CAR3 CARSHALTON URBAN DISTRICT Annual Report OF THE Medical Officer of Health FOR THE YEAR 1938 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1938 - 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 1938. The Public Health Staff, in common with their colleagues in other Departments, have, as you are aware, devoted a considerable part of their time, both in and out of office hours, to the work of the Air Raid Precautions Scheme. They have, at the same time, striven hard, and, I venture to suggest, successfully to maintain the high standard of efficiency of the public health services. Statistically, the year 1938 compares favourably with its predecessors. The death rate remains at a comparatively low figure; infant mortality is again less than for the country as a whole and maternity mortality, though higher than the year before, is lower than the rate for England and Wales. The birth rate shows a slight reduction on 1937 and is but little different from the general figure. Of the commoner infectious diseases there was a reduction in the prevalence of scarlet fever and a further marked fall in the incidence of diphtheria among the resident population (i.e., excluding Queen Mary's Hospital) with no mortality from these two infections. The supervision of sanitary conditions was carried out with the usual systematic thoroughness. Steady progress was maintained in eliminating poor housing conditions and in the abatement of overcrowding. Attention to food and food premises, always of the closest, will be more complete if, as anticipated, the Council become the Food and Drugs Authority under the 1938 Act in October next. Under this arrangement, all aspects of the public health control of food, both those pertaining to wholesomeness and those relating to adulteration, will be in the hands of the Public Health Authority. The Maternity and Child Welfare Scheme made another step forward in its development by the inauguration of special toddler clinics, and the activities of the Centres again reached higher levels. Particularly gratifying was the increased use made of the antenatal sessions. Further accommodation for this service is now urgently required and the completion of the new St. Helier clinic building will be a valuable addition to the scheme. The time is now ripe for a re-organisation of the arrangements for medical attendances at the clinics, under which the appointment of a full-time assistant is clearly desirable. Largely owing to the Air Raid Precautions Scheme, all the members of my Department have been called upon to assume additional duties. Mr. Spicer in particular, has undertaken a considerable amount of the training of the Air Raid Precautions personnel and no little responsibility for organising the First Aid services. To him, as to all the members of the Department, my sincere thanks are due for their valuable assistance given, as always, in unstinting measure. This may well be my last Annual Report in my capacity as Medical Officer of Health for the joint districts of Carshalton and Merton and Morden. Since the joint appointment was made early in 1934, the combined populations have increased from 90,000 to 135,000 approximately, and both districts have now reached a stage of development which requires the full-time attention of a Medical Officer of Health, a stage well beyond that of many districts which have had a full-time Officer for a number of years. It should not be overlooked that, unlike many Urban Councils, each authority is responsible for a very extensive Maternity and Child Welfare organisation, the administration of which claims a large proportion of the Medical Officer's time. I am, Your obedient Servant, F. LAWRENCE SMITH, July, 1939. Medical Officer of Health. CARSHALTON URBAN DISTRICT COUNCIL 1938 PUBLIC HEALTH COMMITTEE. Chairman : Mr. F. J. Reeves. Mrs. E. M. Watson. Mr. H. Haydon. Mr. S. C. Baker. Mr. E. G. Mileham. Mr. H. O. Fleetwood. Mr. G. M. Jennings, J.P. (ex-officio). MATERNITY AND CHILD WELFARE COMMITTEE. Chairman : Mr. A. C. Campling. Mr. S. C. Baker. Mrs. E. F. Webb. Mr. H. Haydon. Mrs. A. Carpenter, J.P. Mr. E. G. Mileham. Mrs. W. Spratt. co-opeted Mr. L. H. Talbot. Mrs. E. M. Robinson, Mrs. E. M. Watson. Mr. G. M. Jennings, J.P. (ex-officio). REPRESENTATIVES ON JOINT HOSPITAL BOARD. Mr. D. W. Cooper. Mrs. E. F. Webb. Mrs. D. M. Ward. 7 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 1th February, 1938). a H. G. Cripps, C.R.S.I. a L. G. Lydiatt, C.R.S.I. (from 1st March, 1938). Senior Health Visitor: Miss E. S. Picard. Health Visitors : Miss N. M. Hills. Miss R. M. Nash. Miss A. M. Askew. Chief Clerk. B. Lamacraft. Part Time Officers. Medical Officer 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.P., M.R.C.S. 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. * Medical Officer of Health to combined districts of Carshalton and Merton and Morden. a Meat and Food Certificate of the Royal Sanitary Institute. 8 Section A Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1938) according to Rate Books 16,074 Rateable Value at 31st December, 1938 £457,607 Sum represented by 1d. rate £1,830 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. With the steadily increasing demands made upon the underground supplies of the Thames Basin, the flows from these springs have been more irregular of recent years. In 1938, towards the end of the year, all but the Lower Pool again failed. The district continued its steady development, 391 new houses being erected compared with 312 in the year before. The northern and central parts of the district are now almost completely developed. The London County Council's Housing Estate on St. Helier covers the extreme northern portion and is continuous over 9 the boundary with the remainder of that Estate situate in Morden. The southern half, which contains the Surrey County Council's Smallholdings and higher rated properties, is less densely and less completely developed. The district is to a large extent, a dormitory area for London, yet possesses a core of long established local life concentrated mostly in the centre. The rapid growth of the last 10 to 15 years has been almost entirely due to outward pressure from the metropolis. Industry and Employment.—There is little local industry carried on. Most of the workers gain their livelihood outside the district. The number of employees engaged in factories and workshops is approximately 670. The following list shows the premises registered under the Factories Act and the persons employed therein :— 1. Factories with Mechanical Power No. Trade. Employees. M. F. 5 Bakery 36 3 18 Boot and Shoe Repairs 24 — 4 Carpentry, Joinery, etc. 8 — 2 Chemical Works 64 — 1 Cardboard Box Making 50 81 1 Electrical Engineering 3 — 1 Floorcloth Manufacture 24 — 2 Grinding 2 — 7 Garages 23 — 1 Herb Drying 3 — 1 Iron Works 14 — 2 Laundries 12 76 1 Printing Works 4 1 1 Punnet Making 5 26 1 Refuse Disposal 10 — 1 Radio Repairs 7 — 1 Sawmill 3 — 1 Trolley Bus Depot 50 — 3 Valeting 4 4 54 346 191 Total 537 10 2. Factories without Mechanical Power. No. Trade. Employees. M. F. 10 Boot and Shoe Repairs 11 — 3 Building and Decorating 3 — 2 Blacksmiths 4 — 9 Carpentry, Joinery, etc. 17 — 6 Cycle Repairs 6 — 1 Carbreaking and Paper Pressing 2 — 4 Dressmaking — 4 6 Garages 12 — 4 Laundries — 7 i Mason 1 — 1 Mop Assembling 1 1 1 Nursery 50 — 1 Potted Meats, etc. — 1 1 Parchment Manufacture 1 — 2 Radio Repairs 4 — 4 Upholstery, etc. 4 1 1 Watch and Clock Repairs 2 — 57 118 14 — Total 132 In addition there are approximately 80 outworkers executing work in their own homes as follows:— 3. Outworkers. Trade. Premises. Outworkers. M. F. Artificial Flowers 3 — 3 Braces 1 — 1 Baby Wear 1 — 1 Embroidery 4 — 4 Fancy Boxes 3 — 3 Feather Sorting 1 — 1 Handbag 1 — 1 Juvenile Clothing 2 — 2 Knitwear 5 — 5 Ladies' Wearing Apparel (frocks, dresses gowns, robes, neckwear, skirts, overalls dressing gowns, lingerie, etc.) 26 29 Lamp Shades 3 — 3 Needlework 1 — 1 Paper Hats 12 — 12 Shirts 1 — 1 So.t Fancy Goods 3 — 3 Tailoring 4 2 2 Toymaking 2 — 2 Umbrella Making 3 — 3 76 2 77 Total 79 11 The number of unemployed living in Carshalton registered at the Sutton Employment Exchange on the 9th January, 1939, was:— Men 750 Women 189 Boys 53 Girls 35 1027 This figure compares with the total of 327 registered at the same exchange two years earlier. Public Assistance. The following information as to public assistance afforded in the district is supplied by the courtesy of the Chief Public Asistance Officer of the Surrey County Council:— Medical Relief :—Number of persons from Carshalton admitted to institutions or hospitals during the 12 months ended 31st December, 1938 891 Number of persons from Carshalton admitted to mental hospitals 30 Other Relief :—Number of persons in receipt of domiciliary assistance on :— Men. Women. Children Total 1 st January, 1938 202 332 625 1159 1st July, 1938 205 324 616 1145 31st December, 1938 221 355 633 1209 Total amount of domiciliary assistance paid to persons in residence at Carshalton during the year £23,666 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. 12 SUMMARY OF VITAL STATISTICS FOR 1938. (Based on the Registrar-General's Figures.) Population. Mid. 1938 Registrar-General's Estimate 58,730 Births. M. F. Total Live (Legitimate) 446 400 846 (Illegitimate) 8 13 21 454 413 867 Birth Rate 14.7 Still-births (legitimate) 22 11 33 (illegitimate) 1 1 2 23 12 35 Stl-bth.Rate per 1,000 total births 38.8 Deaths 244 204 448 Death Rate (crude) 7.6 Infant Mortality. All deaths under 1 year 25 15 40 Infant Mortality Rate (per 1,000 live births) 46.1 Deaths of leg. infts. under 1 year 25 15 40 Rate per 1,000 legmt. births 49.6 Deaths of illeg. infts. under 1 year — — — Rate per 1,000 illegmt. births — Maternal Mortality. Deaths from Sepsis 1 Rate per 1,000 total births 1.1 Deaths from other causes 1 Rate per 1,000 total births 1.1 Maternal Death Rate 2.3 Zymotic Deaths. 7 Principal Zymotic Diseases 6 Deaths from Measles 2 Deaths from Whooping Cough – Deaths from Diarrhoea (under 2 yrs.) 4 Zymotic Death Rate 0.12 Deaths from Tuberculosis. All Forms 37 Rate per 1,000 of population 0.63 Phthisis 34 Rate per 1,000 of population 0.57 Deaths from Cancer. 62 Rate per 1,000 of population 1 .55 13 The Registrar General's statistics relating to population and deaths differ slightly from those compiled from local records. The total figures in respect of 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 mid-year resident population is 58,730. My own estimate, compiled from local information, is 61,560. The average age of the population at the census of 1931 was among the lowest of the districts in Surrey. Since that date, the Carshalton portion of the St. Helier Estate has been developed with the result that the district has since received a large influx of young married people displaced from London and it is probable that the average age is now lower than in 1931. This factor at the present time probably outweighs the tendency towards an annual lowering of the population per house, which is the experience generally of the country as a whole, and it is likely that it will continue to do so for a few years to come. The distribution of the estimated population as between wards is as follows :— TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1938. BY WARDS WARD Houses at Mid. 1938 Estimated Population, Mid. 1938p St. Helier North 2013 8670 St. Helier South 1699 7300 St. Helier West 1901 8060 North-East 2301 8130 North-West 2105 7450 Central 1758 6470 South-East Queen Mary's Hospital 2039 7220 8520 1300 South-West 1964 6960 Whole District 15780 61560 14 BIRTHS. The number of live births registered was 867, of which 454 were males and 413 females. The total is 7 less than in 1937 and the birth rate falls slightly from 15.0 to 14.7, which is the lowest yet recorded for the district. Illegitimate live births included in the total numbered 21, 8 male and 13 female. There were 33 still births, 22 male and 11 female, 2 of which were illegitimate. Ward Birth Rates. No information is available to district Medical Officers of Health with regard to the home addresses of births to residents which take place outside the district. Consequently, the whole of the registered births cannot be classified on a ward basis. For comparative purposes, therefore, use is made of the births notified during the year. These records show that a total of 868 births took place in 1938 to parents in the various wards as follows :— WARD. Live Births. Rate per 1000 Population. Still Births. Still birthrate per 1000 Total Births. St. Helier North 126 14.6 5 38.0 St. Helier South 108 14.7 4 34.8 St. Helier West 126 15.5 4 30.7 North East 161 19.9 4 20.5 North West 101 13.7 3 28.8 Central 62 10.0 3 46.1 South East (excluding Queen Mary's Hosp.) 107 14.9 1 9.2 South West 50 7.2 3 5.6 Domiciliary and Institutional Births. Of the 900 total births (live and still) notified during the year, 315 took place in hospitals and nursing homes. The remainder, 15 with the exception of 1 not stated, occurred in private dwellings. The institutional births represent 36 per cent. of the total, whilst the respective percentages for the wards were as follows:— St. Helier North 28.2 St. Helier South 23.2 St. Helier West 27.7 North-East 44.8 North-West 29.8 Central 52.3 South-East 40.7 South-West 62.2 The distribution of these births follows very closely that for the year before. Domiciliary midwifery is practised mostly on the St. Helier Estate and in the North West Ward. The births which occurred in premises other than domestic dwellings took place in the following institutions:— Live Still Total Carshalton, Beddmgton and Wallington District (War Memorial) Hospital 49 1 50 Surrey County Hospitals 104 6 110 Other Hospitals 49 6 55 Private Nursing Homes 96 4 100 298 17 315 16 TABLE 2. BIRTHS, 1938—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 4 93 (3) 97(3) 33 (2) 1 — 34 (2) 131 (5) St. Helier South 5 86 (2) 91 (2) 21 (2) — — 21 (2) 112(4) St. Helier West 2 94 96 34(4) — — 34 (4) 130(4) North East 29 88(1) 117(1) 45 (3) 3 — 48 (3) 165 (4) North-West 14 71 (3) 85 (3) 17 2 — 19 104 (3) Central 16(1) 30 46(1) 18(2) 1 — 19(2) 65 (3) South-East 11 64(1) 75(1) 33 — — 33 108(1) South-West 10 17 27 23 (3) 2 1 26(3) 53 (3) Total 91(1) 543 (10) 634 (11) 224 (16) 9 1 234 (16) 868 (27) (Figures in brackets indicate still-births included in totals). 17 TABLE 3. Birth and Death Rates for Carshalton, 1922-1938. Year Population (Registrar. General's) Birth Rate Death Rate Infant Mortality Rate Maternal Mortality Rate 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 7.6 46 0.0 1931 28620 16.7 7.5 43.8 8.1 1932 32280 15.05 7.9 47.3 3.89 1933 35260 14.9 8.8 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 15.0 6.6 40.0 0.0 1938 58730 14.7 7.6 46.1 2.3 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 1938. Corresponding rates for Carshalton are added, based on Registrar-General's figures. 18 TABLE 4. COMPARATIVE STATISTICS—1938. England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25000 to 50,000 at 1931 Census) London Administrative County Carshalton Rates per 1,000 Population. Births— Live 15.1 15.0 15.4 13.4 14.7 Still 0.60 0.65 0.60 0.48 0.56 Deaths— * 7.6 All Causes 11.6 11.7 11.0 11.4 †8.3 Typhoid and Paratyphoid Fevers 0.0 0.00 0.00 0.00 0.00 Smallpox 0.00 — 0.00 — — Measles 0.04 0.05 0.03 0.06 0.03 Scarlet Fever 0.01 0.01 0.01 0.01 — Whooping Cough 0.03 0.03 0.02 0.03 — Diphtheria 0.07 0.07 0.06 0.05 — Influenza 0.11 0.10 0.11 0.06 0.05 Notifications— Smallpox 0.00 0.00 0.00 — — Scarlet Fever 2.41 2.60 2.58 2.05 4.06 Diphtheria 1.58 1.85 1.53 1.90 1.78 Enteric Fever 0.03 0.03 0.04 0.05 0.01 Erysipelas 0.40 0.46 0.39 0.46 0.34 Pneumonia 1.10 1.28 0.98 0.98 1.65 Rates per 1,000 Live Births. Deaths under 1 year of age 53 57 51 57 46 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 4.6 Maternal Mortality— • Puerperal Sepsis 0.89) Not available 1.15 Others 2.19 1.15 Total 3.08) 12.30 Rates per 1,000 Total Births (i.e., Live and Still). Maternal Mortality— Puerperal Sepsis 0.86 Not available 1.11 Others 2.11 1.11 Total 2.97 2.22 Notifications— Puerperal Fever 14.42 18.08 12.51 3.53 13.33 Puerperal Pyrexia 15.46 * Crude. † Comparable. 19 DEATHS. The number of registered deaths, as adjusted by transferable deaths, was 448, of which 244 were among males and 204 among females. The crude death rate of 7.6 per thousand population compares with 6.6 in the year before. The "comparable " death rate, arrived at by the application of the areal comparability factor to allow for age and sex differences in the local population and that of the country as a whole, is 8.3 per thousand population. This is the figure for comparison with the death rate of 11.6 for England and Wales. Ward Death Rates. The ward distribution of the total deaths, with the respective death rates, was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1938. WARD. Deaths Death Rate (crude) Mean Age at death St. Helier North 49 5.6 37.9 yrs St. Helier South 40 5.4 46.3 „ St. Helier West 53 6.5 42.7 „ North.East 67 8.3 46.5 „ North.West 52 7.1 54.5 „ Central 80 12.3 60.7 „ South.East (excluding Queen Mary's Hospital) 54 7.4 57.5 „ South.West 53 7.7 63.1 „ Whole District 148 7.2 52.1 „ CAUSES OF DEATH. Heart Disease. Of all the individual groups of diseases, heart affections were responsible for by far the largest number of deaths. They numbered 97 compared with 87 a year ago and represent 22 per cent. of the total. 20 Valvular disease was recorded in 18 of these deaths, the remaining 79 being associated with degeneration of the myocardium with or without corresponding changes in the arterial system. Eighty-four per cent. of the deaths from this cause were in persons 55 years and over. Cancer. Cancer ranked second amongst the chief causes of death. Forty males and 22 females, a total of 62 persons, died from this cause. This compares with 47 in the year before and the death rate for this disease rises to 1.55 per thousand population. The preponderance of fatality among males is noteworthy. The average age at death from cancer was one year less than in the year before. The allocation of these deaths by wards is as follows:— CANCER DEATHS—WARD DISTRIBUTION, 1938. WARD Cancer deaths R te per 1,000 Estimated Population St. Helier North 4 0.46 St. Helier South 4 0.54 St. Helier West 8 0.99 North-East 12 1.47 North-West 8 1.07 Central 9 1.39 South-East 7 0.82 South-West 10 1.43 As in the year before the rate for the north-east ward was the highest. The classification of these deaths by sites affected is given in Table 5. 21 TABLE 5. CANCER DEATHS—BY ORGANS AFFECTED. Group Site Affected. Male Female Total 45 Buccal Cavity 1 — 1 46 Digestive Organs— Oesophagous 2 — 2 Stomach 9 4 13 Liver and Gall Bladder 2 1 3 Intestines 4 4 8 Rectum and Anus 2 — 2 Pancreas — — — 47 Respiratory Organs— Larynx 3 — 3 Lungs 7 3 10 Mediastinum — — — 48 Uterus — 1 1 49 Other female genital organs — 3 3 Breast — 4 4 51 Male genito-urinary organs 5 — 5 52 Skin 2 — 2 53 Other organs 3 2 5 40 22 62 Average age at death :— Males 63.33 years. Females 63.09 years. All persons 63.20 years. Respiratory Diseases. Respiratory infections, including those of an influenzal nature, were less prevalent than in the year before. Influenza was responsible for 3 deaths against 19 in 1937, whilst bronchitis, pneumonia, etc., other than influenza, accounted for 39 compared with 52 previously. The death rate for the respiratory diseases (excluding influenza) was 0.66 per thousand population. Inquests. Inquests were held on 27 deaths, 16 of which were on persons resident in the district. 22 The verdicts returned were as follows:— Natural causes 5 Suicide 10 Accidental Death 10 Misadventure 1 In accordance with medical evidence 1 Five of the total were due to road accidents. INFANT MORTALITY. The number of infants dying in the first year of life was 40, 25 of which were males and 15 females. The infant mortality rate was 46.1 per thousand live births compared with 53 in England and Wales. None of the infant deaths was illegitimate. Neonatal deaths, that is to say those occurring in the first month of life, at 24 represented 58 per cent. of the total. Diseases peculiar to infancy—prematurity, malformations, atrophy, etc., accounted for 25 (60 per cent. of the whole). Diseases obviously due to infections were responsible for 14, of which measles caused 1, tuberculosis 1, respiratory infections 8, and infections of the gastro-intestinal tract 4. 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 71 St. Helier South 5 46 St. Helier West 8 63 North-East 6 37 North-West 2 19 Central 3 48 South-East 5 46 South-West 3 60 23 TABLE 7. INFANT MORTALITY DURING THE YEAR 1938. 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 — — — — — — — — 1 1 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — 1 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions — — — — — — — — — — Laryngitis — — — — — — — — — — Bronchitis — — — — — — — — 1 1 Pneumonia (all forms) 2 — — — 2 1 — 3 1 7 Diarrhœa — — — — — — 1 1 — 2 Enteritis — — — — — 1 1 — — 2 Gastritis — — — — — — — — — — Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation (overlying) 1 — — — 1 — — — — 1 Injury at Birth 2 — — — 2 — — — — 2 Atelectasis 1 — — — 1 — — — — 1 Congenital Malformation — — — — — 3 — — — 3 Premature Birth 13 2 1 — 16 — — — — 16 Atrophy, Debility and Marasmus — — — 1 1 — — — — 1 Other Causes 1 — — — 1 — — 2 — 3 Totals 20 2 1 1 24 5 2 6 4 41 Nett Births in the year—Males 454, Females 413 : Legitimate 846, Illegitimate 33. Nett deaths in the year of Legitimate Infants, 40. Nett deaths in the year of Illegitimate Infants 0. 24 The mortality rates for the wards over the last four years are given below :— WARD Infant Deaths Live Births Infant Death Rate per 1 000 live births St. Helier North 76 1570 48 St. Helier South St. Helier West North-East 23 556 41 North-West 19 457 41 Central 13 236 55 South-East 17 333 51 South-West 6 216 27 MATERNAL MORTALITY. Two maternal deaths were recorded, one due to sepsis and one to other maternal causes. The maternal death rate was 2.22 per thousand total births. In the previous year no maternal death was registered. The rate for the country as a whole was 2.97. The cause of death in each case was stated to be :— Sepsis .. (1) Septicaemia. Incomplete Abortion. Other Causes (2) 1(a) Post partum haemorrhage. Obstetric shock. TABLE 8. MATERNAL MORTALITY, 1922—1938. Year Births Maternal Deaths Maternal Mortality Rate 1922 .. 281 3 10 6 1923 .. 275 1 3-6 1924 .. 278 2 71 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 00 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 1938 .. 868 2 2-2 25 TABLE 9. CAUSES OF DEATH DURING THE YEAR 1938. 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 26 18 4 5 5 8 6 5 17 14 29 16 26 15 36 22 45 40 53 58 247 201 448 ! Typhoid Fever, etc. — — — — — — — — — — — — — — — — — — — — — — — 2 Measles 1 — — — 1 — — — — — — — — — — — — — — — 2 — 2 3 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 5 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 6 Influenza — — — — — — — — — — 1 — — — — _ 1 — 1 — 3 — 3 7 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — 8 Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — 9 Respiratory tuberculosis — — — — — 2 1 1 8 6 6 6 3 — 3 — — — — — 21 15 36 10 Other tuberculosis .. — 1 1 — — — 1 — — — — — — — — — — — — — 3 3 11 Syphilis — — — — — — — — — — 1 — — — 1 — — 1 — — 2 1 3 12 General paralysis of insane, etc. — — — — — — — — — — — — — — — — — — — — — — — 13 Cancer — — — — — — — — 1 2 4 1 6 5 9 4 11 3 9 7 40 22 62 14 Diabetes — — — — — — — — — — — — 1 — — 2 — 2 1 3 2 7 9 15 Cerebral Haemorrhage — — — — — — — — — — — — — 2 — 2 1 4 2 4 3 12 15 16 Heart Disease — — — — 1 — — 1 1 1 3 2 5 1 10 1 17 19 15 19 52 44 95 17 Aneurysm — — — — — — — — 1 — — — — — — — — — — 1 1 1 2 18 Other circulatorvdiseases — — — — — — — — — — — — — 1 2 3 2 1 9 5 13 10 23 19 Bronchitis — 1 — — — — — — — — — — — — 1 — 1 — 3 4 5 5 10 20 Pneumonia (all forms) 3 3 — 2 1 — — 1 1 — 2 — — 1 1 3 1 1 1 4 10 15 25 21 Other respiratory diseases — — 1 — — — — — — — — 1 1 1 — — — — — — 2 2 4 22 Peptic Ulcer — — — — — — — — — — — — 2 1 — 1 — — — — 2 2 4 23 Diarrhoea 2 2 — — — — — — — — — — — — — — — — — — 2 2 4 24 Appendicitis — — — — — 1 1 — 1 — 1 — — — — 1 2 — — — 5 2 7 25 Cirrhosis of liver — — — — — — — — — — — — — — — — — — 2 — 2 — 2 26 Other liver diseases .. — — — — — — — — — — — — — — — — 1 2 1 — 2 2 4 27 Other digestive 1 — — — 1 — 1 — — — 2 — — — 2 — — — — — 7 — 7 28 Nephritis — — — 1 — — 1 — — — 1 1 1 1 1 1 2 — 2 2 8 6 14 29 Puerperal sepsis — — — — — — — — — 1 — — — — — — — — — — — 1 1 30 Other puerperal diseases — — — — — — — — — 1 — — — — — — — — — — — 1 1 31 Congenital causes 16 11 — — — — — — — — — — — — — — — — — — 16 11 27 32 Senility — — — — — — — — — — — — — — — — 1 — 2 6 3 6 9 33 Suicide — — — — — — — — 1 — 2 — 2 — 2 — 1 — 2 — 10 — 10 34 Other violence 2 — 1 1 1 1 1 1 1 1 3 1 1 1 1 3 1 — 2 1 14 10 24 35 Other defined causes.. 1 — 2 — — 4 1 — 2 2 3 4 4 l 3 1 3 7 1 2 20 21 41 26 Section B— Health Services. Nursing in the Home. Two voluntary associations provide nursing facilities in the district. The Council makes an annual grant to both, in return for which they undertake the nursing of cases referred from the public services. The Carshalton District Nursing Association covers the whole of the urban district except that part of the St. Helier Estate lying to the north of Reigate Avenue. Six nurses are employed, three of whom act as midwives. The following information in respect of the working of this Association during 1938 has been kindly supplied by the Honorary Secretary :— Cases attended— Children under 5 years 151 Maternity cases 93 Midwives' cases 106 Other cases 711 Total Cases 1061 Visits made— General .... 10627 Maternity 1751 Midwifery 1857 Casual 726 Antenatal 1455 Clinics 248 Total visits .. 16664 27 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 of the estate 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 1938, have been kindly supplied by the Honorary Secretary :— Cases attended— Children under 5 years 12 Other cases 24 Total cases 36 Number of visits made 364 The district nurses attend the Council's clinics and co-ordination of their work with the public services is thereby promoted. Laboratory Facilities. The 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 582 40 Virulence tests for diphtheria.. 2 1 Sputa for tubercle 69 11 Widal tests for enteric 1 — Faeces for enteric, dysentery, etc. 4 — Swabs for hemolytic streptococci 13 7 28 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 .. .. .. 6 Samples of sewage effluent— For bacteriological examination .. .. .. 1 Samples of milk— For bacteriological examination .. .. 94 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 was encountered in securing the prompt removal of cases admitted to hospital. Non-Infectious Cases.—The removal of non-infectious cases is provided for by the Council's ambulance service. For this purpose, two fully equipped vehicles are housed at The Grove. The joint arrangement with the Borough of Beddington and Wallington terminated on the 31st May, 1938, since when the local service has been under the control of the Fire Brigade, Ambulance and Air Raid Precautions Committee of the Council. 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 Urban District. 10s. 0d. For the removal of one patient from any address within the Urban District to an address within the Boroughs of Beddington and Wallington, Mitcham, Croydon, or Sutton and Cheam and the Urban Districts of Banstead, Coulsdon and Purley or Merton and Morden. 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. 29 The following figures are in respect of the working of the service during the year :— Carshalton Beddington & Wallington. (to 31 st May, 1938.) Total (1) Calls to street accidents, etc. 232 61 293 Answered by own ambulances 230 58 288 Referred to other ambulances 2 3 5 (2) Calls to remove cases from domestic dwellings to nursing homes or hospitals, or vice versa 511 130 741 Answered by own ambulances 511 130 741 (3) Calls answered for services in other districts 12 (4) Total calls answered 1046 Distance travelled on calls miles 8797i Average mileage per call .. .. .. .. .. „ 8.4 Number of occasions on which both ambulances out at same time .. 61 Number of occasions on which a third call transferred to other vices when both ambulances out 3 Greatest number of calls received and answered in one day 8 I am indebted to Mr. C. P. Ingram, the Honorary Ambulance Officer, for the information given above. 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 programme of extensions commenced in 1935 was completed during the year when the new administrative buildings were handed over. The accommodation is now 126 beds as the Board relinquished the tenancy of the auxiliary isolation hospital at Hook Road, Epsom, on the 31st March, 1938. The cases admitted are chiefly scarlet fever and diphtheria, but any notifiable disease, except smallpox and puerperal pyrexia, 30 TABLE 10. CUDDINGTON JOINT HOSPITAL BOARD-LIST OF ADMISSIONS TO CUDDINGTON HOSPITAL DURING 1938. Disease Banstead U.D.C. Carshalton U.D.C. Epsom B.C. Leatherhead u.D.C. Sutton B.C. Others Total No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths Scarlet Fever.. 29 — 210 — 50 — 10 — 99 — 3 — 401 — Diphtheria 12 — 47* — 17 — 4 — 22 — 1 1 103 1 Measles 6 — 18 — 7 — 3 — 6 — — — 40 — Tonsillitis 5 — 11 — 3 — — — 6 — 1 — 26 — Erysipelas 4 — 4 — 2 — — — 1 — — — 11 — Dysentery 2 — 1 — — — — — — — 2 — 5 — Septicaemia .. — — — — I — — — 3 3 — — 4 3 Dermatitis 1 — 2 — — — — — 1 — — — 4 — Erythema — — 2 — — — — — 1 — — — 3 — Anterior Poliomyelitis.. — — 1 — — — — — 1 — — — 2 — Other Diseases 3 1 14 1 6 1 1 — 7 1 11 2 42 6 Totals .. 62 1 310 1 86 1 18 — 147 4 18 3 641 10 ^Includes 10 "Carriers.' 31 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 310 compared with 350 in the year before. General and Maternity.—The Carshalton, Beddington and Wallington District (War Memorial) Hospital, The Park, Carshalton. This voluntary hospital provides 61 beds, arranged as follows :— Public Wards— Women's beds 18 Men's beds 14 Children's beds 8 Maternity beds 2 Emergency beds 5 Private wards (of one bed) 14 61 The hospital is equipped with an X-Ray Department, and has a separate wing for orthopcedic treatment, including massage, electrical treatment, radiant heat, ultra-violet ray, and remedial exercises. The hospital report for 1938 shows that the following cases were admitted :— General Medical and Surgical 1103 Maternity 110 1213 The districts from which the cases were admitted were :— Carshalton 574 Beddington and Wallington 508 Other districts 131 1213 32 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. Tuberculosis. The Surrey County Council is responsible for the anti-tuberculosis scheme in the district. The main institutional provision is the County Sanatorium, Milford, to which 24 persons were admitted from Carshalton during the year. Eighty-eight other cases 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. The erection of the new St. Helier Hospital is proceeding, but meantime the position with regard to hospital accommodation in this part of the County remains very difficult. 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 Tuesdays, 2-3.45 p.m. Road. Thursdays, 2-3.45 p.m. 33 Phoenix Buildings, Stanley Road Wrythe Hall, Wrythe Lane Methodist Central Hall, Green Lane. Toddler Clinics— Phoenix Buildings, Stanley Road Wrythe Hall, Wrythe Lane Maternity Clinics :— Municipal Institute, Rochester Road. Phoenix Buildings, Stanley Road Wrythe Hall, Wrythe Lane Methodist Central Hall, Green Lane. Dental Clinics :— Municipal Institute, Rochester Road. Fridays, 2-3.45 p.m. Wednesdays, 2-3.45 p.m. Fridays, 10-11.45 a.m. Mondays, 2-3.45 p.m First and third Thursdays, 2-3.45 p.m. Tuesdays, 2-3.45 p.m. First, second and fourth Mondays in each month, 10- 11.45 a.m. Fridays, 1.30 p.m. Tuesdays, 10-11.45 a.m. Fridays, 2-3.45 p.m. (Post-natal mothers only on First Friday in each month.) First and third Mondays in each month at 1.30 p.m. Mondays, 10-11.45 a.m. Second and fourth Tuesdays, 2-4 p.m. Second and fourth Saturdays, 9.30-11.30 a.m. DIPHTHERIA IMMUNISATION CLINICS. (Provided by the Council.) Wrythe Hall, Wrythe Lane Second and fourth Wednesday in the month, 10 a.m. 34 SCHOOL CLINICS. (Provided by the Surrey Education Committee.) General Medical :— Municipal Institute, Rochester Wednesdays, 9.30 a.m.-12. Road. Fridays, 9.30 a.m.-12. Middleton Road, St. Helier, Mondays, 9.30 a.m.-12. Morden. Wednesdays, 9.30 a.m.-12. Thursdays, 1.45-4 p.m. Phoenix Buildings, Stanley Road Mondays, 1.45-4 p.m. Dental Clinics :— Municipal Institute, Rochester Road. Mondays, 1.45-4 p.m. Tuesdays, 9.30 a.m.-12. Wednesdays, 1.45-4 p.m. Thursdays, 9.30 a.m.-12. Fridays, 1.45-4 p.m. First and Third Saturdays, 9.30 a.m.-12. Middleton Road, St. Helier, Morden. Mondays, 9.30 a.m.-12. Tuesdays, 9.30 a.m.-12. and 1.45-4 p.m. Wednesdays, 9.30 a.m.-12. and 1.45-4 p.m. Thursdays, 1.45-4 p.m. Fridays, 9.30 a.m.-12. and 1.45-4 p.m. Saturdays, 9.30 a.m.-12. Hill House, Bishopsford Road Mondays, 9.30 a.m.-12. Tuesdays, 9.30 a.m.-12. Wednesdays, 9.30 a.m.-12. Thursdays, 9.30 a.m.-12. Fridays, 9.30 a.m.-12. Phoenix Buildings, Stanley Road Mondays, 9.30 a.m.-12. Wednesdays, 9.30 a.m.-12. Fridays, 9.30 a.m.-12. Second, fourth and fifth Saturdays, 9.30 a.m.-12. 35 TUBERCULOSIS DISPENSARIES. (Provided by Surrey County Council.) Municipal Institute, Rochester Fridays, 10 a.m.—12 noon. Road 3rd Tuesday, 5—7 p.m. Health Centre, Middleton Mondays, 1.30 p.m. Road, Morden 2nd Monday, 5.30 p.m. 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 841 Still births 27 Notified by midwives 548 Notified by doctors and parents 106 Transferred notifications 214 868 868 The total is 29 more than in 1937 and represents 96 per cent, of the number of births registered during the year. The Work of The Centres. The scope of the welfare centres was extended during the year by the inauguration of special toddler clinics at the Wrythe Lane and Stanley Road centres during March. The object of these special clinics is to provide a complete medical overhaul of each child in its third, fourth and fifth years. It has long been realised that the medical supervision of infants under public welfare schemes tends to become less adequate as the child approaches school age unless special efforts are concentrated on the pre-school child. 36 Moreover, in the absence of a routine examination unprompted by complaints, many defects at a stage when correction is comparatively easy, go unrecognised until they produce symptoms. The establishing of toddler clinics helps to fill this gap in the service, and its justification is shown by the table of defects found which is appended later. Consequently the scheme now provides two types of clinics for children—the long established infant welfare clinic which is primarily a consultative session to which mothers may bring their children without appointment, and the special toddler clinics for the purpose mentioned above, attendance at which is by invitation and appointment. The attendances at the infant clinics show a further increase over those of the year before, although the number of children who attended was on much the same scale. New babies coming for the fiist time represented 73 per cent, of the notified births. There was a further satisfactory increase in the work of the maternity clinics. Seventy-four more antenatal mothers attended and the total, expressed as a percentage of the notified births, rose from 50 to 56. The attendances made by these women increased from 1302 to 1797. The number of women who attended for postnatal examination, although three times as many as previously, still represents only a small percentage of the total confinements, but it is encouraging that there is a growing realisation of the need for this type of supervision. Tenders have now been received for the erection of the new clinic in Middleton Road, a brief description of which was given in last year's report. The attendances at the centres are shown in the following Tables :— 37 TABLE 11. ATTENDANCES AT MATERNITY CLINICS. CENTRE No. on Register Attendances Sessions Average attendance per Session * Primary Total Rochester Road. Ante Natal .. 129 106 467 33 14.3 Post Natal 5 — 5 Individuals .. 129 106 472 Wrythe Lane Hall Ante Natal . . 277 223 1095 |97 23.7 Post Natal 49 4 54 Individuals .. 281 227 1149 St. Helier. 20 6.2 Ante Natal . . 41 34 124 Post Natal — — — Individuals .. 41 34 124 Stanley Road. Ante Natal .. 42 32 111 19 6.6 Post Natal 14 1 15 Individuals . . 43 33 126 All Centres. Ante Natal .. 489 395 1797 | 169 11.0 Post Natal 68 5 74 Individuals . . 494 400 1871 *Primary attendance is the first attendance of a woman in relation to the pregnancy under supervision. 38 TABLE 12 ATTENDANCES AT INFANT CONSULTATION CLINICS, 1938. Centre Years. Number who attended during year. New cases to the Centres Number on register at year end. Attendances Number of sessions. Average attendance per session. Primary. Total Rochester Road Under 1 499 225 172 223 3,835 97 59.5 1—5 95 277 59 1,938 Wrythe Lane Under 1 835 241 207 224 3,843 99 65.5 1—5 157 577 55 2,646 Stanley Road Under 1 242 79 65 78 1,385 50 45.5 1—5 34 164 26 890 St. Helier Under 1 318 96 92 93 1,275 47 45.8 1—5 45 210 25 881 All Centres Under 1 1894 641 536 618 10,338 293 56.9 1—5 331 1,228 165 6,355 Total 0—5 1,894 972 1,764 783 16,693 293 39 Toddler Clinics. The following tables give an analysis of the defects found at the toddler examinations and the number dealt with in the three age groups. It will be observed that out of 661 children of ages 2 to 5 years examined, defects were found in 482 (72 per cent.). The number of individual defects found in these 482 children was 995, of which 476 required treatment and 519 observation for the time being. This represents 2.07 defects per child. With regard to the following up of these conditions, it is satisfactory to report that of the 476 conditions recommended for treatment, only 43 failed to receive attention. TABLE 13. ATTENDANCES AT SPECIAL TODDLER (2-5 YEARS) CLINICS, 1938. Centre No. of routine medical examinations Sessions Average attendance per Session Did not attend Infant consultation Clinic 2-3 years 3—4 years 4-5 years Total* Wrythe Lane Hall 167 175 169 511 40 12.8 130 Stanley Road 65 43 42 150 18 8.3 28 Total 232 218 211 661 58 11.0 158 *Each child attended once—this figure, therefore, represents the number of chi'dren who attended TABLE 14. ATTENDANCES AT ALL INFANT WELFARE CLINICS 1938. (Infant Consultation and Special Toddler.) Year Number who attended during the year New cases to the Centre Attendances Session Average attendance per Session Primary Total 0—1 2052 641 618 10338 351 29.4 1-5 466 300 7016 20.0 Total 2052 1107 918 17354 351 49.4 40 TABLE 15. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1938. DEFECT Recommended for Number which received Treatment by Observation Tereatment Own Dr. Hospital At Home by Advice Clinic Total Cleanliness — 6 2 2 Nutrition 6 22 — 1 17 — 18 Ringworm — — — — — — — Impetigo 1 8 1 2 6 — 9 Scabies 1 2 2 — — — 2 Other Skin Conditions 17 26 3 9 II — 23 Blepharitis 2 5 2 3 — — 5 Conjunctivitis 1 5 1 2 1 — 4 Keratitis — — — — — — — Corneal Ulcer — 1 — — — — — Corneal Opacities — — — — — — — Other Conditions 1 — — — — — — Vision — — — — — — — Squint 7 33 1 26 — — 27 Hearing 2 2 — 1 — — 1 Otitis Media 15 2 — 1 — — 1 Other Diseases 1 6 2 1 — — 3 Teeth 50 97 — 9 1 33 43 Tonsils 147 49 4 19 — — 23 Adenoids 66 28 1 9 — — 10 Other Conditions 19 3 — — 1 — 1 Enlarged Cervical Glands 47 2 — — — — — Speech 17 1 — — — — — Heart Disease 26 5 1 4 — — 5 Anaemia 2 16 1 1 9 — 11 Lungs, Tubercular — 3 — — — — — Lungs, Non-tubercular .. 9 18 5 — — — 5 Other Tubercular Diseases 4 4 — 1 — — 1 Epilepsy 1 3 3 — — — 3 Chorea 1 1 I — — — 1 Other Conditions 4 1 — — 1 — 1 Rickets 27 54 — 6 28 10 44 Spinal Curvature 1 6 — — 3 — 3 Other Forms 8 14 — 1 4 — 5 All Other Defects 26 49 — 6 10 — 16 Mental Condition 5 3 — 1 2 — 3 Behaviour 5 1 — — — — — Total 519 476 28 103 96 43 270 41 Health Visiting. Owing to the increased number of fixed welfare sessions at which the attendance of the Health Visitors is required, the time available for home visiting was correspondingly curtailed. The number of home visits, excluding infant life protection visits, fell from 11,287 to 8,893. They were made as follows :— To expectant mothers- First visits 65 — Total visits — 141 To children under 1 year— First visits 866 — Total visits — 3639 To children 1-5 years— Total visits — 5133 8893 Since the end of the year the staff has been increased by the appointment of an additional Health Visitor, bringing the number up to 5. " Assisted " Milk and Other Foods. The provision of fresh milk, dried milk, and other foods on a considerable scale to necessitous mothers and infants has been a marked feature of the scheme for many years. This is a substantial item of expenditure, but is one, the adequate return on which, in terms of health, can least be disputed. The examination of the table which follows shows that 40 more individuals were assisted than in the year before, whilst the increased distribution in fresh milk, to take the chief item, was some 5,000 pints in the case of free issues and more than 6,000 pints in the case of half-price issues. There were increases also in the amounts of other foods distributed, such as Virol and cod liver oil. Assistance given in this way is subject to two primary conditions— (1) a recommendation on medical grounds and (2) the family income being within certain limits fixed by the Council. Each application is carefully scrutinised and the information relating thereto checked in every case. Dental Scheme. The operation of the special toddler clinics recently established has emphasised the necessity for increased attention to dental 42 TABLE 16. DISTRIBUTION OF "ASSISTED" MILK AND OTHER FOODS, 1938. 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 133 206 15459 9722 329½ 219½ 32 — 2800 1712 1514 1778 724 446 544 240 St. Helier South 73 96 5349 3495 218 245 216 156 754 564 896 470 408 164 222 48 St. Helier West 81 127 7038 7143 172 136 32 96 1622 1342 616 758 390 328 328 226 North-East 55 76 3204 2135 79 105 16 256 464 208 436 448 288 52 104 28 North-West 32 52 2810 837 72 64 32 48 660 176 488 210 84 — 80 64 Central 20 23 1900 168 — — 16 — 192 64 192 32 108 — 96 South-East 24 35 1694 1302 117 12 248 — 530 216 174 208 — 16 48 16 South-West 1 1 — — 40 — 44 — — — 16 — — — — — Totals 419 616 37454 24802 1027½ 781½ 636 556 7022 4282 4332 3904 2002 1006 1422 626 43 conditions in the pre-school child. Out of 661 toddlers examined, 147 were found to have dental defects, 97 of which needed immediate treatment. It is fairly safe to say that the majority of these cases would not themselves have sought treatment until more extensive dental damage had occurred, a fact usually first impressed upon the parent by the child's complaint of pain. Mainly as a result of the toddler clinics, facilities for dental treatment have been extended and although 1938 experienced a much busier year than its predecessor, the activities of these clinics in the coming year are likely to reach still greater heights. There is still considerable scope for increased usefulness on the part of the public dental service. The completion of the new St. Helier clinic building will make it possible to effect further improvements in our dental arrangements. Details of the work done during 1938 are as follows :— DENTAL SCHEME—TREATMENT PROVIDED, 1938. Temporary Teeth Permanent Teeth Dentures Supplied Extracted Filled Extracted Filled Full Partial 452 28 174 5 27 8 Anesthetics Gas 140 Local 16 Other operations .. Impressions .. .. 39 Bites 18 Try-ins 20 Dressings 29 Scalings 29 Inspections 163 Dentures supplied— Full Partial Free 5 — Half Price 18 4 Part Cost 3 2 Full 1 2 Total 27 8 44 Attendances at the dental clinics are shown in the following Table :— DENTAL SCHEME—ATTENDANCES, 1938. Centre referred from No. Treated No. of Attendees. Rochester Road Children 17 30 Mothers 19 50 Individuals 36 80 Wrythe Lane. Children 39 49 Mothers 41 128 Individuals 80 177 St. Helier. Children 10 15 Mothers 15 46 Individuals 25 61 Stanley Road. Children 10 18 Mothers 14 28 Individuals 24 46 All Centres. Children 76 112 Mothers 89 252 Individuals 165 364 Number of Sessions held 38 Average attendance per Session :— Children 2.9 Mothers 6.6 Individuals 9.5 45 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. Thirty-six cases were given 688 treatments by the masseuse for the following conditions— Genu-valgum 19 Genu-varum 11 Flat foot 3 Torticollis 1 Thyroid deficiency 1 One child was maintained in a special hospital for the treatment of talipes for a period of 6 weeks. This was a continuation of treatment first commenced in 1937. Three cases were provided with special surgical applicances free of cost and a fourth was given assistance towards the cost of a similar apparatus. 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 two mothers and babies and 7 children received treatment under these arrangements for the following conditions :— 46 Condition Debility following confinement .. Do. do. Tonsillitis and bronchial catarrh.. Measles and pneumonia Nervous child and ? asthma Rheumatic heart Underdevelopment and loss of weight Underweight Broncho-pneumonia Age Duration of Treatmt. Mother & baby 2 weeks, do. do. 1 yr. 2 mths. 4 ,, 2 yrs. 10 mths. 8 ,, 4 years 8 ,, 4 years 10* „ 4 years 8 ,, 3 yrs. 11 mths. 2 „ 3 years 16 ,, Maternity Hospital Treatment. The Council's arrangements for hospital treatment for maternity cases are as described in previous reports. A total of 62 cases was referred from the Council's clinics to maternity institutions as follows :— For obstetric and medical reasons. For unsuitable home conditions. Total. Carshalton (War Memorial Hospital) 5 5 10 County Hospitals 27 19 46 Other Hospitals .. .. 3 3 6 35 27 62 For details of cases of puerperal pyrexia admitted to hospital, see Section F, dealing with infectious diseases. Consultant Service. Specialist advice may be obtained under the scheme for the complications and emergencies of pregnancy and labour and for puerperal pyrexia. The services of the Council's Consultant were called upon on 5 occasions for the following conditions :— Puerperal pyrexia (2). Retained placenta. Post partum haemorrhage. Abnormal presentation. 47 Emergency Maternity Unit. In accordance with the suggestion of the Ministry of Health in Circular 1622, the Council, by arrangement with the Carshalton, Beddington and Wallington District (War Memorial) Hospital, established an emergency maternity unit. It is intended for use in the patient's own home for maternity emergencies where the patient is unfit to be removed to hospital. The medical attendance is provided by members of the hospital medical staff and the nursing assistance by the nursing staff. The equipment is contained in two fitted chests kept at the hospital and the Council's ambulance furnishes the means of transport. To secure the services of the unit, the practitioner communicates with the hospital. It has not been called upon so far. Maternity Outfits. Sterilised outfits in sealed metal containers are provided for use during confinement at cost price. In necessitous cases they may be had at half price or free, according to circumstances. Eleven outfits were provided during the year, 10 free of cost and 1 at half price. Home Helps. The services of a domestic help may be obtained for mothers with limited incomes during confinement or during the illness of a nursing or expectant mother or in other special circumstances. The mother's contribution towards the cost is fixed by an income scale. Thirty-four helps were supplied during 1938, 14 free of cost and 19 on part payment. Midwives. Two midwives are appointed by the District Council under the County Council's Scheme for the provision of a salaried midwifery service formulated under the Midwives Act, 1936. 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. 48 Provision is made for a reduced fee in necessitous cases. The work of the Council's midwives during the year is indicated by the following details :— Cases conducted :— Primip. Multip. Total. (1) As Midwife—Live births Still births 12 93 105 (2) As Maternity Nurse— Live births 2 12 14 Still births — — 14 105 119 Visits made— Antenatal 547 During confinement 2164 Attendances made by expectant mothers at the antenatal clinics with midwife in attendance 59 Medical Aid Forms sent by Midwives— 21 Rise of Temperature 1 Death of baby 1 Malpresentation 1 Pneumonia—baby 1 Prematurity and poor condition of mother 2 Patient's request 1 Circumcision 1 Baby's eyes 2 Anti partum hæmorrhage 4 Convulsions 1 Ruptured perineum 4 Delayed second stage 1 Phlebitis 1 Number of cases which attended antenatal clinics 63 In addition to the Council's 2, there are 11 other midwives resident in the district, 4 of whom are members of the District Nursing Association, 1 on the staff of the District Hospital and 3 County Council midwives. The remainder practice privately. 49 Voluntary Helpers. Voluntary work has been a feature of the maternity and child welfare activities in the district since the inception of the Scheme. Ten public spirited ladies give their time and energy at the centres in the interests of the mothers and children. These enthusiastic workers have now added to their sphere of usefulness by cooperating with the Health Visitors in the creation of a Samaritan fund designed to assist the poorer mothers in the many ways which are ever present and which are not covered by the official scheme. Individual ingenuity and enthusiasm has already made a promising start in raising funds for this purpose. CHILD LIFE PROTECTION. The Health Visitors are appointed Inspectors for the purposes of the Child Life Protection provisions of the Public Health Act, 1936. Strict control is exercised over foster homes and the wellbeing of the foster children carefully supervised. The following summarises the work of administering these statutory provisions Number of registered foster homes with children at the year end 33 Number of new homes registered during the year 19 Number of foster homes removed from the register during the year 13 Total number of foster homes supervised 45 Number of children admitted to the register during the year 77 Number of children removed from the register during the year . 57 Total number of children on the register at year end 60 Total number of children on the register during the year 117 Number of children who died during the year 2 Number of inquests held Number of visits made to foster homes 517 Legal proceedings As mentioned on previous occasions, the factor which creates our greatest difficulty and reacts most detrimentally on the infants' 50 health is the frequent removal from one home to another. The admissions and removals from our register during the year are as great as the number thereon at any one time. An infant of tender age has little chance of thriving under conditions which deny it a settled routine. Unfortunately, the child undergoes these frequent changes of foster care mostly during the first 12 months or so of life, a period when a sound foundation for its physical and mental constitution should be laid down. Not a few foster toddlers present to the welfare doctor, on arrival in this district, the well-known picture of a pale, flabby, pot-bellied, under-nourished body, the reasons for which are not hard to find when one knows the story of its postnatal peregrinations. 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 1938 was 2666, which is 229 less than in the year before. The nursery was open on 213 days which gives an average of 12.5 for each day the nursery was open. 51 Section C.—Sanitary Circumstances. Water Supply. The district is in the supply area of the Sutton District Water Company. The supply is derived from deep wells in the chalk at Sutton, Cheam and Woodmansterne and is augmented at intervals by water derived from river sources. The Cheam well, which had been closed since 1936, was put into supply again in June, 1938. The arrangements for controlling the quality of the supply were given in previous reports. These include routine sampling by the local authorities in the distribution area upon an agreed rota. Further samples are taken as circumstances indicate. Nine samples were taken by this Department during the year, 6 of which were submitted for bacteriological, and 3 for chemical, examination. They indicate a high degree of purity. All showed absence of bacillus coli in 100 ml., except one in which there was 1 organism in 100 ml., but this slight variation from the high standard of the remainder was in a water fed through a storage tank. A sample taken direct from the rising main from the same premises was of the high standard referred to. 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 for drainage of the Surrey County Council's Smallholdings was completed early in 1938. By this means cesspools in connection with 61 premises were abolished. A scheme has also been prepared for the elimination of the cesspools at the Oaks Estate. This was put in hand early in 1939. 52 As regards service water drainage, only small local extensions were necessary during the year. The drainage of 36 premises was connected to the sewer. Eightyseven drainage obstructions, affecting 302 houses, received attention whilst repairs were executed at 130 premises. Rivers and Streams. Towards the end of the year all the springs, except the Lower Pool, which form the source of one head of the River Wandle, failed and the flow was very small. No work of major importance was executed on the river but the routine cleansing was carried out. Five complaints of pollution were investigated but in 4 no case for special action was indicated. In the remaining instance, accidental pollution of a temporary nature was found to have occurred. Closet Accommodation. Eleven cesspools were abolished and only 28 premises are now not provided with water carriage connected to sewers. Eight of these have pail closets and the remaining 20 are drained to cesspools. Public Cleansing. Domestic refuse is collected weekly by covered freighters. Trade refuse is also collected on payment of a moderate charge. As stated in the last report, disposal is by incineration at the Council's 6-cell Destructor. No change was made in this organisation during the year. Sanitary Inspection of the Area. The work of sanitary inspection carried out during the year is indicated by the following details furnished by Mr. H. J. Spicet. M.R.S.I., Chief Sanitary Inspector, under Article 27 of the Sanitary Officers' Regulations, 1935. 53 Six hundred and eight complaints were received, classified as follows :— Drainage Obstructions 98 Rats and Mice 67 General Defective Conditions 45 Smells 41 Crickets 41 Accumulations and Deposits 40 Verminous Premises 37 Shops Acts 30 Miscellaneous 27 Dampness 25 Overcrowding 20 Roofs, Guttering, etc. 14 Drainage Defects 14 Burning Refuse 14 Wasps 13 Refuse Collection 11 Unfit Food 10 Obstructed Sewers 10 Rivers, Ditches, etc. 5 Dustbins 5 Ants 5 Sink Waste Pipes 4 Noise 4 Smoke Nuisance 4 Burst Pipe Damage 3 Cesspools 3 Weeds 3 Food on Forecourt 3 Workmen's Latrines 2 Water Supply 2 Fences 2 Houses Let in Lodgings 2 Rentbook Information 2 Hawkers 2 608 Nine thousand one hundred and seventy five investigations were made and are classified as follows :— Inspections 6145 Re-inspections 3030 Housing (H.A.) 428 Housing (P.H.A.) 1260 Slaughterhouses 45 Dairies 54 Cowsheds 53 54 Milkshops 131 Factories 79 Workshops 72 Outworkers 33 Bakehouse Factories 10 Bakehouse Workshops — Offices 12 Laundry Workshops — Laundry Factories 2 Houses, Drains Tested 159 Food Shops and Business Premises 660 Infectious Disease Premises 343 Infectious Disease Contacts 129 Urinals 68 Smoke Observations 70 Rat Infested Premises 493 Schools 13 9175 Arising out of the investigations, nine hundred and forty-five nformal notices were served for the following purposes :— General Defective Conditions 286 Rats and Mice 267 Accumulations and Deposits 114 Obstructed Drains 70 Rentbooks 53 Defective Drains 46 Verminous Premises .. 33 Miscellaneous 23 Defective Dustbins 17 Paving .. .. .. .. .. 8 Connections to Sewer 4 Food Storage 4 Ditches, Rivers, etc. 4 Smoke Nuisance 4 Hawkers 3 Burning Refuse .. 3 Meat Regulations 2 Houses Let in Lodgings 2 Factory and Workshop Act 2 945 Notices of intention to inspect were served with respect to 428 houses. 55 Eighty-nine formal notices were served under the following Acts :— Section 93, Public Health Act, 1936 62 Section 9, Housing Act, 1936 11 Section 56, Public Health Act, 1936 7 Section 66, Housing Act, 1936 .. 5 Houses Let in Lodgings Bye-Laws 2 Section 75, Public Health Act, 1936 .. 2 89 As a result of the serving of the notices, the following works were executed :— Brickwork repaired and/or renewed 21 Ceiling plaster repaired and made good 105 Ceiling cleansed and purified 157 Ceiling, new provided 3 Chimney pots repaired or renewed 3 Ch imney stacks repaired or renewed 19 Chimney flues repaired 7 Copper repaired and/or renewed 9 Cement fillets renewed 11 Cement plinths renewed.. 3 Cement plinths provided 5 Cesspools emptied 3 Cesspools repaired — Cesspools abolished 12 Damp conditions remedied 105 Damp course renewed and/or repaired 3 Damp course provided 2 Doors repaired (including locks and fasteners) 32 Door sills repaired, renewed or provided 10 Door frames repaired or renewed 6 Door stopping to reveals renewed 4 Drainage repaired or reconstructed (429 ft.) 21 Drainage provided 42 Drainage inspection chamber repaired or renewed 7 Drainage inspection chamber provided 89 Drainage inspection chamber cover renewed 8 Drainage inspection chamber cover provided 89 Drainage stoppers refixed or renewed 7 Drainage stoppers provided 15 Drainage interceptors renewed 2 Drainage interceptors provided 27 Drainage F.A.I, repaired or renewed 7 Drainage F.A.I, provided 31 Drainage M.F.V. renewed 8 56 Drainage M.F.V. provided 25 Drainage soil or vent pipes repaired or renewed 7 Drainage soil or vent pipes provided 26 Drainage, drains tested 159 Drainage, drains cleared 87 Drainage, drains sealed off 3 Drainage, waste gullies repaired and/or renewed or cleared 17 Drainage, waste gullies provided 10 Drainage, waste pipes repaired or renewed 22 Drainage, waste pipes provided 7 Drainage, approximately 69823 feet of new drainage were laid during the year — Ditches cleaned — Disinfestation 48 Dustbins provided 55 Food Storage accommodation provided 10 Food Storage accommodation ventilated 1 Floor boards repaired and/or renewed 27 Floor concrete repaired, renewed and/or made level 13 Floor ventilation repaired and/or renewed 5 Floor ventilation provided 6 Floor ventilators kerbed 5 Fireplaces repaired and/or renewed 19 Firegrates repaired and/or renewed 13 Firegrates, ranges and/or stoves repaired and/or renewed 13 Firegrates, ranges and/or stoves provided 2 Light, more provided 9 Roofs repaired and made weatherproof 110 Roofs stripped and recovered 16 Roofs flashing repaired and/or renewed 1 Roof ridges, hips, valleys repaired and/or renewed 9 Roof guttering and/or down pipes repaired and/or renewed 50 Roof guttering and/or down pipes cleaned out and made to work properly 21 Roof guttering and/or down pipes provided 3 Sinks renewed 8 Sinks provided 3 Stair treads repaired or renewed 8 Stair handrails and/or balusters repaired 4 Stair handrails and/or balusters provided 1 Steps repaired or renewed 6 Soakaways provided 8 Soakaways made to work properly 8 Surface Water drainage repaired and made to work properly 7 Surface Water drainage provided 9 Walls, cement rendered 6 Walls, cement rendering repaired 13 Walls replastered or repaired 104 Walls cleansed and redecorated 173 Walls rebuilt 1 Walls, settlements — Woodwork repaired and/or renewed 1 Windows repaired and/or renewed 26 57 Window frames repaired and/'or renewed 29 Windows made to work properly 15 Windows provided with catches and/or fasteners 12 Window sashcords renewed 86 Window sills repaired and/or renewed 42 Window stopping to reveals 4 Windows, fixed, made to open 3 Window glazing, panes renewed 25 Window glazing, putties renewed 72 W.C. accommodation repaired 1 W.C. provided 39 W.C. pans renewed 24 W.C. pans provided 49 W.C. pans, joints renewed 12 W.C. box seats removed 19 W.C. 'ift up seats provided 69 W.C. seats repaired or renewed 17 W.C. flushing apparatus repaired or renewed 23 W.C. flushing apparatus provided 47 W.C. pail closets abolished 38 Water Supply repaired 7 Water Supply provided 2 Water Supply cisterns repaired 1 Wash Basins, baths, repaired, renewed 3 Wash Basins, baths, provided 5 Weatherboards repaired or renewed 2 Paving, repaired made level 13 Paving provided 13 Paving drained 2 Nuisances 6 Rats and Mice 24 Other Matters (miscellaneous) 66 Gates repaired, renewed 1 Ventilation, more provided 8 Accumulations removed 32 Disinfection and Disinfestation. Following infectious illness disinfection of 439 rooms in 341 houses was carried out. Ninety-three lots of bedding were removed for sterilisation and 6 destroyed. Refuse bins were, as previously, dusted with a disinfectant powder during the summer months. Bed bug infestations were dealt with in 49 premises as follows :— Council Houses. Others Total By hydrogen cyanide 5 15 20 By spraying 6 23 29 11 38 49 58 Treatment by hydrogen cyanide is undertaken by arrangement with a private firm. Fumigation by spraying is done by the Council's staff, the insecticide used being either Solution " D " or Zaldecide. The homes of prospective tenants for Council houses are visited and where verminous conditions are found or suspected, the household effects are treated with hydrogen cyanide in the removal van before being unloaded into the new dwelling. Five van loads of furniture were dealt with in this way during the year. Tenants known to have been verminous at one time are visited periodically with a view to preventing re-infestation. The Council houses are supervised by the Council's Estates Manager. Mosquito Control. Water places in the district owned by the Council were sprayed during the months of February and April to destroy or prevent the breeding of mosquito larvae. Rats and Mice (Destruction) Act, 1919. The annual campaign was organised by the Chief Sanitary Inspector during the second week in November. 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 ; the whole of the sewers in the district were baited with rat bait and premises (both privately owned and owned by the Council) where infestations had occurred or were likely to occur were visited. Smoke Abatement. Four complaints of alleged nuisance from smoke were received and these were effectively dealt with without the necessity of any statutory action. 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 59 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. Thirteen visits of inspection were made to school premises. The sanitary conditions of the schools were generally satisfactory. Since the end of the year work has commenced on the demolition of one old school of antiquated design. Cemeteries. The Surrey County Council Bill referred to in my last report has now become Law and the district is thereby provided with approximately 25 acres of land in Morden for burial purposes. Negotiations are now in progress with the Merton and Morden Urban District Council for a joint scheme incorporating adjacent land in the ownership of that authority. Mortuary. The new Mortuary is now complete. Shops Acts 1912—1938. The Chief and District Sanitary Inspectors are appointed Inspectors under the Shops Acts. There are approximately 580 shops on the register. During the year, 1157 inspections were made and 77 informal notices served for the following infringements :— Sunday trading 33 Assistants' half day and half day notice 19 Exhibition of regulation form F 15 H 13 K 10 VII 6 G 2 Hours employment of young persons 5 Closing hours 3 Half-day closing 3 Mixed shop notices 3 Compensatory holidays 3 60 Evening and Sunday visits are made for the detection of infringements in addition to the inspections made during the routine visits to food shops. Section 10. Details of the operation of Section 10 of the 1934 Act relating to the health and comfort of shop assistants during 1938 are as follows :— Formal notices served .. .. .. 8 Shops without sanitary accommodation and washing facilities .. .. .. 4 Shops without means of providing a reasonable temperature .. .. .. 6 Shops provided with sanitary accommodation or washing facilities .. .. 3 Shops provided with means for providing a reasonable temperature .. .. .. 16 No formal exemption certificates in respect of the provision of sanitary accommodation or washing facilities were issued, but two written undertakings were accepted for two shops on conditions where accommodation was available at other premises, and in one case where only the occupiers of the shop were employed. Of the 16 shops provided with means for maintaining a reasonable temperature, 7 were meat shops, 6 grocery shops, 1 fish shop, 1 hardware shop and 1 fruit and greengrocery. There are still 10 notices outstanding for the provision of means for maintaining a reasonable temperature. Six of these are on meat shops, 2 fruit and greengrocery shops, 1 fish shop and 1 grocery and provision. Offices. Visits were made to offices but no conditions were found which required special action under the Public Health Act, 1936. Camping Sites. One site at The Oaks, which is owned by the Council, was used as a camping ground by boy scouts for week-end camping. The greatest number of campers at any one time was 40. 61 No licences were issued under Section 269 of the Public Health Act, 1936. Swimming Baths and Pools. There is only one small indoor swimming bath, which is privately owned, measuring 46 feet by 23 feet. It is fed from the mains supply and the water is subjected to a constant process of precipitation, filtration and chlorination by gaseous chlorine. A sample was taken at 3 p.m. on a day towards the end of June after 18 persons had paid for admission. The bacteriological condition was as follows :— Number of colonies per ml. developing in 2 days upon agar at 37 deg. C. 2400 Number of colonies per ml. developing in 3 days upon agar at 22 deg. C 5000 B. coli absent from 100 ml. B. welchii present in 10 ml. Diphtheroids absent from 100 ml. Haemolytic streptococci . absent from 100 ml. Streptococcus brevis present. Staphylococcus albus present. Staphylococcus aureus present. " B. coli and many other organisms added to the water by the bathers must have been killed whilst the water was still in the bath, an indication of the effectiveness of the chlorination. The action of the chlorine during transport of the sample for bacteriological examination was prevented. The chemical composition is satisfactory and the clarity of the water shows effective filtration." One hour and 42 minutes after sampling the water contained 0.12 parts per million of free chlorine. 62 Section D — Housing. New Houses. New houses erected during the year numbered 391, compared with 312 in the year before. They were distributed as follows :— WARD. By the Council. By Private Enterprise. Total. St. Helier North — 15 15 St. Helier South — — — St. Helier West — — — North East 4 240 244 North West — 10 10 Central — 46 46 South East — 40 40 South West — 36 36 Whole District 4 387 391 Council's Housing Scheme. The houses erected by the Council under the provisions of the Housing Acts up to the 31st December, 1938, are as follows :— Act under which erected. No. of Properties. (P.—Parlour. Type N.P.—Non-Parlour.) 1919 .. 203 P. 3 bedrooms 2 N.P. 3 Flats 5 .. 210 N.P. 3 „ 1923 12 N.P. 3 „ 28 N.P. 2 „ Flats 8 48 N.P. 1 1924 40 P. 3 „ 72 N.P. 3 „ Flats 56 168 N.P. 2 „ 63 Ac. under which erected. No. of Properties Type (P—Parlour. N.P.—Non-Parlour) 1930 10 N.P. 4 bedrooms 52 N.P. 3 „ 4 N.P. 2 „ Flats 20 N.P. 2 „ 86 1990/36 18 N.P. 2 60 N.P. 3 „ 16 N.P. 4 „ 8 P. 4 „ 102 614 The number of first applications received during 1938 160 The number of tenancies allotted during 1938 40 The number of applications outstanding at 31st Dec., 1938 349 Inspection and action taken under Statutory Powers. 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) 1688 (b) Number of inspections made for the purpose .. 4428 (2) (a) Number of dwelling houses (included under head (1) above), which were inspected and recorded under the Housing Consolidated Regulations, 1925 to 1932 428 (b) Number of inspections made for the purpose 1788 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (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 328 64 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 415 (Including some houses inspected during 1937) 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 8 (2) Number of dwelling houses which were rendered fit after service of formal notices :— (a) By owners 8 (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 .. 68 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners .. .. .. .. .. 56 (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 .. .. .. .. — (2) Number of dwelling houses demolished in pursuance of Demolition Orders — (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 — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 65 4. Housing Act, 1936, Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at end of year 79 (2) Number of families dwelling therein 79 (3) Number of persons* dwelling therein 562 (£>) Number of new cases reported during the year 50 (c) (1) Number of cases of overcrowding relieved during the year 63 (2) Number of persons* concerned in such cases .. 399 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding — * As defined by Section 58 (2) of the Housing Act, 1936. Slum Clearance. The Order made by the Council in connection with Clearance Area No. 6—West Street, involving 6 dwellings and the displacement of 20 persons, was confirmed by the Minister of Health during the year. The premises to re-house these people are now in course of erection and when this scheme is complete the number of dwellings demolished under Clearance Schemes since 1930 will be 64, involving the re-housing of 481 persons. Two houses were demolished by informal action during the year, birnging the number of dwellings individually demolished since 1930 up to 21. 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 beginning of 1938 the number of dwellings remaining overcrowded was 92, housing 633 equivalent adults. During the year under review, a net reduction of 13 in the overcrowded dwellings and of 71 equivalent adults was affected, leaving 79 dwellings, housing 562 equivalent adults, still to be decrowded at the end of the year. The net reduction of 13 cases was brought about as follows "— 66 Overcrowded at 31.12.37 Found overcrowded during 1938 De crowded during 1938 Remaining overcrowded at 31.12.38 Net reduction in overcrowding during year. 92 50 63 Dwellings 79 13 Equivalent adults 633 328 399 562 71 Of the 50 new cases of overcrowding, 9 were illegal. Five of these were abated by informal action and 2 by service of statutory notice. Two were outstanding at the end of the year. The 63 overcrowded cases were abated in the following manner : Provision of alternative accommodation :— (a) By Carshalton Council II (b) By London County Council 25 Left the district 8 By removal of one or more occupants 18 The families themselves securing alternative accommodation The position with regard to overcrowding in the individual wards up to the end of 1938 was as follows :— WARD Houses overcrowded at Survey Houses found overcrowded up to 31.12.38 Houses decrowded up to 31.12.38 Houses remaining overcrowded at 31.12.38 Overcrowding Cases remedied during 1938. Formal Informal Total St. Helier North 40 (a) 31 (A) 48 (A) 23 (b) 8 3 11 (b) St. Helier South 40(b) 31 (b) 51 (b) 20 (b) 12 7 19 (b) St. Helier West 45 (b) 40 (f) 63 (i) 22 (b) 11 8 19 (/) North East 17 (c) 14 (d) 28 (e) 3 1 3 4 North West 10 29 36 3 — 3 3 Central 9(d) 10 17 (d) 2 — 1 1 South West — 3 2 1 — — — South East 12 (e) 14 (g) 21 it) 5 (e) 4 2 6 (k) 173 172 266 79 36 27 63 (a) 39 L.C.C. houses. (b) All L.C.C houses. (c) 4 C.U.D.C. houses. (d) 1 C.U.D.C. house. (e) 5 C.U.D.C. houses. (f) 37 L.C.C. houses. (g) 9 C.U.D.C. houses. (h) 47 L.C.C. houses. (i) 60 L.C.C. houses. (j) 18 L.C.C. houses. (k) 3 C.U.D.C. houses. 67 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. No applications were received during the year. Factories and Workplaces. The following premises were on the register at the end of the year :— Number. Employees. Factories with mechanical power .. 54 537 Factories without mechanical power 57 132 Outworkers premises .. .. 76 79 Factory and Workshop Act, 1901 and the Factories Act, 1937. 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 Acts :— 1. INSPECTIONS for purposes of provisions as to health. (Including inspections made by Sanitary Inspectors.) PREMISES Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) Factories with mechanical power 79 2 — Factories without mechanical power 105 — — *Other premises under the Act (including works of building and engineering, but not including outworkers' premises) — — — Total 184 2 — * Electrical Stations should be reckoned as factories. 68 2. Defects Found. Particulars. Number of Defects. Number of defects in respect of which prosecutions were instituted Found Remedied Referred to H.m. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S.l) 2 2 - - Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — Ineffective drainage of floors (S.6) .. — — — — Sanitary Conveniences (S.7) f insufficient — — — — , unsuitable or defective — — — — I, not separate for sexes — — — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937). - - - - Total 2 2 — — Outwork in Unwholesome Premises, Section 108 Nature of Work (1) Instances (2) Notices served (3) Prosecutions (4) Wearing Apparel :— Nil Making, etc. Nil Nil Cleaning and washing Nil Nil Nil Other trades Nil Nil Nil Total Nil Nil Nil 69 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 licensed to produce Accredited Milk. The number of retailers on the register is 108 with 122 premises, 10 of which were registered during the year. Sixty-six have premises in the district, the remaining 42 retail milk brought from premises outside the district. The bulk of the milk consumed is pasteurised, a relatively small amount of raw milk being sold at the few local farms and one dairyman retailing his supply produced outside the district. Periodic visits of inspection were made to all the milk premises and 94 samples were taken for bacteriological examination, the results of which are given 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 term " Tuberculin Tested " 10 Licences to use the term " Pasteurised " 6 Supplementary licences to use the term " Tuberculin Tested" 9 Supplementary licences to use the term " Pasteurised " 14 70 MILK SAMPLES. Grade Bacterial Count Bacillus Coli Test Methylene Blue Test Tubercle Test. Phosphatase Test. No. examined Highest Lowest Average No. examined Abs. in 1/10 ml. Abs. in 1/100 ml. Abs. in 1/1000 ml. No. examined Satisfactory No. examined Satisfactory No. examined Satisfactory Ordinary 36 98400 2320 13480 36 32 35 36 36 36 5 5 — — Pasteurised 51 26880 800 8040 51 50 51 51 38 38 5 5 12 12 Accredited 7 67200 5300 25425 7 7 7 7 7 7 2 2 — — 71 Meat and Other Foods. Most of the meat supplied to the district comes from the London and Croydon markets where it has already been inspected. Only one slaughterhouse, a registered one, is used in the district. There are 36 purveyors of meat with shops and several hawkers with vans from other districts. Regular visits of inspection are made to all premises and vehicles where food is stored, prepared or sold for human consumption. The number of carcases examined and the number condemned in the district was as follows :— Cattle excluding Cows Cows. Calves Sheep and Lambs Pigs Number killed (if known) — — — — 41 Number inspected — — — — 41 All Diseases, except Tuberculosis. Whole carcases condemned - - - - - Carcases of which some part or organ was condemned Percentage of the number inspected afTected with disease other than tuberculosis — — — — — Tuberculosis only. Whole carcases condemned - - - - - Carcases of which some part or organ was condemned Percentage of the number inspected affected with tuberculosis — — — — — The total food condemned was :— 2 cwts. dog fish. 14 lbs. skate. 4 lbs. cooked gammon of ham. lbs. back bacon. 2 lbs. streaky bacon. I rabbit. 72 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 AduLerated or Deteriorated Prosecutions Convic tions Formal Informal Total Formal Informal Total Milk 26 4 30 1 1 - - Cream 1 — 1 - - - - - Butter 1 — 1 - - - - - Cheese - - - - - - - - Margarine - - - - - - - - Lard - - - - - - - - Meat 2 — 2 - - - - - Flour 1 — 1 - - - - - Tea - - - - - - - - Coffee - - - - - - - - Cocoa - - - - - - - - Sugar - - - - - - - - Sausages - - - - - - - - Confectionery and Jam - - - - - - - - Sausage meat - - - - - - - - Wine - - - - - - - - Beer - - - - - - - - Spirits - - - - - - - - Drugs .. 1 — 1 I — 1 - - *Other articles 5 — 5 2 — 2 - - Totals 37 4 41 3 1 4 — — *Details of other articles Orange Wine 1 — 1 - - - - - Beef Dripping 1 — 1 - - - - - Mint 1 — 1 - - - - - Chocolate Roll 1 — 1 1 — 1 - - Slid 1 - 1 1 - 1 - - 73 The Slaughter of Animals Acts, 1933.—Three persons were licensed to act as slaughtermen and every step was taken to ensure that all animals slaughtered in the District were slaughtered in accordance with the Act. Ice Cream.—There are 64 premises carrying on ice-cream businesses but only three actually manufacture ice cream. All premises and vehicles were periodically inspected. Bakehouses.—There are now five bakehouses in the District. All were visited on several occasions and found to have complied with the requirements in respect of periodical cleansing and whitewashing. 74 Section F.—Prevalence of and Control over Infectious and other Diseases. Where notifications were received in respect of Queen Mary's Hospital for Children, separate figures are given in this section relating to that institution. Queen Mary's is a London County Council Hospital with a patient population of more than 1,000 children, all of whom are admitted exclusively from London and whose contact is almost entirely limited to visitors from the metropolis. A truer picture of the prevalence of infectious disease in the resident population of Carshalton is thereby presented. Notification. The following diseases are notifiable in the district :— Smallpox Relapsing or Dysentery Cholera Continued Fever Acute Primary Diphtheria Cerebro-Spinal Pneumonia Membranous Fever Acute Influenzal Croup Acute Pneumonia Erysipelas Poliomyelitis Acute Encephalitis Scarlatina or Ophthalmia Lethargica Scarlet Fever Neonatorum Acute Polio- Typhus Fever Puerperal Pyrexia Encephalitis Typhoid Fever Tuberculosis Food Poisoning. Enteric Fever Malaria Smallpox. The district has been free from variola infection for the last 5 years. Enteric Fever. One case of enteric fever, a member of the nursing staff of Queen Mary's Hospital, was notified. The diagnosis was based on a 75 positive Widal reaction to bacillus typhosus of 1 in 60. She was admitted to isolation hospital. Dysentery. Nineteen notifications were received, all but one in the first six months of the year. This compares with 53 in the year before. Three of the cases were from Queen Mary's Hospital and were stated to be Sonne infections. They were removed to isolation hospital. The remaining 16 cases were residents of the district. In 4 instances there was more than one case in the same house. The diagnosis in all but one case (a Sonne infections) was based upon clinical evidence. 1 hree were removed to isolation hospital and all recovered. The type of illness was very similar to that experienced in the last year or two and was probably mainly due to infection by the Sonne organism. Scarlet Fever. The prevalence of mild scarlet fever was rather less than in the year before but still remains higher than the general experience, Notifications totalled 239 compared with 294 in the previous year, of wh ch 227 occurred outside hospitals. The incidence for all cases falls from 5.06 to 4.06 per thousand population and that for cases excluding Queen Mary's Hospital from 4.73 to 3.95. The rate for England and Wales was 2.41. Ninety-two per cent, of the cases were removed to hospital. There were 5 " return " cases. No person died of this infection. 76 The distribution of scarlet fever is shown in the following table. TABLE 17 SCARLET FEVER—WARD INCIDENCE, 1938. (Excluding Queen Mary's Hospital.) WARD Cases Rate per 1,000 population. St. Helier North 69 7.93 St. Helier South 47 6.44 St. Helier West 38 4.71 North-East 34 4.18 North-West 12 1.61 Central 10 1.54 South-East 6 0.83 South-West 11 1.58 Whole District 227 3.87 The seasonal prevalence is given in Table 18. TABLE 18. SCARLET FEVER—MONTHLY DISTRIBUTION, 1938. 1938 Ward Total St. Helier North St. Helier South St.Helier West NorthEast NorthWest Central SouthEast SouthWest January 6 4 2 5 2 1 1 2 23 February 2 5 3 2 – 4 l 1 18 March 2 3 – 2 1 1 – 1 10 April 5 4 – 5 2 1 1 1 19 May 4 6 2 3 – 1 – 1 17 June 2 3 1 3 3 – – 1 13 July 6 5 4 – 3 – 1 2 21 August 3 2 1 1 – – – – 7 September 9 3 4 6 – – – 1 25 October 9 3 7 1 – – – – 20 November 10 5 9 3 – 1 2 – 30 December 11 4 5 3 1 1 – 1 26 Totals 69 47 38 34 12 10 6 11 227 Monthly Mean 5.8 3.9 3.2 2.8 10 0.8 0.5 0.9 18.9 77 Multiple Cases.—The houses in which more than one case occurred are shown below:— TABLE 19. SCARLET FEVER—MULTIPLE CASES 1938. WARD Number of houses in which occurred Total Houses Total Cases 1 case 2 cases 3 cases 5 cases St. Helier North 52 7 1 – 60 69 St. Helier South 40 2 1 – 43 47 St. Helier West 30 4 – – 34 38 North-East 26 – 1 1* 28 34 North-West 10 1 – – 11 12 Central 8 1 – – 9 10 South-East 6 – – – 6 6 South-West 11 – – – 11 11 Whole District 183 15 3 1 202 227 *A Home for Foster Children. Home Treatment of Scarlet Fever.—An approach was made to the practitioners in the district to secure their co-operation to giving effect to the Ministry of Health's advice that " whenever possible uncomplicated cases of scarlet fever should be treated at home. This advice is prompted by the risk of cross infection where hospital isolation is provided in multiple bed wards as is the common practice in the majority of hospitals at the present time. Viewed from this aspect alone the advice is sound, but the qualifying words "whenever possible" cover many other important considerations which prevent the advice being implemented, except in a relatively few instances. One great difficulty is the reluctance of practitioners, many of whom are engaged in midwifery practice, to undertake the conduct of infectious illness, particularly a streptococcal infection, in view of the fact that, under conditions of general practice, it is difficult to take adequate precautions against conveying infection without making serious inroads into their valuable time. One conscientious practitioner, to my knowledge, left the visiting of a scarlet fever patient who was being treated at home until the end of his daily round to minimise the risk to his other patients. He was accused of neglecting his case and another doctor was called in. 78 The attitude of the parents has also to be considered. An established practice is difficult to alter. For years children have been removed to hospital almost automatically, have received excellent attention and the family has been relieved of much dislocation of its routine which is necessary for securing effective isolation in a private dwelling. Poor mothers cannot afford the expense of practising effective isolation, and the retention of a notifiable case at home frequently involves the breadwinner in some restrictions to the detriment of his income. The risk of cross infection in the multiple bed wards of our isolation hospitals to-day cannot be denied. The reports of the Chief Medical Officer to the Ministry of Health show that this has been demonstrated conclusively. It is borne out in our local experience by the fact that the Superintendent of the Joint Isolation Hospital reports that the majority of "return" cases have been, not from homes to which children have been discharged after only one month's stay in hospital, but from houses where the original case had been retained in hospital for periods of from 8 to 10 weeks. Whether the present system of hospital treatment for scarlet fever is being carried to excess or not, one practical means of eliminating the risks of the existing practice is indicated quite clearly. However many cases it is desirable to send to hospital, be it few or many, they should be nursed on the cubicle system. It is more costly certainly, but surely that is preferable to perpetuating a system which in its faults tends to foster the dissemination of infections which it is designed to prevent. Diphtheria. There was a further satisfactory fall in the prevalence of diphtheria in the district, excluding Queen Mary's Hospital, although the number of notifications from that institution showed an increase. The total notifications numbered 105, of which 72 were in respect of Queen Mary's Hospital and 33 from the rest of the district. The incidence rates were— Per 1,000 population. All cases notified 1.78 Cases excluding Queen Mary's Hospital 0.57 (England and Wales) 1.58 The reduction in incidence is mostly in those age groups which are affected by diphtheria immunisation, and in this connection it 79 may be observed that 33 per cent. of the total cases occurred in persons over school age, the highest proportion yet recorded for the district. All cases were admitted to isolation hospital. The ward distribution is given in the following Tables:— TABLE 20. DIPHTHERIA-WARD INCIDENCE, 1938. (Excluding Queen Mary's Hospital.) WARD Cases. Rate per 1,000 Population St. Helier North 9 1.04 St. Helier South 10 1.37 St. Helier West 3 0.37 North East 6 0.74 North West – – Central 1 0.15 South East 2 0.27 South West 2 0.29 Whole District 33 0.56 TABLE 21. DIPHTHERIA—MULTIPLE CASES, 1938. Ward No. of houses in which occurred Total houses Total cases 1 case 2 cases St. Helier North 7 1 8 9 St. Helier South 6 2 8 10 St. Helier West 3 – 3 3 North East 4 1 5 6 North West – – – – Central 1 – 1 1 South East 2 – 2 2 South West 2 – 2 2 Whole District 25 4 29 33 80 TABLE 22. DIPHTHERIA-MONTHLY DISTRIBUTION, 1938 1938 WARD Total St.Helier North St.Helier South St.Helier West NorthEast NorthWest Central SouthEast SouthWest January – 6 – – – – – – 6 February 1 – l – – – – – 2 March – – – – – – – – – April – – – l – – – – 1 May 3 – – – – – – – 3 June 2 – – 1 – – – – 3 July – 1 – 1 – – – 1 3 August 2 – – 1 – – – – 3 September 1 2 – – – – – – 3 October – – – 2 – 1 1 – 4 November – 1 – – – – 1 1 3 December – – 2 – – – – – 2 Totals 9 10 3 6 – 1 2 2 33 Monthly Mean 0.75 0.83 0.25 0.50 0.0 0.08 0.16 0.16 2.75 There were no deaths from diphtheria compared with 4 in the year before. Five hundred and eighty-two swabs were examined for diphtheria, of which 40 were positive. Diphtheria "Carriers." During the course of investigations into cases, 10 persons were found to be "carriers" of diphtheria bacilli, 2 of which had avirulent infections. An outbreak of diphtheria occurred among some 30 scholars attending a private school. Four cases were notified and removed to isolation hospital. Careful investigations were carried out and swabs of all the children and staff were secured. The results of the swabs were returned as positive in 8 instances. Seven of these persons presented no symptoms and in 3 the test for virulence showed that the organism was non-virulent. In 6 of these 7 81 "carriers" the infection lay in the nose only, whilst the seventh had positive nose and throat swabs. They were all isolated for varying periods, 6 of them in hospital, and no further cases occurred. Diphtheria Immunisation. The number of persons immunised under the Council's scheme is shown in the tables which follow. The number who took advantage of the public facilities for preventive inoculation was rather less than in the year before. Nevertheless a total of 609 children were immunised. PERSONS IMMUNISED AT THE CLINIC—1938. WARD Age Groups Tolal 0–5 5–15 15 & over St. Helier North 17 5 – 22 St. Helier South 17 2 – 19 St. Helier West 17 5 – 22 North-East 14 8 – 22 North-West 16 8 – 24 Central 4 5 – 9 South-East 17 17 – 34 South-West 8 3 – 11 Totals 110 53 – 163 PERSONS IMMUNISED BY PRIVATE PRACTITIONERS, 1938. WARD Age Groups Total 0–5 5–15 15 & over St. Helier North 3 – – 3 St. Helier South 2 – – 2 St. Helier West – – – – North-East 1 – – 1 North-West 3 4 – 7 Central – 2 1 3 South-East – – – – South-West 3 2 – 5 Totals 12 8 1 21 82 CHILDREN IMMUNISED IN SCHOOLS, 1938 (5-8 Years). Completed at year end Not completed at year end St. Helier No. 6 Infants 71 19 St. Helier No. 7 ,, 82 4 St. Helier No. 8 „ 78 3 St. Helier No. 9 „ 81 1 St. Helier No. 10 ,, 113 4 Total 425 31 Total persons immunised under the Scheme in 1938—609. The immunisation scheme has now been established more than 4 years and 2739 children have been immunised up to the end of 1938. In table 23, which follows, the incidence of and mortality from diphtheria in the immunised and unimmunised children of the district during the 4-year period 1935—1938 is given. It will be observed that this experience indicates that the chances of contracting the disease are reduced by immunisation some 7 times and the risk of a fatal termination is eliminated. Some 3,000 persons die annually from diphtheria in England and Wales, a mortality higher than that of women who die in childbirth—3,000 deaths which could be prevented safely, effectively and at small cost if immunisation were universally practised. Erysipelas. Notifications were received in respect of 20 cases compared with 13 in the year before. The face was affected in 16 instances, the arm in one and the leg in 3. Seven of the total were admitted to hospital. All recovered. Pneumonia. Respiratory infections were rather less prevalent. Ninety-seven cases of pneumonia were notified, only 3 of which were stated to be influenzal as against 30 due to influenza in the year before. Peak periods occurred in March and December. 83 84 TABLE 23. DIPHTHERIA IN UNIMMUNISED AND IMMUNISED CHILDREN 0—15 YEARS, 1935—1938. (Excluding Queen Mary's Hospital.) Year No. of Children 0—15 years Cases Annual Incidence per 1,000 Deaths Annual Death Rate per 1,000 1935 Unimmunised 11,940 51 4.2 1 0.08 Immunised 861 0 Nil. 0 Nil. 1936 Unimmunised 12,788 38 2.9 4 0.31 Immunised 1,519 2 1.3 0 Nil. 1937 Unimmunised 12,363 40 3.2 4 0.32 Immunised 2,202 1 0.4 0 Nil. 1938 Unimmunised 12,321 24 1.9 0 Nil. Immunised 2,739 0 Nil. 0 Nil. 1935 to 1938 Unimmunised 12,353 153 3.0 9 0.18 Immunised 1,830 3 0.4 0 Nil. Measles. Following a year of comparative freedom from measles, 1938 saw the biennial rise in the prevalence of this infection. Cases among school children reported by the Head Teachers numbered 540 as against 89 in the year before. They occurred in the following months:— January 53 February 150 March 240 April 60 May 25 June 9 July 1 August – September 1 October 1 November – December – The disease is not notifiable. Eighteen cases were removed to isolation hospital. There were 2 deaths in male children aged 11 months and 12 years respectively. Whooping Cough. School returns show that among school children the incidence of whooping cough was approximately half what it was in 1937. Sixty-two cases were reported by Head Teachers as against 124 in the year before. There were no deaths. Ophthalmia Neonatorum. Three cases were notified, all of mild or moderate severity. Hospital treatment was not necessary in any, although one child continued to receive attention in the hospital in which it was born. All completely recovered. Cases Vision unimpaired Vision impaired Total blindness Death Notified Treated In hospital At Home 3 1 2 3 – – – 85 Prevention of Blindness. Information as to blindness occurring in children under 5 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. Food Poisoning. Two instances of suspected food poisoning were investigated. Three members of one household were taken ill with severe gastro-intestinal symptoms some 3 hours after partaking of boiled ham to which suspicion was directed. The remains of this ham were examined bacteriologically and yielded a profuse growth of staphylococcus aureus. Examination of faecal specimens from the patients gave negative results. All recovered. The clinical histories and bacteriological findings were compatible with a diagnosis of food poisoning due to staphylococcal toxin. The second enquiry was into the death of an adult, which occurred after an illness of 9 days. Bacillus aetrycke was isolated from the intestinal contents post mortem and death was certified from this infection. Detailed enquiries were made into probable foods which might have been the vehicle of infection, including Cornish cream, smoked haddock and eggs. As no other cases occurred either in the house or in association with the deceased, supporting evidence was entirely lacking. The only food which was not shared by other members of the family at the material time was a foreign hen egg and this was the most likely of all the sources investigated. 86 87 TABLE 24.—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. Helier West North East North West Central South East South West Smallpox – – – – – – – – – – – – – Scarlet Fever 227 3.87 – 69 47 38 34 12 10 6 11 208 92% Diphtheria 33 0.56 – 9 10 3 6 – 1 2 2 33 100% Enteric – – – – – – – – – – – – – Cerebo-Spinal Fever – – – – – – – – – – – – – Puerperal Pyrexia 12 0.20 – 2 – 4 2 1 1 1 9 75% Erysipelas 20 0.34 – 3 2 1 – – 6 6 2 7 35% Pneumonia 94 1.60 – 28 16 9 11 13 10 4 3 26 28% Influenzal Pneumonia 3 0.05 25 – 1 1 – – – 1 – – – Polio-myelitis 1 0.02 – – – 1 – – – – – 1 100% Relapsing Fever – – – – – – – – – – – – – Typhus Fever – – – – – – – – – – – – – Dysentery 16 0.27 – 6 5 3 1 – 1 – – 4 25% Encephalitis Lethargica – – – – – – – – – – – – – Ophthalmia Neonatorum 3 3.46 per 1000births – 1 2 – – – – – – 1 33% Plague – – – – – – – – – – – – – Malaria – – – – – – – – – – – – – 88 TABLE 25. INFECTIOUS DISEASES-Notification by Age Groups, 1938. (Excluding Queen Mary's Hospital.) Disease. Total Cases Notified. Total Cases at all Ages. Under I 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 – 7 15 18 25 120 23 7 6 4 2 – 227 Diphtheria 1 – – 3 – 14 5 4 5 1 – – 33 Dysentery – 3 – – 1 7 – – 3 1 1 – 16 Pneumonia 7 5 6 4 7 16 9 4 10 14 14 1 97 Erysipelas – 2 – – – 1 – – 4 3 9 1 20 Puerperal Pyrexia – – – – – – – – 10 2 – – 12 Ophthalmia Neonatorum 3 – – – – – – – – – – – 3 Polio-myelitis – – – 1 – – – – – – – – 1 89 TABLE 26 —MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1938. (Excluding Queen Mary's Hospital) DISEASE Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 23 18 10 19 17 13 21 7 23 20 30 26 227 Diphtheria 6 2 – 1 3 3 3 3 3 4 3 2 33 Dysentery 5 2 2 – 2 4 – – – – 1 – 16 Acute Polio-Myelitis – – – – – – – – – – 1 – 1 Pneumonia 4 13 27 5 8 5 2 1 3 2 4 20 94 Influenzal Pneumonia – 1 2 – – – – – – – – – 3 Erysipelas 2 3 2 4 2 – 1 – 2 2 1 1 20 Tuberculosis Pulmonary 9 2 8 5 7 8 1 6 6 2 7 1 62 Tuberculosis Non-pulmonary 2 1 3 1 4 2 2 1 – 1 4 1 22 Ophthalmia Neonatorum – – 1 – – – – 1 1 – – – 3 Puerperal Pyrexia 1 2 2 2 2 – – – 1 1 1 – 12 Puerperal Pyrexia— Twelve notifications were received under the Regulations, the main facts in relation to which are as follows:— Para Day of onset. Clinical Notes Admitted to Hospital Result. 1 4th Infection following failed forceps—Caesarian section. Yes Recovered 1 11th Temperature of 4 days duration—responded to Protosil. No „ 1 4th Severe local infection with Haem: Strep: Yes „ 8 3rd Genital tract infection and pyelitis. Yes „ 1 2nd Low grade uterine infection with retained placenta. Yes „ 4 5th P.P.H.—local infection of non-specific nature —severe anæmia—blood transfusion. Yes „ 3 5th Incomplete 3rd stage—local non-specific infection—severe secondary anæmia— transfusion. Yes „ 1 3rd Forceps—low grade infection No „ Mu tip. 9th Premature birth—non-uterine infection— mastitis and tooth abscess. No „ 2 16th Albuminuria of pregnancy—breech presentation—late P.P.H.—b. coll urinary infection Yes „ 2 11th Confined in London Hospital—breast abscess Yes „ 1 11th Confined in London Hospital—still birth. Yes „ The services of a consultant are available to practitioners for cases of puerperal pyrexia and patients needing in-patient treatment may be admitted to Queen Charlotte's Hospital. Five con" sulfations were held and seven cases were admitted to Hospital. Anterior Polio Myelitis—One case was notified in a girl of 3 years. She developed some paresis of one foot, was admitted to hospital and responded well to treatment. Cerebro-spinal Fever—No cases were notified. TUBERCULOSIS. The new cases admitted to the tuberculosis register during the year numbered 122 classified as follows:— 90 M ales— Pulmonary 49 Non-pulmonary 16 Females— Pulmonary 41 Non-pulmonary 16 Of the total additions 84 were primary notifications, 34 were transferred from other districts and 4 came to notice in other ways. For the same period, 104 names were removed from the register for the following reasons :— Recovered 15 Death 39 Withdrawn notifications 5 Otherwise (including removals) 45 After allowing for the additions and reductions, the state of the register at the 31st December, 1938, was as shown in the following table:– TABLE 27. TUBERCULOSIS REGISTER AT DECEMBER 31st, 1938. Pulmonary Non-pulmonary All forms Males 198 78 276 Females 192 55 247 Totals 390 133 523 The total of 523 is 18 more than at the corresponding date twelve months earlier. They were distributed by Wards as follows: TUBERCULOSIS-WARD DISTRIBUTION. Cases on Register at 31st December, 1938. WARD Pulmonary Non-Pulmonary Total Males Females Males Females St. Helier North 45 52 19 6 122 St. Helier South 43 36 10 12 101 St. Helier West 40 36 19 13 108 North-East 17 11 10 7 45 North-West 14 22 8 5 49 Central 9 11 6 4 30 South-East 18 13 5 8 44 South-West 12 11 1 – 24 198 192 78 55 523 390 133 91 It will be observed that the incidence of notified tuberculosis is much higher on the St. Helier Estate due to the fact that a relatively high proportion of tuberculous families were transferred to the district under the London County Council's Housing Scheme. The Surrey County Council is responsible for the antituberculosis scheme in the area. The number of patients from Carshalton who received institutional treatment under the County scheme during the year was as follows:— At Surrey County Sanatorium, Milford 24 At other tuberculosis institutions 88 112 The number of persons who died from tuberculosis during the vear was 39, distributed as to age and sex as follows:— TABLE 28. DEATHS DUE TO TUBERCULOSIS, 1938. Ages Years Pulmonary Non-pulmonary Totals Male Female Male Female 0 – – – – – 1 – – – 1 1 5 – 2 – – 2 15 – 1 – 1 2 25 l 6 – – 7 35 7 6 – – 13 45 7 – – – 7 55 2 1 – – 3 65 4 – – – 4 Totals 21 16 – 2 39 Only one non-notified tuberculosis death occurred, representing 2.5 per cent. of the total deaths. 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 11. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, nor under Section 172 of the Public Health Act. 1936. 92 93 TABLE 29. TUBERCULOSIS—NEW CASES, Age and sex distribution, and manner of admission to register, 1938. 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 – – – – – – – – – – – – – 1– 5 1 – l 4 – – – – – – – – 6 5–10 1 – 2 – – 1 3 1 – – – – 8 10–15 – 3 2 – 1 – 1 1 – – – – 8 15–20 2 4 1 4 2 2 – 1 – – – – 16 20–25 2 1 – – – 2 – 1 – 1 – – 7 25–35 8 13 3 2 3 2 1 1 – 1 – – 34 35–45 10 7 1 1 6 2 – – l – – – 28 45–55 6 1 1 – 2 1 – – l – – – 12 55–65 3 – – – – – – – – – – – 3 65 up – – – – – – – – – – – – – Totals 33 29 11 11 14 10 5 5 2 2 – – 122 84 34 4 AIR RAID PRECAUTIONS. This report would not be complete without some reference to Air Raid Precautions. Although the County Council is the scheme-making authority, much of the work of providing and organising local defence arrangements falls to the lot of the District Council. During the past year these activities were extended at a phenomenal rate and the whole of the Council's staff, and not least that of the Public Health Department, have been increasingly engaged on this particular task. Every effort has been made to maintain the efficiency of existing services which, in themselves, need the fulltime attention of the staff. The degree of success which has attended this effort is a source of satisfaction to the Officers of the Council, as it doubtless is to the body they serve. But what of the future ? Is Air Raid Precautions to be a permanent feature of our daily life ? Will the local Government work in connection therewith remain at the present level ? These are questions affecting the administrative organisation of local authorities which will have to be faced, and when the situation becomes stabilised, if ever it does, consideration will need to be given to the extent to which Air Raid Precautions duties can normally be undertaken by officers, for example the sanitary inspectors, who are appointed specifically for other purposes. A temporary increased effort, albeit a lengthy one, to meet a national emergency at the risk of neglecting public services is no doubt justified and is willingly made by those who serve the public in their capacity as Local Government servants, but one cannot contemplate the future efficiency of the public health services with equanimity if existing conditions continue indefinitely. 94 95 TABLE OF METEOROLOGICAL OBSERVATIONS, CARSHALTON, 1938. 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 29.94 42.6 48.1 38.2 43.1 55–12th 31–4th 2.37 18 38.7 20 February 30.09 41.2 46.5 35.4 40.9 55–25th 29–22nd 0.59 7 55.1 16 March 30.22 47.5 59.7 39.1 49.4 66–20th 28–7th 0.54 4 179.9 2 April 30.21 45.1 54.8 36.2 45.5 64– 1st 26–10th 0.20 3 106.7 11 May 29.89 52.0 59.7 43.6 51.6 75–14th 31–8th 2.38 12 161.1 7 June 30.01 59.0 69.1 52.0 60.5 78–14th 42–2nd 0.50 6 207.8 3 July 29.86 59.7 68.5 53.3 60.9 82–31st 44–1st 1.66 7 161.3 3 August 29.89 60.1 71.8 56.7 64.2 85–1st 42–29th 2.40 12 172.2 8 September 29.87 57.6 68.0 50.1 59.0 78–12th 41–15th 2.28 10 129.6 6 October 29.80 51.6 58.8 43.2 51.0 65–17th 28–24th 2.83 16 105.1 9 November 29.82 50.2 55.5 43.8 49.6 70–5th 31–28th 3.85 17 39.7 20 December 29.76 39.8 46.3 34.5 40.4 56–12th 19–20th 3.15 16 23.2 24 Totals – – – – – – – 22.75 128 1380.4 129 Averages 29.94 50.5 58.9 43.8 51.3 85.0 19.0 – – – – INDEX page Acreage 9 Ambulance — Infectious 29 Non-infectious 29 Air Raid Precautions 94 Bakehouses 74 Bed-bug— Eradication of 58 Births— Notification of 15 Rate 18 Statistics 19 Camping Sites 61 Cancer- Deaths from 21 Rate 21 Cemeteries 60 Child Life Protection 50 Clinics and Treatment Centres- Maternity 33 Dental 45 Diphtheria Immunisation 34 Maternity and Child Welfare 33 School Clinics 35 Toddler Clinics 40 Tuberculosis 33 Venereal Disease 36 Closet Accommodation 53 Convalescent Treatment 46 Day Nursery 51 Deaths— Cancer 21 Classified Causes 26 Distribution 20 Rate 20 Respiratory Diseases 22 Statistics 13 Tuberculosis 92 Dental Scheme 42 Diphtheria— Immunisation 82 Monthly Distribution 81 Multiple Cases 80 Swab Examinations 81 Ward Incidence 80 Dysentery 76 Disinfection & Disinfestation 58 Drainage and Sewerage 52 Employment 10 Enteric Fever 75 Erysipelas 83 96 page Factories 68-69 Food & Drugs (Adulteration) Act, 1928 73 Food Poisoning 86 Food Supply— 72 Health Services- Ambulance 29 Assisted Milk Scheme 42 Clinics and Treatment Centres 33 Consultant Service 47 Day Nursery 51 Hospitals 30 Laboratory Facilities 28 Maternity and Child Welfare 33 Nursing in the Home 27 Health Visiting 42 Heart Disease 20 Hospitals— Admittances 31 General and Maternity 32 Infectious 30 Non-Infectious 32 Smallpox 33 Tuberculosis 33 Housing— Council's Housing Scheme 63 Housing Act, 1936 66 Inspection 64 Overcrowding 66 Rent and Mortgage Interest Restriction (Amendment) Act, 1925 .. 68 Slum Clearance 66 Ice Cream 74 Industry 10 Infant Mortality- Classified Causes 23 Statistics 23-24 Infectious Diseases— Acute Polio-Myelitis 90 Cerebro-Spinal Fever 90 Diphtheria 79 Dysentery 76 Enteric Fever 75 Erysipelas 83 Measles 85 Monthly Incidence 89 Notification Distribution and Deaths 87 Notification by Age Groups 88 Ophthalmia Neonatorum 85 Pneumonia 83 Puerperal Pyrexia 50 Scarlet Fever 76 Smallpox 75 Whooping Cough 85 Inquests 22 Isolation Hospital 33 Admittancfs 30 97 Laboratory Facilities— page Milk Examinations 28 Sputum 28 Swabs 28 Water 29 Maternal Mortality— Causes 25 Statistics 25 Maternity and Child Welfare- Assisted Milk Scheme 42 Attendances at Centres 38-40 Committee 7 Consultant Service 47 Convalescent Treatment 46 Dental Scheme 44 Health Visiting 42 Home Helps 48 Hospital Treatment for Maternity 47 Orthopaedic Treatment 46 Maternity Outfits 48 Midwives 48 Toddler Clinics 40 Work of Centres 36 Measles 85 Meat and Other Foods 72 Meteorology 12 Milk Supply 70 Milk (Special Designations) Order, 1936 70 Milk Scheme 42 Mortuary 60 Natural and Social Conditions 9 Nursing Associations 27 Nursinc in the Home 27 Offices 61 Ophthalmia Neonatorum 85 Orthopaedic Treatment 46 Outworkers 69 Pneumonia 83 Population 14 Prevention of Blindness 86 Public Assistance 33 Public Cleansing 53 Public Health Act, 1936 (Sec. 203) 36 Public Health Committee 7 Puerperal Pyrexia 90 Rateable Value 9 Rats & Mice (Destruction) Act, 1919 59 Rent & Mortgage Interest (Restriction) Act, 1925 68 Representatives on Joint Hospital Board 7 Rivers and Streams 53 98 page Sanitary Circumstances 53 Scarlet Fever— Monthly Distribution 77 Multiple Cases 78 Ward Incidence 77 Schools 59 School Clinics 35 Shops Acts 60 Slaughterhouses 72 Smallpox 75 Smoke Abatement 59 Staff 8 Statistics— Comparable 19 Vital 13 Swimming Baths and Pools 62 Tuberculosis— Deaths 92 New Cases 93 Register 91 Ward Distribution 91 Venereal Diseases 36 Vermin 58 Voluntary Helpers 50 Water Supply 52 Whooping Cough 85 Zymotic Diseases 13 „ Deaths 13 Printed by David Hayes & Cole, Ltd. 82. 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