CARZ CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1937 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1937 PREFACE To the Chairman and Members of the Carshalton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1937. The past year was a very good one from a health point of view and, as indicated by the statistics, compares very favourably with its predecessors. The death rate was the lowest recorded, infant mortality was reduced and maternal mortality fell to nil. The marked fall in the birth rate from 15.7 per thousand population in the year before to 13.3 is a significant feature of the statistics. The incidence of infectious disease was much the same as in the year before, scarlet fever continuing to be prevalent, but in the mild form characteristic of this infection during the past two decades. Sanitary inspection and the administration of the Housing Acts has continued with unabated vigour, and the same strict control was exercised over food and food premises. The successful negotiations with the County Council, which culminated in the sewering of the Smallholdings, was a noteworthy hygienic achievement. The maternity and child welfare scheme established further records. Something approaching 80 per cent. of the babies born in the district now attend the clinics, whilst the number of expecttant mothers who came under clinic supervision in 1937 represented for the first time, 50 per cent. of the births. The institution of special toddler clinics has considerably increased the usefulness of this service. A further advance towards the complete coordination of the local activities for the promotion of successful maternity was made when the appointment of two salaried midwives by the Council was secured under the midwifery scheme formulated by the County Council pursuant to the Midwives' Act, 1936. I would again record my appreciation of the support afforded me by the Council and of the willing co-operation of my colleagues in the other Departments of the Council's service. To my own staff I tender my thanks for their unstinted assistance and wholehearted loyalty. I am, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. June, 1938. CARSHALTON URBAN DISTRICT COUNCIL 1937 PUBLIC HEALTH COMMITTEE. Chairman: Mr. F. J. Reeves. Mrs. A. Carpenter, J.P. Dr. C. G. Nicol. Mr. A. L. Dribbell. Mrs. D. M. Ward. Mr. H. O. Fleetwood. Mrs. E. M. Watson. Mr. J. Goodman, J.P. (ex-officio). MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Mrs. A. Carpenter, J.P. Mr. A. C. Campling. Mrs. D. M. Ward. Mr. A. L. Dribbell. Mr. L. H. Ward. Mr. F. J. Reeves. Mrs. E. M. Watson. Mr. J. Goodman, J.P. (ex-officio). REPRESENTATIVES ON JOINT HOSPITAL BOARD. Mr. G. M. Jennings, J.P. Mr. G. J. Thomas. Dr. C. G. Nicol. Mr. J. Goodman, J.P. (ex-officio). REPRESENTATIVES ON JOINT FIRE PROTECTION AND AMBULANCE COMMITTEE. Mr. D. W. Cooper. Dr. C. G. Nicol. Mr. J. Goodman, J.P. Mr. F. J. Reeves (ex-officio). 5 PUBLIC HEALTH STAFF. Medical Officer of Health: *F. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Sanitary Inspector: a H. J. Spicer, M.R.S.I., Sanitary Inspectors: a K. J. millen, C.R.S.I. (ceased 7th February, 1938). a H. G. Cripps, C.R.S.I. a L. G. Lydiatt (from Ist March, 1938). Senior Health Visitor: Miss E. S. picard. Health Visitors: Miss N. M. Hills. Miss D. I. Gentry (ceased 8th April, 1937). Miss R. M. Nash. Miss O. B. Elliott (from 3rd May to 27th November, 1937). Miss A. M. Askew (from Ist January, 1938). Chief Clerk: B. Lamacraft. Part Time Officers. Medical Officers to Maternity and Child Welfare Centres: Ruth C. Townshend, M.B., B.S., D.P.H. Olive G. Potter, M.B., B.S., L.R.C.A., M.R.C.S. (from 10th December, 1937). Alice C. Caiger, M.B., Ch.B. (from 1st March, 1938). Consulting Obstetrician: W. H. Passmore, M.R.C.S., L.R.C.P. Dentist to the Maternity and Child Welfare Scheme: W. B. Shields, L.D.S., R.C.S. Medical Officer to Diphtheria Immunisation Clinics: Constance M. Hildred, M.B., Ch.B., (from 1st June, 1937). * Medical Officer of Health to combined districts of Carshalton and Merton and Morden. a Meat and Food Certificate of the Royal Sanitary Institute. 6 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1937) according to Rate Books 15,561 Rateable Value at 31st December, 1937 £444,091 Sum represented by 1d. rate £1,802 THE Sanitary District, situated about midway between the Thames and the North Downs, is roughly rectangular in shape. It is approximately one mile in width and, commencing at a datum level of 72 at the northern boundary, it extends for some five miles in a southerly direction up the slope of the North Downs to a height of 450 feet above sea level. The subsoil, which is clay in the northern part, changes to a sandy gravel as one proceeds southwards, and then merges into chalk, which covers the southern half of the district. The River Wandle forms the eastern boundary in the northern half and is fed by several springs which arise near the centre of the district at the outcropping of the chalky subsoil. In the dry periods of recent years some of these springs failed temporarily, but the greater winter rainfall of the last two years helped to maintain more normal flows. Housing development proceeded steadily, 312 new dwellings being added to the total compared with 511 in the year before. The increasing tendency to flat development in the London area is occurring also in this district. The central and northern parts of the district are practically built up, whilst the southern end is as yet comparatively undeveloped. The northern part, which consists largely of the London County Council Estate of St. Helier, planned at 12 houses to the acre, is inhabited in the main 7 by a working-class population of the lower wage-earning groups. The families occupying the higher rated houses are mostly to be found in the south, where dwellings are planned on an average at a lower density. In considering the statistics of the various wards, it is helpful to have some indication of the social conditions existing in the different parts of the district. An attempt has been made to provide this indication by ascertaining as near as possible the average residential rateable value per dwelling and the residential rateable value per head of population in each ward. With the co-operation of the Accountant, an analysis of the rating lists has been made, and by the exclusion of the major non-residential properties, a figure of £398,873 at June, 1937, out of a total rateable value for the district of £437,572 at that date, was obtained. Approximately 93 per cent. of this sum of £398,873 represents the rateable value of dwellings, the remaining 7 per cent. being represented mostly by shops, some of which are combined with dwellings. Ward figures, therefore, based on this sum, although rather higher, very closely approximate the actual residential rateable value in each case. In order to eliminate the effect of the paucity of shop property in the St. Helier South ward, the three St. Helier's Wards have been grouped together. The figures referred to as at June, 1937, are as follows:— Ward No. of dwellings Average R. V. per dwelling Population Residential R.V. per head of population St. Helier North 5593 £ s. d. £ s. d. St. Helier South 17 9 0 23958 4 1 0 St. Helier West North East 2099 26 16 0 7426 6 3 0 North-West 2094 26 18 0 7410 7 12 0 Central 1676 33 15 0 6182 9 3 0 South-East 1987 30 6 0 7034* 8 11 0 South-West 1929 42 11 0 6830 12 1 0 Whole District 15378 25 19 0 58840* 6 15 0 *Excluding Queen Mary's Hospital. Industry and Employment.—There is comparatively little industry carried on within the district. More than 80 per cent 8 of the rateable value is represented by houses and flats. The district is to a great extent a dormitory area, the majority of its workers having their employment outside the area. The number of employees engaged in the factories and workshops is approximately 570. The following list shows the number of such premises registered under the Factories and Workshops Acts and the number of persons employed:— Classification of Factories in the district— No. Trade. Employees. M. F. Total. 6 Bakery 31 3 34 16 Boot Repairing 26 — 26 1 Cardboard-box Making 45 80 125 1 Cabinet Making 5 — 5 4 Chemical Works 59 — 59 1 Floor-cloth Making 35 — 35 7 Garages 21 — 21 1 Grinding 3 — 3 1 Herb Drying 3 — 3 1 Horticultural Woodwork 3 — 3 1 Iron Works 14 — 14 2 Joinery 12 — 12 2 Laundry 7 49 56 1 Printing 3 1 4 1 Punnet Making 2 15 17 1 Refuse Disposal 5 — 5 1 Sawmill 3 — 3 1 Shoe Repairs 2 — 2 1 Trolley Bus Depot 29 — 29 3 Valeting 3 1 4 460 53 311 149 460 Classification of Workshops in the district— Total Factory Employees brought forward 460 No. Trade. Employees. M. F. Total. 1 Bakery — 2 2 2 Blacksmith 4 — 4 12 Boot and Shoe Repairs 13 — 13 11 Carpentry 37 — 37 6 Cycle Repairs 7 — 7 6 Dressmaking — 10 10 5 Laundering 1 8 9 1 Monumental Masonry 1 — 1 1 Mop Assembling 1 1 2 1 Mineral Water Manufacture 2 — 2 1 Potted Meat Manufacture — 2 2 1 Parchment Manufacture 1 — I 10 Repair (cars) service 13 — 13 2 Radio Repairs 3 — 3 1 Shirt Making 1 — 1 1 Sign Writing 2 — 2 I Stair Making 1 — 1 5 Upholstery 5 — 5 1 Watch and Clock Repairs 1 1 2 115 69 Total Employees 93 24 117 567 Figures in respect of the number of Carshalton unemployed registered at the local exchange are not available. Meteorology. Meteorological apparatus exists in the grounds of The Grove and readings are taken each day at 9 a.m., G.M.T. At the end of this report a table is shown of the recorded averages for each month of the year. 10 SUMMARY OF VITAL STATISTICS FOR 1937. (Based on the Registrar-General's Figures.) Population. Mid. 1937 Registrar-General's Estimate 58,030 Births. M. F. Total Live (Legitimate) 435 416 851 (Illegitimate) 16 7 23 451 423 874 Birth Rate 13.3 Still-births 15 6 21 Stl-bth. Rate per 1,000 total births 23.4 Deaths 188 200 388 Death Rate (crude) 6.6 Infant Mortality. All deaths under 1 year 20 16 36 Infant Mortality Rate (per 1,000 live births) 41.1 Deaths of leg. infts. under 1 year 17 16 33 Rate per 1,000 legmt. births 38.7 Deaths of illeg. infts. under 1 year 3 — 3 Rate per 1,000 lllegmt. births 130.4 Maternal Mortality. Deaths from Sepsis — Rate per 1,000 total births — Deaths from other causes — Rate per 1,000 total births — Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases 5 Deaths from Measles — Deaths from Whooping Cough — „ from Diarrhoea (und. 2 yrs). — Zymotic Death Rate 0.08 Deaths from Tuberculosis. All Forms 37 Rate per 1,000 of population 0.63 Phthisis 34 Rate per 1,000 of population 0.58 Deaths from Cancer. 47 Rate per 1,000 of population 0.80 11 The Registrar General's statistics differ slightly in some instances from those compiled from local records. Those total figures relating to the district as a whole which are supplied by the Registrar General are set out in this report, but where comparative figures e.g. as between wards, age groups, etc., are shown, or classification attempted, these are necessarily taken from local records and may show slight discrepancies in the aggregate compared with the Registrar General's totals. POPULATION The Registrar General's estimate of the resident population at June 30th, 1937, is 58,030. My own estimate, based on local information, is 60,100. A useful index to population movements within recent years in the district is provided by an examination of a recent housing survey made under the Housing Act, 1936, of two complete roads on the St. Helier Estate, involving 263 houses which were also included in the original survey under the 1935 Act in December 1935. The following are the details of the two surveys in respect of these roads:— December, 1935 May, 1938 Number of houses surveyed 263 263 Number of houses found occupied 263 262 Number of persons aged 10 years and over 826 843 Number of persons under 10 years and over 1 year 336 294 Total persons over 1 year of age 1162 1137 Equivalent adults 994 990 Equivalent adults per dwelling 3.77 3.76 Babies under 1 year Not enumerated 15 Total persons of all ages 1152 Persons of all ages per dwelling (occupied and vacant) 4.380 12 The St. Helier Estate was chosen for this comparative survey since 70 per cent of the total overcrowding in the district, found to exist at December 1935, was on that Estate, and in the interval between that time and the recent enumeration the decrowding operations of the local Authority would have the maximum effect on the population movements. The number of families occupying these 263 dwellings which have been decrowded in this period is 15, representing 5.7 per cent of the total, whereas the percentage of overcrowded working-class dwellings decrowded in the whole of the district in the same period was 2 per cent and that on the St. Helier Estate as a whole also 2 per cent. From the information obtained in this way it will be observed that, judged by a representative selection of 263 dwellings from a substantial proportion of the total working-class houses in the district where the maximum allowance for decrowding has been made, the number of persons over 1 year of age per house (occupied and vacant) is now 4.33 compared with a figure of 4.29 in December 1935, and that the number of persons of all ages per house (occupied and vacant) is now 4.380. The distribution of the estimated population by wards is shown in Table I. TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1937. BY WARDS WARD Houses at Mid. 1937 Estimated Population, Mid. 1937 St. Helier North 2012 8660 St. Helier South 1699 7300 St. Helier West 1882 7998 North-East 2099 7426 North-West 2094 7410 Central 1676 6182 South-East 1987 7034 8334 Queen Mary's Hospital 1300 South-West 1929 6830 Whole District 15378 60100 13 BIRTHS. The live births registered totalled 874. Of these 451 were males and 423 females. The total is 25 less than in the year before, and so the birth rate falls to 13.3 compared with 15.7 per thousand population for 1936. This rate of 13.3 is the lowest recorded for the district, the previous lowest being 14.9 in 1933. The number of illegitimate births included in the total was 23, 16 male and 7 female, 4 more than in the year before. Still-births numbered 21, of which 15 were males and 6 females. One female still-birth was illegitimate. Ward Birth Rates. Information in respect of registered births is not sufficient to permit of a classification by wards and so use is made for this purpose of the notifications of births received under Part VII of the Public Health Act, 1936, supplemented by reference to the returns of births registered in the district. These sources of information show that 878 live births occurred in 1937 and were distributed between the wards as shown in the following table:— WARD Live Births Rate per thousands population St. Helier North 154 17.7 St. Helier South 114 15.6 St. Helier West 136 17.0 North-East 139 18.7 North-West 133 17.9 Central 66 10.6 South-East (exclg. Qn. Mary's Hos.) 73 10.3 South-West 63 9.2 The same marked difference in the birth rates for the northern and southern halves of the district is exhibited again as in the two preceding years. !4 Domiciliary and Institutional Births. Table 2 classifies the 899 total births (live and still) which occurred during the year according to whether they took place in hospitals, nursing homes, etc., or in private houses. The number which took place in hospitals and maternity homes rose from 264 in 1936 to 337, which raises the percentage of the total from 29 to 37. The percentages for the individual wards were as follows: St. Helier North 28.1 St. Helier South 27.5 St. Helier West 23.5 North-East 44.6 North-West 39.2 Central 50.0 South-East 51.0 South-West 56.9 The higher figures in respect of the wards other than those of St. Helier are accounted for by the greater proportion of births which took place in private nursing homes. The 337 non-domiciliary births took place in the following institutions: Live Still Total Carshalton, Beddington and Wallington District (War Memorial) Hospital 49 - 49 Surrey County Hospitals 78 3 81 Other Hospitals 52 1 53 Private Nursing Homes 150 4 154 329 8 337 15 TABLE 2. BIRTHS, 1937—DOMICILIARY AND OTHERS—BY WARDS. Ward. Born in District. Born Outside the District. Total. In Hospitals and Nursing Homes. In Private Houses. Total In Hospitals and Nursing Homes. In Private Houses. Not Stated. Total. St. Helier North 6 112 (1) 118 (1) 38 (1) - - 38 (1) 156 (2) St. Helier South 14 82 (2) 96 (2) 18 — 2 20 116 (2) St. Helier West 3 107 (3) 110 (3) 30 (1) — — 30 (1) 140 (4) North East 30 78 (1) 108 (1) 33 (1) — — 33 (1) 141 (2) North-West 14 82 (3) 96 (3) 40 — — 40 136 (3) Central 14 33 (1) 47 (1) 20 (1) — 1 21 (1) 68 (2) South-East 16 37 (2) 53 (2) 24 (2) — — 24 (2) 77 (4) South-West 5 28 33 32 (2) — — 32 (2) 65 (2) Total 102 559 (13) 661 (13) 235 (8) — 3 238 (8) 899 (21) (Figures in brackets indicate still-births included in totals). 16 TABLE 3. Birth and Death Rates for Carshalton, 1921-1937. Year Population (RegistrarGeneral's) Birth Rate Death Rate Infant Mortality Rate nal Mortality Rate 1921 14000 17.4 9.8 78 8.1 1922 14240 19.7 8.8 50 10.6 1923 14610 18.8 8.6 36 3.6 1924 15050 18.5 10.1 58 7.1 1925 15660 20.0 10.0 42 3.2 1926 17040 17.0 9.3 31 0.0 1927 18450 16.5 9.1 72 9.8 1928 21910 15.5 9.0 65 14.7 1929 23420 18.8 9.4 61 0.0 1930 25500 17.0 76 46 0.0 1931 28620 16.7 75 43.8 8.1 1932 32280 15.05 7.9 47.3 3.89 1933 35260 14.9 88 64.4 4.23 1934 38110 16.5 8.6 53.5 4.60 1935 51000 15.7 6.6 46.0 4.80 1936 57000 15.7 7.1 46.7 7.57 1937 58030 13.3 6.6 40.0 0.0 Table 4 shows provisional rates issued by the Registrar-General in respect of England and Wales, Boroughs and Great Towns, the Smaller Towns and the London Administrative County for 1937. Corresponding rates for Carshalton are added, based on Registrar-General's figures. 17 TABLE 4. COMPARATIVE STATISTICS-1937. England and Wales 125 County Boroughs and Great Towns including London l48Smaller Towns (Resident Populations 25000 to 50.000 at 1931 Census) London Administrative County Carshalton Rates per 1,000 Population. Births— Live 14.9 14.9 15.3 13.3 13.3 Still 0.60 0.67 0.64 0.54 0.36 Deaths— *6.6 All Causes 12.4 12.5 11.9 12.3 †7.4 Typhoid and Paratyphoid Fevers 0.00 0.01 0.00 0.00 0.01 Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 — Scarlet Fever 0.01 0.01 0.01 0.01 — Whooping Cough 0.04 0.04 0.03 0.06 — Diphtheria 0.07 0.08 0.03 0.05 0.06 Influenza 0.45 0.39 0.42 0.38 0.32 Violence 0.54 0.45 0.42 0.51 0.25 Notifications— Smallpox 0.00 — 0.00 — — Scarlet Fever 2.33 2.56 2.42 2.09 5.06 Diphtheria 1.49 1.81 1.38 1.93 1.60 Enteric Fever 0.05 0.06 0.04 0.05 0.01 Erysipelas 0.37 0.43 0.34 0.44 0.22 Pneumonia 1.36 1.58 1.20 1.18 1.98 Rates per 1,000 Live Births. Deaths under 1 year of age 58 62 55 60 41 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 - Maternal Mortality— Puerperal Sepsis 0.97 Not available - Others 2.26 - Total 3.23 - Rates per 1,000 Total Births (i.e., Live and Still). Maternal Mortality— Puerperal Sepsis 0.94 Not available - Others 2.17 - Total 3.11 - Notifications— Puerperal Fever 13.93 17.59 11.52 4.15 1.11 Puerperal Pyrexia 14.34 5.58 * Crude. † Comparable. 18 DEATHS. The number of registered deaths, as adjusted by transferable deaths, was 388. Of these 188 were males and 200 females. The crude death rate was 6.6 per thousand population compared with 7.1 in the year before. The same figure was recorded in 1935 and is the lowest reached for the district. The comparable death rate was 7.4 per thousand population. This is arrived at by the application of the areal comparability factor (A.C.F.) to allow for age and sex differences in the population compared with the country as a whole. The comparable rate is the one which should be used for comparison with the death rate for England and Wales of 12 4. Ward Death Rates.—The distribution of deaths by wards and the respective death rates were as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1937 WARD. Deaths Death Rate (crude) Mean Age at death St. Helier North 40 4.6 37.6 yrs. St. Helier South 35 4.8 43.7 „ St. Helier West 34 4.2 42.8 „ North-East 63 7.9 48.0 „ North-West 51 6.8 55.0 „ Central 65 10.5 59.7 „ South-East (excluding Queen Mary's Hospital) 57 8.1 52.1 „ South-West 42 6.2 60.7 „ Whole District 387 6.6 46.2 CAUSES OF DEATH. Heart Disease.—The group of diseases classed under this head accounted for 87 deaths. This is by far the largest number classed under any one head. It represents almost 18 per cent 19 of the total deaths and gives a death rate for this cause of 1.4 per thousand population, the same as in the year before. All but eight were over the age of 55 years and the distribution between the sexes was 50 male and 37 female. Twenty of these deaths were ascribed to uncomplicated degeneration of the heart muscle. Cancer. Cancer was responsible for the second largest group of deaths, claiming 47 victims, 18 being males and 29 females. The total is 7 less than in the year before and gives a death rate of 0.80 per thousand population. The classification of these deaths by the organs affected is shown in Table 5. It will be noted that disease of the digestive organs accounted for rather more than half of these deaths and that, contrary to general experience, fatal illness in this situation was twice more frequent in females than in males. The slightly heavier mortality among females, which is to be expected owing to the proneness of the female genital organs to cancer, was increased by this markedly greater incidence of digestive disease in the female sex. Allocation of these deaths by wards is as follows:— CANCER DEATHS—WARD DISTRIBUTION, 1937. WARD Cancer deaths Rate per 1,000 Estimated Population St. Helier North 5 0.57 St. Helier South 5 0.68 St. Helier West 3 0.37 North-East 11 1.48 North-West 6 0.80 Central 7 1.13 South-East 7 0.83 South-West 3 0.43 20 TABLE 5. CANCER DEATHS—BY ORGANS AFFECTED. Group Site Affected Male Female Total 45 Buccal Cavity l 1 2 46 Digestive Organs— Oesophagous 2 — 2 Stomach 1 2 3 Liver and gall bladder 1 3 4 Intestines 2 9 11 Rectum and anus 2 2 4 Pancreas - 1 1 47 Respiratory Organs- Larynx - — — Lungs 4 2 6 Mediastinum 1 1 48 Uterus - 2 2 49 Other female genital organs — 1 1 50 Breast 6 6 51 Male genito-urinary organs 3 - 3 52 Skin 1 - 1 53 Other organs— — - — 18 29 47 Average age at death:— Males 64.0 years. Females 64.2 years. All persons 64.1 years. 21 Respiratory Diseases.—Influenza and infections of the respiratory tract were more prevalent in 1937 than in the year before. Deaths from bronchitis, pneumonia and other respiratory diseases (excluding influenza) numbered 52 against 38 in 1936 and the death rate from this cause was 0.89 per thousand population. The deaths were equally divided between the sexes. Seven were babies under 1 year of age and 15 children under 5 years. Influenzal deaths totalled 19 as against 1 in the year before. Inquests.—Inquests were held on 23 deaths which occurred in the district, 13 of which were residents and 10 non-residents. The verdicts were returned as follows:— Natural Causes 9 Suicide 3 Accidental deaths 6 Misadventure 3 In accordance with medical evidence 2 Four of the total were due to road accidents, one of which was a resident. INFANT MORTALITY. The number of children who died within one year of birth was 35, 19 being males and 16 females. This gives an infant mortality of 40.0 per thousand live births, compared with 46.7 in the preceding year, and with 58 for the country as a whole. Three deaths of illegitimate children, all males, are included in the total. Neo-natal deaths, i.e., those occurring within one month of birth numbered 20 which is approximately 57 per cent of the total. There were no deaths under one year from the common infectious diseases—measles, whooping cough, etc., and none from diarrhoea. Pneumonia accounted for 7, and the diseases peculiar to early infancy, such as prematurity, congenital malformation, marasmus, etc., for 23. 22 The distribution of infant mortality by wards was as follows:— TABLE 6. INFANT MORTALITY-WARD DISTRIBUTION. WARD Infant Deaths Rate per 1.000 live births St. Helier North 9 58 St. Helier South 1 9 St. Helier West 2 15 North-East 5 36 North-West 7 53 Central 3 45 South-East 7 96 South-West 1 16 These figures are too small to have any comparative value. Those taken in respect of the three-year period 1935-1937, for which such information is available, show that the rates approximate more closely to one another in all the wards except the south west where the mortality is a particularly low one (see Table 7). These figures, covering as they do a three-year period, while perhaps still rather inadequate, would tend to show that the chance of survival to the age of one year is distinctly greater in the south-west ward than in the rest of the distridt. TABLE 7 INFANT MORTALITY OVER THREE YEARS 1935-1937 WARD DISTRIBUTION. WARD Infant Deaths Live Births Rate per 1,000 live births St. Helier North 54 1210 44 St. Helier South St. Helier West North-East 17 395 43 North-West 17 356 47 Central 10 174 57 South-East 12 226 53 South-West 3 166 18 23 TABLE 8. INFANT MORTALITY DURING THE YEAR 1937. Deaths classified as to cause and age at death. 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 Smallpox - - - - - - - - - - Chickenpox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - v - - - - - 1 - 1 Convulsions - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - 1 - - - 1 Pneumonia (all forms) - 1 1 - 2 2 1 2 - 7 Diarrhœa - - - - - - - - - - Enteritis - - - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation (overlying) - - - - - 1 - - - 1 Injury at Birth 1 - - - 1 - - - - 1 Atelectasis 1 - - - 1 - - - - 1 Congenital Malformation 3 - - - 3 1 - - - 4 Premature Birth 7 1 2 - 10 4 - - - 14 Atrophy, Debility and Marasmus 1 1 - - 2 1 - - — 3 Other Causes — 1 — - 1 — 1 - - 2 Totals 13 4 3 — 20 10 2 3 - 35 Net Births in the year—Males 451, Females 423: Legitimate 851, Illegitimate 23. Nett deaths in the year oi Legitimate Infants, 33. Nett deaths in the year of Illegitimate Infants 3. 24 MATERNAL MORTALITY. No deaths in 1937 were ascribed to maternal causes compared with 7 in the year before when the maternal death rate was 7.57 per thousand total births. It is seven years since a maternal mortality of nil was recorded. The mortality per thousand births over the last 15 years was 4.5, over the last 10 years 4.4 and over the last 5 years 4.l. TABLE 9. MATERNAL MORTALITY, 1921—1936. Year Births Maternal Deaths Maternal Mortality Rate 1921 244 2 8.1 1922 281 3 10.6 1923 275 1 3.6 1924 278 2 7.1 1925 312 1 3.2 1926 290 0 0.0 1927 305 3 9.8 1928 340 5 14.7 1929 441 0 0.0 1930 434 0 0.0 1931 489 4 8.1 1932 501 2 3.9 1933 542 2 3.6 1934 631 3 4.6 1935 825 4 4.8 1936 923 7 7.57 1937 895 0 0.0 25 TABLE 10. CAUSES OF DEATH DURING THE YEAR 1937. BY AGES AND SEX. No. Causes of Death. 0 — 1 — 5 — 15 — 25 — 35 — 45 — 55 — 65 — 75 — All ages. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Persons All Causes 19 16 7 12 6 4 7 9 12 15 19 11 20 16 20 24 40 36 36 58 186 201 387 1 Typhoid Fever, etc. .. — — — — — — — — — — — 1 — — — — — — — — 1 1 2 Measles 3 Scarlet Fever 4 Whooping Cough i Diphtheria — — 1 — 2 1 — — — — — — — — — — — — — — 3 1 4 6 Influenza — 1 1 1 2 2 1 2 1 1 — — — — — 3 — — 1 3 6 13 19 7 F.ncephalitis Lethargica 1 1 1 8 C.erebro-Spinal Fever 1 1 — 1 9 Respiratory tuberculosis — — — — 1 1 1 5 6 6 3 4 1 — 2 — 1 2 — 1 15 19 34 10 Other tuberculosis . . 1 1 1 1 7 3 11 Syphilis 12 General paralysis of insane, etc. 1 1 1 13 Cancer — — — — — — — — 2 — 2 — 2 7 4 7 6 8 2 7 18 29 47 14 Diabetes — — — — — — — 1 1 — — — 1 — — 1 3 — 3 4 7 15 Cerebral Hemorrhage — 1 — — — — 1 — — — — — — — — 1 — 2 — 7 1 12 16 Heart Disease 1 — 1 5 4 7 6 19 11 18 14 49 37 86 17 Aneurysm 1 1 1 1 2 IB Other Circulatory 1 — 2 4 4 4 7 8 14 22 19 Bronchitis — 1 1 1 2 7 ?. 5 6 8 14 20 Pneumonia 3 3 3 5 1 — 2 — — — 2 1 — 2 3 1 — 3 19 13 32 21 Other respiratory 1 2 1 1 1 1 5 6 22 Peptic Ulcer 1 — 2. 1 1 4 1 5 23 Diarrhoea 24 Appendicitis 1 1 1 25 Cirrhosis of liver 26 Other liver diseases .. 27 Other digestive — — — 1 — — — — — — — — 2 1 — — — — 7 7 4 28 Nephrit's 1 2 1 — 1 — — 2 1 — 1 3 5 7 12 29 Puerperal sepsis 30 Other puerperal 31 Congenital causes 15 8 15 8 23 V | 3 3 3 4 7 33 Suicide — — 3 1 1 3 7 5 34 Other violence — 1 1 1 — — I — 1 — — 1 1 1 ? 6 4 10 35 Other defined causes.. — 1 1 2 — — 1 1 — 3 2 2 2 1 2 2 3 1 2 2 13 15 28 26 Section B—Health Services. Nursing in the Home.—The District is served by two Nursing Associations, to whose funds the Council makes an annual contribution in return for nursing facilities for cases referred through the Public Services. The Carshalton District Nursing Association covers the greater part of the Urban District. Six nurses, 4 of whom act as midwives, are employed. The following information in respect of the working of this Association during 1937 has been kindly supplied by the Honorary Secretary:— Number of children under 5 years, nursed 131 Number of maternity cases attended 88 Number of midwives' cases undertaken 92 Number of other cases attended 656 Total Cases 967 Number of visits made 14,574 The St. Helier District Nursing Association operates mostly in the Merton and Morden section of the St. Helier Estate, but its activities cover that part situated in Carshalton which lies to the north of the Sutton By-Pass. One nurse is employed for general nursing. No midwifery is undertaken. The following figures, relating to the Carshalton portion of the Estate, for 1937 have been kindly supplied by the Honorary Secretary:— Number of children under 5 years, nursed 5 Number of other cases undertaken 19 Total Cases 24 Number of visits made 353 Co-ordination of the work of the Nursing Associations with 27 that of the Council's Welfare Centres is promoted by the attendance of the District Nurses at the Council's clinics. Laboratory Facilities.—1 he Council has arrangements with the Lister Institute of Preventive Medicine, Chelsea Bridge Road, S.W.I. and with Dr. Deas, The Laboratory, Nelson Hospital, Merton, S.W. 19, for the examination of pathological material in connection with infectious disease, tuberculosis and puerperal pyrexia. These facilities are provided for the use of practitioners, free of cost. The following examinations were made during the year:— No. Examined. Positive Results. Swabs for Diphtheria bacilli 582 44 Sputa for tubercle 69 8 Widal tests for enteric 17 — Faeces examinations 9 2 Swabs for Hæmolythic streps — — Cerebro-spinal fluid 1 — Samples of water, milk and food are sent to the County Analyst, The County's Public Health Laboratories or the Laboratory of the Royal Surrey County Hospital, Guildford. In special circumstances use is also made of the facilities afforded at the Ministry of Health Laboratory, Endell Street, W.C.2. The following examinations were made during the year:— Samples of drinking water— For chemical analysis 3 For bacteriological examination 3 Samples of river water— For bacteriological examination 4 Milk samples For bacteriological examination 100 Ambulance Facilities.—Infectious Cases.—For the removal of infectious cases to Isolation Hospital, ambulance facilities are provided by the Cuddington Joint Hospital Board. No difficulty has been encountered in securing the prompt removal of cases admitted to hospital. 28 Non-Infectious Cases— Provision for removal of non-infectious cases, made by the Carshalton, Beddington and Wallington Joint Fire Protection and Ambulance Committee, was the same in 1937 as shown in the report for 1936, viz:—two fully equipped vehicles housed at The Grove, Carshalton. The fees for the use of the service are as follows:— 7s. 6d. For the removal of one patient from one address to another, both within the joint District. 10s. 0d. For the removal of one patient from any address within the joint District to an address within the Boroughs of Croydon, Sutton and Cheam or Mitcham. 1s. 0d. From and including return to garage for all other journeys. per mile. The above charges to include, if necessary, the services of an attendant. A doctor and one friend to be allowed to accompany the patient free of charge. The following figures are in respect of the working of the service in both districts during the year:— Carshalton. Beddington & Wallington (1) Calls to street accidents, etc. 258 185 Answered by own ambulances 257 185 Referred to other ambulance services 1 — (2) Calls to remove cases from domestic dwellings to nursing homes or hospitals, or vice versa 688 305 Answered by own ambulance 688 305 The greatest number of calls received and answered in one day was 14, and out of a total of 1,436 cases, it was only necessary to refer one case to other services. The Beddington and Wallington Borough Council have given notice to terminate the agreement in respect of the joint arrangement on the 31st March, 1938, after which date it is anticipated each district will make its own ambulance provision. I am indebted to Mr. C. P. Ingram, the Honorary Ambulance Officer for the information given above. 29 HOSPITALS. Infectious Diseases.—Carshalton is one of the constituent districts of the Cuddington Joint Hospital Board which provides isolation hospital accommodation for the following areas:— Banstead Urban District. Carshalton Urban District. Borough of Epsom and Ewell. Leatherhead Urban District. Borough of Sutton and Cheam. The accommodation at Cuddington has recently been extended to 126 beds. A new ward block of 24 beds and a new cubicle block of 10 beds were occupied during the year. The auxiliary isolation hospital at Hook Road, Epsom, providing a further 22 beds, is being retained until 31st March, 1938. New administrative buildings have been completed since the end of the year. The cases admitted are chiefly scarlet fever and diphtheria, but any notifiable disease, except smallpox and puerperal pyrexia, is admitted. Non-notifiable diseases, such as measles and whooping cough, are admitted in exceptional circumstances. The information contained in Table 10, supplied by the Clerk to the Board, shows the number of cases admitted from each district during the year. The number admitted from Carshalton was 350 compared with 292 in the year before. 30 TABLE II. CUDDINGTON JOINT HOSPITAL BOARD—STATEMENT OF ADMISSIONS TO CUDDINGTON HOSPITAL DURING 1937. Disease Banstead U.D. Sutton B.C. Leatherh'd U.D. Carshalton U.D. Epsom Others Total No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths Scarlet Fever 31 — 125 — 11 — 263 — 36 — 4 — 470 — Diphtheria 29 — 29 4 4 — *59 3 13 — 4 — 138 7 Tonsillitis 4 — 2 — — — 9 — 4 — — — 19 — Measles 1 — 2 — — — 4 — 2 — — — 9 — Erythema — — I — — — 2 — — — — — 3 — Typhoid 1 — 3 1 — — 1 1 — — — — 5 2 Enteritis 1 — 3 - - - - - - - - - 4 — Erysipelas — — 2 — — — 1 — 1 — — — 4 — Meningitis 1 1 - - - - - - - - 1 1 2 2 Other Diseases 1 — 10 1 1 — 11 — 3 — — — 26 1 Totals 69 1 177 6 16 — 350 4 59 — 9 1 680 12 *Includes 10 "Carriers." 31 General and Maternity.—The Carshalton, Beddington and Wallington District (War Memorial) Hospital, The Park, Carshalton. This voluntary hospital provides 60 beds, arranged as follows:— Public Wards— Women's beds 16 Men's beds 14 Children's beds 8 Maternity beds 2 Emergency beds 6 Private wards (of one bed) 14 60 The hospital is equipped with an X-Ray Department, and has a separate wing for orthopœdic treatment, including massage, electrical treatment, radiant heat, ultra-violet ray, and remedial exercises. The hospital report for 1937 shows that the following cases were admitted:— General Medical and Surgical 1234 Maternity 116 1350 The districts from which the cases were admitted were:— Carshalton 713 Beddington and Wallington 515 Other districts 122 1350 The Council contributes annually to the hospital and has an arrangement for the treatment of maternity cases and children referred from the public welfare services. 32 Tuberculosis.—The hospital accommodation for tuberculosis is provided by the Surrey County Council who are responsible for the anti-tuberculosis scheme in this district. The main provision is the County Sanatorium, Milford, an institution of 300 beds to which 29 persons were admitted from Carshalton during the year. 96 other persons received in-patient treatment at other institutions under the County scheme. Smallpox.—County Isolation Hospital, Clandon. The hospital arrangements for the treatment of smallpox cases in all districts of Surrey are undertaken by the County Council. Provision exists at the Clandon Hospital for the reception of 28 cases. No cases were sent from this district during the year. County and Public Assistance Hospitals.—Under the present arrangements, Carshalton residents requiring in-patient treatment in County Hospitals are received mostly into the Epsom and Kingston Hospitals, but the local facilities have for some time been steadily growing more inadequate. The completion of the new County Hospital at St. Helier will be eagerly awaited, not only by this, but by neighbouring districts in the north eastern part of the County. CLINICS AND TREATMENT CENTRES. MATERNITY AND CHILD WELFARE CLINICS. Clinics provided by the Council are held at the following times and places:— Infant Welfare:— Municipal Institute, Rochester Road Tuesdays, 2-3.45 p.m. Thursdays, 2-3.45 p.m. Phoenix Buildings, Stanley Road Fridays, 2-3.45 p.m. Wrythe Hall, Wrythe Lane Weds., 2-3.45 p.m. Fridays, 10-11.45 a.m. Methodist Central Hall, Green Lane Mondays, 2-3.45 p.m. 33 Toddlers Clinics:— Phoenix Buildings, Stanley Road First and third Thursdays, 2-3.45 p.m. Wrythe Hall, Wrythe Lane Tuesdays, 2-3.45 p.m. Maternity Clinics:— Municipal Institute, Rochester Road First, second and fourth Mondays in each month, 10-11.45 a.m. Phoenix Buildings, Stanley Road Second and fourth Fridays in each month, at 1.30 p.m. Wrythe Hall, Wrythe Lane Tuesdays, 10-11.45 a.m. Fridays, 2-3.45 p.m. (Postnatal mothers only on First Friday in each month). Methodist Central Hall, Green Lane First and third Mondays in each month at 1.30 p.m. Dental Clinics:— Municipal Institute, Rochester Road First, third and fourth Mondays in the month, 10-11.45 a.m. DIPHTHERIA IMMUNISATION CLINICS (Provided by the Council). Wrythe Hall, Wrythe Lane Second and fourth Wednesdays in the month, 10 a.m. 34 SCHOOL CLINICS (Provided by the Surrey Education Committee). General Medical:— Municipal Institute, Rochester Wednesdays, 9.30a.m-12noon Road Fridays, 9.30 a.m.-12 noon Phoenix Buildings, Stanley Road Mondays, 2-4 p.m. Dental Clinics:— Municipal Institute, Rochester Mondays, 1.45-4 p.m. Road Tuesdays, 9.30 a.m.-12 noon Wednesdays, 1.45-4 p.m. Thursdays, 9.30 a.m.-12 noon Fridays, 1.45-4 p.m. First and third Saturdays 9.30 a.m.-12 noon Phoenix Buildings, Stanley Road Mondays, 9.30 a.m.-12 noon Wednesdays 9.30a.m.-l 2 noon Fridays, 9.30 a.m.-12 noon Second, fourth and fifth Saturdays, 9.30 a.m.-l 2 noon Hill House, Bishopsford Road Mondays, 9.30 a.m.-12 noon Tuesdays, 9.30 a.m.-12 noon Wednesdays 9.30 a.m.-l2 noon Thursdays, 9.30 a m.-12 noon Fridays, 9.30 a.m.-12 noon TUBERCULOSIS CLINICS. (Provided by Surrey County Council). Municipal Institute, Rochester Road Fridays, at 10 a.m. Third Tuesday in each month at 5.30 p.m. Health Centre, Middleton Road, Mondays, at 1.30 p.m. Morden. Second Monday in each month at 5.30 p.m. 35 VENEREAL DISEASES CLINICS. The County Council administers the Venereal Diseases Regulations and participates in the London and Home Counties Scheme. Under this arrangement, treatment is available at the Croydon General Hospital and the principal London hospitals. The sessions are numerous, and in some cases continuous, whilst many of these institutions provide in-patient as well as out-patient treatment. MATERNITY AND CHILD WELFARE. Public Health Act. 1936—Section 203. The number of births which were notified, as adjusted by transferred notifications, was as follows:— Live births 820 Notified by midwives 440 Still births 19 Notified by doctors and parents 178 Transferred notifications 221 839 839 The total is 19 less than in 1936 and represents 95 per cent of the live births registered during the year. The Work of the Centres. The most note-worthy feature of the Maternity and Child Welfare Scheme during the year under review was the substantial increase in the use made of the maternity clinics. The number of women who attended for supervision rose from 297 in 1936 to 419, an increase of 40 per cent. The number of attendances made by these women increased by more than 100 per cent, the actual figures being 632 in 1936 and 1325 in 1937. The number of women who attended the clinics represents 50 per cent of the total births notified during the year, which means that very nearly half the expectant mothers in the district came under the supervision of the Council's clinics. This very satisfactory result was in a great measure due to the increased facilities provided by the Council and reflects also great credit on the Medical Officer of the clinics, the health visitors and the voluntary helpers, all of whom constantly strive to make this service attractive and helpful to the mothers of the district. It is a very encouraging augury that the year which saw such increased activity in the maternity clinics should be one without a maternal death. 36 The Infant Welfare clinics again experienced a very busy year. The number of children who attended, and the total attendances they made constitute fresh records. Babies under one year coming for the first time represented 78 per cent of the births notified during the year, demonstrating that a very high proportion of the babies born in the district come under the care of the welfare centres. The attendances at the centres are shown in Tables 12 and 13. TABLE 12. ATTENDANCES AT MATERNITY CLINICS. CENTRE No. on Register Attendances Sessions Average attendance per Session *Primary Total Rochester Road. Ante Natal 118 103 382 28 13.7 Post Natal 3 1 3 Individuals 119 104 385 Wrythe Hall. Ante Natal 247 215 811 46 18.0 Post Natal 17 3 17 Individuals 250 218 828 St. Helier. Ante Natal 28 26 50 12 4.3 Post Natal 2 — 2 Individuals 28 26 52 Stanley Road. Ante Natal 22 21 59 12 5.0 Post Natal 1 — 1 Individuals 22 21 60 All Centres. Ante Natal 415 365 1302 98 13.5 Post Natal 23 4 23 Individuals 419 369 1325 *Primary attendance is the first attendance of a worn in in relation to the pregnancy under supervision. TABLE 13 INFANT WELFARE CENTRES—ATTENDANCES, 1937. Centre Years. Number who attended during year. Number on register at year end. New cases to the Centres Attendances Number of sessions. Average attendance per session. Primary. Total Rochester Road Under 1 479 167 212 205 3,367 98 34.35 1-5 304 61 44 1,459 14.88 Wrythe Lane Under 1 848 ) 229 287 267 3,754 98 38.30 1—5 605 161 99 2,112 21.55 Stanley Road Under 1 } 216 51 60 55 1,137 50 22.74 1—5 150 28 15 966 19.32 St. Helier Under 1 | 382 89 120 118 1,441 48 30.02 1—5 289 65 58 836 17.41 All Centres Under 1 | 1925 536 679 645 9,699 294 32.98 1-5 1,348 315 216 5,373 18.27 Total 0—5 1,925 1,884 994 861 15,072 294 51.26 38 The New Health Centre, St. Helier. The welfare services on the St. Helier Estate, which have been carried on in temporary premises, have for some time necessarily been conducted under difficult conditions. Much careful thought and consideration have been given to plans for the erection of a new health centre to accommodate both maternity and child welfare and school medical services, to serve the northern end of the district and these have now been approved. The lay-out of the building, which is to be placed on a site at the junction of Middleton Road and Green Wrythe Lane, is shown in the accompanying plan. It consists of two wings extending from a central hall which can be divided by a moveable partition to form two waiting rooms with separate entrances when two sets of clinics are being held simultaneously, or can be used in its entirety for lectures, meetings, etc. One wing is designed primarily for infant welfare and maternity clinics and the other for dental and school medical clinics. The former has a comparatively large weighing room opening on to the ante-room of the doctor's consulting room. This ante-room can also be converted by folding cubicles into a dressing room for mothers when the maternity clinics are held. The cubicles are devised so that women enter one side and leave by the other, thus ensuring the maximum degree of privacy. A separate toddlers room is also incorporated. The dental and school medical side provides a medical consultation room and the dentist's surgery with a third room, accessible to both, which can be used either as a treatment room for medical cases, or as a dental recovery room. There are also the usual kitchen, food store, records and staff room, lavatories and pram shelter. The plan provides for approaches from Middleton Road and Green Wrythe Lane, from which thoroughfares it will be screened by a public library which it is proposed to erect on the site, and by suitably placed shrubs and trees. The building has a flat roof designed to carry protection against air raid in the form of sand bags or other suitable material. 39 40 Health Visiting.—The increased programme of clinics at which the attendance of the Health Visitors is required, considerably curtailed the time at their disposal for visiting the homes of mothers and children. In consequence the total visits, exclusive of those made in respect of infant life protection, fell from 10685 in 1936 to 6039 for the year under review. Since the close of the year, special toddler clinics have been instituted and these will make further in-roads into the time available for home visiting. An early increase in the staff of Visitors to 5 is thereby foreshadowed. Home visiting is probably the most effective phase of the welfare service and its place in the scheme must not suffer by reason of increased clinic facilities. Details of the home visits made (exclusive of visits under Infant Life Protection provisions) were as follows:— To expectant mothers— First visits 210 Total visits 544 To children under 1 year— First visits 871 Total visits 4,704 To children 1—5 years— Total visits 6,039 'Assisted' Milk and Other Foods.—Assistance given to mothers and children in the form of milk and foods was on a somewhat smaller scale than in the year before. Nevertheless the quantity supplied was considerable and this expenditure undoubtedly gives an ample return in benefit to health and physical development. It is one of those practical measures which are necessary if the advice and teaching given to the mothers under the scheme is to be implemented and made effective. The manner in which this help was distributed is shown in 41 TABLE 14. DISTRIBUTION OF "ASSISTED" MILK AND OTHER FOODS, 1937, WARD Number Assisted Fresh Milk (pints) Dried Milk (lbs.) Cod Liver Oil (ozs.) Cod Liver Oil & Malt (ozs.) Virol (ozs.) Vitoleum Cream (ozs.) Parrish's Food (ozs.) Families Individls. Free Half price Free Half price Free Half price Free Half price Free Half price Free Half price Free Half price St. Helier North 177 216 11642 7433 286 289 276 — 3099 1433 640 306 600 444 344 304 St. Helier South 76 115 6319 3771 286 162 168 204 996 1068 640 132 492 62 258 148 St. Helier West 97 132 8017 4820 219 107 64 — 2102 720 192 284 396 276 180 64 North-East 32 43 1768 777 166 6 16 16 412 112 192 52 100 — 16 48 North-West 18 30 2105 450 50 26 20 — 348 220 148 — 96 — 84 — Central 17 19 911 387 24 14 — — 256 64 52 — 96 32 16 32 South-East 21 28 1804 964 64 22 — — 416 474 176 16 — 16 48 16 South-West 3 3 — — 4 — — — — — 16 — — — — — Totals .. 441 576 32566 18152 1099 626 480 220 7629 4091 2056 812 1778 830 946 612 42 Table 14. In addition to these grants, 5714 lbs. of dried milk were supplied at cost price at the Centres. Dental Scheme.—Dental clinics are held twice monthly at the Municipal Institute, Rochester Road. A full dental service, including the supply of dentures, is provided. Details of the work done are as follows:— DENTAL SCHEME-TREATMENT PROVIDED, 1937 Temporary Teeth Permanent Teeth Dentures Supplied Extracted Filled Extracted Filled Full Partial 86 7 211 5 9 8 Anæsthetics Gas 70 Local 26 Other operations Impressions 48 Bites 21 Try-ins 22 Dressings 6 Scalings 10 Inspections 89 Dentures supplied— Full Partial Free 2 — Half Price 5 3 Full 2 5 Total 9 8 43 Attendances at the dental clinics are shown in the following Table:— DENTAL SCHEME-ATTENDANCES, 1937. Centre referred from No. Treated No. of Attend ces. Rochester Road Children 9 14 Mothers 18 33 Individuals 27 47 Wrythe Lane. Children 21 28 Mothers 30 118 Individuals 51 146 St. Helier. Children 3 3 Mothers 7 22 Individuals 10 25 Stanley Road. Children 2 2 Mothers 1 11 Individuals 3 13 All Centres. Children 35 47 Mothers 56 184 Individuals 91 231 Number of Sessions held 25 Average attendance per Session:— Children 1.88 Mothers 7.36 Individuals 9.24 44 Orthopaedic Treatment.—The Council has an arrangement with a masseuse for massage and corrective manipulation for early orthopaedic defects in children. Cases requiring specialist opinion are referred to the Croydon General Hospital. Assistance is given where necessary in the provision of surgical appliances and in-patient treatment in special hospitals. During the year one case was helped with special splints for genu-valgum and one case of club foot was maintained in a special hospital for 10 months of the year. Twenty-three children were given 484 treatments by the masseuse for the following defects:— Genu-valgum 18 Genu-varum 3 Weak muscle tones 1 Thyroid deficiency 1 23 Convalescent Treatment.—The scheme provides for convalescent treatment for mothers and babies, and children. The Council subscribes to the Convalescent Home for Surrey and gives financial assistance to cases provided with convalescent treatment through the agency of the Invalid Children's Aid Association. During the year one mother and baby and 4 children received treatment under these arrangements. They were for the following conditions:— Condition Age Duration of treatm't. 1. Debility following confinement Mother & Baby 2 weeks 2. Mismanagement 1½ years 3 months 3. Debility following pneumonia 3 „ 9 weeks 4. Debility and anæmia 3 „ 1 month 5. Debility following bronchitis 4 „ 3 „ Maternity Hospital Treatment.—The Council has an arrangement with the Carshalton, Beddington and Wallington District (War Memorial) Hospital for the admission of women requiring treatment for ante-natal conditions or confinement. Cases of puerperal pyrexia may be sent to Queen Charlotte's Isolation Hospital. The Council accepts financial responsibility in each case and requires a contribution according to means. Maternity cases are also referred to the County Hospitals. 45 The cases referred to hospitals during the year were as follows:— For obstetric and medical reasons. For unsuitable home conditions. Total. Carshalton (War Memorial) Hospital 17 l 18 County Hospitals 36 27 63 Other Hospitals 1 1 2 54 29 83 Consultant Service.—Specialist advice is available to practitioners in cases of complicated labour, emergencies of pregnancy and puerperal pyrexia. A second opinion was provided on 4 occasions during the year for the following conditions:— Puerperal pyrexia. Delayed Labour. Placenta praevia (2). Maternity Outfits.—Sterilised maternity outfits are provided, either free, at half-price or at cost price, according to means. Eleven of such outfits were provided in 1937, 5 at cost price, 1 at half price and 5 free of cost. Home Helps.—The services of a domestic help during confinement can be obtained under the scheme. The mother's contribution is fixed by an income scale. Twenty-nine mothers were provided with this assistance during the year. Midwives.—The County Scheme for a domiciliary midwifery service, formulated under the Midwives Act, 1936, came into operation during September. The scheme provided, in respect of Carshalton, for the appointment of 6 salaried midwives, 2 by the County Council, 2 by the district Council acting as agents for the County Council and 2 by the Carshalton District Nursing Association. The District Council's midwives commenced duty on the 13th September. As Officers of the Local Authority their work forms an integral part of the Council's Maternity and Child Welfare Scheme and is co-ordinated with all the other branches of the service. There is no doubt that this is the most effective arrangement of local midwifery schemes. 46 The full scale fees fixed by the County Council for the services of the midwives are as follows:— As Maternity Nurse 35s. As Midwife 40s. Provision is made in the scheme for reduced fees in necessitous cases. The following indicates the work done by the District Council s 2 midwives from the time of their appointment to the end of the year. Visits made:— Antenatal 140 During confinement 365 Attendances made by expectant mothers at the antenatal clinics with midwife in attendance 20 Cases conducted :— Primip. Multip. Tota| (1) As Midwife Live births 2 14 16 Still births — 1 1 (2) As Maternity Nurse Live births — 1 1 Still births — — — 2 16 18 Medical Aid Forms sent by Midwives 5 Malpresentation 1 Adherent placenta 1 Rupture of perineum 1 Cyanosis of infant 1 Phlebitis of leg 1 Number of cases attended by Council's midwives during the ante-natal period 13 Number of these cases which attended ante-natal clinics 13 Voluntary Helpers.—As in previous years, the welfare centres had the benefit of the untiring and willing assistance of a number of voluntary helpers. The value of this public service given with commendable regularity deserves the appreciation of the residents of the district. INFANT LIFE PROTECTION. The statutory provisions relating to Infant Life Protection previously contained in the Children and Young Persons Acts 47 1908-1932 are now included in Part VII of the Public Health Act, 1936, which came into force on the 1st October, 1937, and the original Acts have been repealed. The 4 Health Visitors are appointed Infant Protection Visitors for the purposes of the Act and strict and regular supervision is exercised over the foster homes in the district. Many of the foster children are received for short periods only, either pending adoption or as temporary arrangements made by the rescue societies until more or less permanent homes can be found. Although the average number of foster children on the register at one time was about 40, yet there were no fewer than 46 newcomers and 47 who left the district during the 12 months. It is primarily these frequent changes from one home to another which are responsible for the poor general condition which many foster infants are found to exhibit. Successful legal proceedings were taken against one person for failing to notify the reception and subsequent removal of a foster child. A fine of 20s. was imposed on each count. Summarised information relating to the supervision of foster children during the year is as follows:— Registered homes under supervision at the end of the year 31 New homes registered during the year 18 Children on the register at the end of the year 40 Children brought on to the register during the year 46 Children removed from the register during the year 47 Total number of foster homes under supervision during the year 46 Total number of foster children on the register during the year 87 Deaths — Legal Proceedings 1 Visits paid to foster children 400 DAY NURSERY. A day nursery administered by a voluntary Committee and situated near the centre of the district provides 18 places. It is supported by a substantial grant from the Council. The number of attendances in 1937 was 2895, an average of 13 for the days on which the nursery was open. The attendances were 390 higher than in the year before. 48 Section C.—Sanitary Circumstances. Water Supply.—The district is in the supply area of the Sutton District Water Company and is supplied chiefly with water from deep wells in the chalk, situated at Sutton, Cheam, and Woodmansterne and occasionally by water derived from river sources. Following the contamination which occurred in 1936, the Cheam Well remained closed throughout the whole of 1937. Reference was made in the report for 1936 to the revised arrangements for the control of this public supply and the analyses which were carried out during 1937 by the Company's resident Chemist and by the Local Authorities showed that the supply was wholesome and bacteriologically of a good quality. It was inevitable that slight difficulties should be encountered on the score of taste and palatability during a period when transition to different methods of treatment were being undertaken and those methods perfected, but at no time was the wholesomeness of the supply impaired. As was to be expected, in view of the happenings of 1936, the quality of the water supply was questioned by consumers from time to time during the year following gastric or intestinal illness which could not readily be otherwise explained, but investigation indicated that there was no foundation whatever for these fears. Six samples were taken by this Department from domestic taps in the district, 3 for chemical and 3 for bacteriological examination and all, as already stated, were satisfactory. The results of both types of analyses of a sample submitted to the Public Analyst and supplied from the Sutton deep wells is given below:— CHEMICAL ANALYSIS IN PARTS PER 100,000 Total solid residue 22.8 Combined chlorine 2.33 Nitric nitrogen 1.41 Nitrous nitrogen 0.022 Ammonia, free and saline 0.0003 Ammonia albuminoid 0.0005 Oxygen absorbed from permanganate in 4 hours at 80° F. .. 0.029 Hardness by acidimetric titration 13 BACTERIOLOGICAL EXAMINATION. Number of colonies per ml. developing upon agar at 22Q C 1 Number of colonies per ml. developing upon agar at 37° C 1 B. coli absent in 100 ml. Streptococci do. B. Welchii do. This is a water of a very high degree of organic purity (the somewhat high figure for permanganate oxygen absorbed is mainly due to the nitrous nitrogen) and the bacteriological character is excellent. 1 his water is well fitted for the public supply. 49 Drainage and Sewerage.—The district has separate sewers for foul and surface water. Sewage is disposed of by an arrangement with the Croydon Corporation whereby the whole of the sewage of the district is pumped to the works of that Authority. The scheme referred to in last year's report for providing main lines of drainage for the southern end of the district was completed in 1937 and the Western Valley section, ending in Grove Lane, has been extended by the Estate developers up to Clock House Farm to provide drainage for that Estate. Following the completion of the Southern Extension Scheme No. 2, as mentioned above, the drainage of the Surrey County Council's Smallholdings, Little Woodcote Estate, was proceeded with by this Council acting as agents for the Surrey County Council and the works were within a few weeks of being finished by the end of 1937. In the Culvers area the scheme described in the report for 1936 for the abolition of the Nightingale Road Pumping Station with re-drainage to the main Culvers Pumping Station has been completed, the old station being put out of action in December. The £12,000 surface water drainage scheme, described in the report for 1936 was completed early in 1937 and appears to have been effective in removing nuisance of flooding at various places between The Warren and the Upper Pool where the new sewer discharges. Fifty drainage obstructions, affecting 326 houses, were dealt with and drainage repairs were executed at 52 premises. Rivers and Streams.—The heavier winter rainfall of the past two years has had its effect in the maintenance of a stronger and more continous flow from the springs which form the source of one head of the River Wandle in this district. The routine work of cleansing was carried out, but no works of major importance were undertaken. In its course through the district, the River Wandle fed two groups of watercress beds. In the autumn, as the result of the attention which was directed to watercress during the typhoid outbreak in Croydon, special investigation of these beds was undertaken and samples of the water in which the commodity was grown 50 were submitted for analysis. No enteric or pathogenic organisms were found. Later in the year one group of these beds was closed and the site developed as a housing estate. Closet Accommodation.—Reference has been made above to the progress achieved during the year in sewering the Smallholdings. Since the end of the year, this scheme has been completed with the result that cesspools draining 61 of these premises have now been abolished. Four other cesspools were abolished during the year. The number of cesspools now remaining is 17 and, with the exception of one or two pail closets, the remainder have water carriage and are drained to sewers. Thirty-one premises were redrained, 27 additional W.C.'s were provided and 75 W.C.'s were repaired or renewed during the year. Public Cleansing.—There is a weekly collection of house refuse by covered freighters. Trade refuse is also collected on payment of a moderate charge. Disposal is by incineration at the Council's 6-cell Destructor. No important change in system, plant or capacity was made in 1937. Sanitary Inspection of the Area.—The work of sanitary inspection carried out during the year is shown in the following report, under Article 27 of the Sanitary Officers' Regulations 1935, of Mr. H. J. Spicer, M.R.S.I., the Chief Sanitary Inspector. Four hundred and sixty-seven complaints were received, classified as follows:— Drainage obstructions 60 Rats and Mice 58 Miscellaneous 49 Shops Acts 31 Dampness 28 Overcrowding 26 General defective conditions 22 Vermin 19 Deposits and accumulations 18 Smells 16 Dustbins 14 Defective roof 14 Defective W.C. 13 Defective Drainage 12 Smoke 12 51 Refuse collection 10 Wasps 10 Sewer obstructions 8 Burning of refuse 8 Unfit food 7 Unclean houses 5 Defective fireplaces 5 Ants 4 Stalls 3 Flooding 3 Noise 3 Sink waste pipe 3 Rags for toys 2 Dogs defiling footways 2 Ceilings 1 Water Supply 1 The number and nature of inspections were as follows:— Inspections 5275 Reinspections 3429 Housing (H.A.) 408 „ (P.H.A.) 1286 Slaughter houses 66 Dairies 34 Cowsheds 67 Milk Shops 114 Factories 37 Workshops 18 Outworkers 38 Bakehouse factories 11 „ workshops 2 Laundry factories 4 Houses drains tested 156 Food shops and business premises 355 Infectious disease premises 582 Urinals 106 Smoke observations 6 Rat infested premises 418 Schools 27 52 One thousand three hundred and eighty-six informal notices were served for the following purposes Toys for rags 2 Information in rentbooks 243 Defective premises 475 Byelaw (Houses let in lodgings) I Rats 299 Vermin 21 Accumulations 97 Drainage obstructions 112 Water courses 79 Miscellaneous 48 House refuse accommodation 24 Drainage defects 75 Connection to sewer 7 Street Traders 13 Smoke nuisances 6 Factory and Workshops 4 1386 (Notices of intention to inspect were served with respect to 408 houses.) Forty-seven formal notices were served under the following Acts: Housing Act, 1936—(Section 9) 2 ,, ,, ,, —(Section 66) 9 Public Health Acts 1875 (Section 91) 20 „ „ „ „ (Section 41) 12 „ „ „ „ (Section 36) 1 „ „ „ „ 1936 (Section 93) 3 47 As a result of the serving of notices, the following works were executed:— premises Brickwork repaired and/or renewed 52 Ceiling plaster repaired and made good 122 cleansed and purified 249 53 premises Chimney pots repaired or renewed 34 stacks repaired or renewed Coppers repaired and/or renewed 12 Cement fillets renewed 39 Cesspools abolished 18 Damp conditions remedied 186 Doors repaired (including locks and fasteners) 49 sills repaired, renewed or provided 19 frames repaired or renewed 8 Drainage repaired or reconstructed 12 provided 29 Inspection chamber provided 39 „ „ cover renewed 8 „ „ cover provided 41 stoppers refixed or renewed 1 „ provided 15 interceptors renewed 1 „ provided 15 F.A.I, repaired or renewed 8 „ provided 15 M.F.V. renewed 8 „ provided 15 Soil or vent pipes repaired or renewed 8 „ „ „ provided 14 drains tested 156 „ cleared 50 waste gullies repaired and/or renewed or cleared 18 „ gullies provided 1 Drainage Waste pipes repaired or renewed 13 approximately 4326 feet of new drainage were laid during the year. Disinfestation 55 Dustbins provided 27 Fences repaired or renewed 5 54 premises Food Storage accommodation provided 37 accommodation ventilated 7 Floor boards repaired and/or renewed 38 concrete repaired, renewed and or made level 13 ventilation repaired and/or renewed ventilation provided 12 Firegrates repaired and/or renewed 52 Ranges and/or Stoves repaired and /or renewed 28 Light more provided 9 Roofs repaired and made weatherproof 93 stripped and recovered 10 flashing repaired and/or renewed 10 ridges, hips, valleys, repaired and/or renewed 10 guttering and/or down pipes repaired and/or renewed 63 Sinks renewed 10 Stair treads repaired or renewed 9 handrails and/or balusters repaired 8 „ „ „ provided 2 Steps provided with handrails 1 Soakaway made to work properly 19 Walls cement rendered 22 „ rendering repaired replastered or repaired 144 cleansed and redecorated 225 settlements 5 Windows repaired and/or renewed 64 provided with catches and /or fasteners 58 sashcords renewed 112 sills repaired and/or renewed 27 stopping to reveals 4 W.C. accommodation repaired 1 provided 29 pans renewed 23 pans provided 30 55 Premises pans joints renewed 0 box seats removed 39 W.C. ventilated 1 lift up seats provided 29 seats repaired or renewed 54 flushing apparatus repaired or renewed 20 „ „ provided 29 Water Supply repaired provided 7 Wash Basins, baths, repaired or renewed 6 Paving repaired made level 37 drained 12 Other Matters (miscellaneous) 66 Glazing putty renewed 44 Gates repaired renewed 6 Accumulations removed 23 Disinfection and Disinfestation.—Disinfection of premises was carried out following infectious disease in 409 instances. One hundred and twenty-one lots of bedding were removed for the same purpose, while 16 lots were destroyed. The practice of powdering dustbins with a disinfectant powder was continued during the warmer months. Infestation by the bed bug was dealt with in 55 houses in the following way:— Council Houses. Others Total By H.C.N, fumigation 6 24 30 By spraying with insecticide 11 14 25 17 38 55 Fumigation with H.C.N, gas was carried out by a private Contractor. Insecticidal spraying was done in the majority of instances by the Department. 56 The homes of all incoming tenants of Council houses are visited and where bed bug infestation is found or suspected, the household effects are fumigated with H.C.N. before being unloaded into the new house. Thirty-four vanloads of furniture were treated in this way in 1937. All Council houses are visited and supervised by the Council's Estates Manager. Mosquito Control.—Water places in the district, owned by the Council, were sprayed on two occasions at periods when it was most likely to destroy or prevent the breeding of mosquito larvae. Rats and Mice (Destruction) Act, 1919.—As in previous years a week's campaign was organised in the district during National Rat Week by Mr. H. J. Spicer, the Chief Sanitary Inspector. The district was posted with double crown posters ; chemists and hardware merchants were supplied with rat destruction literature and details for circulation; advertisements were issued in the local press and the whole of the sewers in the district were baited with rat bait. Smoke Abatement.—Six complaints of alleged nuisance from smoke were received and these were satisfactorily dealt with. No legal action was necessary under the Public Health (Smoke Abatement) Act, nor under the local bye-laws. Schools.—The Department works in co-operation with the County School Medical Service in the control of infectious disease among school children, and in all sanitary matters affecting their health. Policy is based on the recommendations contained in the "Memorandum on Closure and Exclusion from School, 1927," issued conjointly by the Ministry of Health and Board of Education. Twenty-seven inspections to school premises were made. Cemeteries.—The Surrey County Council have promoted a Bill, which if passed into law, will, inter alia, provide the district with approximately 25 acres of land for burial purposes in Lower Morden. 57 Mortuary.—Work is now in progress on the new mortuary building which is of modern design and incorporates adequate facilities for post-mortem examinations. Shops Acts, 1912-1936 .—The Chief Sanitary Inspector and the 2 District Inspectors are appointed Inspectors under the Shops Acts. There are approximately 550 premises which come under the operationn of these Acts. During the year 1049 inspections were made to shops and notices were served in respect of the following 297 infringements:— Mixed shops notices 94 Compensatory holidays 86 Sunday trading 47 Closing hours 11 Assistants' weekly half day notice 10 Temperature maintainance 11 Form H. 7 Shop weekly half day closing notice 6 Form F. 6 Sanitary Accommodation 5 Hours worked by young persons 4 Form G. 4 Form K. (seats) 2 Ventilation maintenance 1 Form VII 1 Misleading notices 1 Meal intervals 1 Statutory notices were served with regard to 7 shops. One hundred and seventy-one informal notices were also served. Periodic inspections of shops are made on Sundays and during evening closing hours. No partial exemption order has been made. Two prosecutions were taken, one for infringement of the Wednesday half day closing, the other for infringement of evening closing hours. Both were successful. Section 10.—Details of the operation of Section 10 of the 1934 Act, relating to the health and comfort of shop assistants, during 1937 are as follows:— 58 (a) Inspections made 1049 (b) Formal notices served 7 (c) Number of shops found without sanitary veniences and suitable washing accommodation 1 Number of exemption certificates granted in respect of sanitary conveniences and washing accommodation 1 (d) Number of shops without means of maintaining a reasonable temperature 11 Number which have complied with the requirements in respect of maintaining a reasonable temperature during the year 18 Swimming Baths and Pools.—There is one privately owned indoor swimming bath in the district, measuring 46 feet long by 23 feet wide. Occasional visits were made to these premises, where the water is subjected to a constant process of precipitation, filtration, and chlorination by gaseous chlorine. A Swimming Baths Sub-Committee, appointed by the Council, is preparing a scheme for the construction of a public baths. 59 Section D.—Housing. New Houses.—New houses erected during 1937 numbered 312 compared with 511 built the year before. They were distributed as follows:— WARD By the Council By Private Enterprise Total St. Helier North — 1 1 St. Helier South — — — St. Helier West — — — North-East 98 51 149 North-West — 29 29 Central — 40 40 South-East — 68 68 South-West — 25 25 Whole District 98 214 3'2 Council's Housing Scheme.—The houses erected by the Council under the various Acts up to 31 st December, 1937, are as follows: Act under which erected. No. of Properties Type (P—Parlour. N.P.—Non-Parlour) 1919 203 P. 3 bedroom 2 N.P. 3 „ Flats 5 N.P. 3 „ 210 1923 12 N.P. 3 bedroom 28 N.P. 2 „ Flats 8 N.P. 1 „ 48 1924 40 P. 3 bedroom 72 N.P. 3 „ Flats 56 N.P. 2 „ 168 1930 10 N.P. 4 bedroom 52 N.P. 3 „ 4 N.P. 2 „ Flats 20 N.P. 2 „ 86 1930/35 18 N.P. 2 bedroom 60 N.P. 3 „ 12 N.P. 4 „ 4 P. 4 „ 94 Total 606 60 A further 8 houses, 4 P.-4 bedroom type and 4 N.P.-4 bedroom type have since been completed on the Cottage Farm Estate. The number of applications received during 1937 298 The number of tenancies allotted during 1937 150 The number of applications outstanding at 31 st Dec., 1937 441 The interest of the working-classes in the houses recently erected is shown by a great increase in the number of applications received. A good proportion of these have been received from residents on the London County Council's St. Helier Housing Estate, who already have adequate accommodation. Since the end of the year all the outstanding applicants were requested to complete a fresh form if they still desired to pursue their applications. As a result of this, the number of applications on the Council's books at February 14th, 1938, was 215. Inspection and action taken under Statutory Powers.— The work performed in relation to housing under the Housing and Public Health Acts was as follows:— 1. Inspections of Dwelling Houses during the Year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1694 (b) Number of inspections made for the purpose 4333 (2) (a) Number of dwelling houses (included under head (1) above), which were inspected and recorded under the Housing Consolidated Regulations, 1925 408 (b) Number of inspections made for the purpose 2482 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 447 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 local authority or their officers 440 (including some houses inspected during 1936). 61 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 2 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 2 (b) By local authority in default of owners — (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 36 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 32 (b) By local authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which lition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1936, Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at end of year 92 (2) Number of families dwelling therein 92 (3) Number of persons dwelling therein 633 (b) Number of new cases reported during the year 68 (c) (1) Number of cases of overcrowding relieved during the year 155 (2) Number of persons concerned in such cases 969i (d) Number of cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil 62 Slum Clearance.—Housing conditions are generally good, the majority of dwellings being of comparatively recent construction. The work of removing those properties which, chiefly through age and disrepair have become unfit for human habitation, was continued. Since the beginning of this programme in 1930, 5 Clearance Orders have been confirmed by the Minister of Health, involving 58 houses and the rehousing of 461 persons. A further 19 houses have been demolished individually, 5 by formal action and 14 by informal action. During the year an official representation in respect of an additional block of 6 cottages forming Clearance Area No. 6—West Street was made to the Council, who proceeded by way of a compulsory purchase order under Section 29 of the Housing Act, 1936. A scheme was undertaken for the erection of 102 houses on the Cottage Farm Estate to provide, inter alIa, rehousing for the tenants displaced from Clearance Area No. 5—William Street referred to in the report for 1936 and for cases of overcrowding. The tenants from the Clearance Area were removed into the new premises and the old premises were demolished during the year. The number of houses made fit during the year under the Housing Acts was 270, 2 by formal and 268 in anticipation of formal action. This brings the total made fit since 1925 under the Housing Acts up to the 31st December, 1937, to 1227. Housing Act, 1936.—Overcrowding.—At the survey of overcrowding completed in the early days of 1936, 173 houses, involving 1162 equivalent adults, were found to be overcrowded. By the end of 1936, in spite of decrowding 49 families, the net number of those overcrowded had increased to 179 with 1163 equivalent adults. During 1937 a nett reduction of 87 in this number was effected, leaving 92 dwellings with 633 equivalent adults still to be decrowded at the end of the year. This nett reduction of 87 cases was broueht about as follows:— Overcrowded at December 31st, 1936 Dwellings found overcrowded during 1937 Houses decrowded during 1937. Remaining overcrowded at 31st December, 1937 Net reduction during year. Families 179 68 155 92 87 Equivalent adults 1163 439½ 969½ 633 530 63 Eleven of the new cases of overcrowding were illegal. Seven were abated by informal action and 3 by service of statutory notice. One was outstanding at the end of the year. The 155 families were decrowded during the year in the following manner:— 1. By provision of alternative accommodation— (a) By Carshalton Council 37 (b) By London County Council 45 2. Left the district 25 3. By removal of one or more occupants 42 4. The families themselves securing alternative accommodation 6 The position in respect of overcrowding in the individual wards up to the end of 1937 was as follows:— Ward. Houses overcrowded at Survey. Houses found overcrowded up to Dec. 31st, 1937. Houses decrowded up to Dec. 31st, 1937. Houses remaining overcrowded at 31st Dec. 1937. St. Helier North 40 (a) 21 (b) 37 (h) 24 (b) St. Helier South 40 (b) 17(5) 32 (b) 25 (b) St. Helier West 45 (b) 26 (f) 44 (i) 27 (b) North-East 17(c) 9(d) 24 (e) 2 North-West 10 25 33 2 Central 9(d) 10 16 (d) 3 South-West - 3 2 1 South-East 12(e) 11(s) 15(j) 8(e) Totals 173 122 203 92 (a) 39 L.C.C. houses. (b) All L.C.C. Houses. (c) 4 Carshalton U.D.C. houses. (d) 1 Carshalton U.D.C. house. (e) 5 Carshalton U.D.C. houses. (/) 24 L.C.C. houses. (g) 7 Carshalton U.D.C. houses. (h) 36 L.C.C. houses. (i) 42 L.C.C. houses. (j) 7 Carshalton U.D.C. houses. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933.—One application was received and granted. 64 Factories, Workshops and Workplaces.—The following premises were on the register at the end of the year. Number Approximate persons employed Factories 53 460 Workshops 68 117 Outworkers' premises 104 107 Factory and Workshop Act, 1901.—The following table, set out in the manner prescribed in Home Office Form 572, indicates the inspections carried out and the action taken under the above Act:— 1. Inspection of Factories, Workshops and Workplaces. (Including inspections made by Sanitary Inspector or Inspectors of Nuisances). Premises. 1 Number of Inspections 2 Number of Written Notices 3 Number of Occupiers prosecuted 4 Factories (including factory laundries) 37 4 — Workshops (including workshop laundries) 56 - - Workplaces (other than outworkers' premises) - - - Total 93 4 - 65 2. Defects found in Factories, Workshops and Workplaces. Particulars 1 Number of Defects Number of offences in respect of which prosecutions were instituted 5 Found 2 Remedied 3 Referred to H.M. Inspector 4 Nuisances under the Public Health Acts*— Want of cleanliness 3 3 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances — — — — Sanitary accommodation— Insufficient — — — — Unsuitable or defective — — — — Not separate for sexes 1 — — — Offences under the Factory and Workshop Acts— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — (Excluding offences relating to outwork and offences under the sections mentioned in the schedule to the Ministry of Health. (Factories and Workshops Transfer of Powers) Order, 1921) — — — — 4 3 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 66 Outwork in Unwholesome Premises, Section 108 Nature of Work (1) Instances (2) Notices served (3) Prosecutions (4) Wearing Apparel:— Making, etc. Nil Nil Nil Cleaning and washing Nil Nil Nil Other trades Nil Nil Nil Total Nil Nil Nil Section E.—Inspection and Supervision of Food. Milk Supply.—There are four producers of milk in the district with a total of about 120 cows. Two are licenced to produce Accredited Milk. The number of retailers on the register is 112, of whom 5 were registered during the year. Fifty-seven of the retailers have premises in the district, the remaining 41 retail milk brought from premises outside. Very little raw milk is sold in the district, the bulk of the supply being pasteurised, although not all sold as pasteurised. Periodic inspection is carried out of all cowsheds, dairies and milkshops and 100 samples of graded and ungraded milk were taken for bacteriological examination during 1937. An analysis of the results of these examinations is shown in table 15. Milk (Special Designations) Order, 1936.—Licences to retail milk under the above Order were issued by the Council as follows:— Licences to use the "Tuberculin Tested" 7 „ „ „ „ "Pasteurised" 10 Supplementary Licences to use the term "Tuberculin Tested" 10 Supplementary Licences to use the term "Accredited" 1 „ „ „ „ „ "Pasteurised" 12 Meat and Other Foods.—Most of the meat consumed in the district comes from the London and Croydon Markets and has already been inspected. 67 TABLE 15. MILK SAMPLES, 1937 Total Bacterial Count Bacillus Coli. Test Methylene Blue Test Tubercle Test Grade No. examined Highest Average Lowest No. examined Absent in l/10th c.c. Absent in 1/100th c.c. Absent in 1/I000th c.c. No. examined Satisfactory No. examined Negative Ordinary 51 480,000 42,554 960 51 36 43 48 51 44 — — Pasteurised 41 80,000 11,065 400 41 39 41 41 26 24 — — Accredited 8 56,600 10,540 1360 8 7 7 7 8 7 — — Only one slaughterhouse, a registered one, is used in the district to which 66 visits were made in 1937. There are 34 purveyors of meat with shops in the district and several hawkers with vans from other districts. Frequent visits of inspection are made by the Sanitary Inspectors to premises where food is stored. DreDared or sold for human consumption. The number of carcases examined and condemned was as follows:— Cattle excl'd'ng Cow Cows. Calves Sheep and Lambs Pigs Number killed (if known — — 9 77 166 Number inspected — — 9 77 166 All diseases except tuberculosis. Whole carcases condemned — — — — 4 Carcases of which some part or organ was condemned — — — — 3 Percentage of the number inspeced affected with disease other than tuberculosis — — — — 4.2 Tuberculosis only. Whole carcases condemned — — — — 4 Carcases of which some part or organ was condemned — — — — 2 Percentage of the number inspected affected with tuberculosis — — — — 3.6 69 The total food condemned was:— Swine : 8 carcases and offal. 2 heads. 1 lung. 2 livers. Fish : 5 stone of whiting. 60 lbs. cod fish. The Slaughter of Animals Acts, 1933.—Three persons were licenced to act as slaughtermen and every step has been taken to ensure that all animals slaughtered in the District have been slaughtered in accordance with the Act. Ice Cream.—There are 60 premises trading in ice-cream but only in three is ice cream actually manufactured. All premises and ice cream vehicles were periodically inspected. Bakehouses.—There are seven bakehouses within the District. All were visited and found to have complied with the require ments in respect of cleansing and whitewashing. 70 Food and Drugs (Adulteration) Act.—1928. The following information supplied by the County Medical Officer shows the samples of foods and drugs analysed and the action taken under the above Act in respect of the Carshalton area:— Articles Analysed Adulterated or Deteriorated Prosecutions Con- victions Formal Informal Total Formal Informal Total Milk 22 2 24 1 — 11 — — Cream — — — — — — — — Butter 2 — 2 — — — — — Cheese — — — — — — — — Margarine — — — — — — — — Lard — — — — — — — — Meat 1 — 1 — — — — — Flour — — — — — — — — Tea — — — — — — — — Coffee — — — — — — — — Cocoa — — — — — — — — Sugar — — — — — — — — Sausages 2 — 2 — — — — — Confectionery and Jam — — — — — — — — Sausage meat — — — — — — — — Wine — — — — — — — — Beer — — — — — — — — Spirits 2 — 2 1 — 1 — — Drugs — — — — — — — — *Other articles 7 — 7 — — — — — Totals 36 2 38 2 — 2 — — *Details of other articles Ground Almonds 2 — 2 — — — — — Wood Vinegar 1 — 1 — — — — — Choc-o-nuts 1 — 1 — — — — — Crystallised fruit drops 1 — 1 — — — — — No. 15 Rose Pink Tint 1 — 1 — — — — — Opedia 1 — 1 — — — — — * Adulterated sample incorrectly pasturised. 71 Health Propaganda.—The district participated in the Surrey County Health Campaign which was promoted conjointly by the County Council and the Authorities of the more urbanised districts of the County. The organised activities covered the period October 1937, to March 1938, and included 5 Health Days, one in each month, excepting December, when films were shown to school children, meetings organised for mothers in the afternoon and for the general public in the evening, at which experienced speakers gave addresses on health topics with which they were specially qualified to deal. These talks were illustrated also by films. Section F.—Prevalence of and Control over Infectious and other Diseases. Separate figures are given in this section where they occur relating to Queen Mary's Hospital for Children and for the rest of the district. The London County Council Hospital is almost a closed community and has a patient population of over 1,000 children drawn exclusively from London and whose human contact is almost entirely with visiting residents of London. The prevalence of the common infectious diseases, particularly scarlet fever and diphtheria, was again heavier on the St. Helier Estate. Notification.—The following diseases are notifiable in the district :— Smallpox. Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlatina or Scarlet Fever. Typhus Fever. Typhoid Fever. Enteric Fever. Relapsing or Continued Fever. Cerebro-Spinal. Acute Poliomyelitis. Ophthalmia Neonatorum. Puerperal Pyrexia Tuberculosis. Malaria. Dysentery. 72 Acute Primary Pneumonia. Acute Influenzal Pneumonia. Acute Encephalitis Lethargica. Acute Polio- Encephalitis. Smallpox.—No cases were notified. Enteric Fever.—One case of enteric fever due to the bacillus typhosus was notified in an adult female who was employed in that part of South Croydon which was at risk during the Typhoid outbreak in that town in the last months of 1937. She was admitted to isolation hospital but succumbed to the disease. The incidence and death rates for this disease were 0.01 per thousand population. Dysentery.—During the last two months of the year the district experienced an unusual prevalence of diarrhoea. A series of cases were investigated and the dysenteric organism of Sonne was isolated in each instance. There is no doubt that this unusual incidence was due to this organism. Fifty-three notifications of dysentery were received but it is certain that they represented only the more severe cases of this illness at a time when this organism was active over a large part of the London area. The illness on the whole was of short duration and was not accompanied by dangerous features. It attacked both sexes and all ages indiscriminately. There was no evidence to indicate any particular food as the primary source of this infection but it no doubt owed much of its persistence to the handling of food by mild ambulatory or incompletely recovered cases. Scarlet Fever.—Scarlet Fever of a mild type was again very prevalent. Two hundred and ninety-four notifications were received compared with 240 in the year before. Of the total, 275 occurred outside hospitals. The incidence rates were, therefore:— All cases notified 5.06 per 1,000 population. Cases excluding Queen Mary's Hospital 4.73 „ „ „ (England and Wales 2.33 „ „ „ ) Two hundred and sixty-three cases, representing 89 per cent of the total were removed to isolation hospital. There were no deaths. 73 The distribution of the infection is shown in the following table. TABLE 16 SCARLET FEVER—WARD INCIDENCE, 1937 (Excluding Queen Mary's Hospital.) WARD Cases Rate per 1,000 population, St. Helier North 102 11.88 St. Helier South 51 6.99 St. Helier West 34 4.25 North-East 22 2.99 North-West 36 4.91 Central 9 1.53 South-East 16 2.30 South-West 5 0.74 Whole District 275 4.73 As in the year before the attack rate was highest on the St. Helier Estate. The seasonal prevalence is shown in Table 17. TABLE 17. SCARLET FEVER-MONTHLY DISTRIBUTION 1937. Wards 1937 St Helier North St.Helier South St Helier West NorthEast NorthWest Central SouthEast SouthWest Total January 4 6 - 2 1 3 4 - 20 February 6 7 3 1 3 — 3 - 23 March 1 4 2 — 1 1 1 - 10 April — 5 2 2 5 1 1 - 16 May 7 4 5 3 6 1 2 2 30 June 7 1 4 5 6 1 - — 24 July .. 3 7 4 4 7 — 1 1 27 August . . 3 2 3 2 — — 1 — 11 September 24 4 3 — 2 1 2 1 37 October .. 29 5 2 1 2 — - — 39 November 9 5 4 2 2 1 1 1 26 December 9 1 2 — 1 — — — 13 Totals 102 51 34 22 36 9 16 5 275 Monthly Mean 8.5 4.2 2.8 1.8 3.0 0.7 1.3 0.4 22.9 74 Multiple Cases—The houses in which more than one case occurred are shown below:— TABLE 18. SCARLET FEVER—MULTIPLE CASES 1937. WARD Number of houses in which occurred Total Houses Total Cases 1 case 2 cases 3 cases St. Helier North 77 11 1 88 102 St. Helier South 45 3 — 49 51 St. Helier West 23 4 1 28 34 North-East 15 2 l 18 22 North-West 20 5 2 27 36 Central 7 1 — 8 9 South-East 12 2 — 14 16 South-West 5 — — 5 5 Whole District 204 28 5 237 275 There were 14 " return cases" Diphtheria—Ninety-three cases were notified, of which 46 were from Queen Mary's Hospital. The balance of 47 cases occurring in the district was 6 less than in the year before. The incidence rates were:— All cases notified 1.60 per 1,000 population. Cases excluding Queen Mary's Hospital 0 80 ,, „ ,, (England and Wales 1.49 ,, ,, „ ) All were admitted to isolation hospital. The ward distribution of the notified cases is shown in table 19 TABLE 19. DIPHTHERIA—WARD INCIDENCE 1937 (Excluding Queen Mary's Hospital.) Ward Cases Rate per 1000 population St. Helier North 7 0.82 St. Helier South 9 1.23 St. Helier West 13 1.63 North-East 7 0.95 North-West 4 0.55 Central 7 1.19 South-East — — South-West — — Whole District 47 0.80 75 TABLE 20. DIPHTHERIA—MULTIPLE CASES 1937. Ward No. of houses in which occurred Total houses Total cases 1 case 2 cases 3 cases 4 cases St. Hel:er North 7 7 7 St. Helier South 9 — — — 9 9 St. Helier West 7 — 2 — 9 13 North-East 5 1 - — 6 7 North-West 2 1 3 4 Central 7 - - — 7 7 South-East - - - - - - South-West - - - - - - Whole District 37 2 2 — 41 47 TABLE 21. DIPHTHERIA—MONTHLY DISTRIBUTION 1937. WARD 1937 St.Helier North St.Helier South St.Helier West NorthEast NorthWest Central SouthEast SouthWest Total January — — 1 4 l 4 — — 10 February 1 — — — — 1 — — 2 March 1 1 l 1 — 1 — — 5 April — 2 2 May 2 2 — — 1 — — — 5 June — — 3 — — — — — 3 July 1 — — i — — — — 2 August — 1 4 — l — — — 6 September — — 3 1 1 — — — 5 October - - - - - - - - - November 1 2 - - - - - - 3 December 1 1 1 — — 1 — — 4 Totals 7 9 13 7 4 7 — — 47 Monthly Mean 1.78 2.29 3.32 1.78 1.02 1.78 0.0 0.0 3.92 There were 4 deaths from diphtheria, 3 boys aged 11 years, 5 years and 4 years and 1 girl aged 5 years. 582 swabs were examined for diphtheria, of which 44 were positive. 76 Diphtheria "Carriers."—Ten persons were found on examination to have positive swabs but without any clinical evidence of diphtheria. With an increasing number of persons becoming artificially immunised, it becomes more and more important carefully to investigate the significance in each case of a positive swab. Where, as in this district, a practice is made of securing swabs of the home contacts of every case of diphtheria, it is inevitable that many immunised children will be swabbed and a certain proportion will probably be found to have positive swabs without suffering from the illness. This is one type of " carrier," but there is another which is more difficult to identify and that is the one which carries diphtheria whilst suffering from another infection. A striking instance of this occurred during the year. Two sisters, both of whom had been immunised 12 months previously, developed sore throats. The doctor in attendance, in view of the fact that the brother had suffered from diphtheria a year before, swabbed both patients and the result in both cases was returned as positive. They were admitted to isolation hospital and a third child in the home, without symptoms, was then swabbed and also found to be positive. She too was admitted to hospital. The two immunised patients with sore throats each presented a typical clinical picture of follicular tonsillitis and had no evidence of diphtheria other than the positive swab. Had the investigation been left at that stage it would have been difficult to maintain the view which was formed, that these cases, while carrying diphtheria bacilli, were not suffering from the disease but from a follicular tonsillitis. However, further swabs were examined and the diphtheria organisms, again found, were tested for virulence and in all three cases, the two with sore throats and the one without symptoms, the bacilli were found to be non-virulent. Whilst it is an easy matter to assert that patients with throat infections cannot be suffering from diphtheria where the organism is shown to be non-virulent, what of the cases with positive virulent swabs but against which is the clinical evidence and the fact of immunisation ? Diphtheria Immunisation.—The number of persons immunised under the Council's scheme is shown in the tables which follow : 77 PERSONS IMMUNISED AT THE CLINIC-1937. WARD Age Groups Total 0—5 5-15 15 & over St. Helier North 24 5 29 St. Helier South 21 8 — 29 St. Helier West 13 4 — 17 North-East 13 43 — 57 North-West 32 16 — 48 Central 9 14 — 23 South-East 8 8 — 16 South-West 2 2 — 4 Total 122 100 - 222 PERSONS IMMUNISED BY PRIVATE PRACTITIONERS, 1937. WARD Age Groups Total 0-5 5-15 15 & over St. Helier North 1 2 3 St. Helier South — - - - St. Helier West — 3 — 3 North-East 2 4 — 6 North-West 6 4 — 10 Central 2 2 — 4 South-East — - — - South-West 1 1 — 2 Total 12 16 — 28 CHILDREN IMMUNISED IN SCHOOLS, 1937 (5-8 Years). Completed at year end Not completed at year end St. Helier No. 6 Infants 104 3 St. Helier No. 7 ,, 98 3 St. Helier No. 8 ,, 82 2 St. Helier No. 9 „ 59 - St. Helier No. 10 „ 81 1 Total 424 9 Total persons immunised under the Scheme in 1937—683, 78 Erysipelas.—Notifications were received in respect of 13 cases of erysipelas compared with 15 in the year before. The face or head was affected in each case. Four received hospital treatment, the remainder were nursed at home. There was one death in an elderly male. Pneumonia.—Respiratory infections were more prevalent in 1937 and there was a corresponding increase in the notifications of pneumonia. One hundred and fifteen cases were notified, of which 30 were stated to be influenzal. All but 4 of the influenzal cases occurred during the first three months of the year. Measles.—The biennial wave of measles infection did not coincide with 1937. As a result only 89 cases among school children were reported by the Flead Teachers, compared with 491 in the year before. They occurred in the following months:— January 13 July 1 February 14 August — March 16 September 1 April 36 October — May 4 November 1 June 3 December — There were no deaths from measles. Whooping Cough.—Like measles, whooping cough is not a notifiable disease in the district. School reports show that 124 cases occurred among school children, distributed throughout the the year as follows:— January 1 February 8 March 27 April 37 May 18 June 19 July 7 August - September 5 October 1 November — December 1 There were no deaths from this disease. Ophthalmia Neonatorum.—One case of this disease of the new-born was notified. It was of moderate severity and was admitted to a special hospital under the Council's scheme. It was discharged after approximately six weeks treatment with its vision unimpaired. 79 Cases Vision unimpaired Vision impaired Total blindness Death Notified Treated In hospital At Home 1 1 - l — — — Prevention of Blindness.—Information as to blindness occurring in children under five years of age coming to our notice through the maternity and child welfare scheme is transmitted to the Surrey Voluntary Association for the Blind, in accordance with the recommendation contained in Memo. 162/B.D. No action was taken under Section 66 of the Public Health Act, 1925, nor under Section 176 of the Public Health Act, 1936. Puerperal Fever and Puerperal Pyrexia.—Notifications received under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, were as follows:— Puerperal Fever 1 Puerperal Pyrexia 5 The services of a Consultant are available to practitioners for cases of puerperal fever and puerperal pyrexia, whilst patients requiring special treatment may be admitted to Queen Charlotte's Isolation Hospital under the Council's Scheme. One consultation was held for pyrexia. Three of the cases were admitted to Queen Charlotte's Hospital. Two of the 6 cases were not residents of the district. The main facts relating to these cases are as follows:— 80 Notified as Para. Day of onset Duration of Pregnancy Clinical Notes Admitted to Hospital Result 1. Pyrexia 1 4th Term Due to influenza. No Recovered 2. Pyrexia 1 4th Term Caesarian section— sapraemia due to retained clot. No Do. 3. Pyrexia 4 4th Term Confined in a London hospital—still-birth. Do. 4. Pyrexia 1 10th Term Breech presentation— local streptococcal infection. Yes Do. 5. Pyrexia 1 6th Term Eclampsia—forceps infected fibroid—mixed urinary tract infection. Yes Do. 6. Fever 1 3rd Term Utennary inertia—forceps. Yes Do. Acute Polio-myelitis—One case, a boy of five years, was notified. The infection caused paralysis of the whole of the right leg. He was admitted to hospital and, although improved, is still receiving treatment for some residual paralysis. Cerebro-spinal Fever.—A male infant of 4i months was notified to be suffering from meningococcal meningitis. He was admitted to hospital but died after six weeks' treatment. 81 TABLE 22.—INFECTIOUS DISEASES—Notification, Deaths and Distribution. (Excluding Queen Mary's Hospital). disease Cases notified Case rate per 1000 population Deaths Distribution of cases No. of cases removed to hospital Percentage of cases removed to hospital St.Helier North St. Helier South St. Heiier West North East North West Central South East South West Smallpox _ - Scarlet Fever 275 4.73 - 102 51 34 22 36 9 16 5 254 92% Diphtheria 47 0.80 4 7 9 13 7 4 7 — — 47 100% Enteric 1 0.02 1 — — - — — — — 1 1 100% Cerebro-spinal Fever 1 0.02 1 - - 1 - - - 1 100% Puerperal Pyrexia 5 00.9 — — — - 2 — 2 1 — 2 40% Puerperal Fever I 0.02 1 1 100% Erysipelas 13 0.07 — 3 2 2 1 — 1 1 3 4 30% Pneumonia 85 1.45 30 28 18 14 6 1 5 4 9 14 16% Influenzal Pneumonia 30 0.51 — 7 6 — 6 2 4 1 4 4 30% Polio-myelitis 1 0.02 - - - - - - - 1 — 1 100% Relapsing Fever — — — — — — — — — — — — - Typhus Fever - — — — — — — — — — — — - Dysentery 53 0.92 — 12 13 14 3 4 1 1 5 5 9% Encephalitis Lethargica — — — — — — — — — — — — - Ophthalmia Neonatorum 1 1.1 4per 1000 births - - - - - 1 - - - 1 100% Plague — — — — — — — — — — — — - Malara — — — — — — — — — — — — - 82 TABLE 23. INFECTIOUS DISEASES-Notification by Age Groups, 1937. (Excluding Queen Mary's Hospital.) Disease. Total Cases Notified Total Cases at all Ages. Under 1 year 1—2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and Over Scarlet Fever l 5 17 17 24 151 37 8 13 2 — — 275 Diphtheria — 1 4 3 22 11 1 2 3 — — 47 Enteric Fever - - - - - - - - - 1 — — 1 Dysentery 2 7 2 4 2 11 6 2 9 6 2 — 53 Pneumonia 13 8 6 13 8 24 2 1 14 10 12 4 115 Erysipelas 1 1 — — — — 1 — 1 4 3 2 13 Puerperal Pyrexia - - - - - - - - 4 1 — — 5 Puerperal Fever ophthalmia - - - - - - - - 1 - - - 1 Neonatorum 1 - - - - - - - - - - - 1 Polio-myelitis - - - - - 1 - - - - - - 1 Cerebro-spinal fever.. 1 - - - - - - - - - - - 1 83 TABLE 24 —MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1937. (Excluding Queen Mary's Hospital) DISEASE Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Smallpox - - - - - - - - - - - - - Scarlet Fever 20 23 10 16 30 24 27 11 37 39 26 13 275 Diphtheria 10 2 5 2 5 3 2 6 5 — 3 4 47 Dysentery — — — — — — 3 — — — 31 19 53 Enteric - - - - - - - - - - 1 — 1 Cerebro-spinal Fever - - - - - - 1 - - - - - 1 Acute Polio-Myelitis - - - - - - - 1 - - - - 1 Pneumonia 9 4 4 7 5 6 3 3 3 6 17 18 85 Influenzal Pneumonia.. 17 7 2 — — — — 1 — — 2 1 30 Erysipelas — 5 2 1 — — 1 — — I 1 2 13 Tuberculosis Pulmonary 4 5 12 6 13 7 4 1 3 5 8 4 72 Tuberculosis Non-pulmonary 2 2 1 3 3 1 3 2 3 — 5 I 26 Ophthalmia Neonatorum - - - - 1 - - - - - - - 1 Puerperal Pyrexia and Fever 1 - - 1 - - - - - - 3 1 6 84 TUBERCULOSIS. The new cases admitted to the tuberculosis register in 1937 numbered 151, classified as follows :— Males— Females— Pulmonary 41 Pulmonary 72 Non-pulmonary 24 Non-pulmonary 14 Of these, 55 were newcomers transferred from other districts. During the same period 107 persons were removed from the register, leaving 505 cases recorded at December 31st. The constitution of the register at that date is shown in the following table:— TABLE 25. TUBERCULOSIS REGISTER AT DECEMBER 31st, 1937. Pulmonary Non-pulmonary All forms Males 185 74 259 Females 195 51 246 Total .. 380 125 505 The total of 505 is 51 more than at the corresponding date in 1936, and was distributed by Wards as shown below:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1937. WARD Pulmonary Non-Pulmonary Total Males Females Males Females St. Helier North 36 50 20 10 116 St. Helier South 38 40 10 15 103 St. Helier West 40 41 18 9 108 North-East 23 12 9 4 48 North-West 15 20 9 4 48 Central 6 9 3 3 21 South-East 17 13 4 6 40 South-West 10 10 1 — 21 185 195 74 51 505 380 125 85 The Surrey County Council undertake the treatment of tuberculosis in this district. 125 persons from Carshalton received treatment in the following institutions during the year:— Surrey County Sanatorium, Milford 29 Other tuberculosis institutions 96 125 The number of persons who died of tuberculosis was two fewer at 37. The death rate was therefore, 0 63 per 1,000 of the population. The deaths were distributed as to age and sex as follows:— TABLE 26. DEATHS DUE TO TUBERCULOSIS, 1937. Ages Years Pulmonary Non-pulmonary Totals Male Female Male Female 0 1 — — — l 1 5 1 l - — 2 15 1 5 — — 6 25 6 6 — — 12 35 3 4 1 — 8 45 1 — — — 1 55 2 — — — 2 65 1 3 — l 5 Totals 15 19 1 2 37 The Council provides a free service for the examination of sputum for tubercle bacilli. In the past year 69 specimens were examined with a positive result in 8. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, nor under Section 172 of the Public Health Act, 1936. 86 TABLE 27. TUBERCULOSIS NEW CASES, Age and sex distribution, and manner of admission to register, 1937. Age Group Years Primary Notifications (" A ") Cases transferred from other districts Cases brought to notice otherwise than by notification or transfer Total New Cases Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. M. F. M. F. 0— 1 - - - - - - - - - - - - o 1— 5 — — 3 1 — 1 - - - - - - 5 5—10 1 — 2 — 1 1 — 1 — — — — 6 10—15 3 1 1 3 — 1 2 1 — — — — 12 15—20 1 8 1 2 — 2 2 — — — - — 16 20-25 1 9 3 1 4 1 1 - - - - - 20 25—35 7 13 - 1 5 16 1 1 1 — — — 45 35-45 8 11 6 - 3 5 - 1 34 45-55 4 2 1 1 - - 1 - - - - - 9 55—65 2 1 - - - - - - - - - - 3 65 up - - - - - - - - - - - 1 1 Totals 27 45 17 9 13 27 7 4 1 — — 1 151 98 51 2 87 TABLE OF METEOROLOGICAL OBSERVATIONS, CARSHALTON, 1937. Latitude 5122 N. Longitude 0.9 W. Month. Average Barometric Pressure Temperature Absolute Temp. Rainfall Sunshine Average 9 a.m. Average Maximum Average Minimum Mean Maximum Minimum Inches Days Hours Sunless Days January 29.65 42.3 47.3 36.9 42.1 54- 6th 27—28th 5.06 18 25-5 24 February 29.54 44.0 49.3 38.3 43.8 56-15th 30—28th 4.43 20 48-4 15 March 29.56 39.9 45.4 32.8 39.1 55-20th 24- 9th 3.62 16 62-5 16 April 29.79 49.3 56.2 42.2 49.2 62-27th 33- 1st 2.69 14 82-5 9 May 29.97 54.0 64.6 47.3 55.9 78—29th 38- 5th 2.64 13 167-5 11 June 30.02 57.9 69.8 50.4 60.1 80-11th 44- 2nd 1.86 8 194-8 5 July 30.00 62.6 66.8 55.1 60.9 81- 3rd 48—29th 0.40 7 111-4 8 August 30.04 62.2 74.6 55.1 64.8 86- 6th 49—15th 3.21 6 191-6 4 September 29.71 54.9 66.3 48.3 57.3 77- 7th 38—20th 2.36 14 136-1 5 October 29.93 51.7 59.1 45.8 52.4 67— 2nd 36-18th 3.59 10 57-7 21 November 29.98 41.5 46.8 34.6 40.7 55- 4th 23—20th 1.7 5 33-0 21 December 29.80 40.1 42.7 33.3 38.0 54— 1st 25—19th 4.58 13 0-1 30 Totals - - - - - - - 35.91 144 1111.1 169 Averages 29.83 50.0 57.4 43.3 50.3 67.0 34.6 - - - - 88 INDEX. page Acreage 7 Ambulance— Infectious 28 Non-infectious 29 Bakehouses £0 Bed-bug—Eradication of 57 Births— Notification of 4 Rate 17 Statistics 18 Cancer— Deaths from 20 Rate 21 Cemeteries 58 Clinics and Treatment Centres— Maternity 23 Dental 44 Diphtheria Immunisation 34 Maternity and Child Welfare 33 School 35 Toddler 34 Tuberculosis 35 Venereal Disease 36 Closet Accommodation 51 Convalescent Treatment 45 Day Nursery 48 Deaths- Cancer 20 Classified Causes 26 Distribution 19 Rate 19 Respiratory Diseases 22 Statistics Tuberculosis Dental Scheme 43 Diarrhoea and Enteritis under two years 22 Diphtheria— Immunisation 77 Monthly Distribution 76 Multiple Cases 76 Swab Examinations 76 Ward Incidence 76 Dysentery 73 Disinfection & Disinfestation 57 Drainage and Sewerace 50 Employment 8 Enteric Fever 73 Erysipelas 79 89 page Factory and Workshops 65-66 Food & Drugs (Adulteration) Act, 1928 71 Food Supply— 67 Health Services- Ambulance 28 Assisted Milk Scheme 42 Clinics and Treatment Centres 33 Consultant Service 46 Day Nursery 48 Hospitals 30 Infant Life Protection 47 Laboratory Facilities 28 Maternity and Child Welfare 33 Nursing in the Home 27 Health Propaganda 72 Health Visitinc 41 Heart Disease 19 Hospitals- Admittances 31 General and Maternity 32 Infectious 30 Non-Infectious 32 Smallpox 33 Tuberculosis 33 Housing- Council's Housing Scheme 60 Housing Act, 1936 63 Inspection 61 Rent and Mortgage Interest Restriction (Amend.) Act, 1925 64 Slum Clearance 63 Ice Cream 70 Industry 8 Infant Life Protection 47 Infant Mortality- Classified Causes 24 Statistics 23-24 Infectious Diseases- Acute Polio-Myelitis 81 Cerebro-Spinal Fever 81 Diphtheria 75 Dysentery 73 Enteric Fever 73 Erysipelas 79 Measles 79 Monthly Incidence 84 Notification, Distribution and Deaths 83 Notation by Age Groups 82 Ophthalmia Neonatorum 79 Pneumonia 79 Puerperal Fever and Pyrexia 80 Scarlet Fever 73 Smallpox 73 Whooping Cough 79 Isolation Hospital 30 Admittances 31 90 Laboratory Facilities— pace Milk Examinations 28 Sputum 28 Swabs 28 Water 28 Maternal Mortality- Causes 25 Statistics 25 Maternity and Child Welfare- Assisted Milk Scheme 41 Attendances at Centres 37 Committee 5 Consultant Service 46 Convalescent Treatment 45 Dental Scheme 43 Health Visiting 41 Home Helps 46 Hospital Treatment for Maternity 45 Orthopaedic Treatment 45 Maternity Outfits 46 Midwives 46 New Health Centre 39 Work of Centres 36 Measles 79 Meat and Other Foods 67 Meteorology 10 Milk Supply 67 Milk (Special Designations) Order, 1936 67 Milk Scheme 42 Mortuary 58 Natural and Social Conditions 7 Nursing Associations 27 Nursing in the Home 27 Ophthalmia Neonatorum 79 Orthopaedic Treatment 45 Pneumonia 79 Population .12 Prevention of Blindness 80 Public Assistance 33 Public Cleansing 51 Public Health Act, 1936 (Sec. 203) 36 Public Health Committee 5 Puerperal Fever 80 Puerperal Pyrexia 80 Rateable Value 7 Rats & Mice (Destruction) Act, 1919 57 Rent & Mortgage Interest (Restriction) Act, 1925 64 Representatives on— Joint Hospital Board 5 Joint Fire Protection and Ambulance Committee 5 Rivers and Streams 50 91 pace Sanitary Circumstances 49 Scarlet Fever— Monthly Distribution 74 Multiple Cases 75 Ward Incidence 74 Schools 58 School Clinics 35 Shops Acts 58 Slaughterhouses 69 Smallpox 73 Smoke Abatement 58 Staff 6 Statistics— Comparable 18 Vital 11 Swimminc Baths and Pools 59 T uberculosis— Deaths 86 New Cases 87 Register85 Ward Distribution 85 Venereal Diseases 36 Vermin 51 Voluntary Helpers 47 Water Supply 49 Analyses 49 Whoopinc Couch 79 Zymotic Diseases 11 Deaths 11 Printed by Bertram Johnson, Ltd. 85, Manor Road, Wallington, Surrey