CAR 4 Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1939 PRINTED BY THE " CROYDON TIMES," LTD., 104, HIGH STREET, CROYDON. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1939 1 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 1939, and in so doing apologise for its late appearance, which, as the Council will appreciate, has been occasioned by circumstances beyond my control. Although Reports such as this lose some of their value if not presented within a reasonable time, they are still essential if the record of health administration is to be maintained. Such continuity is necessary if we are to keep ourselves in a position to assess progress and to be able successfully to review the trend of policy. The statistics show that, taken as a whole, the year will favourably stand comparison with those of the past. Some show an improvement on 1938, others are not quite so good, but on balance there was no marked change. The birth rate fell to a new low record. General and infant mortality were better than in the year before and were both substantially less than that for the country as a whole. Maternal mortality was higher than for the preceding year, since three such deaths were recorded as against two. The situation with regard to the major infectious diseases was particularly good. Prevalence of all was lower, and no deaths resulted from any. Tuberculosis was rather more in evidence, and it will be surprising if it does not become more so as the result of continued war-time conditions. Sanitary supervision, in spite of a depleted staff and the many difficulties in the way of remedial action imposed by the war, was maintained at a high level of efficiency. Our health standards must not be lowered, but policy must now take account of the hard facts of the situation, and requirements must be determined more than ever by what is practicable. The Maternity and Child Welfare Scheme continued to progress and its activities refused to be interrupted by the threat of air raids. Still more mothers and infants attended the Clinics, although the attendances were somewhat less. It was, however, a great disappointment when the arrangements for building the new Clinic at St. Helier, which had reached an advanced stage, had to be deferred until after the war. 3 Your Public Health staff, like those of other Departments, which had for some time been increasingly engaged on preparing the local Scheme of Air Raid Precautions, was, with the outbreak of war, callcd upon to devote still more of their energies to putting the Scheme into operation, and, since the majority of the male members joined H.M. Forces in the early months of the war, it will be appreciated that the maintenance of the health services was not achieved without considerable difficulty and without great personal effort on the part of each of those who remained to carry on the Service. The main task of to-day is to win the war, and your staff is conscious that in helping to maintain the health and fitness of the community they are playing no small part in the national effort. War brings with it new factors affecting the general well-being, new risks and dangers to health as well as to life and limb. This war, in particular, transforming as it has done our towns, our villages and our homes into the actual battle-ground, presents us with health problems not previously experienced. Such conditions call for constant vigilance and prompt action to deal with any new threat to health before it assumes unmanageable proportions. It speaks well for the high standard of the health of the community and the organisation developed for its protection that it has suffered so little from the present great upheaval in our daily lives. I am, Your obedient Servant, F. LAWRENCE SMITH, September, 1941. Medical Officer of Health 4 PUBLIC HEALTH STAFF. Medical Officer of Health. F. Lawrence Smith, M.B., Ch.B., D.P.H. Chief Sanitary Inspector. * H. J. Spicer, M.R.S.I. Deputy Chief Sanitary Inspector. * H. G. Cripps, C.R.S.I. (With H.M. Forces from September.) Sanitary Inspectors. * L. G. Lydiatt, C.R.S.I. * G. E. Maton, C.R.S.I. Senior Health Visitor. Miss E. S. Picard. Health Visitors. Miss N. M. Hills. Miss A. M. Askew. Miss R. M. Nash. Miss M. J. Thomas (from 1st May). Chief Clerk. B. Lamacraft (with H.M. Forces from September). A. E. Wills (temporary from September). Part Time Officers. Medical Officers to Maternity & 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. 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. (with H.M Forces from September) Medical Officer to Diphtheria Immunisation Clinics. Constance M. Hildred, M.B., Ch.B. * Meat and Pood Certificate of the Royal Sanitary Institute. 5 Section A- Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1039) according to Rate Books 16,212 Rateable Value at 31st December, 1939 .£468,012 Sum represented by Id. rate £1,848 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. The flow of water from the springs, however, in 1939, has, on the whole, been fairly maintained and was greater than in the year before, when nearly all failed at one period. In the year which saw the outbreak of war, it is not surprising that the rate of housing development was reduced. New dwellings erected totalled 117, compared with 391 in the previous year, constructional work of this type coming to a halt completely in September. 6 As stated in previous reports, Carshalton is chiefly a dormitory area, there being little industrial activity actually established within the district. It is well supplied with open spaces, and a successful issue to the endeavours made to include The Oaks Estate in the London Green Belt will ensure an additional island of rusticity in the spreading tide of urbanisation. Industry and Employment. The extent of recorded unemployment at the end of the year was very comparable with the position 12 months earlier. In early 1940 the number of unemployed living in Carshalton and registered at the Sutton Exchange was as follows:— Men 573 Women 308 Boys 73 Girls 89 1043 It should be observed that these figures are not complete, since other residents may be registered as unemployed at other Exchanges. Public Assistance. The following information as to public assistance afforded in the district is supplied by the courtesy of the Chief Public Assistance 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, 1039 88 Number of persons from Carshalton admitted to mental hospitals 20 Other Relief: Number of persons in receipt of domiciliary assistance on:— Men. Women. Children. Total. 1st January, 1939 218 347 631 1,196 1st July, 1939 226 364 637 1,227 31st December, 1939 208 385 658 1,251 Total amount of domiciliary assistance paid to persons in residence at Carshalton during the year ,£25,582 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. 7 SUMMARY OF VITAL STATISTICS FOR 1939. (Based on the Registrar-General's Figures). Population. Mid. 1939 Registrar-General's Estimate (a) 59,510 (b) 59,070 Births. M. F. T otal. Live (Legitimate) (c) 419 360 779 (d) 420 362 782 (Illegitimate) (c) 8 5 13 (d) 8 5 13 (c) 427 365 792 (d) 428 367 795 Birth Rate 13.2 Still-births (Legitimate) 12 8 20 (Illegitimate) – – – 12 8 20 Stl.-bth. Rate per 1,000 total births 24.7 Deaths Death Rate (crude) 7.1 Infant Mortality. All deaths under 1 year 17 11 28 Infant Mortality Rate (per 1,000 live births) 35.4 Deaths of leg. infts. under 1 year 14 9 23 Rate per 1,000 legitimate births 29.4 Deaths of illeg. infts. under 1 year 3 2 5 Rate per 1,000 illegitimate births 384 Maternal Mortality. Deaths from Sepsis 0 Rate per 1,000 total births 0 Deaths from other causes 3 Rate per 1,000 total births 3.7 Maternal Death Rate 3.7 Zymotic Deaths. 7 Principal Zymotic Diseases 3 Deaths from Measles 0 Deaths from Whooping Cough 0 Deaths from Diarrhoea (under 2 yrs) 3 Zymotic Death Rate 0.05 Deaths from Tuberculosis. All Forms 46 Rate per 1,000 of population 0.77 Phthisis 42 Rate per 1,000 of population 0.71 Deaths from Cancer. 68 Rate per 1,000 of population 1.15 (a) for calculation of birth rates ; (b) for calculation of death rates or incidence of infectious disease; (c) for calculation of birth rates ; (d) for calculation of infant and maternal mortality. 8 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 classification has been made, e.g., by age groups, sex, wards, etc., it has necessarily been based on our own records, which may, in the aggregate, show slight discrepancies compared with the Registrar-General's totals. POPULATION. Consequent upon the movement of the resident population resulting from mobilisation and other war-time circumstances, some variation in the basis of calculation of certain vital statistics has been made by the Registrar-General Two population figures have been supplied: (a) For the calculation of birth rate, 59, 190, and (b) For the calculation of death rates or the incidence of notifiable disease, 59,070. My own estimate of the mid-year population is 61,700. The distribution of the estimated population as between wards is as follows:— TABLE 1. ESTIMATED RESIDENT POPULATION, MID-1939, BY WARDS. Ward. Houses at Mid-1929. Estimated Population Mid-1939. St. Holier North 2,026 8,744 St. Helier South 1,699 7,072 St. Helier West 1,964 8,482 North-East 2,487 9,036 North-West 2,123 7,256 Central 1,761 5,959 South-East 2,090 7,259 (Queen Mary's Hospital) 1,300 South-West 2,005 6,592 Whole District 16,155 61,700 BIRTHS As previously indicated, a departure from the usual statistical treatment of transferable deaths for 1939 has been made. Up to the 30th September the pre-war practice of transference to areas of the mother's usual residence has been maintained. From and after 1st October, the primary assignment for the purpose of calculating Birth rates has likewise been in accordance with pre-war practice, but for the purposes of calculating Infant and Maternal Mortality a secondary assignment has been made to the area in which a mother may be temporarily residing as a result of the war. The figures for live births issued by the Registrar-General on this basis are:— For calculation of birth rates, 427 males, 360 females—787. For calculation ofinfant mortality,etc.,428males,362 females—790. 9 The birth rate fell to 13.2 from 14.7 and is the lowest on record. Illegitimate live births included in the total numbered 13, 8 male and 5 female. There were 20 still births, none of which was illegitimate. Ward Birth Rates. Classification by wards is made from local records. Information available from notifications received under the Public Health Act, supplemented by the returns of the local Registrar, shows that 807 births (787 live, 20 still) took place during the year to residents of the various wards as follows:— Ward. Live Births. Rate per 1,000 population. Still Births. Still birth rate per 1,000 total births. St. Helier North 130 14.8 8 58.0 St. Helier South 86 12.1 — — St. Helier West 100 12.8 3 26.8 North-East 145 16.0 6 39.7 North-West 85 11.7 2 23.0 Central 77 12.9 — — South-East (excluding Queen Mary's Hosp.) 95 13.1 — — South-West 60 9.1 1 16.4 Domiciliary and Institutional Births. The proportion of births which took place in Hospitals and Nursing Homes was approximately the same as in the year before. These numbered 313 out of a total of 807, compared with 315 in 1938. They represent 38 per cent. of the whole. The respective percentages for the individual wards being:— St. Helier North 24.6 St. Helier South 37.1 St. Helier West 24.1 North-East 45.0 North-West 35.6 Central 44.1 South-East 34.7 South-West 37.3 The births which occurred in premises other than domestic dwellings took place in the following institutions:— Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial) Hospital. 47 6 53 Surrey County Hospitals 120 1 121 Other Hospitals 48 3 51 Private Nursing Homes 88 — 88 303 10 313 10 11 TABLE 2. BIRTHS, 1939—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 (1) 102 (6) 106 (7) 30 (1) 1 1 32 (1) 138 (8) St. Helier South 4 53 57 28 1 — 29 86 St. Helier West 3 85 (1) 88 (1) 24 (2) — — 24 (2) 112 (3) North-East 28 (2) 81 (2) 109 (4) 40 (2) 2 — 42 (2) 151 (6) North-West 6 (1) 55 61 (1) 25 (1) 1 — 26 (1) 87 (2) Central 12 41 53 22 2 — 24 77 South-East 16 39 55 36 4 — 40 95 South-West 7 24 (1) 31 (1) 28 2 — 30 61 (1) Totals 80 (4) 480 (10) 560 (14) 233 (6) 13 1 247 (6) 807 (20) (Figures in parenthesis indicate still-births included in totals). TABLE 3. COMPARATIVE STATISTICS—1939. 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 15.0 14.8 15.6 12.3 13.2 Still 0.59 0.59 0.57 0.44 0.33 Deaths— All Causes 12.1 12.0 11.2 11.9 * 7.1 † 7.9 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 — Smallpox — — — — — Measles 0.01 0.01 0.01 0.00 — Scarlet Fever 0.01 0.00 0.00 0.00 — Whooping Cough 0.03 0.03 0.02 0.03 — Diphtheria 0.05 0.04 0.04 0.02 — Influenza 0.21 0.19 0.20 0.18 0.10 Notifications— Smallpox 0.00 — —• — — Scarlet Fever 1.89 1.96 1.78 1.53 3.42 Diphtheria 1.14 1.21 1.16 0.98 0.86 Enteric Fever 0.04 0.03 0.04 0.03 — Erysipelas 0.34 0.40 0.31 0.37 0.15 Pneumonia 1.02 1.21 0.89 0.99 1.62 Rates per 1,000 Live Births. Deaths under 1 year of age 50 53 40 48 35 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 6.3 3.0 8.2 3.8 Maternal Mortality— Puerperal Sepsis 0.77 Not available. — Others 2.16 3.79 Total 2.93 3.79 Rates per 1,000 Total Births (i.e. Live and Still). Maternal Mortality— Puerperal Sepsis 0.74 Not available. — Others 2.08 3.70 Total 2.82 3.70 Notifications— Puerperal Fever 14.35 17.26 12.99 3.31 7.40 Puerperal Pyrexia 14.22 * Crude. †Comparable. 12 DEATHS. After adjustment by transferable deaths, the number registered was 419, of which 220 were males and 199 females. This gives a crude death rate of 7.1 per 1,000 population, compared with 7.6 in the year before. The " comparable " death rate, produced by the application to the crude rate of the comparability factor to allow for age and sex differences in the local population and that of the country as a whole, is 7.9. This is the rate which should be compared with the death rate for England and Wales of 12.1. Ward Death Rates. The distribution of the deaths by Wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1939. Ward. Deaths Death Rate (crude) Mean Age at death St. Helier North 45 5.2 44.8 yrs. St. Helier South 41 5.8 30.0 ,, St. Helier West 42 4.9 45.9 ,, North-East 61 6.7 51.6 ,, North-West 58 8.0 56.2 „ Central 88 14.3 66.5 ,, South-East (excluding Queen Mary's Hospital) 41 5.6 56.8 „ South-West 44 6.7 70.4 „ Whole District 420 7.0 54.4 „ TABLE 4. BIRTH AND DEATH RATES FOR CARSHALTON, 1922—1939. Year Population (RegistrarGeneral's) Birth Rate Death Rate Infant Mortality Rate Maternal Mortality Rate 1922 14,240 19.7 8.8 50 10.6 1923 14,610 18.8 8.6 36 3.6 1924 15,050 18.5 10.1 58 7.1 1925 15,660 20.0 10.0 42 3.2 1926 17,040 17.0 9.3 31 0.0 1927 18,450 16.5 9.1 72 9.8 1928 21,910 15.5 9.0 65 14.7 1929 23,420 18.8 9.4 61 0.0 1930 25,500 17.0 7.6 46 0.0 1931 28,620 16.7 7.5 43.8 8.1 1932 32,280 15.05 7.9 47.3 3.89 1933 35,260 14.9 8.8 64.4 4.23 1934 38,110 16.5 8.6 53.5 4.60 1935 51,000 15.7 6.6 46.0 4.80 1936 57,000 15.7 7.1 46.7 7.57 1937 58,030 15.0 6.6 40.0 0.0 1938 58,730 14.7 7.6 46.1 2.3 1939 a 59,510 13.2 7.1 35.4 3.7 b 59,070 13 The death rate for the Central Ward, which has been consistently the highest since separate statistics were compiled, is a reflection of the high average age of the population in that part of the district, it being the oldest. Further confirmation of this is provided by the relatively higher rate for that Ward of deaths from cancer, which is a disease of adult life. CAUSES OF DEATH. Heart Disease. This group of diseases, which of all causes is responsible for more deaths than any other, accounted for approximately a quarter of the total. Since this disease is mainly one of late adult life, it is likely to assume increasing prominence as the main cause of death so long as the normal expectation of life continues to increase. In conformity with past experience, something approaching 90 per cent. of these deaths were in persons over 55 years of age. The majority can be regarded as inevitable, resulting from natural wear and tear. Those associated with infective conditions, particularly those of the rheumatic fever type and not primarily degenerative, numbered 8 out of a total of 104. Cancer. The efforts made to combat this formidable disease, as reflected in its mortality statistics, have to contend with two factors—the detection of more cases of the disease in the less obvious sites as the result of improved methods of diagnosis, and the fact that as the increased expectation of life demonstrates, more and more people survive to an age which is more prone to cancer. Like heart disease, cancer is chiefly a condition of advanced age. During the year, 68 deaths were recorded, 40 in males and 28 in females, giving a death rate for this disease of 1.15 per thousand, compared with 1.05 in the year before. For the second year in succession there was a preponderance of mortality amongst males. Until 1938 the reverse had been the case. Upon examination it is found that this change is largely accounted for by the greater number of deaths in males due to cancer of the digestive system. Deaths from disease in this site were, during the last two years, more than twice as common in males than in females. It would be helpful to know how far there has been an actual relative increase in digestive cancer amongst males and how far there may have been more accurate diagnosis of disease of this deep-seated type. The mortality in the individual Wards is given below:— CANCER DEATHS—WARD DISTRIBUTION, 1939. Ward. Cancer Deaths Rate per 1,000 Estimated Population St. Helier North 4 0.46 St. Helier South 3 0.42 St. Helier West 5 0.59 North-East 11 1.22 North-West 8 1.10 Central 18 3.02 South-East 7 0.96 South-West 12 1.82 14 The significance of the relatively higher rate in the Central Ward has already been commented upon. The classification of these deaths according to the sites affected is given in Table 5:— TABLE 5. Group. Site Affected. Male Female Total 45 Buccal Cavity 1 — 1 46 Digestive Organs— Oseophagus; 3 — 3 Stomach 10 4 14 Liver and Gall Bladder 1 3 4 Intestines 6 2 8 Rectum and Anus 2 1 3 Pancreas — — — 47 Respiratory Organs— Larynx — — — Lungs 7 2 9 Mediastinum — — — 48 Uterus — 3 3 49 Other female genital organs. — 5 5 50 Breast — 6 6 51 Male genito-urinary organs. 8 — 8 52 Skin 1 — 1 53 Other organs— Eyes 1 — 1 Glands of axilla — 1 1 Brain — 1 1 40 28 68 Average age at death :— Males 64.50 years Females 59.57 years All persons 62.47 years Respiratory Diseases. 1939 was not an unfavourable year for respiratory infections. Influenza accounts for 6 deaths, whilst pneumonia, bronchitis and other respiratory diseases were responsible for 31. The total of 37 for this group compares with 42 in 1936 and 52 in 1937. 15 Inquests. Inquests were held on 18 deaths, 10 of which were on persons resident in the district. The verdicts returned were as follows:— Natural causes 4 Suicide 1 Accidental Death 9 Misadventure 2 In accordance with medical evidence 2 Five of the total were due to road accidents. INFANT MORTALITY. The deaths of 28 infants under 1 year of age were registered, 17 of which were males and 11 females. This gives an infant mortality rate of 35 per 1,000 live births, which compares with the rate of 50 for the country as a whole. Five of the total infant deaths were of illegitimate infants. A rather higher percentage than usual, viz. 64 per cent., occurred during the first 4 weeks of life, practically all of which were the result of diseases peculiar to infancy—prematurity, congenital malformations, etc. The deaths for which infections were responsible wholly or partly numbered 9, 31 per cent. of the total. 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 4 30 St. Helier South 3 34 St. Helier West 5 45 North-East 8 55 North-West 5 58 Central 1 13 South-East 3 31 South-West — 0 MATERNAL MORTALITY. Three deaths were allocated to diseases of pregnancy, childbirth and the puerperal state, all of which were due to causes other than sepsis. The Maternal Death rate was accordingly 3.07 per 1,000 total births and compared with the rate of 2.97 for England and Wales. The cause of death in each case was certified as:— (1) I (a) Pulmonary embolism. (b) Child birth. (2) I (a) Syncope following Ceasarean section. (b) Albuminuria of pregnancy. (3) I (a) Air embolism during an operation for (b) Curetting for incomplete miscarriage. All received hospital treatment. 16 17 TABLE 7. INFANT MORTALITY DURING THE YEAR 1939. Deaths classified as to cause and age at death. Cause of Death. Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total ; under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Smallpox — — — — — — — — — — Chickenpox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — Whooping Cough — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — —_ — 1 — 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — _ 1 — 1 Meningitis (not Tuberculous) — — — — — — — 1 — — Convulsions — — — — — _ — — Laryngitis — — — — — — — — — Bronchitis — — — — — 1 — 1 Pneumonia (all forms) — — — — — 1 1 — 2 Diarrhoea — — — — — — — — — Enteritis — — — 1 1 — 1 1 — 3 Gastritis — — — — — — — — — — Syphilis — — — — — — — — — Rickets — — — — — — — — — — Suffocation (overlying) — — — — — — — — — — Injury at Birth 1 — — — 1 — — — — 1 Atelectasis 1 — — — 1 — — — 1 Congenital Malformation 1 — — — 1 2 — — — 3 Premature Birth 10 1 1 — 12 1 — — — 13 Atrophy, Debility & Marasmus — — 1 — 1 — — — — 1 Other Causes 1 — — — 1 — — — — 1 Totals 14 i. 2 1 18 5 3 3 29 Net Births in the year—Males 428, Females 362, Legitimate 782, Illegitimate 13. Net deaths in the year of Legitimate Infants, 23. Net deaths in the year of Illegitimate Infants, 5. 18 TABLE 8. CAUSES OF DEATH DURING THE YEAR 1939. 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 18 11 1 3 9 4 11 14 10 14 21 17 20 11 31 23 33 42 48 59 222 198 420 1 Typhoid Fever, etc. — — — — — — — — — — — — — — — — — — — — — — — 2 Meales — — — — — — — — — — — — — — — — — — — — — — — 3 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 5 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 6 Influenza — — — — — — — — — — — — 1 — — 1 2 1 — 1 3 3 6 7 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — 8 Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — 9 Respiratory Tuberculosis — — — — 1 — 1 8 6 10 4 3 5 2 2 — — — — — 19 23 42 10 Other Tuberculosis 1 1 1 — — — 2 — — — — — — — 1 — — — — — 5 1 6 11 Syphilis — — — — — — — — — — — 1 — — 1 — — — — — 1 1 2 12 Genl. Paralysis of Insane.etc. — — — — — — — — — — — 1 — — — — — — — — — 1 1 13 Cancer — — — — — — — 1 — — 3 7 4 4 8 2 20 8 5 6 40 28 68 14 Diabetes — — — 1 — — — — — — — — 1 — — 1 — — — — 1 2 3 15 Cerebral Haemorrhage — — — — — — — — — — — — — — — 3 3 5 3 2 6 10 16 16 Heart Disease — — — — 1 — 2 1 2 1 2 1 4 2 7 7 12 14 18 30 48 50 104 17 Aneurysm — — — — — — — — — — — — — — — — — — — 1 — 1 1 18 Other Circulatory Diseases — — — — — — — — — — — — — — 1 3 2 4 4 10 7 17 24 19 Bronchitis 1 — — — — — — — — — — — — — 2 — —. 2 2 1 5 3 8 20 Pneumonia (all forms) 2 — — — 3 1 1 — 1 — — — — — 3 2 4 1 3 — 17 4 21 21 Other Respiratory Diseases — — — — — — — 1 — — — — 1 — — — — — — — 1 1 2 22 Peptic Ulcer — — — — — — — — — — 2 — 1 — — 1 — — — — 3 1 4 23 Diarrhoea — 3 — — — — — — — — — — — — — — — — — — — 3 3 24 Appendicitis — — — — — 1 1 — — — — 1 — — — — — — 1 — 2 2 4 25 Cirrhosis of Liver — — — — — — — — — — — — — — — — — — — — — — — 26 Other Liver Diseases — — — — — — — 1 — — — — — — — — 1 — — — 1 1 2 27 Other Digestive — — — — 1 — — — — — 1 — — 1 — — 2 — 1 2 5 3 8 28 Nephritis — — — 1 — — — — — — 2 — — 1 — 2 2 1 1 1 5 6 11 29 Puerperal Sepsis — — — — — — — — — — — — — — — — — — — — — — — 30 Other Puerperal Diseases — — — — — — — — — 2 — 1 — — — — — — — — — 3 3 31 Congenital Causes 13 7 — — — — — — — — — — — — — — — — — — 13 7 20 32 Senility — — — — — — — — — — — — — — — — — 1 2 2 2 3 5 33 Suicide — — — — — — 1 — — 1 1 — — — — 1 — — — — 2 2 4 34 Other Violence — — — — 2 — 2 — 1 — 2 — — — 2 — 1 1 1 1 11 2 13 35 Other defined Causes 1 — — 1 1 2 1 2 — — 4 2 3 1 4 — 4 4 7 2 25 14 39 Section B—Health Services. Nursing in the Home. Home nursing is provided by two Voluntary Associations, to whose funds the Council make an annual contribution in respect of nursing facilities for cases referred from the public services. The Carshalton District Nursing Association covers the greater part of the urban district, i.e., all but that portion of the St. Helier Estate lying to the north of the Sutton by-pass. The nursing staS consists of six, three of whom are midwives included in the County Council's domiciliary midwifery scheme. The following information in respect of the work of this Association during 1939 is supplied by courtesy of the Honorary Secretary:— Cases Attended. Visits Made. Expectant Mothers 7 45 Children under 5 years 125 898 Maternity Cases 81 1,369 Midwives Cases 95 1,604 General 685 9,337 993 13,253 That portion of the St. Helier Estate in Carshalton lying to the north of the Sutton by-pass is served by the St. Helier District Nursing Association, whose activities extend over the whole of the Morden section of the Estate and which is situated in the Merton and Morden Urban District. One nurse is employed for general nursing, and no midwifery is undertaken. The nursing carried out in the Carshalton district by this Association during the year is indicated by the following figures kindly supplied by the Honorary Secretary:— Cases Visits Children under 5 years 10 86 General 31 492 41 578 The nurses of both Associations attend the Council's Clinics. Laboratory Facilities. The laboratory facilities for the examination of pathological material in connection with infectious diseases, puerperal pyrexia, and tuberculosis, as shown in the Report for the previous year, were continued. continued. The examinations made under these arrangements were as follows:— No. Examined. Positive Results. Swabs for diphtheria 465 21 Virulence tests for diphtheria 1 — Sputa for tubercle 39 5 Widal tests for enteric 1 — Fæces for enteric, dysentery, etc. 7 2 Swabs for hæemolytic streptococci 17 6 The arrangements for the examination of water, milk and food were in the main, similar to those recorded in the Report for 1938. 19 They were modified by the utilization in appropriate instances of the Emergency Public Health Laboratory Service established by the Ministry of Health at the outbreak of war. The following examinations were made during the year:— Water for bacteriological examination 5 Water for chemical analysis 3 Milk for bacteriological examination 57 In October, the District Council became the Food and Drugs Authority under the 1938 Act. Under these powers the County Analyst, Mr. E. H. Hinks, was, with the approval of the Minister, appointed to act for the District Council in January, 1940. Mr. Hinks' laboratory is situated at 16, Southwark Street, London S.E.I. Ambulance Facilities. The arrangements for the removal of infectious and non-infectious cases set out in the Report for the previous year remain the same. I am indebted to Mr. C. P. Ingram, the Honorary Ambulance Officer, for the following information in respect of the working of the civil ambulance service during the year:— Calls to Street Accidents, etc 322 Answered by own ambulances 321 Transferred to other authorities 1 Calls to remove cases from domestic dwellings to nursing homes, hospitals, or vice-versa 494 Answered by own ambulances 494 Calls answered for other authorities in other districts 56 Total calls answered 872 Distance travelled on calls (miles) 7,159½ Average mileage per call (miles) 81/3 Number of occasions on which both ambulances were out at the same time 33 Number of occasions on which a third call was transferred to other services when both vehicles were out 1 Greatest number of calls answered in any one day 10 HOSPITALS. Infectious Diseases. The hospital facilities for the isolation and treatment of cases of infectious illness at the Cuddington Isolation Hospital were as described in the Report for 1938. Table 9 shows the admissions to the hospital from the constituent districts of the Joint Board. The total from Carshalton of 242 was a reducton of 68 on the figure for the previous year and was mainly due to a fall in the number of scarlet fever cases admitted. General and Maternity. The Carshalton, Beddington and Wallington District (War Memorial) Hospital, The Park, Carshalton. The normal accommodation of this voluntary hospital is 61 beds, arranged as shown in the previous Report. Under the Government's Emergency Hospital Scheme, this was increased to 101 at the outbreak of war. 20 21 TABLE 9. CUDDINGTON JOINT HOSPITAL BOARD—LIST OF ADMISSIONS TO CUDDINGTON HOSPITAL DURING 1939. Disease. Banstead U.D.C. Sutton & Cheam B.C. Leatherhead U.D.C. Carshalton U.D.C. Epsom & Ewell B.C. Others. Total. No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths No. Deaths Scarlet Fever 10 — 96 — 38 — 162 — 89 — 6 401 Diphtheria 1 1 9 1 3 — 16* — 3 — — — 32 2 Rubella — — 1 — 1 — 2 — — — 2 — 6 — Tonsillitis 3 — 12 — 4 — 17 — 8 — — — 44 — Chicken Pox — — 9 — 2 — 7 — 1 — — — 19 — Whooping Cough — — 2 1 3 — 4 — 2 — — — 11 1 Cerebro-spinal Meningitis — — 2 — — — 1 1 1 — — — 4 1 Erythema — — 1 — — — 3 — — — — — 4 — Erysipelas 1 — 5 — — — 2 — 1 — — — 9 — Others 7 — 31 1 10 — 28 1 11 — 6 — 93 2 Totals 22 1 168 3 61 — 242 2 116 — 14 — 623 6 * Including 2 " Carriers." The Hospital Report for 1939 shows that the following cases were admitted:— From Carshalton 524 From Beddington and Wallington 436 From other districts 98 1,058 Of the 1,058 in-patients, 93 were maternity cases, 22 of which were from Carshalton. The Council has an arrangement with the hospital for the treatment of maternity cases and children referred from the public clinics. Tuberculosis. The County Council administers the anti-tuberculosis scheme in this district. Sanatorium treatment is provided at the County Sanatorium, Milford, where 24 cases were admitted from Carshalton during the year. 79 other cases were admitted to other hospitals and institutions under county arrangements. Smallpox, There were no cases of smallpox to admit to the Isolation Hospital, Clandon, which constitutes the county hospital provision for this disease and has accommodation for 28 cases. County and Public Assistance Hospitals. The new St. Helier Hospital was not completed by the end of the year, consequently hospital cases admitted under county arrangements were sent to various hospitals throughout Surrey, mainly to Redhill and Epsom. 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. Phoenix Buildings, Stanley Road. Fridays, 2—3.45 p.m. Wrythe Hall, Wrythe Lane. Wednesdays, 2—3.45 p.m. Fridays, 10—11.45 a.m. Methodist Central Hall, Green Mondays, 2—3.45 p.m. Lane. Toddler Clinics:— Phoenix Buildings, Stanley Road. First and Third Thrusdays, 2—3.45 p.m. Wrythe Hall, Wrythe Lane. Tuesdays, 2—3.45 p.m. 22 Maternity Clinics:— Municipal Institute, Rochestar Road. Phœnix Buildings, Stanley Road. Wrythe Hall, Wrythe Lane. Mondays, 10—11.45 a.m. Tuesdays, 10—11.45 a.m. Tuesdays, 10—11.45 a.m. Fridays, 2—3.45 p.m. (Post-natal mothers only on first Friday in each month.) Methodist Central Hall, Green Lane. First and third Mondays in each month at 1.30 p.m. Dental Clinics:— Municipal Institute, Rochester Road. 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 Wednesdays in the month, 10 a.m. SCHOOL CLINICS. (Provided by the Surrey Education Committee.) Treatment of Minor Ailments:— Municipal Institute, Rochester Road. Wednesday and Fridays, 9.30 a.m.—12 noon. General Medical:— 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 noon Wednesdays, 1.45—4 p.m. Thursdays, 9.30 a.m.—12 noon. Fridays, 1.45—4 p.m. First and third Saturdays, 9.30 a.m.—12 noon. Hill House, Bishopsford Road. Mondays, 9.30 a.m.—12 noon Tuesdays, do. Wednesdays, do. Thursdays, do. Fridays, do. TUBERCULOSIS DISPENSARIES. (Provided bv the Surrev County Council.) Municipal Institute, Rochester Road. Fridays, 10 a.m. Third Tuesdays, 5.30 p.m. Middleton Road, St. Helier. Mondays, 1.30 p.m. Second Mondays, 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. 23 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 773 Notified by midwives 511 Still births 19 Notified by doctors and parents 54 Transferred notifications 227 792 792 The total is 76 fewer than in the year before and represents 98 per cent, of the number of births registered during the year. The Work of the Centres. Up to September the activities of the Welfare Clinics maintained the usual high level, but with the outbreak of war and the threat of danger from the air the normal rhythm as interrupted. Attendances fell owing partly to abstention by mothers and partly due to the policy which was instituted of regulating attendances so that no unduly large number of women and children were congregated in the Clinics at any one time. But the Clinics carried on, and at no Centre were they closed down. The essentials of this yital service were maintained, and great credit is due to the Clinics staffs and voluntary workers who accepted, and still accept, the great responsibility for the care of mothers and children at the Centres where danger from the air is ever present. Protection against blast and splinters was provided at or near each Centre either in basements under the premises or in specially constructed shelters adjoining. Although the total attendances fell for the reasons indicated, the number of women and children who attended the Centres rose to the record figure of 2,828, in spite of the fact that the births in 1939 were the lowest for 4 years. The further increase in the mothers who took advantage of the Maternity Clinics is particularly gratifying. The number represents 66 per cent, of the notified births, a rise of 10 per cent, over the year before and the greatest percentage yet recorded. Infants under 1 year attending for the first time at 587 represent 76 per cent, of the notified live births. Since the number of women attending the Maternity Clinics was 524, it will be observed that the mothers of the district are more and more tending to use the ante-natal and post-natal medical facilities to an extent similar to that they make of the Infant Clinics. Only a few years ago the disparity between the use made of these services was very marked. This is demonstrated by the following figures:— Year. No. of women attending Maternity Clinics expressed as per cent, of notified births. No. of children under 1 year attending Clinics expressed as per cent, of notified births. 1934 27 72 1935 39 82 1936 34 72 1937 50 78 1938 56 73 1939 66 76 24 The outbreak of war put an end, for the time being, to the steps which were in progress for the erection of a new Health Centre on the St. Helier Estate. Meantime the Clinics carry on as best they may in the old premises. To meet the convenience of residents living in the extreme southern end of the district in the vicinity of Clock House Farm, a weekly bus service from that locality to the Stanley Road Clinic was instituted in March. This was greatly appreciated and well used by the mothers living in that area. The attendances at the centres are shown in the following tables:— TABLE 10. ATTENDANCES AT MATERNITY CLINICS. CENTRE. No. on Register. Attendances Sessions. Average attendance per Session. *Primary Total. Rochester Road. Ante-Natal 137 112 502 38 13.5 Post-Natal 10 2 10 Individuals 139 114 512 Wrythe Lane Hall. Ante-Natal 289 108 453 99 4.9 Post-Natal 30 3 31 Individuals 292 111 484 St. IIelier. Ante-Natal 40 36 106 24 4.4 Post-Natal - - - Individuals 40 36 106 Stanley Road. Ante-Natal 52 37 211 31 7.1 Post-Natal 9 1 10 Individuals 53 38 221 All Centres. Ante-Natal 518 293 1272 192 6.9 Post-Natal 49 6 51 Individuals 524 299 1323 * Primary attendance is the first attendance of a woman in relation to the pregnancy under supervision. 25 TABLE 11. ATTENDANCES AT INFANT CONSULTATION CLINICS, 1939. Centre. Years. Number who Attended During Year. New Cases to the Centres. Number on Register at Year End. Attendances. Number of of Sessions. Average Attendance per Session. Primary. Total. Rochester Road Under 1 643 237 185 225 3299 100 52.9 1—5 77 428 58 1997 Wrythe Lane Under 1 808* 212 177 181 2502 81 49.8 1—5 85 802 24 1534 Stanley Road Under 1 342 104 89 88 1823 49 55.0 1—5 44 212 14 868 St. Helier Under 1 341 97 91 93 1152 47 43.0 1—5 47 228 36 870 All Centres Under 1 2304 650 542 587 8776 277 50.7 1—5 253 1670 132 5269 Totals 2025 903 2212 719 14045 277 26 * Includes 109 who attended other Centres also. Toddler Clinics. Children from 2 to 5 years who were examined at the special Toddler Clinics numbered 606, approximately 200 from each of the age groups, 2 years + , 3 years + , 4 years + . The number of defects found was 852, of which 437 were referred for observation and 415 recommended for treatment. The number of children found to have defects was 460, which was 76 per cent, of the total, compared with 72 per cent, found defective the year before. Although the number of defective children was slightly higher than in 1938, the number of defects per child examined was 1.4, compared with 1.6 in the previous year. TABLE 12. ATTENDANCES AT SPECIAL TODDLER (2-5 Years) CLINICS, 1939. Centre. No. of routine medical examinations. Sessions Average attendance per Session Did not attend Infant Consultation Clinic. 1 2—3 years 3—4 years 4—5 years Total* Wrythe Lane Hall 191 153 155 499 40 12.5 269 Stanley Road 37 36 34 107 20 5.3 10 Totals 228 189 189 606 60 10.1 279 * Each child attended once—this figure, therefore, represents the number of children who attended. TABLE 13. ATTENDANCES AT ALL INFANT WELFARE CLINICS—1939. (Infant Consultation and Special Toddler.) Year. Number who attended during the year. New cases to the Centre. Attendances. Sessions. Average attendance per Session Primary. Total. 0—1 | 2304 650 587 8776 337 26.0 1—5 253 132 5877 17.4 Totals 2304 903 719 14653 337 43.4 27. TABLE 14. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1939. Defect. Recommended for Number which received Treatment by Observation. Treatment. Own Dr. Hospital. At Home by Advice Clinic Total. Cleanliness 1 - - - - - — Nutrition 5 17 - — 11 — 11 Ringworm Skin — 1 1 — - — 1 Impetigo 1 2 - 1 1 — 2 Scabies — — - —. - — — Other skin conditions 4 14 - 4 7 — 11 Blepharitis Eyes — 6 1 5 — — 6 Conjunctivitis — 5 1 3 1 — 5 Keratitis - - - - - - - Corneal Ulcer - - - - - - - Corneal Opacities - - - - - - - Other Conditions — 3 1 2 — — 3 Vision 2 — - — — — — Squint 12 20 - 20 — — 20 Hearing Ears 3 1 - 1 — — 1 Otitis Media 7 1 - 1 — — 1 Other Diseases 1 — - — — — — Teeth 41 73 - 2 — 40 42 Tonsils 128 35 3 20 — — 23 Adenoids 69 31 2 17 — — 19 Other Conditions 11 9 1 1 1 — 3 Enlarged Cervical Glands 32 17 3 5 — — 8 Speech 17 2 — 3 — — 3 Heart Disease 23 2 1 1 — — 2 Anaemia 3 25 — — 15 — 15 Lungs, Tubercular 4 2 — 2 — — 2 Lungs, non-tubercular 11 3 1 1 —. — 2 Other Tubercular Diseases - 4 - 4 - - 4 Epilepsy 1 1 1 — — — 1 Chorea — 1 - - - - - Other Nervous Conditions 3 - - - - - - Rickets 9 25 — 4 7 7 18 Spinal Curvature 1 8 — 1 2 1 4 Other Deformities 10 23 — 1 11 1 13 Mental Condition 9 3 - - - - Behaviour 2 1 — — 1 — 1 All Other Defects 27 80 2 15 24 18 59 Total 437 415 18 114 81 67 280 28 TABLE 15 DISTRIBUTION OF "ASSISTED" MILK AND OTHER FOODS, 1939. Ward. Number Assisted Fresh Milk (pints) Dried Milk (lbs.) Cod Liver Oil (ozs.) Cod Liver Oil & Malt (ozs.) Virol (ozs.) Vitroleum Cream (ozs.) Parish'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 124 157 15751 10449 167 111 368 112 3524 2340 3426 2416 290 128 480 740 St. Helier South 75 91 6243 4403 318 126 184 310 1012 820 1784 996 176 108 604 260 St. Helier West 79 102 9316 4405 286i 86 16 32 2304 1049 1680 776 480 — 960 152 North East 60 72 6520 3505 106 69 144 40 1049 448 1240 880 48 112 272 240 North West 25 33 2808 1088 69 25 36 — 768 144 872 224 — 16 64 — Central 17 19 1722 86 55 — 16 48 412 16 372 12 — — 172 16 South East 25 35 2485 786 112 1 184 4 264 208 344 16 — — — — South West 3 4 336 — — — 48 — — — — — — — — — Totals 408 513 45181 24722 1114 418 996 546 9333 5025 9718 5320 994 364 2552 1408 29 Health Visiting. In the previous year the steady increase in the number of clinics had made serious in-roads into the time available to the visitors for home visiting. Following the appointment of an additional Health Visitor early in 1939, the Scheme had the benefit of the services of 5 full-time visitors. Consequently more time could again be devoted to home visiting, and the number of visits increased to a level approaching that for 1937. Details of the visits, excluding Child Life Protection visits, are as follows:— To expectant mothers— First visits 145 — Total visits — 319 To children under 1 year— First visits 860 — Total visits - 3776 To children 1-5 years— Total visits — 6010 10105 " Assisted " Milk and Other Foods. The assistance given in the form of milk and other special foods was on much the same scale as previously. Although approximately 100 fewer individuals were assisted, the total quantity of food issued was rather more than in 1938. Details are given in Table 15. Dental Scheme. As foreshadowed in the last Report, one of the most notable features of the welfare service in 1939 was the great increase in the activities of the Dental clinics. Following upon an extension of the clinic programme from 38 sessions in 1938_to 81 in the year under review, the dental work carried out under the scheme was more than doubled. One fact has special significance and reflects the increased attention paid to dental conservation. Although more children received treatment, the number of temporary teeth extracted was only 278, compared with 452 in the year before, whereas the number of fillings increased three times. This satisfactory feature is due, in no small degree, to the cumulative effect of the operation of the scheme in recent years and to education of the parents in the necessity for early treatment at the first signs of dental disease. Details of the work clone during the year are as follows:— DENTAL SCHEME—TREATMENT PROVIDED, 1939. Temporary Teeth. Permanent Teeth. Dentures Supplied. Extracted Filled. Extracted Filled. Full. Partial. 278 100 407 164 41 27 Anaesthetics Gas. 144 Local 45 30 Other Operations Impressions 75 Bites 42 Try-ins 48 Dressings 18 Scalings 62 Repairs 4 Inspections 234 Dentures supplied—• Full Partial Free 7 7 Half Price 10 7 Part Cost 17 6 Full 7 7 Totals 41 27 Attendances at the Dental Clinics are shown in the following table:— DENTAL SCHEME—ATTENDANCES, 1939. Centre Referred from No. Treated. f attendances. Rochester Road. Children 19 50 Mothers 23 131 Individuals 42 181 Wrythe Lane. Children 48 146 Mothers 48 239 Individuals 96 385 St. Helier. Children 7 14 Mothers 19 107 Individuals 26 121 Stanley Road. Children 16 28 Mothers „ 7 33 Individuals 23 61 All Centres. Children 90 238 Mothers 97 510 Individuals 187 748 Number of Sessions held 81 Average attendance per Session:— Children 2.9 Mothers 6.3 Individuals 9.2 31 Orthopedic Treatment. Local arrangements for massage and the facilities for Institutional treatment and the provision of surgical appliances were as described in the previous Report. 845 treatments were given by the Masseuse for the following 40 cases:— Rickets 4 Torticollis 1 Curvature of the spine 9 Genu-varum 19 Genu-valgum 13 46 One child was maintained in a special hospital for 17 weeks for Erb's palsy, another for 22 weeks for arthritis of the knee. A further case was provided on two occasions with special surgical appliances free of cost. Convalescent Treatment. The Council subscribes to the Convalescent Home for Surrey and gives financial assistance to cases provided with treatment under the auspices of the Invalid Children's Aid Association. Fourteen children were sent to Convalescent Homes under these arrangements to recuperate from the following conditions:— Condition. Age. Duration of Treatment. Whooping Cough and Congestion of Lungs 4 yrs. 15 weeks Asthma 4 yrs. 9 mths. 6 ,, Asthma and Bronchitis 4 yrs. 6 mths. 15 „ Bronchitis 4 yrs. 6 mths. 12 „ Debility 2 yrs. 6 mths. 6 ,, Bronchial Catarrh and Whooping Cough 3 yrs. 5 mths. 4 „ Rickets 1 yr. 1 mth. 16 „ Bronchitis 4 yrs. 6 mths. 6 ,, Undernourishment 4 yrs. 8 „ Bilateral Lobar-pneumonia 3 yrs. 28 „ Debility 4 yrs. 9 mths. 8 „ Impetigo 3 yrs. 4 mths. 8 „ Impetigo 2 yrs. 1 mth. 8 „ Whooping Cough 4 yrs. 8 „ Maternity Hospital Treatment, The Council has an arrangement with the War Memorial Hospital for the admission of maternity cases needing hospital treatment. These facilities, by reason of the limited accommodation at the hospital, are very restricted and more use is made of the county hospitals. The number of cases referred to hospital from the Council's clinics increased to 105 from 62 in the year before. 32 They were sent to the following institutions for the reasons indicated:— For obstetric and medical reasons. For unsuitable home conditions. Total. Carshalton (War Memorial Hospital) 14 1 15 County hospitals 37 44 81 Other hospitals 7 2 9 58 47 105 For details of cases of puerperal pyrexia admitted to hospital, see Section F, dealing with infectious diseases. Consultant Service. The services of an obstetric consultant which are available under the Scheme for the emergencies of pregnancy and complications of labour were called upon in only one instance. This was a notified case of puerperal pyrexia which developed endometritis. Emergency Maternity Unit This service, whereby skilled obstetric and nursing assistance, together with transportable equipment, is available for dealing with maternity emergencies in the patients' homes was established on the advice of the Ministry of Health. It is operated in conjunction with the maternity facilities of the War Memorial Hospital, but has not yet been called upon. Maternity Outfits. Sterilised outfits for use during confinement are supplied under the Scheme at cost price, or less than cost price, according to means. 24 were issued during the year, 4 free of cost, one at half-price and 19 at cost price. Home Helps. Domestic assistance may be secured under the Scheme for mothers with young children during confinement or under other special circumstances. The contribution of the mothers is fixed by income scales. In the year under review the number of Home Helps supplied was 51, in respect of 16 of which no charge was made^ the remainder on part payment. This service is extending year by year and is becoming a prominent feature of the Scheme. 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. 33 The full scale fees fixed by the County Council for the services of the midwives are as follows:— As Maternity Nurse 35s. As Midwife 40s. Provision is made 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 10 129 139 Still births 2 3 5 (2) As Maternity Nurse—Live births 7 10 17 Still births — — — 19 142 161 Visits made— Ante-natal 825 During confinement 2781 Medical Aid Forms sent by Midwives 34 Rise of Temperature 3 Still birth 1 Malpresentation 5 Persistent Vomiting 1 Prematurity 1 Hydramnios 1 Swelling of Hand and Legs 1 Baby's Eyes 2 Haemorrhage 3 Adherent Placenta 1 Ruptured Perineum 9 Delayed Second Stage 3 Phlebitis 2 Haematuria 1 Number of cases which attended ante-natal clinics 78 In addition to the Midwives appointed by the Council, there are 11 others resident in the district. Of these, 4 are on the staff of the Nursing Association, 3 are County Midwives, and one is a member of the local hospital staff. In the 1st July the Order made by the Minister of Health came into force prohibiting unqualified persons attending upon women in child-birth for reward. Voluntary Helpers. The official staff has, since the inception of the scheme, had the valuable assistance of a number of voluntary workers. Their regular and untiring efforts at the Welfare Centres play a large part in the successful operation of the Maternity and Child Welfare Scheme. 34 CHILD LIFE PROTECTION. The Council, as the welfare authority, is responsible for the administration of the Child Life Protection provisions of the Public Health Act, 1936. All the Health Visitors are appointed Inspectors for this purpose and exercise a careful supervision over the conditions under which children are kept for reward. The following is a summary of the main items of information with regard to their work. Number of registered foster homes with children at the year end Number of new homes registered during the year 17 Number of foster homes removed from the register during the year 25 Total number of foster homes supervised 44 Number of children admitted to the register during the year 59 Number of children removed from the register during the year 71 Total number of children on the register at year end 48 Total number) of children on the register during the year119 Number of children who died during the year — Number of inquests held — Number of visits made to foster homes 512 Legal proceedings DAY NURSERY. The Carshalton Day Nursery, administered by a voluntary Committee and assisted by a grant from the Council, has provided nursery facilities in the district for many years. The premises were closed at the end of July for the usual August holidays, and, in view of the difficulties brought about as a result of the outbreak of war, they remained closed for the remainder of the year. Early in 1940, shelter facilities were provided, and, with certain modifications in the organisation, it was re-opened. The number of places authorised is 18. The attendances numbered 1937 for the 135 days on which the nursery was open, giving an average attendance of 14.3 per day. 35 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, Cleam and Woodmansterne and is augmented at intervals by water derived from river sources. In January, the Minister of Health issued Memorandum 221 for the guidance of water undertakers, setting out in some detail the nature of the precautions which should be taken in their day-to-day administration. The considerations raised therein were discussed with representatives of the Water Company in their appfication to local arrangements. Eight samples of the public supply were taken by the Department, 5 for bacteriological examination and 3 for chemical analysis. All were entirely satisfactory except for one, which showed some trace of undesirable contamination. A " repeat " sample taken immediately the report was available failed to confirm the previous finding and was completely satisfactory. It should be observed that the wholesomeness of any controlled water supply cannot be judged on the results of the analysis of isolated samples. It cannot be passed as fit or condemned as unfit on a single examination. Several factors may invalidate the findings of an analysis. There may, for instance, have been a slight error in the technique of sampling or a local and temporary source of pollution in the house from which the sample was taken. The primary responsibility rests with the Water Company, who, in conformity with recognised practice, have instituted arrangements for the regular and repeated examination of their supplies, the results of which are considered in the light of the circumstances under which the supply is produced. From the point of view of the Local Authority, control by way of water analyses should be in the nature of a check by periodic routine sampling, together with special samples taken immediately circumstances come to notice which indicate a potential risk from the supply. An analysis which indicates deterioration in the usual high quality unsupported by other evidence should be read as a warning calling for the prompt investigation of all the circumstances involved. In short, opinion based only on reports of isolated samples is of very little value and may be definitely misleading. 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. No additions or alterations of any note were made during the year, but the Scheme for the elimination of cess-pools at the Oaks Park, referred to in the previous Report, was completed. The drainage of two houses was connected to the sewers and one cess-pool abolished. Seventy-seven drainage obstructions affecting 250 houses received attention. Drainage repairs were executed at 53 premises. 36 Rivers and Streams. There were no works of major importance to record. The flow from the springs of the Wandle was fairly well maintained during the year. One complaint of pollution of the River Wandle was investigated. The pollution was traced to a factory on the Wallington side of the river and the matter passed to that Authority for attention. Closet Accommodation. There are now approximately 18 premises with drainage connected to cess-pools. Eight premises are served by pail closets. Three additional W.C.'s were provided to existing premises, and 32 W.C.'s were either renewed or repaired. Public Cleansing. Domestic refuse is collected weekly by covered freighters. Trade refuse is also collected on payment of a moderate charge. Disposal is by incineration at the Council's 6-cell Destructor. 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. Spicer, M.R.S.T., Chief Sanitary Inspector, under Article 27 of the the Sanitary Officers' Regulations, 1935. Sanitary Inspection. Four hundred and sixty-six complaints were received, as follows:— Drainage Obstructions 72 Sewer Obstructions 2 Drainage Defects 14 General Defective Conditions 42 Dampness 28 Roofs, Guttering, Etc. 16 Sink Waste Pipes 4 Burst Water Pipes 4 Water Supply 4 Dust-bins 12 Accumulations and Deposits 27 Burning Refuse 8 Refuse Collection 30 Smoke Nuisances 3 Rivers, Ditches and Ponds 2 Cesspools 1 Flooding 3 Unfit Food 16 Shops Acts 20 Houses Let-in-Lodgings 1 Overcrowding 18 Rent Book Information 1 Smells 10 Verminous Premises 29 Rats and Mice 35 Crickets 8 Wasps 18 Ants 3 Flies 2 Animals 9 Gypsies 4 Noises 4 Miscellaneous 15 466 37 Ten thousand six hundred and fourteen investigations were made for the following purposes:— Inspections 4062 Re-inspections 2530 Housing (H.A.) 340 Housing" (P.H.A.) 924 Slaughterhouses 59 Dairies 29 Cowsheds 35 Milkshops 78 Factories 129 Outworkers 41 Bakehouse Factories 17 Bakehouse Workshops — Offices 12 Laundry Workshops — Laundry Factories 4 Houses, Drains Tested 15 Foodshops and Business Premises 587 Infectious Disease, Premises 305 Infectious Disease, Contacts 57 Urinals 65 Smoke Observations 11 Rat Infested Premises 244 Schools 12 Premises re Cesspools 88 Stables 18 A.R.P. 950 Food Enquiries 2 10614 Seven hundred and sixty informal notices were served for the following purposes:— General Defective Conditions 370 Rats and Mice 115 Accumulations and Deposits 67 Obstructed Drains 47 Drainage Defects 19 Verminous Premises 18 Dust-bins 27 Paving 3 Food Storage 4 Smoke Nuisance 2 Burning Refuse 3 Cesspools 10 Water Supply 6 Gypsies 1 Animals 1 Rent Books 22 Houses—Let-in-Lodgings 1 Factory Acts 18 Food Contamination 9 Unsatisfactory Food Premises 7 Miscellaneous 10 760 (Notices of intention to inspect were served with respect to 338 houses.) 38 Thirty-two formal notices were served under the following Acts:— Section 93—Public Health Act, 1936 16 Section 9—Housing Act, 1936 — Section 56—Public Health Act, 1936 6 Section 66—-Housing Act, 1936 6 Houses Let-in-Lodgings Bye-Laws — Section 75—Public Health Act, 1936 4 32 As a result of the serving of the notices, the following works were executed:— No. of Premises. Brickwork repaired and/or renewed, repointed 14 Ceiling plaster repaired and made good 89 Renewed, cleansed and purified 113 New provided 1 Chimney Pots repaired or renewed 5 Stacks repaired or renewed 6 Flues repaired 3 Coppers repaired and/or renewed 1 Provided 1 Cement fillets renewed 7 Plinths renewed 9 Plinths provided — Cesspools emptied 5 Damp conditions remedied 91 Course provided 3 Doors repaired (including locks and fasteners) or renewed 8 Sills repaired, renewed or provided 8 Frames repaired or renwed 3 Stopping to reveals renewed 6 Drainage repaired or reconstructed 8 houses 57 ft. of drain laid Connected to sewer 1 Inspection chamber repaired or renewed 5 provided 1 Cover renewed 5 Cover provided 1 F.A.I, repaired or renewed 3 M.F.V. renewed 6 Soil or Vent pipes repaired or renewed 4 Drains tested 5 Drains cleared 77 drain obstructions. 250 houses Drains sealed off 1 Waste gullies repaired and/or renewed 9 Waste pipes repaired or renewed 10 Disinfestation 30 Dustbins provided 59 Fences repaired or renewed 1 Food Storage accommodation provided 2 Ventilated 4 Floor boards repaired and/or renewed 23 Concrete repaired, renewed and/or made level 1 Ventilation repaired and/or renewed 7 provided 3 39 No. of Premises Fireplaces repaired and/or renewed 14 Firegrates repaired and/or renewed 4 Ranges and/or Stoves repaired and/or renewed 12 Light, more provided 2 Roofs repaired and made weatherproof 97 Flashing repaired and/or renewed 2 Ridgeships Valleys repaired and/or renewed 5 Gutteiing and/or down pipes repaired and/or renewed 48 Guttering and/or down pipes cleaned out, made to work properly 12 Sinks renewed 6 Stair treads repaired or renewed 2 Handrails and/or ballusters repaired 2 Steps repaired or renewed 2 Surface Water drainage repaired, made to work properly 8 Walls cement rendered 1 cement rendering, repaired 2 Replastered or repaired 87 Cleansed and redecorated 114 Windows repaired and/or renewed 26 Frames repaired and/or renewed 14 Made to work properly 2 Sashcords renewed 46 Sills repaired and/or renewed 21 Stopping to reveals 4 W.C. accommodation repaired 1 Provided 3 Pans renewed (Inc. trap) Pans provided (inc. trap) 3 Pans, joints renewed 12 Lift-up seats provided 2 Seats repaired or renewed 6 Flushing apparatus repaired or renewed 19 provided 2 Water supply repaired 7 Provided 2 Wash Basins, baths, repaired, renewed 1 provided1 Weatherboards repaired or renewed 1 Paving repaired, made level 15 Provided 2 Drained 3 Nuisances 4 Rats and Mice 13 Other Matters 24 Glazing panes renewed 8 Putty renewed 10 Ventilation more provided 5 Accumulation removed 23 Shops 26 Disinfection and Disinfestation. In connection with the control of infectious diseases, 316 rooms in 295 houses were fumigated, 36 lots of bedding sterilised and 12 lots of bedding destroyed. Three hundred and twelve library books were also fumigated. Refuse bins are dusted with a disinfecting powder during the summer months. 40 Bed bug infestations were dealt with in 28 premises as follows:— Council Houses Others Total By hydrogen cyanide 7 8 15 By spraying 5 8 13 12 16 28 The hydrogen cyanide process is carried out by arrangement with private contractors. The gas is liberated from liquid cyanide in the rooms up to the requisite concentration. Liquid spraying of insecticides is undertaken by the Department's staff, using either Solution " D " or Zaldecide. The arrangements for vermin control exercised when occupation of Council houses is taken up or transfers made were as previously reported. Ten van-loads of furniture were treated by H.C.N, under these arrangements during the year. Treated cases of infestation are followed up and advice given where necessary with a view to preventing re-infestation. The Council houses are supervised by the Estates Manager. Mosquito Control and Other Pests 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. In addition, 32 wasps' nests were destroyed and 4 houses were sprayed for the destruction of fleas, silver fish, crickets and ants, respectively. Rats and Mice (Destruction) Act, 1919. The National Rat Week Campaign usually organised by the Chief Sanitary Inspector was not held during 1939, but action under the Act was taken throughout the year where circumstances indicated it. Smoke Abatement. Three complaints of alleged nuisance from smoke were effectively dealt with without the necessity for 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 is based on the recommendations cotained in the " Memorandum on Closure and Exclusion from School, 1927," issued conjointly by the Ministry of Heath and Board of Education. Twelve visits were made to schools in the district, but no insanitary conditions were found which required attention. Disposal of the Dead. The Council owns 25 acres of land in Morden which is the proposed contribution to a joint Scheme with the neighbouring Authority of Merton and Morden for burial accommodation. 41 Mortuary facilities are provided in the newly constructed building in Mill Lane. This incorporates a post-mortem room, viewing room, refrigerating plant, pathologist's room, and waiting room. Shops Acts, 1912—1938. The Chief and District Sanitary Inspectors are appointed Inspectors under the Acts. During the year, 949 inspections to shops were made and 65 informal notices were served regarding the following infringements:— Sunday trading 7 Assistants'half day and half day notice 12 Exhibition of regulation form F 10 H 10 K 7 VII 2 ,, ,, G 3 Hours employment of young persons 2 Closing hours 23 Half-day closing 2 Mixed shop notices — Compensatory holidays 3 There were approximately 580 premises on the register which came under the operation of the Shops Acts, 1912—1938, and, in addition to inspections which were made during other routine food inspections of shops, evening and Sunday inspections were carried out regularly. Section 10. Details of the operation of Section 10 of the Shops Act, 1934, relating to the health and comfort of shop assistants during 1939 are as follows:— Formal notices 10 -Shops without sanitary accommodation or washing facilities 3 Shops without means of providing a reasonable temperature 11 Shops provided with sanitary accommodation or washing facilities 4 Shops provided with means for providing a reasonable temperature 3 No formal exemption certificates for the exemption of the provision of sanitary accommodation or washing facilities were issued, but one written undertaking was accepted for a shop on conditions where accommodation was available at other premises. Of the 3 shops provided with means for maintaining a reasonable temperature, 1 was a butcher's shop and 2 grocery shops. 42 Shops (Sunday Trading Restrictions) Act.— Section 1. One prosecution under the above Act was taken against a shopkeeper for permitting his shop to be open for articles which were not exempted under the Act, and he was fined £1 and costs. Offices. Twelve inspections were made of offices as to any action which might be necessary under the Public Health Act, 1936, but no conditions were found requiring any specific action. Camping Sites. There were no sites which were used for camping purposes during the year. Swimming Baths and Pools. There is only one small swimming bath in the district, which is privately owned. The water used is from the main supply and is subjected to a constant process of precipitation, filtration and chlorination by gaseous chlorine. 43 Section D—Housing. New Houses. New houses erected numbered 117, compared with 391 in the year before. Building ceased with the outbreak of war. The new houses were erected as follows:— Ward. By the Council. By Private Enterprise. Total. St. Helier North - 9 9 St. Helier South — — — St. Helier West — 6 6 North East 10 28 38 North West — 14 14 Central — — — South East —. 31 31 South West — 19 19 Whole District 10 107 117 Council's Housing Scheme. The houses erected by the Council under the provision of the Housing Acts up to the 31st December, 1939, are as follows:— Act under which No. of Type. erected. Properties. (P.-Parlour. N.P.—non-Parlour.) 1919 203 P. 3 bedrooms 2 N.P. 3 Flats 5 N.P. 3 210 1923 12 N.P. 3 28 N.P. 2 Flats 8 N.P. 1 ,, - 48 1924 40 P. 3 72 N.P. 3 Flats 56 N.P. 2 — 168 1930 10 N.P. 4 52 N.P. 3 4 N.P. 2 Flats 20 N.P. 2 - 86 1930/36 18 N.P. 2 60 N.P. 3 16 N.P. 4 8 P. 4 - 102 1938 10 N.P. 2 624 The number of first applications received during 1939 91 The number of tenancies allotted during 1939 34 The number of applications outstanding at 31st Dec., 1939 400 The number of first applications received during 1939 91 The number of tenancies allotted during 1939 34 The number of applications outstanding' at 31st Dec. 1939 400 Inspection and action taken under Statutory Powers. I. Inspection of Dwelling Houses during the year. (1) (a) Total number of dwellings inspected for housing defects (under Public Health or Housing Acts 1264 (b) Number of inspections made for the purpose 3516 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 to 1932 340 (b) Number of inspections made for the purpose 1154 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 219 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 275 (Including some houses inspected during 1938) 3. Action under Statutory Powers During the Year, (a) Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936 Number of dwelling houses in respect of which notices were served requiring repairs — Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners — (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 5 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 7 (Includes notice served in 1938) (b) By local authority in default of owners — (c) Proceedings under Sections II and 13 of the Housing Act, 1936. (1) Number of dwelling houses in respect of which demolition orders were made — (2) Number of dwelling houses demolished in pursuance of demolition orders 45 (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 — 4. Housing Act, 1936, Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at end of year 60 (2) Number of families dwelling therein 60 (3) Number of persons dwelling therein 415½ (b) Number of new cases reported during the year 31 (c) (1) Number of cases of overcrowding relieved during the year 50 (2) Number of persons concerned in such cases 338½ (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 — Slum Clearance. The tenants displaced from Clearance Area No. 6—West Street were re-housed, though the buildings have not yet been demolished. To date, six Clearance Schemes have been carried out since 1930, involving the re-housing of 481 persons. During the year five individual houses, displacing 14 persons, were demolished by formal procedure, and 16 houses, displacing a further 50 persons, were demolished informally in anticipation of formal procedure. Housing Act, 1936—Overcrowding. At the beginning of the year there were 562 equivalent adults, comprising 79 families, living under overcrowded conditions as defined by the Housing Acts. By the end of 1939, after allowing for new cases and abatement of existing cases, there was a- net reduction in the number of 19 families, representing 146J equivalent adults. The reduction was as follows:— Overcrowded at 31.12.38 Found overcrowded during 1939 Decrowded during 1939 Remaining overcrowded at 31.12.39 Net reduction during year. Families 79 31 50 60 19 Equivalent Adults 562 192 338½ 415½ 146½ Six of the new cases were illegal and two were outstanding at the end of the year. The 50 cases abated were decrowded as follows:— Provision of alternative accommodation:— (a) By Carshalton Council 16 (b) By London County Council 12 Left the district 1 By removal of one or more occupants 15 By the families themselves securing alternative accommodation 6 46 The position with regard to overcrowding up to the end of 1939 in the individual Wards was as shown below:— Ward. Houses overcrowded at Survey 193(5 Houses found overcrowded up to 31.12.39 Houses decrowded up to 31.12.39 Houses still overcrowded at 31.12.39 Overcrowding Cases remedied during 1939. Formal Informal Total St. llelier North 40(a) 39 (6) 59 (h) 20 (b) 9 2 11(b) St. Helier South 40 (b) 38 (b) 66 (b) 12 (b) 9 6 15 (b) St. Helier West 45 (6) 46(f) 76 (0 15 (b) 8 5 13(6) North East 17(c) 18(/) 32 (k) 3 1 3 4 (d) North West 10 32 39 3 1 2 3 Central 9(d) 11 18 (d) 2 — 1 1 South West 4 3 1 — 1 1 South East 12 (a) 15 (g) 23 0) 4 (c) — 2 2(/) Totals 173 203 316 60 28 22 50 (a) 30 Iy.C.C. Houses (6) All I,.C.C. Houses. (c) 4 C.U.D.C. Houses. (d) 1 C.U.D.C. House. (t) 5 C.U.D.C. Houses. (/) 43 1,-C.C. Houses. (g) 10 C.U.D.C. Houses. {h) 58 Iy.C.C. Houses. (i) 73 I,.C.C. Houses. (» 11 C.U.D.C. Houses. [k) 6 C.U.D.C. Houses. (/) 2 C.U.D.C. Houses. Overcrowded houses abated by C.U.D.C. 16 New Houses provided and occupied — Old Houses provided and occupied 16 The progress made in remedying overcrowding since the Housing Survey of 1936 is indicated by the following figures:— Number Overcrowded Equivalent Families Adults At Survey, 1986 173 1,162 December 31st, 1936 178 1,163 December 31st, 1937 92 633 December 31st, 1938 79 562 December 31st, 1939 60 415 By the complete cessation of building as the result of the war, the scope for further relief of overcrowding has been considerably reduced. With the possible destruction of properties due to enemy action, it is probable that the overcrowding position as a whole will become aggravated. Moreover, the war-time movement of population, which ebbs and flows with the varying intensity of air attack in this and other districts, is likely to give rise to temporary but considerably increased overcrowding in different parts of the district. Houses Made Fit. Two hundred and forty-three houses have been repaired and made fit by formal procedure under the Housing Act of 1930. Of these, 7 were made fit during 1938. One thousand three hundred and ninety-four houses have been repaired and made fit informally since 1930. Of these, 213 were made fit during 1938. Tents, Vans, Sheds and Similar Structures. Except to deal with an occasional caravan halting on the extreme southern boundary of the district no action was necessary. 47 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:— No. Employees. Factories with mechanical power 52 781 Factories without mechanical power 53 147 Out-workers premises 76 78 Factories Act, 1937. The following table sets out the inspections made and the action taken under the Factories Act:— 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 61 11 - Factories without mechanical power 85 7 — *Other premises under the Act (including works of buildings and engineering, but not including outworkers' premises) - - - Total 146 18 — * Electrical Stations should be reckoned as factories. 2. Defects Found. Particulars. Number of Defects. Number of offences in respect of which prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of Cleanliness 1 1 - - Want of Ventilation 1 1 - — Overcrowding — — - — Want of Drainage of Floors — — - — Other Nuisances 2 2 - — insufficient 1 1 Sanitary Unsuitable or Defective 13 13 - — modation not Separate for sexes — — - — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s.101) — - - - Other Offences — — - — Total 18 18 — — 48 Section E—inspection and Supervision of Food. Milk Supply. Only a small amount of raw milk is sold in the district, including that which is retailed at the various farms. Only one producer-retailer sells raw milk in the district produced outside the district. The bulk of the milk supply consumed in the district is pasteurised in accordance with the Milk (Special Designations) Order, 1936. The number of cowkeepers on the register is 4, with a total of about 130 cows. Two of them are licenced to use the term "Accredited Milk." The number of retail purveyors of milk on the register is 73, of whom 2 were registered during the year. Forty-five of the retailers have premises in the district, the remaining twenty-eight retail milk brought from premises outside the district. The cowsheds, dairies and milk shops in the district have been regularly inspected, and 57 samples of graded and ungraded milk in course of delivery to the consumer were taken. One large dairy premises was reconstructed and remodelled on hygienic lines for the storage and redistribution of milk and other dairy produce. One other small dairy was rebuilt. 49 Details of the samples are as follows:— Grade. Bacterial Count. Bacillus Coli Test. No. examined Highest Lowest Average No. examined. Abs. in 1/10 cc Abs. in 1/100 cc j Abs. in 1/1000 cc Ordinary 22 110800 3400 28783 22 13 19 22 Pasteurised 35 22000 480 8185 35 35 35 35 Grade. Methylene Blue Test. Tubercle Test. Phosphatase Test. No. examined. Satisfactory No. examined. Satisfactory No. exam- Satisfactory factory Ordinary 22 22 - _ _ _ Pasteurised 35 35 — — 5 5 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 " 7 Licences to use the term " Pasteurised " 10 Supplementary Licences to use the term " Tuberculin Tested " 11 Supplementary Licences to use the term "Pasteurised" 12 Meat and Other Foods. Most of the meat supplied to the district comes in from the London and Croydon Markets already inspected, but periodical inspections were made of all premises and vehicles where meat and food is stored, prepared or sold for human consumption. There is only one slaughterhouse (at present registered) used in this district, and action under the Food and Drugs Act, 1938, with regard to this slaughterhouse was being considered at the end of the year. The number of carcases examined at the slaughterhouse was as follows:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) — 1 51 Number inspected — — 1 — 51 All Diseases Except Tuberculosis. Whole carcases condemned — — — — Carcases of which some part or organ was condemned 9 Percentage of the number inspected affected with disease other than tuberculosis — — 17% 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:— 3 pigs' plucks. 5 sets pigs' lungs. 1 pig's liver. 7 lbs. salmon. 30 lbs. mackerel. 24 lbs. herrings' roes. 8 stone skate wings. 5 stone dog fish. 13 lbs. English lamb. 26 lbs. English beef. There are 35 purveyors of meat with shops in the district and several hawkers with vans who come from other districts. 50 Food and Drugs Act, 1938. Following the passing of the Food and Drugs Act, 1938, steps were taken during the latter part of the year which resulted in the Council being made the Food and Drugs Authority early in 1940. The following table shows the action taken m Carshalton under the Acts during the year by the Surrey County Council, which continued to exercise those functions until they were transferred to the District Council. Articles. Analysed. Adulterated or Deteriorated. Prosecu tions. Convic tions. Formal. Informal. Total. Formal. Informal. Total. Milk 16 3 19 — — — — — Cream 1 — 1 1 — 1 — — Butter 1 — 1 — — — — — Cheese — — — — — — — — Margarine — — — — — — — — Lard — — — — — — — — Meat — — — — — — — — Flour — — — — — — — — Tea — — — — — — — — Coffee — — — — — — — — Cocoa — — — — — — — — Sugar — — — — — — — — Sausages — — — — — — — — Confectionery and Jam 3 — 3 — — — — — Sausage Meat — — — — — — — — Wine — — — — — — — — Beer — Spirits 2 — 2 — — — — — Drugs — *Other Articles 2 3 5 — — — — — Totals 25 6 31 — — — — — *Details of other Articles. Cream Ice — 1 1 — — — — — Blackcurrant Jelly 2 — 2 — — — — — Bleach Ointment — 2 2 — — — — — 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. 61 Section F—Prevalence of and control over infectious and other diseases. As in previous years, figures are given in this Section not only for the district as a whole, but for the district excluding Queen Mary's Hospital. This L.C.C. Institution of some 1,100 beds is a closed community with a large child population admitted exclusively from London district. The separate statistics enables a truer picture to be given of the incidence of infectious disease among the resident population of the area. Notification. Under the Measles two diseases became additions, the list of Smallpox Cholera Diphtheria Membranous Croup Erysipelas Scarlatina or Scarlet Fever Measles Whooping Cough Tuberculosis Dysentery and Whooping Cough Regulations, 1939, these notifiable on the 23rd October. With these notifiable diseases is as follows:— Acute Influenzal Pneumonia Acute Polio- Encephalitis Typhus Fever Typhoid Fever Enteric Fever Relapsing or Continued Fever Cerebro-Spinal Fever Acute Poliomyelitis Ophthalmia Neonatorum Puerperal Pyrexia Malaria Acute Primary Pneumonia Acute Encephalitis Lethargica Food Poisoning Smallpox. For the sixth successive year no notifications of smallpox were received. Enteric Fever. Following two years in each of which only one case of enteric fever was reported, 1939 was entirely free from this infection. Dysentery. Twenty-four cases of dysentery were notified, of which 11 occurred in Queen Mary's Hospital. Of the other 13 among residents, 7 were Sonne infectious affecting two families, 4 persons in one and 3 in the other. They made uneventful recoveries after domiciliary treatment. In 3 others the diagnosis was made on clinical evidence and the nature of the infection was not determined bacteriologically. It is interesting to note that on the day of onset each of these 3 persons had partaken of fried duck egg of continental origin purchased from the same shop gnd supplied from the same consignment. The history of the illness in each was consistent with infection by the Salmonella group of food-poisoning organisms. They all recovered after treatment at home. 52 Two further eases were mild attacks not confirmed baeteriologically. They recovered at home. The remaining case was an amoebic dysentery in an adult who had spent some years in India. He was admitted to a London hospital, where the diagnosis was established. The cases occurring in Queen Mary's Hospital (11) were all Sonne infections. Scarlet Fever. The total number of scarlet fever notifications was 202, of which 15 were from Queen Mary's Hospital. The incidence rate was, accordingly, 3.42 per 1,000 for the whole district and 3.16 for the district excluding the hospital. These figures compare with 4.06 and 3.95 respectively in the year before. The rate for England and Wales was 1.89. No person died of this infection. Eighty-eight per cent, of the cases were removed to hospital. There were 9 " return cases," i.e., cases occurring in the same home within one month of the return from hospital of a previous case. The intervals between the return of previous cases and the onset of the " return cases " were as follows:— 2 cases at 4 days' interval, 2 cases at 5 days' interval, 2 cases at 6 days' interval, 1 case at 7 days' interval, 1 case at 10 days' interval, 1 case at 20 days' interval. The notified cases were distributed throughout the district as follows:— TABLE 16. SCARLET FEVER—WARD INCIDENCE, 1939. (Excluding Queen Mary's Hospital.) Ward. Cases. Rate per 1,000 population. St. Helier North 42 4.80 St. Helier South 34 4.81 St. Helier West 51 6.01 North-East 18 1.99 North-West 18 2.48 Central 10 1.68 South-East 4 0.55 South-West 10 1.52 Whole District 187 3.10 Table 17, giving seasonal prevalence, shows that the incidence was fairly evenly distributed over the year. 53 TABLE 17. SCARLET FEVER—MONTHLY DISTRIBUTION, 1939. Ward. Total St. Helier North St. Helier South St. Helier West North East North West Central. SouthEast SouthWest January 4 3 5 2 1 —. 2 2 19 February 2 5 2 2 — — — — 11 March 9 3 — 6 1 — — 3 22 April 2 3 4 1 1 — — 1 12 May 4 2 3 1 5 — — — 15 June 1 2 7 3 1 3 1 1 18 July 3 4 8 — 1 1 — 2 19 August 2 3 6 — 4 1 — 1 17 September 2 — 5 1 — 3 — — 11 October 3 5 5 1 2 1 — — 17 November 7 1 3 1 3 1 1 — 17 December 3 3 3 9 Totals 42 34 51 18 18 10 4 10 187 Multiple 'Cases.—The houses in which more than one case occurred are shown below:— TABLE 18. SCARLET FEVER—MULTIPLE CASES, 1939. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case 2 Cases 3 Cases 4 Cases St. Helier North 27 6 1 34 42 St. Helier South 25 1 1 1 28 34 St. Helier West 34 7 1 — 42 51 North East 14 2 — — 16 18 North West 13 1 1 — 15 18 Central 4 1 — 1 6 10 South East 4 — — — 4 4 South West 8 1 — — 9 10 Whole District 129 19 4 2 154 187 In the last Annual Report reference was made to the steps taken to promote domiciliary treatment of scarlet fever in suitable cases, also to the difficulties met with in securing such arrangements. In this connection it is interesting to note that 88 per cent, of all cases were admitted to hospital. Diphtheria. Following upon a period of 4 years in which there was a progressive decrease in diphtheria prevalence, the incidence of this disease in 1939 was still further reduced, and was less than half that in the year before. 54 A total of 51 cases were notified, only 14 of which occurred in the district exclusive of Queen Mary's Hospital. The attack rate was accordingly 0.86 per 1,000 for the whole district and 0.23 exclusive of the hospital. These figures compare with 1.78 and 0.57 respectively for the year before and with the rate of 1.14 for England and Wales. All cases were admitted to hospital, and for the second year in succession no death resulted from this infection. The Ward distribution is given in the following tables:— TABLE 19. DIPHTHERIA—WARD INCIDENCE, 1939. (Excluding Queen Mary's Hospital.) Ward. Cases. Rate per 1,000 Population. St. Helier North 6 0.69 St. Helier South 2 0.28 St. Helier West 4 0.47 North East 1 0.11 North West - - Central — — South East 1 0.14 South West — — Whole District 14 0.23 TABLE 20. DIPHTHERIA—MULTIPLE CASES, 1939. Ward. No. of houses in which occurred. Total. Houses. Total. Cases. 1 Case. 2 Cases. 3 Cases. St. Helier North 3 — 1 4 6 St. Helier South 2 — 2 2 St. Helier West 4 — — 4 4 North East 1 — — 1 1 North West — — — — — Central - - — — — South East 1 — — 1 1 South West — — — — — Whole District 11 — 1 12 14 55 TABLE 21. DIPHTHERIA—MONTHLY DISTRIBUTION, 1939. 1939. Ward. Total St. Helier North St. Helier South St. Helier West North East North West Central South East South West January - 2 3 - - - - - 5 February - - - - - - - - - March - - - - - - - - - April - - - - - - 1 - 1 May June — — — — — — — — July 2 - — - — — — 2 August 2 2 September 2 — — — — — — 2 October November — — — 1 — — — — 1 December — — 1 — — — — 1 Totals 6 2 4 1 — — 1 — 14 Monthly Mean 0.50 0.17 0.33 0.08 — — 0.08 — 1.16 Diphtheria " Carriers." With a steadily increasing proportion of the population becoming artificially immunised against diphtheria it is particularly important to distinguish between cases of disease and those in which the presence of the diphtheria bacilli is unaccompanied by symptoms and is of no pathological significance. Immunisation, whilst protecting the individual from invasion of the tissues of the body which results in disease, has no influence on the proneness to harbour the organism. This distinction is all the more necessary in that the local practice of swabbing all domestic contacts of each case investigates precisely those who are likely to be temporary " carriers " of the organism. Experience has shown that the majority of " carriers " detected in this way and presenting no symptoms of illness have been df a very temporary nature. They have given a positive swab on routine contact swabbing, but after removal to hospital for isolation purposes have thereafter given negative reports. Another class of "carrier" which gives rise to more difficulty are those which present the definite clinical features of other disease, mostly streptococcal follicular tonsillitis, but which, when swabbed as a precautionary measure, return a positive result for diphtheria bacilli. 56 Among these are included cases where the initial swab was doubtful. They were given the benefit of the doubt and returned as positive. Repeat swabs in hospital invariably fail to confirm the first report. The third group of carrier are those who, whether presenting symptoms of illness or not, are found to have a positive swab, but in which the organism on investigation by animal inoculation is shown to have no virulence. By -arrangement with the Medical Superintendent of the Isolation Hospital, all persons with positive swabs are carefully investigated and the significance of the swab report assessed as accurately as all the information available allows. Classified in this manner, 10 persons during the year were designated as " carriers." Of these 4 were not ill and included 2 nasal infections; 5 were suffering from tonsillitis, and one, whilst suffering from tonsillitis, carried a non-virulent diphtheria organism. In all except the one with the non-virulent culture the swabs taken in hospital failed to confirm the original positive report before admission. Diphtheria Immunisation. Owing to the pressure of other work, chiefly that of Civil Defence, the usual annual programme of immunisation sessions held in the schools had to be omitted in 1939. Facilities at the special public Immunisation Clinics and the supply of materials to private practitioners were maintained. A total of 157 children had their immunisation treatment completed during the year. They were treated under the following arrangements: PERSONS IMMUNISED AT THE CLINICS—1939. Ward. Age Groups Total 0—5 5—15 15 & over St. Helier North 14 4 - 18 St. Helier South 12 7 19 St. Helier West 8 10 18 North East 13 4 17 North West 9 1 10 Central 6 4 10 South East 35 16 51 South West 6 2 — 8 Totals 103 48 — 151 57 PERSONS IMMUNISED BY PRIVATE PRACTITIONERS—1939. Ward. Age Groups. Total. 0—5 5—15 15 & Over St. Helier North — — — — St. Helier South St. Helier West 1 1 2 North East — — — North West 1 — 1 Central — — — South East 1 1 2 South West 1 — 1 Totals 4 2 — 6 The Immunising material used was Toxoid-Antitoxin Flocules (B.W. <£ Co.) normally in 3 doses of 1 cc, 1 cc and 1.5 cc at fortnightly intervals. Table 22 shows the comparative incidence among the immunised and un-immunised persons in the district. Although the risk of contracting diphtheria is very considerably reduced by immunisation, of much greater importance is the fact that fatality resulting from this infection is eliminated. Measles. From October 23rd, 1939, measles became a notifiable disease under the Measles and Whooping Cough Regulations. Prior to this date the chief source of information as to measles incidence were the reports from the Head Teachers of the Schools of the Education Authority. Measles in Carshalton, in common with the London district, has in the past shown a biennial periodicity, epidemic prevalence alternating with years when the infection is almost absent. 1939 was not a "measles" year, and only three cases came to our notice, one notified under the Regulations and 2 by the school reports, as compared with 540 reported among the school children in the year before. 58 Table 22. DIPHTHERIA IN UNIMMUNISED AND IMMUNISED CHILDREN 0—15 YEARS, 1935—1939. (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 Un-immunised 11,940 51 4.2 1 0.08 Immunised 861 0 0 0 0 1936 Un-immunised 12,788 38 2.9 4 0.31 Immunised 1,519 2 1.3 o 0 1937 Un-immunised 12,363 40 3.2 4 0.32 Immunised 2,202 1 0.4 0 0 1938 Un-immunised 12,321 24 1.9 0 0 Immunised 2,739 0 0 0 0 1939 Un-immunised 12,220 14 1.1 0 0 Immunised 2,934 0 0 0 0 1935 to 1939 (Average) Un-immunised 12,236 33.4 2.70 1.8 0.14 Immunised 2,051 0.6 0.29 0 0 59 Whooping Cough. This disease also became notifiable in October. Only one case was notified in the last two months, while 120 throughout the whole year were reported by the Head Teachers among school children. Ophthalmia Neonatorum. Six cases were notified, 2 of which were severe. Two received inpatient treatment in special hospitals under the Council's Scheme. One other attended hospital out-patients. All recovered without impairment of vision. Cases. Vision Unimpaired. Vision Inpaired Total Blindness. Death Death. Notified. Treated. In Hospital At Home. 6 2 4 6 — — — 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. Food poisoning is a notifiable condition, but more frequently instances come to our notice as the result of complaints lodged by the family affected as to the wholesomeness of some particular food believed to be the cause of the illness. Two such instances were reported which may have been the result of "food poisoning" organisms or their toxins. An adult complained that a meat pie of which she had eaten had given rise to sickness and diarrhoea. Remains of the pie were examined at the Ministry of Health's Laboratory, but this revealed only the presence of organisms indicative of staleness and not of the "food poisoning" group. The patient recovered after a brief illness. 60 In the second case, three members of a family developed acute gastro-intestinal symptoms two or three hours after a meal at which tinned salmon was eaten. There were no remains which could be examined, and the examination of the contents of other tins from the same consignment gave negative results. The symptoms were consistent with the ingestion of pre-formed toxins. All patients recovered in the course of seven days or so. Puerperal Pyrexia. Five cases were notified, details of which are as follows:— Day of Admitted Para. onset. Clinical Notes. to Hospital. Result. 3 5th Forceps delivery—mild local infection with diphtheroids and strep - viridans Yes Recovered 3 3rd Miscarriage — infection with haem: streps. Yes. ,, 1 3rd Forceps—uterine infection with haem: strep : and cystitis (enterococcus). Yes. ,, 1 ? Miscarriage. Yes ,, 1 17 th Mastitis No ,, Erysipelas. Nine notifications were received. In seven of the cases the face was affected, in one the arm and the leg in the other. Five of the patients were removed to hospital. All recovered. Pneumonia. The prevalence of acute respiratory infections was on much the same scale as in the year before. Ninety-six cases of pneumonia were notified, of which 14 were stated to be of influenzal origin. The peak period was, as usual, in the winter, the highest monthly figures beingrecorded in January. Polio=myelitis. Two cases of " Infantile Paralysis " were notified. One, a child of 5 years", developed a mild attack with local paralysis limited to the right arm. It received hospital out-patient treatment and recovered the use of the limb. The other case, a child of 10 years, received prolonged treatment in isolation and special hospitals for paresis of the back muscles. She was discharged eventually with no material disability. 61 TABLE 23.—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 187 3.10 — 42 34 51 18 18 10 4 10 164 88% Diphtheria 14 0.23 — 6 2 4 1 — — 1 — 14 100% Enteric - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - Puerperal Pyrexia 5 0.08 — — — — 1 — — 1 3 4 80% Erysipelas 9 0.15 — 2 1 1 2 — 1 2 —• 5 56% Pneumonia 82 1.35 — 25 8 10 10 8 7 6 8 9 11% Influenzal Pneumonia 14 0.23 — 3 3 — — 2 3 1 2 — - Polio-myelitis 2 0.03 1 — 1 — 1 — — — — 1 50% Relapsing Fever - - - - - - - - - - - - - Typhus Fever - - - - - - - - - - - - - Dysentry 13 0.21 — 4 4 1 —• 1 — — 3 1 8% Encephalitis Lethargica — — — — — — — — — — — — — Ophth. Neonatorum 6 0.10 —. 1 1 1 1 — 1 — 1 3 50% Plague - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - Measles* 1 0.01 - - 1 - - - - - - - - Whooping Cough* 1 0.01 — 1 - - - - - - - - - * Compulsorily notifiable only from October 23rd, 1939. 62 TABLE 24. INFECTIOUS DISEASES—Notifications by Age Groups, 1939. (Excluding Queen Mary's Hospital.) Diseases. Total Cases Notified. Total Cases at all Ages Under 1 year 1—2 2—3 3—4 4—5 5—10 10-15 15—20 20—35 35—45 45—65 65 and over Scarlet Fever 4 11 20 24 89 22 2 12 2 1 — 187 Diphtheria — 1 — — 1 7 3 — — 2 — — 14 Puerperal Pyrexia - - - - - - - - - 4 1 - — 5 Erysipelas - - - - - - - - 1 1 4 3 9 Pneumonia 12 7 - 3 1 18 3 5 16 6 7 4 82 Influenza Pneumonia 1 1 1 5 2 — 4 14 Polio-myelitis — — — * — 1 — 1 — — — — 2 Dysentry — — — 1 — 4 4 — 1 1 2 — 13 Ophthalmia Neonatorum 5 - - - - - - - - - - - 5 Measles - - - - - - - - - - - - 1 Whooping Cough 1 - - - - - - - - - - - 1 63 TABLE 25. MONTHLY INCIDENCE OF INFECTIOUS DISEASE, 1939. (Excluding Queen Mary's Hospital.) Disease. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 19 11 22 12 15 18 19 17 11 17 17 9 187 Diphtheria 5 — — 1 — — 2 2 2 - 1 1 14 Puerperal Pyrexia — — — 2 — - - - 2 - 1 - 5 Erysipelas 2 —. — 3 2 1 - 1 - - - - 9 Pneumonia 23 19 7 10 6 5 2 3 1 3 3 82 Influenzal Pneumonia — 6 7 1 - - - - - - - 14 Polio-myelitis — — — — 1 1 - - 2 Dysentry 1 4 — — 3 4 1 13 Ophthalmia Neonatorum 1 — — - 1 1 - 1 1 - 1 - 6 Measles — — - - - - - - - - - 1 1 Whooping Cough — — — — — - - 1 1 Tuberculosis Pulmonary 8 6 8 4 5 6 3 4 3 3 8 1 59 Tuberculosis Non-pulmonary 3 4 4 1 3 3 2 2 — 1 2 1 26 64 TUBERCULOSIS. The new cases admitted to the tuberculosis register during the year numbered 132, classified as follows:— Males— Females— Pulmonary 57 Pulmonary 36 Non-pulmonary 19 Non-pulmonary 20 Of the total additions 85 were primary notifications, 38 were transferred from other districts and 9 came to notice in other ways. For the same period 153 names were removed from the register for the following reasons:— Recovered 30 Deaths 49 Withdrawn notifications 1 Otherwise (including removals) 73 After allowing for the additions and deductions, the state of the register at the 31st December, 1939, was as shown in the following table:- TABLE 26. TUBERCULOSIS REGISTER at DECEMBER 31st, 1939. Pulmonary. Non-pulmonary. All Forms. Males 212 71 283 Females 167 52 219 Totals 379 123 502 The total of 502 is 21 less than at the corresponding date 12 months earlier. They were distributed by Wards as follows:— TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1939. Ward. Pulmonary. Non-Pulmonary. Total. Males. Females Males Females St. Helier North 45 43 18 9 115 St. Helier South 43 32 7 11 93 St. Helier West 42 30 14 12 98 North East 24 13 10 5 52 North West 16 21 10 6 53 Central 9 6 6 3 24 South East 20 10 5 6 41 South West 13 12 1 — 26 Totals 212 167 71 52 502 379 123 65 The additions were 10 more than in 1938, and, with continuation of war conditions, it is probable that the incidence of tuberculosis will continue to increase. The cases which received institutional treatment under the County Council Scheme numbered 103, 9 fewer than in the year before. They were admitted to:— Milford County Sanatorium 24 Other Institutions 79 103 The number of persons who died from tuberculosis during the year was 49, compared with 39 in the previous year. They were distributed as to age and sex as follows:— TABLE 27. DEATHS DUE TO TUBERCULOSIS, 1939. Age Years. Pulmonary. Non-pulmonary. Totals. Male. Female. Male. Female. 0 1 2 3 1 — - 5 — — 1 - 1 15 2 8 1 - 11 25 4 11 — 1 16 35 6 4 — — 10 45 4 2 — —• 6 55 2 — — —. 2 65 — — — — — Totals 19 25 2 3 49 Two unnotified tuberculosis deaths occurred, representing 4.1 per cent, of the total deaths. Thii"ty-nine specimens of sputum were examined for tubercle bacilli under the Council's scheme, 5 of which gave positive results. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, nor under Section 172 of the Public Health Act, 1936. 66 67 TABLE 28.—TUBERCULOSIS—NEW CASES, Age and Sex Distribution, and Manner of Admission to Register, 1939. Age Group Years. Primary Notifications "A" Cases tranferred from other Districts. Cases brought to notice other 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 _ 1 1 _ _ _ _ _ _ _ 2 5 1— 5 — 1 2 2 - - - - - - - - 5 5—10 1 2 5 3 3 - 1 2 - - 1 - 18 10—15 2 2 2 5 - - 1 - - - - - 12 15—20 4 2 1 2 1 - 2 - - - - - 12 20—25 4 4 1 1 1 4 - - - - 1 - 16 25—35 9 3 - 1 8 6 2 1 1 2 - - 33 35-45 7 6 - 1 4 - 2 - - - - 1 21 45—55 3 3 _ - - - - - - - - - 6 55—65 2 - - - - - - - 1 - - - 3 65 up 1 - - - - - - — — - - — 1 Totals 34 23 12 16 17 10 8 3 2 2 2 3 132 85 38 9 TABLE OF METEOROLOGICAL OBSERVATIONS, CARSHALTON, 1939. LATITUDE 51.22 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 29.53 42.9 46.2 36.4 41.3 55— 8th 24— 5th 4.72 20 19.50 25 February 29.95 41.9 50.1 36.1 43.1 60—11th 26— 2nd 1.59 10 76.40 11 March 29.93 42.3 48.9 37.0 42.9 57— 5th 30—10th 1.21 12 72.90 15 April 29.86 48.6 56.3 38.8 47.5 70—20th 30— 7 th 2.53 15 175.10 6 May 29.97 52.7 62.4 43.9 53.1 75—24th 36— 3rd 1.90 6 184.60 6 Tune 29.96 58.8 67.7 49.0 58.3 85— 6th 40—12th 1.29 10 210.20 4 July 29.89 61.5 68.8 52.9 60.8 79— 3rd 45— 2nd 2.28 15 169.76 4 August 29.87 61.1 70.8 54.4 62.6 80—21st 46—12th 3.12 11 166.13 4 September 30.04 60.1 67.2 50.3 58.7 79— 8th 37—29th 1.85 8 117.81 5 October 29.81 48.3 54.9 41.1 48.0 65— 5th 31—25th 5.84 18 70.08 12 November 29.78 47.4 54.1 40.6 47.3 60— 7th 29— 4th 4.00 18 30.58 18 December 29.90 37.8 41.3 31.3 36.3 55— 1st 18—29th 1.47 10 16.80 23 Totals 29.87 50.3 57.4 42.6 50.0 85 18 31.80 153 1309.86 133 G8