CAR 10 ??? Carshalton Urban District Annual Report OF THE Medical Officer of Health FOR THE YEAR 1945 Printed by the "Croydon Times," Ltd., 104., High Street, Croydon. 66721 CARSHALTON URBAN DISTRICT ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1945 i PREFACE To the Chairman and Members of the Carshalton Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1945. During this period, peace at last brought an end to the terrible wastage of war. These years of concentrated destruction have left us poorer in many ways, not least in the means to maintain the health and well-being of the community. Great gaps in the essential needs of housing, food and clothing alone require to be filled and call for the same sense of urgency which characterised our efforts during the period of hostilities. The degree of success achieved in this programme of rebuilding will in no small measure determine the standard of public health in the years that lie immediately ahead. As the contents of this report indicate, the health of Carshalton came through the war with great credit, but who shall say to what fine limits the margin of safety was reduced, and who could with confidence assert how much longer it could withstand the strain to which war has subjected it. The fact that in 1945 the health of the district was in many ways the best yet recorded, and that this should have been achieved after a long and devastating war, is the most hopeful augury for the future if the many problems that await our attention are tackled with energy and resolution. Vital statistics are the yard sticks for the measurement of public health, and uninteresting as they may be to most, it is only by an examination of such figures that we can assess progress. So many of these indices are for- 1945 the most favourable yet in our local experience that one is tempted to use the hackneyed phrase " a record year." Certainly there is considerable justification for it. The birth rate at 15.0 per 1,000, though not so high as in 1944, is markedly above that for the five years prior to that year. The crude death rate is again a very favourable one, lower than in the year before, and considerably less than for England and Wales. The rate of natural increase as expressed by the difference between the birth and death rates still provides a comfortable margin, but if it is to be maintained a higher birth rate is necessary in the future, as 3 with the increasing average age of the population resulting from the fact that the district is almost completely developed, the death rate will most probably rise in the years to come to something approaching the national mortality. Among the causes of death cancer again figures prominently, it being responsible, as in 1944, for the highest proportion yet recorded of the total mortality. Next follow three mortality figures which should give particular satisfaction in that they are affected more directly than any other by the Council's health services. Infant mortality at 23 per 1,000 live births is half that for England and Wales, and is the lowest yet in Carshalton, the previous best being 27 in 1942. It is hard to realise that only 25 years ago this rate was three times higher. Maternal mortality was nil, there being no deaths attributable to maternal causes. The death rate from the seven principal infectious diseases known as the Zymotic Death Rate was also a record low one for the district, only two deaths being due to these infections during the year. As to the prevalence of infectious disease, cases of scarlet fever and whooping cough were much fewer than in the year before, with no deaths from either. Diphtheria attacked 8 more residents, but still many less than in pre-immunisation days, and with no fatality. 1945 was a " measles " year, and the expected epidemic wave duly materialised and caused one death. There were no cases of typhoid, paratyphoid or smallpox. The number of cases of tuberculosis rose slightly, but the deaths fell to a level more favourable than before the war. The maternity and child welfare scheme continued to function with marked success, and had the satisfaction of contributing to the two remarkable achievements already mentioned, a record low infant mortality and the absence of any maternal death. Public appreciation of this service as evidenced by the attendances at the various clinics, already at a high level, continued to increase. No fewer than 90 per cent, of the babies born each year now attend the clinics—another record figure—whilst the number of expectant mothers who received ante-natal supervision either at our clinics or the associated county hospital clinic represents 68 per cent, of the notified births, also the highest yet. The scheme plays a major part in the welfare of mothers and children. How much better it could do, had it but the advantages of modern well-equipped health centres. The increasing request for hospital accommodation for confinement noticed during the war persisted, and although the percentage of expectant mothers provided with hospital accommodation is now twice what it was in pre-war years, the demand is not yet satisfied. The general shortage of trained nurses had its repercussion on the local hospital services. Both the County Hospital of St. Helier, and the War Memorial Hospital were denied the use of many beds owing to depletion of their staff, professional and domestic. 4 Sanitary work had to contend with increasing difficulties as a result of the position in regard to labour and materials. Nowhere were these restrictions so acutely felt as in the maintainence of a reasonable standard of fitness of domestic dwellings. Much had to be left undone; and housing repair notices had to be modified to exclude all items except the most urgent repair necessities. Provision exists, certainly, for such essential work to receive priority, but the procedure and formalities involve an enormous loss of time. Overcrowding and the evils that flow from it remain our chief health problem. The scope for the relief of this situation by the provision of additional dwellings within the Urban District is very limited. Unless our open spaces are to be sacrificed to the prejudice of public health in the future, it will be necessary to rehouse most of our unaccommodated families outside the area. The opportunities for the exploitation of the scarcity of food supplies still remain in a marked degree, and the Ministry of Food has made many orders in a praiseworthy effort to curb the unscrupulous and prevent the more blatant abuses. The intricacies of these regulations, which to be effective must be in precise and detailed form, are creating much additional administrative work for the department, and for the food inspectors in particular. There seems little doubt that legislation of this nature will in future assume a much more prominent place in local public health service. Milk because of its particular vulnerability as a vehicle for the spread of disease, has always received more legislative attention than any other commodity. In the last and recent years it has become increasingly difficult to maintain the standards which have been set, and a high proportion of the samples of pasteurized milk taken during the year failed to fulfil the prescribed tests. Difficulties of plant and labour were advanced in explanation, and no doubt do exist, but it is to be hoped that these defects will soon be remedied. Restriction of the consumer's choice of retailer must carry with it the obligation to provide a safe milk. An eminent public health administrator once said, " only an educated people can be healthy." The truth of this assertion is being increasingly borne upon us. More and more evidence accumulates that the health of the community rests, not so much on restrictive legislation as upon the personal behaviour of each and every member, and that in the ultimate the public well-being is a matter of individual responsibility and conscience. Legislation cannot ensure that the typhoid carrier washes his hands on every necessary occasion, nor can regulations prevent a selfish parent sending her ailing child to a nursery knowing it to have been in close contact with measles. Where better could education in this direction be instilled than in the schools ? Simple hygiene and health conduct are subjects deserving of a place in the school curriculum. A word of thanks, in conclusion, to all the members of my department. Another difficult year has been successfully negotiated with 5 cheerful willingness and marked efficiency. I am indebted also to the Council and its Committees for their encouragement and that large measure of trust and responsibility which, at their hands, I am privileged to enjoy. I am, Your obedient servant, F. LAWRENCE SMITH, Medical Officer of Health. August, 1946. 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 to 1.12.45.) Sanitary Inspectors. * L. G. Lydiatt, C.R.S.I. * S. R. Maton, C.R.S.I. (With H.M. Forces to 19.11.45.) * J. East, C.R.S.I. (temporary) V. A. Vickers, M.R.S.I, (temporary) Senior Health Visitor. Miss R. M. Nash. Health Visitors. Miss A. A. Askew. Miss M. J. Thomas. Miss H Gray (from 8.10.45). Miss D. Longlands (from 29.10.45). Chief Clerk. B. Lamacraft (with H.M. Forces to 15.10.45). Miss V. Hotten (acting to 15.10.45). 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. Dentist to the Maternity and Child Welfare Scheme. H. C. Scott, L.D.S., R.F.P.S, (Glas.). Anaesthetist to Maternity and Child Welfare Scheme. W. O. Whittaker, M.R.C.S., L.R.C.P. (to 26.5.45). ' Evei.een Ashworth, M.B., B.S. (from 23.6.45). *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 1945) according to Rate Books 15,909 Rateable Value at 31st December, 1945 £481,318 Sum represented by 1d. rate £1,979 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. For several years past these springs have failed for more frequent and lengthy periods as a result of the increased abstraction from the Thames Basin. \ It was not possible to restart housing developments by the end of the year, and hence there was no new construction to relieve the growing overcrowding. Carshalton is largely a dormitory area for workers in London, there being little local industry established within its boundaries. The northern and central parts are highly urbanised, whilst the southern portion has a lesser housing density. Most properties are of the working class type, the average rateable value of dwellings being less than £25. 8 SUMMARY OF VITAL STATISTICS FOR 1945. (Based on the Registrar-General's Figures). Population. Registrar-General's Estimate 54,230 Births. Males. Females. Total. Live (Legitimate) 378 393 771 (Illegitimate) 28 17 45 406 410 816 Birth Rate 15.0 Still-births (Legitimate) 11 9 20 (Illegitimate) — — — 11 9 20 Still-birth Rate per 1,000 total births 23.9 Deaths. 243 201 445 Death Rate (crude) 8.2 Infant Mortality. All deaths under 1 year 8 11 19 Infant Mortality Rate (per 1,000 live births) 23.2 Deaths of leg. infts. under 1 year 8 11 19 Rate per 1,000 legitimate births 24.6 Deaths of illeg. infts. under 1 year — — — Rate per 1,000 illegitimate births — Maternal Mortality. Deaths from Sepsis — Rate per 1,000 births — Deaths from other causes — Rate per 1,000 total births Maternal Death Rate — Zymotic Deaths. 7 Principal Zymotic Diseases 2 Deaths from Measles 1 Deaths from Whooping Cough — Deaths from Diarrhoea (under 2 years) 1 Zymotic Death Rate 0.03 Deaths from Tuberculosis. All Forms 28 Rate per 1,000 of population 0.51 Phthisis 27 Rate per 1,000 of population 0.49 Deaths from Cancer. 90 Rate per 1,000 of population 1.66 9 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. UNEMPLOYMENT. The official figures of unemployment as supplied by the Sutton Exchange are insignificant. They do not in any way refute the fact that there was a dearth of labour in almost every direction. The number registered as unemployed at December 31st was as follows: — Men 51 Women 32 Boys 13 Girls 7 103 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: — Mcdical Relief: Total number of persons in Carshalton admitted to Public Assistance Institutions or Homes during 12 months ended 31st December, 1945 88 Total number of persons from Carshalton admitted to Mental Hospitals during 12 months ended 31st December, 1945 51 10 Other Relief: Number of persons in receipt of domiciliary assistance on:— Men. Women. Children. Total. 1st January 82 133 125 340 1st July 82 156 146 384 31st December 85 165 162 412 Total amount of domiciliary relief paid to persons resident in Carshalton during 1945 £14,131 POPULATION. The population of the district during 1945 was still some thousands lower than at the outbreak of war. It fell considerably as a result of evacuation during the latter half of 1944, but rose steadily during 1945 with the return of the evacuees and the gradual release of members of H.M. Forces. It is estimated that at mid-year the number was 54,440, which is still some 5,000 less than in 1939. The distribution of the population at mid-year was estimated as follows:— TABLE 1 ESTIMATED RESIDENT POPULATION, MID-1945, BY WARDS. Ward. Houses at Mid-1945. Estimated Population Mid-1945. St. Helier North 1,987 7,740 St. Helier South 1,660 6,240 St. Helier West 1,874 7,320 North-East 2,489 8,200 North-West 2,119 6,510 Central 1,706 5,303 South-East 2,090 6,510 (Queen Mary's Hospital) 760 South-West 1,983 5,860 Whole District 15,908 54,440 BIRTHS. The number of live births registered was 816, of which 406 were males and 410 females. The birth rate of 15.0 per 1,000 population compares with 17.0 in the year before. Still-births totalled 20, giving a rate of 23.9 per 1,000 total births. No information is available from the Registrar General as to the home addresses of babies whose births are registered outside the district. For a computation of ward birth rates use is made of the notification of births received under the Public Health Act. The variation in the birth rates of the individual wards given below follows that experienced for several years past. The North-East Ward has the highest and the South-West the lowest birth rate. Ward. Live Births. Birth Rate per 1,000 Population. Still Births. Still Birth Rate per 1,000 total births. St. Helier North 126 lb.2 5 38.1 St. Helier South 83 13.3 — — St. Helier West 110 15.0 4 35.1 North-East 181 22.0 8 42.3 North-West 116 17.8 — — Central 82 15.4 1 12.0 South-East (excluding Queen Mary's Hosp.) 93 14.2 1 10.6 South-West 65 11.1 — — 11 The number of babies born in hospitals, nursing homes, etc., has risen considerably in recent years, chiefly as a result of increased institutional accommodation being available at the St. Helier Hospital. The percentage of institutional births for the different wards in 1945 was as follows : — St. Helier North 58 St. Helier South 56 St. Helier West 60 North-East 64 North-West 64 Central 59 South-East 59 South-West 72 Of the 875 births, 528 occurred in the following hospitals and nursing homes: — Live. Still. Total. Carshalton, Beddington and Wallington District (War Memorial)) Hospital 71 2 73 St. Helier County Hospital 333 9 342 Other Surrey County Hospitals 29 2 31 Other Hospitals 27 — 27 Private Nursing Homes 55 — 55 Totals 515 13 528 TABLE 2. BIRTHS, 1945, DOMICILIARY AND OTHERS — BY WARDS. Ward. Born in District. Born Outside District. In Hospitals and Nursing Homes. In Private Houses. Total. In Hospitals and Nursing Homes. In Private Houses. Total. Total. St. Helier North 69(2) 55(2) 124(4) 7(1) – 7(1) 131(5) St. Helier South 42 36 78 5 — 5 83 St. Helier West 55(2) 45(1) 100(3) 14(1) — 14(1) 114(4) North-East 108(6) 68(2) 176(8) 13 — 13 189(8) North-West 62 41 103 13 — 13 116 Central 40(1) 34 74(1) 8 1 9 83(1) South-East 31 37(1) 68(1) 25 1 26 94(1) South-West 25 18 43 22 — 22 65 Totals 421(11) 328(6) 766(17) 107(2) 2 109(2) 875(19) (Figures in brackets indicate still-births included in totals.) 12 TABLE 3. BIRTH AND DEATH RATES FOR CARSHALTON, 1922—1945. Year. Population (RegistrarGeneral's). Birth Rate. Death Rate. Infant Mortality Rate. Maternal Mortality Rate. 1922 14,240 19.7 8.8 50 10.6 1923 14.610 18.8 8.6 36 3.6 1924 15,050 18.5 10.1 58 7.1 1925 15,660 20.0 10.0 42 3.2 1926 17,040 17.0 9.3 31 0.0 1927 18,450 16.5 9.1 72 9.8 1928 21,910 15.5 9.0 65 14.7 1929 23,420 18.8 9.4 61 0.0 1930 25,500 17.0 7.6 46 0.0 1931 28,620 16.7 7.5 43.8 8.1 1932 32,280 15.05 7.9 47.3 3.89 1933 35,260 14.9 8.8 64.4 4.23 1934 38,110 16.5 8.6 53.5 4.60 1935 51,000 15.7 6.6 46.0 4.80 1936 57,000 15.7 7.1 46.7 7.57 1937 58,030 15.0 .6.6 40.0 0.0 1938 58,730 14.7 7.6 46.1 2.3 1939 a 59,510 13.2 7.1 35.4 3.7 b 59,070 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 1945 54,230 15.0 8.2 23.2 0.0 13 TABLE 4. COMPARATIVE STATISTICS—1945. 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 16.l‡ 19.1 19.2 15.7 15.0 Still 0.46‡ 0.58 0.53 0.40 0.37 Deaths— All causes 11.4‡ 13.5 12.3 13.8 8.2 . Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 _ Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.01 0.02 — Diphtheria 0.02 0.02 0.02 0.01 — Influenza 0.08 0.07 0.07 0.07 0.03 Smallpox — — — —, — . Measles 0.02 0.02 0.02 0.01 0.01 Rates per 1,000 Live Births. Deaths under 1 year of age 46 † 54 43 53 23 Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 7.8 4.5 7.6 1.2 Rates per 1,000 Civilian Population. Notijications— Typhoid Fever 0.01 0.01 0.01 0.01 — Paratyphoid Fever 0.01 0.00 0.01 0.00 — Cerebro Spinal Fever 0.05 0.05 0.05 0.06 0.01 Scarlet Fever 1.89 2.02 2.03 1.57 1.99 Whooping Cough 1.64 1.65 1.47 1.25 1.91 Diphtheria 0.46 0.52 0.56 0.31 0.44 Erysipelas 0.25 0.28 0.24 0.31 0.23 Smallpox 0.00 0.00 0.00 0.00 — Measles ... ' ... 11.67 10.39 11.19 9.03 12.64 Pneumonia ... 0.87 1.03 0.72 0.78 0.73 Rates per 1,000 Total Births (Live and Still). Puerperal Fever 9.93 12.65 8.81 3.60 37.08 Puerperal Pyrexia 15.87 § Maternal Mortality— Abortion with Sepsis 0.25 — Abortion without Sepsis 0.08 not available - Puerperal Infections 0.24 — Other Puerperal causes 1.22 — A dash (—■) signifies none. † Per 1,000 related births. ‡ Rates per 1,000 Total Population. § Including Puerperal Fever. 14 DEATHS. The number of deaths registered was 445, of which 244 were males and 201 females. This gives a crude death rate of 8.2 per 1,000 population compared with 11.4 for the country as a whole, and with 9.5 for this district in the year before. The distribution by wards was as follows: — WARD DEATH RATES AND MEAN AGE AT DEATH, 1945. ] Deaths. Death Rate (crude). Mean Age at death. St. Helier North 34 4.4 55.3 yrs. St. Helier South 32 5.1 53.6 „ St. Helier West 44 6.0 53.9 „ North-East 76 9.3 55.9 „ North-West 65 10.0 67.9 „ Central 80 15.1 70.2 „ South-East (excluding Queen Mary's Hospital) 56 8.6 59.3 „ South-West 58 10.0 64.2 „ Whole District 445 8.2 61.4 yrs. The high average age at death in the Central Ward is remarkable, but is mainly the consequence of a high average age of the residents of that ward. Cancer deaths in 1944 reached the highest level yet recorded in Carshalton. The rate for that year at 1.6 per 1,000 population was repeated in 1945. As is to be expected the wards with the oldest population have the highest cancer death rates, since this is a disease of middle and advanced age. Although still less than the rate for the country as a whole, it is likely to approach the national figure as, with the passage of time, the average age of the population of the district gradually approximates that for England and Wales. CANCER DEATHS—WARD DISTRIBUTION, 1945. Ward. Cancer Deaths. Rate per 1,000 Estimated Population. St. Helier North 11 1.43 St. Helier South 7 1.13 St. Helier West 6 0.82 North-East 17 2.07 North-West 13 2.00 Central 12 2.26 South-East 11 1.69 South-West The classification of cancer Table 5. 12 deaths by sites 2.07 affected is given in 15 TABLE 5. Group. Site Affected. Male. Female. Total. 45 Buccal Cavity 1 4 46 Digestive Organs— Oesophagus 2 5 7 Stomach 8 5 13 Liver and Gall Bladder — 3 3 Intestines 3 3 6 Rectum and Anus 8 4 12 Pancreas 2 2 4 47 Respiratory Organs— Larynx and Trachea 4 — 4 Lungs and Bronchi 11 1 12 48 Uterus — 6 6 49 Other female genital organs — 1 1 50 Breast — 12 12 51 Male genital organs, 1 — 1 52 Urinary organs 3 1 4 53 Skin — — — 54 Brain — 1 1 55 Other organs— Leg — — — Arm — — — Abdomen 1 — — Maxillary Antrum — — — Generalised 1 — 1 44 45 89 Average age at death—- Males 57.1 years. Females 61.3 „ All persons 59.2 „ There was a welcome fall in deaths from tuberculosis for the second year in succession, the rate for the year under review being 0.51 per 1,000 population. This mortality despite an increase in the number of cases is now more favourable than before the war. Further details are to be found later in this report. The year was also a more favourable one for mortality from the common infectious diseases, the seven principal infections, namely, smallpox, scarlet fever, diphtheria, measles, whooping cough, enteric fever and infantile diarrhoea, accounting for only two deaths, the lowest yet recorded. This is particularly gratifying, as this mortality probably more than any other reflects the sanitary and protective measures instituted in the district. Road accidents accounted for three deaths, one more than in the year before, whilst other forms and violence caused seven. Inquests. Inquests were held on 42 persons whose deaths occurred in the district and the following verdicts were returned: — 16 Natural causes 9 Suicide 4 Accidental 22 Misadventure 4 Open verdict 2 Chronic alcoholism 1 Eighteen of the total were residents of the district. Nine deaths were due to road accidents. INFANT MORTALITY. The deaths of 19 infants during the first year of life were registered, 8 of which were males and 11 females. The infant mortality rate of 23 per 1,000 live births is the lowest yet recorded for the district, the previous most favourable figure being 27 in 1942. The present rate is half that for England and Wales as a whole. It is remarkable moreover that no illegitimate infant died, neither was any still-birth illegitimate. More than half the infants who died were either premature or had congenital malformation. Only four died from obviously infective conditions. TABLE 6. INFANT MORTALITY—WARD DISTRIBUTION. Ward. Infant Deaths. Rale per 1,000 Live Births. St. Helier North 2 16 St. Helier South 3 36 St. Helier West 1 9 North-East 6 33 North-West — — Central 2 24 South-East 7 75 South-West - - MATERNAL MORTALITY There was no death attributable to diseases of pregnancy, childbirth or the puerperal state. 17 18 TABLE 7. INFANT MORTALITY DURING THE YEAR 1945. Deaths Classified as to Cause and Age at Death. Cause of Death. Under 1 week 1—2 weeks 2—3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Smallpox — — — — — — — — — — Chickenpox — — — — — — — — — — Measles — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions — — — — — — — — — Laryngitis — — — — — — — — — Bronchitis — — — — — — 1 2 — 3 Pneumonia (all forms) — 1 — — 1 — — — — 1 Diarrhoea — — — — — — — — — Enteritis — — _ Gastritis — Syphilis — — — — — — — — — Rickets — Suffocation (overlying) — Injury at Birth 1 — — 1 — — 1 Atelectasis 1 — 1 1 Congenital Malformation 1 2 3 2 1 1 7 Premature Birth 2 3 — 5 5 Atrophy, Debility and Marasmus — — — — — — — — — — Other Causes 3 — — — 3 — — — — 3 Totals 8 4 2 — 14 2 2 3 — 21 19 TABLE 8. CAUSES OF DEATH DURING THE YEAR 1945. HY 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 ... 10 11 1 — 2 1 6 5 4 7 21 12 44 15 38 19 63 45 55 86 244 201 445 1 Typhoid and Paratyphoid — — — — — — — — — — — — — — — — — — — — — — — 2 Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — 3 Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — 4 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — 5 Diphtheria — — — — — — — — — — — — — — — — — — — — — — — 6 Tuberculosis of Respiratory System — — — — — — 2 2 3 1 4 1 4 1 5 1 1 2 — — 19 8 27 7 Other Forms of Tuberculosis — — — — — — — — — — — — — — 1 — — — — — 1 — 1 8 Syphilitic Diseases — — — — — — — — — — — — — — 1 — — — — — 2 — 2 9 Influenza — — — — — — — — — — — — 1 1 — — — — — — 1 1 2 10 Measles — — — — 1 — — — — — — — — — — — — — — — 1 — 1 11 Ac. Polio Myelitis and Polio Encephalitis — — — — — — — 1 — — — — — — — — — — — — — 1 1 12 Ac. Infantile Encephalitis - - - - - - - - - - - - - - - - - - - - - - - 13 Cancer of Buc. Cav and Oesophagus(M) Uterus(F) - - - - - - - - - - - - 1 1 3 1 2 - - 2 6 8 14 Cancer of Stomach and Duodenum - - - - - - - - - - - - 2 1 1 1 2 1 3 3 8 6 14 15 Cancer of Breast — — — — — — — — — 1 — 3 — 3 — 1 — 4 — — — 12 12 16 Cancer of all Other Sites - - - - - - - - - - 4 4 13 1 4 4 9 7 4 5 34 21 55 17 Diabetes - - - - - - - - - - - - - - - - - - - 1 1 1 2 18 Intra-cranial Vascular Lesions - - - - - - - - - - - - 3 3 3 3 10 5 6 15 22 £6 48 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 10 11 1 — 2 1 6 5 4 7 21 12 44 15 38 19 63 45 55 86 244 201 445 19 Heart Disease - - - - - - - - - 2 4 1 4 1 11 2 22 15 23 34 64 55 119 20 Other Diseases of Circulatory System - - - - - - - - - - - - 1 - 1 1 4 2 4 9 9 13 22 21 Bronchitis — 2 — — — — — — — — 1 — 5 — — — 2 1 4 2 12 5 17 22 Pneumonia 2 - - - - 1 - - - - 2 1 1 — 1 — 3 1 4 4 13 7 20 23 24 Other Respiratory Diseases Ulcer of Stomach or — — — — — — — 1 1 — 2 — — — 3 — 1 1 — 2 7 4 11 denum — — — — — — — — — — — — 2 1 —. — 2 — — — 4 1 5 25 Diarrhoea, under 2 years 1 - - - - - - - - - - - - - - - - - - - 1 — 1 26 Appendicitis - - - - - - - - - - 1 - - - - - - - - - 1 — 1 27 Other Digestive Diseases - - - - - - - - - - - - - - 5 2 1 — — 2 6 4 10 28 Nephritis ... — — — — — — — — — 2 — 1 — — 1 1 1 1 1 2 3 7 10 29 Puerperal and Post Abort. Sepsis - - - - - - - - - - - - - - - - - - - - - - - 30 Other Maternal Causes - - - - - - - - - - - - - - - - - - - - - - - 31 Premature Birth 2 3 - - - - - - - - - - - - - - - - - - 2 3 5 32 Congenital Malformation, Birth Injury, Infant Diseases 5 6 1 — — — — — — — — — — 2 — — — — — — 6 8 14 33 Suicide - - - - - - - 1 - 1 - - - - - - 1 - - - 1 2 3 34 Road Traffic Accidents — — — — — — 1 — — — — — 2 — — — — — — — 3 — 3 35 Other Violent Causes — — — — — — 1 — — — — 1 1 — 1 — — — — 3 3 4 7 36 All Other Causes — — — — 1 — 2 — — — 3 — 3 — — — 3 2 6 4 18 6 24 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 seven, 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 1945 is supplied by courtesy of the Honorary Secretary : — Cases Attended. Visits Made. Expectant Mothers 2 7 Children under 5 years 63 275 Maternity Cases 42 726 Midwives Cases 81 1,531 Puerperal Pyrexia 2 10 General 488 7,119 678 9,668 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 cover the Morden section of the St. Helier Estate. 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 1 37 General 29 410 30 447 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. 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.I. Milk samples were sent to the Public Analyst, and for bacteriological examination to the Epsom E.P.H. Laboratory. 21 The following examinations were made:— No. Positive Examined. Results. Swabs for diphtheria 217 19 Sputum for tubercle 19 5 Faeces for enteric, dysentry, etc. 23 4 Swabs for puerperal sepsis 1 1 Water:— For chemical analysis 3 For bacteriological examination 5 Food and Drugs.— Analyses 141 Bacteriological examination of milk 92 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 Servict during the year. Calls to Street Accidents, etc. 210 Answered by own ambulances 185 Transferred to other authorities 25 Calls to remove cases from domestic dwellings to nursing homes, hospitals, or vice versa 866 Answered by own ambulances 818 Transferred to other authorities 48 Calls answered for other authorities in other districts 93 Total calls answered 1,096 Distance travelled on calls (miles) 8 075 Average mileage per call (miles) 7.36 Number of occasions on which both ambulances were out at the same time 6 Number of occasions on which a third call was transferred to other services when both vehicles were out or one under repair 73 Greatest number of calls answered in any one day 9 The service is free to residents for all types of cases for removal within a 20-mile radius, and to and from County Hospitals. The number of calls answered is 172 more than in 1944, chiefly due to an increase in street accidents requiring the services of an ambulance and to a greater number of calls answered for neighbouring authorities. Complete reciprocal arrangements exist with most of the neighbouring authorities. 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 1945 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 such patients. 22 23 TABLE 9. CUDDINGTON JOINT HOSPITAL BOARD. List of Admissions to Cuddington Hospital from 1st January to 31st December, 1945. Disease. Banstead. Carshalton. Epsom and Ewell. Leatherhead. button and Cheam. H.M. Forces. Others. Total. No. Died. No. Died. No. Died. No. Died. No. Died. No. Died. No. Died. No. Died. Scarlet Fever 32 90 42 11 69 - 4 2 250 - Sc. F. + Complications 1 — 3 - — — — — 1 5 No evidence — — 3 - 2 _ _ 5 ___ Diphtheria 7 — 17 - 4 — 2 1 16 6 1 53 1 Diph.+Complications 2 — — - 2 — — — 1 - — — — 9 - Diph. carrier 2 — 8 - 1 — 2 10 - — 23 No evidence — 2 - 1 1 1 _ - - 5 __ Tonsilitis 3 2 - 6 - 3 - - - 14 Tonsilitis+Complications — — — - — — 1 3 - 1 5 No evidence 1 — — - 1 2 Measles 8 — 9 - 7 7 14 4 2 51 _ Measles + Complications — — — 1 2 - 2 3 7 1 No evidence 4 - 1 1 __ 1 7 Rubella 2 1 - - - - - 1 - - - - - 4 No evidence 1 - - - - - - - - 1 - - - 2 Whooping Cough 1 — 1 - 6 — 2 3 2 15 - Wh. Cough+Complications — — 2 - 2 — — 1 1 - — 5 1 No evidence - - - - - - - - - - - - - - 1 Dysentery (Inc. Sonne) 2 — 4 - 12 — — — 4 — 1 — 23 - Dysentery Carrier - - - - - - - - - - - - - - 1 - No evidence — — 1 - 1 — — — 2 - Typhoid (Inc. Para) — — — - 3 — 1 1 - — — 5 - No evidence — • — — - — — — —. 1 . — 1 - Meningitis — — 1 - 1 — — 1 1 - — — 3 1 No evidence — — — - — — — 3 — 3 - Other Diseases 12 1 15 — 10 1 7 — 23 1 7 — 4 — 74 3 Totals 75 1 160 1 98 1 36 2 166 2 27 — 13 — 575 7 76 161 99 38 168 27 13 582 CUDDINGTON JOINT HOSPITAL BOARD. Patients in other Hospitals from 1st January to 31st December, 1945. Disease. Banstead No. Died. Carshalton No. Died. Epsom and Ewell No. Died. Leather- head No. Died. Sutton and Cheam No. Died. Total No. Died. Scarlet Fever 3 — 1 — 1 — - - — — 5 — Tonsillitis — — 1 — — — — — — — 1 — Measles — — 1 — — — — — 1 — 2 — Mumps 1 — - - - - - - - - 1 — Mumps and Complications - - - - - - - - 1 — 1 — Urticaria — — — — — — 1 - 1 — Totals 4 — 3 — 1 — — — 3 — 11 — The hospital arrangements for smallpox are in the hands of the County Council who provide accommodation at the Isolation Hospital, Clandon. General hospital facilities are provided in the main by the St. Helier Hospital, the county institution situate within this Urban District, construction of which was delayed by the war. Owing to difficulties with regard to building and staffing it is not yet in full commission. It will ultimately provide more than 800 beds. The Carshalton, Beddington and Wallington (War Memorial) Hospital has for many years provided valuable hospital facilities. Its normal complement of 62 beds was temporarily increased to 101 during the war by the addition of 39 emergency beds, under the Government emergency hospital arrangements. At the end of 1945, like many other similar institutions, the hospital was suffering from shortage of staff, and 19 of its 62 beds has necessarily to be put out of commission. The hospital report for 1945 supplies the following information : — Beds. (a) Complement at December 31st, 1945 43 (b) Average daily complement during year 85 (c) Average daily number of calls during the year on account of shortage of staff 19 (d) Average daily number open during years— (i) E.H.S. Casualty beds 13 (ii) Other beds 53 (e) Average daily number occupied during the year— (i) E.H.S. Casualty beds 0.3 (ii) Other beds 38 24 Number of in-patients admitted during the year— Civ. 1019 E.H.S. 5 Average number of days each patient was resident 13 The in-patients were admitted from the following districts:— Civ. E.H.S. Carshalton 487 4 Beddington and Wallington .438 1 Other districts 94 — 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. Toddler Clinic 1st and 3rd Weds. 2—4 p.m. Dental Clinic Mondays 10—12 a.m. Fourth Saturday 10—12 a.m. Wry the 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. 25 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 846 Notified by midwives 7*29 Still births 19 Notified by doctors and parents 35 Transferred notifications 101 865 865 The total is 58 less than in the year before, and represents 103 per cent, of the number of births registered during the year. Health Visiting. The staff of Health Visitors was seriously depleted during the year. The normal establishment of five was reduced to three for six months, and only in the last quarter was it restored to full strength. Consequently the scale of visiting was much less than was desirable. The visits made, excluding those in connection with the Child Life Protection provisions of the Public Health Act referred to later in this report, were as follows: — To expectant mothers— First visits 90 Total visits 134 To children under 1 year— First visits 894 Total visits 2,842 To children 1-5 years— Total visits 4,061 7,037 Clinic Activities. A full programme of welfare clinics was in operation throughout the year at the five centres established under the scheme. The number of sessions averaged 12½ per week. These have since been increased to 14 by an additional weekly ante-natal session, and a fortnightly Toddler Clinic at the Rochester Road Centre. A record number of expectant mothers attended the ante-natal clinics. New cases totalled 514, whilst those on the register during the year numbered 620. Never before has this latter figure reached 600. The number of new cases represents an increase of 40 per cent, over the 1944 figure. A further 60 mothers attended exclusively the maternity clinic of the St. Helier Hospital, and when these are taken into account the number of expectant mothers who received clinic supervision during the year represented 68 per cent, of the notified births. A high proportion of Carshalton babies are now 26 born in the St: Helier County Hospital, and closely co-ordinated arrangements exist between the hospital maternity services and the Council's clinics. The new babies under one year attending the Infant Welfare Clinics also established a new record. The number at 731 represents 90 per cent, of the notified live births, and compares with the previous highest percentage of 86 in 1941. TABLE 10. ATTENDANCES AT MATERNITY CLINICS—1945. CENTRE. No. on Register. Attendances. Sessions. Average attendance per Session. *Primary. Total. Rochester Road. Ante-Natal 163 143 601 Post-Natal 19 6 19 49 12.7 Individuals 169 149 620 Wrythe Lane Hall. Ante-Natal 337 278 1323 Post-Natal 17 2 16 96 13.9 Individuals 339 280 1339 St. Helier. Ante-Natal 8 7 32 Post-Natal — — — 21 1.5 Individuals 8 7 32 Stanley Road. Ante-Natal 96 74 340 Post-Natal 16 4 20 50 7.2 Individuals 100 78 360 The Mount. Ante-Natal 16 12 42 Post-Natal 3 1 3 22 2.0 Individuals 17 13 45 All Centres. .Ante-Natal 620 514 2338 Post-Natal 55 13 58 638 10.0 Individuals 633 527 2396 * Primary attendance's the first attendance of a woman in relation to the pregnancy under supervision. A further 60 primary attendances were made by Carshalton mothers to the St. Helier Hospital Ante-Natal Clinic. 27 28 TABLE 11. ATTENDANCES AT INFANT CONSULTATION CLINICS, 1945. 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 1 562 218 173 218 2817 101 42.9 1—5 38 369 38 1517 VVrythe Lane Under 1 838 269 217 269 2775 100 36.3 1—5 11 579 11 830 St. Helier Under 1 215 84 83 84 1279 49 35.1 1—5 7 120 7 44ft Stanley Road Under 1 528 138 106 128 2059 51 60.5 1—5 46 372 41 102 The Mount Under 1 102 22 12 16 274 22 31.3 1—5 17 81 7 415 All Centres Under 1 2245 731 594 715 9204 323 41.6 1—5 119 1521 104 4260 Totals 2245 844 2245 819 13464 323 41.6 Premature Births—Circular 174/44. Special provision including an air-conditioned room and incubators exists at the St. Helier County Hospital for the care of premature babies. These arrangements are under the supervision of a paediatrician. Removal to the hospital is by ambulance equipped with an electrically heated incubator. The number of premature births notified during the year was 105. Of these 15 were born at home and 90 in hospital. Further details of these premature infants are as follows : — The number of babies born at home— (i) who were nursed entirely at home 13 (ii) who died during the first 24 hours 1 (iii) who survived at the end of one month 14 The number of those born in hospital— (i) who died in the first 24 hours 4 (ii) who survived at the end of one month 77 The survival rate after one month for all premature babies was 86 per cent. These figures are in respect of all the births which occurred in the district, mostly in the St. Helier Hospital, only a proportion of which were Carshalton residents. Routine Medical Inspection of Toddlers:— Special Toddler Clinics were established at the Wrythe Lane and Stanley Road Centres, and have since been extended to the Rochester Road Centre. The aim is to secure an annual systematic medical overhaul of toddlers in their 3rd, 4th and 5th years. These clinics were suspended during the latter half of 1944 on account of difficulties arising out of the war, but the normal programme was re-instated at the beginning of 1945. Considering the many claims on the mothers' time it is gratifying to report that the parents of some 700 children accepted the appointments given to them for this routine medical examination. The number is greater than in the more leisured pre-war years, and is the highest yet. Of 697 children examined 510 had some defect. The number of defects observed was 815, for 437 of which treatment was advised, and 377 observation. Apart from the fact that the scope of these examinations is much more comprehensive than the consultations at the weekly infant clinics, the usefulness of this scheme is further indicated by the fact that 230 toddlers who were examined had not attended the regular welfare sessions during the year, and 31 had never previously attended a clinic at any time. Experience shows that as an infant approaches the age of five its attendances at the welfare clinic get progressively fewer, not infrequently ceasing altogether after about 18 months. The mother feels that her child has become less dependent upon her, and that her problems are fewer. A child's feeding certainly becomes less specialised, but its psychological needs assume considerable importance during the early years of mental development. 29 TABLE 12. DEFECTS FOUND AT SPECIAL TODDLER EXAMINATIONS—1915. Defect. Recommended for Number which received Treatment by Observation. Treatment. Own Dr. Hospital. At Home by Advice. Clinic Total. Cleanliness - 1 - - 1 - 1 Nutrition 8 17 — 1 14 — 15 Ringworm " - - - - - - - Impetigo Skin - - - - - - - Scabies - - - - - - - Other skin conditions 6 17 — 2 12 1 15 Blepharitis — 2 — — 2 — 2 Conjunctivitis - 3 — 2 1 — 3 Keratitis - - - - - - - Corneal Ulcer Eyes - - - - - - - Corneal Opacities 1 — — 1 — — 1 Other Conditions 4 1 — 1 — — 1 Vision 1 — — — — — — Squint 18 12 — 12 — — 12 Hearing 4 3 — 1 — — 1 Otitis Media Ears 4 3 — — 1 — 1 Other Diseases 3 4 — — 2 1 3 Teeth 28 39 — 4 2 22 28 Tonsils 130 30 — 12 — — 12 Adenoids 29 17 — 2 — — 2 Other Conditions 8 11 - - - - - Enlarged Cervical Glands 36 4 — 2 — — 2 Speech 2 2 — 2 — — 2 Heart Disease 16 1 1 — — — 1 Anaemia _ 74 - — 74 — 74 Lungs, Tubercular — 1 — 1 — — 1 Lungs, non-Tubercular 7 14 3 9 2 — 14 Other Tubercular' Diseases - - - - - - - Epilepsy — 1 — — - — — Chorea — — — — - — — Other Nervous Conditions 2 1 - - - 1 1 Rickets 1 13 - 1 4 3 8 Spinal Curvature — 2 — — — 2 2 Other Deformities 21 40 — 1 20 15 36 Mental Condition 1 6 1 3 — 4 Behaviour 3 2 — — 1 — 1 All Other Defects 44 117 3 1 27 33 64 Total 377 438 7 56 166 78 300 30 TABLE 13. ATTENDANCES AT SPECIAL TODDLER (2-5 Years) CLINICS, 1945. Centre. No. of routine medical examinations. Reinspec tions. Total attendances. Sessions. Average attendance per Session. Did not attend Infant Consultation Clinic. 2—3 years. 3—4 years. 4—5 years. Wrythe Lane 214 181 126 — 521 48 10.8 201 Stanley Road 97 33 46 13 189 22 8.6 29 Totals 311 214 172 13 710 70 10.1 230 Each child attended once for routine examination. TABLE 14. ATTENDANCES AT ALL INFANT WELFARE CLINICS, 1945. (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 2942 731 715 9204 393 23.4 1—5 150 135 4970 12.8 Totals 2942 881 850 14174 393 36.2 Supply of Milk and Other Foods. Dried milk and vitamin products supplied by the Ministry of Food for mothers and children are issued at the Welfare Centres. A limited range of other foods and vitamin products, including proprietary brands of dried milk, are also available at the clinics under the Councils' own arrangements. The value of the sales of these commodities is approximately £700 per annum, mostly in respect of milk powder. 31 Dental Scheme. A dental clinic is held at the Rochester Road Centre approximately six times per month. A part-time Dental Surgeon and Anaesthetist are in attendance, and the scope of this service is comprehensive. The work carried out during the year is indicated by the following information: — DENTAL SCHEME—TREATMENT PROVIDED, 19J5. Temporary Teeth. Permanent Teeth. Dentures Supplied. Extracted. Filled. Extracted. Filled. Full. Partial. 58 35 481 120 52 94 Anaesthetics Gas 102 Vinesthene 24 Local 27 Inspections 277 Other operations Impressions 184 Bites 140 Try-ins 143 Dressings 2 Scalings 42 Repairs 12 Remodelling 6 Dentures supplied— Full Partial Free 6 2 Half Price 5 4 Part Cost 5 7 Full 36 81 Total 52 94 32 Attendances at the Dental Clinics were as follows: — DENTAL SCHEME—ATTENDANCES, 1945. Centre Referred from. No. Treated. No. of attendances. Rochester Road. Children 22 29 Mothers 48 221 Individuals 70 250 Wrythe Lane Children 21 31 Mothers 91 370 Individuals 112 401 St. Helier. Children - - Mothers 15 56 Individuals 15 56 Stanley Road Children 8 16 Mothers 20 100 Individuals 28 116 The Mount Children - - Mothers 1 6 Individuals 1 6 St. Helier Hospital Mothers 1 7 Individuals 1 7 Day Nursery. Children 1 2 Individuals 1 2 All Centres. Children 52 78 Mothers 166 760 Individuals 228 838 Number of Sessions held 84 Average attendance per Session : — Children 0.9 Mothers 9.0 Individuals 9.9 33 Orthopasdic Treatment For the treatment of minor orthopaedic defects the Council has an arrangement with a local private masseuse whereby children are referred from the Council's clinics and attend the private premises of the masseuse. During the year 43 children received 854 treatments for the following defects : — Genu-valgum 4 Genu-varum 34 Kyphosis 1 Muscular weakness 4 43 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. One case was provided with a surgical appliance during the year at part cost. Convalescent Treatment. As a result of war-time difficulties provision of convalescent home treatment was on a much reduced scale. Children in need of this treatment are referred to the Invalid Children's Aid Association, with whom the Council has an arrangement. The Council also subscribes to the Convalescent Homes for Surrey in respect of the treatment of mothers and babies. One case received treatment for two weeks under this arrangement for a bronchial condition in a child contact of tuberculosis. Maternity Hospital Treatment Most of the mothers needing institutional accommodation for confinement are admitted to the St. Helier County Hospital. An agreement exists with the local War Memorial Hospital for the admission of maternity cases, but it is becoming increasingly difficult to secure the admission of cases referred from the Council's clinics. The cases referred and admitted to hospital during the year were as follows : — For obstetric For unsuitable and medical home reasons. conditions. Total. Carshalton (War Memorial) Hospital — 3 3 St. Helier County Hospital ... 45 32 77 Other County Hospitals ... 4 10 14 49 45 94 Although only 94 cases were referred from the Council's clinics, it should be observed that no fewer than 483 Carshalton babies were born in hospital, and a further 55 in private nursing homes. 34 There has for some time past been a growing tendency for mothers to seek institutional accommodation for their confinement. Among the contributory causes are, lack of adequate domestic accommodation, lack of domestic help, and convenience. Whilst the number of cases admitted for purely medical reasons is no greater, the percentage of institutional births has more than doubled in the last ten years. Although the demand still exceeds the available accommodation, there is no doubt that the existing beds can cater for those who have undeniable claims to admission. The chief risk in the present situation is that necessitous cases may be excluded by the filling of the beds with cases whose only claim is one of convenience. Unmarried Mothers and Illegitimate Children The number of illegitimate births has doubled since pre-war years, not a small part of the increase being in respect of births to married women. The Council's Welfare Service works in co-operation with the Sutton and District Girls' Aid Association in the care of unmarried mothers. This arrangement includes the following facilities : — 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. The moral welfare worker of the association has given the following information as to the mothers assisted during the year : — Unmarried mothers assisted 8 Admitted to special homes 5 Transferred to R.C. Worker 1 Went to relations in the country 1 Admitted to institution (second child) 1 Of the babies born to these girls— 2 were adopted. 2 were with their mothers in domestic posts. 1 is in a home (mother paying). 1 is with a foster-mother 1 is with a grand parent Married women assisted 4 Transferred to R.C. Worker 2 Child adopted 1 Child died after 5 days 1 The Council accepted financial responsibility for the maintenance in shelter homes of six unmarried mothers for a total of 81 patientweeks. 35 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. Two were issued during the year at cost price. Home Helps. The same difficulty in securing the services of women to act as home helps under the scheme was experienced as in recent years. Improved rates of pay failed to attract suitable applicants, and the needs of many expectant mothers could not be met. Seven helps were provided during the year. Midwives. Two midwives are appointed by the District Council under the County Council's midwifery scheme formulated under the Midwives Acl 1936. The fees fixed by the County Council for the services of the 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 21 105 126 Still births — 3 3 (2) As Maternity Nurse— Live births 3 2 5 Still births — — — 24 110 134 Visits made— Ante-natal 1593 Nursings 2376 Post-natal 377 36 Medical Aid Forms sent by Midwives 33 Rise of Temperature 3 Torn Perineum 15 Delayed Labour 5 Malpresentation 3 Adherent Placenta 1 Discharging Eyes 1 Malformation of Infant 1 Convulsions in Infant 1 Fractured Coccyx 1 Post Partum Haemorrhage 1 Number of cases which attended the ante-natal clinics 51 Thirty-one other midwives resident in the district declared their intention to practice in 1945. Of these, 22 were on the staff of the St. Helier Hospital, 4 on the staff of the War Memorial Hospital, 3 were District Nursing Association Midwives, and one a County Council midwife. Voluntary Helpers. The scheme has always had the assistance of voluntary helpers in the Infant Welfare Clinics. Nine ladies gave their valuable services in 1945 with the same regularity and enthusiasm as they have always shown. 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 18 Number of new homes registered during the year 10 Number of foster homes removed from the register during the year 9 Total number of foster homes supervised 27 Number of children admitted to the register during the year 17 Number of children removed from the register during the year 20 Total number of children on the register at year end 22 Total number of children on the register during the year 39 Number of children who died during the year — Number of inquests held — Number of visits made to foster homes 98 Legal proceedings — Adoption of Children (Regulation) Act, 1939. This Act, which came into operation in 1943, 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 37 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 7 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 7 (c) Number of children notified under Section 7 (3) : — (i) under supervision at the end of the year 4 (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 t DAY NURSERIES. The Carshalton Day Nursery in Camden Road, administered by a voluntary committee, has for many years provided day-time nursery facilities. During the war the accommodation was extended to 24 places,-but the age range of children admitted was restricted to the 2—5-year groups, and this is still the practice. The number of children on the register at the year end was 27. The mothers of 16 were in full-time employment, and those of 11 in part-time. The total attendances were 5,053, compared with 4,549 in the year before. This gives an average daily attendance of 17.3 for the 291 days on which the nursery was open. The nursery receives a yearly grant from the Council. The Council's War-time Nursery in Green Wrythe Lane was established in 1942. Originally designed for 40 children, it was extended during 1945 to provide day-time care for 74, the new extension being opened on the 12th February. The hours of opening are 7 a.m. to 6 p.m., Monday to Friday; 7 to 1 p.m. on Saturday. The applications for admission have been greater since the end of the war than during the period of hostilities. The attendances were as follows: — 39 Total attendances—under 2 years 5059 over 2 years 7317 12366 Days open 289 Average daily attendances—under 2 years 16.9 over 2 years 24.5 41.4 Attendances excluding Saturdays— under 2 years 4852 over 2 years 7002 11854 Days open, excluding Saturdays 251 Average daily attendance, excluding Saturdays—under 2 years 19.5 over 2 years 29.2 48.7 Since the close of the year the Nursery has been transferred to the Council's Maternity and Child Welfare Scheme, and is being continued as a Day Nursery for children 0—5 years of age as before. 39 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. Further samples are taken by this department should occasion justify such an action. 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. Five samples for bacteriological, and three for chemical examination were taken by this Council, and were reported satisfactory. One of these, a representative sample for this supply, was reported upon by the Public Analyst as follows: — Chemical analysis in parts per 100,000. Total solid matter in solution (dried at 180° C.) 16.4 Combined chlorine 1.40 Nitric nitrogen 0.44 Nitrous nitrogen none Ammonia, free and saline 0.0045 Ammonia, albuminoid 0.0015 Oxygen absorbed from permanganate in 4 hours at 26.7° C. 0.005 Hardness—by acidimetric titration— Temporary 9.3 Permanent 2.6 Total 11.9 pH 7.6 Reaction for free chlorine : positive, equivalent to 0.3 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. 0 Organisms of the coliform group absent in 100 ml. Streptococci do. CI. welchii do. This water is of high organic purity and its bacteriological condition is excellene- The water is suitable for the public supply. 40 The supply is not regarded as having particular plumbo-solvent action. None of the houses depends on a stand-pipe, all having a piped supply direct to the house. Drainage and Sewerage. The Culvers Avenue site of 10.8 acres, required for the erection of 103 temporary houses, was sewered and drained during the year. In this work 433 yards of 6in. soil sewers, 258 yards of 6in. and 200 yards of 9in. surface water sewers were laid. Two hundred and seventy drainage obstructions, affecting 699 houses, were dealt with chiefly concerning combined drainage systems. Rivers and Streams. One complaint was received which was adequately dealt with. Closet Accommodation. All houses have water closets, only 27 of which, in unsewered areas, are not connected to sewers. Public Cleansing. The collection of food refuse for pig feeding was continued, and continued to present not a little difficulty from the point of view of public hygiene. Disposal of refuse, other than that having salvage value, is, as previously, by incineration at the Council's destructor. 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 1,799 complaints as follows : — Drains obstructed 299 Sewers obstructed 2 Drainage defects 24 General defective conditions 155 Dampnes 22 Roofs, gutters, etc. 46 Sink waste pipes 18 Water supplies 28 Dustbins 437 Accumulations 22 Refuse collection 127 Smoke nuisance 3 Rivers, ditches, ponds UnSound food 119 Overcrowding 42 Obnoxious effluvia 35 Verminous premises 1 Scabies 97 Head lice 1 Rats and mice 195 Wasps 25 41 Ants 10 Beetles 1 Flies 10 Animals 15 Insects, various 39 Animal food storage Dirty milk bottles, sour milk 8 Miscellaneous 16 1,799 Ten thousand, two hundred and eighty-nine visits of inspection and re-inspection were made for the purposes set out below : — Public Health Act (houses) 3,362 Public Health Act reinspections 2,965 Housing Act — Housing Act reinspections — Dairies 52 Cowsheds 23 Milk Shops 63 Factories 80 House drains tested 90 Suspected rat infested premises 1,066 Foodshops and business premises 876 Infectious disease premises 207 Infectious disease contacts 88 Urinals 91 Premises re cesspools Schools 22 Offices 20 Bakehouses 17 Stables 36 Smoke observation 9 Outworkers' premises 27 Evacuees' premises 388 Piggeries Wasp nests 19 Vermin (Scabies and Head Lice) 107 A.R.P. 85 Food and Drugs and other samples 368 Shop premises 199 Insects 6 Accumulations 2 10,289 Eight hundred and ten informal notices were served concerning the following matters :— 42 General defective conditions 212 Rats and mice 36 Accumulations and deposits 20 Obstructed drains 152 Drainage defects 55 Verminous premises 9 Dustbins 222 Animal food storage 1 Water supply 4 Animals 10 Factory Acts 2 Food contamination 2 Unsatisfactory food premises 9 Miscellaneous 2 Burst pipes 10 Overcrowding 55 Shelters — Smoke nuisance — , 810 Forty-three formal notices were served by authority of the Council under the following Acts: — Section 93, Public Health Act, 1930 38 Section 75 do. do. 4 Rats and Mice (Destruction) Act, 1919 1 43 As a result of investigations made and notices served, the following work was carried out: — Brickworlt, repaired and/or repointed 5 Ceiling plaster repaired and/or made good (including plaster board) 48 Ceilings cleaned and purified 40 Chimney pots repaired and/or made good stacks repaired and/or made good 2 flues repaired 1 Cement fillets renewed and/or repaired 1 Damp conditions remedied 37 Doors repaired, including locks and fasteners 22 Door frames repaired and/or made good 6 stopping to reveals renewed Drainage repaired and/or reconstructed 48 provided inspection chamber repaired and/or made good 5 inspection chamber covers renewed 19 stoppers or caps refixed and/or renewed 1 interceptors renewed 2 fresh air inlet repaired and/or renewed 1 mica flap valve renewed 1 soil vent repaired and/or renewed 8 drains tested 170 43 drains cleared (affecting 699 houses) 270 drains sealed off 5 waste gullies repaired, renewed or cleared 25 waste gullies provided 3 Waste pipe, repaired and/or renewed 15 Disinfestation 8 Dustbins provided 282 Food storage, accommodation provided 1 Floor boards repaired and/or made good 35 concrete repaired, renewed and/or made level 1 ventilation repaired and/or renewed 1 ventilation provided 1 Fire places repaired and/or made good 12 Fire grates repaired and/or renewed 2 Ranges, stoves repaired and/or renewed 10 Roofs repaired and made weatherproof 71 ridges, hips, valleys repaired and/or renewed 2 flashings repaired and/or renewed 2 Down pipe, guttering repaired and/or renewed 22 cleaned out and made to work properly 2 Sinks renewed 1 provided 1 Stair treads repaired, renewed or made level 5 handrails and/or balusters repaired 4 Steps repaired and/or renewed 2 Soakaway provided 1 made to work properly 2 Surface water drainage repaired and made to work properly 1 Walls, cement rendered rendering repaired 5 replastered and/or repaired 38 cleansed and redecorated 47 rebuilt 1 Woodwork repaired and/or renewed Windows repaired and/or renewed 25 Window frames repaired and/or renewed 21 Windows made to work properly 5 provided with catches or fasteners 2 sash cords renewed 14 Window sills (external) repaired 9 Windows fixed, made to open 3 W.C. accommodation repaired 13 W.C.'s provided 2 W.C. pans renewed 15 pan joints renewed 7 seats repaired and/or renewed 11 flushing apparatus repaired or renewed 21 Water supply repaired 22 Wash basins, baths renewed or repaired 1 Paving repaired and/or made level 3 Nuisances abated 1,673 Rats and mice 167 Glazing panes renewed 18 Ventilation, more, provided Accumulations removed 15 44 Housing repairs, necessitated by enemy action carried out under the supervision of the Engineer and Surveyor, are not included in this report. Disinfection. In connection with cases of infectious disease, 207 rooms and 242 library books were fumigated. Fifty-eight lots of bedding were steam disinfected. Vermin Control. Persons. For the cleansing of verminous persons and their personal clothing the Council have established a Cleansing Station, equipped with a Thresh Steam Disinfector in Rochester' Road. A trained nurse ' is in attendance to deal with women and children, and a male operator for the men. Financial arrangements have been made with the Education Authority for the treatment of school children. The nurse in charge undertakes the following up of the families affected to ensure that treatment is carried to a successful conclusion. The homes are also visited by the Sanitary Inspectors when necessary, and appropriate action in respect of the premises taken as required. The following cases were dealt with at the Council's Station during the year: — Families. Persons. Attendances. For scabies 222 691 1327 For pediculosis 35 113 226 257 804 1553 School children included in these totals were : — For scabies 205 For pediculosis 75 Where possible, the practice of treating all members of affected families is followed. The Sanitary Inspectors visited 92 houses, and arranged for the treatment of 421 persons in the operation of the Scabies Order, 1941. Premises. The previous practice of hydrogen cyanide fumigation for premises badly infested by the bed bug had to be suspended during the war, and has not yet been resumed. Eighteen properties were treated by insecticidal spraying as follows: — Council Houses 4 Other Houses 13 C.D. Premises 1 Six other L.C.C. houses were sprayed by the staff of that Authority. Fumigation and spraying is carried out by the department, using formaldehyde blocks and various insecticidal liquids. Towards the end of the year experiments for the eradication of bed bugs and other insects by the use of D.D.T. in vapour form were being made. Thirty-eight lots of bedding were steam disinfected, and two lots destroyed during the year. 45 Pest Control. Eight premises were sprayed for the eradication of flies, fleas, etc. Eighteen wasp nests in, or in proximity to, dwellings were destroyed at the cost of the complainants. No sprayings for the destruction of mosquito larvae were carried out. Rats and Mice (Destruction) Act, 1919. Ministry of Food Infestation Order, 1943 (S.R. & O. 680). Rodent destruction work for the preservation of food supplies was intensified. During the year 3,860 investigations were made, whilst 195 complaints were received and dealt with. The number of infestations found was 167 (135 rats and 32 mice). The rat infested premises were : — Poultry and rabbit sheds 61 Defective drains 3 Other sheds 37 Old shelter banks 2 Open ground and dumps 29 Garages 5 Dwelling houses 8 135 Preliminary notices were served in 137 instances. At 117 private premises work of destruction was carried out at the owner's expense, and 25 Council properties received attention. Smoke Abatement. No complaints were received during the year. Schools. Having in mind war damage and the suspension of normal maintenance work, the sanitary conditions of the schools was fairly satisfactory. Many of the present improvisations, particularly in connection with school meals, need to be replaced by permanent and satisfactory arrangements, including adequate accommodation for this service. Redecoration in the schools, as in many homes, is long overdue. 46 Disposal of the Dead. The Merton and Morden and Carshalton Joint Cemetery Board, established in 1943, owns 58 acres of land in lower Morden for the burial needs of both districts. Some 19 acres have been laid out, but interments have not yet begun. The remaining unused part of Carshalton Church Yard will meet local needs for a limited period longer. Exploratory discussions have been held with other Authorities with a view to providing local cremation facilities. Modern and adequate mortuary facilities, with provision for postmortem examinations, are provided at the Council's Mill Lane mortuary. Shops Act 1912—1936. One hundred and ninety-five inspection of shops and business premises were made and no informal or formal action was necessary regarding infringements. There were approximately 580 shop premises on the register. Section 10 (Health and Comfort). It was necessary to take action in two cases for the provision- of sanitary accommodation. Offices. Twenty inspections of offices were made but no action was necessary. Swimming Baths. The one privately owned swimming bath is still closed. 47 Section D—Housing. New Houses. No new houses were constructed during the year. Council's Housing Scheme. The dwellings in the ownership of the Council total 624 houses and flats. During the year sites were acquired in Culvers Avenue and on the Clockhouse Farm Estate for housing purposes. The site in Culvers Avenue was laid out and ready for the erection of 103 factorymade temporary houses by the end of the year. In November authorisation was received to acquire the land on the Clockhouse Farm Estate, plans having already been prepared for approximately 140 houses on this site, which will be of the permanent type. Various other small sites owned by the Council capable of accommodating 64 houses were appropriated for housing purposes, and arrangements were made to acquire other small sites in private ownership. Only a very small amount of land in the district is available for housing development. 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) 3327 H.A.—Nil. P.H.A.—3327 (b) Number of inspections made for the purpose 6290 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 473 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) 369 48 3. Action under Statutory Powers during the year. (a) Proceedings under Sections, 9 10 and 16 of the Housing Act 1936. Number of dwelling houses in respect of which notices were served requiring repairs — Number of dwelling houses which were rendered fit after service of formal notices : — (a) By owners — (b) By local authority in default of owners ... — (b) Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 42 (2) Number of dwelling houses in which defects were remedied after service of formal notices : — (a) By owners 36 (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 92 (2) Number of families dwelling therein 139 (3) Number of persons dwelling therein 311 (b) Number of new cases reported during the year 41 (c) (1) Number of cases of overcrowding relieved during the year 21 (2) Number of persons concerned in such cases 144 (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. No action of this nature was undertaken. Overcrowding. The position with regard to overcrowding deteriorated still further with the absence of any new housing construction. The number of outstanding applicants for tenancies received by the Council is now approximately 1,650. There are no accurate figures as to the existing extent of overcrowding. This can only be obtained by a comprehensive survey such as was carried out in 1936 under the Housing Act, 1935. At the present time whilst some of the adult residents are still serving with the Forces, there is no doubt that the average level of occupation per house is less than in 1939, but the number of families is probably higher as a result of the higher age constitution of the population, 49 which now contains a larger proportion of married people. The figures shown below in respect of overcrowding are those resulting from visits to houses in the course of routine sanitary work, and do not in any way purport to indicate the complete position. During the year 41 new cases of overcrowding were found, and 21 were remedied, leaving 92 dwellings known to be overcrowded with 677 equivalent adults in occupation still to be de-crowded at the year end. Details are as follows : — Overcrowded at 31.12.44. Dwellings found overcrowded up to 31.12.45. Houses decrowded during 1945. Remaining overcrowded at 31.12.45. Decrease during year 1945. Families 72 41 21 92 20 Equivalent Adults 510 311 144 677 167 Sixteen of the new cases of overcrowding were illegal. The 21 cases of overcrowding were abated during the year by : — Provision of alternative accommodation : — (a) By Carshalton Council 4 (b) By London County Council 8 Left the district 3 By removal of one or more occupants 6 The history of known overcrowding since the survey of 1936 is indicated by the following: — Ward. Houses overcrowded at Survey. Houses found overcrowded up to 31.12.45 Houses decrowded up to 31.12.45 Houses remaining overcrowded at31.12.45 Overcrowded cases remedied during 1945. Formal. Informal. Total. St. Helier North 40(a) 108 (f) 117(i) 31 (m) 3 1 4(b) St. Helier South 40(b) 92(g) 117(b) 15(b) 2 2(b) St. Helier West 45 (b) 102(g) 119(l) 28(b) 6 3 9(b) North-East 17(c) 36(c) 45(k) 8(k) 2 — 2(k) North-West 10 41 48 3 - 1 1 Central 9(d) 15 22(d) 2(d) 1 1 2 South-West - 5 4 1 - — — South-East 12(e) 25(h) 33(l) 4(l) 1 — 1(l) Totals 173 424 505 92 15 6 21 (a) 39 L.C.C. houses. (g) 91 L.C.C. housese. (b) All L.C.C. houses. (h) 19 C.U.D.C. houses. (c) 4 C.U.D.C. houses. (i) 116 L.C.C. houses.. (d) 1 C.U.D.C. house. (j) 128 L.C.C. houses. (e) 5 C.U.D.C. houses. (k) 43 C.U.D.C. houses. (f) 105 L.C.C. houses. (1) 32 C.U.D.C. houses. (m) 31 L.C.C. houses. 50 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 slightly from 99 to 104, of which 64 had mechanical power. The total employees fell from 1,900 approximately to 1,740, of whom 800 were males and 940 females. No formal notices were necessary, and only two informal notices were served under the Factories Act. 61 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." Regular inspections have been made of the farms. Only a very small amount of unp^steurised or raw milk is consumed in the district. Milk Retailers. The number of registered retailers was 22 compared with 73 before the war, the reduction being due to rationalisation of deliveries. The results of the chemical analyses of milk are shown under the section dealing with Food and Drugs Act. Milk (Special Designations) Regulations 1936-1943. Licences under these Regulations were issued as follows : — Principal Licences—Tuberculin Tested 5 Pasteurised 7 Supplementary Licences—Tuberculin Tested 8 Pasteurised 7 Bacteriological Examination of Milk. Ninety-two samples of milk were submitted for examination under the Milk (Special Designations) Regulations. Sixty-two complied and 30 failed to comply with the prescribed tests. The unsatisfactory samples were mostly of pasteurised milk. Food and Drugs Act, 1938. Defence (Sale of Food) Regulations, 1943. Food Standard Orders. Labelling of Food Orders, etc. One hundred and forty-one samples of the undermentioned foods and drugs were submitted to the Public Analyst with the results indicated. 52 Article. Samples. Reported as Genuine. Adulterated or otherwise irregular. Formal. Informal. Baking Powder 1 - 1 - Butter 2 — 2 — Cake Mixtures 3 — 3 — Chocolate Cup 1 — 1 — Cocoa 1 — — 1 Coffee and Chicory 2 — 2 — Curry Powder 2 — 2 — Drug (as prescribed) 1 — 1 — Fish Paste 1 — 1 — Gelatine 2 — 2 — Herring (Smoke Spread) 1 — 1 — Ice Cream — 1 1 — Jam, Plum 1 — 1 — „ Damson 1 — 1 — „ Apple and Blackberry 1 — 1 — Lard 3 — 3 — Lemon Flavour Mould 1 — 1 — Margarine 2 — 2 — Milk 81 — 81 — Mustard 2 — 2 — Orange Flavour 1 — 1 — Pancake Mixture 1 — 1 — Pepper 1 — 1 — Sausage (Pork) 3 — 3 — „ (Beef) 2 — 2 — Raising Powder 3 — 3 — Relish 1 — 1 — Rice 1 — 1 — Sauce 1 — 1 — Semolina 1 — 1 — Scone Mixtures 2 — 2 — Sponge Mixture 3 — 3 — Strawberry Flavour Mould 1 — 1 — Sugar (Dem.) 1 — 1 — Stuffing, Sage and Onion 1 — 1 — „ Pork and Duck 1 — — 1 „ Thyme and Parsley 1 — — 1 Tea 1 — 1 — Vinegar (Malt) 4 — 2 2 „ (Non-brewed) 1 - 1 - Totals 140 1 136 5 Details of the non-genuine samples are as follows:— Malt Vinegar—Nos. 15 and 18. Both samples, whilst conforming to the required standard of acetic acid content, were found to contain added common salt to the extent of one per cent. Although this is not a normal ingredient of 53 vinegar, it was claimed by the makers that its addition prevented the growth of "mother," which is a micro-organic growth apt to appear after prolonged storage. In the absence of any statutory ruling in the matter no action was taken. Cocoa—No. 58. This was a sample containing only 11½ per cent. of fat, whereas cocoa ordinarily sold in this country contains at least 20 per cent. Proceedings were instituted under Section 3 (1) of the Food and Drugs Act, 1938, when the vendors successfully pleaded a warranty. The commodity and the warranty were both several years old, and under Section 80 (1) (b) proceedings against the warrantor must be taken within 12 months. In the circumstances, although a prima facie offence had been committed, no action likely to succeed could be taken against the manufacturer, and the case had to be withdrawn. It would seem reasonable that if a manufacturer can claim immunity if his warranty is more than a year old, the vendor should not be permitted to reply upon a warranty if his goods have been kept in stock longer than that period. Stuffing—No. 120, Thyme and Parsley. No. 141, Pork and Duck. In both these samples the labels did not specify the ingredients as required by the Labelling of Food (No. 2) Order, 1944, and warnings were given to the retailers. 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 130 Fish „ 272 Vegetables „ 321 Milk „ 407 Soup „ 22 Jam „ 29 Marmalade „ 18 Beef lbs. 2¾ Pork „ 10 Ox Kidney „ 36 Rabbit „ 60 Chicken 2 Duck „ 58 Fish Stones 84 Cheese lbs. 114 Margarine „ 56 Sugar „ 19 Shredded Wheat „ 16 Oats—Porridge lbs. 20 Sultanas „ 16 Cauliflower „ 40 Peas „ 179 Apples „ 70 Oranges „ 12 Custard Powder „ 31 Soup Powder „ 13½ Yorkshire Mix. „ 36 Cafe Au Lait Powder „ 3 Sweets „ 5½ Soup Powder pkts. 20 Gravy Powder „ 2,692 Salad Cream botts. 15 Sauce „ 17 Dried Egg pkts. 2 Paste jars 12 Eggs shell 50 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. 54 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. Notification. The following diseases are notifiable in the district:— Smallpox. Dysentery. Cerebro-spinal Fever. Cholera. Acute Influenzal Acute Poliomyelitis. Diphtheria. Pneumonia. Ophthalmia Membranous Croup. Acute Polio-encephalitis. Neonatorum. Erysipelas. Puerperal Pyrexia. Scarlatina or Scarlet Fever. Typhus Fever. Malaria. Typhoid Fever. Acute Primary Measles. Enteric Fever. Pneumonia Whooping Cough. Relapsing or Continued Fever. Acute Encephalitis Tuberculosis. Lethargica. Food Poisoning. Smallpox No cases were notified, Enteric Fever. For the second consecutive year there was no case of typhoid or paratyphoid fever. Dysentery. Fifteen cases were notified compared with 69 in the year before. Of the 15, 3 were residents, the remaining 12 being patients in hospital admitted from other districts. All were Sonne infectious, and all recovered. Cerebro=Spinal Fever. One case of meningo-coccal meningitis occurred in a baby of four months. It was admitted to Isolation Hospital and recovered. Acute Poliomyelitis. Two cases of "infantile paralysis" were notified. One a noncivilian male of 35 was discharged from isolation hospital to an E.M.S. Hospital. The other case, a female aged 20, had extensive paralysis involving respiration, and received hospital treatment for 4½ months. She died from a supervening broncho-pneumonia. 55 • Scarlet Fever. There was a very welcome fall in 1945 in the number of scarlet fever cases. A total of 109 notifications was received, 107 of which were in respect of residents. The incidence rates were— All cases 2.0 per 1,000 population. Residents 1.9 per 1,000 population. The total incidence at 2.0 per 1,000 compares with 3.04 in 1944. School children provided 75 per cent. of the cases, and children of pre-school age 17 per cent. The heaviest incidence, as usual, was in the 5—10-year age group, 50 per cent. of the total being within these age limits. All but 13 were admitted to isolation hospital. The higher level of housing occupation again made satisfactory home isolation impossible in most cases. There was no "return" cases. No death occurred in any case. TABLE 15. SCARLET FEVER—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1945. (Excluding hospital patients non-resident in Carshalton.) 1945. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. SouthWest. January - - 1 3 - - - - 4 February 4 1 1 — 1 — — — 7 March — 2 2 1 — — — — 5 April 1 3 1 — — — 5 — 10 May 2 2 1 5 — 1 — — 11 June 1 — 3 2 — — 1 — 7 July 3 1 2 1 — — 1 — 8 August — - 1 1 — — 3 — 5 September — 1 1 3 1 2 3 4 15 October 2 - 4 — — 2 3 — 11 November 1 1 5 — 1 2 3 2 15 December — 2 3 2 — 2 — — 9 Totals 14 13 25 18 3 9 19 6 107 Monthly Mean 1.2 1.1 2.1 1.5 0.25 0.75 1.6 0.5 8.9 Case rate per 1,000 population 1.81 2.09 3.42 2.19 0.46 1.69 2.92 1.03 1.98 56 TABLE 16. SCARLET FEVER—MULTIPLE CASES, 1945. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. 3 Cases. 4 Cases. St. Helier North 14 - - - 14 14 St. Helier South 11 1 — — 12 13 St. Helier West 21 2 — — 23 25 North-East 18 — — — 18 18 North-West 1 1 — — 2 3 Central 9 — — — 9 9 South-East 15 2 — - 15 19 South-West 6 — — — 6 6 Whole District 95 6 — — 99 107 Diphtheria. A total of 24 cases of diphtheria was notified, of which 15 were Carshalton residents. This compares with 27 cases (7 residents) in 1944. The incidence rates given by these figures are as follows:— All cases 0.44 per 1,000 population. Residents 0.27 per 1,000 population. One-third of the resident cases were over school age. This is in keeping with the trend which has been observed with the increased practice of artificial immunisation, namely a gradual shifting of the overall reduced incidence towards the adult age groups. There has been no absolute increase of the deaths in the adult population, but the reduction in the incidence amongst children has resulted in a higher proportion amongst adults. All cases were admitted to hospital, and there were no deaths. 57 TABLE 17. DIPHTHERIA—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1945. (Excluding hospital patients non-resident in Carshalton.) 1945. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. Northwest. Central. SouthEast. Southwest. January - - - - - - - - - February 1 - - - - - - - 1 March — — — 1 — — — — 1 April — — — 1 — — — — 1 May 1 - - - - - - 1 2 June 1 — — — 4 — — — 5 July — — — — — - - — — August — 1 — 1 — - — — 2 September — — — — 1 - — — 1 October — — — — 1 - — — 1 November - - - - - - 1 — 1 December - - - - - - - - - Totals 3 1 — 3 6 - 1 1 15 Monthly Mean 0.25 0.08 — 0.25 0.59 — 0.08 0.08 1.25 Case rate per 1,000 population 0.39 0.16 — 0.36 0.92 — 0.15 0.17 0.28 TABLE 18. DIPHTHERIA—MULTIPLE CASES, 1945. Ward. No. of houses in which occurred. Total Houses. Total Cases. 1 Case. 2 Cases. 3 Cases. 4 Cases. St. Helier North 3 - - - 3 3 St. Helier South 1 — — — 1 1 St. Helier West — — — - — — North-East 3 — — — 3 3 North-West 3 — 1 — 4 6 Central — — — — — — South-East 1 — — — 1 1 South-West 1 — — — 1 1 Whole District 12 — 1 — 13 15 58 During the course of investigation into cases, eight " carriers" of diphtheria organisms were found. The number of swabs examined for diphtheria during the year was 217, of which 19 were positive. 128,000 units of anti-toxic serum were issued to practitioners. Diphtheria Immunisation. A further 1,077 children under 15 years of age completed a full course of immunising injections during the year as follows:— Age Groups. Total. 0—5 5—15 At Council Clinics 743 21 764 In Carshalton Schools 73 5 78 By Private Practitioners 4 236 240 820 262 1082 Less outward transfers 17 35 52 Plus inward transfers 26 21 47 Carshalton Residents 829 248 1077 In order to maintain a high level of immunity single reinforcing doses are advisable after an interval. It is very desirable that children who receive their original treatment in infancy should have immunity reinforced at the time of their entry to school. This policy has been pursued locally, and school children in the infant departments have been offered these further injections after an interval of three years. During the year 841 children received a reinforcing dose of diphtheria prophylactic under the scheme. The position with regard to immunisation at December 31st, 1945, was as follows:— Age Groups. Total. Under 5 5—15 Estimated number of children resident in the district 3,850 10,930 14,780 Number immunised at 31st December 2,244 8,145 10,389 Percentage immunised 58 75 70 The material used was A.P.T. in two doses of 0.5 c.c., at approximately a month's interval. 59 Erysipelas. Twelve cases were notified, all residents but two. The site of infection was the face in seven, the leg in three, the ear in one, and the finger in one. Two of the patients were admitted to hospital; all recovered. Pneumonia. The notifications of pneumonia totalled 40, all residents but one. Influenza was stated to be the cause in one case. Measles. Following a year when the district was free from measles the epidemic wave returned in February, 1945, rose to a maximum in April, and subsided in July. The number of cases notified was 686, four of which were hospital patients not resident in the district. Approximately half were in children 5—10 years of age. There was one death in a child of five years suffering from diabetes. TABLE 19. MEASLES—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1945 (Excluding hospital patients non-resident in Carshalton.) 1945. Ward. Total. St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. Southwest. January 1 - - 3 2 - 2 3 11 February 3 6 3 19 3 4 2 5 45 March 9 9 23 20 16 3 15 8 103 April 19 16 38 59 15 6 37 17 207 May 27 2 15 39 12 12 56 29 192 June 27 19 6 7 3 1 10 16 89 July 7 7 3 2 — 1 1 1 22 August 3 1 — — 1 2 — 1 8 September 1 — — — — 4 — — 5 October - - - - - - - - - November - - - - - - - - - December - - - - - - - - - Totals 97 60 88 149 52 33 123 80 682 Monthly Mean 8.08 5.00 7.33 12.41 4.33 2.75 10.25 6.66 56.83 Case rate per 1,000 population 12.59 9.68 12.05 18.18 8.00 6.22 19.08 13.79 12.63 60 Whooping Cough. The number of cases notified at 106 (all residents) was 79 less than in the year before. The incidence was fairly evenly distributed over the year and over the district. There was no death. TABLE 20. WHOOPING COUGH—WARD INCIDENCE AND MONTHLY DISTRIBUTION, 1945. (Excluding hospital patients non-resident in Carshalton.) 1945. Ward. Total St. Helier North. St. Helier South. St. Helier West. NorthEast. NorthWest. Central. SouthEast. South- West. January 4 - - - - 1 1 - 6 February 1 1 - 1 — - - - 3 March — — - 3 - - - 1 4 April — — — 3 4 - - - 7 May 1 — — 7 6 1 - - 15 June — 4 1 — 1 1 - - 7 July 2 5 — 2 - - - - 9 August 3 1 2 - 1 1 1 4 13 September 2 — 3 — - 2 - 2 9 October 1 1 3 - - - 3 4 12 November 3 — 1 1 - - 5 3 13 December 4 1 1 — — 1 - 1 8 Totals 21 13 11 17 12 7 10 15 106 Monthly Mean 1.75 1.01 0.91 1.41 1.00 0.58 0.83 1.25 8.84 Case rate per 1,000 population 2.73 2.09 1.50 2.07 1.85 1.32 1.54 2.58 1.96 Ophthalmia Neonatorum. There was one case of this ophthalmic infection in the new born. Recovery was complete after three weeks' home treatment under a private doctor. Puerperal Pyrexia. In-patient accommodation for maternity cases has in recent years been established on a considerable scale at the St. Helier County Hospital. Some 1,800 babies, from an extensive part of Surrey, are 61 now born there each year. In view of the fact that the primary qualification for admission to these beds is obstetric abnormality either present or anticipated, it is to be expected that the number of notifications of Puerperal Pyrexia returnable by this district will be considerably higher than in earlier years. During 1945 32 notifications were received, eight of which were in respect of Carshalton mothers. St. Helier Hospital confinements provided 24, the War Memorial Hospital five, and domiciliary confinements three. All received hospital treatment, and all recovered. The following summarises the chief features of these cases:— 19 were primigravidse. 6 were cases of abortion. 15 had uterine infections. 7 had urinary infections. 1 had B. Welchii septicaemia. 1 had pre-natal staphylicoccal pneumonia followed by empyema. 1 had post-obstetric pulmonary complication. 2 had pulmonary tuberculosis. 4 had mastitis. 1 had mental disturbance. 5 followed Caesarian section. 5 followed forceps delivery. 5 had obstetric assistance for induction of the third stage. Tuberculosis. The new cases admitted to the tuberculosis register during the year numbered 120 classified as follows:— Males— Females— Pulmonary 57 Pulmonary 44 Non-pulmonary 10 Non-pulmonary 9 Of the total additions 88 were primary notifications, 28 were transferred from other districts, and 4 came to notice in other ways. For the same period 97 names were removed from the register for the following reasons:— Recovered 20 Deaths 28 Otherwise (including removals) 49 After allowing for the additions and deductions, the state of the register at the 31st December, 1945, was as shown in the following table:— 62 TUBERCULOSIS—WARD DISTRIBUTION. Cases on Register at 31st December, 1945. Ward. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. St. Helier North 54 65 14 8 141 St. Helier South 43 40 12 17 112 St. Helier West 48 37 12 16 113 North-East 38 36 15 9 98 North-West 30 19 6 5 60 Central 30 15 3 1 49 South-East 24 18 4 18 57 South-West 26 13 4 2 45 Totals 293 243 70 69 675 536 139 The total of 675 is 13 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 37 At other tuberculosis institutions 133 170 63 The number of persons who died from tuberculosis during the year was 28, distributed by age groups as follows:— TABLE 21. DEATHS DUE TO TUBERCULOSIS, 1945. Age, Years. Pulmonary. Non-Pulmonary. Total. Male. Female. Male. Female. 0 - - - - - 1—5 - - - - - 5—15 - - - - - 15—25 2 2 - - 4 25—35 3 1 - - 4 35—45 4 1 - - 5 45—55 4 1 - - 5 55—65 5 1 1 - 7 65—75 1 2 - - 3 Totals 19 8 1 - 28 Three deaths of unnotified cases represent 11 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 19 such examinations were made with a positive result in five. No action was taken under the Public Health (Prevention of Tuberculosis) Regulations 1925, nor under Section 172 of the Public Health Act 1936. 64 65 TABLE 22. TUBERCULOSIS. New Cases, Age and Sex Distribution and Manner of Admission to Register, 1945. 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—5 1 1 - - - - - - - - - - 2 5—10 2 - 4 1 1 1 - 1 - - - - 10 10—15 3 4 2 - - - - 1 - - - - 10 15—20 6 8 1 - 2 2 - 1 - - - - 20 20—25 9 8 - - 1 2 - - - - 1 - 21 25—35 8 3 - 2 2 5 1 1 1 - - - 23 35—45 5 6 1 - 4 1 - 1 1 - - - 19 45—55 6 1 - 1 1 - - - - - - - 9 55—65 2 2 - - - - - - 1 - - - 5 65 up 1 - - - - - - - - - - - 1 Totals 43 33 8 4 11 11 1 5 3 - 1 - 120 88 28 4 66 TABLE 23. 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 eases removed to Hospital. St. Helier North. St. Helier South. St. Helier West. North East North West Central South East South West Scarlet Fever 107 1.98 - 14 13 25 18 3 9 19 6 94 89 Diphtheria 15 0.28 - 3 1 - 3 6 - 1 1 15 100 Cerebro Spinal Fever 1 0.02 - - — — — 1 — — — 1 100 Puerperal Pyrexia 8 0.15 - — 2 — 3 — 3 — — 8 100 Anterior Polio Myelitis 2 0.04 - — — 1 — — 1 — — 2 100 Erysipelas 12 0.22 — 2 — 3 3 1 1 1 1 2 17 Pneumonia 39 0.72 — 7 3 2 5 5 7 3 7 5 12.5 Dysentery 3 0.05 - — 1 — 1 1 — — — 2 66.7 Ophthalmia Neonatorum 1 0.02 - - - - 1 - - - - - - Measles 682 21.63 1 97 60 88 149 52 33 123 80 12 1.77 Whooping Cough 106 1.93 - 21 13 11 17 12 7 10 15 3 2.83 67 TABEE 24. INFECTIOUS DISEASES. Notification by Age Groups, 1945. (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 - 3 3 7 6 54 27 2 4 1 - - 107 Diphtheria - - 1 - - 5 4 3 2 - - - 15 Cerebro Spinal Fever 1 - - - - - - - - - - - 1 Puerperal Pyrexia - - - - - - - - 7 1 - - 8 Anterior Polio Myelitis - - - - - - - 1 - 1 - - 2 Erysipelas - - - - - - - - 3 4 3 2 12 Pneumonia - 1 2 3 2 5 - 1 3 6 11 5 39 Dysentery - - - - - 1 - - - 1 1 - 3 Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 Measles 21 59 68 72 87 321 34 10 7 3 - - 682 Whooping Cough 10 15 7 19 10 42 - 1 1 1 - - 106 68 TABLE 25. MONTHLY INCIDENCE OF' INFECTIOUS DISEASES, 1945. (Excluding hospital patients non-resident in Carshalton.) Disease. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 4 7 5 10 11 7 8 5 15 11 15 9 107 Diphtheria — 1 1 1 2 5 — 2 1 1 1 — 15 Puerperal Pyrexia 1 1 2 — — — 1 1 2 — — — 8 Erysipelas 1 1 1 1 — 1 2 1 — 2 1 1 12 Pneumonia 1 3 8 3 4 3 2 — — 1 2 12 39 Anterior Polio Myelitis - - 1 - - - - - - 1 - - 2 Dysentery 1 — — 1 1 - - - - - - - 3 Ophthalmia Neonatorum — — — — — — 1 — — — — — 1 Cerebro Spinal Fever — — — — — — — — 1 — — — 1 Whooping Cough 6 3 4 7 15 7 9 13 9 12 13 8 106 Measles 11 45 103 207 192 89 22 8 5 - — — 682 Tuberculosis Pulmonary 9 6 6 9 7 4 2 5 10 3 2 13 76 Tuberculosis Non-pulmonary — 1 — 6 — — 1 1 — — 1 2 2 INDEX PAGE Acreage 8 Ambulance 22 Bakehouses 54 Bed Bug—Eradication of 45 Births— Distribution 11 Institutional 12 Notification of 26 Rates 9-11-13 Cancer 15 Cemeteries 47 Child Life Protection 37 Clinics and Treatment Centres 25 Closet Accommodation 41 Convalescent Treatment 34 Day Nurseries 38 Deaths— Classification 19 Distribution 15 Rate 9-13-15 Dental Scheme 32 Diphtheria 57 Immunisation 59 Dysentery 55 Disinfection 45 Disposal of Dead 47 Drainage and Sewerage 41 Employment 10 Enteric Fever 55 Erysipelas 60 Factories 51 Food—Inspection and Supervision 52 Food and Drugs Act 52 Health Services 21 Health Visiting 26 Hospitals 22 Housing— Council's Scheme 48 Inhabited Houses 8 Inspection 48 Overcrowding 49 Ward Distribution 11 69 PAGE Industry 8 Infant Mortality 17-18 Infectious Diseases 55 Inquests 16 Isolation Hospital 22 Admissions to 23 Laboratory Facilities 21 Maternal Mortality 17 Maternity and Child Welfare— Adoption of Children (Regulation) Act, 1939 37 Attendances at Clinics 27-28-31 Child Life Protection 37 Clinic Activities 26 Consultant Service 36 Convalescent Treatment 34 Day Nurseries 38 Dental Scheme 32 Health Visiting 26 Home Helps 36 Hospital Treatment for Maternity 34 Emergency Maternity Unit 36 Illegitimate Children 35 Maternity Outfits 36 Midwives 36 Orthopaedic Treatment 34 Premature Births 29 Supply of Milk and Other Foods 31 Toddler Clinics 29 Measles 60 Milk Supply 52 Milk (Special Designations) Order 52 Mortuary 47 Natural and Social Conditions 8 Nursing Associations 21 Officers 7 Ophthalmia Neonatorum 61 Orthopaedic Treatment 34 Pest Control 46 Pneumonia 60 Population 10 Public Assistance 10 Public Cleansing 41 Puerperal Pyrexia 61 Rateable Value 8 Rats and Mice Destruction 46 Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 51 70 PAGE Rivers and Streams 41 Sanitary Circumstances 40 Sanitary Inspection 41 Scarlet Fever 56 Schools 46 Shops Acts 47 Smallpox 55 Smoke Abatement 46 Staff 7 Statistics— Comparable 14 Vital 9 Swimming Baths 47 Tuberculosis 62 Unmarried Mothers 35 Vermin Control 45 Voluntary Helpers 37 Water Supply 40 Whooping Cough 61 Zymotic Diseases 9 Deaths from 9 71