Home Help Service. The activities of this service continue to increase, particularly as there is no comparable agency in this District, and applications for the service of a Home Help should be addressed to the Home Help Organiser, 115 Brighton Road, Purley. In case of emergency the following telephone numbers may be used: UPLands 7014 or 9277, preferably between 9.30 and 10.30 a.m. Home Helps can only be supplied to cases genuinely needing their assistance in which ill-health or old-age are involved; the capacity of the Service is limited, but preference is given to those in greatest need, the degree of help varying with the physical and social circumstances of the family. Family Planning. The local Family Planning Clinic is now held at the Surrey County Council Clinic, Westway, Caterham-on-the-Hill. Residents needing advice are seen only by appointment and this should be obtained by application to the Divisional Medical Officer at 115 Brighton Road, Purley. Health Visitation. The Health Visitors are mainly based on 115 Brighton Road, Purley, UPLands 9277, where they can normally be contacted direct or through the Divisional Health Visitor between 9.0 and 10 a.m. daily. Infant Welfare Centres. Apart from staff changes, the only important alteration during 1955 was in the hall in which the Riddlesdown Centre is held. The following Infant Welfare Centres are held regularly from 2-4 p.m.:— Methodist Church. Brighton Road, Coulsdon Every Thursday. Church of St. Francis, Rickman Hill, Coulsdon Every Tuesday. St. John's Hall, Bradmore Green. Old Coulsdon Every Wednesday. Methodist Church, Sylverdale Road, Purley Every Friday. Baptist Church, Addington Road, Selsdon Every Monday. Congregational Church, Sanderstead Road, Every Wednesday. Sanderstead Whitgift Sports Pavilion. Lime Meadow Avenue, Every other Sanderstead Thursday. Church Hal 1, Mitchley Avenue, Purley 2nd and 4th Tuesday in each month. Community Centre, Hooley 1st and 3rd Wednesday in each month. Slightly greater use was made of the Centres in 1955 than in 1954 as illustrated by the following statistics, those for 1954 being given in brackets:— The total attendance was 14,647, (13,442), the number of new cases being 628 (597), and the average attendance at the 406 sessions being 36 (33). The doctors' consultations numbered 4,172 (3,735) or 10.8 (9.9) per session. 29 Day Nurseries. The two local Day Nurseries are situated as follows:— Telephone: "Hazelglen" Day Nursery, Sanderstead Road, Sander- stead. (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 They can only accept the children of residents on grounds of health in the widest sense, including bad home conditions, or when the mother is the sole wage earner. Applications for admission should be made to the Divisional Medical Officer, 115 Brighton Road, Purley. 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; also that, where a number of vacancies are a semi-permanent feature, as at Sanderstead, these cannot be filled at an economic charge with children whose mental health and whose parents' physical and mental wellbeing would benefit. 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 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 30 Families" and children neglected in their own homes, and, in addition to emergency meetings, all current cases are reviewed, at quarterly case conferences. Other Addresses for Reference. Ambulances. Ambulance Station, 115a, Brighton Road, Purley. Sanderstead Fire and Ambulance Station, Limpsfield Road, Sanderstead. Requests should be made to MITcham 2084, or in cases of emergency dial 999. Authorised Officer for Mental Health Services. Telephone: Mr. D. E. Twivey, 44, Reigate Hill, Reigate Reigate 3357 Blind Welfare Worker. T elephone: 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 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 Hospital Groups. Telephone: Croydon General Hospital, London Road, Croydon CROydon 7755 Redhill County Hospital, Earlswood Common, Redhill Redhill 3581 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. 31 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. E. G. Griffiths (Principal Divisional Welfare Officer) WALlington 9237 Mrs. J. M. Parker (Divisional Welfare Officer) Caterham 4713 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 A. J. G. Budge, 37, Hartley Road. Croydon. THOrnton Heath 4250 coulsdon and purley guild of social service. Secretary: Miss Honeyman, 105, Brighton Road, Purley UPLands 6800 coulsdon and purley old people s welfare association. Secretary: Miss D. M. Barnett, 71, Brighton 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). Organiser: 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 1955. (1)(a) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 349 (b) Number of inspections made for the purpose 2,177 (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 77 (b) Number of inspections made for the purpose 749 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 27 (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 232 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 172 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 3 (b) By Local Authority in default of Owners 1 (b) Proceedings under the Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 13 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 3 (b) By Local Authority in default of owners 10 (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 3 (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) Acts, 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 2 (2) Number of families dwelling therein 2 (3) Number of persons dwelling therein (b) Number of new cases of overcrowding reported during the year 3 (c) (1) Number of cases of overcrowding relieved during the year 5 (2) Number of persons concerned in such cases 22 (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 27 By other persons 487 For the second year in succession there was an increase in the number of dwellings inspected for housing defects and a very substantial increase in the number of visits necessitated thereby, due to the duties imposed upon Local Authorities in implementing the Housing Repairs and Rents Act, 1954. Under Section 1 of this Act, the Council was required to submit to the Ministry of Housing and Local Government by the 30th August, 1955, proposals for dealing with houses in the District which appeared to be unfit for human habitation within the meaning of Section 9 of the Housing Repairs and Rents Act, 1954, and suitable for action under Section 11 or Section 25 of the Housing Act, 1936. The problem in this District may be said to be a comparatively minor one, but, although there are no large areas of such properties, there is nevertheless a small number of houses which it is considered should be dealt with under these Sections of the Housing Act. A survey carried out for the purpose of estimating the number of houses coming within the scope of these two Sections covered approximately 200 houses and detailed inspections were made of more than half this number. As a result, the Council have submitted proposals for dealing with 27 houses under Parts II and III of the Housing Act, 1936 during the next five years. The Chief Sanitary Inspector reports "that many houses omitted from the proposals can be considered at best as of a border line character only, and unless a radical change in the attitude of 34 property owners to the repair of rented property is encouraged, or made economically possible in the near future, further deterioration will result and clearance made necessary. This latter problem has been the subject of comment in previous years and it is becoming apparent that the rent increase provisions of the 1954 Act are proving a failure. Since the Act came into force in August, 1954, only 25 Certificates of Disrepair have been issued by the Council, of which 18 have been revoked on completion of the necessary repairs. It is evident that owners of property with statutory deductions of the order of £6 or £7 are not prepared to risk the possibility of having to carry out repairs costing possibly £100 or more in order to obtain a gross increase of rent of £12 or £14 per annum. It should be recalled also that to qualify for the repairs increase the house must be in "good repair" as respects both structure and decoration and not merely fit for human habitation. Nevertheless, many of these houses if repaired or improved will provide good housing accommodation for many years. To say as did the White Paper entitled "Houses — The Next Step" that if a house cannot be made fit at reasonable expense it becomes a candidate for demolition and replacement, over-simplifies, in my opinion, a very complex problem." Another measure which aimed at preserving the older type house was the making of "Improvement Grants" towards the provision of modern amenities, but this also has not been very successful in practice. The Council, in 1954, agreed to operate these provisions of the Housing Act in respect of sub-standard properties, but by the end of 1955 only 6 applications for Grant had been approved, and only two of them related to rented properties. However, in spite of the difficulties that surround housing work in these post-war days of high costs, a measure of success was achieved in the repair of insanitary houses, by persuasion coupled with the application of statutory provisions when the occasion demanded, as will be evident from the preceding statistics. 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, seven further samples were obtained for various reasons, making 23 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 35 the quality or quantity of water supplied by the Companies. One unsatisfactory report on a bacteriological sample was attributed to faulty sampling technique. The Cane Hill Hospital Management Committee has made arrangements with the Public Health Department of the London County Council for routine sampling and supervision of the water supply from the relatively shallow well in their grounds, which is used exclusively by this Hospital. Adequate chlorination is essential and steps have been taken to ensure this and to effect closer co-operation between the officers of the three authorities interested in the standard of this supply. The results of two chemical and two bacteriological examinations of the water in public supply are given below and these are fairly typical of the reports received:— Chemical Analysis. Sutton District Water Company. East Surrey Water Company. Parts per Million. Grains per Gallon. Parts per Million. Grains per Gallon. Total solid matter (dried at 180°C.) 178.0 - 122.0 - Chlorine present as chloride 14.3 — 16.4 - Ammonia, free 0.005 - 0.05 - Ammonia, albuminoid 0.002 - 0.00 - Nitrate nitrogen 53 - 5.9 - Nitrite nitrogen trace - trace - Oxygen absorbed from permanganate solution in 4 hours at 27°C. 0.11 _ 0.11 - Hardness — Temporary 97.0 - 40.0 - Permanent 30.0 - 37.0 - Total 127.0 8-9 77.0 5.4 Iron and other metals absent - absent - Residual chlorine absent - 0.07 - pH 7.5 8.4 Electric conductivity at 20°C. 255 units 165 units Bacteriological Examination. Probable number of coliform bacilli, Mac Conkey 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-eight 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 28.76 inches, this being a decrease of 36 0.78 inches compared with the previous year. The monthly totals throughout the year were as follows:— inches. January 3.37 February 1.90 March 1.42 April 0.41 May 4.68 June 2.57 July 1.42 August 1.44 September 2.65 October 4.64 November 1.32 December 2.94 DRAINAGE AND SEWERAGE. A total of 2,035 yards of new sewers was constructed during the year mainly to cope with development by the Council and private builders. Included in the total is the provision of a new sewer of approximately 973 yards in Old Farleigh Road and Beech Way, Selsdon, which provides main drainage for 18 existing houses and is the first stage of a scheme propounded in 1937 for the extension of the sewer towards Farleigh. The cause of the periodical nuisance and dislocation produced by flooding at Purley Fountain has not yet been dealt with satisfactorily, and a particularly severe incident occurred after a thunderstorm in July. A number of premises, including 15 food shops and a public house, were affected and considerable quantities of foodstuffs were rendered unfit for human consumption. Happily there are signs that a solution to this long standing problem is becoming more probable. CLOSET ACCOMMODATION. During the year, 21 houses and a block of offices were connected to the sewer, and 21 cesspools abolished. It has been the Council's long standing policy to eliminate cesspool drainage in the District wherever possible, and since 1950, when this policy was resumed after the war, 93 houses and 7 other premises, including a large private school, have been connected to the public sewer and no less than 92 cesspools and 6 pail closets have been abolished. At the end of the year the following pail closets and cesspools remained in use:— Premises with pail closets 11 Number of cesspools 117 The contents of pail closets at private premises are disposed of in the gardens by the occupiers of the houses. 37 PUBLIC CLEANSING. The collection of refuse was continued on a weekly basis throughout the year, and the charges for trade refuse collection and for cesspool emptying remained unchanged. The Council's charges for cesspool emptying provide for the collection of 12 loads a year at 7/6 a load from cesspools at private dwellings, all additional loads in the same year being at the rate of 15/- a load, and for the emptying of cesspools at all commercial premises at the rate of £1. 5s. 0d. a load. SMOKE ABATEMENT. The chimneys of the small factories in the District give little trouble and no serious nuisance was recorded during the year. RIVERS AND STREAMS. From time to time inspections are made of the watercourses in the District, and they have been cleared whenever necessary. No particular difficulty has arisen in regard thereto. CAMPING SITES. The Boy Scouts' camping site at Featherbed Lane continues to be used, and is conducted in a very satisfactory manner. The action under Section 57 of the Surrey County Council Act. 1931, as amended, which was taken by the local Council in 1951 to obtain prohibition orders in respect of certain areas in the District has continued to prove effective in preventing nuisance arising from gipsy encampments. 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, 21 samples of water were obtained for chemical and bacteriological examination. Adverse reports were received in respect of 2 samples of water from the same pool, both indicating insufficient chlorination. Representations were made to the persons concerned and subsequent samples proved satisfactory. 38 SHOPS AND OFFICES. As far as possible inspections have been made of the sanitary accommodation, washing facilities, heating and ventilation of shops and offices, and improvements have been effected as circumstances have permitted. Surveys are carried out as and when necessary to observe compliance with the Shops Act in respect of general closing hours, half day closing and Sunday trading, with individual inspections as necessary in respect of conditions of employment of young persons. In addition, advice is given to traders on the operation of the Shops Act as related to specific trades. 39 FACTORIES AND WORKPLACES. Factories Acts, 1937 and 1948. PART I. 1. INSPECTIONS. Premises. Number on Register. Number of Inspections. Written notices. Occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 39 46 1 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 151 229 6 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 10 7 — — Total 200 282 7 — 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 1 1 — — (b) Unsuitable or defective 20 18 — 1 — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 6 5 — — — Total 27 24 — 1 — 40 PART VIII. OUTWORK. (Sections 110 and 111) Naturt of Work. Section no. Section in. No. of out-workers in August list required by Sect, no (i) (c). No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwholesome premises. Notices served. Prosecutions. Wearing apparel Making, etc. 32 Cleaning and washing — — — — - Umbrellas, etc. 1 — — — — - Making boxes 1 — — — — - Carding, etc. of buttons etc. 17 Duster Dolls 9 — — — — - Cosaques, Christmas crackers, Christmas stockings, etc. 4 — — — — - Total 64 — — — — — 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 1955:— Complaints Received. General disrepair and insanitary conditions 37 Dampness 22 Overcrowding 3 Defective drainage systems 12 Blocked drainage systems 175 Defective drainage fittings. 4 Defective W.C. pans and flushing apparatus 2 Defective service water pipes 9 Defective hot water systems 4 Defective chimney stacks 2 Absence of, or defective dustbins 6 Insanitary pig waste bins 4 Accumulation of refuse, etc 18 Rats and mice 389 Keeping of animals 4 Insect pests, etc 41 Wasps' nests 39 Smoke nuisance 10 Contaminated food 18 Unsound food 58 Miscellaneous 63 Total 920 41 Summary of Visits Made. Number of houses visited 416 Number of reinspections and calls made 2,035 Verminous premises 42 Insect pests 161 Water supply 2 Tents, vans and sheds . 46 Schools 12 Places of entertainment 3 Licensed premises 56 Storage of refuse 67 Accumulation 123 Piggeries, fowls and other animals 134 Stables 18 Rodent control 5,244 Drainage inspected 2,701 Drainage tested 265 Cesspools 91 Urinals 12 Sewers and street gullies 272 Cowsheds, dairies and milkshops 57 Ice-cream premises 47 Meat shops 101 Food preparing premises 394 Other food shops 557 Bakehouses—Power 55 „ Other 3 Slaughterhouses 12 Food Inspection—Meat 25 „• „ Other food 136 Factories—Power 174 Other 27 Workplaces 23 Outworkers 76 Heating Appliances (Fireguards) Act 31 Merchandise Marks Act 7 Pet Animals Act 4 Shops Act 695 Hairdressing establishments 50 Infectious disease enquiries 333 Infectious disease contacts 26 Food poisoning enquiries 18 Disinfection 123 Disinfestation 50 Swimming baths 96 Sampling—Food and Drugs Act, 1938 231 „ Ice-cream 144 „ Milk (bacteriological) 247 „ Milk (biological) 49 „ Water 25 Interviews 2,198 Miscellaneous visits 1,048 Total 18,762 Work Carried Out and Defects Remedied. Drainage and Sanitary Fittings: Drains examined and tested 694 Drains repaired or reconstructed 69 Flood valves inserted in drainage systems 1 Blocked drains cleared 192 Soil and vent pipes repaired or renewed 8 Inspection chambers provided or repaired 69 Fresh air inlets repaired or renewed and/or stoppers provided 39 New W.C. pans fixed 13 42 W.C. flushing cisterns repaired or renewed 11 Cesspools cleansed, repaired or renewed 1 Cesspools abolished and house drains connected to sewer 21 Soakaways reconstructed or provided 12 Rain water diverted from soil drain 4 Eaves gutters and stack pipes renewed or repaired 58 New lavatory basins fixed 6 Baths provided or repaired 4 Glazed sinks renewed or repaired 5 Waste pipes trapped, repaired or renewed 13 Sink gully dishings repaired 19 Miscellaneous 8 General Housing Repairs: Defective roofs repaired 41 Chimney stacks repaired or rebuilt 14 External walls repaired 12 Yards paved, or paving repaired 13 Steps repaired or renewed 8 Dampness in walls remedied 27 Damp-proof courses provided 12 Additional sub-floor ventilation provided 1 Walls and ceilings repaired 82 New ceilings provided 6 Internal woodwork cleansed and/or redecorated 13 Walls of rooms cleansed and/or redecorated 55 Ceilings of rooms cleansed and/or redecorated 53 Floors repaired or renewed 28 Staircases repaired or renewed 3 Windows repaired or renewed 58 Doors repaired or renewed 41 Firegrates repaired or renewed 24 Domestic boilers repaired or renewed 5 Water storage tanks repaired or renewed 4 Service water pipes repaired or renewed 13 External paintwork renewed 10 Boundary fences and gates repaired or renewed 13 Coal sheds repaired or renewed 1 Portable dustbins provided . 6 Premises improved (with or without grant aid) 2 Electricity supply repaired or renewed 2 Miscellaneous 13 Food Premises: Premises reconstructed 2 Staff room provided 1 Lockers for clothing provided 1 Hot water supply provided for ablution purposes 7 Lavatory basins provided 4 Glazed sinks provided 7 Draining boards provided 7 Waste pipes repaired or renewed 5 Staff and public sanitary accommodation repaired 12 Staff and public sanitary accommodation cleansed 13 Staff sanitary accommodation provided 3 Walls and ceilings cleansed, repaired and redecorated 91 Floors repaired, relaid, recovered or cleansed 6 Equipment cleansed and repaired 10 Additional lighting provided 1 Additional ventilation provided to kitchens 1 Windows repaired or cleansed 5 Doors repaired or renewed 1 Food store provided 1 Rain water pipes and gutters repaired or renewed 2 Roofs repaired 1 43 Blocked drains cleared and drains repaired 2 Dustbins provided 12 Accumulations removed 27 Miscellaneous 19 Ralproofing: Work carried out by occupiers of premises after completion of treatment 17 Healing Appliances (Fireguards) Act, 1952: Fires altered or withdrawn from sale 6 Notices Served. Preliminary Notices 446 Statutory Notices 63 Legal Proceedings. During the year legal proceedings were instituted in respect of non-compliance with a Statutory Notice served under the provisions of Section 39 of the Public Health Act, 1936, requiring the provision of a new drainage system at a large house. The Summons was heard at Wallington Magistrates Court and the defendant was fined £1. 0s. 0d. with £5. 5s. 0d. costs. An Order was made by the Court that the necessary works of drainage referred to in the Notice should be executed within three months from the date of the Order. 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 disease. HAIRDRESSING ESTABLISHMENTS. During the year a survey of all hairdressing establishments in the District was carried out with a view to assessing the need or otherwise to make Byelaws in respect of such premises under the provisions of the Surrey County Council Act, 1936. Thirty-five premises were inspected, comprising 25 ladies' and 10 gentlemen's establishments in which 69 females and 21 males were employed. While very few premises were, it was thought, originally designed for the purpose, and their subsequent adaptation could be improved, the general impression was that the trade wishes to maintain a high standard of hygiene, and every assistance was 44 given by the proprietors in connection with the inspection of their premises. The Public Health Committee later considered a set of draft Byelaws received from the Ministry of Housing and Local Government and, with minor amendments, agreed to submit them to the Minister for preliminary approval. DISINFESTATION. During the year 2 houses needed to be, and were disinfested owing to the presence of bed bugs. Action was also taken by the Department in 53 cases of infestation with other pests such as flies and wasps. In the majority of cases disinfestation was carried out by spraying with a proprietary insecticide. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The following table is a tabular statement indicating the action taken in 1955 under this Act. During the year, 93 visits were made to the Council Depots at Millstock, Purley Oaks, Kenley and Old Lodge Lane, and land at Littleheath Woods, Selsdon. In accordance with the requirements of the Ministry of Agriculture and Fisheries a routine test baiting of the sewers in the District was carried out, with negative results. The Council's charges for services rendered in the destruction of rats and mice at premises other than private dwellings were increased during the year from 6/3d. per hour to 8/9d. per hour plus the cost of materials. The flat rate charge of 5/0d. in respect of private dwellings remains the same. 45 the Council continues to undertake the routine disinfestation of local schools and school canteens owned by the County Council, as and when necessary, on a contract basis. Type of Property. Number of properties inspected by the Local Authority as a result of— Number of properties found to be infested by- Number of treatments carried out by Department by arrangement with occupier. Number of Notices served under Section 4. Number of inspections made. Notification Otherwise. Total. Rats. Mice. Rats. Mice. Treatment. Structural works, i.eproofing. Primary and reinspections. Sewer treatment. Total. Local Authority 1 24 31 1 4 7 4 — — Dwelling Houses 309 140 450 231 36 210 34 — — Business Premises 70 69 138 43 28 35 28 — — 4,507 737 5,244 Agricultural 3 6 9 3 - 2 — — — Total 389 239 628 284 68 254 66 — — 46 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 19 Premises registered as Dairies 1 The only remaining Dairy at which milk is processed in the District 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. Most of the milk now consumed in the District is produced and processed outside the District and retailed by the large dairy companies. By virtue of the Milk (Special Designations) (Specified Areas) Order, 1951, the use of a special designation is obligatory in respect of all sales of milk within the Urban District. Milk Sampling. The routine sampling of milk was continued and a total of 328 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, 1949-1954. Designation. Methylene Blue. Phosphatase. Turbidity. ber. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. U nsatisfactory. Pasteurised 198 192 6 198 - - - T.T. (Raw) 27 24 3 — — - - T.T. (Pasteurised) 18 18 — 18 — — — Sterilised 30 — — — - 30 — Totals 273 234 9 216 — 30 — 47 BIOLOGICAL. Designation. Number. Tubercle Bacillus. Present A bsent Tuberculin Tested 36 — 36 Ungraded 19 2 17 Totals 55 2 53 Only a comparatively small number of samples failed to pass the Methylene Blue (keeping quality) test, 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, were submitted to routine biological testing. Of the 55 samples taken, 2 indicated the presence of tubercle bacillus. Both samples were obtained from the same farm on the same day. The circumstances were reported to the Divisional Veterinary Officer of the Ministry of Agriculture and Fisheries, and investigations carried out subsequently resulted in the elimination of 2 cows from the herd. Milk (Special Designation) Regulations, 1949- 1954. Licences to sell milk under the above Regulations were issued as follows :— Dealers: Tuberculin Tested 13 Pasteurised 14 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, 96 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, 47 visits of inspection were made to these premises. The manufacture of ice-cream was not carried out at any of the premises registered for that purpose during the year, and thus, 48 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 128 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 110 Grade II 14 Grade III 4 Grade IV 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. As judged by these standards the above results can be considered satisfactory. MEAT. There are no slaughtering facilities in the District, apart from those at Cane Hill and Netherne Hospitals which provide meat for consumption by the inmates, and the arrangements made to carry out post-mortem inspections of all animals slaughtered at these Institutions were continued. No slaughtering, however, was recorded at Cane Hill, while at Netherne Hospital the carcases and offals of 8 cattle and 2 calves were inspected for evidence of disease with negative results. 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. 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. Frequent inspections of shops are carried out, and, during the year, 101 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 49 Bakers 28 Greengrocers and Fruiterers 50 Cafes and Restaurants 60 Grocers 78 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. The Chief Sanitary Inspector reports: "There has been a steady improvement in the standard of Food Hygiene in food premises in the District during the past few years, largely as a result of the genuine desire on the part of the majority of food traders to give a better service, stimulated by the national publicity given to the subject and the continuing interest of the general public in the campaign for cleaner food. This has been supplemented by the regular inspections made of all food premises by the Sanitary Officers, and in this respect, it should be stressed that the maintenance of a high standard of hygiene cannot be achieved by a 'once and for all' effort, but only by a continuous policy of attention to detail." Advice and assistance has been given whenever necessary, and in the course of this work during the year, 83 swabs were taken from washed crockery and 5 samples of washing up water were taken for bacteriological examination. Samples of food submitted for bacteriological examination included synthetic cream, cream doughnuts, buns, egg albumin and dried 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. UNSOUND FOOD. The following unsound foods were surrendered during the year, the total bulk being more than that surrendered in 1954, chiefly due to the results of flooding in Purley:— cwts. lbs. ozs Canned Soups 7 9 Canned Meat 1 43 2 Canned Fish 5 0½ Canned Vegetables 34 0 Canned Fruits 1 2 8 Canned Milk and Cream 60 12 Meat, Bacon, Poultry, etc. 1 6 12 Fish 4 85 0 Fresh Vegetables 18 1 0 Fresh Fruit 1 37 8 Butter, Fats and Cheese 85 0 Sugar, Jam, etc. 1 52 14 50  cwts. lbs. ozs. Flour, Bread, Cereals and Biscuits 3 36 5½ Pickles and Sauces 12 0 Dried Fruit 2 15 0 Eggs 22 6 Miscellaneous 31 121 Total 36 90 9½ Beer and Soft Drinks 402 gallons. 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 1955 and submitted to the Public Analyst, with the results shown:— Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Almond essence 1 1 Albumen - 2 2 — — — Arrowroot 1 - 1 — — — Ale 2 - 2 — — — Butter 3 - 3 — — — Bay leaves 1 - 1 — - — Beef, minced 1 - 1 — - — Bread l 1 2 — - — Baking powder 2 - 2 - - — Blackcurrant syrup 1 - 1 - — — Brandy 1 - 1 - — — Coffee 2 - 2 - — - Cheese l - 1 - - - Cake 1 1 2 - - - Cake flour 2 - 2 - - - Cake decorations 1 - 1 - - - Cream 1 - 1 - - — Cream buns 1 - 1 - - — Curry powder 1 - 1 — - — Cooking fat 1 - 1 — - — Cocoa 1 - 1 - - - Cream of tartar 1 - 1 - - - Champagne perry 1 - 1 - - - Cherries, glace 1 - 1 - - - Chicklettes 1 - 1 - - - Epsom salts 1 - 1 - - - Fruit, dried 3 - 3 - - - Fruit, tinned 2 2 4 - - - Flour - 1 1 - - - Gin 1 - 1 - - - Ginger, ground 1 - 1 - - - Glauber salts 1 - 1 - - - Herbs, dried mixed 1 — 1 - - - Ice cream 1 - 1 - - - Jelly, table 1 - 1 - - - Linctus 2 — 2 — - - 51 Article. Analysed. Non-Genuine. Formal. Informal. Total. Formal. Informal. Total. Lactachoc l - l - - - Margarine l — l — - - Meringue powder — 1 l — - - Milk 59 — 59 - - - Mincemeat 1 — 1 - - - Nutmeg, ground 1 — 1 - - - Olive oil 1 — 1 - - - Orange squash 1 - 1 - - - Paste, meat 1 — 1 — - - Peas, tinned 1 — 1 — - - Pepper 2 - 2 — - — Pickle 1 - 1 — - — Quinine, tincture of 1 - 1 - - — Rice 9 - 2 — - - Rum 1 - 1 — - — Sago 1 - 1 — - — Salad cream 1 - 1 — - — Sausages, beef 6 - 6 — - — Sausages, pork 9 1 10 - 1 1 Sausagemeat, beef 1 — 1 - - — Semolina 1 - 1 — - — Shortbread 1 - 1 1 - 1 Soup 1 - 1 - - — Sugar 2 - 2 — - — Sweets 5 1 6 2 - 2 Tea 3 - 3 — - — Vinegar 2 - 2 — - — Vitamin tablets 1 — 1 — - — Whisky 2 - 2 — - — Totals 154 10 164 3 1 4 It will be noted that adverse reports were received on 4 samples and the following is a summary of the action taken. Cambridge Sausages. The Public Analyst stated that the meat content (including fat) of this sausage was 61 per cent and observed that Cambridge Sausages are high quality pork sausages, the meat of which consists of pork with a little veal. He further stated that pork sausages of ordinary commercial quality contain not less than 65 per cent of meat and in his opinion, Cambridge Sausages should contain at least this proportion. In view of a recent High Court decision on an appeal against the dismissal by Justices of a similar case, no further action was taken. Scotch Butter Shortbread. The constituents of this sample included 10% butter with a total fat content, including butter fat, of 25 per cent. The Public Analyst observed that the article contained only one half of the proportion of butter claimed in the statement printed on the label. 52 This product was made by a local baker and after full investigation, it was concluded that a proportion of the butter in the recipe was inadvertently replaced with margarine or margarine and butter mixture. A warning letter was sent to the person concerned. Whipped Cream Bon Bons. Buttermint Toffee Rolls. Both these samples were reported as deficient in the 4 per cent milk fat or butter fat content required in sweets of this description. In the first case, the retailers confirmed that the sweet had been described as "Whipped Bon Bons" since 1953. Further investigation revealed that the label normally displayed was missing and temporary staff on the counter had described the sweets as "Whipped Cream Bon Bons" in error. No further action was taken. In the second case, the manufacturers agreed to make certain modifications in the formula of the article. 53 TABLE I. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1955. Disease. At all ages. Number of cases notified. At Ages—Years. Total cases notified in each Ward. Under 1 year. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Coulsdon East. Coulsdon West. Purley. Kenley. Sanderstead. Selsdon and Farleigh. Woodcote. Diphtheria Typhoid fever — - - - - - — - - — - — - — - - — - - - Paratyphoid fever 3 - - - - - 1 - 1 1 - — - 1 1 - 1 - - - Scarlet fever 46 - - 2 3 3 27 5 5 1 - — - 4 7 13 5 14 2 1 Erysipelas 4 1 - — — — — — — 1 - 2 - 1 1 1 — 1 - - Puerperal pyrexia 3 - - — — — — — — 2 1 — - — — — — 1 - 2 Pneumonia 31 - 1 — — — 5 2 2 1 4 8 8 1 6 13 3 7 1 - Dysentery 98 - 10 7 5 3 10 2 1 18 11 17 14 30 38 8 16 4 1 1 Encephalitis — - — — — — — — — — — — — — - - - - - - Poliomyelitis 17 - — — — 2 3 4 — 5 2 1 — 6 4 6 — 1 — - Measles 1,012 6 51 94 104 134 587 22 3 8 2 1 — 90 172 718 48 313 163 8 Whooping cough 64 3 4 7 — 13 27 6 2 1 1 — — 5 7 26 7 14 ? 3 Malaria — — — — — — — — — — — — — - - - - - - - Ophthalmia neonatorum — - - - - - - - - - - - - - - - - - - - Food Poisoning 5 — — — 1 — 2 — — 1 — 1 — — 1 — — — 4 — Totals 1.283 10 66 110 113 155 662 41 14 39 21 30 22 138 237 285 80 355 173 15 54 TABLE II. THE MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1955 Jan. Feb. Mar. A pril May June July Aug. Sept. Oct. Nov. Dec. Total Diphtheria - - - - - - - - - - - — — Typhoid fever — — — — — - — - - - - - - Paratyphoid - - - - - - -— 1 1 1 - - 3 Scarlet fever 5 2 13 4 11 3 2 1 - 1 - 4 46 Erysipelas — — — — — 1 1 1 - 1 - - 4 Puerperal pyrexia 1 — 1 — — - 1 - - - - - 3 Pneumonia 4 7 1 8 2 1 - 1 1 - 4 2 31 Dysentery 3 16 33 8 19 2 15 - 1 1 - - 98 Poliomyelitis 1 — — — — 1 - - 4 5 6 - 17 Measles 15 96 217 322 170 164 19 7 - - 1 1 1,012 Whooping cough 7 3 2 5 3 10 11 11 1 4 2 5 64 Malaria - - - - - - - - - - - - - Encephalitis - — — - - - - - - - - - - Food poisoning - - - 1 - - - 3 1 - - - 5 Totals 36 124 267 348 205 182 49 25 9 13 13 12 1,283 55 TABLE III. INFECTIOUS DISEASE NOTIFIED EACH YEAR SINCE 1925. Disease 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 1955 - - - - 2 2 3 4 - - — — - — — — — — - — — — — — — — — — - — - Scarlet fever 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 46 Diphtheria 14 17 11 23 26 17 8 21 16 24 52 35 8 10 10 25 7 9 7 19 15 8 — — — — — — — - - Erysipelas 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 4 Typhoid and paratyphoid fever 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 3 Meningococcal infections - - - - - - - — — — 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 - 3 Poliomyelitis — — 1 1 — 1 — 2 — 1 1 — 3 1 1 1 2 3 — — 2 1 11 2 9 10 - 8 9 1 17 Polio-encephalitis - - - - - - - - - - - - 2 - - - - - - - - 1 - - - - - - - - - Acute encaphalitis 1 — 1 1 - - - 1 - - - - - - - 1 - - - - - - - - - - - 1 - 1 - Ophthalmia neonatorum - 12 - 3 - 1 1 2 - 1 - 1 1 1 — 1 1 — 1 — - — — — — 1 — — — — — Pneumonia 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 31 Malaria — — — — — — — — — — — — — — — — — — — — — — — 1 — — — — — Measles 2 11 214 479 275 52 705 41 218 567 600 477 810 170 1319 9 1012 Dysentry 1 , — 5 _ — — — — 6 — 1 2 10 85 224 121 21 42 172 82 43 71 14 28 22 48 13 12 98 Whooping cough 6 1 136 36 55 51 100 31 115 201 42 242 204 196 66 131 64 Food poisoning 2 6 2 5 2 74 5 Tuberculosis:- Pilmonary 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 47 Other forms 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 3 Totals 114 113 153 174 232 162 135 154 196 235 265 213 197 162 207 323 743 809 632 337 1137 335 564 990 880 998 1260 579 1617 359 1333 56 TABLE IV. DEATHS OCCURRING DURING THE YEAR, 1955. 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 5 4 2 13 - - - - - 5 7 1 Other tuberculosis 1 — — - 1 - - - - - 1 — - Syphilitic disease 1 1 1 2 5 - - - - - 1 1 3 Diphtheria - - - - - - - - - - - - - Whooping cough — — — — — - - - - - — — — Meningococcal infections 1 — — — 1 - 1 - - - — — — Poliomyelitis 1 — — — 1 - - - - - — 1 - Measles - - - - - - - - - - - - - Other infective and parasitic diseases - - - - - - - - - - - - - Cancer 52 56 11 24 143 - - - - - 3 51 89 1 Leukaemia 2 2 —- 4 - - - - - — 3 Diabetes — 1 1 — 2 - - - - - - - 2 Vascular lesions of nervous system 35 40 7 18 100 - - - - - 2 19 79 Coronary disease, angina 53 38 19 32 142 - - - - - 1 27 114 Hypertension with heart disease 3 6 6 9 24 - - - - - - 4 20 Other heart disease 30 46 17 36 129 - - - - - - 14 115 Other circulatory disease 13 19 12 20 64 - - - - - 2 2 60 Influenza — 1 - 1 2 - - - - - - 1 1 Pneumonia 12 18 19 40 89 - - - 1 - 2 10 76 Bronchitis 12 8 3 3 26 - - - - - - 5 71 Other respiratory diseases 5 1 2 2 10 - - - - - - 3 7 Ulcer of stomach and duodenum 2 2 1 - 5 - - - - - - 1 4 Gastritis, enteritis and diarrhoea - - 1 2 3 - - - - - - 2 1 Nephritis and nephrosis 3 3 2 1 9 - - - - - - 3 6 Hyperplasia of prostate 11 — 2 — 13 - - - - - - - 13 Pregnancy, childbirth, abortion - - - - - - - - - - - - - Congenital malformation 1 2 - - 3 1 - - - 1 1 - - Other defined and illdefined diseases 16 35 18 20 89 18 1 - - 1 3 20 46 Motor vehicle accidents 3 4 1 - 8 - - - - - 4 1 3 All other accidents 8 3 2 9 22 1 - - 3 1 ] 3 13 Suicide 2 2 2 1 7 - - - - - - 6 1 Homicide and operations of war — 1 1 — 2 - — — 1 — — — 1 Totals 269 294 132 222 917 20 2 — 5 3 26 184 677 57 INDEX. Page Addresses of Health and Welfare Services 30,31,32 Ambulances 31 Analysis of Mortality 12,13,14 Area 7,8 Bacteriological work 25 Bed Bugs, Eradication of 45 Birth Rates 6,8 Births, Live, Illegitimate and Still 6,8 Camping Sites 38 Cancer 10,11 Causes of Deaths 10,57 Clinics : Diphtheria Immunisation 23 Family Planning 28 Infant Welfare 29 Maternity 27 School 29 Mothercraft and Relaxation 28 Closet Accommodation 37 Day Nurseries 30 Deaths and Death Rates 6,8,9,57 Diphtheria 15 Diphtheria Immunisation 23 Disinfection 26 Disinfestation 45 Drainage and Sewerage 37 Dysentery 17 Enteric Fever 17 Erysipelas 17 Eye Defects 30 Factories 40,41 Food and Drugs Act 51,52 Food Supply: Milk 47 Meat 49 Unsound 50 Food Premises 49 Food Poisoning 18 Hairdressing Establishments 44 Health Visitors 29 Health Propaganda 27 Heart Disease, etc 10 Home Helps 29 Home Safety Council 32 Houses, Inspection of 33 Houses, Inhabited 8 Housing 33,34 Ice-Cream 48 Illegitimate Babies 9 Infectious Disease: Cases Notified 15,54,55,56 Control of 23 Monthly incidence of 55 School Notifications 22 Inspection and Supervision of Food 47 58 INDEX—continued. Laboratory Facilities 25 Legal Proceedings 44 Massage Establishments 26 Measles 19 Meat 49 Meningococcal Infections 18 Midwifery Service 28 Milk and Dairy Regulations 47 Milk (Special Designation) Regulations 48 Milk, Sampling of 47 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 38 Public Health Committee 3 Puerperal Pyrexia 17 Rainfall 36 Rateable Value 6 Rats and Mice Destruction 45,46 Rivers and Streams 38 Sanitary Inspections, etc 41.42,43 Scabies 23 Scarlet Fever 16 Schools 44 Sewerage 37 Shops 39 Slaughterhouses 49 Smallpox 15 Smoke Abatement 38 Social Conditions Staff 3 Statistics : Housing 33,34 Vital 6,8 Swimming Baths 38 Tuberculosis 20,21 Tuberculosis Immunisation 25 Typhoid Fever 17 Vaccination 24 Violence, Deaths from 12 Water Supply 35,36 Welfare Services 30 Whooping Cough 19 Whooping Cough, Immunisation 25 59