CAR 9 Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR ft 1944 Printed by the "Croydon Times," Ltd., 104, High Street, Croydon. CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1944 1 PREFACE To the Chairman and Members of the Car.shai.ton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1944. The ban on the publication of information likely to be of use to the enemy having been removed, this is the first full Report since 1939, and it is helpful to note how the health of the district has fared through more than five years of total war. Perhaps the most outstanding feature is the fact that despite the numerous adverse circumstances which a conflict of this magnitude produces the general well-being was maintained at a level far above that which could have been anticipated. That after so long a sustained effort there should be evidence of general mental and physical strain is inevitable, but there is, so far, no instance of a definite breakdown in communal health in any direction. Whether this war will yet produce its aftermath similar to the 1918-19 pandemic of severe influenza remains to be seen. Unfortunately, we cannot look forward to such an early easing of our many burdens as after the last war, and we still have a difficult time ahead. Examining the vital statistics individually, we find that the birth rate has risen from 13.2 per 1,000 population in 1939 to 17.0 in 1944, though not before it dipped to the lowest on record of 12.2 in 1940. The recovery to 17.0 only equals the rate for 1930 and is still below the average for the decade 1920-30. Although the death rate has risen slightly, it is still a favourable index compared with the national figure and the rate of natural increase, as represented by the difference between the birth and death rates, is higher than pre-war. The trend of infant mortality continues satisfactorily, the rate during the last three years being under 40 per 1,000 births and 1942 producing the lowest recorded in Carshalton. Much the same can be said of maternal mortality, there being an average of 2 such deaths per year over the last five years. One noteworthy change in this connection is the greatly increased demand for institutional confinements. Whereas before the war approximately one-third of the births occurred in hospitals and nursing homes and two-thirds in private houses, the position is now reversed. Of the causes of death, cancer claimed an increased number of victims, and the death rate from this disease has reached the highest level yet recorded. The variations in the death rates from other causes are without significance. 3 The prevalence of infectious diseases among the resident population throughout the war years was not unfavourable. Diphtheria incidence was generally lower, the number of cases ranging between 45 in 1940 and 7 in each of the last two years, with a total of 7 deaths in non-immunised persons. Scarlet fever of a mild type, which caused no deaths, was fairly prevalent throughout the period, with a peak in 1943, but showing a substantial fall in 1944, when there was only one-third the number of cases in the year before. The longestablished biennial periodicity of epidemic measles was changed probably as the result of child population movements on a considerable scale, an outbreak of the usual epidemic proportions occurring in each of the years 1940-1-2-3. The year 1944 was virtually free from measles, and it would appear that the rhythm of this infection is reverting to its two-yearly character. Whooping cough, though never characterised by such extensive outbreaks, had a higher degree of fatality, causing 5 such deaths in the 5 years 1940-44, against 4 from measles, although the number of cases was only one-third of those due to measles. Cases of enteric fever were few, true typhoid being entirely absent in each war year except in 1943, when there were 2 illdefined cases. There is little doubt that a mild form of dysentry, due to the Sonne organism and giving rise to indisposition for a few days only, is fairly common and that a good deal of this infection escapes detection in the guise of "diarrhoea," "dietetic errors," etc. The increased risk of tuberculosis arising from war-time conditions has been brought to public attention. The number of tuberculous persons in this district has risen steadily between the end of 1939 and 1944 from approximately 8 to 12 per 1,000 of the population. One compensatory feature, however, is the fact that the death rate from this disease is materially unchanged from pre-war years. As the result of improved methods of detection, notably mass radiography, it is probable that in future a substantially higher proportion of cases will come to notice with the disease in its earlier stages when the prospects of cure are greatly increased. The provision of badly needed additional hospital accommodation in this part of the County was seriously delayed by the outbreak of war, work on the new St. Helier County Hospital coming almost to a standstill in September, 1939. Having withstood considerable damage from enemy bombing, progress is again being made, and although not yet in full commission, it is playing a major part in the local hospital services. Despite many handicaps, your Maternity and Child Welfare scheme strove hard to maintain that high standard of service which it had achieved in the years before the war and, judging by the relevant vital statistics, in large measure succeeded. Except for the suspension of the special toddler clinics during the second half of 1944, when many of the children were evacuated, the scope of the scheme was not reduced, nor was the programme of clinic sessions except sliehtly at two of the five centres for 4 months of last year. Among the many tasks of reconstruction which now face us, the provision of adequately designed and equipped welfare centres to conform to better standards of service ranks high on the list of priorities. 4 Sanitary administration was beset by many difficulties. Conditions necessitated by the war had to be borne which would not have been tolerated in other times, and when remedies were feasible the absence of labour and materials frequently precluded action being taken. The record of achievement on the part of your sanitary staff, under the experienced guidance of your Chief Sanitary Inspector, as indicated in the pages which follow, shows that every opportunity which was possible in the circumstances was taken to promote local hygienic conditions. Housing work caused us the greatest sense of frustration. The relief of ever-growing overcrowding was virtually an impossibility, whilst remedial measures to premises had to be limited to the most urgent and pressing essentials. No one can deny that housing is now our first priority, but it is as well to remember that houses have a long life, often unfortunately longer than is warranted, and what we provide now will be with us for many years to come. Shall we, in our present justifiable impatience, create slum dwelling for 1960, or shall we take care to limit our emergency programme of temporary houses to those we are able to replace within their useful life? Carshalton has, to all intents and purposes, reached its maximum stage of desirable development, and our present overcrowding can only be satisisfactorily solved by one or other of two events—either a natural decrease in the population or the transfer of population outside the district. Discarding the first policy of " wait and see," we are left with the second as the only possible solution. The distribution and control of food was, for very necessary reasons, taken over by the Ministry of Food. Supplementary to the existing statutory provisions of the Food & Drugs Act, administered by local authorities under the aegis of the Ministry of Health, the newly created Ministry of Food has, since its establishment, issued a series of Orders under the Defence Regulations for the protection of the public health and of the public from fraud. Although they owe their origin to the increased temptation to exploit war-time food scarcity, those measures which prescribe standards for everyday commodities would greatly facilitate the supervisory functions of the Council in the post-war period, and it is to be hoped that, except where they serve an exclusive war-time purpose, they will be continued when the Defence Regulations lapse. This brief review would not be complete without some reference to Civil Defence. When hostilities threatened, the central authority was faced with the necessity for some scheme for dealing with the results of that bombing of the civilian population which could with certainty be anticipated. In local government they found an experienced organisation already in being which offered a ready solution of the problem. How well the local municipal authorities shouldered this great additional responsibility, how efficiently they mustered local resources in the service of their own populations and in the help of their neighoburs through six long, anxious years has brought fitting tribute from those best able to judge. Carshalton, like other London districts, has its scars. Many of its residents suffered injury and 76 5 lost their lives on the home front. Your officers who had the responsibility of administering your Civil Defence scheme are proud to have had the opportunity of voluntarily serving the community in this capacity in the dark days through which we have passed and to have had the honour of leading in the field such a capable body of men and women who, when the call came, gave of their best regardless of their own safety and to the limit of their endurance. I am, Your obedient servant, F. LAWRENCE SMITH, August, 1941 Mcdical Officer oj Health. 6 PUBLIC HEALTH STAFF. Medical Offier 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.) Sanitary Inspectors. *L. G. Lydiatt, C.R.S.I. *S. E. Maton, C.R.S.I. (With H.M. Forces.) *J. East, C.R.S.I. (temporary) A. W. Kent (temporary), resigned 21.5.44. V. A. Vickers, M.R.S.I, (temporary) from 18.9.44. Senior Health Visitor. Miss E. S. Picard, resigned 31.10.44. Health Visitors. Miss N. Hills, resigned 21.10.44. Miss A. A. Askew. Miss R. M. Nash. Miss M. J. Thomas. Chief Clerk. B. Lamacraft (with H.M. Forces). A. E. Wills (temporary) resigned 28.10.44. Miss V. Hotten (acting) from 28.10.44. Part Time Officers. Medical Officers to Maternity and Child Welfare Centres. Ruth C. Townshend, M.B., B.S., D.P.H. Olive G. Potter, M.B., B.S., L.R.C.P., M.R.C.S. Alice C. Caiger, M.B., Ch.B. Consulting Obstretrician. W. H. Passmore, M.R.C.S., L.R.C.P. Dentists to the Maternity and Child Welfare Scheme. W. B. Shields, L.D.S., R.C.S. (with H.M. Forces). H. C. Scott, L.D.S., R.F.P.S. (Glas.). Anaesthetist to Maternity and Child Welfare Scheme. W. O. Whitttaker, M.R.C.S., L.R.C.P. *Meat and Food Certificate of the Royal Sanitary Institute. 7 Section A—Natural and Social Conditions of the District. Area (in acres) 3,346 Number of inhabited houses (end of 1944) according to Rate Books 15,977 Rateable Value at 31st December, 1944 £484,003 Sum represented by 1d. rate £1,990 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. As mentioned in previous reports, the flow of these springs has been increasingly irregular in recent years as the result of the withdrawal of more and more of the underground water supplies of the Thames Basin. As in other war years, there was no new housing development and accommodation shortage increased still further. Carshalton is largely a dormitory area for the metropolis, there being little local industry of any magnitude. The northern and central parts are highly urbanised, while the southern portion has a lesser housing density. A large proportion of the properties are of the working-class type and the average rateable value of premises, either whole dwellings or including dwellings, is £24 10s. Od. 8 UNEMPLOYMENT. War-time demand for labour was constantly in excess of the supply and the officially recorded extent of unemployment was of negligible proportions and of no significance as an index of the balance between supply and demand. The number of individuals living in Carshalton registered as unemployed by the Sutton Exchange at the end of the year was as follows:— Men 12 Women 11 Boys 15 Girls 33 71 PUBLIC ASSISTANCE. The following information as to public assistance afforded in the district is supplied by the Chief Public Assistance Officer of the Surrey County Council:— Medical Relief: Total number of persons in Carshalton admitted to Public Assistance Institutions or Homes during 12 months ended 31st December, 1944 85 Total number of persons from Carshalton admitted to Mental Hospitals during 12 months ended 31st December, 1944 41 Other Relief: Number of persons in receipt of domiciliary assistance on:— Men. Women. Children. Total. 1st January 95 130 186 411 1st July 90 147 179 416 31st December 80 130 126 336 Total amount of domiciliary relief paid to persons resident in Carshalton during 1944 £12,553 SUMMARY OF VITAL STATISTICS FOR 1944. (Based on the Registrar-General's Figures). Population. Registrar-General's Estimate 52,300 Births. Males. Females. Total. Live (Legitimate) 451 399 850 (Illegitimate) 21 20 41 472 419 891 Birth Rate 17.0 Still-births (Legitimate) 8 5 13 (Illegitimate) 1 1 2 9 6 15 Still-birth Rate per 1,000 total births 16.5 9 Deaths. Death Rate (crude) 9.5 Infant Mortality. Males. Females. Total. All deaths under 1 year 21 14 35 Infant Mortality Rate (per 1,000 live births) 39.2 Deaths of leg. infts. under 1 year 20 13 33 Rate per lr000 legitimate births 38.8 Deaths of illeg. infts. under 1 year 1 1 2 Rate per 1,000 illegitimate births 48.7 Maternal Mortality. Deaths from Sepsis 0 Rate per 1,000 births 0 Deaths from other causes 1 Rate per 1,000 total births 1.1 Maternal Death Rate 1.1 Zymotic Deaths. 7 Principal Zymotic Diseases 6 Deaths from Measles 0 Deaths from Whooping Cough 1 Deaths from Diarrhœa (under 2 years) 4 Zymotic Death Rate 0.11 Deaths from Tuberculosis. All Forms 33 Rate per 1,000 of population 0.63 Phthisis 27 Rate per 1,000 of population 0.51 Deaths from Cancer. 84 Rate per 1,000 of population 1.60 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 RegistrarGeneral's totals. POPULATION. The population of the district fluctuated during the war years with the varying progress of the conflict and the degree of air attack to which the district was subjected. At mid-year 1944 the estimated population computed from local information was 55,630. As the result of the flying bomb offensive, considerable evacuation, 10 chiefly of mothers and children, both Government sponsored and voluntary, took place in the latter half of the year, and by December 31st the estimated population had fallen to 52,300. The distribution of the population at mid-year was as follows: — TABLE 1 ESTIMATED RESIDENT POPULATION, MID-1944, BY WARDS. Ward. Houses at Mid-1944. Estimated Population Mid-1944. St. Ilelier North 2,020 7.930 St. Ilelier South 1,684 6,330 St. Ilelier West 1,914 7,510 North-East 2,489 8,200 North-West 2,134 6,(510 Central 1.734 5,440 South-East 2.099 6,560 (Queen Mary's Hospital) 1,100 South-West 2,006 5,950 Whole District 16,080 55,630 BIRTHS. The number of live births registered was 891, of which 472 were males and 419 females. The birth rate of 17.0 per 1,000 population compares with 13.9 in the year before and is the highest since 1930. Still births totalled 15 and the rate per 1,000 total births of 16.5 is the lowest recorded. Birth rates for the individual wards based on the notifications under the Public Health Act, supplemented by the weekly returns of the local Registrar, are given in the following table. The very high rate for the north-east ward is noteworthy. This part of the district has consistently for several years past had the highest birth rate. Ward. Live Births. Birth Rate per 1,000 Population. Still Births. Still Birth Rate per 1,000 total births. St. Ilelier North 124 15.6 3 23.6 St. Helier South 99 15.6 3 29.4 St. Helier West 121 16.1 4 32.0 North-East 199 24.2 2 9.9 North-West 119 18.0 3 '24.6 Central ... 87 16.0 2 22.4 South-East (excluding Queen Mary's Hosd.) 100 15.2 1 9.9 South-West 78 13.1 1 12.6 11 The increasing use made of institutional accommodation for confinement is shown by the percentage of births which occurred in hospitals and nursing homes and which in 1944 rose to 60 per cent. The percentages for the various wards were as follows:— St. Helier North 59 St. Helier South 64 St. Helier West 65 North-East 58 North-West 59 Central 66 South-East 52 South-West 65 Out of a total of 946 births, 573 occurred in the following institutions:— Live. Still. Total. Carshalton, Beddington and Wellington District (War Memorial Hospital 71 1 72 St. Helier County Hospital 275 8 283 Other Surrey County Hospitals 81 2 83 Other Hospitals 57 1 58 Private Nursing Homes 75 2 77 Totals 559 14 573 TABLE 2. BIRTHS, 1944, DOMICILIARY AND OTHERS — BY WARDS. Ward. Born in District. Born Outside District. Total. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. St. Helier North 46(1) 50(1) 96(2) 29(1) 2 31(1) 127(3) St. Helier South 48(1) 34 82(1) 17(1) 3(1) 20(2) 102(3) St. Helier West 52(1) 42(1) 94(2) 29(1) 2(1) 31(2) 125(4) North-East 84(2) 79 163(2) 34 4 38 201(2) North-West 50(1) 47(1) 97(2) 23(1) 2 25(1) 122(3) Central 41(1) 30(1) 71(2) 18 — 18 89(2) South-East 24(1) 45 69(1) 29 3 32 101(1) South-West 28 25 53 24(1) 2 26(1) 79(1) Totals 373(8) 352(4) 725(12) 203(5) 18(2) 221(7) 946(19) (Figures in brackets indicate still-births included in totals.) 12 TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON. 1922—1944. Year. Population (Registrar; General'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 1920 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 05 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 1930 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 1940 58,340 13.3 8.7 43.8 5.1 1941 56,840 12.2 8.4 40.5 1.4 1942 57,120 14.0 7.5 27.5 2.4 1943 56,600 13.9 8.2 39 4.9 1944 52,300 17.0 9.5 39 1.1 13 TABLE 4. COMPARATIVE STATISTICS—1944. 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 Civilian Population. Births— Live 17.6‡ 20.3 20.9 15.0 17.0 Still 0.5‡ 0.64 0.61 0.42 0.28 Deaths— All causes 11.6‡ 13.7 12.4 15.7 9.5 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough ... 0.03 0.03 0.02 0.04 0.01 Diphtheria ... 0.02 0.03 0.03 0.01 0.01 Influenza 0.12 0.10 0.11 0.08 0.03 Smallpox 0.00 — — — — Measles 0.01 0.01 0.01 0.00 — Rates per 1,000 Live Births. Deaths under 1 year of age 46 † 52 44 61 39 Deaths from Diarrhoea and Enteritis under 2 years of age 4.8 7.3 4.4 10.1 4.3 Rates per 1,000 Civilian Population. Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.00 0.01 0.01 0.01 Cerebro Spinal Fever 0.05 0.06 0.04 0.06 0.03 Scarlet Fever 2.40 2.41 2.67 1.57 3.04 Whooping Cough 2.49 2.49 2.29 2.90 3.90 Diphtheria 0.58 0.67 0.69 0.31 0.51 Erysipelas 0.29 0.32 0.28 0.37 0.21 Smallpox 0.00 0.00 0.00 0.00 — Measles 4.16 4.51 3.94 2.98 0.51 Pneumonia 0.97 1.13 0.82 0.93 0.57 Rates per 1,000 Total Births (Live and Still). Puerperal Fever 10.34 13.13 9.25 3.61 50.77 Puerperal Pyrexia 14.14 Maternal Mortality— Abortion with Sepsis 0.31 not available 1 — Abortion without Sepsis 0.09 — Puerperal Infections 0.28 — Other Puerperal causes 1.25 1 1.10 *A dash (—) signifies that there were no deaths. †Per 1,000 related births. ‡Rates per 1,000 Total Population. 14 DEATHS. The number of deaths registered was 499, of which 248 were males and 251 females. This total, including civilian deaths due to enemy action, gives a death rate of 9.5 per 1,000 population. The distribution between the wards was as follows:— WARD DEATH RATES AND MEAN AGE AT DEATH, 1944. Deaths. Death Rate (crude). Mean Age at death. St. Helier North 51 6.4 47.1 yrs. St. Helier South 37 5.8 49.2 „ St. Helier West 52 6.9 47.5 „ North-East 61 7.4 54.9 „ North-West 86 13.0 59.3 „ Central 81 14.9 65.6 „ South-East (excluding Queen Mary's Hospital) 76 11.5 60.8 „ South-West 56 9.4 63.6 „ Whole District 500 9.5 57.3 yrs. The mortality from cancer is the highest yet recorded. Mainly it is the result of the increasing average age of survival, since it is a disease of middle and advanced life, and until progress in the treatment of this condition shows a marked advance, it is likely that cancer will continue to account for an increasing proportion of the total deaths. The death rates from cancer from 1929 were as follows:— 1929 1.1 1937 0.8 1930 1.3 1938 1.05 1931 1.1 1939 1.15 1932 1.08 1940 1.11 1933 1.1 1941 1.49 1934 1.2 1942 1.28 1935 0.8 1943 1.59 1936 0.96 1944 1.60 The years 1935-1937 to a considerable extent reflect the rapid lowering the average age of the total population by the completion of the St. Helier Estate. The rising trend since the low figure of 1935 has no doubt been accelerated in the last four years by evacuation from the district which resulted in a decrease in the number of mothers and children. 16 CANCER DEATHS—WARD DISTRIBUTION, 1944. Ward. Cancer Deaths. Rate per 1,000 Estimated Population. St. Helier North 10 1.26 St. Helier South 6 0.94 St. Helier West 8 1.06 North-East 6 0.73 North-West 15 2.26 Central 11 2.02 South-East 13 1.98 South-West 13 2.19 The classification of cancer deaths by sites affected is given in Table 5. TABLE 5. Group. Site Affected. Male. Female. Total. 45 Buccal Cavity 3 1 4 46 Digestive Organs— Oesophagus — — — Stomach 7 8 15 Liver and Gall Bladder — — — Intestines 10 9 19 Rectum and Anus 4 3 7 Pancreas 1 1 2 47 Respiratory Organs— Larynx and Trachea — 1 1 Lungs and Bronchi 8 — 8 48 Uterus — 4 4 49 Other female genital organs — 2 2 50 Breast 1 7 8 51 Male genital organs — — — 52 Urinary organs 4 2 6 53 Skin — 1 1 54 Brain 1 — 1 55 Other organs— Leg 1 — 1 Arm 1 — 1 Abdomen — 1 1 Maxillary Antrum — 1 1 41 41 82 Average age at death— Males 62.0 years. Females 62.0 „ All persons 62.0 „ Tuberculosis was responsible for fewer deaths than in the year before—33 as against 46. 16 Enemy bombing resulted in the loss of 32 lives during 1944, whilst road accidents accounted for 2 only, which is the lowest for many years. Inquests. Inquests were held on 42 persons whose deaths occurred in the district and the following verdicts were returned:— Natural causes 6 Suicide 5 Accidental 25 Misadventure 5 Open verdict 1 Eleven of the total were residents of the district. Four deaths were due to road accidents. INFANT MORTALITY. The deaths of 35 infants under 1 year were registered, 21 of which were males and 14 females. The infant mortality rate of 39 compares with 46 for the country as a whole and is the same as in the year before. Two of the deaths were of illegitimate children. Fifty per cent. occurred within one month of birth. Developmental and wasting diseases, as opposed to other cases which are mainly infectious, were responsible for 15 of the total infant deaths. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward. Infant Deaths. Rate per 1,000 Live Births. St. Helier North 6 48 St. Helier South 3 30 St. Helier West 5 41 North-East 6 30 North-West 11 91 Central — —- South-East 3 30 South-West 1 13 MATERNAL MORTALITY One death only was due to diseases of pregnancy, childbirth and the puerperal state, the certified cause of death being "Rupture of a tubal pregnancy." 17 18 TABLE 7. INFANT MORTALITY DURING THE YEAR 1944. 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 — — — — — — 1 — — 1 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — 1 — 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions — — — — — — — — — — Laryngitis — — — — — — — — — — Bronchitis — — — — — — — — — — Pneumonia (all forms) — — — — — 3 1 1 — 5 Diarrhoea — — — — — 2 — — — 2 Enteritis — — — — — 1 — — 1 2 Gastritis — — — — — — — — — — Syphilis — — — — — — 1 — — 1 Rickets — — — — — — — — — — Suffocation (overlying) — — — — — — — — — — Injury at Birth 3 1 — 1 5 — — — — 5 Atelectasis — — 1 1 2 — — — — 2 Congenital Malformation 3 — 1 — 4 — — — — 4 Premature Birth 4 — — — 4 — — — — 4 Atrophy, Debility and Marasmus — — — — — — — — — — Other Causes 1 1 1 — 3 2 3 — — 8 Totals 11 2 3 2 18 8 6 2 1 35 19 TABLE 8. CAUSES OF DEATH DURING THE YEAR 1944. BY AGE 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 21 14 1 3 6 4 7 15 3 16 26 11 22 22 47 28 53 57 61 83 247 253 500 1 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — 3 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping Cough 1 — — — — — — — — — — — — — — — — — — — 1 — 1 5 Diphtheria — — — — — — — — — — — — — — — 1 — — — — — 1 1 6 Tuberculosis of Respiratory System — — — — — — — 5 2 2 6 2 3 1 6 — — — — — 17 10 27 7 Other Forms of Tuberculosis — 1 — — — — 1 1 — 1 1 — — — — 1 — — — — 2 4 6 8 Syphilitic Diseases — 1 — — — — — — — — — — — — 1 1 — — — 1 1 3 4 9 Influenza 1 — — — — — — — — — — — — — — — — — 1 — — — 2 10 Measles — — — — — — — — — — — — — — — — — — — — — — — 11 Ac. Polio Myelitis and Polio Encephalitis — — — — — 1 — — — — — — — — — — — — — — — 1 1 12 Ac. Infantile Encephalitis — — — — — — — — — — — — — — — — — — — — — — — 13 Cancer of Buc. Cav and Oesophagus(M) Uterus(F) — — — — — — — — — 2 — — — — — 1 1 1 2 3 4 7 14 Cancer of Stomach and Duodenum — — — — — — — — — — — 1 1 1 1 1 3 3 2 2 7 8 15 15 Cancer of Breast — — — — — — — — — — — — — 1 1 1 — 3 — 2 1 7 8 16 Cancer of all Other Sites — — — — 1 — — 1 1 1 3 2 4 2 10 4 6 9 5 3 30 22 52 17 Diabetes — — — — — — — — — — — — — — — — — — — 1 — 1 1 18 Intra-cranial Vascular Lesions — — — — — — — — — — — — — 1 3 2 8 7 11 12 22 22 44 20 TABLE 8—Continued. CAUSES OF DEATH DURING THE YEAR 1944. BY AGE 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 21 14 1 3 6 4 7 15 3 16 26 11 22 22 47 28 53 57 61 83 247 253 500 19 Heart Disease — — — — — — 1 3 — — 2 2 3 4 8 7 17 22 27 36 58 74 132 20 Other Diseases of Circulatory System — — — — — — — — — — — — 1 2 2 3 2 2 3 2 8 9 17 21 Bronchitis — — — 1 — — — — — — 2 — 3 1 2 — 3 3 2 8 12 13 25 22 Pneumonia 1 3 — 1 1 1 1 — — 2 — — — 1 — 1 2 — 1 2 6 11 17 23 Other Respiratory Diseases 1 1 — 1 3 1 1 1 — — 2 4 7 11 24 Ulcer of Stomach or Duodenum — — — — — — — — — — 2 — 1 — 3 — — — — — 6 6 25 Diarrhoea, under 2 years 4 1 — — — — — — — — — — — — — — — — — 4 1 5 26 Appendicitis — — 1 — — — — 1 — — 1 — — — 1 — — — — 1 3 2 5 27 Other Digestive Diseases — 1 — — 1 — — — — 1 1 — — 2 2 — 1 2 1 1 6 7 13 28 Nephritis — — — — — — — — — — 1 — 1 — 1 — 1 1 — 1 4 2 (i 29 Puerperal and Post Abort. Sepsis — — — — — — — — — — — — — — — — — — — — — — — 30 Other Maternal Causes — — — — — — — — — — — 1 — — — — — — — — — 1 1 31 Premature Birth 2 2 — — — — — — — — — — — — — — — — — — 2 2 4 32 Congenital Malformation, Birth Injury. Infant Diseases 12 4 — — 1 — — — — — — — — — — — — — — — 13 4 17 33 Suicide — — — — — — — — — — — 1 — — 1 — — — 1 — 2 1 3 34 Road Traffic Accidents — — — — — — — — — — — — — 1 — — — —— — — 1 1 2 35 Other Violent Causes — 1 — 1 2 1 2 3 — 5 5 2 3 — 4 2 6 2 2 1 24 18 42 36 All Other Causes — — — — — 1 1 — — 2 1 — 1 2 — 2 2 2 3 8 8 17 25 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 staff 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 1944 is supplied by courtesy of the Honorary Secretary:— Cases Attended. Visits Made. Expectant Mothers ... 2 17 Children under 5 years ... 57 335 Maternity Cases ... 52 874 Midwives Cases ... 78 1,597 General ... 466 5,905 655 8,728 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 7 35 General 30 370 37 405 The nurses of both Associations attend the Council's Clinics. Laboratory Facilities. The arrangements in operation during the year were as follows:— Clinical material in connection with infectious disease, puerperal pyrexia and tuberculosis were submitted for examination to the Emergency Public Health Laboratories established at the St. Helier County and Sutton and Cheam Hospitals. Dr. Deas who for many years had carried out this work at the Nelson Hospital, retired in March and was unable to continue in his capacity as bacteriologist. Food and Drugs and Water samples were examined by Mr. E. Hinks, the Council's Public Analyst, whose Laboratory is at 16, Southwark Street, London, S.E.1. Milk samples were sent both to the Public Analyst and to the Laboratory of the Royal Surrey County Hospital. 21 The following examinations were made:— No. Examined. Positive Results. Swabs for diphtheria 92 5 Sputum for tubercle 12 1 Fæeces for enteric, dysentry, etc. 23 4 Swabs for puerperal sepsis 1 1 Water:— For chemical analysis 2 For bacteriological examination 2 Food and Drugs.— Analyses 116 Ambulance Facilities. Infectious Cases—The removal of infectious cases to isolation hospital is provided by the ambulances of the Cuddington Joint Hospital Board. Non-infectious Cases—The following information, kindly supplied by the Hon. Ambulance Officer, indicates the use made of the Council's Ambulance Service during the year. Calls to Street Accidents, etc 134 Answered by own ambulances 126 Transferred to other authorities 8 Calls to remove cases from domestic dwellings to nursing homes, hospitals, or vice versa 795 Answered by own ambulances 766 Transferred to other authorities 29 Calls answered for other authorities in other districts 32 Total calls answered 924 Distance travelled on calls (miles) 6,956 j Average mileage per call (miles) 7.8 Number cf occasions on which both ambulances were out at the same time 19 Number of occasions on which a third call was transferred to other services when both vehicles were out or one under repair 37 Creates', number of calls answered in any one day 8 In September, 1943, the ambulance was made free to residents for all types of cases for removal within a radius of 20 miles and to and from county institutions. The total number of journeys made in 1944 at 924 compares with 731 in 1943 and with 872 in 1939, the first complete year after the combined service with Beddington and Wallington was terminated. HOSPITALS. Carshalton is included in the area of the Cuddington Isolation Hospital Board whose isolation hospital is situated on the southern boundary of the Borough of Sutton and Cheam. Cases of infectious illness admitted from this and other districts of the Board during 1944 are shown in Table 9, which is followed by a statement of the cases admitted to other isolation hospitals under arrangements made by the Cuddington Board. One ward block is now adapted for the reception of typhus cases and for the cleansing of personnel handling ruch patients. 22 23 TABLE 9. CUDDINGTON JOINT HOSPITAL BOARD. List of Admissions to Cuddington Hospital from 1st January to 31st December, 1944. Disease. Banstead. Carshalton. Epsom and Ewell. Leatherhead. Sutton and Cheam. H.M. Forces. Others. Totals. No. Died. No. Died. No. Died. No. Died. No. Died. No. Died. No. Died. No. Died. Scarlet Fever 19 — 89 — 45 — 55 — 117 — 4 — 9 — 338 — Sc. F.+ Complications 1 — 2 — 2 — — — 4 — — — — — 9 — Pos. Tongue, No Rash — — — — — — 1 — — — — — — — 1 — No evidence — — 1 — 1 — 1 — 2 — — — — — 5 — Diphtheria 1 — 9 — 4 — — — 4 — 3 — — — 21 — Diph. + Complications — — — — 1 — — — 3 1 — — — — 4 1 Diph. Carriers — — 3 — 5 — — — 1 — 1 — 1 — 11 — No evidence — — 2 — — — 1 — 2 —. — — — — 5 — Tonsilitis 3 — 2 — 2 — — — 2 — 2 — — — 11 — Measles — — — — 2 — 7 — 3 — — — — — 12 — Measles + Complications — — 1 — 1 — — — — — — — — — 2 — No evidence — — — — — — — — — — — — 1 — 1 — Meningitis 3 1 2 — 1 1 — — 1 — — — — — 7 2 No evidence — — 1 — — — — — — — — — 1 — 2 — Whooping Cough 13 — 5 — 1 — 11 — 8 — — — 1 — 39 — Wh. Cough + Complns — — 1 1 1 — 1 — — — — — 1 — 4 1 Patient Not Whooped 1 — — — — — — — — — — — — — 1 — No evidence 3 — — — 1 — 1 — 1 — — — — — 6 — Chicken Pox 5 — 9 — — — — — 4 — 2 — — — 20 — C. Pox + Complications — — 1 — — — — — 1 — — — — — 2 — No evidence — — 1 1 — — — — — — — — — — 1 I Mumps — — — — 2 — 1 — — — 8 — — — 11 — Mumps + Complications — — — — — — — — — — — — — — 1 — No evidence — — 1 — — — — — — — — — — — 1 — Dysentery (inc. Sonne and Salmonella) — — 7 — — — — — 4 — 1 — 1 — 13 — No evidence — — 2 — — — — — — — — — — — 2 — Typhoid — — — — 3 — 1 — 2 1 — — — — 6 1 No evidence — — — — 1 — — — — — 1 — — — 2 — Other Diseases 5 — 13 — 8 — 6 — 19 1 14 1 — — 65 2 Totals 54 1 152 2 81 1 86 — 178 3 37 1 15 — 603 8 54 152 81 86 178 37 15 603 CUDDINGTON JOINT HOSPITAL BOARD. Cases sent to Other Hospitals during 1944. Original Diagnosis. Banstead. Carshalton. Epsom/ Ewell. Leatherhead. Sutton/ Cheam. Total. Scarlet Fever — 7 3 " 1 7 18 Measles — — 2 — 1 3 Erysipelas — I 1 — — 2 Whooping Cough 1 — 1 — 1 3 Dysentery 1 — 1 — — 2 Meningitis — 1 — — — 1 Diphtheria — — — — 1 1 Diarrhoea & Vomitting — — 2 — — 2 2 9 10 1 10 32 The hospital arrangements for smallpox are in the hands of the County Council who provide accommodation at the Isolation Hospital, Clandon. The general hospital facilities for this part of the County have been markedly improved by the gradual extension of the available accommodation at the St. Helier County Hospital. Its ultimate capacity for more than 800 in-patients when fully utilised will still further increase the efficiency of the local health services. The Carshalton, Beddington and Wellington War Memorial Hospital had yet another year of solid achievement. The bed accommodation, temporarily increased under E.H.S. arrangements, was 101. The Annual Report for 1944, in supplying the information which follows, shows that it admitted some 200 casualties due to enemy air attack. Beds. Average daily number open during the year— (1) E.H.S. Casualty beds occupied by casualties 4.2 (2) Other beds 32.5 Number of in-patients admitted during the year— Civ. 865 E.H.S. 207 Average number of days each patient resident— Civ. 13.8 E.H.S. 7.5 24 The in-patients were admitted from the following districts:— Civ. E.H.S. Carshalton 413 74 Beddington and Wallington ... 367 109 Other districts 85 24 CLINICS AND TREATMENT CENTRES. The following programme of clinics is provided by the Council under its Maternity and Child Welfare Scheme at the Centres indicated. Rochester Road Centre:— Infant Welfare Clinic Tues. and Thurs. 2—4 p.m. Maternity Clinic Mondays 10—12 a.m. Dental Clinic Mondays 10—12 a.m. Fourth Saturday 10—12 a.m. Wrythe Lane Centre:— Infant Welfare Clinic Wed. and Fridays 2—4 p.m. Maternity Clinic Tues. and Fridays 10—12 a.m. Toddler Clinic Tuesdays 2—4 p.m. Stanley Road Centre:— Infant Welfare Clinic Fridays 2—4 p.m. Maternity Clinic Tuesdays 10—12 a.m. Toddler Clinic 1st and 3rd Thurs. 2—4 p.m. St. Helier Centre—Green Lane:— Infant Welfare Clinic Mondays 2.30—4 p.m. Maternity Clinic Mondays 2—2.30 p.m. The Mount Centre:— Infant Welfare and Maternity Clinics 2nd and 4th Weds. 2—4 p.m. Diphtheria immunisation treatment is available for children under 5 years at all the infant welfare and toddler clinics. 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 905 Notified by midwives 726 Still births 18 Notified by doctors and parents 68 Transferred notifications 129 923 923 The total is 105 more than in the year before, and represents 102 per cent, of the number of births registered during the year. 25 Health Visiting. With so many mothers either engaged on war work or out on protracted shopping expeditions effective home visiting was a difficult matter. Much time was necessarily lost in many fruitless calls. In October the Senior Health Visitor retired on superannuation and for the remainder of the year the staff of Visitors was reduced to 4. The visits made, exclusive of Child Life Protection visits referred to later in this report were as follows:— To expectant mothers- First visits 97 Total visits 152 To children under 1 year— First visits 909 Total visits 3,226 To children 1-5 years— Total visits 5,586 8,964 Clinic Activities. During 1944 When the war was in its fifth year the renewal of enemy air attack resulted in the evacuation of considerable numbers of mothers and children in July and August. The work of the welfare centres was as a consequence considerably dislocated. Attendances during the second half of the year were much reduced and for a time some of the sessions were discontinued, whilst the Toddlers Clinics were suspended until the end of the year. Nevertheless, in the circumstances, the activities of the scheme were continued at a very satisfactorly level. Evacuation affected primarily the Infant Clinics, the attendances of children showing a fall on the 1939 figures of 30 per cent. On the other hand, the work of the Ante-natal Clinics was well maintained, the new cases and the number of attendances being little changed from the year before. A substantial proportion of the expectant mothers, booked for their confinement at the St. Helier Hospital, now receive their ante-natal supervision at the hospital clinic and when these are taken into account the number of such mothers who received clinic supervision represented 56 per cent, of the notified births. 26 TABLE 10. ATTENDANCES AT MATERNITY CLINICS. CENTRE. No. on Register. Attendances. Sessions. Average attendance per Session. * Primary. Total. Rochester Road. Ante-Natal 157 125 653 48 13.9 Post-Natal 14 2 14 Individuals 159 127 667 Wrytiie Lane Hall. Ante-Natal 231 174 855 52 16.6 Post-Natal 11 1 11 Individuals 232 175 866 St. Helier. Ante-Natal 17 10 56 24 2.3 Post-Natal — — — Individuals 17 10 56 Stanley Road. Ante-Natal 84 49 275 51 5.8 Post-Natal 19 — 22 Individuals 84 49 297 The Mount. Ante-Natal 14 5 41 24 2.0 Post-Natal 6 1 6 Individuals 15 6 47 All Centres. Ante-Natal 503 363 1880 199 9.7 Post-Natal 50 4 53 Individuals 507 367 1933 * Primary attendance is the first attendance of a woman in relation to the pregnancy under supervision. A further 149 primary attendances were made by Carshalton mothers to the St. Helier Hospital Ante-Natal Clinic. Toddler Clinics. Until suspended in July, 324 toddlers between 2 and 5 years of age received a comprehensive medical overhaul at the special Toddler Clinics provided at the Wrythe Lane and Stanley Road Centres. The number of defects found totalled 493, averaging 1.5 defects per child examined. One hundred and ten children, approximately one-third of the total, had no defects. 27 28 TABLE 11. ATTENDANCES AT INFANT CONSULTATION CLINICS, 1944. 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 1 536 221 193 221 2365 87 40.0 1—5 32 327 31 1111 Wrythe Lane Under 1 584 175 163 171 1634 86 27.4 1—5 16 379 10 720 Stanley Road Under I 417 129 110 129 1670 51 44.0 1—5 16 276 8 574 St. Heller Under 1 193 90 81 89 788 48 23.0 1—5 5 95 4 315 The Mount Under 1 94 35 24 34 408 24 30.7 1—5 4 61 2 329 All Centres Under 1 1824 650 571 644 6865 296 33.5 1—5 73 1138 55 3049 Totals 1824 723 1709 699 9914 296 33.5 TABLE 12. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1944. Defect. Recommended for Number which received Treatment by Observation. Treatment. Own Dr. Hospital. At Home by Advice. Clinic Total. Cleanliness — — — — — — — Nutrition 1 8 — — 6 — 6 Ringworm Skin — — — — — — — Impetigo 1 1 — — 1 — 1 Scabies — 2 — — 1 1 2 Other skin conditions 6 13 — 1 6 2 9 Blepharitis Eyes — — — — — — — Conjunctivitis — — — — — — — Keratitis — — — — — — — Corneal Ulcer — — — — — — — Corneal Opacities — — — — — — — Other Conditions — 1 — 1 — — 1 Vision — — — — — — — Squint 17 10 — 4 — — 4 Hearing Ears 1 — — — — — — Otitis Media — 2 — 1 — — 1 Other Diseases 2 — — — — — — Teeth 30 26 — — 1 16 17 Tonsils 58 30 — 7 — — 7 Adenoids 27 26 — 7 — — 7 Other Conditions 5 — — — — — — Enlarged Cervical Glands 18 12 — 6 — — 6 Speech 12 1 — — — — — Heart Disease 9 1 — — — — — Anaemia — 27 — — 22 — 22 Lungs, Tubercular — 2 — 2 — — 2 Lungs, non-Tubercular — 5 1 1 2 — 4 Other Tubercular Diseases — — — — — — — Epilepsy 1 — — — — — — Chorea — — — — — — — Other Nervous Conditions — — — — — — — Rickets 2 15 — — 2 7 9 Spinal Curvature 1 2 — — — 2 2 Other Deformities 3 10 — — 1 7 8 Mental Condition 3 7 — 1 — 4 5 Behaviour 1 2 — — — — — All Other Defects 47 45 — 5 21 12 38 Total 245 248 1 36 63 51 151 29 TABLE 13. ATTENDANCES AT SPECIAL TODDLER (2-5 Years) CLINICS, 1944. Centre. No. of routine medical examinations. Consulta tions. Total attendances. Sessions. Average attendance per Session. Did not attend Infant Consul- tion Clinic. 2—3 years. 3—4 years. 4—5 years. Wrythe Lane 88 65 67 — 220 28 7.8 109 Stanley Road 43 26 17 18 104 13 8.0 18 Totals 131 91 84 18 324 41 7.9 127 Each child attended once for routine examination. TABLE 14. ATTENDANCES AT ALL INFANT WELFARE CLINICS, 1944. (Infant Consultation and Special Toddler.) Year. Number who attended during the year. New cases to the Centres. Attendances. Sessions. Average attendance per Session. Primary. Total. 0—1 1951 650 644 6865 337 20.3 1—5 105 87 3373 10.0 Totals 1951 755 731 10238 337 30.3 Supply of Milk and Other Foods. The national scheme for the supply of dried milk and vitamin products to mothers and children which is operated by the Welfare Centres has to a large extent replaced the provision which was previously made by the Council. A limited range of other food and vitamin products, including proprietary brands of dried milk, are available at the clinics under the Council's own arrangements. These are available at cost price or free in necessitous cases. The value of the sale of these commodities is in the region of £700 per annum, mostly in respect of dried milk. The free issues during 1944 were as follows:— Cow and Gate Dried Milk 101b. Cod Liver Oil and Malt 11b. 30 Dental Scheme. For the treatment of mothers and children a Dental Clinic is established at the Rochester Road Centre. The scope of the service is comprehensive and a part-time Dental Surgeon and Anaesthetist are in attendance. The work carried out during the year is indicated by the following information:— DENTAL SCHEME—TREATMENT PROVIDED, 1944. Temporary Teeth. Permanent Teeth. Dentures Supplied. Extracted. Filled. Extracted. Filled. Full. Partial. 57 29 496 72 45 38 Anaesthetics Gas 104 Local 23 Inspections 189 Other operations Impressions 116 Bites 91 Try-ins 86 Dressings — Scalings 26 Repairs 16 Dentures supplied— Full Partial Free — 1 Half Price 6 — Part Cost 9 12 Full 30 25 Totals 45 38 31 Attendances at the Dental Clinics were as follows:— DENTAL SCHEME—ATTENDANCES, 1944. Centre Referred from. No. Treated. No. of attendances. Rochester Road. Children 8 13 Mothers 46 183 Individuals 54 196 Wrythe Lane. Children 11 19 Mothers 48 192 Individuals 59 211 St. Helier. Children 1 1 Mothers 13 58 Individuals 14 59 Stanley Road. Children 17 35 Mothers 18 71 Individuals 35 106 The Mount. Children — — Mothers 1 5 Individuals 1 5 St. Helier Hospital. Mothers 2 4 Individuals 2 4 Day Nursery. Children 4 6 Individuals 4 6 All Centres. Children 41 74 Mothers 128 513 Individuals 169 587 Number of Sessions held 80 Average attendance per Session:— Children 0.9 Mothers 6.4 Individuals 7.3 32 The scheme in respect of women is limited statutorily to "expectant and nursing mothers." Its value as a preventive health measure is thereby considerably restricted. The effects of dental disease are cumulative and by the time many women become eligible for clinic treatment much physical damage has already been done by the lack of earlier treatment. Moreover, pregnancy is not by any means the appropriate time to embark on extensive dental operations. The remedy is to make treatment available to all women of reproductive age. Orthopaedic Treatment The Council has an arrangement with a private masseuse for the treatment of minor orthopaedic defects in children referred from the clinics. During the year, 439 treatments were given for the following 20 cases:— Sprain 1 Torticollis 1 Curvature of the spine 1 Genu-varum 11 Genu-valgum 9 Muscular weakness 3 26 This number is considerably less than in the year before when 56 children were treated, the reduction being in a large part the result of evacuation during the second half of the year. Under an arrangement with the management, orthopaedic cases are referred to the Out-Patient Department of the Croydon General Hospital and assistance is available towards the cost of in-patient treatment and the provision of surgical appliances. Three cases were provided with special surgical appliances, two free of charge and a third at part cost, during the year. Convalescent Treatment. The Council accepts financial responsibility for the cost of convalescent treatment of cases referred from the clinics to the Invalid Children's Aid Association. It also subscribes to the Convalescent Home for Surrey to enable mothers and babies to secure convalescent treatment. The following seven children received treatment under these arrangements during the year for the conditions indicated:— Condition. Age Duration of Treatment T.B. Contact, bronchial 3½ 5 months T.B. Contact 2½ 2½ months T.B. Contact, bronchial 41/12 11 months Debility, enlarged glands and malnutrition 3½ 5½ months General debility 2 3 months Debility, rickets and malnutrition 2¼ 1 month Bronchitis following Whooping Cough 4½ 6 months 33 Maternity Hospital Treatment The St. Helier County Hospital has provided a much needed addition to the maternity accommodation available for the north-east part of Surrey. Most of the cases attending this Council's ante-natal clinics and needing hospital facilities are referred to the County Hospitals. The Council also has an arrangement with the War Memorial Hospital for the admission of suitable maternity cases, but the accommodation there is very restricted. The cases referred to hospital during the year were as follows:— For obstetric and medical reasons. For unsuitable home conditions. Total. Carshalton (War Memorial) Hospital 2 1 3 St. Helier County Hospital 33 15 48 Other County Hospitals 6 17 23 41 33 74 It should be observed that whilst only 74 were referred to hospital from the ante-natal clinics no fewer than 576 Carshalton babies were born in hospitals and nursing homes. During the latter half of the year 23 expectant mothers were evacuated under the Government scheme for confinement in emergency maternity homes in the north of England. For details of cases of puerperal pyrexia admitted to hospital, see Section F dealing with infectious diseases. Unmarried Mothers and Illegitimate Children—Circular 2866. The arrangements for the care of unmarried mothers are made in co-operation with the Sutton and District Girls' Aid Association. The scope of this service includes the following:— Admission to the local or an affiliated shelter home before and after the confinement which is conducted in a convenient hospital. Advice on such matters as affiliation and marriage, negotiation with the putative father. Clinic supervision, obtaining baby clothes, help with adoption and many other relevant matters. The balance of the cost of maintenance in shelter homes, which cannot be met from other sources, is invariably defrayed by the Council. Some 20 unmarried mothers were assisted in these ways during 1944. In their consideration of Circular 2866, the Council concurred in the view of the Minister of Health that the Welfare Authority should co-operate with and reinforce the work of existing: voluntary moral welfare associations. In view of the long and effective experience 34 of the local association it was felt that to appoint a welfare worker to the Council's staff, and so increase the number of Visitors for this service, would tend to destroy the confidence of those girls whom it was desired to help, as well as duplicate the functions of the voluntary association's worker. Foster homes are rarely a satisfactory solution of the care of illegitimate children. When a mother loses daily contact with her baby soon after birth her interest in her child invariably weakens, often to vanishing point, and the child is soon deprived of its strongest safeguard, the constant exercise of the maternal instinct. Still further is it doubtful whether the local authority should find and finance foster mothers. It is almost impossible, by periodic visiting, to be adequately satisfied on the conduct of the foster mother and since so large a proportion undertake this duty primarily to augment the family income, it is difficult to see how the authority can effectively supervise such a home and take disciplinary action if, by placing the child there and financing the arrangement, they have, in effect recommended it. No authority can assume that degree of responsibility which is now generally expected of them when they are able to exercise only that limited amount of control which is possible over a private household. Consultant Service The services of an obstetric consultant are available for the emergencies of pregnancy and complications of labour. This provision was not utilised during the year. Emergency Maternity Unit. On the suggestion of the Ministry of Health, a Mobile Maternity Unit was established in 1938 to provide skilled obstetric and nursing assistance in the patients' homes. It is based on the War Memorial Hospital and is available to any practitioner in emergency. The Unit has been called upon once only, in 1942, since it was set up. Maternity Outfits. Sterilised outfits for use during confinement are supplied at cost price or less than cost price in necessitous cases. Twenty-six were issued during the year at cost price. Home Helps. The provision of domestic assistance for mothers during confinement and in special circumstances, which is a long established part of the scheme, was a mattter of increasing difficulty throughout the war years. Endeavours to secure full-time or part-time paid helps were without avail and resort had to be made to making financial arrangements with obliging neighbours where possible in individual cases. Needless to say, this only met the needs of a very small proportion of those mothers who required help. Five mothers were assisted in this way during the year compared with 51 in 1939, although the need was far greater. 35 Midwives. Two midwives arc appointed by the District Council under the County Council's mdiwifery scheme formulated under the Midwives Ac1 1036. The fees fixed by the County Council for the services of (he midwives are as follows:— As Maternity Nurse 35/As Midwife 40/- Provision is made for a reduced fee in necessitous cases. The work carried out by this Council's midwives during the year is indicated by the following details:— Cases conducted:— Primip. Multip. Total (1) As Midwife—Live births 15 103 118 Still births — — — (2) As Maternity Nurse— Live births 1 5 6 Still births — — — 16 108 124 Visits made— Ante-natal 837 Nursings 2432 Post-natal 245 Medical Aid Forms sent by Midwives 38 Rise of Temperature 2 Malpresentation 2 Discharging Eyes 6 Haemorrhage 3 Retained Placenta 1 Ruptured Perineum 16 Delayed Labour 5 Phlebitis 1 Phimosis 2 Number of cases which attended ante-natal clinics 66 Twenty-seven other midwives resident in the district declared their intention to practice in 1944. Of these 18 were on the staff of the St. Helier Hospital, two on the staff of the War Memorial Hospital and three were District Nursing Association midwives. Voluntary Helpers. Voluntary help in the clinics has been a feature of the scheme since its inception. Nine persons gave part-time assistance in this way durng 1944. The scheme also had, as in previous war years, the help of members of the local Civil Defence Casualty Service when not required for operational duty. 36 CHILD LIFE PROTECTION. The Health Visitors act as inspectors under the Child Life Protection provisions of the Public Health Act 1936. The following details indicate the extent of their activities during the year:— Number of registered foster homes with children at the year end 19 Number of new homes registered during the year 14 Number of foster homes removed from the register during the year 13 Total number of foster homes supervised 29 Number of children admitted to the register during the year 34 Number of children removed from the register during the year 34 Total number of children on the register at year end 25 Total number of children on the register during the year 44 Number of children who died during the year — Number of inquests held — Number of visits made to foster homes 218 Legal proceedings — Adoption of Children (Regulation) Act, 1939. This Act, which came into operation in 194, imposed upon the Welfare Authority the duty of visiting and examining children under 9 years of age in the care of adopters and the premises in which the children are being kept during the period before an Adoption Order is made by the Court. For this purpose the Health Visitors, by virtue of their appointment as Child Life Protection Visitors under Section 209 of the Public Health Act, act as visitors and supervisors. Powers similar to those in respect of foster children are provided by the Act. The following epitomises the information contained in the "Adoption Act" Register:— (a) Number of persons who gave notice under Section 7 (3) during the year 4 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 4 (c) Number of children notified under Section 7 (3):— (i) under supervision at the end of the year 3 (ii) who died during the year Nil (iii) on whom inquests were held during the year Nil (d) Particulars of any proceedings taken during the year Nil 37 DAY NURSERIES. The Carshalton Day Nursery in Camden Road is administered by a voluntary committee and receives a substantial yearly grant from the Council. It now provides 24 places, the accommodation having been increased to meet war-time needs by six places in 1943. Fifty individual children made 4,549 attendances during the year giving an average attendance of 15 on each of the 303 days the nursery was open. The figures were adversely affected in July and August when the flying bomb offensive was at its height. The Council's War-time Nursery in Green Wrythe Lane, which was opened in September, 1942, provides accommodation for 40 children from 0-5 years of age. Erected mainly by Civil Defence labour on land acquired by the Council before the war for a new Health Centre and Library, it is a non-residential nursery giving full day-time facilities from 7 a.m. to 7 p.m., Monday to Friday, and from 7 a.m. to noon, on Saturday. Except during the flying bomb attack in the summer it was used to capacity from Monday to Friday each week Attendance on Saturday mornings is invariably very small. The following are the attendance figures:— Total attendances—under 2 years 4121 over 2 years 4888 9009 Days open 303 Average daily attendances—under 2 years 13.6 over 2 years 16.1 29.7 Attendances excluding Saturdays— under 2 years 3864 over 2 years 4662 8526 Days open excluding Saturdays 254 Average daily attendance excluding Saturdays— under 2 years 15.2 over 2 years 18.3 33.5 Towards the close of the year negotiations were in progress with the Ministry of Health for the extension of the nursery to 74 places and for the erection of further nurseries in other parts of the district. 38 Section C— Sanitary Circumstances. Water Supply. All the properties in the district have a mains supply of water. The Sutton District Water Company supplies almost the whole of the area except for some 170 dwellings in the extreme north which are served by the Metropolitan Water Board. Daily examinations of the raw and finished waters are made by the Company's chemist, who is employed full-time. These are supplemented at intervals by chemical and bacteriological examinations undertaken for the Company by The Counties Public Health Laboratory. A further check on the suitability of the supply is provided by monthly examinations carried out on a rota by the Public Health Departments of the districts supplied by the Company. In addition to softening, the water is treated with chloramine, the process being arranged so as to leave a trace of residual chlorine in the finished product. Two routine samples were taken by this Council in accordance with the rota referred to and were satisfactory. One of these, which is fairly representative, was reported upon as follows:— Chemical analysis in parts per 100,000. Total solid matter in solution (dried at 180° C.) 17.2 Combined chlorine 1.30 Nitric nitrogen 0.42 Nitrous nitrogen 0.004 Ammonia, free and saline 0.0025 Ammonia, albuminoid 0.001 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.008 Hardness—by acidimetric titration— Temporary 10.5 Permanent 3.0 Total 13.5 pH 7.5 Reaction for free chlorine: positive, equivalent to 0.17 part per million. The water was bright and clear and was normal in colour. Bacteriological examination. Action by free chlorine during transit of the sample was prevented at the time of sampling. Number of colonies per ml. developing upon agar in 2 days at 37° C. 0 Number of colonies per ml. developing upon agar in 3 days at 22° C. 1 Coli aerogenes organisms absent in 100 ml. Streptococci do. B. welchii do. This water is of high organic purity and its bacteriological condition is excellent. The water is suitable for the public supply. The supply is not regarded as being liable to plumbo-solvent action. 39 As an additional precaution against pollution resulting from possible enemy action, chlorine treatment was stepped up during the war. Arrangements were also devised in co-operation with the Company for warnings to be issued when pollution might be suspected following air-raids and for supplies of hypochlorite to be issued to householders for domestic treatment if recourse had to be had to sources of doubtful quality. Further emergency measures included a scheme for the treatment and utilisation of the supplies from chalk wells in private ownership should the works of the Company be put out of action. The area is well provided with these alternative sources. No instance of contamination occurred which called for special action. None of the houses depends on a stand pipe, all having a piped supply direct to the house. In the summer, the Company applied for authority to increase the daily abstraction from the Cheam Wells which in 1936 suffered gross pollution from sewage. At the enquiry held by one of the Ministry of Health inspectors, the application was opposed by this and other Councils on the grounds that they were not satisfied that the need for increased supplies existed and that alternative sources should, if possible, be used in preference to one which had an unsatisfactory history. The Minister decided that "he would not be justified at the present time in granting the Order for which the Company have applied." Drainage and Sewerage. No extensive drainage or sewerage works were undertaken. One hundred and sixty drainage obstructions affecting 460 houses were dealt with chiefly concerning combined drains. Rivers and Streams. No complaints were received. Closet Accommodation. All dwellings have water closets connected to the sewers except 27, which are mainly in unsewered areas and have w.c.'s drained to cesspools. Public Cleansing. War-time salvage arrangements continued to reduce the quantity of domestic refuse. The collection of pig-food in the manner determined by the restrictions of war-time can only be regarded from a public health point of view as a necessary evil to be tolerated only so long as the food emergency lasts. Disposal of refuse was, as previously by incineration at the Council's destructor. 40 Sanitary Inspection. The following information, supplied by the Chief Sanitary Inspector, under Article 27 of the Sanitary Officers' Regulations, 1935 indicates the action taken in sanitary inspection during the year. Investigations were made with regard to 1,390 complaints as follows:— Drainage Obstructions 152 Sewer Obstructions 1 Drainage Defects 46 General Defective Conditions 120 Dampness 16 Roofs, Gutterings, etc. 23 Sink Waste Pipes 12 Water Supply 16 Dustbins 286 Accumulations and Deposits 13 Refuse Collection 9 Smoke Nuisances 3 Rivers, Ditches, Ponds 1 Unfit Food 154 Overcrowding 17 Effluvia (Obnoxious) 39 Verminous Premises 29 Scabies 174 Head Lice 1 Rats and Mice 180 Wasps 40 Ants 2 Beetles 4 Flies 5 Animals 14 Insects (various) 12 Animal Food Storage 9 Miscellaneous 5 Dirty Milk Bottles and Sour Milk 7 1,390 Seven thousand six hundred and ten visits were made for the purposes set out below:— Public Health Act (Houses) 2,353 Public Health Act Reinspections 2,014 Housing Act — Reinspections 55 Overcrowding Enquiries 61 Dairies 27 Cowsheds 21 Milkshops 50 Factories 66 Houses—Drains Tested 56 Suspected Rat Infested Premises 663 Food Shops and Business Premises 1,004 Infectious Disease Premises 136 Infectious Disease Contacts 58 Urinals 23 Premises re Cesspools 6 41 Schools 36 Offices 20 Bakehouses 11 Stables 12 Smoke Observations 4 Outworkers Premises 21 Air Raid (Public Shelters) 9 Piggeries 25 Wasps' Nests 43 Vermin (Scabies and Head Lice) 228 A.R.P. 270 Food and Drugs and other samples 193 Shop Premises 145 7,610 Seven hundred and eighty-seven informal notices were served concerning the following matters:— General Defective Conditions 219 Rats and Mice 137 Accumulations and Deposits 14 Obstructed Drains 43 Drainage Defects 70 Verminous Premises 39 Dustbins 179 Animal Food Storage 4 Water Supply 3 Animals 7 Factory Acts 4 Food Contamination 7 Unsatisfactory Food Premises 12 Miscellaneous (Overcrowding) 2 Burst Pipes 5 Overcrowding 41 Smoke Nuisances 1 787 Forty-six formal notices were served by authority of the Council under the following Acts:— Section 93 Public Health Act, 1936 19 Section 39 do. do. 3 Section 75 do. do. 6 Section 24 do. do. 5 Section 79 do. do. 1 Section 9 Housing Act, 1936 10 Byelaws 1 Rats and Mice (Destruction) Act, 1919 1 46 As a result of investigations made and notices served, the following work was carried out: — Brickwork Repaired and/or Re-pointed 4 Ceiling plaster repaired and made good 75 cleansed and purified 98 42 Cesspools abolished 1 Chimney Pots repaired 3 Stacks repaired and/or renewed 2 Flues repaired 4 Coppers repaired 6 Damp conditions remedied 62 Doors repaired (including locks and fasteners) 8 Sills repaired 1 Frames repaired 3 Drainage repaired or reconstructed 29 Provided 1 Connected to sewer 1 Inspection chamber, repaired or renewed 1 Inspection chamber cover renewed 7 Raking arm, stoppers, refixed or renewed 2 F.A.I, repaired or renewed 1 M.F.V. provided 1 Soil vents repaired or renewed 1 Drains tested 79 Drains cleared (460 houses) 160 Drains sealed off 1 Waste gullies repaired or cleared 9 Waste gullies provided 1 Waste pipes repaired or renewed 11 Disinfestations 27 Dustbins provided 281 Food Storage accommodation provided 1 Fences repaired or renewed 1 Floor boards repaired or renewed 39 Reconcreted and made level 3 Ventilation, repaired or renewed 6 Fireplaces repaired or renewed 4 Firegrates repaired or renewed 4 Light, additional provided 1 Ranges, stoves, etc., repaired or renewed 2 Roofs, repairs and made weatherproof 54 Stripped and re-roofed 5 Down pipe guttering, repaired or renewed 31 Down pipes cleaned out and made to work properly 5 Stair treads, repaired, renewed, or made good 1 Handrails and/or baluster repaired 1 Surface Water drainage' repaired or made to work 8 Walls, cement rendered 1 Rendering repaired 5 Replastered or repaired 65 Cleansed and redecorated 107 Woodwork, repaired and / or renewed 3 Windows, repaired or renewed 14 Frames, repaired or renewed 9 Made to work properly 4 Sashcords renewed 33 Sills (external) repaired 2 W.C. accommodation repaired 9 Provided 1 Pans renewed 11 Pans provided 1 Pans, joints renewed 2 Flushing apparatus repaired or renewed 25 Water supply cisterns repaired or renewed 4 Baths 1 43 Wash Basins provided 1 Water Supply repaired 24 Nuisances abated 1,559 Rats and Mice 84 Other Matters 1 Glazing, panes renewed or repaired 9 Accumulations removed 15 Housing repairs, necessitated by enemy action, are carried out under the supervision of the Engineer and Surveyor and the information given in this report does not include work of this description. Disinfection. Following infectious illness 164 rooms and 225 library books were fumigated. Forty-seven lots of bedding were sterilised. Vermin Control. For the treatment of verminous persons, part of the Rochester Road Clinic, fitted as a Gas Cleansing Station under the Civil Defence scheme, was adapted for this use by the installation of a Thresh low-pressure disinfector and two slipper baths. The Cleansing Station was staffed with the help of Civil Defence personnel and dealt with the following cases:— Families. Persons. Attendances. For scabies 184 798 1432 For pediculosis 52 201 369 The practice of treating all members of the families affected by scabies is followed and instances of reinfestation have been few. Carefully co-ordinated arrangements have been made with the school medical service for the control of verminous conditions in school children so that they are included in the treatment of the family as a unit. Visits for the control of pediculosis are made in the first instance by the nurse-in-charge of the Cleansing Station followed, where necessary, by the Sanitary Inspector. The latter visits in connection with scabies infestation and takes appropriate action with regard to the premises as well as making arrangements for the attendance of the family at the Cleansing Station where this is the desirable course. Following up, after treatment, is done by the nurse. The Sanitary Inspectors visited 234 homes, 226 for scabies and eight for pediculosis under The Scabies Order during the course of the year. Four lots of bedding were sterilised at the Cuddington Isolation Hospital. Patients' personal clothing is treated in the Thresh disinfector at the Cleansing Station. 44 The following premises were dealt with for bed bug infestation: Method. Council Houses. Other Houses. Civil Defence Premises. Total. Spraying with Insecticide Solution 1 16 7 24 Eight lots of bedding were sterilised and five destroyed. Six houses were sprayed by the L.C.C. Normally, hydrogen cyanide fumigation is used in appropriate cases and is carried out by arrangement with a private contractor. Where possible all furniture, etc., of prospective Council house tenants suspected or found to be verminous, is treated separately with hydrogen cyanide, but in extensive infestations it is done in and with the house before removal. Owing to the contractors being employed on Government work no cyanide fumigation was carried out during the year. The alternative method of spraying with insecticidal solutions, such as Zaldecide or Solution D, more suited to minor degrees of infestation, or where conditions do not allow of the cyanide process, is performed by the staff of the Department. Pest Control. No sprayings were done for the destruction of mosquito lava:. Forty wasp nests inside and adjacent to dwellings were destroyed at the cost of the complainants. Twelve premises were sprayed to destroy fleas, crickets and cockroaches. Rats and Mice (Destruction) Act, 1919. Ministry of Food Infestation Order, 1943 (S.R. & O. 680). Under the above Act and Order the Council were directed on 11th June, 1943, to administer the provisions contained therein in an effort to destroy the rat pest and for the protection of food supplies. Following the complete survey for rat infestation made of the district in 1943 the whole of the directions continued to be administered and a full time rodent operator, acting under the direction of the Chief Sanitary Inspector, was employed. A total of 3,679 investigations were made, whilst 145 complaints in respect of rats and 55 of mice were dealt with. The 124 minor 45 rat and 23 mice infestations found were associated with the following structures:— Poultry and rabbit sheds 95 Storage sheds 16 Defective drainage 1 River and railway banks 1 Anderson shelter banks 4 Stables 2 Timber piles 1 Dwelling houses 3 Preliminary notices were served in 137 instances. At 106 private premises the work of destruction was carried out by the Council at the occupiers' expense and 14 Council premises received attention. Smoke Abatement. No complaints were received. Schools. The improvised arrangements for school feeding to meet wartime needs introduced an element of hygienic risk. The handling and issue of large quantities of milk for some hundreds of children in each school, especially where supplies were delivered in bulk, was not without its danger. Although the value of this scheme to child nutrition far outweighs such considerations, it is to be hoped that it may soon be possible to secure those adequate administrative arrangements for school feeding which we know to be desirable. The sanitary arrangements were generally satisfactory although, as in the case of houses, redecorating, as a contributory means of periodic cleansing is in all cases long overdue. Disposal of the Dead. The Merton and Morden and Carshalton Joint Cemetery Board came into existence under an Order made by the Minister of Health in July, 1943. It will administer some 58 acres in lower Morden as a burial ground for both districts. Approximately 19 acres have been laid out and consecrated, but interments have not yet commenced. Modern and adequate mortuary facilities, with provision for postmortem examinations, are provided at the Council's Mill Lane mortuary. Shops Act 1912—1936. Two hundred and eighty-three inspections of shops and business premises were made and no informal or formal action was necessary regarding infringements. 46 There were approximately 438 shop premises on the register, but on account of the war and other control by the Food Executive Committee no systematic enquiry into the changes and closing down of businesses was undertaken. There were recorded, however, one business which closed down and two which changed ownership. Section 10 (Health and Comfort). It was not necessary to take any action regarding the provision and maintenance of reasonable temperatures or in respect of sanitary accommodation. Offices. Twenty inspections of offices were made but no action was necessary. Swimming Baths. The one privately owned swimming bath has been closed during the period of the war. 47 Section D—Housing. New Houses. As in other war years, there was no new housing construction. Council's Housing Scheme. The dwellings in the ownership of the Council were as stated in the report for 1939. They total 624 houses and flats. In common with the general experience, the absence of new development during the past five years, together with some destruction from enemy action, has resulted in an acute shortage of accommodation. Inspection and Action Taken Under Statutory Powers. 1. Inspections of Dwelling Houses during the year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) H.A.—Nil. P.HA.—1703 1703 (b) Number of inspections made for the purpose 3737 (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 — (b) Number of inspections made for the purpose — (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those ferred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 394 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 (including houses inspected during 1943) 267 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 10 Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners — 48 (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied (2) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 27 (b) By local authority in default of owners — 4. Housing Act 1936. Part IV—(Overcrowding). (a) (1) Number of dwelling houses overcrowded at the end of year 72 (2) Number of families dwelling therein 72 (3) Number of persons dwelling therein 510 (b) Number of new cases reported during the year 23 (c) (1) Number of cases of overcrowding relieved during the year 24 (2) Number of persons concerned in such cases 165 (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 and Demolition. Action of this nature, for obvious reasons, remains suspended. Overcrowding. As the inevitable result of growing housing shortage, the amount of overcrowding steadily increased. Accurate statistics as to the extent of this condition are not available, since only those dwellings which are found to be overcrowded during visits for other purposes are recorded. Hence the figures here quoted do not give a complete picture of the position and there is ample evidence for the belief that the trouble is very much greater than the number of recorded cases indicates. In this connection it should be noted that the applications for tenancies received by the Council now number approximately 1,500. During the year 23 new instances of overcrowding came to notice and 24 were relieved, leaving 72 dwellings housing 510 equivalent adults still to be decrowded at the year end. Details of these cases are as follows : — Overcrowded at 31.12.44. Dwellings found overcrowded up to 31.12.44. Houses decrowded during 1944. Remaining overcrowded at 31.12.44. Decrease during year 1944 Families 73 23 24 72 1 Equivalent Adults 505 75½ 165 510 — 49 Nine of the new cases of overcrowding were illegal and 14 were outstanding at the end of the year. The 24 cases of overcrowding were abated during the year by: — Provision of alternative accommodation : — (a) By Carshalton Council 2 (b) By London County Council 5 Left the district 3 Removal of one or more occupants 11 The families themselves securing alternative accommodation 2 Additional room given in existing premises 1 The history of known overcrowding since the housing survey of 1936 is indicated by the following : — Ward. Houses overcrowded at Survey. Houses found overcrowded up to 31.12.44. Houses decrowded up to 31.12.44. Houses remaining overcrowded at 31.12.44 Overcrowded cases remedied during 1944. Formal. Informal. Total. St. Helier North 40(a) 98(f) 113(i) 25 (m) 3 8 11(b) St. Helier South 40(6) 87(g) 115(b) 12(b) — 2 2(b) St. Helier West 45 (b) 90(g) 110(j) 25(b) 2 3 5(b) North-East 17(c) 29(c) 43(k) 3(k) 2 1 3(k) North-West 10 39 47 2 — — - Central 9 (d) 12 20(d) 1(d) — — — South-West - 4 4 — - — - South-East 12(e) 24(A) 32(0 4 — 3 3(0 Totals 173 383 484 72 7 17 24 (a) 39 L.C.C. Houses. (b))'AH L.C.C. Houses. (c) 4 C.U.D.C. Houses. (d) 1 C.U.D.C. House. (e) 5 C.U.D.C. Houses. (f) 91 L.C.C. Houses. (g) 84 L.C.C. Houses. (h) 19 C.U.D.C. Houses. (i) 11.2 L.C.C. Houses. (j) 107 L.C.C. Houses, (k) 40 C.U.D.C. Houses. (l) 31 C.U.D.C. Houses, (m) 31 L.C.C. Houses. Tents, Vans, Sheds and Similar Structures. No action. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. No applications were received during the year. Cellar Dwellings. No action. Factories and Workplaces. The number of factories on the register increased by three to 99, of which 59 had mechancial power. Employees numbered approximately 800 males and 1,100 females. No formal notices were necessary, but four informal notices under the Factories Act were served. 50 Section E—Inspection and Supervision of Food. Milk Supply. » Cowkeepers. There are three cowkeepers registered in the district, two of whom are licensed by the County Council, to use the term " Accredited Milk." Approximately 100 cows are kept in the district. Regular inspections have been made of the farms and samples of the milk taken. All milk (excepting the specially designated milk) consumed in the district is pasteurised, though not all sold under the designation " pasteurised." Milk Retailers. The register contains the names of 22 milk retailers residing either inside or outside the district, the reduction in the number during the war being solely due to rationalisation of deliveries. The results of the chemical analyses of milk are shown under Food and Drugs Act report. Milk (Special Designations) Regulations 1936-1943. Licences under these Regulations have been issued as follows : — Principal Licences—Tuberculin Tested 5 Pasteurised 7 Supplementary Licences—Tuberculin Tested ... 8 Pasteurised 7 51 Food and Drugs Act, 1938. One hundred and sixteen samples were procured—90 formal and 26 informal, classified as follows : — Article. Formal Sample. Informal Sample. Genuine. Not Genuine. Baking Powder 1 — — 1 — — Bun Flour 1 1 — 2 Butter Sauce — 1 1 — Cake Pudding Mixture — 1 — 1 Cake Flour — 1 1 — Chocolate Cup — 2 2 — Cocoa 1 — 1 — Coffee — 1 1 — Custard Powder 1 — 1 — Egg Powder — 1 1 — Fish Paste — 1 1 — Horse Radish Sauce — 1 1 — Isinglass — 1 — Lemonade — 1 1 — Lemon Flavour — 2 2 — Meat Paste — 1 1 — Mustard Sauce —. 1 1 — Milk 80 — 78 2 Onion Stuffing — 1 1 — Pudding Mixture 2 4 4 2 Salad Powder — 1 1 — Sage and Onion - 1 1 — Soup — 1 1 — Sponge Mixture — 1 1 — Suet 1 — 1 — \inegar 1 1 2 — Whiskey 1 — 1 — Wine 1 — 1 — Totals 90 26 109 7 Details of the non-genuine samples are as follows: — Milk—No. 23. Added water was indicated by the freezing test only. A further sample proved to be genuine. Bun Flour—Nos. 12 and 20. These samples were found to contain 145 parts of fluorine per million. Prosecution was authorised and a summons issued, but in view of the magistrate's decision at similar proceedings against the same vendors at Croydon, the case was withdrawn. Milk—No. 44. This sample had a 6 per cent. deficiency in milk fat. Prosecution resulted in a fine of £10, and 4 guineas costs. 52 Cake and Pudding Mixture—No. 47. Prosecution was taken on the grounds that this mixture was unfit by reason of the presence of large quantities of flour mites. The case was lost as the result of an error in procedure. Yorkshire Pudding and Pancake Mixture—Nos. 59 and 64. Although stated to contain egg, the label was deemed to be misleading in that the egg content was about one-quarter of that generally used in the preparation of Yorkshire pudding made with fresh or dried egg. Prosecution was pending at the year end. Food Inspection. The following articles of food found to be unsound, diseased or unwholesome and unfit for human food, were surrendered and either destroyed or taken charge of by the Ministry of Food Salvage Department, or so disposed of as to prevent them from being used for human food : — Meat cans 327 Milk „ 347 Soup ,, 97 Vegetables „ 221 Fish „ 470 Fruit „ 29 Jam 124 Marmalade „ 43 Ham „ 63 Rabbits lbs. 348 Beef „ 12½ Veal „ 10½ Chicken „ 7 Ham „ 9½ Bacon „ 165 ½ Sausage „ 46½ Cheese „ 56 Margarine „ 62|¾ Butter „ 65¼ Bread qtn. 59 Eggs 711 Egg Substitute pkts. 22 Dried Egg „ 64 Sugar lbs. 898 Baking Powder „ 59 Fish Stones 51½ Cake Mixture pkts. 234 Cocoa lbs. 97¼ Coffee jars 16 Sweets lbs. 38 Flour „ 358 Batter Flour „ 24 Pea Flour „ 112 Tea lb. 24½ Minerals botts. 75 Slab Cake lbs. 180½ Pies and Cakes 276 Milk Powder lbs. 55½ Ice Cream Powder ,, 24½ Ovaltine „ 7 Mustard „ 126 Nutmegs 34¾ Sauce botts. 94 Pickles „ 45 Vinegar „ 7 Paste jars 24 Soda bicarb. lbs. 13½ Lemonade Powder „ 7¾ Salad Dressing jars 29 Blancmange Powder lbs. 38 Fruit „ 490 Vegetables „ 1,476 Cereals ,, 168 Dried Fruits „ 167½ Browning jars 8 Custard Powder. pkts. 4 Cordials botts. 5 Stuffing lb. 1 Oxo cubes 20 Spice lbs. 10½ Marmite jar 1 Chocolate Powder pkts. 2 Stuffing „ 7 Daisy Powder „ 31 Soya Flour lbs. 9 Lard „ 65½ The Slaughter of Animals Act, 1933. One application for a licence under the Act was received. Bakehouses. There are five bakehouses in the district and all have received periodical inspections. No specific action was taken during the year. 53 Section F—Prevalence of and Control over Infectious and other Diseases. The district has, within its boundaries, three General Hospitals, two of which, namely, Queen Mary's Hospital for Children and the St. Helier County, are particularly large institutions which are part of the hospital services for London and the County of Surrey respectively. Many of the cases notified from the St. Helier Hospital are admitted there from other districts already suffering from a notifiable disease but not diagnosed until after admission. In order, therefore, to give a clearer picture of the prevalence of infectious disease in the resident population of the district, separate figures are given in this Section which exclude cases of hospital patients who are not residents of the district. The figures given are after correction for original errors in diagnosis except in the case of Queen Mary's Hospital patients. Notification. The following diseases are notifiable in the district: — Smallpox. Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlatina or Scarlet Fever. Measles. Whooping Cough. Tuberculosis. Dysentery. Acute Influenzal Pneumonia. Acute Polioencephalitis. 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 Eethargica. Food Poisoning. Smallpox. No cases were notified Enteric Fever. No case of true typhoid fever was reported, but two of paratyphoid were notified. One, a soldier on leave, was suffering when he arrived home. The other was a member of the nursing staff of a hospital. Both received hospital treatment and recovered. Dysentery. Sixty-nine persons were notified to be suffering from dysentery, mostly Sonne infections, and of these 57 were hospital patients not resident in the district. All the cases in which the infecting organism was isolated were Sonne infections. There were no deaths. Cerebro-spinal Fever. Two cases, females of 4 and 36 years, were removed to isolation hospital where the diagnosis of meningo-coccal meningitis was confirmed bacteriologically. Both recovered after sulphonamidc treatment. 54 Scarlet Fever. Following a year of unusually high prevalence scarlet fever cases fell in 1944 to one-third of the number in 1943. Residents who succumbed to this infection numbered 104 out of a total of 159 cases. The incidence rate was therefore : — All cases 3.04 per 1,000 population. Residents 1.90 per 1,000 population. Half the resident cases were schoolchildren, one-third were under five years of age and the remainder over school age. Ninety-one per cent, were admitted to hospital and all recovered from what was generally a mild infection. In 1943 no less than 20 per cent. of these cases were nursed at home and the increased proportion admitted to isolation' hospital during the year under review is mainly the result of the shortage of housing accommodation with a corresponding general lack of isolation facilities in domestic homes. There was one " return " case. TABLE 15. SCARLET FEVER—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1944. (Excluding hospital patients non-resident in Carshalton.) 1944. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January 3 — 2 4 1 - 1 2 13 February 2 — 2 — — 1 3 — 8 March 4 2 3 5 5 — 4 — 23 April 1 2 1 3 1 — 5 1 14 May 1 — 4 — — — — — 5 June — — — — 1 — — — 1 July — — 1 4 — — — — 5 August — — — I — — — — 1 September 1 1 — — — — — 1 3 October 1 2 9 — 1 — — — 6 November 2 — 6 2 2 3 1 1 17 December 2 1 2 1 — — 1 1 8 Totals 17 8 23 20 11 4 15 6 104 Monthly Mean 1.4 0.6 1.9 1.7 0.9 0.3 1.2 0.5 8.6 Case rate per 1,000 population 2.14 1.26 3.06 2.44 1.66 0.73 2.28 1.01 1.90 55 TABLE 16. SCARLET FEVER—MULTIPLE CASES, 1944. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. 3 Cases. 4 Cases. St. Helier North 17 — — — 17 17 St. Helier South 5 — 1 — ' 6 8 St. Helier West 21 1 — — 22 23 North-East 13 2 1 — 16 20 North-West 6 1 1 — 8 11 Central 9 Li 1 — — 3 4 South-East 5 — — — 5 5 South-West 3 — 1 — 4 6 Whole District 72 5 4 — 81 94 Ten further cases occurred in hospitals. Diphtheria. As in the year before diphtheria incidence was very low. Out of 27 cases only seven were residents in the district giving attack rates as follows : — All cases 0.51 per 1,000 population. Residents 0.12 per 1,000 population. Five of the eight wards were entirely free of diphtheria throughout the year. It should be observed that 20 of the total of 27 notifications were in respect of Queen Mary's Hospital patients and that no information is available as to whether the diagnosis was subsequently confirmed in these cases. One noteworthy feature of the illness among the resident population was that four of the seven cases were over 15 years of age, only three being of school or pre-school age. None of these cases died though one adult contracted the infection whilst in a mental institution outside the district and died therefrom. The incidence of diphtheria among the resident population since 1934 was as follows : — Year. Cases. Incidence (per 1,000 population). Year. Cases. Incidence (per 1,000 population). 1934 66 1.73 1939 14 0.23 1935 58 1.13 1940 45 0.77 1936 53 0.95 1941 26 0.45 1937 47 0.80 1942 23 0.40 1938 33 0.57 1943 7 0.12 1944 7 0.12 56 TABLE 17. DIPHTHERIA—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1044. (Excluding hospital patients non-resident in Carshalton.) 1944. Ward. Total. St. Heliei North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January — 1 — — — — — — 1 February — — — — — — — — — March — — — — — — — — — April — — — — — — — — — May — — — — — — — — — June — 1 — — — — 1 — 2 July — — — — — — — — — August — — — — — — — — — September — — — — — — — — — October — 1 — 1 — — — — 2 November — — — 2 — — — — 2 December — — — — — — — — — Totals — 3 — 3 — — 1 — 7 Monthly Mean — 0.25 — 0.25 — — 0.08 — 0.59 Case rate per 1,000 population 0.47 0.36 — 0.15 — 0.12 There was no instance of more than one case in a house. During the course of investigations three persons were found to be temporary " carriers " of the infection. They cleared up with isolation hospital treatment after an interval of two months in the case of two of them and one month in the third. The number of swabs examined for diphtheria under the Council's laboratory arrangements was 92 of which 5 were positive. No anti-toxic serum was issued to practitioners during the year. 57 Diptheria Immunisation. A further 775 children under 15 years of age received a full course of immunising injections as follows: — Age Groups. Total. 0—5 5—15 At Council Clinics 437 21 458 In Carshalton Schools 11 243 254 By Private Practitioners 24 8 32 472 272 744 Less outward transfers 8 40 48 Plus inward transfers 12 67 79 Carshalton Residents 476 299 775 The position in respect of immunisation at 31st December, 1944, was as follows : — Age Groups. Total. Under 5 5—15 Estimated number of children resident in the district 3,650 10,500 14,150 Number immunised at 31st December 1,993 8,700 10,693 Percentage immunised 54 83 75 The material used was A.P.T., usually in two doses of 0.3 c.c. and 0.5 c.c. at an interval of one month. Erysipelas. Eleven cases were notified, all residents of the district but one. Seven were of the facial type and the same number received in-patient hospital treatment and recovered. Pneumonia. The severer respiratory infections were less prevalent, 30 cases of pneumonia being reported compared with 60 in the year before. Four of the total were of influenzal origin. Measles. The district was practically free of measles in 1944, only three cases being notified. There were no deaths. 58 Whooping Cough. The number of cases notified in the resident population was 185. A further 19 occurred in patients of local hospitals admitted from other districts. There was one death in a baby under one year of age. The ward distribution is shown in the following table: — TABLE 18. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1944. (Excluding hospital patients non-resident in Carshalton.) 1914. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. Southwest. January 4 3 3 12 2 3 2 — 29 February 5 5 1 26 — — 1 — 38 March 9 1 3 3 2 — — — 18 April — 2 3 8 3 1 1 4 22 May 4 2 — 5 4 2 4 9 30 June 4 3 2 4 2 8 1 24 July 5 — 1 — — 2 2 1 11 August 3 — — — — — — — 3 September 3 — — — — — — 1 4 October 1 — — — — — — — 1 November — — 2 1 — — — — 3 December — — 1 — — — — 1 2 Totals 38 13 17 57 15 10 18 17 185 Monthly Mean 3.2 1.1 1.4 4.7 1.2 0.8 1.5 1.4 15.4 Case rate per 1,000 population 4.79 2.05 2.26 6.95 2.27 1.83 2.74 2.85 3.53 Ophthalmia Neonatorum. Only one case of this eye infection in the new born was notified. It recovered completely after ten days' treatment in hospital. Puerperal Pyrexia. With the provision of a substantial amount of maternity accommodation at the St. Helier Hospital the yearly number of notifications of puerperal pyrexia has risen markedly. This is in accordance with expectation and is the result of two factors—the admission to the hospital maternity wards of a large proportion of abnormal cases in which the risk of infection is high and the more meticulous notification than is the general experience. 59 The number notified during the year was 46. Of these three occurred during domiciliary confinement, two in the War Memorial Hospital and 41 in the St. Helier Hospital. Fourteen of the total were residents of Carshalton. All but one received hospital treatment, and all recovered. The following is a summary of the chief features of these cases : — 29 were primigravidæ. 18 had uterine infections. 8 had urinary infections. 3 had acute mastitis. 3 had influenza. 2 had tonsillitis (1 followed by septicaemia). 1 had cellulitis following blood transfusion. 2 had diarrhoae—cause unknown. 1 had septicaemia due to anaerobic organism. 1 had bronchial pneumonia following collapse of the lung. 3 had pyrexia of unknown origin. 6u 61 TABLE 19. INFECTIOUS DISEASES.—Notifications, Deaths, and Distribution. (excluding hospital patients non-resident in Carshalton) Disease. Cases notified. Case rate per 1000 population. Deaths Distribution by Wards. 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 Scarlet Fever 104 0.20 — 17 8 23 20 11 4 16 5 95 91 Diphtheria 7 0.13 — — 3 — 3 — — 1 7 100 Cerebro Spinal Fever 2 0.04 — — — 1 1 — — — — 2 100 Puerperal Pyrexia 14 0.27 — 2 1 3 2 — 3 2 1 11 79 Para-Typhoid 2 0.03 — — 1 — — 1 — — — 2 100 Erysipelas 10 0.19 — — 3 1 1 — — 3 2 6 60 Pneumonia no 0.57 3 3 5 2 7 3 1 3 6 7 23 Dysentery 12 0.23 — 1 3 — 2 3 — 3 — 4 33 Ophthalmia Neonatorum 1 0.01 — — — — — — 1 — — 1 100 Measles 11 0.21 — 1 1 — 1 2 2 3 1 — — Whooping Cough 185 3.5 1 38 13 17 56 16 10 18 17 4 2 62 TABLE 20. INFECTIOUS DISEASES. Notification by Age Groups, 1944. (Excluding hospital patients non-resident in Carshalton.) Disease. Total Cases Notified. Total Cases at all Ages Under 1 year 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and over Scarlet Fever — 2 6 14 8 40 12 12 7 2 1 — 104 Diphtheria — 1 — — — 2 — 1 2 — 1 — 7 Cerebro Spinal Fever — — — — 1 — — — — 1 — — 2 Puerperal Pyrexia — — — — — — — 1 10 3 — — 14 Para-Typhoid — — — — — — — 2 — — — 2 Erysipelas — — — — — — — 3 1 — 1 2 10 Pneumonia — 2 1 2 2 2 — 2 1 3 8 7 30 Dysentery — 3 — — 1 1 — 3 2 — 2 — 12 Ophthalmia Neonatorum 1 — — — — — — — — — — — 1 Measles 2 1 2 — 1 4 — 1 — — — — 11 Whooping Cough 14 13 29 17 30 70 4 4 3 — 1 — 185 63 TABLE 21. MONTHLY INCIDENCE OF INFECTIOUS DISEASES, 1944. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July- Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 12 9 23 14 5 1 5 1 3 6 15 10 104 Diphtheria 1 — — — — 2 — — — 2 2 — 7 Puerperal Pyrexia 3 4 2 4 1 — — — — — — — 14 Erysipelas 2 3 2 1 1 — — 1 — — — — 10 Pneumonia 9 9 3 1 2 3 — 1 — — 1 1 30 Para-Typhoid — 1 — — — — — — — 1 — — 2 Polio Myelitis — — — — — — — — — — — — — Dysentery 2 1 — 4 1 — — — — 3 1 — 12 Ophthalmia Neonatorum — — 1 — — — — — — — — — 1 Cerebro Spinal Fever — — 1 — 1 — — — — — — — 2 Whooping Cough 46 26 19 17 34 22 11 3 2 3 1 1 185 Measles 1 — 2 — 1 2 2 — — 1 2 — 11 Tuberculosis Pulmonary 10 9 5 6 6 13 7 4 3 7 8 6 84 Tuberculosis Non-pulmonary 3 1 — — 1 1 1 1 — 2 2 — 12 TUBERCULOSIS. The new cases admitted to the tuberculosis register during the year numbered 127 classified as follows : — Males— Females— Pulmonary 63 Pulmonary 44 Non-pulmonary 9 Non-pulmonary 11 Of the total additions 90 were primary notifications, 29 were transferred from other districts and eight came to notice in other ways. For the same period 84 names were removed from the register for the following reasons : — Recovered 4 Deaths 36 Otherwise (including removals) 44 After allowing for the additions and deductions, the state of the register at the 31st December, 1944, was as shown in the followingtable : — TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1944. Ward. Pulmonary. Non-Pulmonary. Total Males. Females. Males. Females. St. Helier North 57 65 21 8 151 St. Helier South 40 35 12 19 106 St. Helier West 43 34 8 16 101 North-East 40 30 15 8 93 North-West 32 26 7 7 72 Central 22 11 4 1 38 South-East 24 14 4 10 52 South-West 28 17 2 2 49 Totals 286 232 73 71 662 518 144 The total of 662 is 39 more than at the corresponding date twelve months earlier. The Surrey County Council is responsible for the anti-tuberculosis scheme in the area. The number of patients from Carshalton who received institutional treatment under the County scheme during the year was as follows : — At Surrey County Sanatorium, Milford 36 At other tuberculosis institutions 110 146 64 The number of persons who died from tuberculosis during the year was 33 distributed by age groups as follows : — TABLE 22. DEATHS DUE TO TUBERCULOSIS, 1944. Age, Years. Pulmonary. Non-Pulmonary. Total Male. Female. Male. Female. 0 — — _ 1 1 1—5 — — — — — 5—15 — — — — 15—25 — 5 1 1 7 25—35 2 2 — 1 5 35—45 6 2 1 — 9 45—55 4 1 — — 5 55—65 5 — — — 5 65—75 — — — 1 1 Totals 17 10 2 4 33 Only one of the deaths was of an unnotified case representing three per cent. of the total deaths from this disease. The Council provides a free service for the examination of sputum for tubercle bacilli. In the past year 12 such examinations were made with a positive result in one. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations 1925, nor under Section 172 of the Public Health Act 1936. 65 66 TABLE 23. 1UBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register 1944 Age Group Years. Primary Notifications " A." Cases transferred 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 1-5 - 1 - - - - - - - - _ 1 5-10 1 - 2 - - - - 1 - - _ _ 4 10-15 3 2 1 - — - - 1 - - - _ 7 15-20 9 9 1 3 — - 1 - - - - - 23 20-25 7 10 - - 3 3 1 - - 1 - _ 25 25-35 10 5 2 1 6 5 - - - - - 1 30 35-45 6 5 - — 5 1 - - 2 - - - 19 45-55 5 1 - - - - - - 1 1 - - 8 55-65 5 - ~~ - - - - 1 - _ - - 6 65 up - 1 - — 1 - - - 1 - - - 3 Totals 46 34 6 4 15 9 2 3 4 2 - 2 127 90 29 8